Retinal detachments (RDs) in children can occur for a variety of reasons. Unlike in adults, where retinal tears usually result from posterior vitreous detachment, in children there are many causes of detachment - e.g. trauma, lattice with atrophic holes and many hereditary, systemic and ocular diseases.<\/p>\n
The patient's age and clinical presentation can help to determine the cause of the retinal detachment and guide the best surgical approach. While retinal retinal detachments (RRDs) can occur in young children, they are more common in older children. In young children, exudative and ulcerative-type retinal detachments should be included in the differential diagnosis, which will likely influence the type of treatment.<\/p>\n
We looked for a specialist in Retinal Surgery. Mr. Stratos Gozzarides explains how he would manage some difficult cases of retinal detachment (mainly of fracture origin) in children.<\/p>\n
An 8-year-old boy presents with retinal detachment, which includes the macula. The other eye has extensive lattice without cracks. You suspect Stickler syndrome. The patient is difficult to examine in the office, so schedule an examination under anesthesia before surgical repair.<\/p>\n
How would you decide on the surgical rehabilitation technique?;<\/strong><\/p>\n Stratos Gozzarides: In pediatric cases, there are two important parameters: the age of the patient and the pathology. Scleral bandaging combined with vitrectomy is the best option for this 8-year-old child.<\/p>\n In children, we want to maximize the effectiveness of treatment and minimize the number of procedures performed. By performing a bandage and vitrectomy, we maximize the effectiveness of treatment with a single surgery.<\/p>\n We will make use of silicone oil or long-life gas. The final choice will depend on the ability to remove the vitreous and traction. If there is no ability to remove the vitreous or if there are areas where it is still attached, I would choose silicone oil. If I am able to remove all of the traction and vitreous, the use of long-lasting gas is ideal.<\/p>\n Would you intervene in the other eye, and if so, how?;<\/strong><\/p>\n Stratos Gozzarides: Yes, I would intervene in the other eye. The question is not whether I would intervene, but how. Opinions are divided as to the approach - prophylactic bandaging, cryocoagulation or laser. Most of the data is on cryotherapy and no comparative studies have ever been done on the effectiveness of the other options. None of these approaches is a guarantee, as retinal detachment behind the \"support\" remains possible.<\/p>\n The method I would follow, as a precaution for the other eye, would be a hard laser bandage.<\/p>\n A 6-month-old girl presents with bilateral bullous retinal detachment. No prematurity is reported in her history.<\/p>\n How would you explain the cause of his detachments?;<\/strong><\/p>\n Stratos Gozzarides: This is a very unusual case of retinal detachment with a large sac. The fact that these detachments are bubbly essentially removes retinopathy of prematurity from the differential diagnosis, whether the patient was premature or not. Bilateral congenital retinal detachment is usually retinal tractional.<\/p>\n If large sacs appear, they are likely to represent bubbly clefts, which we would not normally see in a newborn girl. Bilateral vesicular retinal detachment may also be seen very rarely in Facioscapulohumeral Muscular Dystrophy (FSHD). So, I would start with a thorough family history and with imaging under anesthesia, including fluorescein angiography and OCT, to confirm that they are indeed bubbly retinal detachments. I would follow up with genetic testing, based on the suspicions that would arise from the anesthetic examination.<\/p>\n Under what circumstances would you choose vitrectomy to treat detachments?;<\/strong><\/p>\n Stratos Gozzarides: Bilateral vesicular detachment in a child sounds like an exudative process. The most important thing is to understand the cause of the exudative vesicular detachment and then treat it appropriately.<\/p>\n In an unusual situation like this, it is important to always consider the possibility of retinoblastoma. If there is a suspicion, there are specific steps to follow.<\/p>\n A 15-year-old boy presents with a giant retinal tear (GRT) with retinal detachment, including the macula, following an eye injury while playing basketball. On clinical examination, his other eye has extensive lattice degeneration.<\/p>\n How would you treat the eye with the giant crack?;<\/strong><\/p>\n Stratos Gozzarides: The eye with the giant crack will be treated by vitrectomy, with subsequent insertion of silicone gas or oil. If the detachment was old and the edge of the crack was rigid, I would do a direct gas-silicone exchange. If it was a recent detachment, the retina was flexible and the vitreous detachment was complete, I would use long-lasting gas.