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Vol 14, No 1 (2019)

Clinical studies
Postnatal risk factors of type 1 retinopathy of prematurity in children with a gestational age less than 27 weeks
Saidasheva E.I., Buyanovskaya S.V., Kovshov F.V.
Abstract

Aim: The aim of this study is to determine the prognostic significance of postnatal risk factors for Type 1 retinopathy of prematurity (ROP) in children born before 27 weeks of gestation.

Materials and methods: From 2009 to 2014, we observed 239 patients with gestational age (GA) of 22–26 weeks (average, 24.9 ± 1.0 weeks) and birth weight of 490–1200 g (average, 776.9 ± 140.1 g), who subsequently developed ROP. Depending on the stage of active ROP, the children were divided into four groups: group 1 included 83 children with stage 1 of ROP, group 2 included 70 children with stage 2 of ROP, group 3 included 57 newborns with stage 3 of ROP plus disease (threshold), and group 4 consisted of 29 patients with aggressive posterior ROP. Thus, 86 (36%) children in groups 3 and 4 had an unfavorable course — Type 1 ROP. Screening and monitoring of the disease were performed in accordance with federal clinical guidelines.

Results: The development of severe stages of ROP correlated with a decrease in the mean gestational age (p = 0.0002) and birth weight (p = 0.0006). Fifteen risk factors that are associated with the somatic condition of patients with gestational age less than 27 weeks in the postnatal period were studied. The reliability of their significance in the development of Type 1 ROP was determined by the length of stay on mechanical ventilation (more than 45 days), multiple blood transfusions (more than 6), and early surgical treatment of an open ductus arteriosus.

Conclusion: Consideration and correction of identified postnatal risk factors for the development of Type 1 ROP will enable timely prediction and minimize the likelihood of an adverse course of the disease. Therefore, improving the organization and quality of neonatal care for children with gestational age less than 27 weeks could prevent the development of severe forms of ROP.

Russian Pediatric Ophthalmology. 2019;14(1):5-11
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A comparative analysis of the frequency and severity of active retinopathy of prematurity depending on the degree of maturity of the child for 2009–2011 and 2012–2014 in the neonatal center of St. Petersburg
Saidasheva E.I., Buyanovskaya S.V., Kovshov F.V.
Abstract

Aim: The aim of this retrospective comparative analysis is to compare the frequency and severity of manifestations of retinopathy of prematurity (ROP) depending on the gestational age (GA) of patients in the neonatal center of St. Petersburg for 2009–2011 and 2012–2014.

Materials and methods: From 2009 to 2014, we observed 1801 premature babies at risk for ROP with a GA of 22–32 weeks (average, 28.0 ± 2.1 weeks). Of these, 415 children (23%) were born at the extreme gestational term (GA ≤ 26 weeks). Regarding the period of hospital stay, the studied patients were divided into two groups: group 1 had 785 children with GA of 23–32 weeks (average, 27.9 ± 1.8 weeks) for 2009–2011, and group 2 had 1016 children with GA 22–32 weeks (average, 28 ± 2.3 weeks) for 2012–2014. The screening and monitoring for ROP were performed in accordance with federal clinical guidelines.

Results: The frequency of ROP in deeply premature infants over the years of observation increased by 31.4%, from 42.8% to 74.2%. ROP prevailed in children with GA 22–26 weeks (92%) compared with more mature (GA 27–32 weeks) newborns–(59.2%). Also, the threshold stages of the disease (Type 1 ROP) developed more often among children (28.9%) with GA up to 27 weeks, and only in 7.1% of cases in children with GA 27–32 weeks. In addition, the number of adverse outcomes in children with stages 3–4 ROP was 4.3% and 1.1%, respectively). This indicator was affected by a significant increase (by 11.4%) in the survival of children with GA 22–24 weeks. At the same time, in children with GA 27–32 weeks, this indicator remained stable for six years.

Conclusion: An increase in the survival rate of deeply premature babies with GA of 22–26 weeks was expected to lead not only to an increase in the incidence of ROP, but also to its severe stages (by 12.2%) and, as a result, an increase in the level of visual impairment from early childhood.

