Journal Club Update
Pediatric retinal detachment surgery requires surgeons to adjust their goals and expectations.
Phillip J. Ferrone, MD, joined Retina Today Journal Club hosts Jonathan L. Prenner, MD, and Richard S. Kaiser, MD, to discuss retinal detachment surgery in children.
“Children is a broad category,” Dr. Kaiser pointed out. Dr. Ferrone agreed, and offered a rough schematic to classify children by age: patients less than 6 years old, patients 6 to 10 years old, and patients older than 10 years. Such a system can be useful when first assessing surgical risk and long-term visual and anatomic outcome. For example, buckle use in patients less than 6 years old may interfere with eye growth.
It became clear during the course of the discussion that a strict schematic arranged via age group is not a perfect system. Dr. Ferrone said that elements such as pathology are essential to consider when calculating which surgical approach would be best for a particular patient.
Watch it Now
Drs. Ferrone, Kaiser, and Prenner review the nuances of pediatric retinal detachment surgery.
“If I had a 5-year-old with, let’s say, trauma, and they had a supratemporal dialysis, I would use a segmental sponge in that case,” Dr. Ferrone said. “If I had an infant with, say, an unusual type of retinal detachment that wasn’t amenable to vitrectomy because … it was addressed a little later, and already the ridge was pulled out to the ora serrata, then I would use an encircling 240 element on that and then cut it 3 months later, leaving the element in place so there’s still some physical effect from the buckle.”
Dr. Ferrone said that surgeons operating on pediatric patients must adjust their game plans given the unique dynamics of the pediatric eye. He told Dr. Prenner that surgeons “don’t have to remove as much gel and be as aggressive” with younger patients.
“Do you have the get the hyaloid off?” Dr. Prenner asked. “You can’t, correct?”
“It’s difficult and often you don’t have to,” Dr. Ferrone explained. “I trim the vitreous base very well [and] clean out as much vitreous as” possible to avoid creating iatrogenic damage.
Dr. Prenner summarized the talk by noting that, in children 6 to 10 years old, buckles are still primarily the way to go, and that those performing vitrectomy should proceed with caution and limited goals.
Dr. Ferrone agreed, but he noted that vitrectomy alone without a buckle works well in cases of penetrating injury, such as pencil-in-the-eye cases commonly seen in young patients. n
RECENT RETINA TODAY JOURNAL CLUB EPISODES
• Episode 37: Managing Pediatric Retinal Detachments, with Phillip J. Ferrone, MD; Jonathan L. Prenner, MD; and Richard S. Kaiser, MD
• Episode 38: Systemic Effects of Anti-VEGF Therapy, with Usha Chakravarthy, MD, FRCS, FRCOphth, PhD; Jonathan L. Prenner, MD; and Richard S. Kaiser, MD
• Episode 39: Managing Giant Retinal Tears, with Damien Rodger, MD, PhD; Jonathan L. Prenner, MD; and Richard S. Kaiser, MD