Vol 10, No 3 (2015)

Articles
Acquired dacriocystites in the young children: the clinical features, etiology, treatment strategy
Galeeva G.Z., Samoilov A.N.
Abstract
This paper is focused on the characteristics of dacriocystites in the young children with special reference to the causes underlying their development. It substantiates the necessity of different strategies for the treatment of congenital and acquired dacriocystitis in the young children. The most characteristic clinical picture of acquired dacriocystitis is described along with the etiological structure of pathogenic agents and their sensitivity to antibacterial preparations. The most efficacious strategy for the treatment of acquired dacriocystitis in the young children is proposed that includes sanitation of the nasopharynx and therapeutic lavage; it thereby allows to avoid repeated catheterization of lachrymal passages.
Russian Pediatric Ophthalmology. 2015;10(3):5-7
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Do infection and its activation influence the effectiveness of the treatment of uveitis with genetically engineered biological drugs?
Denisova E.V., Katargina L.A., Slepova O.S., Starikova A.V., Lyubimova N.V., Osipova N.A.
Abstract
We analyzed the relationship between infection and its activation on the one hand and the effectiveness of the treatment of uveitis with genetically engineered biological drugs on the other hand. The study included 69 children presenting with endogenous uveitis. The serological markers of chronic and acute infections were detected before and during the period of up to 5 years after the onset of therapy (184 serum samples). It was shown that prior to the prescription of the genetically engineered biological drugs, infection with herpes viruses was documented in 92.6% of the children. Chronic type 1 and 2 herpes simplex infection was confirmed in 55.5% of the patients,cytomegalovirus infection in 63%, and Epstein-Barr virus infection in 88.9%. One or several markers of active infection were identified in 42.1% of the infected subjects. Infection with herpes simplex virus occurred more frequently than that with Epstein-Barr virus or cytomegalovirus (41.7% and 11.1%, and 7.7% respectively). Seropositivity for pathogens was documented only in a few cases, viz. 11.1% of the patients were infected with mycoplasma and 11.1% with ureaplasma, 7.4% with Chlamydophila pneumonia and 3.7% with toxoplasma. Only 7.4% of the children included in the study were totally free from infection with the above pathogens. The patients treated with genetically engineered biological drugs tended to be more frequently infected than before therapy. Specifically, infection with cytomegalovirus increased from 63% to 88.9 and with Epstein-Barr virus from 88.9% to 100%. Moreover, the occurrence of serological markers of activation of herpes simplex virus-1 increased from 22.2% to 44.4% and those of activation of herpes simplex virus-2 from 3.7% to 22.2%. The analysis of seropositivity dynamics separately for different pathogens demonstrated the presence of type 1 and 2 herpes simplex viruses in 10.5% of the patients and cytomegalovirus in 25% of the previously seronegative patients, the markers of activation of herpes simplex virus-1, herpes simplex virus-2, cytomegalovirus, and Epstein-Barr virus appeared in 50%, 18.2%, 5%, and 11.5% of the chronically infected children respectively without their detection. Active uveitis was diagnosed in 62.9% of the children infected with one or several herpes viruses during the period when they showed up infection activation markers and in 73.1% of the children having no such markers. The occurrence of such markers in the uninfected children amounted to 90% (p > 0.05). The results of the present study indicate that the children treated with the genetically engineered biological drugs had both primary herpes virus infection and the newly appearing markers of infection activation which can be attributed to the immunosuppressive action of these preparations. Despite the absence of the clear-cut relationship between uveitis activity and the presence of the above serological markers, the growing seropositivity rate and the frequency of the virus activation markers reflect the potential risk of manifestations of the subclinical infection. It suggests the necessity of its laboratory monitoring and further investigations.
Russian Pediatric Ophthalmology. 2015;10(3):8-11
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The risk factors of uveitis in the children presenting with juvenile idiopathic arthritis
Drozdova E.A., Yadykina E.V.
