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Int Ophthalmol

DOI 10.1007/s10792-016-0287-3

ORIGINAL PAPER

Etiologies and surgical outcomes of pediatric retinal


detachment in Hong Kong
Helena P. Y. Sin . Wilson W. K. Yip .
Vesta C. K. Chan . Alvin L. Young

Received: 4 May 2016 / Accepted: 2 July 2016


Ó Springer Science+Business Media Dordrecht 2016

Abstract The purpose of this study was to study the detachment is often associated with predisposing
etiologies and operative outcomes of pediatric retinal factors. The presence of congenital/developmental
detachment at a tertiary eye referral center in Hong ocular anomalies causing retinal detachment is more
Kong over a 10-year period. A retrospective study of frequent in younger children and with worse func-
patients (below 18 years of age) who received primary tional and visual outcomes. Continuing efforts to
retinal detachment repair operations at a University improve treatment strategies for this group of patients
Teaching Hospital between 2005 and 2015 was are needed.
conducted. The study comprised 37 patients with 39
eyes affected who received primary retinal detach- Keywords Congenital anomalies  Myopia 
ment (RD) surgery. Two patients had bilateral RD. Pediatric  Retinal detachment  Scleral buckling 
69.2 % were male. The mean follow-up period was Vitrectomy
40.6 ± 28.6 months. Their mean age at presentation
was 13.4 ± 5.5 years. There were contributing factors
for RD identified in 33 eyes (84.6 %), of which
congenital/developmental anomalies (23.1 %), high Introduction
myopia with refractive error greater than -6 diopters
(17.9 %), and trauma (15.4 %) ranked the top 3 causes Retinal detachment (RD) in children is a rare disease
for RD. The retina was reattached after one surgical compared to adults and it accounts for 2 to 6 % of all
procedure in 69.2 %. Final anatomical success rate cases of rhegmatogenous RD [1]. Management of
was 82.1 %. Postoperatively, 68.8 % of eyes had pediatric retinal detachment (PRD) is challenging, due
improved or stable vision. Functional visual loss with to delay in diagnosis, complicated predisposing fac-
visual acuity less than 5/200 was found to be 30.6 % of tors, and preexisting conditions. In retrospective
eyes which were mostly from younger patients and studies in the United Kingdom [2, 3] and the United
those with congenital anomalies. Pediatric retinal States [4, 5], trauma and congenital or developmental
abnormalities are the leading predisposing factors for
PRD. Asian studies conducted in Taiwan [6–8] and
H. P. Y. Sin (&)  W. W. K. Yip  Japan [9] identified high myopia and atopic dermatitis
V. C. K. Chan  A. L. Young (AD) as the most important risk factors. The anatom-
Department of Ophthalmology & Visual Sciences,
ical success rates for PRD operations were lower than
The Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong SAR those in adults, ranging from 72 to 85 % [1, 4–6, 8, 10].
e-mail: spy229@ha.org.hk The present study aimed to identify the etiologies and

