PEDIATRIC SURGERY
CLICK ON THE TOPIC
RETINAL DETACHMENT - FAMILIAL EXUDATIVE VITREORETINOPATY (FEVR) - CONGENITAL RETINOSCHISIS - OPTIC PIT/OPTIC NERVE COLOBOMA - CHOROIDAL ANGIOMA - TRAUMATIC MACLAR HOLE - PEDIATRIC VITRORETINAL SURGERY
HAMARTROMA OF THE RETINA AND EPITHELIUM OR PIGMENTED (CHRRPE) - PEDIATRIC CATARACT SURGERY
STRABISM SURGERY - KERATOCONUS SURGERY
PEDIATRIC VITREORETINAL SURGERY
Pediatric vitreoretinal surgery is an ophthalmologic surgical procedure that focuses on the management and treatment of retinal and vitreous disorders in children.
The retina is the light-sensitive tissue located at the back of the eye, while the vitreous is the clear gel that fills the eye socket.
Here are some main aspects of pediatric vitreoretinal surgery:
1. Directions:
- Pediatric vitreoretinal surgery can be performed to treat conditions such as retinopathy of prematurity (ROP), retinal detachment, retinoblastoma (retinal tumor), among other retinal conditions that affect children.
2. Common Procedures:
- Retinal detachment surgery: In case of retinal detachment, the surgeon can use various techniques to put the retina back in place.
- Surgery for retinopathy of prematurity: This procedure may involve removing scar tissue or abnormalities from the retina.
3. Tools and Techniques:
- The surgery involves the use of surgical microscopes, specialized lenses, fiber optics and microsurgical instruments to operate on the retina and vitreous of children.
4. Anesthesia:
- Depending on the procedure and the age of the patient, the surgery can be performed with general or local anesthesia.
5. Risks and Recovery:
- As with any surgery, there are associated risks, and recovery may require time and specialized care.
The decision to perform pediatric vitreoretinal surgery will depend on the child's specific condition and will be made by an ophthalmic surgeon who specializes in pediatric ophthalmology.
Post-operative management and follow-up are essential to monitor treatment response and ensure the patient's long-term well-being.
PEDIATRIC RETINAL DETACHMENT
Retinal detachment can also happen in children, and vitreoretinal surgery is necessary to restore the correct position of the retina and prevent permanent vision loss.
Particular characteristics:
1. Evaluation and Diagnosis:
- It often happens that the child does not report any problems. For the child everything is normal. The diagnosis is often made randomly during a routine visit. Hence the importance of screening visits even when everything seems to be going well.
Retinal detachment in pediatric age usually originates from congenital anomalies or can be of traumatic origin
3. Patient Preparation:
- Your child may receive general anesthesia to ensure comfort during the procedure.
4. Intervention:
- Episcleral surgery is a common part of vitreoretinal surgery and indicates the placement of elements made of silicone or other compatible material on the external wall of the eye called cerclage or plumbage.
Cryotreatment or laser treatment seals the retina to the external wall of the bulb using cold or hot techniques respectively.
Vitrectomy is a common part of vitreoretinal surgery and may involve removing some of the vitreous from the eye to gain better access to the retina. During vitrectomy, microsurgical instruments can be used to perform several useful maneuvers. After vitrectomy, the retina is reattached to the eye wall. This may require special maneuvers and the use of gas, or silicone oil in the eye to keep the retina in the correct position while it heals.
5. Healing and Monitoring:
- After the surgery, the child undergoes a period of recovery and regular monitoring to evaluate the success of the surgery and address any complications.
The surgery aims to restore normal ocular anatomy and preserve vision.
The success of treatment may depend on various factors, including the severity of the detachment and the time elapsed between detachment and medical intervention.
FEVR: FAMILIAL EXUDATIVE VITREORETINOPATY
Familial Exudative Vitreoretinopathy (FEVR) is a hereditary ophthalmological disease that affects the retina and vitreous.
This condition is characterized by an abnormality in the development of blood vessels in the retina, which can lead to problems in normal retinal vasculature.
