Vol 12, No 2 (2017)

Articles
THE SELECTED PAGES OF THE HISTORY OF PEDIATRIC OPHTHALMOLOGY IN SAINT PETERSBURG
Brzheskiy V.V., Konikova O.V.
Abstract
The history of pediatric ophthalmology in Saint Petersburg dates back to the opening of the city children’s hospital “in memory of the sacred coronation of their Imperil Majesties” under the patronage of Nikolas II, Emperor of Russia, in 1905. Based at this facility, the Russia’s first department of pediatric ophthalmology was founded in 1935 to be affiliated with Leningrad Pediatric Medical Institute. The department was successively headed by professors V.V. Chirkovsky, L.A. Dymshits, V.I. Grigor’eva, A.I. Gorban’, and E.E. Somov. The present head of the department is professor V.V. Brzheskiy. One more department of pediatric ophthalmology was opened in 1983 based at the Leningrad Institute of Advanced Medical Training. It was successively headed by the associate professor V.V. Kolotov, professors S.S. Saporovsky and R.L. Troyanovsky, E.I. Saidasheva, d-r med. sci. At present, an extensive network of children’s clinics and specialized kindergartens for the children suffering from visual impairment successfully operates in Saint-Petersburg, besides two schools for the blind and visually impaired children, the eye diagnostic centre for the children and adults, and three pediatric ophthalmological hospitals. The city pediatric ophthalmology service is headed by R.V. Ershova. N.N. Sadovnikova is in charge of the Ophthalmological Department of the Clinic of Saint Petersburg State Pediatric Medical University. The Ophthalmological Department of K.A. Raukhfus municipal city hospital No 19 is headed by A.V. Baranov, PhD, and the Department of Eye Microsurgery at the Leningrad regional Children’s Clinical Hospital by O.V. Diskalenko. The present-day clinical, scientific, and educational potential of the Saint-Petersburg pediatric ophthalmological community formed at the base of many-year experience of the preceding generations of physicians continues to further increase which creates conditions for the formulation and successful achievement of the new ambitious goals.
Russian Pediatric Ophthalmology. 2017;12(2):62-72
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“DRY EYE” SYNDROME IN THE CHILDREN: CURRENT POSSIBILITIES FOR DIAGNOSTICS AND TREATMENT (THE GUIDELINES FOR PRACTITIONERS)
Brzheskiy V.V.
Abstract
Purpose. The «dry eye» syndrome in the children occurs much less frequently than in the adults, but it is often diagnosed in the contact lens wearers, the subjects presenting with the computer vision syndrome, and in the children with glaucoma (especially against the background of the instillations of the hypotensive eye drops with a preservative), chronic uveitis, diabetes mellitus, and certain congenital diseases of the eyelids and lacrimal glands. On the one hand, the pathology being considered is very similar in the children and adults in terms of etiology and pathogenesis, but on the other hand, it has a number of peculiar age-related features as regards the clinical course and the modes of treatment of this disease specific for either group of the patients. To begin with, the children very rarely complain about this condition and exhibit the relatively mild objective manifestations of the disorder (xerosis), with the exception of its extremely severe forms. Finally, the specific treatment of the children suffering from the «dry eye» syndrome with the majority of the medications currently available for the purpose is hampered by the age-related limitations whereas they are extensively and successfully used for the treatment of the same condition in the adults. Accordingly, the approaches to diagnostics of the «dry eye» syndrome in the children differ from those in the adults. Specifically, questioning of the children and their parents (to evaluate the complaints and the medical history) is of negligible diagnostic value whereas in the adults this approach provides the most valuable diagnostic information. In addition, it is very difficult to conduct a series of diagnostic tests in the young children due to their restless behavior during the examination. Conclusion. At the same time, there are currently the considerable opportunities for the diagnostics and treatment of the «dry eye» syndrome due to the ready availability of “artificial tear” preparations and stimulators of regeneration as well as the possibility of lacrimal duct obturation. It implies the necessity of the more extensive introduction of these modalities into the pediatric ophthalmological practiced.
