Traumatic retinal detachment in patients with self-injurious behavior: an international multicenter study

Abstract Purpose To describe the clinical characteristics, surgical outcomes and management recommendations in patients with traumatic rhegmatogenous retinal detachment (RRD) due to self-injurious behavior (SIB). Design International, multicenter, retrospective, interventional case series. Participants Patients with SIB from 23 centers with RRD in at least one eye. Methods Clinical histories, pre-operative assessment, surgical details, post-operative management, behavioral intervention and follow-up examination 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 A total of 107 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 mean age at presentation was 15.7 ±11.4 years and 73.1% were male. The most common systemic diagnoses related to SIB were autism spectrum disorder (35.9%), trisomy 21 (21.8%), cognitive impairment (12.8%) and cerebral palsy (12.8%). The most common behaviors were face hitting (74.4%), eye rubbing (25.6%) and head banging (16.7%). 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 followup (81 eyes). Primary initial surgeries were vitrectomy alone (33.3%), primary scleral buckle (SB) (25.9%) and vitrectomy with SB (39.7%), and 5 prophylactic SBs were placed. Twenty-three eyes (21.5%) with RRDs were deemed inoperable. The single surgery anatomic success rate (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) predicted RRDs that were more likely to fail reattachment (P=0.04 and P=0.05, respectively, if restricting to the 64 patients with ≥12 months followup). The use of a SB predicted final attachment rate during the initial surgery (P=0.005) or at any surgery (p=0.008; P=0.012 and 0.002, respectively, if restricting to patients with ≥12 months followup). Anatomic reattachment correlated with better visual acuity (P Conclusions RRD from SIB poses therapeutic challenges due to limited patient cooperation, bilateral involvement, chronic RRDs, and ongoing trauma in a vulnerable and neglected patient population. The surgical success rates in this study were some of the lowest in the modern retinal detachment literature. The use of a SB may result in better outcomes, and visual function can be restored in some patients.