Year : 1983 | Volume
: 31 | Issue : 7 | Page : 892--894
Study of juvenile retinal detachment
DN Gangwar, MR Dogra, IS Jain, SPS Grewal
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Candigarh, India
D N Gangwar
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
|How to cite this article:|
Gangwar D N, Dogra M R, Jain I S, Grewal S. Study of juvenile retinal detachment.Indian J Ophthalmol 1983;31:892-894
|How to cite this URL:|
Gangwar D N, Dogra M R, Jain I S, Grewal S. Study of juvenile retinal detachment. Indian J Ophthalmol [serial online] 1983 [cited 2022 Aug 15 ];31:892-894
Available from: https://www.ijo.in/text.asp?1983/31/7/892/29697
Retinal detachment in children is relatively uncommon. Studies available on juvenile retinal detachment include patients under 20 years of age It is generally observed that juvenile retinal detachment presents a late to the ophthalmolgist whereas retinal lesions develop early. To the best of author's known information available on this subject from India. So the main purpose is to highlight this problem in out setup. We present our experiences reguarding etiology, types of breaks, retinal detachment, treatment modalities and final outcome of these patients.
MATERIAL AND METHODS
756 cases who attended retinal detachment clinic of PGIMER, Chandigarh, From January, 1974 to June 1982 were reviewed to find out cases of juvenile retinal detachment (under 20 years of age). 73 (9.6%) of cases had juvenile retinal detachment. Out of these 50 cases had complete record and were the subject of this study.
There were 38 (76%) males and 12 (24%) females, 45 (90%) were - between 10-20 years of age and only 5 (10%) presented below 10 years age. Duration of retinal detachment varied from one day to many years. Three patients (6%) had bilateral retinal detachment. All cases complained of diminision of vision which was noticed either accidently or accured suddenly especially following trauma. In nine eyes, one to two quadrant of retina were detached, 12, had 2-3 quadrant of retinal detachment whereas 32 eyes had more than 3 quadratfts of retinal detachment. Only 17 cases had total retinal detachment. Typical fundus picture was seen in cases with partial retinal detachment. Most of these cases had dmcation lines, thinned out retina with involved macula and a dialysis or multiple holes with ragged edges. In these cases attached retina appeared healthy. Partial retinal detachment was mostly in inferotemporal region. Out of 50 patients 27 (54%) were operated upon a rest were considered unoperable or they refused surgery. Average period of follow-up in operated patients varied from 3 months to 3 years (average 6 months). Initial visual acuity varied from accurate perceptions of light to counting finger. Surgical procedure was selected on the particular need of an eye and was in no way different from that undertaken in adults. Important etiological factors were trauma, myopia,m vitreo retinal degeneration, aphakia, coloboma, dialysis and familial retinal detachment.
Trauma: Blunt trauma was the predominant etiological factor in 18 (36%) cases. This included 16 male and 2 famele cases. All except one were more than 10 years of age. Injuries were sustained by cricket and hockey ball (8), fall (4), slap (1), condensor burst (1) and unknown (3). One patient had bilateral retinal detachment with high myopia. Duration of presentation varied from one day to four years average (7 months). 9 (50%) had simultaneous retinal detachment with thrauma whereas other 9 (50%) developed two weeks to two years after trauma (average 1.2 years) Five cases had dialysis out of which three were in iferotemporal and two superonasal. Four had horse shoe tears in temporal retina. Multiple retinal holes were seen temporally in three patients. Three cases had secondary mucular hole. Seven had no evident retinal breaks. Four patients had evidence of blunt trauma in other parts of eye in the form of subluxated lens, traumatic cataract, traumatic mydriasis, secondary glaucoma and vitreous haemorrhage. Retinal detachment was considered operable in only 10 cases. All but one had anatomical reattachment of retina. Seven regained a visual acuity of 6/12-6/36 whereas two patients had 3/60 and 6/60 vision. High rate of inoperabilitywas done to long standing retinal detachment, sequel of blunt trauma and refusal for surgery by the patients.
