Russian Pediatric OphthalmologyRussian Pediatric OphthalmologyРоссийская педиатрическая офтальмология1993-18592412-432XEco-Vector62753110.17816/rpoj627531Case reportsКлинические случаиReview ArticleSpontaneous closure of macular holes in childrenСамопроизвольное закрытие макулярных разрывов у детейhttps://orcid.org/0000-0002-4857-0374KatarginaLyudmila A.КатаргинаЛюдмила Анатольевна
Russian Federation

MD, Dr. Sci. (Med.), Professor

доктор медицинских наук, профессор

katargina@igb.ruhttps://orcid.org/0000-0003-3735-62494111-4330DenisovaEkaterina V.ДенисоваЕкатерина Валерьевна
Russian Federation

MD, Cand. Sci. (Med.)

кандидат медицинских наук

deale_2006@inbox.ruhttps://orcid.org/0000-0001-6523-5191DemchenkoElena N.ДемченкоЕлена Николаевна
Russian Federation

MD, Cand. Sci. (Med.)

кандидат медицинских наук

dem-andrej@yandex.ruhttps://orcid.org/0000-0002-3151-69105872-6819OsipovaNatalya A.ОсиповаНаталья Анатольевна
Russian Federation

MD, Cand. Sci. (Med.)

кандидат медицинских наук

natashamma@mail.ruhttps://orcid.org/0000-0001-6465-2313BelovaMaria V.БеловаМария Викторовна
Russian Federation

MD, Cand. Sci. (Med.)

кандидат медицинских наук

mbelova.doc@gmail.comHelmholtz National Medical Research Center of Eye DiseasesНМИЦ глазных болезней им. Гельмгольца14062024192891002802202404032024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://ruspoj.com/1993-1859/article/view/627531

AIM: This study aimed to analyze clinical cases of spontaneous macular hole (MH) closure in children and determine the optimal approach for managing patients with this disease.

MATERIAL AND METHODS: Data from 32 patients aged 6–17 years (average: 11.3 years) were evaluated, including 32 eyes with a full thickness macular hole and 1 eye with a lamellar macular hole. All patients were treated in the Department of Pediatric Ocular Pathology of the Helmholtz National Medical Research Center of Eye Diseases in 2013–2023. They underwent a comprehensive ophthalmological examination, including optical coherence tomography (OCT) of the macular area.

RESULTS: Spontaneous MH closure was observed in five eyes (15.2%) of five patients (15.6%). The etiological factor of the disease was ocular contusion in two cases, photodamage in one case, and an inflammatory process in the posterior segment of the eye in two cases. A small diameter MH (100–261 µm) and its overgrowth soon after formation were common to all patients, that is, less than 2 months in 3 of 5 children and within 6 months in all patients.

CONCLUSION: Spontaneous closure of MH with a small diameter and in the early stages after its formation is rare in pediatric patients. For MH with a diameter of up to 200 µm according to OCT and the absence of other indications for surgical treatment, a wait-and-see approach for 3 months with regular (once a month) examination is recommended. In cases with MH closure tendency, continued follow-up is crucial; if it persists after 3 months or increases at any period of follow-up, surgical treatment is indicated.

Цель. Проанализировать клинические случаи самопроизвольного закрытия макулярных разрывов (МР) у детей и определить оптимальную тактику ведения пациентов с этим заболеванием.

Материал и методы. Проанализированы данные 32 пациентов в возрасте от 6 до 17 лет (в среднем 11,3), в том числе 32 глаза со сквозным, один — с ламеллярным макулярным разрывом. Все больные находились на лечении в отделе патологии глаз у детей НМИЦ глазных болезней им. Гельмгольца в 2013–2023 гг. Всем детям выполнено комплексное офтальмологическое обследование, включая оптическую когерентную томографию (ОКТ) макулярной зоны.

Результаты. Самопроизвольное закрытие МР наблюдалось в 5 глазах (15,2%) 5 пациентов (15,6%). В 2 случаях этиологическим фактором заболевания была контузия глаза, в 1 — фотоповреждение, в 2 — воспалительный процесс в заднем отрезке глаза. Общим для всех пациентов был небольшой минимальный диаметр МР (100–261 мкм) и его зарастание в ближайшие сроки после формирования, а именно, менее 2 месяцев у 3 из 5 детей, у всех — в пределах 6 месяцев.

Заключение. Самопроизвольное закрытие МР у детей наблюдается относительно редко, при небольших отверстиях и в ранние сроки после их формирования. При МР с минимальным диаметром до 200 мкм по данным ОКТ и отсутствии других показаний к оперативному лечению целесообразна выжидательная тактика в течение 3 месяцев с регулярным (1 раз в месяц) обследованием. При тенденции к закрытию МР необходимо продолжение наблюдения, при его персистенции через 3 месяца или увеличении на любом сроке наблюдения показано хирургическое лечение.

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