Accuracy of scleral transillumination techniques to identify infant ciliary body for sclerostomy and intravitreal injections

Abstract

Importance There is variation in the literature for sclerotomy and intravitreal injection placement in young children, ranging from 0.5 to 3.0 mm from the limbus. We assess the accuracy of scleral transillumination to identify the ciliary body in infants for safe sclerotomy and intravitreal injections in young children. Background The study compares the perilimbal “dark band” seen on scleral transillumination (STI) with the ultrasound biomicroscopy (UBM), and compares these measurements with the current guidelines for sclerotomy in infants. Design Prospective case series in a tertiary paediatric hospital. Participants Children aged ≤36 months undergoing general anaesthesia for eye procedures. Methods Scleral transillumination was performed to measure the perilimbal dark band. UBM of the ciliary body region was then performed, and correlated with transillumination findings. Main Outcome Measures The midpoints of STI and UBM were compared to current cadaver‐based guidelines to assess the safe point for sclerotomy. Results Twenty children were recruited, 36 STI and 35 UBM measurements were obtained. The posterior edge of the dark band had good correlation with the posterior border of the ciliary body. Transillumination and UBM correlated well for midpoint measurements. The midpoint of the dark band on transillumination was confirmed to be in the ciliary body by UBM in all cases. Conclusions and Relevance The STI technique is a useful and fast technique to demonstrate the ciliary body. The midpoint of the dark band on STI correlates well with the UBM, and has a potential use for confirming safe‐entry into the posterior segment if using current guidelines. The current cadaver‐based paediatric guidelines safely avoid retinal injury.

A systematic review of ultrasound biomicroscopy use in pediatric ophthalmology

“…Neoplastic and uveitic applications (retinoblastoma and toxocariasis, respectively) are the most prominent posterior segment applications of UBM. Additional publications utilizing UBM to evaluate the pediatric posterior segment included correlation of scleral transillumination to UBM images for localization of intravitreal injection or sclerotomy site [77] and evaluation for choroidal detachment in the setting of rhegmatogenous retinal detachment [78].…”

The changing face of the ciliary body in the paediatric population

“…Further modifications developed by Lemley et al based on clinical experience suggested a slightly more posterior approach. Sharma et al, using STI as reported in this issue, identified similar dimensions to Lemley et al The advantage with the Sharma technique is the direct simplified clinical measurement technique independent of growth tables.…”

“…The recommended location for posterior segment sclerostomy placement varies widely in the literature depending on the method used to assess the location for different ages of the child . In this issue, Sharma et al describes a novel technique using scleral transillumination (STI) to accurately identify the ciliary body as the midpoint of the dark band on transillumination. In their study, there was good correlation between the ciliary body identified on ultrasound biomicroscopy (UBM) and STI in all cases.…”

Ciliary body length revisited by anterior segment optical coherence tomography: implications for safe access to the pars plana for intravitreal injections

“…Intravitreal injections are applied through the pars plana of the CB, 3.5–4.0 mm posterior to the limbus [ 3 ]. For children, a distance of 0.5–3.5 mm from the limbus depending on the age is used [ 4 , 5 ]. For this reason, it is important to have a thorough anatomical understanding of the CB and its extent.…”