Pediatric retinal surgery: 3 key pearls

J. Peter Campbell, MD, MPH, sat down with David Hutton, Managing Editor, Ophthalmology Times®, to discuss pediatric retina surgery and 3 key pearls to consider while performing the surgery.

Video transcript

Editor’s note: This transcript has been edited for clarity.

David Hutton

Hello, I'm David Hutton of Ophthalmology Times, the Vit-Buckle Society held its annual meeting in Las Vegas, and I'm joined today by Doctor Peter Campbell, who made a presentation titled, Pediatric Retina Surgery Tips, at this year's event. Thank you so much for joining us today. Tell us a little bit about your presentation.

J. Peter Campbell, MD, MPH

Thanks so much, David. It was a real honor to be here and present to the Vit-Buckle Society. It's a lot to cover for pediatric retinal surgery in 7 minutes or less. But I tried to just focus on a couple key pearls that you don't always think about when you move from operating on adults to operating on children.

The first is just understanding what you're looking at. And I titled that "What the heck am I looking at?" And that's because children have very, very different pathologies, sometimes than adults.

The second point is that, you know, in adults, we often focus on rhegmatogenous retinal detachment, but we know that there are, as we learn as residents, 3 types of retinal detachments, rhegmatogenous, tractional, and exudative. You see a lot more variety in children.

And so first is understanding what you're looking at, two is understanding what type of detachment if it's a detachment pathology. And the key pearl there is, you try and keep it at the end of surgery what it was at the beginning. That is, if it's a tractional detachment, you try and avoid having a break, because that makes things more complicated. If it's exudative, you try and treat the exudation and the underlying cause, and you try not to make it rhegmatogenous. So keep the category of disease the same as you started.

And then the last is understanding your limits. There's this tension in pediatric retinal detachment surgery, especially tractional retinal detachment surgery about when to stop. You want to relieve traction, but you again don't want to convert it from a tractional detachment to a rhegmatogenous detachment. I've titled that part "Darned if you do darned if you don't" and there's a lot of learning as you go in terms of how much to do. One of my mentors described it as redirecting a ship away from an iceberg. You want to turn it enough that you can avoid the iceberg, but not so much that you cause other problems.

So I think the last part of the presentation is just knowing your limits and when in doubt, when in doubt stop. And as Tony Capone used to say, "live to fight another day." And so the idea is that in children it's much better to do less than more, whereas in adults sometimes you want the retina to be perfectly flat and beautiful at the end of surgery and pediatric retina it's not always the case.

So knowing what you're looking at, trying to not do too much in your trying to fix the retina and knowing when to walk away are the sort of 3 pearls that tried to leave in in those 7 minutes.