[Retinal detachment in children and adolescents. Specific clinical features].

Background: Due to the long life expectancy, retinal detachment is a special threat to visual acuity in children and adolescents. This study presents the clinical features of retinal detachment in childhood and adolescence up to the age of 20 years.

Patients And Methods: A cohort was selected comprising 259 patients who suffered from unilateral or bilateral retinal detachment, were not older than 20 years of age at the first diagnosis of the first or only affected eye and had undergone surgery at least once at the Department of Ophthalmology of the University Medical Center of Munich during a period of 18 years (1980-1998). This patient collective was retrospectively analyzed with respect to the clinical features of the first retinal detachment. The group consisting of only one affected eye or the first affected eye (259 eyes) was included. The fellow eyes affected later were excluded (19 eyes).

Results: The time period between the first visual symptoms and the diagnosis of retinal detachment was on average 9.6 weeks and the most commonly manifested symptom was loss of vision (36.3% of patients). In 40.2% of the patients the detachment was discovered fortuitously. The most frequent presentation (34.0%) was a 2-quadrant retinal detachment and was (sub)total in 27.0% of eyes. Macular detachment was found in 154 eyes (59.5%). The commonest type of retinal break was a tear near the ora serrata (36.1% of all breaks). Giant tears (12.8% of all breaks) occurred preferentially in the area of the ora serrata, round atrophic holes were identified especially in the area of the equator, often in the form of a chain of holes. Breaks most frequently occurred in the inferior temporal quadrant. In 22.4% of retinal detachments no break was found even intraoperatively. A primary proliferative vitreoretinopathy (PVR) of at least stage C was involved in 25.5% of detachments.

Conclusion: In childhood and adolescence a characteristic delay of diagnosis enables a large sized expansion of the retinal detachment with frequent macular involvement and a high proportion with (sub)total detachment and severe primary PVR. Tears in the ora serrata area, giant tears, multiple round atrophic holes in the area of the equator and a high rate of undetectable breaks are the intrinsic characteristics of juvenile retinal detachment.