Pediatric Patients

386

41 Pediatric Patients

Table 41.2 The pediatric eye and the VR surgeon

Variable

Comment

Examination of both person and

Doubt history – try to find a witness in case of trauma

eyeball more difficult

Discard the white lab coat

Consider restraining the unruly/restless child for examination

or use short-acting narcosis

Amblyopia – timing of

The eye typically reaches full vision capability by age 5

intervention

years; in those under ~8 years lack of a sharp imagea leads

to deprivation amblyopia

This gives extra urgency to treating young children with a

condition that would be less urgent in older children and

adults

Healing-capacity and tolerance

Ciliary body damage that would lead to hypotony or phthisis

toward abnormalities higher

in adults may spare the child of both

Postoperative inflammation

This is true in all, but especially in heavily pigmented eyes.

heavier, fibrin reaction more

Stronger-than-normal anti-inflammatory treatment is

common

indicated

Both the orbit and the eyeball

Intraocular access is more difficult than in (most) adults. The

are small

surgeon may be limited in his choice of the lid speculum

(see Chap. 19)

Cornea: less rigid

Sutures get loose faster and require removal earlier than in

adults

Lens: anterior capsule thinner

Capsulorhexis more difficult; scissors are often needed in

eyes with capsular scarring

Lens: zonules stronger

If the posterior capsule needs to be removed, the zonules

must be severed, not torn (see Sect. 38.5.2), and an

anterior vitrectomy (see below) must always precede the

capsule removal

Lens: swelling

If the capsule is broken, the swelling may occur rapidly, and

lead to very high IOP

Lens: cataract removal

Posterior capsulectomy and anterior vitrectomy should

always be performed

Lens: nucleus soft

Aspiration is sufficient to remove it

Lens: IOL implantation

The age cut-offb is controversial

Difficult to predict the IOL power

Pars plana: more anterior

See Table 40.1

Vitreous: more adherent to

If the posterior capsule needs to be removed, a judicious

posterior lens capsule

anterior vitrectomy must precede it

Vitreous: more adherent to

It may be dangerous or even impossible to create a PVD;

posterior retina

consider using ocriplasminc

ILM peeling

It is technically more difficult and may be impossible to

complete

PVR

The risk is higher; the pathology is more aggressive, presents

earlier, and recurs more often. A child is many times more

likely than an adult to lose vision if PVR occurs

Often the ciliary body is also involved, with a much higher

risk of phthisis development