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C.A. Lemley, D.P. Han; 12 Years Experience With Pediatric Pars Plana Vitrectomy Using Morphometric Data to Plan Sclerotomy Site Location . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1469.
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To report a method for planning sclerotomy placement in pediatric patients undergoing pars plana vitrectomy (PPV).
Morphometric data of ciliary body length in various pediatric age groups has been previously reported (Aiello, et al. Arch Ophthalmol. 110:802–805, 1992). These data were used to plan anterior–posterior sclerotomy placement to minimize lens or retinal injury in PPV. Three port PPV was performed in children age 1 month to 18 years. Distance of the sclerotomies from the limbus was 1.5 mm in those age 1 to 6 months, 2.0 mm in those 6 months to 1 year, 2.5 mm in those 1 to 2 years, 3.0 mm in those 2 to 6 years, and 3.5 mm in those 6 to 18 years. These measurements provided approximately 1.5 mm clearance from the ora serrata for the most conservative estimate of ciliary body length for each age group.
Between 1993 and mid 2005, 82 pediatric PPV surgeries were performed using this sclerotomy planning method. 12 children were age 1 to 6 months, 5 were age 6 months to 1 year, 2 were age 1 to 2 years, 13 were age 2 to 6 years, and 50 were age 6 to 18 years. 21 of the 82 surgeries involved pars plana lensectomy or were performed on patients known to be previously aphakic. None of the 82 surgeries were complicated by inadvertent lens trauma. None of the patients had retinal tears, dialyses or detachments due to sclerotomy placement.
Consensus on anterior–posterior placement of sclerotomy sites in children undergoing PPV is ethereal. We have attempted to standardize placement of sclerotomies based on previously reported morphometric data for different pediatric age groups. In our experience, this method has been successful in minimizing both inadvertent lens and retinal trauma during PPV and may provide a standard for future use.
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