Pediatric retinal detachment surgery in the US: Primary scleral buckling achieved best visual acuity

Yoshihiro Yonekawa, MD, from the Wills Eye Hospital, Mid Atlantic Retina, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, and colleagues took a look at retinal detachments in pediatric patients to get a broad view on the status of treatment on a national level.

The goals of this multicenter cohort study were to determine the demographics of retinal detachment in children in the US and report the treatment modalities and visual outcomes, according to Dr. Yonekawa.

The investigators examined the aggregated electronic health records of all identified children who ranged in age from 1 to 17 years between January 2015 and August 2021 in a national database. All children had a rhegmatogenous retinal detachment (RRD) based on the ICD10 and CPT codes. The investigators then analyzed the demographic data, comorbidities, visual acuity (VA) levels, and treatment modalities.

Cohort analysis

The study identified 2,200 children (62% boys) with RRD throughout the US. The mean patient age was 12.0 years in the following distributions: 1 to 3 years, 90 children; 4 to 6 years, 122 children; 7 to 9 years, 234 children;10 to 12 years, 399 children, 13 to 15 years, 434 children; and 16 to 17 years, 921 children.

Dr. Yonekawa reported that the prevalence rate of RRD increased significantly with patient age (P = 0.009). Several ocular co-morbidities were associated with the RRDs. These included myopia (34.6%), ocular trauma (15.0%), and a history of prematurity (11.5%).

Most patients (55.4%) were treated within 1 week of the development of the RRD; 15.8% were treated from 1 to 2 weeks following development, 10.5% in 2 to 3 weeks, 7.5% in 1 to 2 months.

Various treatment approaches were used. These included only laser retinopexy as the initial treatment modality in 23.3%, primary vitrectomy in 21.5%, primary scleral buckle in 33.3%, and vitrectomy with scleral buckle in 21.7%. The retina was attached with a single surgery in 76% of cases.

The mean presenting VA was 20/100 overall, and the mean VA 1 year following the treatment was 20/80. Patients treated with primary scleral buckle achieved a mean of 20/63, and patients treated with either primary vitrectomy or vitrectomy with scleral buckle achieved a mean of 20/200.

Based on these findings, the investigators concluded that the prevalence rates of retinal detachment in children increased with age. Myopia, trauma, and history of retinopathy were common underlying risk factors for development of RRDs. Treatment techniques varied throughout the country, but the incisional surgical intervention with the best visual outcome was primary scleral buckling.

“Retinal detachment in children is relatively uncommon, but something that all retina surgeons will encounter. This is the first time that we examined the clinical presentation, treatment choices of surgeons, and outcomes at a national level. Primary scleral buckling is the best treatment modality for the vast majority of pediatric RRDs, and this study supports this,” Dr. Yonekawa commented.