Anterior segment examination in paediatric patients: the closed probe system

The anterior segment examination with the use of immersion shells has always required general anesthesia or deep sedation in very young children. The purpose of this paper is to describe a new examination technique that uses a closable standoff screwed to high frequency transducer to examine the anterior segment of pediatric patients with no sedation or anesthesia. A 35-MHz probe (nominal frequency) was screwed into an open plastic cylinder closed by a biocompatible changeable Mylar film and filled with distilled water (Hiscan, Optikon, Rome, Italy). A total of 33 pediatric patients (min 1 month; max 192 months; mean 71.30; median 63; SD +/- 56.53) were examined with this system for the following pathologies: vitreoretinal problems (n=8), congenital cataract (n=7), cysts at different sites (n=4), uveitis (n=3), congenital glaucoma (n=3), traumatized eyes (n=3), retinoblastoma (n=2), retinopathy of prematurity (n=2) and bilateral corneal congenital opacity (n=1). The probe was used both in contact with the lid skin in the very young or over the conjunctiva after topical anesthesia. Although many artifacts exist due to the free eye movements and Mylar membrane duplication artifacts, all images clearly depicted normal anatomy and pathologic findings, especially the iris, ciliary body and ciliary processes. The use of movie recording (8 images per second) helps reduce the examination time and is of great help if after-movements are to be shown. With the present technique, the examinations may be repeated more frequently with no problems.