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Proliferative Retinopathies in Children

15

 

Philip J. Ferrone and Steven Awner

 

 

 

15.1  Introduction

15.2  Historical Context

The proliferative retinopathies are a varied assortment of diseases, which include:

1.Diabetes mellitus (DM)

2.Sickle cell disease (SC)

3.Familial exudative vitreoretinopathy (FEVR)

4.Retinopathy of prematurity (ROP)

5.Incontinentia pigmenti (IP)

6.Norrie’s disease

7.Retinitis pigmentosa (RP)

8.Chronic retinal detachment

The first two entities, diabetes and SC, develop retinopathy based upon a systemic metabolic disruption of retinal physiology. The other proliferative retinopathies, except for chronic retinal detachment, are due to either genetic or developmental abnormalities. They all exert their deleterious effects by inducing ischemia and thereby disrupting the metabolic needs of the retina. This invariably leads to neovascularization (NV) of the retina with resultant glial organization with or without hemorrhage into the vitreous. Subsequent contraction of the vitreous gel causes retinal detachment and often blindness.

P.J. Ferrone (*)

Columbia University, Long Island Vitreoretinal Consultants, 600 Northern Blvd, Great Neck, NY 11021, USA

e-mail: p_ferrone@hotmail.com

S. Awner

State University of New York at Buffalo, Western New York Ophthalmology, 3980 Sheridan Drive, Suite 402, New York, NY 14226, USA

With the exception of diabetes, the proliferative retinopathies are primarily peripheral retinopathies. The detection, clinical classification, and treatment of these diseases were greatly facilitated by the development of the indirect ophthalmoscope. The development of cryotherapy to ablate areas of ischemia in the peripheral retina was instrumental in the treatment of many of these diseases (FEVR, ROP, IP, and Norrie’s disease). Subsequently, the development of indirect laser delivery systems contributed greatly to treating the ischemic retina and preventing blindness in entities such as diabetes, SC, FEVR, ROP, IP, Norrie’s disease, and NV associated with RP. In addition, safe pediatric general anesthesia further advanced the treatment of these diseases. It was not until all of these advances were present that true progress could be made against the blinding effects of these diseases.

15.3  Overview with Clinical Significance

Several of the diseases listed in this chapter can cause their blinding effects in infancy, and these include ROP, FEVR, IP, and Norrie’s Disease. The others, such as diabetes, Sickle cell, RP, and chronic RD, usually cause NV later in childhood (teenage years) or into adulthood (greater than 18 years). With all of these diseases however, once the NV starts, the process of glial organization and vitreous contraction may begin. Once the vitreous contracts significantly, retinal ablation (whether it be with laser or cryotherapy) may be not sufficient to control the disease. Consequent retinal detachment may require scleral buckling or vitreous surgery to relieve traction on the retina, with concurrent retinal ablation to

J. Reynolds and S. Olitsky (eds.), Pediatric Retina,

351

DOI: 10.1007/978-3-642-12041-1_15, © Springer-Verlag Berlin Heidelberg 2011