Russian Pediatric Ophthalmology. 2017;12(2):73-81
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THE SPECIFIC FEATURES OF FLUORESCEIN ANGIOGRAPHY OF THE RETINA IN THE CHILDREN OF DIFFERENT AGE AND THE POSSIBLE COMPLICATIONS OF ITS APPLICATION
Zaitcev N.A.
Abstract
Purpose. The objective of the present study was the further adaptation of the fluorescence angiography technique for the examination of the children of different ages and the evaluation of the nature, severity, and frequency of complications likely to develop in the course of such examination as a result of intravenous administration of sodium fluorescein and its intake. Material and methods. A total of 957 children at the age varying between 1.5 months and 16 years were divided into two age groups. The first group consisted of 204 (21.3%) children under the age of 1.5 months and up to 5 years including premature babies in whom fluorescence retinal angiography was performed under general anesthesia with the use of the specially developed and improved methodology. The second group was comprised of 753 (78.7%) children at the age between 6 and 16 years. To 649 of these children (86.2%), the dye was injected intravenously whereas to 104 (13.8%) of them sodium fluorescein was given per os. Results. We have developed and further improved the method for fluorescence angiography in the children of various ages including premature infants. The fluorescence angiography of the fundus of the eye in the children at the age from 1.5 months and up to 16 years resulted in the complications of varying severity in 5.2% of the patients. Mild complications in the form of nausea or vomiting accounted for 3.8% of their total number. The moderately severe complications (1.0%) manifested themselves as the development of the collaptoid state or urticaria. The severe complications (0.2%) were apparent as bronchospasm and laryngospasm. No complications whatever were documented in the children after the oral intake of a 10% sodium fluorescein solution. Conclusion. The intravenous fluorescence angiography is a fairly safe method for the examination of the fundus of the eye in the children, however it can be accompanied in rare cases (3.8%) by the complications the majority of which (75%) are mild disorders. Both intravenous administration of sodium fluorescein under general anesthesia and its oral intake can be regarded as safe interventions.
Russian Pediatric Ophthalmology. 2017;12(2):82-86
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THE HISTOLOGICAL STUDY OF THE STRUCTURES OF THE ANTERIOR CHAMBER ANGLE IN THE CHILDREN OF DIFFERENT GESTATIONAL AGE UNDER THE NORMAL CONDITIONS AND IN THE PRESENCE OF CONGENITAL GLAUCOMA
Zertsalova M.A., Fedotova E.P., Brzheskiy V.V., Nasirov R.A.
Abstract
Purpose. The objective of the present study was to obtain and investigate the tissue samples taken from the anterior chamber angle of the children of different gestational age under the normal conditions and in the presence of congenital glaucoma; the secondary objective was to carry out the histological study of the pieces of tissues removed from the glaucoma patients of different gestational age undergoing hypotensive filtration surgery (sinusotrabeculectomy). Materials and methods. The anterior chamber angle histological preparations from a total of five enucleated eyes were available for the intravital investigation of the trabecular meshwork (two of them were obtained from the full-term infants and one from a premature baby). Results. The histological study of the structures of the anterior chamber angle of the enucleated eyes has demonstrated the presence in all the cases of cornea, Descemet’s membrane, trabecular meshwork, Schlemm’s canal, and iris. The morphological structure of the anterior chamber angle associated with congenital glaucoma shows up some peculiar features compared with the normal one, such as its block by the permanent fibrous membrane which penetrates deep into the trabecular meshwork that, in its turn, is formed from the rough and thickened tissue. The histological picture of the fetal eye at different gestational age exhibits the open anterior chamber angle, the well developed porous trabecular meshwork, and fragmentation of Descemet’s membrane near the trabecular meshwork. No signs of fibrous degeneration of the trabecule have been apparent. Conclusion. The intravital investigation of the trabecular meshwork has demonstrated some peculiar features that differ depending on the gestational age in birth. In the full-term babies, it is hypoplastic and covered with the rough fibrous membrane at certain places. Its histological picture is similar to that of the preparations of the enucleated eyes. In the premature babies, the trabecular meshwork is fibrous and characterized by enhanced cellularity; it undergoes fibrous degeneration that becomes apparent after the birth of the premature child (it is supposed to be related to the proliferative processes inherent in such babies).