Here are some key aspects of FEVR:
1. Retinal Vascular Anomaly:
- In FEVR, the blood vessels of the retina develop abnormally, with areas of insufficient or excessive vascularization.
2. Exudation of Liquids:
- The condition can cause fluid and blood to leak from the retina, which can lead to a variety of eye problems, including retinal detachment and the formation of fibrous membranes.
3. Variable Symptoms:
- Symptoms of FEVR can vary greatly from person to person and can include decreased vision, visual distortion or, in severe cases, blindness.
4. Inheritance:
- FEVR is a hereditary disease, which means it can be passed from affected parents to their children.
5. Bilaterality: the disease affects both eyes although often with different severity
- It is important to evaluate both eyes carefully
5. Treatment:
- Treatment of FEVR may include surgical interventions such as vitrectomy (removal of the vitreous) or parasurgical interventions such as cryotreatment or laser treatment
Since FEVR is a hereditary disease, it is important to identify and monitor patients at risk early, especially if there is a family history of the condition.
Management of FEVR often involves regular eye evaluation and involvement of pediatric ophthalmology or retina specialists to tailor treatment to the patient's specific needs.
CONGENITAL RETINOSCHISIS
Congenital retinoschisis is a condition in which a separation of the layers of the retina occurs from birth.
Here are some characteristics of congenital retinoschisis:
1. Presentation from birth:
- The condition is congenital, meaning it is present at birth or develops shortly after.
2. Divergent structure of the retinal layers:
- In retinoschisis, the layers of the retina do not remain well together but separate from each other
3. Variable position and extension:
- The location and extent of retinoschisis can vary greatly between individuals.
4. Manifestations and Symptoms:
- Retinoschisis can cause vitreous hemorrhage and retinal detachment. Therefore symptoms such as reduced vision, visual distortions or blurred vision have different severity depending on the severity and location of the condition.
5. Inheritance:
- In some cases, congenital retinoschisis can be hereditary, although not always.
6. Treatment:
- Treatment of retinoschisis can vary depending on the nature and severity and complications. In some cases, regular monitoring approaches may be recommended, while in other cases parasurgical intervention may be necessary which may be cryotreatment, laser treatment or surgery such as episcleral surgery and/or vitrectomy.
Management of congenital retinoschisis requires careful evaluation by an ophthalmologist who specializes in the management of retinal diseases. Treatment and prognosis will depend on the patient's specific situation.
OPTIC PIT/COLOBOMA OF THE OPTICAL NERVE
Optic pit, also known as optic nerve coloboma, is a congenital malformation of the optic nerve. Coloboma is a condition in which part of the eye tissue, in this case, the optic nerve, does not develop properly during gestation, creating a lack of tissue or a crack.
Here are some characteristics of the optic pit or coloboma of the optic nerve:
1. *Location:*
- Optic pit occurs in the area of the optic nerve, which is the part of the nerve that carries visual information from the retina to the brain.
2. *Appearance:*
- It may appear as a depression or crack in the area of the optic nerve.
3. *Impact on Vision:*
- Optic pit can affect vision, causing a visual defect known as scotoma, which is an area of vision where visual perception is impaired or absent.
4. *Associated with Ocular Anomalies:*
- In some cases, optic pit may be associated with other ocular abnormalities, such as retinal coloboma.
5. *Changes in Clinical Expression:*
- The severity of optic pit can vary greatly between individuals. In some cases, it may not cause significant vision problems, while in other cases it may lead to more severe vision impairment.
6. *Monitoring and Treatment:*
- Management of optic pit often involves regular monitoring by an ophthalmologist to evaluate vision and the evolution of the condition. In some cases, surgery may be necessary, but not all cases require active treatment.
The specific management of optic pit depends on the individual clinical situation, and consultation with an ophthalmology specialist is essential for the evaluation and treatment plan.
AMARTROMA OF THE RETINA AND PIGMENTED EPITHELIUM (CGRRPE)
Hamartoma is a benign tumor formation made up of disorganized tissue that is normally found in a specific part of the body.
