Vol 11, No 2 (2016)

Articles
The factors responsible for impairment of vision and the algorithm for the regular medical check-up of the patients following retinopathy of prematurity
Kogoleva L.V., Katargina L.A.
Abstract
Objective. To develop the algorithm for the regular medical check-up of the patients following retinopathy of prematurity based on the investigation of the main factors responsible for the impairment of vision in the patients presenting with this pathology. Material and methods. A total of 655 patients (1307 eyes) at the age varying from 4 to 18 years with cicatrical retinopathy of prematurity were available for the examination, The standard methods employed for the ophthalmological examination were supplemented by optical coherent tomography, retinal tomography, registration of different kinds of electroretinograms, multichannel visual evoked potentials, computed perimetry, evaluation of spatial contrast sensitivity. Results. It was shown that the main factors responsible for the impairment of vision in the patients presenting with retinopathy of prematurity are the following ones: (1) the degree of residual changes in the fundus at the cicatrical stage of retinopathy of prematurity, (2) late complications, (3) the concomitant pathology of the conduction pathways and higher portions of the visual analyzer, (4) concomitant eye pathology, (5) refractive and oculomotor disorders, (6) functional incompetence of the retina due to prematurity and/or the consequences of retinopathy of prematurity suffered in the past. Conclusion. The organization of the regular medical check-up of the patients following retinopathy of prematurity implies the necessity of the comprehensive clinical and functional examination throughout the entire lifespan of the subjects with this pathology for the purpose of timely identification and correction of the revealed disorders.
Russian Pediatric Ophthalmology. 2016;11(2):70-76
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The results of the treatment of cataract in the children and adolescents at the age under 14 years
Pashtaev N.P., Pozdeyeva N.A., Bat'kov E.N., Lukin V.P., Tolmacheva T.G., Nikitin V.P., Tikhonova O.I., Shipunov A.A., Mikhailov N.O.
Abstract
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.
Russian Pediatric Ophthalmology. 2016;11(2):77-81
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The influence of constant slight myopic defocus prescribed in the binocular and alternating monocular spectacle formats on the onset and progression of myopia in the children
Tarutta E.P., Khodzhabekyan N.V., Filinova O.B., Milash S.V., Kruzhkova G.V.
Abstract
Objective. To elucidate the long-term influence of constant slight myopic defocus prescribed in the binocular and the alternating monocular spectacle formats on the dynamics of refraction and its components in the children. Material and methods. The study involved 129 children (258 eyes) at the age varying from 5 to 12 years. The patients were divided into four groups. Group 1 was comprised of 48 children at the age of 5-8 years presenting with emmetropia and risk factors of the development of myopia. Group 2 consisted of 46 children at the age from 7 to 11 years with slight myopia between -0.75 and -2.25 D to whom the alternating continuous wearing of two pairs of spectacles was prescribed. The first control group was composed of 15 children (30 eyes) at the age from 6 to 9 (mean 7.5 ± 1.4) years presenting with pseudomyopia without correction. The second control group was comprised of 20 children (40 eyes) at the age from 7 to 12 (mean 9.7 ± 1.2) years having slight myopia and wearing conventional spectacle correction. Results. The children of group 1subjected to constant slight myopic defocus during one month experienced a shift of refraction toward hypermetropia attributable to the thinning of the lens and deepening of the anterior chamber. None of the children in this group developed myopia during the follow-up period of up to 9 years. In the patients of group 2, refraction remained unaltered during either 4 years (81.8% of the cases) or 7 years (66.6% of the cases). An insignificant increase in the length of the antero-posterior axis was documented in these children along with the significant increase of the horizontal diameter (HD) of the eyeball. The dynamic observation of the children of both control groups during 3 years has demonstrated the strengthening of cycloplegic refraction associated with the significant increase of the length of the antero-posterior axis and the insignificant increase of the transverse diameter of the eyeball. Conclusion. The permanent slight myopic defocusing of the image in the binocular spectacle format slows down the growth of the eyes and the shift of refraction toward myopia in the children with mild hypermetropia, emmetropia, and slight myopia. The proposed method for alternating monolateral constant slight myopic defocus inhibits progression of myopia in 81.8% of the children presenting with mild myopia during 4 years and in 66.6% of them during 7 years.
Russian Pediatric Ophthalmology. 2016;11(2):82-88
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The analysis of complications due to the erroneous strategy of the surgical treatment of the upper lid ptosis
Filatova I.A., Shemetov S.A.
Abstract
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.
Russian Pediatric Ophthalmology. 2016;11(2):89-92
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Binocular diplopia: the diagnostics and treatment
Aklaeva N.A.
Abstract
Binocular diplopia is a complex form of oculomotor pathology. The present article describes the modern approaches to the diagnostics of this condition and its combined treatment including both functional and surgical methods as well as prismatic correction. The proposed scheme for the management of binocular diplopia makes it possible to achieve the significant improvement of the major functional characteristics and to markedly enhance the quality of life of the patients with this pathology.
Russian Pediatric Ophthalmology. 2016;11(2):93-98
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The clinical case of orbital dirofilariasis in an adolescent patient
Revta A.M., Shabalina N.A., Bebyakova N.A., Poslavskaya T.N., Kalinina L.P.
Abstract
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.
Russian Pediatric Ophthalmology. 2016;11(2):99-101
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The federal clinical guidelines on “The diagnostics and treatment of uveitis associated with juvenile idiopathic arthritis”
Katargina L.A., Brzheskiy V.V., Guseva M.R., Denisova E.V., Drozdova E.A., Zhukova O.V., Nikishina I.P., Starikova A.V.
Abstract
Federal clinical recommendations were approved at the presidium meeting of the All Russian Organization “Association of ophthalmologists” 24.09.2015
Russian Pediatric Ophthalmology. 2016;11(2):102-111
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The school for pediatric ophthalmologists
Denisova E.V.
Abstract
17 марта 2016 года в конференц-зале ФГБУ «Московский НИИ глазных болезней им. Гельмгольца» Минздрава России прошло первое заседание Школы детского офтальмолога.
Russian Pediatric Ophthalmology. 2016;11(2):112-112
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