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surgical outcomes of PRD operations in a University and anatomical outcomes at the last follow-up sessions
Teaching Hospital in Hong Kong over a 10-year were recorded. VA was measured using Snellen
period, and contributed to offering doctors more chart except in patients who were uncooperative.
information when discussing with parents the risks VA of counting fingers, hand motions, light per-
and potential benefits of surgery for PRD. ception, and no light perception (NLP) were
assigned the ratios of 1/200, 0.5/200, 0.25/200,
and 0.125/200, respectively [11]. The Snellen visual
Methods acuities were converted to LogMAR scale for
statistical analysis. Eyes with vision that could not
Data of children aged 0–18 years who underwent RD be checked were not taken into consideration when
surgery at Prince of Wales Hospital from June 1, 2005 assessing the improvements in VA. Anatomical
to June 1, 2015 were retrieved using the Clinical Data success was defined as persistent retinal reattach-
Analysis and Reporting System (CDARS) of the ment for at least 6 months postoperatively, regard-
Hospital Authority’s Clinical Management System less of the presence or absence of silicone oil inside
and from operative records. Medical and operation the eye. Eyes with best corrected visual acuity
records of all patients were reviewed. Those who (BCVA) \5/200 at the last follow-up were consid-
received primary RD surgery with at least 3 months of ered as functional visual loss. All statistical analyses
postoperative follow-up data were included in this were performed using SPSS 19.0 statistics software.
study. The study was approved by the local clinical For univariate analyses, Student’s t test was used
research ethics committee (CREC reference no: for independent data, whereas paired t test was used
2015.586) and conducted according to the principles for paired observations. Statistical significance was
expressed in the Declaration of Helsinki. Information defined as P \ 0.05.
collected included age at presentation, gender,
affected eye, medical and ocular history, and possible
risk factors for RD. Eyes were divided into seven Results
groups according to predisposing factors [6, 10]:
Patient demographics and etiologies of PRD
Group 1: Congenital/developmental ocular anoma-
lies (excluding eyes with history of intraocular
Surgeries for primary RD were performed in 37
surgery).
patients with 39 affected eyes. Two boys had bilateral
Group 2: Myopia more than -6 diopters (D) but
retinal detachment. Baseline characteristics of patients
without a history of trauma, atopic dermatitis (AD),
and the etiologies of PRD can be found in Table 1.
intraocular surgery, or congenital or developmental
Their mean age was 13.4 ± 5.5 years. Twenty-seven
ocular anomalies.
patients were male (69.2 %). The mean follow-up
Group 3: Trauma history.
period was 40.6 ± 28.6 months. The types of PRD
Group 4: History of intraocular surgery.
were rhegmatogenous in 84.6 %, tractional in 7.6 %,
Group 5: Atopic dermatitis (AD).
exudative in 2.6 %, and combined in 5.1 %. There
Group 6: Uveitis.
were contributing factors for PRD identified in 33 eyes
Group 7: Nil.
(84.6 %). Five eyes (12.8 %) had multiple risk factors.
For an eye that had multiple predisposing risk Patients’ clinical characteristics, operative details, and
factors, the eye was assigned to a group based on the surgical outcomes of PRD according to etiological and
main underlying etiology for RD. The ophthalmic age subgroups are shown in Tables 2 and 3. The top 3
findings at presentation, including best corrected rankings of contributing factors were congenital/
visual acuity (VA), refractive error, lens status, macula developmental anomalies (9 eyes, 23.1 %), high
status, types of breaks, and any presence of prolifer- myopia (7 eyes, 17.9 %), and trauma (6 eyes,
ative vitreoretinopathy (PVR) C grade C, were 15.4 %). Congenital/developmental etiologies identi-
recorded. The initially applied surgical techniques, fied in Group 1 (9 eyes) included retinopathy of
any use and types of internal tamponade, and the total prematurity (ROP) of stage 4 (1 eye), X-linked
number of RD repair operations were recorded. VA retinoschisis (2 eyes), Coat’s disease (2 eyes), morning

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Table 1 Baseline Total cases (patient, eyes) 37, 39


