儿童视网膜脱离.ppt

Richard Markham Bristol Eye Hospital, UK RD in children is uncommon (1.5 – 5% of all RDs) but important in working years affected Increasing incidence from 0 – 16yrs Most have identifiable underlying cause Males make up 73% of total Late presentation is common in children Causes of RD in children Trauma Associated conditions High myopia Idiopathic 53% 27% 17% 19% Trauma Makes up 53% of children’s RD (range 34%–65%) Presentation 1 day to 3 years after injury Boys 79% of total Dialysis was break type in 50% Agents of trauma Tennis ball Rugby contact Football Hockey stick Lacrosse stick Frisbee Shotgun pellet Stone Firework Assault NAI Self harm Conditions associated with paediatric RD Wagner / Stickler Syndrome Marfan’s Syndrome X-Linked retinoschisis Uveal coloboma Retinopathy of prematurity (ROP) Pseudophakia after congenital cataract surgery Atopic dermatitis Cerebral palsy Retinal necrosis (HSV retinitis) Myopia 25% myopic 17% high myopes (-6.0D to -22.0D) 10% giant tears Idiopathic In idiopathic RD group (no history of trauma), 76% were dialysis, so undocumented injury may underlie these as well May therefore be only 5% truly idiopathic Types of retinal break Treatment Scleral explants/encirclement may be more appropriate than vitrectomy in many cases Scleral explant for retinal dialysis Vitrectomy for re-detachment, PVR, or serious trauma eg IOFB Vitrectomy silicone oil for giant tears Separation of vitreo-retinal interface may be a problem Posturing may be impossible Results Re-attachment rate 52% - 87% Complication rate up to 58% Visual improvement 53% worse 13%, same 33% only 12% 6/12 Very much dependent on severity of any injury and timeliness of presentation Macula off at presentation in 66% -77% (cf. 41% in adults) Complications More frequent in younger age groups Amblyopia Related to silicone oil Uveitis Secondary cataract Other RD in children Coats ROP NAI Familial exudative vitreoretinopathy RD in childre