Vol 12, No 3 (2017)

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.

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.

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.

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.