Setting expectations, postop care ‘crucial’ in pediatric retinal repair
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NEW YORK — A focus on follow-up care and monocular precautions may help improve outcomes in pediatric patients undergoing retinal repair, according to a presenter at OSN New York Retina.
Self-injurious behaviors that may contribute to ocular trauma, such as head banging and smacking of the face and eyes, have a prevalence of roughly 50% in pediatric patients diagnosed with intellectual disability, Vaidehi S. Dedania, MD, assistant professor of ophthalmology at NYU Grossman School of Medicine, said in the presentation. Such blunt trauma can result in traumatic cataract, glaucoma and retinal detachment, which is seen in 9% to 16% of cases.
Pediatric patients often lack the ability to recognize or verbalize loss of vision, which may lead to gradual disease progression, higher rate of fovea-involved retinal detachment and a later diagnosis, which also leads to poorer outcomes, Dedania said. They are also predisposed to a higher risk for proliferative vitreoretinopathy (PVR).
“What’s the prognosis? It’s usually actually pretty poor. A lot of the reason for that is these patients are younger. They’re more prone to PVR. Their ability to cooperate with positioning and instructions can impact their risk of success,” Dedania said.
Treatment options for retinal detachment include scleral buckle, vitrectomy, scleral buckle with the addition of vitrectomy, cryotherapy, laser, and external drainage with the addition of cryotherapy or laser. Strong vitreoretinal adhesion, cooperation with postoperative management, and care and predisposition to PVR should be considered when determining treatment options, Dedania said in the presentation.
Goals of treatment are improved visual function as well as globe preservation, and multiple surgeries are often required to achieve retinal reattachment. Factors that may affect outcomes include the presence of PVR, continuation of self-injurious behavior and the age at presentation, Dedania said.
Discussing goals of surgical intervention and setting expectations with patients and/or guardians is crucial, as is frequent postoperative follow-up, which will allow for early diagnosis of recurrent detachment in addition to other sequelae, Dedania said.
“It’s really important to set patients up for this because if you do have to go back or if there is failure, they will be upset,” Dedania said.
Other postoperative considerations include suturing all wounds and burying sutures where possible, recommending hospital admission or temporary rehabilitation, and encouraging the use of a safety helmet with eye protection.
“Frequent follow-up in the postoperative period will allow for early diagnosis of recurrent retinal detachment or other sequelae,” Dedania said.
Monocular precautions and consideration of prophylaxis in the fellow eye with scleral buckle may allow patients to maintain vision and quality of life, Dedania said.
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Dedania VS. Retinal detachment repair in self-inflicted trauma. Presented at: OSN New York and OSN New York Retina; Oct. 15-17, 2021; New York.
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