Wright LM, Harper A, Chang EY. Management of Infantile and Childhood Retinopathies: Optimized Pediatric Pars Plana Vitrectomy Sclerotomy Nomogram. Ophthalmol Retina. 2018 Dec;2(12):1227-1234. doi: 10.1016/j.oret.2018.06.008. Epub 2018 Aug 16.
This excellent paper provides important surgical data for retina specialists taking care of pediatric patients. A relatively larger lens size and shorter anatomic pars plana make the pars plana approach more delicate in children.
Drs. Wright, Harper, and Chang intraoperatively measured the location of the anatomic ora serrata using transillumination in 171 eyes of children with congenital and acquired vitreoretinopathies and age-matched controls ranging from post-menstrual age (PMA) 34 weeks to chronologic age 23 years. They found that the distance from the ora serrata to the surgical limbus was greatest in the superior quadrant, followed by the temporal, inferior, and nasal quadrants in all groups.
Practically, one may consider biasing the nasal sclerotomy a bit more anterior and superior than the temporal sclerotomies in younger children, and intravitreal injections may be administered temporally when possible. While the location of the anatomic ora serrata varied between groups (coloboma, persistent fetal vasculature (PFV), Stickler syndrome and/or myopia, and retinopathy of prematurity (ROP), the ora to limbus distance increased in all groups as the children aged.
Generally, children with coloboma and PFV had shorter ora-limbus distances than patients with FEVR or controls, while those with Stickler’s / high myopia had longer ora-limbus distances. For reasons not entirely clear, the authors also found a negative correlation between PMA and ora-limbus distance in patients with ROP.
The authors used this data to create an extremely high-yield nomogram (table below) for optimal pars plana placement of sclerotomies and/or intravitreal injections in children with vitreoretinopathies. While one should still examine and/or measure the ora serrata in pediatric patients to ensure a safe pars plana approach, this paper provides useful data that will help avoid iatrogenic surgical complications.
Edward H. Wood, MD
Assistant Professor of Ophthalmology
Byers Eye Institute at Stanford University School of Medicine
Palo Alto, CA