Vol 11, No 4 (2016)

Articles
The results of the implantation of the Ahmed valve drainage devices for the treatment of refractory glaucoma in the children
Ivanova V.F.
Abstract
Purpose. To study and evaluate the safety and the effectiveness of Ahmed valve implantation for the treatment of refractory glaucoma in the children. Materials and methods. The study included 17 patients (18 eyes) at the age varying from 7 months to 15 years who had undergone the implantation of the Ahmed valve drainage devices for the treatment of uncompensated glaucoma. The FP7 and FP8 valve models were implanted into 7 eyes and 11 eyes respectively. Primary implantation was performed in 6 patients (6 eyes) and secondary implantation in 11 ones (12 eyes). The follow-up period after the implantation ranged from 1 months to 6 years (mean 17,7 ± 5,7 months). Results. All the patients presented with the severe forms of refractory glaucoma including multiply corrected (by surgical intervention) uncompensated congenital glaucoma, concomitant glaucoma, and secondary glaucoma. Terminal glaucoma occurred in 7 eyes and far-advanced glaucoma in 9 eyes. The mean intraocular pressure (IOP) before surgery was 32,2 ± 8,3 mm Hg, mean postoperative IOP 17,5 ± 6,3 mm Hg. No intraoperative complications were documented. The postoperative complications in the form of cilio-choroidal detachment developed in 4 children, posterior retraction of the drainage tube, vertical strabismus, and eyeball subatrophy in 1 patient each. The perfectly successful outcome of the operation and compensation of IOP without the additional prescription of the anti-hypertensive drugs were achieved in 12 (70,5%) patients (13 eyes); however, the number of such eyes decreased to 8 or 44,5% within 6 and more months after surgery even though IOP remained compensated due to anti-hypertensive medication. Five (29,5%) children had compensated IOP immediately after surgery as a result of the intake of anti-hypertensive preparations; in two of them IOP was normalized within 6-12 months without prescription of the anti-hypertensive medication. Visual acuity in the end of the observation period remained unaltered in 12 eyes and was improved to 0,02 in 6 eyes upon hand motion near the face due to the reduction of corneal oedema. Conclusion. Despite the small number of the patients included in the present study, the results obtained give evidence that the application of the Ahmed valve drainage devices provides an efficient tool for the reduction of IOP in the children presenting with refractory glaucoma. However, this treatment modality is associated with the risk of serious complications that can be prevented by the choice of the correct indications, the adequate surgical techniques, and the treatment modalities ensuring careful postoperative care.
Russian Pediatric Ophthalmology. 2016;11(4):174-178
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On the problem of the classification of congenital glaucoma
Katargina L.A., Tarasenkov A.O., Mazanova E.V.
Abstract
Objective. To monitor congenital glaucoma and to determine the proportion of the exposed stage of the disease revealed during the initial examination and the long-term follow up. Materials and methods. The present study included 27 children (47 eyes) at the age ranging from 8 to 17 years presenting with various forms of compensated congenital glaucoma at the initial, advanced, and terminal stages of the disease. Results. The clinical and functional characteristics of the eyes at each stage of congenital glaucoma were analyzed during the initial examination and the long-term follow-up period. It was found that the currently universally accepted classification of congenital glaucoma that subdivides the disease into stages based on the structural anatomical changes in the eyes ceases to adequately reflect the objective state of the visual system as the child grows. Conclusion. The study has demonstrated that the stage of congenital glaucoma needs to be corrected in accordance with the age and growth of the child and the possibility of its examination with the use of the psychophysical methods and the evaluation of visual acuity.
Russian Pediatric Ophthalmology. 2016;11(4):179-183
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The comparative analysis of the effectiveness of implantation of toric, spherical and aspherical intraocular lenses for the surgical treatment of congenital cataract
Pershin K.B., Pashinova N.F., Cherkashina A.V., Tsygankov A.Y.