<\/p>\n Would your choice be different, as far as surgical repair is concerned, if it was a giant breakup and not a giant crack?;<\/strong><\/p>\n Stratos Gozzarides: Scleral bandaging as an initial option is fantastic in cases of retinal detachment of the dissolving type. De facto, the vitreous is attached and the ceiling of the tear can be easily supported by the instruments of the dressing. Even in cases of cracks with giant dissolution, my primary choice is scleral bandaging.<\/p>\n Would you intervene condoms in the other eye?;<\/strong><\/p>\n Stratos Gozzarides: This is the moment when an extended discussion with the child and the parents is necessary. Many times, we are faced with families whose children have dreams about sports or children and parents who would not agree to stop playing contact sports. For these kids, I would give them a prophylactic laser bandage.<\/p>\n A 10-year-old boy suspected of having Marfan syndrome comes to you for a second opinion. His right eye was surgically bandaged for detachment a month ago. His left eye has extensive untreated lattice. On examination, his right eye has a segmental scleral dressing from the 10th to the 12th hour. There is a residual detachment with an open hole at the 9th hour.<\/p>\n How would you deal with this boy and on what grounds?;<\/strong><\/p>\n Stratos Gozzarides: I would intervene in the patient's right eye. The child's eye will continue to grow. So, as the eye grows, there will probably be additional traction on the retina and a possibility that the detachment will progress. Besides, eyes with partial detachment are potentially unstable. Add this to the child's underlying syndromic condition and there is no compelling reason not to treat his right eye.<\/p>\n But how we treat the right eye depends on how big the detachment is. As I would in an adult, if it's a small, localized detachment and the rest of the fundus looks good, I would suggest laser to prevent the detachment. The more extensive the subretinal fluid collection, the more likely I would be to put him back into surgery. Then the question would be, should we just do a vitrectomy or should we also reconsider our view on scleral bandaging to completely protect the eye.<\/p>\n Would you have condomed his left eye?;<\/strong><\/p>\n Stratos Gozzarides: In this case, I would treat the left eye with laser photocoagulation and monitor it very closely, constantly checking its condition, despite the laser. In children's retinas, we cannot overemphasize how important it is to manage the \"good\", \"better\" or \"normal\" eye.<\/p>","protected":false},"excerpt":{"rendered":" \u039f\u03b9 \u03b1\u03c0\u03bf\u03ba\u03bf\u03bb\u03bb\u03ae\u03c3\u03b5\u03b9\u03c2 \u03b1\u03bc\u03c6\u03b9\u03b2\u03bb\u03b7\u03c3\u03c4\u03c1\u03bf\u03b5\u03b9\u03b4\u03bf\u03cd\u03c2 (RDs) \u03c3\u03c4\u03b1 \u03c0\u03b1\u03b9\u03b4\u03b9\u03ac \u03bc\u03c0\u03bf\u03c1\u03bf\u03cd\u03bd \u03bd\u03b1 \u03b5\u03bc\u03c6\u03b1\u03bd\u03b9\u03c3\u03c4\u03bf\u03cd\u03bd \u03b3\u03b9\u03b1 \u03b4\u03b9\u03ac\u03c6\u03bf\u03c1\u03bf\u03c5\u03c2 \u03bb\u03cc\u03b3\u03bf\u03c5\u03c2. \u03a3\u03b5 \u03b1\u03bd\u03c4\u03af\u03b8\u03b5\u03c3\u03b7 \u03bc\u03b5 \u03c4\u03bf\u03c5\u03c2 \u03b5\u03bd\u03ae\u03bb\u03b9\u03ba\u03b5\u03c2, \u03cc\u03c0\u03bf\u03c5 \u03bf\u03b9 \u03c1\u03c9\u03b3\u03bc\u03ad\u03c2 \u03c4\u03bf\u03c5 \u03b1\u03bc\u03c6\u03b9\u03b2\u03bb\u03b7\u03c3\u03c4\u03c1\u03bf\u03b5\u03b9\u03b4\u03bf\u03cd\u03c2 \u03c3\u03c5\u03bd\u03ae\u03b8\u03c9\u03c2 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03bf\u03c0\u03af\u03c3\u03b8\u03b9\u03b1 \u03b1\u03c0\u03bf\u03ba\u03cc\u03bb\u03bb\u03b7\u03c3\u03b7 \u03c4\u03bf\u03c5 \u03c5\u03b1\u03bb\u03bf\u03b5\u03b9\u03b4\u03bf\u03cd\u03c2, \u03c3\u03c4\u03b1 \u03c0\u03b1\u03b9\u03b4\u03b9\u03ac \u03c5\u03c0\u03ac\u03c1\u03c7\u03bf\u03c5\u03bd \u03c0\u03bf\u03bb\u03bb\u03ad\u03c2 \u03b1\u03b9\u03c4\u03af\u03b5\u03c2 \u03b3\u03b9\u03b1 \u03b1\u03c0\u03bf\u03ba\u03cc\u03bb\u03bb\u03b7\u03c3\u03b7 – \u03c0.\u03c7. \u03c4\u03c1\u03b1\u03cd\u03bc\u03b1, lattice \u03bc\u03b5 \u03b1\u03c4\u03c1\u03bf\u03c6\u03b9\u03ba\u03ad\u03c2 \u03bf\u03c0\u03ad\u03c2 \u03ba\u03b1\u03b9 \u03c0\u03bf\u03bb\u03bb\u03ad\u03c2 \u03ba\u03bb\u03b7\u03c1\u03bf\u03bd\u03bf\u03bc\u03b9\u03ba\u03ad\u03c2, \u03c3\u03c5\u03c3\u03c4\u03b7\u03bc\u03b9\u03ba\u03ad\u03c2 \u03ba\u03b1\u03b9 \u03bf\u03c6\u03b8\u03b1\u03bb\u03bc\u03b9\u03ba\u03ad\u03c2 \u03b1\u03c3\u03b8\u03ad\u03bd\u03b5\u03b9\u03b5\u03c2. \u0397 \u03b7\u03bb\u03b9\u03ba\u03af\u03b1 \u03ba\u03b1\u03b9 \u03b7 \u03ba\u03bb\u03b9\u03bd\u03b9\u03ba\u03ae […]<\/p>\n","protected":false},"author":1,"featured_media":216,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-1626","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-5"],"yoast_head":"