Abstract
This paper is devoted to the analysis of the risk factors of the development of uveitis in the children presenting with juvenile idiopathic arthritis, i.e. one of the autoimmune inflammatory diseases characterized by the chronic slow clinical course and the development of severe complications leading either to visual impairment or blindness. The authors present a review of the literature with special reference to the uveitis risk factors of interest. The emphasis is laid on the clinical variants of juvenile idiopathic arthritis, genetic factors contributing to the development of this pathology, the antinuclear factor and its relationship with the gender, as well as the role of cytokines in pathogenesis of uveitis concurrently with juvenile idiopathic arthritis
Russian Pediatric Ophthalmology. 2015;10(3):12-15
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The state of the locomotor apparatus in the visually impaired children and adolescents
Egorova T.S.
Abstract
This article was designed to report the results of the examination of the musculoskeletal system in 171 visually impaired children and adolescents at the age from 7 to 18 years with the use of the original equipment including a TODP topographic system and computed optical tomography (COT). The method is based on the projection of the structured images of the spinal column in the form dot matrices, systems of lines and stripes in three planes: frontal, horizontal, and sagittal. The majority of the patients were schoolchildren suffering from high complicated myopia, postoperative aphakia (pseudoaphakia) following the removal of congenital cataract, retinopathy of prematurity, optic nerve atrophy, and tapetoretinal abiotrophy of the retina. It was shown that changes in the spinal column, such as scoliosis, grade 1-2 kyphosis, hyperlordosis, and torsion, as well as flat foot, deformation of the lower extremities and the chest begin to manifest themselves in adolescence, i.e. during the period of the most intense growth in the children. It is concluded that both the means for the enhancement of the resolving power of the eye and the methods for stimulation of the development of the skeletal muscles must be employed in order to improve the posture in the visually impaired schoolchildren. The results of the present study suggest the necessity of regular examination of the locomotor apparatus of the schoolchildren to ensure the timely orthopedic correction of the emerging defects which is especially important during the childhood and adolescence.
Russian Pediatric Ophthalmology. 2015;10(3):16-20
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The specific clinical and functional features of congenital aniridia with a concomitant pathology
Katargina L.A., Mazanova E.V., Tarasenkov A.O.
Abstract
The results of the comprehensive ophthalmological and general somatic examination of 26 children (49 eyes) presenting with congenital aniridia have demonstrated the combination of various pathologies in the anterior and posterior segments of the eye in the majority of the patients (92.3%) including glaucoma (73.0% of the children), congenital cataract (19,2% of the children), corneal opacity (46.1% of the children), hypoplasia of the retina and optic disk (15.3% of the children), and other problems. The characteristic anatomical and functional features of the affected eyes has been revealed along with the disposition of the examined children to developing postoperative complications that need to be taken into consideration for the correct diagnosis and prognosis of a given pathology, the choice of the adequate strategies for the treatment and the long-term follow up of the children presenting with congenital aniridia.
Russian Pediatric Ophthalmology. 2015;10(3):21-23
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The strategy of an ophthalmologist choosing the combined treatment modality for the management of habitual accommodation overstrain based on the analysis of the dynamic colour perception
Kovalevskaya M.A., Bogatyreva E.S.
Abstract
The analysis of colour perception is one of the most informative functional tests for the evaluation of the quality of the treatment. It has demonstrated the improvement of the general clinical and ophthalmological characteristics as well as colour perception in 36 patients of the clinical group 1A. The improvement of the general clinical characteristics after the combined treatment was documented in 32 patients comprising the clinical group 1B. However, the results of the Farnsworth-Munsell 100 Hue (FM-100) test suggest the impairment of colour vision in the latter group, probably due to the application of colour light stimulation in the patients making up this group. Our studies show that the use of colour- and photostimulation may adversely affect the binocular accommodation response and the habitual accommodation tone which exerts the negative effect on dynamics of colour perception as a result of habitual accommodation overstrain. To-day, the problem of refractive errors is at the forefront of pediatric ophthalmology. However, it is not always possible to adequately estimate the functional reserves of the visual analyzer in such patients. The functional tests based on self-analysis, such as FM-100, make it possible to follow up dynamics of the loss of the functional reserves of the retina and the optic nerve associated with different forms of refraction abnormalities and thereby to forecast the possible loss of the visual functions.
