Scleral Buckling Surgery in the Treatment of Retinal Detachment in Children – Own Results

The aim of our work was to evaluate the changes of visual acuity to the distance and to the nearest before and after surgery, and during the observation period, the assessment of anatomical length changes of the eyeball , the assessment of the intraocular pressure in the eyes after the procedure, the assessment of changes of the anatomical success to the retina using ultrasound in the projection (B). obtained results were subjected to statistical analysis using the STATISTICA We used the non- parametric Mann- Whitney U- test. Postoperative - panfotocoagulation, in hemorrhagic choroid disconecction, associated with inammation - sinusitis, secondary to uveitis, proliferative diseases - choroidal melanoma, retinoblastoma, lymphomas. Exudative retinal detachment may also occur in the course of hypertensive retinopathy, preeclampsia, eclampsia, leukemia. Treatment of exudative retinal detachment depends on pathomechanism and etiology.

The effect of application of the retina managed to get in 71% of eyes in the test group. 28% of eyes in this group require additional application of laser retinal as a complement to the residual retinal detachment.
So obtained secondary effect of application of retinal eye surgery. While 29% of the eyes needed vitrectomy with vitreoproliferation and in the course of the retinopathy of prematurity.

Conclusion:
Retinal detachment is a very serious ophthalmologic condition that requires rapid surgical intervention.The latitudinal enlacement treatment is a treatment that does not disturb the proper development of the eyeball. The effect of the treatment is not predictable.
The anatomical condition described as the retinal application does not always lead to a functional effect.

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Retinal detachment is a condition in which the retinal nervous system is detached from the functionally layer associated with the choroidal layer, in other words the epithelial epithelium.
The traditional division of retinal detachments is distinguished by three types: rhegmatogenous, traction and exudative. Rhegmatogenous retinal detachment occurs in the world with a frequency of 6.5-18 cases per 100,000 inhabitants.
In children, rhegmatogenous retinal detachment occurs on average at the age of 13 years and more often in boys. (1) According to some reports, it occurs more often in warm months -June or July. It may be related to dehydration of the vitreous body and greater production of free oxygen radicals. (2) The risk factor is accelerated and rapid detachment of the vitreous, which can occur in myopic eyes, after injuries or surgery. Also the eyes with the in ammatory process predispose to retinal detachment.

Patophysiology:
Retinal detachment results from the posterior detachment of the vitreous body as a result of changes in its morphology and as a result of the existence of traction in a place more prone to tear, which facilitates the passage of uid under the retina.
The process of the posterior detachment of the vitreous body, i.e. its liquefaction, is a natural aging process, but in predisposed eyes it may proceed in a pathological way. Premature aging of the vitreous body occurs in myopic eyes or in eyes with an in ammatory process such as uveitis, after injuries or other surgical procedures. Accelerated ow of the vitreous also occurs in the course of general diseases in which there is disturbed metabolism of II type of collagen -Marfan's syndrome, Ehlers-Danlos and Stickler's syndrome. The aging mechanism of the vitreous body is not fully understood. According to various theories, it may start with the gradual degradation of glycosaminoglycans, secondarily it causes a change in interaction with II, IX and XI type of collagen. In addition, the role of free oxygen radicals and metalloproteinase enzymes is important(3).
Retinal photoreceptors are metabolically dependent on pigmented epithelial cells, after losing this contact, they gradually degenerate. These changes occur several hours after the separation of both layers.
According to studies on an animal model, apoptosis of photoreceptors may start as early as 8 hours after the detachment, and 90% of cells die within the rst 3 days. In publications created since 1990, the percentage of primary application ranges from 85% to 90%, and the nal 95%. If the spot before the procedure is applied, the chance of visual acuity above 0.4 is 80%, , if the layer is delaminated the chance is 30%. In the case of traction retinal detachment, the most common cause is proliferative diabetic retinopathy, trauma that frequently penetrates the presence of a foreign body and retinopathy of premature babies. Treatment of traction retinal detachment is usually a vitrectomy procedure through the at part of the ciliary body.

Methods
The aim of our work was to assess changes in visual acuity to distance and nearest vision before and The following were assessed: changes in visual acuity for distance and nearest vision, changes in the length of the anatomical axis of the eyeball, intraocular pressure, con guration of the retina in ultrasonography in B projection before surgery, after surgery and during the observation period.
The obtained results were subjected to statistical analysis using the STATISTICA 13.3 software program. We used the non-parametric Mann-Whitney U-test.