Myopia: 13 (26%) had myopia as precipitating factor of which 9 were male and 4 female. Two patients had bilateral retinal detachmentwith high myopia. Myopia varied from -3.00 to -12.00 dipters with an average of -6.5 dipters; duration of retinal detachment varied from one week to one year (average one month). Two cases had no evident retinal breaks. Four had retinal dialysis, three came with horse shoe tears, two developed multiple tear with other two developing multiple holes with lattice degeneration. 10 out of 15 eyes were operated and all had anatomic reattachment of retina. Six recovered 6/12 to 6/36 vision whereas four could recover only counting finger to 6/60. Two patients: refused surgery and three eyes were unoperable.
Vitreoretional Degeneration: Five patients all male had some vitreoretinal degenerations. One case had bilateral retinal detachment and one case of unilateral detachment had bilateral retinoschiesis. Three eyes that were operated upon had reattachment of retina with 6/66 or better vision. Two patients had lattice degeneration with hole which were treated prophylactically.
Aphakia: Three cases were aphakic. Average period between cataract extraction and retinal detachment eight years (range 1 to 10 years). All had unilateral unoperable retinal detachment due to late reporting, vitreous changes, fixed holes and no localisation of breaks.
Coloboma: Three cases of bilateral iris and choroidal coloboma had total retinal detachment in one eye each without any evident breaks. Total surgical failure was observed despite resurgery in two cases.
Dialysis: There were 10 cases with dialysis. Two patients had inferotemporal dialysis for which no cause could be attributed. One case refused surgery and other developed massive pre-retinal fibrosis following surgery.
Familial retinal detachment: Two children each from three families were observed to have retinal detachment. In first family two brothers with high myopia had bilateral retinal detachment. Left eye was involved first in both and showed total retinal detachment with disinsertion of retina and complicated cataract. Right eye in each showed similar giant retinal dialysis (270°). Second family had two sisters both had total retinal detachment in left eye without any evident breaks. It was old retinal detachment with hypotony in eyes of both cases. They did not turn for surgery subsequently.
Third family had a brother who had-3.0D myopia and dialysis inferotemporally with retinal detachment in left eye. His sister had total reinal detachment with fixed folds and no evident breaks.
Unknown causes: 8 had no known cause for retinal detachment.
A9.4% incidence of juvenile retinal detachment (JRD) in the present series collaborates the incidence of 3.2 to 12.1% reported in literature.,,, Males between 10-20 years are most prone to JRD. Most of the cases of JRD have retinal detachment of long duration in contrast to adults. JRD cases do net complain of flashes or fleaters as in adults. Partial retinal detachment, demarcation lines and hard border indicate slow progress of retinal detachment. Breaks, dialysis and detachment had prediliction for the lower temporal retina.
Familial retinal detachment in three families showed tendancy for same eye involvement. Similar dialysis and similar retinal fold was observed in one family. Bilaterality of retinal detachment in three families calls for detailed examination of other eye and also of other family members. Among the etiological factors trauma, myopia and hereditary factors are the most important (74%). Emphasis has been laid on the roll of trauma and myopia in literature also.,,,, sub Surgical procedure and the behaviour of the patients in post-operative period is same as in adults. However incidence of inoperability is high as compared to adults. Authors have found long duration and associated traumatic damage to be the main factor for this. Anatomical and functional success following surgery is good and compares favourably with that in adults in our set up and that reported in literature.,, Better visual prognosis was present in patients with recent onset, single breaks and only partial retinal detachment. incidence of resurgery in our series was four out of 27 (11.1%).
There is no known information available on juvenile retinal detachment from our country. We have included patients upto 20 years of age in this group. 73 (9.6%) had juvenile retinal detachment in our set up. 50 cases were available for complete study. Trauma and myopia were most important etiological factors in 62% of cases. Interesting observation of familial retinal detachment was observed in 3 families. Total surgical failure resulted in cases of coloboma and aphakia with retinal detachment. Only 27 (54%) were operated upon out of which 21 had anatomical reattachment of retina with variable functional recovery. Incidence of resurgery was only 11.1%
|1||Jaun Verdaguer T., 1982, Amer J. Ophthalmol 93: 145|
|2||Symposium on Juvenile Ret. Detachment, 6th Gonin meeting (1969). Modern Problems in Ophthalmology 8: 152|
|3||Tass Man W., 1967, Trans,. Am. Ac. Ophthalmol. Ore 171: 455|
|4||Hudson JR., 1965, Trans. Ophthalmol Sec. UK, 75: 79|
|5||Jaun. J. Arentisen and Robert B. Welch., 1974, Paed. J. Ophthalmol 11: 198|