characteristics of patients
and etiologies for retinal Male (no, %) 27 (69.2 %)
detachment Mean age (range) 13.4 ± 5.5 years (1 month—18 years)
Age group (no, %)
0–10 8 (20.5 %)
11–15 10 (25.6 %)
16–18 21 (53.8 %)
Mean follow-up (range) 40.6 ± 28.6 months (6–100.7 months)
Type of RD (no, %)
Rhegmatogenous 33 (84.6 %)
Tractional 3 (7.7 %)
Exudative 1 (2.6 %)
Combined 2 (5.1 %)
Bilaterality 2 (5.4 %)
Lens status (no, %)
Phakic 36 (92.3 %)
Clear lens 32 (88.9 %)
Cataract 4 (11.1 %)
Pseudophakic 2 (5.1 %)
Aphakic 1 (2.6 %)
Average refractive error (range), n = 22 -5.2D (-22D to ?3D)
Macula detached (no, %) 32 (82.0 %)
Retinal break (no, %), n = 18
Retinal hole 9 (50 %)
Dialysis 4 (22.2 %)
Flap tear 3 (16.7 %)
Giant retinal tear 2 (11.1 %)
Presence of PVR C (no, %) 8 (20.5 %)
Multiple predisposing factors 5 (12.8 %)
Etiology (no, %)
1: Congenital/developmental anomalies 9 (23.1 %)
2: High myopia 7 (17.9 %)
3: Trauma 6 (15.4 %)
4: Intraocular surgery 4 (10.3 %)
5: Atopic dermatitis 4 (10.3 %)
PVR proliferative 6: Uveitis 3 (7.7 %)
vitreoretinopathy; RD 7: Nil 6 (15.4 %)
retinal detachment

glory syndrome (2 eyes), and syndromal disorders (2 Most eyes were phakic (92.3 %), of which 4 eyes
eyes). 62.5 % of patients aged below 10 years had (11.1 %) had significant lens opacities. Macula was
congenital/developmental anomalies, while it was detached in 82.1 % of eyes at presentation. PVR grade
12.5 % in those aged 11 years or above (Table 3). CC was present in 21 %. The types of retinal breaks
Three patients in Group 4 (intraocular surgery) had the were identifiable from the operation records in 18
past history of eye operations due to congenital/ cases among 33 eyes with rhegmatogenous RD, with
developmental anomalies, namely congenital cataract, the commonest causative retinal break being retinal
Marfan syndrome with subluxated lens, and persistent hole (50 %). Retinal dialysis was found in 4 eyes
hyperplastic primary vitreous. (22.2 %) (Table 1).

123
Table 2 Clinical characteristics, operative details, and surgical outcomes of retinal detachment according to etiological subgroups
Congenital High myopia Trauma Group 3 Intraocular surgery Atopic dermatitis Uveitis Group Nil Group 7 Total
Group 1 Group 2 Group 4 Group 5 6

