Fig. 7.49 This retinoschisis RRD has been reattached. There is extensive laser retinopexy to the outer leaf breaks

vitreoretinopathy, uveitis and previous retinopathy of prematurity (Weinberg et al. 2003; Akabane et al. 2001). The frequency of bilateral vision threatening abnormalities in these patients is reportedly high at 89 % (Fivgas and Capone 2001). PVR rates are also high (40 %) because of slow presentation. Both final retinal reattachment rates and visual acuity outcomes are lower than for adult surgery.

Be aware that a pars ciliaris tear may be present in a shallow total RRD without a good history of trauma.

7.10Atopic Dermatitis

This has been associated with RRD in 2.2 % of patients in Japan (Hida et al. 2000) with a high incidence of cataract and PVR.

7.11Refractive Surgery

Although RRD has been described associated with LASIK (Farah et al. 2000), the causal relationship remains uncertain with only 17 patients having RRD from 1 to 36 months after LASIK out of 31,739 patients treated in one study (Arevalo et al. 2001).

Ambler et al. 1991; Ambler and Gutman 1991; Sneed et al. 1990). The outer leaf breaks can then be flattened and treated with endolaser and internal tamponade. This often means extensive laser as the outer breaks are large, and often their extent is not obvious.

Note: The retina of the outer leaf is fragile and liable to contract with heavy laser; therefore, apply carefully to avoid increasing the size of the outer breaks.

The inner retina is often slightly short but seems to settle if the outer leaf breaks are sealed. A deroofing method whereby the inner leaf is removed to allow access to the outer layer has been used but seems unnecessary. PVR if present results in a reduction in success rate. If the schisis itself extends into the macula, visual recovery will not occur even with flattening of the retina because the nerve fibres in the retina have been severed. Juvenile XL retinoschisis rarely needs surgery, but some have described surgical approaches (Rosenfeld et al. 1998; Ferrone et al. 1997; Trese and Ferrone 1995; Regillo et al. 1993).

7.9Juvenile Retinal Detachment

Children occasionally present with RRD usually with a predisposing factor such as trauma, high myopia, Stickler’s syndrome, previous intraocular surgery, familial exudative

7.12Congenital Cataract

Patients with prior surgery for congenital cataract may present with RRD. These can be dealt with by the usual methods although PPV is often favoured because of the ability to deal with residual medial opacities.

7.13Others

RRD can complicate many other conditions which are more fully described elsewhere in this text. Any condition which causes posterior vitreous detachment in the presence of vitreoretinal adhesions or which injures the retina by causing a full thickness break can potentially cause RRD, such as:

•Uveitis

•Trauma

•Viral retinitis

•Retinal vein occlusion

•Von Hipple–Lindau disease

•Sickle-cell disease

•Dropped nucleus

•Needle stick injury

•Vitreoretinal surgery

•Retinopathy of prematurity

7.14Summary

Applying the principles of break closure, retinopexy and temporary support of the retina can be applied to a variety of rhegmatogenous retinal detachment presentations.

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