Russian Pediatric Ophthalmology. 2017;12(2):87-90
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THE CLINICAL AND BIOMECHANICAL CHARACTERISTICS OF THE EYE INJURIES INFLICTED BY “PLASTIC BULLETS” IN THE IN CHILDREN OF DIFFERENT AGE
Kutukov A.Y., Kutukova N.V.
Abstract
Introduction. During the recent years, the overall structure of eye injuries in the children has been characterized by a significant proportion of damages inflicted by “plastic bullets” fired from a toy weapon. Biomechanics of “plastic bullets” syndrome has not been described in sufficient detail. Aim. The purpose of the present study was to determine the force of impact of the plastic bullets on the eyeball and the degree of elevation of intraocular pressure in the injured eyes. Material and methods. A “Chron-1” ballistic chronograph was used throughout the study. Moreover, we designed the original device that allows to make the necessary measurements in the simple and precise manner. Its application enabled us to measure the speed of the plastic bullets covering the distances much greater than it was possible to determine with the help of the ordinary ballistic chronographs. Results. The calculated data were compared with the clinical symptoms of this type of eyeball contusions in 55 children. The inflicted changes in their eyes observed in the experiments proved to be consistent with those apprehended theoretically. Both suggest a very high risk of injury to the eye created by this type of the shooting toys. Conclusion. The proposed measuring system makes it possible to simplify and improve the accuracy of the evaluation of the kinetic energy of the plastic bullets fired from a toy weapon. It has a greater potential for conducting the relevant studies compared with that provided by the standard ballistic chronographs. The results of the present experimental study are in excellent agreement with the clinical observations and give evidence of the very high risk of injury to the eye created by the shooting toys firing “plastic bullets”.
Russian Pediatric Ophthalmology. 2017;12(2):91-96
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THE PREVALENCE OF RETINOPATHY OF PREMATURITY UNDER THE CONDITIONS OF THE PERINATAL CENTER BASED AT THE CHILDREN’S MULTI-DISCIPLINARY HOSPITAL
Sadovnikova N.N., Prisich N.V., Brzheskiy V.V., Olina O.S., Li A.G., Murasheva O.A., Arynova A.T.
Abstract
Introduction. Retinopathy of prematurity remains one of the most challenging problems in neonatal ophthalmology and the leading cause of blindness and disability in the young children. Purpose. The objective of the present study was to evaluate the prevalence of retinopathy of prematurity and the effectiveness of its treatment under the present conditions of nursing the preterm infants. Materials and methods. We carried out the ophthalmological observations and treatment of 393 premature children admitted to the Perinatal Centre of the Saint Petersburg State Pediatric Medical University during the period from 2014 to 2016 for the provision of the specialized care needed to manage various obstetric and perinatal pathological conditions. The patients included the children born with a body weight from 450 to 2500 g (average weight of 1056 ± 301,9 g) at the 23d to 33d weeks of gestation (mean age at birth 28,77 ± 2,37 weeks). Results. The frequency of retinopathy of prematurity and dynamics of its clinical course as well as the need for its laser and surgical treatment in such patients differed during these three years. The number of children with retinopathy of prematurity in the group with the extremely low birth weight increased from 75.0% in 2014 to 96.3% in 2016 largely due to the rise in the occurrence of the early stages of the disease among the preterm infants in combination with severe concomitant cardiosurgical and neurosurgical pathologies. 77.8% of the children in this group needed to be treated with the use of preventive retinal laser photocoagulation. However, only every third infant born at the 28-33d week of gestation actually received the required surgical treatment. The effectiveness of retinal laser photocoagulation increased from 85% in 2014 to 95% in 2016. Conclusion. The management of the preterm children presenting with retinopathy of prematurity based at the perinatal centre with the integrated maternity hospital and the multidisciplinary children’s hospital creates the optimal conditions for the comprehensive treatment of such patients
Russian Pediatric Ophthalmology. 2017;12(2):97-101
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THE ANALYSIS OF THE DEMOGRAPHIC SITUATION AND THE STATE OF THE PERINATAL CARE IN THE ALTAI REGION (PART 1)
Lebedev V.I.
