Vol 12, No 3 (2017)

Articles
GLAUCOMA IN THE CHILDREN PRESENTING WITH STAGES IV AND V OF RETINOPATHY OF PREMATURITY: THE PECULIAR FEATURES OF THE TREATMENT AND OUTCOMES
Konikova O.A., Diskalenko O.V., Gaydar M.V., Brzheskiy V.V.
Abstract
Purpose. The objective of the present work was to study the specific features and the effectiveness of the management of glaucoma in the children presenting with stages IV and V of retinopathy of prematurity after vitreoretinal surgical treatment of retinal detachment. Material and Methods. A total of 172 patients (299 eyes) with stages IVa, IVb, and V of retinopathy of prematurity were involved in the prospective cohort study after they had undergone the vitreoretinal surgical intervention for the treatment of retinal detachment. The duration of the follow-up period was 5 years. The treatment of glaucoma included cyclophotocoagulation and the implantation of the Ahmed glaucoma valve drainage. Results. In the early postoperative period, the anatomical success of the surgical treatment of retinal detachment at stages IVa and IVb of the retinopathy of prematurity was estimated at 95,3% and 97,1% respectively; the frequency of smoothing out of the retina associated with the formation of the retinal reattachment zones at stage V of the disease amounted to 63.6%. The frequency of the development of glaucoma was estimated to be 24,0% at stage IVa, 18,3% at stage IVb, and 9,2% at stage V. The clinical manifestations of glaucoma developing at stage IVa retinopathy of prematurity were especially well apparent in the patients with the congenital disease. The secondary neovascular glaucoma without buphthalmos was usually associated with stages IVb and V of retinopathy of prematurity. The effectiveness of cyclophotocoagulation efficacy was estimated to be 36,4% at stage IVa compared with 50,0% and 57,3% at stages IVb and V respectively. The implantation of the Ahmed glaucoma valve drainage proved efficient in 9 out of the 10 cases; still 77.8% of the patients needed a repeated revision for the evaluation of the state of the Ahmed valve drainage. The study has demonstrated that the overall success of the glaucoma treatment in the children presenting with stages IVa retinopathy of prematurity was 100% compared with 3.5% and 33.3% in those with stages IVb and V of the disease respectively. Conclusion. The glaucoma developing in the children with stages IV and V of retinopathy of prematurity is a refractory neovascular condition especially if it is associated with stages IVb and V of the primary disease.
Russian Pediatric Ophthalmology. 2017;12(3):122-127
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PRENATAL ULTRASONIC DIAGNOSTICS OF ABNORMALITIES OF THE ORGAN OF VISION
Korlyakova M.N., Saidasheva E.I., Voronin D.V.
Abstract
Aim. The objective of the present work was to evaluate the possibilities for the prenatal ultrasonic examination with a view to diagnostics of developmental abnormalities in the organ of vision and its accessory apparatus. Material and methods. A total of 1300 protocols of the comprehensive assessment of the ultrasonic picture of the orbital structures in the fetuses obtained between the 10th and 40th weeks of physiological pregnancy were available for the analysis. The screening of 1045 (80%) fetuses was carried out during the 10th-14th, 20th-24th, and 32nd -34th weeks of pregnancy. The data on 3026 fetuses with the prenatally diagnosed and postnatally verified congenital malformations were analyzed retrospectively for determining the frequency and the structure of the developmental disorders in the organ of vision. Results. The frequency of identification of congenital malformations of the organ of vision by means of prenatal echography of the fetal orbital structures was 0,262 per 1,000 full-term pregnancies. It was shown that the abnormalities in the position of the eyeballs (hypotelorism, hypertelorism, exophthalmos) are possible to diagnose during I and II trimesters of the pregnancy whereas the abnormalities of their size (microphthalmia) and number (anophthalmos, aphakia) are especially well apparent in the second half of the pregnancy; simultaneously, the abnormalities in the structure of the organs of vision (cataract), complicated disorders (cyclopia), and the abnormalties in the lacrimal sac (dacryocystocele) can be diagnosed. The abnormalities of the organ of vision and its accessory apparatus accounted for 2,8% of all congenital malformations. In the overall structure of congenital malformations, the orbital abnormalities most frequently occurred in the combination with the facial malformations (53-75%), nervous system disorders (75-78%), disturbances in the blood circulatory system (38-41%), and the diseases of the locomotor apparatus (43-63%). Conclusion. Prenatal expert ultrasonography performed in the optimal for the screening studies periods of pregnancy provides a highly efficacious (91%) tool for the diagnostics of congenital and hereditary malformations and developmental disorders including pathology of the orbit, eye, and its accessory structures.