Russian Pediatric Ophthalmology. 2015;10(3):24-28
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The experience with the use of pterygo-palatine anesthesia for the osteoplastic interventions in pediatric ophthalmic surgery
Korobova L.S., Poduskov E.V., Legostaeva O.A., Gorbunova E.D., Milashchenko T.A., Erashov M.A.
Abstract
The objective of the present study was to estimate the effectiveness and the adequacy of pterygo-palatine anesthesia for the plastic correction of the inferior orbital wall by means of double-access ophthalmic surgery. The study included the analysis of the anesthesiological support during 46 interventions for the treatment of the orbital injuries in the children aged 13-17 years. The results of the treatment were compared in three groups of the patients. Those in group 1 were given the nonsteroidal anti-inflammatory agent paracetamol and pterygo-palatine anesthesia (14 nacroses). The patients comprising control group 1 were given paracetamol and retrobulbar anesthesia (16 narcoses) whereas the patients of control group 2 were treated with the use of the natcotic analgetic fentanyl (16 narcoses). The following hemodynamic parameters were measured: the heart rate, systolic, diastolic, and mean arterial pressure, and ECG along with the concentrations of the inhaled anesthetics in the blood, the blood oxygenation level, and capnometry. It was shown that the application of regional anesthesia with a 0.75% naropin solution for the purpose of osteoplastic ophthalmic surgery on the children provides sufficiently deep narcosis in the absence of its undesirable effects on the hemodynamic parameters. It makes it possible to avoid the use of narcotic preparations and reduce the concentration of inhaled anesthetics. It is concluded that the proposed method improves the quality of the surgical treatment by reducing hemorrhage in the operative field; moreover, it significantly improves the postoperative period by virtue of long-term pain relief and rapid recovery of consciousness. Taken together, these effects accelerate rehabilitation of the patients.
Russian Pediatric Ophthalmology. 2015;10(3):29-32
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Uveal melanoma in the children and adolescents: the analysis of the original observations of 21 patients
Saakyan S.V., Amiryan A.G., Tsygankov A.Y.
Abstract
This article was designed to report the results of the retrospective analysis of 21 patients (13 boys and 8 girls) at the age varying from 1 to 20 years presenting with uveal melanoma. This group accounted for 1.36% of the total number of primary patients with uveal melanoma treated during the period from 2005 to 2012. The children and adolescents are known to most frequently present with non-pigmented and poorly-pigmented tumours. Morphologically, most of these neoplasms are spindle-cell tumours. It was shown that the majority of the patients with this pathology are referred to the specialized clinical centres at the late stages of the disease due to the absence of its early diagnostics and adequate examination of the children at the local ophthalmological facilities.
Russian Pediatric Ophthalmology. 2015;10(3):33-36
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The specific clinical features of the changes in the organ of sight of the children presenting with the perinatal lesion of the central nervous system
Khamraeva L.S., Usmanova E.A., Bobokha L.Y.
Abstract
The results of the study of 50 patients at the age varying from 10 days to 8 years presenting with perinatal pathology of the central nervous system are presented. All the patients underwent ophthalmological, clinical, laboratory, and instrumental examinations with the participation of the highly specialized doctors. The clinical peculiarities of the following conditions in the organ of sight associated with perinatal pathology of the central nervous system were investigated: glaucoma in 17 (34%) children, cataract in 15 (30%) children, optic disk atrophy in 8 (16%) children, pathology of the accessory visual structures (primary strabismus) in 4 (8%) children, hypoplasia of the optic disk in 3 (6%) children, and retinal angiopathy in 3 (6%) children. Moreover, nystagmus and secondary strabismus were diagnosed in 11 (22%) children in combination with some of the aforementioned conditions. The analysis of the results of neurosonography (NSG) revealed hypoxic-ischemic disorders with the enhanced pulsation in the cerebral blood vessels and dilatation of the ventricles in 10 (72%) children presenting with congenital glaucoma, in 3 (21%) children with congenital cataract, and in 1 (7%) patient with nasolacrimal canal stenosis. The electroencephalographic study has demonstrated the hyperactivity of the subcortical brain structures in 6 (12%) children with pathology of the fundus of the eye and strabismus associated with juvenile cerebral palsy and the consequences of the birth trauma. The following perinatal risk factors of the development of the above ophthalmological pathologies were identified: iron deficiency anemia in 23 (46%) cases, early toxicosis of pregnancy in 17 (34%) cases, and acute respiratory infections in 13 (26%) cases.