Abstract
Purpose. The objective of the present study was to analyse the demographic situation in the Altai region with special reference to the survival rate among the newborn infants and the influence of neonatal mortality on the demographic characteristics of the population. Material and methods. We undertook the statistical analysis of the Altai region demographic yearbook for the last 11 years (from 2005 to 2016). Results and conclusions. The study has demonstrated the steady decline (between 46% and 43.8%) in the population of the Altai region (mostly in the rural areas) during the period from 2006 to 2016. Despite the decline of the total population, there has been a tendency toward the growth of the children’s population (apparent since 2011) that increased by 28.997 persons. The relatively stable birth rate is associated with the increased number of the premature babies in the neonatal population structure including the infants with the extremely low body weight (from 56 born in 2008 to 88 in 2015). Simultaneously, there has been a significant reduction in the infant mortality rate within the first 168 hours after birth. Conclusion. Optimization of the system for monitoring and treatment of premature infants at risk of retinopathy of prematurity in the Altai region characterized by low population density and non-uniform distribution is the urgent challenging necessity.
Russian Pediatric Ophthalmology. 2017;12(2):102-106
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THE CLINICAL AND GENETIC ASPECTS OF DIFFUSE INFILTRATING RETINOBLASTOMA: A LITERATURE REVIEW AND CLINICAL CASE PRESENTATION
Saakyan S.V., Tsygankov A.Y.
Abstract
Purpose. The objective of the present study was to provide a short review and summarize the available information concerning the main symptoms of diffuse infiltrating retinoblastoma encountered in the ophthalmological practice and compare them with the manifestations of typical retinoblastoma. The secondary objective was to discuss the genetic paradigm of diffuse infiltrating retinoblastoma that is frequently interpreted as a sporadic condition despite the evidence suggesting its genetic predisposition and inheritable etiology that have become increasingly widely recognized during the last years. A literature search for the information about diffuse infiltrating retinoblastoma in the Russian, English, German, and Spanish scientific journals made it possible to reveal a total of 77 patients described in the available literature. In addition, the main specific clinical and gender-related features of diffuse infiltrating retinoblastoma were identified. The results of initial working diagnostics and referral diagnoses are presented with special reference to the importance of the molecular-genetic analysis and the multidisciplinary approach to the treatment and examination of the patients and their relatives. It is concluded that the adequate medical follow-up care needs to be provided in order to diagnose the possible associated cancers. A clinical case of diffuse infiltrative retinoblastoma in a 6-year old male patient is presented.
Russian Pediatric Ophthalmology. 2017;12(2):107-112
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THE CLINICAL CASES OF KERATOCONJUNCTIVITIS ENCOUNTERED IN THE PEDIATRIC PATIENTS PRESENTING WITH ATOPIC DERMATITIS
Panova I.E., Patlasova L.A., Chervonyak L.A., Tagieva E.P.
Abstract
The eye damage in the children presenting with atopic dermatitis is known to occur in 20-40% of the cases. The nonspecific nature of the ophthalmological symptoms of this pathology markedly complicates differential diagnostics and the choice of the pathogenetically-based therapeutic modalities. This article describes the clinical cases that demonstrate the seriousness of this problem and illustrate the necessity of the comprehensive interdisciplinary approach to its solution. It is concluded that the use of the “Restasis” pharmaceutical for the treatment of dry eye syndrome associated with atopic dermatitis in the young patients is justified as contributing to a stable remission of the disorder and producing no undesirable side effects.
Russian Pediatric Ophthalmology. 2017;12(2):113-116
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