Abstract
Objective. The comparative analysis of the outcomes of the surgical treatment of the children presenting with congenital cataract and astigmatism following the implantation of toric, spherical, and aspherical intraocular lenses (IOLs). Materials and methods. A total of 97 children (127 eyes) presenting with congenital cataract were selected for the present study. Group 1 consisted of the patients suffering from corneal astigmatism of more than 1,0 D who had undergone toric IOLs implantation (25 children, 38 eyes). Group 2 was comprised of the patients with corneal astigmatism of more than 1,0 D who had undergone implantation of spherical and aspherical intraocular lenses (40 children, 48 eyes). Group 3 was composed of 32 children (41 eyes) with corneal astigmatism of less than 1,0 D who had undergone implantation of non-toric intraocular lenses. Lensectomy was performed with the use of the small (1,8 mm and 2,2 mm) incision technique. Various IOL models (Alcon, USA) were used for implantation. The vector analysis of astigmatic correction (Alpinus) was employed to evaluate the quality of astigmatism correction. Results. The patients of all groups experienced a significant improvement of postoperative non-correctable and maximally correctable visual acuity during the long-term follow-up period (over 3 years in duration). In the children comprising group 1, the estimated value of vector astigmatism (-0,72) was close to the actual postoperative value (-0,81). The TIA axis was 113,7 degrees and the SIA axis 92,6 degrees. The vector difference was 0,18 diopters which suggested the high precision of astigmatism correction. The correction index averaged 1,12 ± 0,14. The IOL index was 0,25 ± 0,16 in comparison with its ideal value of 0.0. In the children of group 2, the estimated value of vector astigmatism (-0,87) was significantly higher than the actual postoperative values (-0,56). The TIA axis was 134,3 degrees and the SIA axis 77,1 degrees (p <0,05). Conclusion. The removal of congenital cataract and implantation of toric IOLs for the management of the children presenting with initial astigmatism provides an efficient and safe method for the surgical treatment of this condition. The comparative analysis of the functional results of such approach for the patients of different groups has demonstrated a significantly better correction of astigmatism in the patients treated with the use of implantation of toric intraocular lenses.
Russian Pediatric Ophthalmology. 2016;11(4):184-191
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The results of reconstructive penetrating keratoplasty in the children
Pleskova A.V., Mazanova E.V.
Abstract
Objective. To evaluate the immediate and long-term biological and functional results of reconstructive penetrating keratoplasty (RPKP) in the children. Materials and methods. We undertook a comparative analysis of the outcomes of 86 cases of the surgical intervention on 74 children presenting with corneal opacities of different etiology who had been treated with the application of reconstructive penetrating keratoplasty based at the Department of Eye Pathology in Children, The Helmholtz Moscow Research Institute of Eye Diseases. All operations were made by the same surgeon during the period from 2008 to 2014. The results of reconstructive penetrating keratoplasty were compared with the outcomes of conventional penetrating keratoplasty. The biological results were evaluated in terms of the graft survival (Kaplan-Meir’s) model. The duration of the postoperative follow-up period ranged from 5 months to 8 years and averaged 20,8 ± 9,7 months in the children treated with the use of reconstructive penetrating keratoplasty and to 3,0 ± 15,4 months in the patients treated by means of conventional penetrating keratoplasty. Results. During the early postoperative period (within 1 and 6 months after surgery), the difference in the graft survival rate between the two groups was practically non-existent. After 1 month, the transparency of the transplanted cornea was fairly well preserved in the children of both groups, but persisted for 6 months only in 72% and 95% of the patients treated by reconstructive and conventional penetrating keratoplasty respectively. One year after surgery, the graft survival in the children treated with the use of reconstructive penetrating keratoplasty was documented in 54% of the cases in comparison with 78% in the patients treated by means of conventional penetrating keratoplasty. The difference between the two groups was statistically significant (p < 0,05). Two and three years after surgery, the transparency of the transplanted cornea in the children treated with the use of reconstructive penetrating keratoplasty fell down to 50% and 20% respectively. During the same periods, the transparency of the transplanted cornea in the children treated by means of conventional penetrating keratoplasty remained as high as 76% and 62% respectively. Conclusion. Although the combination of penetrating keratoplasty with other surgical modalities results in the almost three-fold reduction of the probability of engraftment of the transparent corneal transplant in the remote postoperative period in comparison with the standard implantation of the donor cornea transplant, this operation provides the only possibility for the restoration of vision in the children suffering from severe corneal pathology.
