Surgery for proliferative vitreoretinopathy in children – Sisyphus toil

Author: Rafal Leszczynski (Poland)

Co-authors: Sebastian Sirek, Piotr Grygierczyk, Joanna Grzbiela, Ewa Mrukwa-Kominek

Purpose

To present the outcomes of vitrectomy and phacoaspiration with intraocular lens implantation in a child suffering from retinal detachment and proliferative vitreoretinopathy.

Setting/Venue

1.Department of Opthalmology, School of Medicine in Katowice, Medical University of Silesia, Poland 2.Professor K. Gibiński University Hospital Centre, Medical University of Silesia, Poland

Methods

8-year-old child was admitted to the Division of Pediatric Ophthalmology with funnel-shaped retinal detachment and proliferative vitreoretinopathy. Visual acuity was light perception with inaccurate localization. Ultrasound revealed PVR CA12. Open funnel-shaped retinal detachment, retinal fibrosis and folds were seen.The lesions were more pronounced anterior to eyeball equator. Lens phacoaspiration and intracapsular artificial lens implantation. Posterior central and peripheral vitrectomy was performed. Triamcinolone injection facilitated visualization of the vitreous body and removal of epiretinal proliferation. Following Brilliant Peel administration, ILM was peeled over the entire area of the posterior pole. Marked fibrosis of the pre-equatorial retina forced us to perform circular retinotomy as well as several incisions along retinal meridians. Subretinal proliferations were removed. Complete retinal reattachment occurred after ILM peeling over the entire retinal circumference and PFCL administration. Silicone oil was injected after retinal laser photocoagulation and removed after 3 months.

Results

Retinal reattachment, visual acuity increase to 1,00logMAR and intraocular pressure stabilization in the postoperative period. Over the next two years, visual acuity decreased and subretinal membranes recurred.

Conlusions

A combination of chromovitrectomy and cataract surgery helps improve the anatomic outcome in children with retinal detachment and proliferative vitreoretinopathy. The use of a dye during PPV allows intraoperative visualization of the vitreous body and epiretinal membran es. Nevertheless, ILM peeling over the entire retinal circumference does not eliminate epiretinal membrane recurrence.

Financial Disclosure

I do not have any special financial relations with any company, I have no financial interest in writing paper