Vol 11, No 2 (2016)

Objective. To analyze the results of the surgical treatment of cataract of different etiology in the children and adolescents at the age under 14 years based at the Cheboksary branch of C.N. Fedorov Eye Microsurgery Complex during the past 10 years. Material and methods. We undertook the retrospective comparative analysis of the results of the surgical intervention for the treatment of cataract in the children and adolescents at the age varying between 3 months and 14 years (390 eyes). The majority of the children presenting with post-traumatic cataract were at the age of 4-6 years. The long-term results of surgery were evaluated in 194 children (253 eyes or 65%) during the 6-36 month follow-up period. The presence of cataract was documented in 209 eyes of the patients with congenital cataract (including 92 ones with unilateral and 58 with bilateral cataract respectively). Post-traumatic cataract was documented in 44 eyes. Facoaspiration combined with the implantation of an intraocular lens and without it was performed in in 242 and 11 eyes respectively. The post-operative complications that developed in 79 children required the secondary surgical treatment. Results. The inflammatory reaction during the post-operative period was apparent in the children given the surgical treatment during the first year of life. The visual acuity in the patients with congenital cataract increased to 0.8-1.0 in 12.3% of the cases, to 0.5-0.7 in 49.2% of the cases, and to 0.2-0.4 in 23.1% of the patients. In the children presenting with post-traumatic cataract, the visual activity increased to 0.8-1.0 in 3.7% of the cases, to 0. 5-0.7 in 14.8 in 14.8% of the cases, and to 0.2-0.4 in 33.3% of the patients with this pathology. Conclusion. The removal of cataract with simultaneous implantation of the intraocular lens into the capsular sac is the highly physiological treatment that improves the conditions for the management of amblyopia and makes it possible to increase the number of eyes with improved visual function after the surgical treatment of this pathology. The application of the small-incision technology allows the occurrence of inflammatory reactions during the post-operative period to be reduced.

Objective. The purpose of the present study was to analyze the complications developing as a result of the application of the incorrect strategy of the surgical treatment of the upper lid ptosis. Material and methods. The analysis of the clinical material covers the period of 10 years. A total of 275 patients presenting with the upper lid ptosis underwent the surgical intervention. A separate clinical group consisting of 89 patients (32.4%) was distinguished, each having been previously operated from 1 to 4 times (m = 1.8) either without effect, with a poor effect, or suffering various complications. The age of the patients varied from 3 to 63 (mean 14.7 ± 5.3) years. The children (n = 61) accounted for 68.5% of the total number of the patients. All the patients underwent the surgical treatment consisting of the revision and cutting of the scar, the excision of inadequate “frontalis suspensions”, resection of the levator muscle, and frontalis sling suspension of the upper eyelid to a brow with the use of the mersilen mesh. Results. The analysis of the available clinical materials has demonstrated the following mistakes in the choice of the strategy of the surgical treatment of the upper lid ptosis: (1) Inadequate frontalis sling suspensions in 72.5% of the cases were performed. Nevertheless, the surgery of the suspension type was carried out in 38.3% of the cases of the mild and moderately severe ptosis when the levator function remained intact and sufficient. (2) In the majority of the patients, the technical errors resulting in inadequate “frontalis suspensions” took place, with the suspensions being either mistakenly fixed to the soft tissues of the upper eyelid or rigidly attached to the periosteum of the upper edge of the orbit rather than to the upper tarsal plate. Moreover, 21.4% of the patients presented with the cicatrices at the internal surface of the upper eyelids following frontalis suspension even though the surgical intervention envisaged neither the opening of the conjunctiva nor the resection of the tarsal plate. (3) The inadequate choice of a material for frontalis suspension (strings, rigid tapes, fishing line, and elastics). (4) The large number of repeated surgical interventions during a short period of time. In all the cases, the surgical treatment caused the improvement of the patients’ conditions as appeared from the reduction of the degree of ptosis, the better expression of the crease of the upper eye lid, and lagophthalmia of 1-3 mm. In addition, the mobility of the upper eyelids increased upon the resection of the levator muscle (m = 3.9 mm). In the presence of complications of the previous operations for the resection of the levator, its function also increased (m = 2.3 mm). Conclusion. The majority of the complications have been caused by the incorrect choice of the method for the surgical treatment of the upper lid ptosis which suggests the necessity of the differential approach to the diagnostics and surgical treatment of this pathological condition taking into consideration its cause and severity. Of primary importance is the choice of the treatment by the pathogenetically substantiated method.

The authors report the clinical case of a 15 year-old adolescent patient presenting with orbital dirofilariasis that has been for the long time mistakenly regarded as chronic dacryocystitis.

17 марта 2016 года в конференц-зале ФГБУ «Московский НИИ глазных болезней им. Гельмгольца» Минздрава России прошло первое заседание Школы детского офтальмолога.