Results
In the examined patients the visual acuity of distant was on average 0.28 on admission. After the surgery, it was on the level of 0.31, and subsequent periods of observation are presented in Table I and Figure 1.
The average value of visual acuity before surgery was 0.3. In the distant observation period 0.4.
In the examined patients the visual acuity of nearest was on average 1,13 on admission. After the surgery, it was on the level of 1,21 and subsequent periods of observation are presented in Table II and Figure 2.
The average value of visual acuity before surgery was 1,0. In the distant observation period 0,6.
The latitudinal cerclage procedure did not cause signi cant changes in intraocular pressure in the eyes assessed.
Observation are presented in Table III and Figure 3.
Another analyzed parameter: change in the length of the anatomical axis of the eyeball before and after the surgery. Observation are presented in Table IV and Figure 4. There were no signi cant changes in the length of the anatomical axis of the eyeballs in the operated children.

Discussion
Retinal reattachment was achieved in 71% of eyes with the studied group. In the case of 28%, additional applications of the retinal laser were required as a complement to residual detachment. A secondary effect of retinal operation of the operated eyes was obtained. However, in 29% of cases, a pars plana vitrectomy was required through the most often in cases with vitreoproliferation and in the course of retinopathy of premature babies.zMany researchers also addressed the subject of analyzing the results of treatment of children after eye cerclage procedure.
Butler and co-authors (7) examined 15 children with an average age of 12.4 years who underwent a latitudinal enlacement treatment. In 40% of children, the detachment was caused by injury, in 15% of children myopia (greater than -6.0), lenghtenedness in 10% of children, in other children, the detachment occurred in the eyes with retinopathy of premature babies. Anatomical retina application was obtained in 86.5% of children -13 children. The average visual acuity after surgery was 0.5, it was 26.6% of children.
in our case, the average visual acuity of operated patients was 0.4.
Read and co-authors (8) analysis an analysis of the results of children operated on due to retinal detachment. There were 206 patients (231 eyes), 25 children had retinal detachment on both sides, which required surgical supply. 67 children had traction retinal detachment (premature babies, PHPV), 51 children of retinal detachment was caused by the aperture (dissection related to chromosome X, myopia), 60 children had retinal detachment due to injury. The best corrected visual acuity achieved by the authors was 0.1. Anatomical retinal application was best achieved in children with hole derivative retinal detachment and it was 78%. In our studies we obtained the effect of the primary retinal application in 71% of eyes.
In the work of Pieczara (9) and co-authors, retinal detachment was mainly caused by blunt injuries (57.1%). In our case, injuries accounted for 39% of retinal detachment. When analyzing surgical techniques, there have been reports on the use of Endo tools during latitudinal cerclage. Jo J (10) and Shanmugam (11) used conventional chandelier's lighting and scleral sclerosis to facilitate banding. As new techniques require re nement and a wider introduction to surgery.
Meier (12) in his work he emphasizes that retinal detachment in children represent a small percentage, it is only 3.2 -6.6% of total detachment. Unfortunately, the percentage of successes, that is, functional and anatomical application are worse than in adults.
It is also worth paying attention to the possibility of retinal detachment in the second eye, it is about 15%. Therefore, it is important to apply preventive treatment -retinal laser retraction, avoiding unnecessary and dangerous efforts.

Conclusions
Retinal detachment is a very serious ophthalmologic condition that requires rapid surgical intervention.
The latitudinal enlacement treatment is a treatment that does not disturb the proper development of the eyeball.
The effect of the treatment is not predictable.
The anatomical condition described as the retinal application does not always lead to a functional effect. All authors con rmed that this manuscript has not been published, either in whole or in part, and is not in press or under review elsewhere. All authors approved the nal manuscript and agreed with its submission to BMC Ophthalmologhy.

Funding
Not applicable.

Availability of data and materials
The data that support the ndings of this study are available on request from the corresponding author DB.

Ethics approval and consent to participate
The study has been approved by the medical ethics committee of the Medical University of Silesia in Katowice. Written informed consent was obtained from the parents of each participant.

Consent for publication
Not applicable. Figure 1 After the surgery, it was on the level of 0.31, and subsequent periods of observation are presented in Table I and Figure 1. Figure 1 After the surgery, it was on the level of 0.31, and subsequent periods of observation are presented in Table I and Figure 1.
Page 11/14 Figure 2 After the surgery, it was on the level of 1,21 and subsequent periods of observation are presented in Table  II and Figure 2.

Figure 2
Page 12/14 After the surgery, it was on the level of 1,21 and subsequent periods of observation are presented in Table  II and Figure 2. Observation are presented in Table III and Figure 3. Observation are presented in Table III and Figure 3.

Figure 4
Another analyzed parameter: change in the length of the anatomical axis of the eyeball before and after the surgery. Observation are presented in Table IV and Figure 4.