Hamartomas can occur in different tissues or organs of the body and can take different shapes depending on the site of development.
One of these is hamartoma of the retina and retinal pigment epithelium. This is a condition in which retinal tissue does not develop normally, leading to a buildup of glial cells in the retina.
Features of retinal hamartoma include:
1. Location:
- It is generally found in the central regions of the retina.
2. Appearance:
- It may appear as a mass of non-functioning tissue, with contractile characteristics, so much so as to induce folds in the retina itself
3. Visual Engagement:
- Retinal hamartomas can vary in their influence on vision. Some may be asymptomatic, while others may cause visual disturbances and image distortion
4. Diagnosis and management:
- The diagnosis of retinal hamartoma is made through examination of the ocular fundus, digital retinography and OCT
- Management may involve regular monitoring to assess any changes in vision or size of the hamartoma and depending on the impairment of the visit, surgical removal via vitrectomy may be indicated.
Vitrectomy can protect against further visual decline and often even lead to improved vision.
It is important to note that the term "hamartoma" can be used in various medical contexts, and its specific meaning can vary depending on the type of tissue involved. Management and clinical impact depend on the location and specific characteristics of the hamartoma.
CHOROIDAL ANGIOMA
Choroidal angioma is a benign tumor in the blood vessels of the choroid, which is the layer of tissue located between the retina and sclera.
Here are some key characteristics of choroidal angioma:
1. Location:
- Choroidal angioma develops in the choroid, which is the vascular region located under the retina in the eye.
2. Type:
- It can present itself in different forms, including localized or diffuse angiomas of different thicknesses.
3. Symptoms:
- The condition can be asymptomatic in many cases and is discovered during a routine eye exam.
- In some patients, it can cause exudate retinal detachment, i.e. due to the passage of serous fluid from the choroid to the subretinal space with consequent even serious visual disturbances.
4. Treatment:
- Management of choroidal angioma depends on the size, location and associated symptoms.
- In some cases, regular monitoring may be sufficient. In others, you may need to consider treatment options such as laser therapy or other procedures such as phtodynamic therapy, micropulsed laser, or surgical subretinal fluid drainage treatments. I described a particular surgical treatment of exudative retinal detachment associated with choroidal angioma (REF).
5. Association with Sturge-Weber Syndrome:
- In some cases, choroidal angioma may be associated with Sturge-Weber syndrome, a condition characterized by vascular malformations in the brain, around the eye, and on the skin.
Management of choroidal angioma requires detailed evaluation by an ophthalmology specialist.
The diagnosis and treatment plan will be tailored to the patient's specific situation and the characteristics of the angioma.
TRAUMATIC MACULAR HOLE
Traumatic macular hole is a full-thickness hole in the macula (center of vision), which occurs following ocular trauma, usually a direct injury to the eye area.
Here are some characteristics of the traumatic macular hole:
1. Cause:
- It is caused by direct trauma to the eye, such as car accidents with contusions, falls, sports activities (tennis ball or soccer and the like) or by phototoxic trauma (laser beam, eclipse, vision of the sun).
2. Location:
- The traumatic macular hole develops in the region of the macula, which is the most sensitive part of the retina.
3. Symptoms:
- The condition causes central vision disturbances, distorted vision, blurring or spots in vision.
4. Diagnosis:
- The diagnosis of a traumatic macular hole is confirmed through ophthalmological tests, such as OCT (optical coherence tomography) and a fundus examination.
5. Treatment:
- Treatment depends on the size and severity of the hole. In some cases, no intervention may be necessary because the traumatic hole tends to resolve spontaneously. In others, surgery may be recommended to close the hole and restore macular function.
Traumatic macular hole is a serious condition that requires the attention of an ophthalmology specialist.
Treatment can significantly influence outcome, and management is individualized based on the patient's specific circumstances.
