Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Murray Ocular Oncology and Retina, Miami, Florida.
Retina. 2018 Jul;38(7):1393-1402. doi: 10.1097/IAE.0000000000001725.
Pediatric retinal detachments (RDs) are unique in etiology, anatomy, and prognosis compared with the adult population. The mechanisms of pediatric RD include tractional (TRD), rhegmatogenous retinal detachment, traumatic, and other types, such as exudative or hemorrhagic. This study examined visual and anatomical outcomes of pediatric RD undergoing surgical repair at a single university referral center.
A retrospective consecutive case series of patients clinically diagnosed and undergoing surgery for RD between birth and 15 years of age from 2002 to 2013 at a single academic institution.
A total of 206 patients (231 eyes) were included in this study, of which 25 (12%) had bilateral RD. Of those patients, 67 (29%) had TRD (retinopathy of prematurity, persistent fetal vasculature, or familial exudative vitreoretinopathy), 51 (22%) had rhegmatogenous retinal detachment (myopia, X-linked retinoschisis, or Stickler syndrome), 60 (26%) had traumatic RD, and 53 (23%) were due to other types of RD, such as Coats disease or coloboma. Presenting best-corrected visual acuity better than 20/200 correlated with better final best-corrected visual acuity (P < 0.0001). Anatomical success was strongly correlated with visual acuity outcome (P < 0.00001) and was significantly more likely in rhegmatogenous retinal detachment versus TRD (78% vs. 39%, P < 0.05). The rates of obtaining a final best-corrected visual acuity > 20/200 were poorer in TRD (10%) compared with rhegmatogenous retinal detachment (39%, P < 0.01) or traumatic RD (28%, P < 0.05).
Visual and anatomical outcomes varied among categories of RD. Rhegmatogenous retinal detachments were associated with the best outcomes (anatomical success and globe conservation), whereas TRDs generally had poorer visual and anatomical outcomes.
与成人相比，小儿视网膜脱离（RD）在病因、解剖和预后方面具有独特性。小儿 RD 的机制包括牵拉性（TRD）、孔源性视网膜脱离、外伤性和其他类型，如渗出性或出血性。本研究检查了在单一大学转诊中心接受手术修复的小儿 RD 的视力和解剖结果。
对 2002 年至 2013 年期间在单一学术机构临床诊断并接受 RD 手术治疗的出生至 15 岁患者的回顾性连续病例系列。
本研究共纳入 206 例患者（231 只眼），其中 25 例（12%）为双眼 RD。这些患者中，67 例（29%）为 TRD（早产儿视网膜病变、持续性胎儿血管或家族性渗出性玻璃体视网膜病变），51 例（22%）为孔源性视网膜脱离（近视、X 连锁性视网膜色素变性或 Stickler 综合征），60 例（26%）为外伤性 RD，53 例（23%）为其他类型的 RD，如 Coats 病或视网膜色素上皮层脱离。最佳矫正视力优于 20/200 与最终最佳矫正视力较好相关（P<0.0001）。解剖成功与视力结果密切相关（P<0.00001），且孔源性视网膜脱离明显优于 TRD（78% vs. 39%，P<0.05）。TRD 的最终最佳矫正视力>20/200 的获得率（10%）低于孔源性视网膜脱离（39%，P<0.01）或外伤性 RD（28%，P<0.05）。
RD 各分类的视力和解剖结果不同。孔源性视网膜脱离与最佳结果（解剖成功和眼球保留）相关，而 TRD 通常视力和解剖结果较差。