Russian Pediatric Ophthalmology. 2017;12(3):128-132
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THE CHARACTERISTIC OF THE MAIN PARAMETERS OF COMPUTED ACCOMMODOGRAPHY FOR THE SCHOOL CHILDREN PRESENTING WITH MYOPIA AND EMMETROPIA
Ershova R.V., Brzheskiy V.V., Sokolov V.O., Kravchenko E.A.
Abstract
Purpose. The objective of the present study was to estimate the possibilities for the application of objective computed accommodometry as a diagnostic tool for the examination of the school children presenting with myopia and emmetropia. Material and methods. 262 (524 eyes) children of 7-17 years were examined using accommodometry. The study involved 184 (368 eyes) children with myopia and 78 (156 eyes) ones with emmetropia. All the patients were examined with the use of the Righton Speedy-K ver. MF-1 autorefractometer. Results. The preliminary analysis of the results of 2321 accommodograms taken in the children presenting with emmetropia and myopia revealed various forms of the accommodation response (balanced, weak, superfluous and labile). The accommodation coefficients was calculated for each patient. Accomodograms suggesting the unbalanced response prevailed among the children with myopia whereas those indicative of the normal accommodation response were more frequently obtained in the children with emmetropia; moreover, the relative number of such accommodograms increased with the age of the patients. The children with myopia showed the enhanced accommodation response manifest as its increased strength in the combination with a rise in its growth intensity and the frequency of microfluctuations. However, both the strength and the intensity of the response decreased with the age in the children suffering progression of myopia. The progress of myopia was accompanied by the further enhancement of microfluctuations and was responsible for the tendency toward instability of the accommodation response whereas stationary short-sightedness was associated with the stronger and more stable accommodation response. The accommodograms suggestive of the weak accommodation response corresponded to the large absolute accommodation volume and reserve of accommodation for far distance vision. High values of the relative accommodation reserve in the children with myopia were associated with the unstable accommodograms and the high frequency of microfluctuations. At the same time, the high values of the relative accommodation reserve in the children presenting with emmetropia are combined with the weak accommodation response. Conclusion. The data obtained by means of objective accommodography allow to extend the existing understanding of the accommodation function in the children with progressive myopia and provide a basis for the recommendation of this technique for a wider application in the clinical practice.
Russian Pediatric Ophthalmology. 2017;12(3):133-138
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ORGANIZATION OF PROVISION OF THE OPHTHALMOLOGICAL CARE FOR THE CHILDREN PRESENTING WITH RETINOPATHY OF PREMATURITY IN THE CHELYABINSK REGION UNDER CONDITIONS OF TRANSITION TO THE INTERNATIONAL CRITERIA FOR LIVE BIRTH
Panova I.E., Kireeva G.N., Chervonyak I.A., Tagieva E.P.
Abstract
Aim. The objective of the present study was to contribute to the improvement of the work of the services providing the ophthalmological care for the children presenting with retinopathy of prematurity in the Chelyabinsk region based on the analysis of the main characteristics of their activities under conditions of transition to the international criteria for live birth. Materials and methods. We have elaborated the model for the organization of the ophthalmological aid to the children comprising the group of enhanced risk of development of retinopathy of prematurity based at a multi-disciplinary pediatric healthcare facility of the Chelyabinsk region. The analysis of its work covered the period of 7 years and included such characteristics as the prevalence of retinopathy of prematurity in the high-risk group with special reference to the severity of this condition, its threshold and terminal stages as well as the frequency of aggressive posterior retinopathy of prematurity. The overall prevalence of retinopathy of prematurity among the children’s population of the Chelyabinsk region during the period from 2009 till 2015 was estimated to amount to 36.4%. The threshold stage of this condition (including its aggressive posterior variant) was shown to have occurred in 26.7% of the examined children. Results. Despite the ever increasing survival rate among the extremely prematurely born infants, the number of the blind patients among those examined in the present study decreased by a factor of 4.5. The advantages of the proposed model for the provision of specialized ophthalmological care for the preterm children include the possibility of parallel monitoring the indicators of ophthalmological and somatic conditions of the children with the participation of the highly skilled physicians, anesthesiologists, and neonatologists. Conclusion. The results of this study can be used to further improve the quality of the screening for retinopathy of prematurity among the preterm infants and the adequate treatment of this condition for preserving vision in a greater number of such patients.
