Vol 7, No 2 (2012)

The authors undertook the analysis of the effectiveness and the causes behind the failure of various stepwise remedial measures provided for the children presenting with atresia of the nasolacrimal canal. The study included 285 children at the age varying from 2 weeks to 15 years (346 eyes). 235 or 85.6% patients (296 eyes) suffered complications in the form of neonatal dacryocystitis. Lacrimation was completely recovered after probing and bougienage of the nasolacrimal canal (in 93.6% and 45.7% of the cases respectively), after the subsequent bougienage and Ritleng lacrimal intubation with the use of a silicone filament (58.3%), and after dacryocystorhinostomy by the modified method of Taumi (77.8%). All these interventions should be performed for the patients exhibiting the clinical signs of dacryocystitis (taking into consideration their age) in a sequential fashion, after each preceding procedure failed to yield the desired effect. Instillation of antibacterial preparations with a broad spectrum of actions is indicated during the preparation to each next surgical intervention.

The present study included 34 children aged from 4 to 16 years presenting with uveitis associated with rheumatoid diseases, such as juvenile idiopathic arthritis (n = 32) and Behcet’s disease (n = 2). The levels of tumour necrosis factor-alpha (TNF-alpha) in blood sera (BS) and lacrimal fluid (LF) were measured in the patients differing in the activity of the inflammatory processes in the eyes within a period from 4 days to 2 years 9 months after the onset of the treatment with TNF-alpha inhibitors (infliximab and adalimumab). A total of 57 BS samples and 27 LF samples taken from the affected eyes were available for the analysis. Active uveitis was diagnosed in 76.9% of the 26 cases in the absence of TNF-alpha in BS and in 35.5% of the 31 cases at the cytokine levels from 2 to 21 pg/ml (i.e. the two-fold difference, p < 0.01). The analogous results were obtained by the measurement of TNF-alpha in LF. Its absence in LF was associated with the inflammatory process in 84.6% of the 13 cases and 14.3% of the 14 cases at the cytokine level from 2 to 10 pg/ml (p < 0.001). Remission of uveitis was most frequently achieved in the patients having low TNF-alpha concentrations in both fluids. It means that remission of uveitis may be achieved and maintained by the reduction of TNF-alpha concentrations in BP and LF to an optimal minimal level; there is no need to completely suppress its secretion. It is concluded that immunological monitoring facilitates the correction of the treatment and the improvement of the outcome of the disease.

A total of 47 children with uveitis of different localization and etiology were available for the estimation of overall lacrimation and stability of the precorneal lacrimal film. The study demonstrated a high frequency of dry eye syndrome (DES) diagnosed in 85% of the patients suffering the moderately or strongly impaired lacrimation and stability of the precorneal lacrimal film (in 46% and 28% of the cases respectively). The multi-factor character of dry eye syndrome was documented. Its development was shown to be related to the frequency of relapses of uveitis, the presence of a systemic rheumatoid disease, local anti-inflammatory and hypotensive therapy, systemic immunosuppressive treatment, and/or surgical interventions on the anterior parts of the eyes. DES was shown to be associated with the dystrophic changes in the cornea. The necessity of early diagnostics of dry eye syndrome in the patients presenting with uveitis and of prescription of tear replacement therapy is substantiated.

The data concerning the current state of the problem of female alcoholism, the incidence and prevalence of fetal alcohol syndrome (FAS) are overviewed and analysed. The state of the organ of vision was estimated in 22 schoolchildren presenting with fetal alcohol syndrome. The study has demonstrated the high frequency of pathological changes in the eyelids and optic nerve hypoplasia (in 63.6% and 40.9% of the patients respectively).

The objective of the present study was to estimate the efficacy of the modified method for the surgical treatment of recurrent dacryocystitis in the children by probing the nasolacrimal canal with its subsequent filling with a mixture of an antibiotic-containing viscoelastic solution for temporary intubation. A total of 1000 children aged from 3 months to 5 years presenting with recurrent dacryocystitis were treated by this method. As a result, normal lacrimation was recovered in 77% of the children under the age of 3 years. This non-invasive method is easy to operate and does not require the use of any additional special instruments.

Ophthalmological care of newborn infants is a constituent component of the comprehensive neonatal health care program. The adequate organization of its delivery is an important reserve for the reduction of the frequency and severity of visual impairment since the early age leading to children’s disablement. The results of analysis of the current state and drawbacks of the organization of the ophthalmological care in Sankt-Peterburg are presented. It is concluded that the existing comprehensive stepwise system for the provision of diagnostic, therapeutic, and rehabilitative aid to the children with ophthalmological problems starting from the very first days of their life is sufficiently efficacious.

The authors report the results of the experimental evaluation of the efficacy of a new parmaceutical dosage form of derinat eye drops. The study was carried out using the experimental rabbit model of ophthalmoherpes. In the first series of experiments, the therapeutic efficacy of derinat eye drops, 0.25%, was compared with that of 3% zovirax eye ointment. It was shown that derinat produced a well-apparent therapeutic effect comparable with that of zovirax. The clinical efficacy of combined therapy with derinat and zovirax with different intervals between the applications of either preparation was estimated in the 2 nd and 3d series of experiments. It is concluded that it is important to strictly comply with the prescribed intervals (2 hours) between the applications of the tested medications.

The clinical-surgical classification of congenital cataracts has been elaboratedn based on the results of the longterm (up to 25 years) examination and surgical treatment of more than 1000 newborn infants and children at the age varying between 2 weeks and 18 years (1600 eyes). The classification was theoretically validated and verified in clinical practice. The patients were allocated to the three groups based on the type of congenital cataracts: group 1 — zonular cataracts (with preserved normal anatomy of the lens and intermittent opacification of the lenticular substance), group 2 - total cataracts (with preserved normal anatomy and complete opacification of the lens), and group 3 — atypical cataracts (with altered anatomical structure, volume, and shape of the lens and its either complete or irregular opacification). Morphological features of the child’s whole body and congenital cataracts as well as the presence or absence of the accompanying eye pathology and the state of residual vision were used as the basis for the formation of the above three groups. Collectively, these features should be taken into consideration for the choice of the optimal time and the type of surgical intervention for the removal of cataracts (primary intraocular lens (IOL) implantation, preservation of the posterior capsule, etc.). The data obtained are of special importance for the prediction of the outcome of the disease and its treatment.

The authors report a case of a herpetic corneal ulcer complicated by the toxico-allergic eye reaction. At the early stage of the disease, it was interpreted as Acanthamoeba keratitis associated with the wearing of contact lenses. The diagnosis was based on the results of analysis of the clinical picture and course of the disease. It was later confirmed by additional studies and the results of antiviral therapy.