Russian Pediatric Ophthalmology. 2016;11(4):192-195
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The influence of the central corneal thickness on the characteristics of the ophthalmic tone in the children presenting with congenital microphthalmia
Sudovskaya T.V., Bobrovskaya Y.A., Makarova A.A., Kokoeva N.S., Veklich Y.O.
Abstract
Objective. To evaluate the influence of the central corneal thickness on the characteristics of the ophthalmic tone in the children presenting with congenital microphthalmia of different severity and to describe its clinical significance for diagnostics of glaucoma and prescription of hypotensive therapy. Materials and methods. A total of 40 children (80 eyes) at the age from 5 to 17 years presenting with congenital microphthalmia of different severity were available for the examination. The children remained under the examination during 10 and more years. They were divided into three groups in terms of severity of microphthalmia. Thirteen children were admitted with the diagnosis of “glaucoma”. The comprehensive ophthalmological examination was supplemented by the measurement of the central corneal thickness. Results. The analysis of the results of the examination gave evidence of the increased central corneal thickness in all the patients with grade 1 - III microphthalmia included in the study. The measurement of the central corneal thickness is important for the establishment of the diagnosis of “glaucoma” because it exerts the direct influence on the characteristics of the ophthalmic tone in the children presenting with congenital microphthalmia. Conclusion. The present study has demonstrated the fairly well apparent relationship between the central corneal thickness, the severity of microphthalmia and intraocular pressure (IOP) in the children presenting with congenital microphthalmia. The higher the severity of microphthalmia the greater the central corneal thickness and the intraocular pressure.
Russian Pediatric Ophthalmology. 2016;11(4):196-199
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Conjunctivitis and dacryocystitis in the children: the clinical characteristic and modern approaches to the treatment
Arestova N.N., Katargina L.A., Yani E.V.
Abstract
Conjunctivitis and dacryocystitis are the most frequent eye diseases in the children, especially in those of the early age. The approaches to its treatment are characterized by a number of peculiarities. Conjunctivitis is most often treated with the use of local medications (including antibacterial, antiviral, and anti-allergic preparations) depending on the etiology of the disease. The modern strategy of antibacterial therapy of conjunctivitis is based on the application of the new antibiotic agents of the quinolone class to which only a small number of the strains of microorganisms exhibit resistance. To enhance the action of such pharmaceutical products, their accelerated administration is required together with the use of long-acting eye medicines and medications possessed of the combined action. The principal treatment modality for the management of dacryocystitis is the surgical restoration of the patency of the lacrimal drainage system by the probing of the lacrimal ducts in the combination with the local antibiotic treatment for the elimination of the inflammatory process in the lacrimal sac and sanation of the entire lacrimal drainage system. The local antibacterial therapy should be prescribed taking into consideration the shifts in the epidemiological spectrum of the bacterial ophthalmic infections in the children that have been documented during the recent years, in the first place the rise in the occurrence of resistant strains associated with the tendency toward the prevalence of the Gram-negative pathogens.
Russian Pediatric Ophthalmology. 2016;11(4):200-206
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The experience with the application of multimodal anesthesia in pediatric ophthalmology for the treatment of the children presenting with retinopathy of prematurity
Korobova L.S., Balashova L.M., Poduskov E.V., Kuznetsova Y.D., Milashchenko T.A., Ovchar R.A.
