Paediatric retinal detachment:a review

Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments,late diagnosis and bilateral involvement with respect to those which occur in adulthood.Moreover,the anatomical success,when achieved,is frequently not related to a functional recover.Postsurgical adverse events,refractive errors and amblyopia may additionally undermine the final outcome.Up to date there are few reviews regarding the approach of retinal detachment in children,mainly dealing with rhegmatogenous retinal detachment.In this review,rhegmatogenous,retinopathy of prematurityrelated and Coats’-related PRDs were considered.The available literature from the last decades were reviewed and summarized.Epidemiology,etiology and clinical presentation,together with therapeutic approaches and outcomes have been reviewed and discussed.

Induction of oxidative stress in human aqueous and vitreous humors by Nd:YAG laser posterior capsulotomy

AIM： To evaluate whether the Q-switched Nd：YAG laser treatment applied in routine capsulotomy elicits oxidative stress in aqueous and vitreous humors. METHODS： Thirty-six patients who had to undergo a 25 gauge pars plana vitrectomy due to vitreoretinal disorders were enrolled, 15 of them underwent a Q-switched Nd：YAG laser capsulotomy 7 d before vitrectomy due to posterior capsule opacification（PCO）（Nd：YAG laser group） while the remaining 21 patients were not laser treated before vitrectomy（no Nd：YAG laser group）. Samples of the aqueous and vitreous humors were collected during vitrectomy from all patients for the assessment of oxidative parameters which were compared between the Nd：YAG laser group and no Nd：YAG laser group. Thiobarbituric acid reactive substances（TBARS）, a product of membrane lipid peroxidation, nitrite levels, the antioxidative activities of SOD and catalase, the 4-HNE-protein conjugate formation, indicating structural modifications in proteins due to lipoperoxidation, were assessed in aqueous and vitreous samples. RESULTS： In the human vitreous humor TBARS levels are significantly higher in the Nd：YAG laser group compared to the no Nd：YAG laser group and importantly, there is a significant correlation between the TBARS levels and the total energy of Nd：YAG laser used during capsulotomy.Moreover the anti-oxidative activities of SOD and catalase were significantly decreased by Nd：YAG laser treatment, both in aqueous and vitreous humors. In accordance with the TBARS data and anti-oxidative enzyme activities, significantly higher levels of proteins were conjugated with the lipoperoxidation product 4-HNE in the aqueous and vitreous humors in the Nd：YAG laser-treated group in comparison to no Nd：YAG laser group. CONCLUSION： These data, clearly suggest that any change that Q-switched Nd：YAG photo disruption may cause in the aqueous and vitreous compartments, resulting in a higher level of oxidative damage might be of considerable clinical significance particularly by accelerating the aging of the anterior and posterior segments of the eye and by worsening the intraocular pressure, the uveal, the retinal（especially macular） pathologies.