Sex-based differences in retinal detachment in a genotyped Stickler syndrome cohort: implications for preventive management.

Stickler syndrome is a genetically inherited vitreoretinopathy that can lead to retinal detachment from early childhood. There is currently no consensus preventive treatment. We aimed at determining whether sex influences the age of onset of rhegmatogenous retinal detachment (RRD) in COL2A1 and COL11A1 Stickler patients. This is a retrospective study including genotyped Stickler patients from two tertiary centres with at least one RRD. We analysed differences in the age of occurrence of RRD according to sex and genetic mutation. A multivariate analysis was used to analyse risk factors for RRD including sex, presence of preventive treatment, congenital myopia or extra-ophthalmologic conditions. 58 patients with at least one RRD were included. In girls with COL2A1 variants (n=30), the average age of RRD onset was later (21.3 (±14.5) years; range: 5.4-66.0), and the age distribution was broader than in boys with COL2A1 variants (n=19, 10.07 (±5.7) years; range: 0.5-19.7; p<0.0001). Among COL11A1 patients, there was no significant difference in age of RRD between boys and girls. Preventive treatment (360° laser or scleral buckling) was the only independent protective factor for RRD (RR=-0.49 (±0.002); p<0.001). In COL2A1-Stickler syndrome, males tend to experience RRD at an earlier age. In COL11A1-Stickler patients, RRD occurs earlier in life but no sex difference was found. Based on these findings, if preventive treatment is considered, it should be performed before puberty, particularly earlier in boys with COL2A1-related Stickler syndrome and in both male and female patients with COL11A1 variants.