Russian Pediatric Ophthalmology. 2015;10(3):37-40
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The laser-assisted treatment of iris flocculi in the children
Arestova N.N., Katargina L.A., Kalinichenko R.V.
Abstract
The authors describe two cases of papillary margin flocculi in the children and the results of their successful laser-assisted treatment. It was shown that papillary margin flocculi can obstruct the area of the pupil and thereby cause obscurity and visual impairment in the children. The application of a YAG-laser for the drainage and destruction of papillary margin flocculi measuring up to 4-6 mm makes it possible to significantly reduce the size of the flocculi. Elimination of their protrusion into the pupil area clears the optically significant region and thereby improves visual acuity without a surgical intervention and the related complications.
Russian Pediatric Ophthalmology. 2015;10(3):41-43
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Lochmann’s syndrome in the child. A case report
Sudovskaya T.V., Bobrovskaya Y.A., Kokoeva N.S.
Abstract
The authors report a clinical case of the rare syndromic disease, oculo-dento-digital dysplasia, described for the first time by W. Lochmann in 1920 and currently known as Lochmann’s syndrome. The patient was a two-month old child with this condition whose somatic status was characterized by multiple malformations including bilateral syndactilism of II-III toes, foot tetradactilia, deformation of fingers, congenital heart disorder (with the functioning oval window and the chord in the left ventricular cavity), and hypoxic lesion of the central nervous system. The pathological changes in the visual analyzer manifested themselves in the form of bilateral anophthalmos, the underdevelopment of the eyelids, the abnormal growth of the eyelashes, the absence of the upper eyelid folds, the marked shortening and narrowing of the eye slits, and the significant reduction of the size of the conjunctival cavity. Rehabilitation of this patient consisted of stepwise ocular prosthetics and the treatment by the specialists in the related disciplines
Russian Pediatric Ophthalmology. 2015;10(3):44-45
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Epidemiology and survival of the children aged 0-14 years presenting with malignant neoplasms of the eye and its adnexa in Sankt-Peterburg
Merabishvili V.M., Punanov Y.A., Demin E.V., Merabishvili E.N., Vorob’eva L.A.
Abstract
Up to 1989, the state statistical reporting in Russia did not envisage a registration of primary cases of malignant neoplasms among the children taking account of their age and sex as well as the localization of the tumours. Only since 2011, thanks to our proposal, malignant neoplasms of the eye and its adnexa became to be indicated in a separate line in the state reporting form No 7 “Information about malignant tumour morbidity”. The present publication reports for the first time in this country the selected results of the estimation of the prevalence of malignant neoplasms of the eye among the children in Russia averaged over the country’s population and extracted from the first Russian population-based cancer registry of Sankt-Peterburg functioning in accordance with the international standards. The formation of the cancer control information system including pediatric oncology is currently underway. Many specialized institutions of this country, both local and federal, provide only incomplete relevant information to the territorial cancer registries which accounts for the substantial underestimation of primary cases of malignant tumours among the children. The establishment of children’s cancer registries in the Federal districts would significantly reduce the underestimation of the primary cases of malignant tumours among the children and markedly improve the accuracy of information contained in the registration cards. The authors present for the first time the data on five-year survival of the children aged 0 - 14 years presenting with malignant neoplasms of the eye and its accessory visual apparatus taking into consideration the age and sex of the patients as well as the histological structure of the tumours at the population level over a long observation period.
Russian Pediatric Ophthalmology. 2015;10(3):46-49
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Federal clinical recommendations "Diagnostics, monitoring and treatment of the children with congenital cataract"
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Abstract
Russian Pediatric Ophthalmology. 2015;10(3):50-56
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