Russian Pediatric Ophthalmology. 2017;12(3):139-144
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THE ROLE OF VARIOUS REGULATORY FACTORS IN PATHOLOGICAL VASOPROLIFERATION IN THE RETINOPATHY OF PREMATURITY
Katargina L.A., Osipova N.A.
Abstract
Retinopathy of prematurity continues to occupy one of the leading positions in the structure of vision disability among the children. The problem of optimizing the prognosis of this condition, its early diagnostics, and adequate treatment remains a serious challenge and is inextricably connected with the better understanding of the pathogenesis of this disease. It is known that the mechanism underlying the development of retinopathy of prematurity involves the imbalance between the angiogenic factors controlling the process of growth and development of blood vessels in the immature retinal tissue in the combination with the biochemical and immunological disturbances of homeostasis in the prematurely born infants as a result of systemic somatic pathology and the unfavourable multifactorial influence of the environmental conditions, in the first place the effect of elevated oxygen concentrations used for the nursing the preterm babies. A large number of papers have been devoted to the study of various factors contributing to the development of retinopathy in preterm patients at the molecular level. For the purpose of the present review, the search for the relevant literature was carried out using the Medline database. The role of the vascular endothelial growth factor (VEGF-A) and insulin-like growth factor-1 (IGF-1) in the development of pathological vasoproliferation associated with retinopathy of prematurity has been most thoroughly explored. Information about the role of VEGF-A in the pathogenesis of the disease provided the basis for the use of anti-VEGF therapy in the clinical practice for the treatment of certain forms of retinopathy. However, the complicated and multifactorial character of the pathogenesis of this disease as well as the need for the enhancement of the effectiveness of its treatment and optimization of the screening procedure dictates the necessity of looking for additional approaches to the solution of this problem and of studying the relationships between various factors involved in the disturbance of retinal angiogenesis in the children presenting with retinopathy of prematurity.
Russian Pediatric Ophthalmology. 2017;12(3):145-152
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THE APPLICATION OF TYPE A BOTULINUM TOXIN FOR THE TREATMENT OF PATIENTS PRESENTING WITH VARIOUS FORMS OF STRABISMUS
Efimova E.L.
Abstract
The use of type A botulinum toxin (BTX-A) for the treatment of strabismus was for the first time proposed in the early 1980s by the American ophthalmologist Alan Scott. The earliest applications of the botulinum toxin in the clinical practice included the treatment of strabismus and blepharospasm. The use of this agent can be particularly useful in the situations where the surgical treatment of strabismus is either undesirable or impracticable for one or another reasons; moreover, injections of BTX-A were successfully used to treat the patients presenting with severe diplopia. The results of the application of the botulinum toxin reported by different authors vary considerably which dictates the necessity of a deeper insight into the mechanisms underlying its action and their further investigation. The commonest complications of therapy with this medication are a temporary ptosis and vertical deviation. The systemic complications of BTX-A application have never been documented; its repeated injections are believed to be safe for the patients.
Russian Pediatric Ophthalmology. 2017;12(3):153-162
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THE CLINICAL CASES OF PALLISTER-KILLIANS’S SYNDROME IN A CHILD
Sudovskaya T.V., Kokoeva N.S., Bobrovskaya Y.A., Makarova A.A.
Abstract
This article was designed to report a clinical case of a rare syndromic disease - Pallister-Killians’s syndrome characterized by the signs of mental deficiency, abnormal features of cranial bones , congenitally reduced arterial pressure, multiple abnormalities of the facial features (including the eyes and the mouth cavity), ears, skeleton, the cardiovascular system, nervous system, and other systems of the body. The syndrome was described for the first time in 1977 by Philip Pallister and thereafter investigated in more detail by Maria Teschler-Nicola and Wolfgang Killian in 1981. In our case, the somatic status of a 3 month-old child presenting with this pathological condition was characterized by a large variety of congenital defects of the nervous system, including corpus collosum hypoxia, ischemic lesions of the brain tissue, bilateral subependymal pseudocysts, lenticulostriate agniopathies, and congenital heart failure. The pathological changes of the visual analyzer manifested themselves as unilateral grade 3 microphthalmos, sclerocornea, optic nerve disk coloboma, narrowing of the palpebral fissure, considerable decrease of the size of the conjunctival cavity in the absence of the appreciable alterations in the eye ball. Rehabilitation of the affected child with congenital microphthalmos included gradual ocular prosthetics and the treatment by the specialists of other medical professions.
