First Author: I.Jürgens SPAIN
Co Author(s): A. Rey A. Dyrda
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To describe the main steps for successful treatment of a paediatric case of recurrent retinal detachment with anterior migration of the scleral buckle under the rectus muscles five years after the first surgery.
Institut Catala de Retina, Barcelona
A 12-year-old girl was referred to our Institute for a second opinion. She had a previous history of a rhegmatogenous retinal detachment after a blunt ocular trauma at the age of 7. She had been treated with vitrectomy, and scleral buckling.She had developed a cataract that had been operated one year later, and had had 2 vitrectomies with silicone oil tamponade because of recurrent retinal detachment with proliferative vitreoretinopathy(PVR)and subretinal silicone oil migration. When she came for the first time her visual acuity was light perception. Ocular examination disclosed a 360-degree migration of the whole encircling band,a recurrent retinal detachment with PVR and subretinal silicone oil.
The challenging first key surgical step was to separate the scarred conjunctiva from the underlying sclera. During isolation of the rectus muscles,it was noted that the sutures of the encircling band had not been loosened and that the band had migrated through the sclera.The silicone band was removed and a new scleral buckle was placed.Vitrectomy was then performed and a completely adhered posterior hyaloid was dissected and extracted. Subretinal silicone oil was removed and an air-silicone oil exchange was performed after laser photocoagulation of the retinal dialysis and the retinotomy. Final visual acuity was counting fingers. There was no recurrence of retinal detachment.
The main steps for successfully treatment of paediatric retinal detachments include: Avoiding unnecessary vitrectomies in patients that can be treated with a scleral buckle (e.g. retinal dialysis), separating the posterior hyaloid when performing a vitrectomy, adjusting the silicone band in a growing eye to avoid migration, releasing all membranes to avoid reproliferation and subretinal silicone oil migration, and suturing the conjunctiva carefully to avoid massive scarring of the sclera.