Ab Externo Transscleral Removal of Submacular Proliferative Bands in Pediatric Rhegmatogenous Retinal Detachment with PVR: A Surgical Technique Case Series.

PURPOSE: To describe an ab externo surgical technique for submacular band removal in pediatric patients with rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR). METHODS: Ten eyes of 10 pediatric patients diagnosed with RRD and PVR grade C associated with submacular bands. All eyes underwent submacular band removal using an ab externo transscleral approach combined with scleral buckling and 23-gauge pars plana vitrectomy. Preoperative localization of submacular bands was performed using optical coherence tomography and/or B-scan ultrasonography, with intraoperative targeting guided by Resight viewing. RESULTS: Submacular band removal via the ab externo approach was successfully performed in all 10 eyes. The mean patient age was 10.8 ± 3.2 years (range, 5-16 years). Preoperative hypotony (intraocular pressure <6 mmHg) was present in three eyes. Postoperatively, visual acuity improved in four patients, remained stable in four, and worsened in two. No cases of postoperative epiretinal membrane formation or significant subretinal hemorrhage were observed. Retinal reattachment was achieved in 9 of 10 eyes (90%), while one eye progressed to pre-phthisis. CONCLUSIONS: Ab externo submacular band removal appears to be a useful adjunct to pars plana vitrectomy in selected pediatric RRD cases with PVR, allowing relief of submacular traction without the need for retinotomy.