123
No of eyes 9 7 6 4 4 3 6 39
Male 6 (66.7 %) 4 (57.1 %) 5 (83.3 %) 2 (50.0 %) 3 (75.0 %) 2 (66.7 %) 5 (83.3 %) 27 (69.2 %)
Age (mean ± SD) 9.80 ± 7.82 14.57 ± 3.05 14.00 ± 2.37 9.52 ± 8.8 17.25 ± 0.50 16.67 ± 0.58 15.00 ± 2.76 13.37 ± 5.48
Lens status
Phakic (Nos. with 9 (100.0 %) (1, 7 (100.0 %) (1, 6 (100.0 %) (1, 1 (25.0 %) (0, 4 (100.0 %) (1, 3 (100.0 %) 6 (100.0 %) 36 (92.3 %) (4,
cataract) 11.1 %) 14.3 %) 16.7 %) 0.0 %) 25.0 %) (0, 0 %) (0, 0 %) 11.1 %)
Pseudophakic 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 2 (50.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 2 (5.1 %)
Aphakic 0(0.0 %) 0 (0.0 %) 0 (0.0 %) 1 (25.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 1 (2.6 %)
RF error (Diopters) -0.75 ± 5.45 -11.0 ± 5.54 -3.00 ± 2.65 -6 -1 0 – -5.16 ± 5.71
Macular off 9 (100.0 %) 6 (85.7 %) 5 (83.3 %) 2 (50.0 %) 2 (50.0 %) 3 (100.0 %) 5 (83.3 %) 32 (82.1 %)
PVR C C 4 (44.4 %) 1 (14.3 %) 0 (0.0 %) 2 (50.0 %) 0 (0.0 %) 0 (0.0 %) 1 (16.7 %) 8 (20.5 %)
Initial operative details
PPV ? SB 3 (33.3 %) 4 (57.1 %) 3 (50.0 %) 0 (0.0 %) 1 (25.0 %) 1 (33.3 %) 3 (50.0 %) 15 (38.5 %)
PPV only 5 (55.6 %) 2 (28.6 %) 0 (0.0 %) 3 (75.0 %) 2 (50.0 %) 2 (66.7 %) 0 (0.0 %) 14 (35.9 %)
SB 1 (11.1 %) 1 (14.3 %) 3 (50.0 %) 1 (25.0 %) 1 (25.0 %) 0 (0.0 %) 3 (50.0 %) 10 (25.6 %)
Lens surgery 1 (11.1 %) 2 (28.8 %) 1 (16.7 %) 0 (0.0 %) 3 (75 %) 0 (0.0 %) 0 (0.0 %) 7 (19.4 %)
Tamponade 8 6 3 3 3 3 3 29
n = 29
Gas 2 (25.0 %) 2 (33.3 %) 1 (33.3 %) 3 (100.0 %) 1 (33.3 %) 1 (33.3 %) 0 (0.0 %) 10 (34.5 %)
Silicone oil 4 (50.0 %) 4 (66.7 %) 2 (66.7 %) 0 (0.0 %) 2 (66.7 %) 2 (66.7 %) 3 (100.0 %) 17 (58.6 %)
Heavy oil 2 (25.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 2 (6.9 %)
Anatomical outcome n = 39
Primary success 4 (44.4 %) 5 (71.4 %) 6 (100.0 %) 0 (0.0 %) 3 (75.0 %) 3 (100.0 %) 6 (100.0 %) 27 (69.2 %)
Final success 6 (66.7 %) 5 (71.4 %) 6 (100.0 %) 3 (75.0 %) 3 (75.0 %) 3 (100.0 %) 6 (100.0 %) 32 (82.1 %)
Mean no of 1.44 ± 0.73 1.14 ± 0.38 1 2.25 ± 0.50 1.25 ± 0.50 1 1 1.28 ± 0.56
operations
Functional outcome
Preop VA a/v 4 7 6 2 4 3 6 32
Final VA a/v 6 7 6 4 4 3 6 36
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Int Ophthalmol

Most eyes (76.9 %) received single RD repair


surgery only, with 9 eyes receiving 2 to 3 operations.
1.05 ± 0.79

0.93 ± 0.86
19 (59.4 %)

11 (30.6 %)
23 (63.9 %)
9 (28.1 %)
The primary surgery most commonly performed was

20/220

20/170
combined pars plana vitrectomy (PPV) with scleral
Total

0.32
buckling (SB) (n = 15, 38.5 %), followed by PPV
only (n = 14, 35.9 %). In these 2 groups (n = 29),
silicone oil was frequently used as the tamponade
Nil Group 7

0.75 ± 0.81

0.58 ± 0.63
1 (16.7 %)
5 (83.3 %)

1 (16.7 %)
5 (83.3 %)
agent (17 eyes, 58.6 %). Primary surgical repair with
20/110

20/80
SB was performed in 10 eyes (25.7 %). Concomitant

0.65
lens surgery (cataract extraction with or without
intraocular lens implantation) was performed in 7
Uveitis Group

0.88 ± 0.35

1.16 ± 0.77

eyes among 36 phakic eyes (19.4 %).


2 (66.7 %)

1 (33.3 %)
2 (66.7 %)
0 (0.0 %)
20/150

20/290

0.42 Anatomical and functional outcomes


6

Primary anatomical success after a single operation


Atopic dermatitis

a/v available; PPV: pars plana vitrectomy; PVR proliferative vitreoretinopathy; SB scleral buckling; VA visual acuity
was achieved in 69.2 %, whereas the final success rate
1.02 ± 1.12

1.17 ± 1.41

for all was 82.1 % (Table 2). The primary anatomical


1 (25.0 %)
3 (75.0 %)