Abstract
Purpose. The objective of the present study was the comparative evaluation of the effectiveness and adequacy of the regional anesthetic medication as a component of multimodal anesthesia applied in ophthalmological surgery for the treatment of the children presenting with retinopathy of prematurity. Materials and methods. The study included the comparative analysis of anesthetic support in 120 cases of the surgical intervention for the treatment of retinopathy of prematurity in the children at the age varying from 1 month to 1 year. The comparison involved three groups of the patients. The main group was comprised of the children treated with the non-steroidal anti-inflammatory agent paracetamol in the combination with retrobulbar (peribulbar) or infraocular anesthesia and the peripheral van Lint block (14 anesthesias). The control group 1 consisted of the children treated with the narcotic analgesic fentanyl (46 anesthesias) while the control group 2 was composed of the children (n = 60) given inhalation anesthesia with the use of oxygen, nitrous oxide, and sevorane). The principal hemodynamic characteristics including the heart rate, mean, systemic, systolic, and diastolic arterial pressure as well as electrocardiogram, concentration of inhalation anesthetics, capnometry, and the blood oxygenation level were monitored. In addition, the severity of pain and the frequency of apnoea during the postoperative period were evaluated. Results. The application of regional anesthesia with the use of a 0.2% solution of naropin in ophthalmological surgery for the treatment of retinopathy of prematurity in the children ensures strong enough anesthetic effect in the absence of the additional therapeutic interventions that might influence the hemodynamic characteristics and allows to refuse to use narcotic preparations as well as reduce the concentration of inhalation anesthetics. This method improves the course of the postoperative period by virtue of the long-standing anesthetic effect, rapid restoration of consciousness, the absence of postoperative apnoea, reduction of the postoperative starvation time, and the promotion of accelerated rehabilitation of the patients.
Russian Pediatric Ophthalmology. 2016;11(4):207-211
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Anti-VEGF therapy of retinopathy of prematurity
Sadovnikova N.N., Prisich N.V., Brzhesky V.V.
Abstract
Laser photocoagulation of avascular retina remains the standard method for the treatment of retinopathy of prematurity (RP). At the same time, the outcomes of combined multi-stage surgical interventions on the patients presenting with this condition leave much to be desired. In the present review, we have undertaken the analysis of more than 50 articles related to the use of antibodies against the vascular endothelial growth factor (Anti-VEGF) that were published during the period from 2005 to 2015; the analysis included the use of the “off-label” medications as the potentially promising method for the treatment of retinopathy of prematurity. In the overwhelming majority of the studies, the use of anti-VEGF therapy as monotherapy or in the combination with conventional laser photocoagulation has been shown to be efficient for the treatment of stage III+ of the active period of retinopathy of prematurity. One of the important advantages of monotherapy is it does not cause the irreversible destruction of the peripheral retina, in contrast to the action of laser photocoagulation. Moreover, the intravitreal administration of the inhibitors of angiogenesis does not interfere with the growth of blood vessels in the peripheral retina as demonstrated by fluorescein angiography and electroretinography. At the same time, the results of certain published investigations give evidence of the important role played by the vascular endothelial growth factor in the processes of angiogenesis, glomerulogenesis, and alveolarization during the normal lung development. In addition, it has been demonstrated that bevacizumab can migrate from the vitreous body and penetrate into the systemic circulation where it causes the reduction of the serum VEGF levels in the infants presenting with retinopathy of prematurity. In connection with this, the majority of the authors emphasize the necessity of further investigations (based on the results of monitoring the concentration of serum VEGF) for the evaluation of the safety of such medications, their potential long-term effects on other organs and systems in the course of their development as well as possible adverse reactions they are likely to induce. Some problems related to the timing and dosage of the intravitreal administration of the inhibitors of angiogenesis remain a matter of controversy.
Russian Pediatric Ophthalmology. 2016;11(4):212-220
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The inter-regional scientific and practical conference with international participation “Retinopathy of prematurity. Ways to interaction”. Ekaterinburg, 23-24 June 2016
Stepanova E.A.
Abstract
Russian Pediatric Ophthalmology. 2016;11(4):221-223
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The school of pediatric ophthalmology - the work continues
Denisova E.V., Mazanova E.V.
Abstract
Russian Pediatric Ophthalmology. 2016;11(4):224-224
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