Management of Complicated Vitreoretinal Cases in Children

  • Eric Nudleman
  • Antonio CaponeJr.Email author


Pediatric vitreoretinopathies pose unique challenges to the retinal surgeon because of the distinct anatomic and physiological differences from adult retinal diseases. The pars plana, through which the vitreoretinal instrumentation may be safely introduced, is not fully formed until approximately the age of 8 or 9 months, thereby necessitating entry through the pars plicata when a posterior approach is desired in the newborn eye [17]. The vitreous gel, which is well formed and firm in normal newborn eyes, may be optically empty or abnormally syneretic in various pediatric diseases. The vitreoretinal adhesion is stronger in children than in adults, making the surgical induction of posterior vitreous detachment relatively difficult [19, 44]. The biochemistry of the newborn eye is influx, with rising and falling levels of vascular endothelial growth factor (VEGF), insulin-like growth factor 1, tumor growth factor-b, and other cytokines, which may affect the progression or stabilization of pediatric vitreoretinopathies [10, 47, 54]. To operate safely, the pediatric vitreoretinal surgeon must understand the characteristics that define diseases, such as retinopathy of prematurity (ROP), familial exudative vitreoretinopathy (FEVR), persistent fetal vasculature syndrome (PFVS), congenital x-linked retinoschisis (CXLRS), and Coats disease. Here we discuss key features of the surgical approach to complicated pediatric vitreoretinopathies.


Retinal Detachment Fluorescein Angiography Posterior Vitreous Detachment Stickler Syndrome Avascular Retina 
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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of OphthalmologyShiley Eye Center and Jacobs Retina Center, University of CaliforniaSan DiegoUSA
  2. 2.Department of OphthalmologyOakland University William Beaumont School of Medicine, Associated Retinal ConsultantsRoyal OakUSA

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