First Author: C.Wong SINGAPORE
Co Author(s): A. Tsai S. Ong E. Wong C. Ang S. Lee G. Tan
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To describe and compare the clinical characteristics and surgical outcomes of pediatric retinal detachments (RD) in eyes with high myopia (HM) and moderate myopia (MM).
Singapore National Eye Centre
This is a retrospective review of 52 eyes of 47 pediatric patients with primary axial myopia (spherical equivalent (SE) -2.0D) presenting with rhegmatogenous retinal detachment over a 20-year period treated at the Singapore National Eye Centre. All eyes underwent retinal reattachment surgery by scleral buckling (SB), pars plana vitrectomy (PPV) or combined scleral buckling and pars plana vitrectomy (SB+PPV). Eyes with secondary pathology, such as trauma, previous surgery, uveitis, subluxed lenses or atopic dermatitis were excluded from analysis. HM was defined as SE of -6.0D. Case records were reviewed for baseline clinical characteristics and surgical outcomes at 6 months after surgery. Anatomic success and visual outcomes were assessed.
The mean age was 15.3 ± 3.0 years and most patients were male (79.3%). Thirty-seven eyes (71.2%) were HM. The mean SE was -4.15 ± 0.92D and -10.2 ± 4.9D in eyes with MM and HM respectively. The most common pathology in the HM group was lattice with multiple breaks (35% vs 17.6%, p=0.39), while the MM group most commonly presented with lattice with single break (29.4% vs 12.5%, p=0.39). Proliferative vitreoretinopathy(PVR) was more common in eyes with HM than MM (18.9% vs 0%, p=0.09). All eyes in the MM group underwent SB. In the HM group, 30 eyes (81.1%) underwent SB, 2 (5.4%) underwent PPV and 5 (13.5%) underwent SB+PPV. Primary (59.3% vs 100%, p=0.03) and final anatomical success rates (73% vs 100%, p=0.046) were significantly lower in the HM group than the MM group. HM eyes were also significantly more likely to have final best corrected visual acuity worse than 6/60 (24.3% vs 0%, p=0.046). In eyes that underwent primary SB, both HM and MM eyes experienced significant myopic shift (p<0.001 and p=0.009 respectively) post operatively. There was no significant difference in the degree of myopic shift (-2.821.99D and -2.001.62D in the MM and HM groups respectively, p=0.31).
Highly myopic paediatric patients with rhegmatogenous RD have a clinical presentation that is distinct from their moderately myopic counterparts. The poorer anatomical and functional outcomes in these eyes highlight the importance of myopia prevention in the paediatric age group.