Russian Pediatric Ophthalmology. 2019;14(1):12-17
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Possibilities of a differentiated approach to the treatment of congenital and acquired myopia
Tarutta E.P., Markosian G.A., Iomdina E.N., Kruzhkova G.V., Tarasova N.A.
Abstract

Aim: The aim of this investigation is to study the pathogenetic, clinical, and functional differences between congenital and acquired myopia for creating differentiated strategies of treatment and preventing complications in various forms of myopia.

Materials and methods: This study included 377 patients, aged 2.5 to 43 years. It involved performing 120 operations (120 eyes) on 90 patients according to our methods, using a sealant by the Snyder-Thompson method. The observation period was from 3 to 8 years. The ophthalmic examination included visometry, autorefractometry for conditions of cycloplegia, biomicroscopy, ophthalmoscopy, echobiometry, and an examination on the analyzer of biomechanical properties of the eye. The level of cortisol in the serum and the vegetative Kerdo index (KI) were determined according to a known technique.

Results: We have established that the characteristic features of congenital myopia are relatively higher when compared with acquired high myopia, the values of corneal hysteresis (CG), and acoustic sclera density (APS), a less pronounced hormonal imbalance, and a narrower range of vibrations of the KI. Scleral reinforcement surgery sealed the posterior pole and had a 100% stabilizing effect for one year, 95.2% for three years, and 90.5% for six to eight years. A decrease in the frequency of high degree amblyopia was revealed in patients with soft contact lenses (62.8%), with a bioptic correction type of 70%, and in patients with toric MKL (TQCL) by 72%.

Conclusions: The proposed additional diagnostic criteria for congenital and acquired myopia allow the verification of the diagnosis. They should be considered in predicting the course and choosing appropriate treatment strategies for various forms of myopia. The developed technique of scleral reinforcement treatment of complicated high myopia by sealing the posterior pole of the eye with an implant from a biologically active synthetic plastic material that does not undergo biodegradation. This makes it possible to improve the metabolism of the tissues of the posterior pole, stabilize the myopic process effectively, increase visual functions, and inhibit the development of ocular complications. An optimal correctional tactic was developed for increasing visual acuity in patients with congenital nearsightedness above 10.0 Dpt., and myopic astigmatism of medium and high degrees, which consisted of the combination of MKL with spectacular correction of the astigmatic component (bioptics).

Russian Pediatric Ophthalmology. 2019;14(1):18-24
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Risk factors for myopia in preschool and early school age and its prevention
Tarutta E.P., Proskurina O.V., Tarasova N.A., Markosian G.A.
Abstract

Heredity is the most important risk factor for myopia, especially if both parents are nearsighted. Pseudomyopia should also be considered a high-risk factor. Other factors include refraction less than + 0.75 D up to 6 years, emmetropia at the age of 7–10 years, the length of the anterior-posterior axis of the eye more than 23.5 mm, values of relative accommodation resources lower than 1.0 D, an AC/A ratio more than 4 PD/D, and relative peripheral hyperopia. Also, the presence of asymmetry of off-axis refraction, refraction of the nasal half of the eye that is stronger than the temporal half. The influence of these factors on the development of myopia is closely related to the environment, urbanization, level of education, level of fitness, and general health. Disposable risk factors are highlighted, including hypodynamia with a high visual load, and the time spent less than 10 hours a week outdoors. The reliable prevention measures that are recognized include limiting the visual load, perform active outdoor activities for at least 10–14 hours a week, and participate in physical education and some sports. In addition, it is essential to have some form of accommodative training, correction of peripheral hyperopia, and induction of myopic defocus on the periphery of the retina, along with functional treatment and local drug therapy.

Russian Pediatric Ophthalmology. 2019;14(1):25-33
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Clinical recomendations
Main tasks of the follow-up of children with pseudophakia (aphakia) after extraction of congenital cataracts
Kruglova T.B., Katargina L.A., Egiyan N.S., Mamykina A.S.
Abstract

The treatment of children with congenital cataracts is a complex problem. In addition to the surgical stage, a major role is played by a system of rehabilitation measures in the post-operative period that is aimed at obtaining maximal functional results. The presented complex of rehabilitation measures is based on many years of experience treating children with congenital cataracts in Department of Children’s Eye Pathology of Moscow Helmholtz Research Institute of Eye Diseases.

Russian Pediatric Ophthalmology. 2019;14(1):34-40
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