PEDIATRIC CATARACT SURGERY
Pediatric cataract surgery is a surgical procedure that aims to remove the lens that is cloudy from birth
Here is an overview of how pediatric cataract surgery usually takes place:
1. Preliminary Evaluation:
- Your child undergoes a comprehensive eye evaluation to determine the severity of the cataract and evaluate the overall health of the eye.
2. Anesthesia:
- The procedure is performed under general anesthesia.
3. Engraving:
- A minimal incision is made in the eye to access the lens.
4. Cataract Removal:
- The cloudy lens (cataract) is removed from the eye. In pediatric surgery, it may be necessary to manage the lens material differently than in adults.
5. Replacement of the crystal:
- The cataract is replaced with an intraocular lens (IOL)
6. Self-Sealing Stitches or Incision:
- Depending on the specific procedure, stitches may often be used rather than self-sealing incisions.
7. Recovery and Follow-Up:
- After the operation, the child is monitored by a specialist to ensure correct healing and visual adaptation.
Pediatric cataract surgery requires specific skills and particular attention, considering the differences in the ocular structure and response of children compared to adults.
Post-operative management and regular follow-up are essential to ensure the best possible visual outcome.
STRABISM SURGERY
Pediatric strabismus surgery, also known as strabismus or eye muscle correction surgery, is a surgical procedure that aims to correct the alignment of the eyes in children with strabismus.
Strabismus occurs when the eyes are not aligned correctly and may point in different directions.
Here is an overview of how strabismus surgery usually takes place in pediatrics:
1. Preliminary Evaluation:
- Before surgery, your child undergoes a comprehensive eye evaluation to determine the cause of the strabismus and plan the surgery.
2. Anesthesia:
- The procedure is generally performed under general anesthesia to ensure the child's comfort during the surgery.
3. Regulation of the Eye Muscles:
- During surgery, the surgeon adjusts the length or tension of the eye muscles to realign the eyes into the correct position.
4. Recovery and Follow-Up:
- After surgery, the child is monitored for recovery and may need to follow a visual rehabilitation program with orthoptic visits.
It is important to note that pediatric strabismus surgery does not always completely resolve the problem, and in some cases, additional procedures or treatments may be necessary.
The decision to perform surgery depends on the severity of the strabismus, the underlying cause, and other individual patient factors.
Regular follow-up with a pediatric ophthalmology specialist is essential to evaluate the success of the surgery and make any adjustments or further interventions if necessary.
KERATOCONUS SURGERY
Pediatric keratoconus surgery aims to treat keratoconus, an ocular condition characterized by progressive, conical deformation of the cornea.
This deformity can affect vision and the eye's ability to focus light properly on the retina.
Here are some surgical procedures for pediatric keratoconus:
1. Corneal Cross-Linking (CXL):
- This procedure uses ultraviolet (UVA) light and riboflavin (vitamin B2) to strengthen collagen fibers in the cornea, stabilizing its structure and slowing or stopping the progression of keratoconus.
2. Implantation of Intracorneal Segments (ICRS):
- ICRS are small rings inserted into the cornea to change its shape and improve the focusing of light on the retina.
3. Cornea Transplant (Keratoplasty):
- In more severe cases or when other options are not sufficient, a cornea transplant may be considered. In pediatric keratoconus, transplantation can be more complex, and we often try to postpone this option as long as possible.
4. Intraocular lenses (IOLs):
- In some cases, especially if keratoconus is associated with cataracts, a combined operation may be necessary to address both conditions.
The choice of procedure depends on the severity of keratoconus, the patient's age, and the individual's response to different treatment options.
Management of pediatric keratoconus requires careful evaluation and regular monitoring by a pediatric ophthalmology or corneal specialist.
It is critical to involve parents or guardians in decision-making and post-operative care, as collaboration is crucial to the successful management of keratoconus in children.
EYE CARE CLINIC
CRYSTAL PALACE third floor
Via Cefalonia, 70
24124 - Brescia
Telephone 0302428343
STUDIO DIECIDECIMI
Via Cesare Vivante, 1
95123 - Catania
Telephone 3516449431