1 (25.0 %)
3 (75.0 %)
Group 5

success rates were much lower in 2 groups of patients,


20/210

20/300

0.39

namely those with history of intraocular surgeries and


those with congenital/developmental anomalies,
which were 0 and 44.4 %, respectively. The final
Intraocular surgery

anatomical success rates in those 2 groups were 75.0


0.17 ± 0.00

0.54 ± 0.33
2 (100.0 %)

and 66.7 %, respectively. As to the age subgroup, both


2 (50.0 %)
2 (50.0 %)
0 (0.0 %)

the primary and final anatomical success rates were the


Group 4

20/30

20/70

lowest in patients below 10 years old, 37.5 and


0.36

62.5 %, respectively. Initial and final VA assessment


results are shown in Fig. 1. Initial and final VA could
Trauma Group 3

not be assessed in 7 and 3 eyes, respectively. 37.5 % of


1.12 ± 0.72

0.50 ± 0.37
2 (33.3 %)
2 (33.3 %)

5 (83.3 %)

eyes had improved VA, while 31.3 % had stable VA at


0 (0.0 %)
20/260

the last follow-up. Postoperatively, the proportion of


20/60

0.06

patients with VA C20/200 increased from 59.4 to


63.9 % (Table 2). Functional visual loss with VA\5/
200 at the last follow-up was found to be 30.6 % of
High myopia

1.25 ± 0.87

0.99 ± 0.96

eyes, which were mostly those with congenital/


3 (42.9 %)
4 (57.1 %)

2 (28.6 %)
5 (71.4 %)
Group 2

developmental anomalies (4 eyes, 36.4 %). Five eyes


20/360

20/200

0.40

(45.5 %) with functional visual loss belonged to


patients below 10 years old (Table 3). Overall, the
mean postoperative BCVA (LogMAR 0.93 ± 0.86;
range from NLP to 20/20) was not statistically
1.63 ± 0.56

1.80 ± 0.77
2 (50.0 %)
1 (25.0 %)

4 (67.7 %)
1 (16.7 %)
Congenital

different from preoperative VA (LogMAR


Group 1

20/1260
20/850

1.05 ± 0.79; range from HM to 20/20; P = 0.32).


0.29
Final VA (Snellen)
Preop VA C20/200

versus preop VA)


Table 2 continued

Final VA C20/200
P value (Final VA
Preop VA \5/200

Final VA \5/200

Discussion
(logMAR)

(logMAR)
(Snellen)
Preop VA

Preop VA

Final VA

In this study, we found that congenital/developmental


anomaly was the leading cause (23.1 %) of PRD.
62.5 % of them were below 10 years old. If we

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Table 3 Clinical characteristics, operative details, and surgical outcomes of retinal detachment according to age subgroups
0–10 years 11–15 years 16–18 years Total

No of eyes 8 (20.5 %) 10 (25.6 %) 21 (53.8 %) 39 (100.0 %)


