Pediatric rhegmatogenous retinal detachment: predictors of anatomic and functional success.

Purpose: This study describes presenting clinical features and surgical techniques associated with successful repair of pediatric rhegmatogenous retinal detachment (RRD).

Methods: This is a retrospective case series which involved 242 cases younger than 18 years with new-onset RRD with descriptive statistics for the full group. Further exclusion established 168 cases that underwent surgery with minimum 3-month follow-up. Comparison of features associated with successful outcomes was analyzed using Chi-squared tests, logistic regression and univariate generalized equation models.

Results: We measured proportion of patients with BCVA ≤ 1.0 logMAR and/or an increase in final BCVA of 0.3 logMAR with respect to baseline and complete reattachment at final visit; 104 eyes (62%) achieved total reattachment, and 91 eyes (54%) achieved visual success. Absence of macular involvement, subtotal RRD and older age group (13-18) were associated with both success measures. There were higher visual and anatomic success rates with primary scleral buckling (SB, 66% and 79%; OR 9.26 and 11.09) and combined SB plus pars plana vitrectomy (PPV, 54% and 58%; OR 5.67 and 3.94) compared with PPV alone (26% and 17%).

Conclusion: A majority of patients achieved anatomical success with repair. Trauma and myopia were the most common etiologic associations, with myopic cases having better outcomes. Success was more likely in patients with subtotal RRD or uninvolved macula at presentation; previous intraocular surgery was a risk factor for failure. Younger patients had a higher likelihood of worse outcomes. Initial PPV showed a lower rate of success than either SB or combined SB/PPV.