Pediatric Rhegmatogenous Retinal Detachment and its Treatment

Pediatric rhegmatogenous retinal detachments have a different clinical presentation and different treatment algorithms than adult rhegmatogenous retinal detachments. The absence of posterior vitreus detachment and the predominance of retinal holes and dialysis in the etiology can be counted among these differences. Slow onset of visual loss and the inability of the pediatric age group to appreciate the symptoms leads to the development of variable amounts of proliferative vitreoretinopathy at clinical presentation. The presence of the crystalline lens and exaggerated wound healing response of the young eye changes the usual treatment approach of the adult detachments, and combination surgeries are frequently required. Scleral buckling surgery is the primary treatment option in the pediatric age group. It may be applied segmentally or circumferentially according to the level of the retinal breaks and the extent proliferative vitreoretinopathy present. Vitrectomy may be added according to the treatment response or the level of proliferative vitreoretinopathy present. Phakic lens status, abnormally posterior insertion of posterior vitreus base, and hyalocyte cellular remnants despite successful intraoperative posterior vitreus detachment are the obstacles that may be encountered in vitrectomy for pediatric retinal detachment. Pediatric rhegmatogenous retinal detachments require a higher number of surgeries per patient and have a lower final retinal attachment rate than adult cases. Examination and prophylactic treatment of the fellow eye must be carried out as the underlying retinal breaks and predisposing lesions are frequently bilateral with the exception of trauma in this age group.