Etiologies
Congenital Group 1 5 (62.5 %) 0 (0.0 %) 4 (19.0 %) 9 (23.1 %)
High myopia Group 2 0 (0.0 %) 4 (40.0 %) 3 (14.3 %) 7 (17.9 %)
Trauma Group 3 0 (0.0 %) 5 (50.0 %) 1 (4.8 %) 6 (15.4 %)
Intraocular surgery Group 4 2 (25.0 %) 0 (0.0 %) 2 (9.5 %) 4 (10.3 %)
Atopic dermatitis Group 5 0 (0.0 %) 0 (0.0 %) 4 (19.0 %) 4 (10.3 %)
Uveitis Group 6 0 (0.0 %) 0 (0.0 %) 3 (14.3 %) 3 (7.7 %)
Nil Group 7 1 (12.5 %) 1 (10.0 %) 4 (19.0 %) 6 (15.4 %)
Clinical characteristics
Male 6 (75.0 %) 7 (70.0 %) 14 (66.7 %) 27 (69.2 %)
Age (mean ± SD) 3.92 ± 3.51 12.39 ± 1.37 17.19 ± 0.81 13.37 ± 5.48
Lens status
Phakic (No. with cataract) 7 (87.5 %) 0 (0.0 %) 10 (100.0 %) 2(20.0 %) 19 (90.5 %) 2 (10.5 %) 36 (92.3 %) 4 (11.1 %)
Pseudophakic 0 (0.0 %) 0 (0.0 %) 2 (9.5 %) 2 (5.1 %)
Aphakic 1 (12.5 %) 0 (0.0 %) 0 (0.0 %) 1 (2.6 %)
RF error (Diopters) 1.25 ± 2.04 -8.17 ± 7.44 -5.25 ± 4.13 -5.16 ± 5.71
Macular off 8 (100.0 %) 8 (80.0 %) 16 (76.2 %) 32 (82.1 %)
PVR C C 6 (75.0 %) 0 (0.0 %) 2 (9.5 %) 8 (20.5 %)
Initial operative details
PPV ? SB 2 (25.0 %) 5 (50.0 %) 8 (38.1 %) 15 (38.5 %)
PPV only 5 (62.5 %) 1 (10.0 %) 8 (38.1 %) 14 (35.9 %)
SB 1 (12.5 %) 4 (40.0 %) 5 (23.8 %) 10 (25.6 %)
Lens surgery 0 (0.0 %) 2 (20.0 %) 5 (26.3 %) 7 (19.4 %)
Tamponade n = 29 6 7 16 29
Gas 4 (66.7 %) 2 (28.6 %) 4 (25.0 %) 10 (34.5 %)
Silicone oil 1 (16.7 %) 5 (71.4 %) 11(68.8 %) 17 (58.6 %)
Heavy oil 1 (16.7 %) 0 (0.0 %) 1 (6.2 %) 2 (6.9 %)
Anatomical outcome n = 39
Primary success 3 (37.5 %) 10 (100.0 %) 14 (66.7 %) 27 (69.2 %)
Final success 5 (62.5 %) 10 (100.0 %) 17 (81.0 %) 32 (82.1 %)
Mean no of operations 1.50 ± 0.53 1 1.33 ± 0.66 1.28 ± 0.56
Functional outcome
Preop VA a/v 3 10 19 32
Final VA a/v 7 10 19 36
Preop VA (LogMAR) 1.87 ± 0.75 1.00 ± 0.67 0.94 ± 0.81 1.05 ± 0.79
Preop VA (snellen)
Preop VA \5/200 2 (66.7 %) 3 (30.0 %) 4 (21.1 %) 9 (28.1 %)
Preop VA C20/200 1 (33.3 %) 6 (60.0 %) 12 (63.2 %) 19 (59.4 %)
Final VA (logMAR) 1.46 ± 1.00 0.53 ± 0.15 1.06 ± 0.95 0.93 ± 0.86
Final VA (Snellen) 20/580 20/70 20/230 20/170
Final VA \5/200 5 (71.4 %) 1 (10.0 %) 5 (26.3 %) 11 (30.6 %)
final va C20/200 2 (28.6 %) 9 (90.0 %) 12(63.2 % 23 (63.9 %)
P value (final VA versus preop VA) 0.55 0.06 0.33 0.32

a/v available; PPV pars plana vitrectomy; PVR proliferative vitreoretinopathy; SB scleral buckling; VA visual acuity

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Fig. 1 Scatterplot of final versus preoperative LogMAR visual circles indicate eyes with retina successfully repaired. Closed
acuity for 32 eyes of children treated with surgery for retinal circles indicate eyes with retina remained detached at final
detachment. Points above and below the diagonal line represent follow-up
eyes with worsened and improved vision, respectively. Open

