Russian Pediatric Ophthalmology

Few studies have analyzed choroidal neovascularization (CNV) in children because of the low incidence of this complication in pediatric ophthalmology. However, given the significant effect on visual acuity and diagnostic difficulties in children, the study of this complication is relevant.

AIM: This study aimed to analyze the etiological structure and clinical features of CNV in children.

MATERIAL AND METHODS: From 2014 to 2022, 61 eyes of 54 children (26 girls and 28 boys) had CNV. The patients underwent standard ophthalmologic examination and optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular zone and optic disc using the RS-3000 Advance 2 Tomograph (Nidek, Japan).

RESULTS: At the time of CNV diagnosis, the children were 5–17 years old, with a mean of 11±3 years. In 30 children (55.6%), CNV was caused by inflammatory lesions of the retina and choroid. Of these cases, 11 occurred during remission, whereas 21 occurred alongside pathologies of the retina, choroid, and optic nerve of noninflammatory genesis (8 of which were associated with Best’s disease). In three children, CNV was considered idiopathic. The development time of postinflammatory CNV ranged from 1 month to 12 years, with an average of 7.3±5 months from disease onset. Type 2 CNV was found in most cases (48 eyes, 78.7%).

CONCLUSION: CNV is a rare complication of various ocular diseases in children. In our cohort, it was most frequently observed in children with inflammatory lesions of the retina and choroid, even during remission. Patients at risk of CNV must be actively monitored because it occurs in various forms.

Sulfacrylate is a medical glue used in general and vascular surgery, traumatology, maxillofacial surgery, thoracic and abdominal surgery, and dentistry. To connect tissues in plastic ophthalmic surgery, the toxic properties of Sulfacrylate should be studied.

AIM: To evaluate the toxic effect of Sulfacrylate in human cell culture in vitro.

MATERIAL AND METHODS: In vitro studies were conducted on human fibroblast cultures of the M-22 line from the 20th passage. Sulfacrylate was used in the present study (registration certificate for a medical device no. FSR 2010/09805; December 31, 2010). A lyophilized bandage based on human type 1 collagen was used to fix the glue. The total number of cells at the bottom of wells, cell density at the bottom of wells and on collagen dressings (1 thousand cells per cm²), structural integrity of cells and their morphology, integrity of cell membranes were evaluated.

RESULTS: The toxic effect of collagen dressings with Sulfacrylate was limited by the size of the bandage. Collagen dressings with Sulfacrylate did not affect the viability of cells not in direct contact with the dressings and did not cause a pronounced decrease in the proliferative activity of cells. The minimum optimal dosage of adhesive for plastic ophthalmic surgery was 1–3 µkl.

CONCLUSION: The use of Sulfacrylate in plastic ophthalmic surgery is feasible; however, the volume used should be minimized.

AIM: To describe the clinical manifestations and management experience of patients with X-linked congenital retinoschisis (XLRS).

MATERIAL AND METHODS: The study was conducted in the ophthalmology department of the multidisciplinary clinical medical center Bonum (Yekaterinburg). Two brothers with XLRS were under observation. They underwent complete ophthalmological examinations, including electrophysiological examinations, optical coherence tomography (OCT), and fundus photoregistration. The mother refused genetic testing.

RESULTS: Both siblings had early (up to 1 year) manifestations of central foveolamellar and peripheral bullous retinoschisis. The parents are phenotypically healthy, and the relatives have no hereditary eye diseases. The younger brother had a progressive peripheral retinoschisis and underwent barrier laser retinopexy; as a result, the progression stopped at the last examination. Acetazolamide 125 mg given orally daily for 4 weeks did not have a noticeable effect on the volume of bullous cavities. The older brother had been under observation for >4 years, and spontaneous closure of retinal cavities on the periphery in one eye and retinal detachment in the other after surgical treatment of retinoschisis were observed.

CONCLUSION: Clinical cases of long-term follow-up of two brothers with XLRS are described. OCT is indicated to diagnose, assess the length and the state of the vitreoretinal interface, and monitor XLRS. Electroretignography is a specific and sensitive method for the complex diagnosis of XLRS. Barrier laser retinopexy is indicated for progressive peripheral retinoschisis. The efficacy and safety of carbonic anhydrase inhibitors in patients with XLRS require further study.

Chiasm gliomas are very important heterogeneous group of tumors manifesting in the first and second decades of life and is the second leading cause of blindness in children with neurosurgical pathology. It is a benign, slow-growing piloid astrocytoma, accounting for 1–5% of intracranial gliomas in children. The incidence of neurofibromatosis type 1 among patients with chiasm glioma ranges from 7 to 60%. The location of the tumor is determined based on ophthalmological symptoms, neuroimaging data (MRI), and surgical findings. The initial growth of the tumor occurs in the anterior visual pathway structures (optic nerves, chiasm, optic tracts) and leads to ophthalmological symptoms, which are dominant in the clinical manifestations of the disease. Chiasm damage may occur in one or both optic nerves, in one or both optic tracts. Damage to the chiasm manifests as bitemporal heteronymous hemianopsia. Moreover, the spread of the tumor to the optic nerves is accompanied by decreased visual acuity. Damage to the optic tract is manifested by homonymous hemianopia and normal visual acuity. However, isolated damage to the optic tract is uncommon and usually occurs with chiasm and optic nerve lesions; hence, visual disturbances are more complex. Lesions in the optic nerve fibers in the chiasm and optic nerves/tracts lead to primary descending atrophy of the optic nerves. Papilledema with optic nerve atrophy indicates occlusive hydrocephalus. Delayed diagnosis of the disease affects treatment results.