Russian Pediatric Ophthalmology. 2017;12(3):163-165
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THE PECULIAR FEATURES OF THE PERFORMANCE AND INTERPRETATION OF THE RESULTS OF THE CONTRAST-ENHANCED X-RAY EXAMINATION OF THE LACRIMAL TRACT IN THE CHILDREN
Berejnova S.G., Tishkova A.P.
Abstract
Introduction. The contrast-enhanced X-ray study makes up an important stage in diagnostics of the pathological changes in the lacrimal pathways carried out after the ophthalmological examination of the patients complaining of lacrimation, lacrimal channel test, and washing of the lacrimal passages. Aim. The objective of the present study was to evaluate the diagnostic value and significance of the contrast-enhanced X-ray study of the lacrimal passages as a component of the algorithm for the examination of the pathologically changed lacrimal tract. Material and methods. The present study included the analysis of the results obtained in the contrast-enhanced X-ray study carried out during the period from 2014 to 2015; a total of 217 patients suffering from tear shedding were involved in the study. We developed indications and contraindications for the application of the technique under consideration. In accordance with the proposed guidelines for the purpose, the adult patients should be examined with the use of the contrast-enhanced X-ray method under local anesthesia and most of the young children under general anesthesia. It is important to wash lacrimal pathways immediately before the contrast administration. All X-ray contrast agents contain iodine; therefore, all the patients need to be preliminarily tested for the presence of allergy to iodine. Visualization is performed in the nasal-frontal, nasal-mental, and lateral projections. The children are examined in the supine position when lying face up. The variants of the normal X-ray picture of the lacrimal pathways that are important to know for the correct interpretation of the data obtained during the examination are described. Normally, the contrast material completely disappears from the lacrimal pathways within a few seconds to 4-7 minutes after its the administration to the patient. Results. The results of the present contrast-enhanced X-ray study that involved 217 patients examined in 2014-201) provide information about the levels of strictures in the lacrimal passages of adults and children. If the tumour is localized in the inferior internal angle of the orbit, the contrast-enhanced X-ray examination of the lacrimal pathways should be preferred because it makes possible the layer by layer assessment of the state of the bony orbital walls, paranasal sinuses, and soft tissue structures; moreover, it allows to follow up the spread of the tumor along the lacrimal tract. Conclusion. The contrast-enhanced X-ray examination of the lacrimal passages provides a powerful tool for the diagnostics of the diseases of the lacrimal pathways. Specifically, it permits to identify the lacrimal tract strictures at the entrance to the lacrimal sac that prove to occur in 29% and 10% of the adult patients and children respectively and to detect the enlargement of the lacrimal sac in 15% of the adults and in 25% of the children. The method is indispensable for the characteristic of the state of the nasolacrimal duct after an injury.
Russian Pediatric Ophthalmology. 2017;12(3):166-169
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VISUAL EVOKED CORTICAL POTENTIALS IN THE CHILDREN PRESENTING WITH CRANIOSYNOSTOSIS. THE DESCRIPTION OF THE CLINICAL CASES AND THE ANALYSES OF THE LITERATURE DATA
Kurenkova N.V., Zolnikova I.V., Klitvina G.A., Demenkova O.N.
Abstract
This article is devoted to the abnormalities of the visual function associated with the rare and severe congenital pathology - craniosynostosis in the hildren. We observed three clinical cases of partial craniosynostosis: scaphocephaly, plagiocephaly, and trigonocephaly. In addition to the standard ophthalmologic examination, we carried out the electrophysiological study to measure visual evoked potentials r (VEP). In the case of trigonocephaly, we documented significant changes in the amplitude-time characteristics of VEP and revealed partial atrophy of the optic nerves. Strabismus was detected in the cases of plagiocephaly and trigonocephaly. We obtained evidence of the association between different types of craniosynostosis and the anatomical features, such as location of the cranial sutures, and the manifestations of the pathological process underlying the changes in VEP especially its amplitude and temporal characteristics. They included the prolonged implicit time of the PI00 component most pronounced in the cells with the angulsar size of 8 minutes and the decrease of the PI00 peak amplitude. The damage to the optic nerves, especially the secondary one, due to the papilledema can be prevented by the early diagnostics of craniosynostosis. When craniosynostosis is suspected in the children, they need to undergo the ophthalmological examination. Early diagnostics with the use of not only the standard methods of ophthalmological studies but also of electrophysiological investigations allows to significantly improve the prognosis in different types of craniosynostosis in the children.
Russian Pediatric Ophthalmology. 2017;12(3):170-176
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