included the 3 eyes that had received intraocular in Taiwan [6–8], Japan [9], and a study by Fong et al.
surgeries related to congenital/developmental anoma- in Hong Kong [10] also reported myopia as an
lies in Group 1, 30.8 % of eyes had some form of important underlying cause and accounted for 23 to
congenital anomalies. Recently, Fong et al. reported 38 % of patients. Different cutoff points for myopia
their 12-year review in 47 children with rhegmatoge- were used, such as -4D [6, 9] or -6D [8, 10]. We used
nous RD in a tertiary hospital in Hong Kong [10]. They -6D as the cutoff point for high myopia. Our patients
found that high myopia is the commonest identifiable with high myopia had a refractive error of -10D,
risk factor, while PRD due to congenital/developmen- which were on average 13.4 years old. The prevalence
tal anomalies was less common (16.3 %) and 50 % of of myopia in children in Asian countries (ranging from
them presented between 11 and 15 years [10]. In the 30 to 60 %) [13–17] was much higher than that
past reports from Taiwan [6–8] and Japan [9, 12], reported in Europe and the United States (ranging
congenital/developmental anomalies accounted for from 13 to 18 %) [18, 19]. Myopia is highly prevalent
11.8 to 49 % of PRD. in Hong Kong and more than 60 % of children are
High myopia C6D was the second commonest myopic by age 12 [16]. The prevalence of high myopia
cause for PRD (17.9 %) in our study. Previous studies C-6D in children in Hong Kong was 1.8 % and

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increased from 0.7 % at the age of 6 to 3.8 % by the and 45.5 % of them belonged to patients below
age of 12 [16]. This explained that high myopia was a 10 years old. Past studies also showed that poorer
more important cause for PRD in Asia than in the outcomes tended to occur in patients with congenital
western countries [1, 4, 5]. AD was found to be the abnormalities, trauma, or prior surgery [6, 7]. Multiple
second commonest cause of PRD (18.4 %) by Fong factors could account for the poor visual outcome.
et al. and was associated with poor visual outcome. Eyes with congenital/developmental anomalies often
However, AD was less common (10.5 %) in our study have abnormal vitreoretinal junction and stronger
and found only in patients aged above 11 years. vitreoretinal traction. As they often presented at a
Delay in diagnosis of PRD is a common problem, younger age, there were problems of delay diagnosis,
evidenced by macula detachment in 82.1 % of eyes development of PVR, difficulty in proper positioning,
and the presence of PVR Cgrade C in 20.5 % of eyes and visual rehabilitation in the postoperative period.
in our study. The presence of PVR Cgrade C in PRD This study has its limitations, as it is retrospective
was found in 18 to 59 % of eyes in other studies and was conducted in a tertiary center, and referral
[1, 4–6, 8, 10]. biases could not be excluded. Also this study only
Vitrectomy with or without buckling procedures included those operable cases. Some cases were
was used as the initial surgical repair technique in inoperable at the beginning and thus were not included
74.4 % of cases in our study. The rate was similar to in the analysis of the etiologies of RD.
those reported in the studies by Gonzales et al. [1] In conclusion, congenital/developmental anoma-
and Fivgas et al. [5], which were 74 and 72 % of lies, high myopia, and trauma were the leading causes
cases, respectively. In some reports, SB was the of retinal detachment in children in this series. Most
most commonly performed initial procedure children with underlying congenital/developmental
[6, 9, 10]. The rate of successful retinal reattach- anomalies presented at ages below 10. They had
ment was 82.1 % in our study, which is comparable higher retinal redetachment rates and poorer visual
to other studies (ranging from 72 to 85 %) outcomes. Regular follow-up and detailed fundus
[1, 4–6, 8, 10]. Analysis according to etiological examination should be performed in children at risk so
subgroups showed that patients with congenital that pathologies could be detected earlier.
anomalies had the worst primary and final anatom-
Compliance with ethical standards
ical success rates. Similarly, younger patients (be-
low 10 years old) also had worse anatomical success Conflict of interest The authors declare that they have no
rates of surgery for PRD. PVR is one of the major conflict of interest.
causes of failure in retinal reattachment surgery. All
patients with congenital/developmental anomalies
presented with detached retina at the macula, and
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