Russian Pediatric Ophthalmology

Clinical examination data of three various ages children with Bloch-Sulzberger syndrome ophthalmic manifestations are presented. It was found that this ocular pathology detects in early postnatal age and manifests with the presence of peripheral retinal avascular zones and retinal vessels changes. The long-term ophthalmic manifestation of the syndrome may have different clinical changes, various clinical and functional outcome that determines the necessity for compulsive ophthalmological examination in the early stages and dispensary observation of children with Bloch-Sulzberger syndrome.

This research was designed to evaluate the efficiency and safety of the orbital and periorbital areas hemangiomas’ combined conservative treatment in 105 infants. Hormone and radiotherapy used in 37 children, 33 children received only radiotherapy, 35 children underwent surgical intervention. The average age was 17,5±6,8 months. Radiotherapy was performed fractionally, single doses varied from 0.3 Gy to 1.7 Gy. Total number of fractions depended on tumor size and its rate of growth, nearly 5-8 per course, total tumor dose ranged from 8 to 12 Gy. It was demonstrated that previous surgical and parasurgical intervention lead to radiotherapy poor starting conditions, treatment prolongation, increase total radiation dose. This study shows a high clinical efficiency of hemangiomas’ combined treatment using radio- and hormonal therapy, good cosmetic effect and reducing of complications incidence. The use of these approaches in hemangiomas’ treatment is characterized by more rapid process completing, which is obviously due to the high radiosensitivity of infantshemangiomas.

20 patients (40 eyes) aged from 5 to 19 years were examined to study the objective and subjective accommodation parameters at its spasm.The control group consisted of 130 patients (260 eyes) with varying degreesmyopia. Habitual accommodative tonus was on average -2,95 D, maximum was 17,37 D. Habitual accommodative tonus in the open field was much lower: -0.49 D. The tonus of accommodative resting position reachedunusually high values: on average-2.58 D and maximum -9.56 D. Objective accommodative response on average was normal, but it had the average of extremely low and inflated values. Typically the objective accommodative response varied considerably in fellow eyes. Thus, in 10% of cases overvalued binocular accommodative response accompanied by a sharp decline of monocular. Objective verification of the accommodative negative part revealed a decreased ability of theciliary muscle inspasm to relax in response to the plus lens.

The purpose of the study was to explore the possibilities of femtosecond laser-assisted anterior lamellar keratoplasty in patients with corneal opacities of various etiology. Materials and Methods. Femtosecond laser-assisted anterior lamellar keratoplasty (FALK) performed in 8 patients (4 males, 4 females) with superficial corneal opacities at the age from 16 to 20 years. Etiology of corneal opacities: in 3 cases - keratitis of unknown etiology, 2 - herpetic keratitis, 2 - burns, 1 - ulcer. Examination technics: visometry, autorefractometry, biomicroscopy, ophthalmoscopy, tonometry, ultrasonic examination, optical coherence tomography of the anterior segment (OCT), confocal microscopy. Results. A year later all patients showed a clear layering graft retention. One year after surgery corrected visual acuity was on average 0.5 (0.2 - 1.0). According to the anterior segment OCT transplant adaptation was complete in all cases and full compliance with corneal transplant and recipient bed was achieved. In all casestransplants were uniform in all quadrants. According to confocal microscopy data we achieved a healthy graft with good density of keratocytes, normal stroma reflectivity, interface hyperreflektivity and several activated keratocytes. The average of endothelial cells density loss for one year after surgery was 1,8 %, what is comparable to the annual loss of endothelial cells as a result of natural involution processes. Therefore, laser radiation does not have an impact on the cornea deep layers during operation. Conclusions. Femtosecond laser application in the anterior lamellar keratoplasty allows to control all sections parameters (size, shape, depth and location), thereby reducing the risk of intra - and postoperative complications. According to the anterior segment OCT data the thickness of layered graft and the recipient bed was the same in all quadrants after surgery, indicating the precision of this surgical method.

This paper presents the structure and diseases of the cornea pathology leading to childhood blindness and visual impairment in different regions of the world. Epidemiology of corneal opacities in children examined in historical perspective, taking into account the socio-economic development of society. In economically developed European countries and America, the main cause of corneal opacities in children are congenital malformations of the eye anterior segment, in developing countries, the leading cause of corneal blindness occupy inflammatory corneal opacity (due to previous infectious keratitis), and eye injuries.

Federal clinical recommendations were approved at the presidium meeting of the All-Russian Organization «Association of ophthalmologists» December 19, 2013