Elizabeth J Rossin1, Irena Tsui2, Sui Chien Wong3, Kirk K Hou2, Supalert Prakhunhungsit4, Michael P Blair5, Michael J Shapiro5, Lisa Leishman5, Aaron Nagiel6, Jacob A Lifton6, Polly Quiram7, Alexander L Ringeisen7, Robert H Henderson8, Natalia Arruti8, Dominic M Buzzacco9, Shunji Kusaka10, Philip J Ferrone11, Peter J Belin11, Emmanuel Chang12, Jean-Pierre Hubschman2, Timothy G Murray13, Ella H Leung14, Wei-Chi Wu15, Karl R Olsen16, C Armitage Harper17, Safa Rahmani18, Jessica Goldstein17, Thomas Lee6, Eric Nudleman19, Linda A Cernichiaro-Espinosa20, Jay Chhablani21, Audina M Berrocal4, Yoshihiro Yonekawa22. 1. Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. 2. Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California. 3. Department of Ophthalmology, Great Ormond Street Hospital and NIHR Biomedical Research Centre, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Royal Free Hospital, London, United Kingdom. 4. Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida. 5. Retina Consultants, Ltd, Des Plaines, Illinois. 6. The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California. 7. VitreoRetinal Surgery, PA, Minneapolis, Minnesota. 8. Department of Ophthalmology, Great Ormond Street Hospital and NIHR Biomedical Research Centre, London, United Kingdom. 9. Midwest Retina, Inc, Dublin, Ohio. 10. Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan. 11. Long Island Vitreoretinal Consultants, Great Neck, New York. 12. Retina and Vitreous of Texas, Houston, Texas. 13. Miami Ocular Oncology and Retina, Miami, Florida. 14. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. 15. Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. 16. Retina Vitreous Consultants, Monroeville, Pennsylvania. 17. Austin Retina Associates, University of Texas-Austin, University of Texas-San Antonio, Austin and San Antonio, Texas. 18. Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 19. Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, San Diego, California. 20. Asociacion para Evitar la Ceguera en México, Mexico City, Mexico. 21. Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India; Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania. 22. Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: yyonekawa@midatlanticretina.com.
Abstract
PURPOSE: To describe the clinical characteristics, surgical outcomes, and management recommendations in patients with traumatic rhegmatogenous retinal detachment (RRD) resulting from self-injurious behavior (SIB). DESIGN: International, multicenter, retrospective, interventional case series. PARTICIPANTS: Patients with SIB from 23 centers with RRD in at least 1 eye. METHODS: Clinical histories, preoperative assessment, surgical details, postoperative management, behavioral intervention, and follow-up examination findings were reviewed. MAIN OUTCOME MEASURES: The rate of single-surgery anatomic success (SSAS) was the primary outcome. Other outcomes included new RRD in formerly attached eyes, final retinal reattachment, and final visual acuity. RESULTS: One hundred seven eyes with RRDs were included from 78 patients. Fifty-four percent of patients had bilateral RRD or phthisis bulbi in the fellow eye at final follow-up. The most common systemic diagnoses were autism spectrum disorder (35.9%) and trisomy 21 (21.8%) and the most common behavior was face hitting (74.4%). The average follow-up time was 3.3 ± 2.8 years, and surgical outcomes for operable eyes were restricted to patients with at least 3 months of follow-up (81 eyes). Primary initial surgeries were vitrectomy alone (33.3%), primary scleral buckle (SB; 26.9%), and vitrectomy with SB (39.7%), and 5 prophylactic SBs were placed. Twenty-three eyes (21.5%) with RRDs were inoperable. The SSAS was 23.1% without tamponade (37.2% if including silicone oil), and final reattachment was attained in 80% (36.3% without silicone oil tamponade). Funnel-configured RRD (P = 0.006) and the presence of grade C proliferative vitreoretinopathy (P = 0.002) correlated with re-detachment. The use of an SB predicted the final attachment rate during the initial surgery (P = 0.005) or at any surgery (P = 0.008. These associations held if restricting to 64 patients with ≥12 months followup. Anatomic reattachment correlated with better visual acuity (P < 0.001). CONCLUSIONS: RRD resulting from SIB poses therapeutic challenges because of limited patient cooperation, bilateral involvement, chronicity, and ongoing trauma in vulnerable and neglected patients. The surgical success rates were some of the lowest in the modern retinal detachment literature. The use of an SB may result in better outcomes, and visual function can be restored in some patients.
PURPOSE: To describe the clinical characteristics, surgical outcomes, and management recommendations in patients with traumatic rhegmatogenous retinal detachment (RRD) resulting from self-injurious behavior (SIB). DESIGN: International, multicenter, retrospective, interventional case series. PARTICIPANTS: Patients with SIB from 23 centers with RRD in at least 1 eye. METHODS: Clinical histories, preoperative assessment, surgical details, postoperative management, behavioral intervention, and follow-up examination findings were reviewed. MAIN OUTCOME MEASURES: The rate of single-surgery anatomic success (SSAS) was the primary outcome. Other outcomes included new RRD in formerly attached eyes, final retinal reattachment, and final visual acuity. RESULTS: One hundred seven eyes with RRDs were included from 78 patients. Fifty-four percent of patients had bilateral RRD or phthisis bulbi in the fellow eye at final follow-up. The most common systemic diagnoses were autism spectrum disorder (35.9%) and trisomy 21 (21.8%) and the most common behavior was face hitting (74.4%). The average follow-up time was 3.3 ± 2.8 years, and surgical outcomes for operable eyes were restricted to patients with at least 3 months of follow-up (81 eyes). Primary initial surgeries were vitrectomy alone (33.3%), primary scleral buckle (SB; 26.9%), and vitrectomy with SB (39.7%), and 5 prophylactic SBs were placed. Twenty-three eyes (21.5%) with RRDs were inoperable. The SSAS was 23.1% without tamponade (37.2% if including silicone oil), and final reattachment was attained in 80% (36.3% without silicone oil tamponade). Funnel-configured RRD (P = 0.006) and the presence of grade C proliferative vitreoretinopathy (P = 0.002) correlated with re-detachment. The use of an SB predicted the final attachment rate during the initial surgery (P = 0.005) or at any surgery (P = 0.008. These associations held if restricting to 64 patients with ≥12 months followup. Anatomic reattachment correlated with better visual acuity (P < 0.001). CONCLUSIONS: RRD resulting from SIB poses therapeutic challenges because of limited patient cooperation, bilateral involvement, chronicity, and ongoing trauma in vulnerable and neglected patients. The surgical success rates were some of the lowest in the modern retinal detachment literature. The use of an SB may result in better outcomes, and visual function can be restored in some patients.