Russian Pediatric Ophthalmology

BACKGROUND: Intraocular lens implantation in the capsular bag is one of the most effective methods to correct aphakia in children. However, management of infants is associated with challenges of predicting growth of artificial eyes, calculating an intraocular lens implanted in a child’s growing eye, and high frequency of refraction surprises in the long term period, in particular myopia.

AIM: The study aimed to create mathematical models (formulas) to predict growth of the anterior-posterior axis after congenital cataract surgery with intraocular lens implantation in infancy based on the characteristics of the child’s eye.

METHODS: A single-center, retrospective study included analysis of medical records, and a prospective study was performed to re-measure the anterior-posterior axis. The study included data from medical records of children with congenital cataracts who underwent surgery in infancy at the Helmholtz National Medical Research Center of Eye Diseases. To assess the effect of various factors on anterior-posterior axis growth in pseudophakic children with after congenital cataract surgery, we conducted a multi-factor ANOVA of its growth by the child’s age. The study was performed using logistic regression with a binary dependent variable.

RESULTS: Mathematical calculations generated regression models which confirmed the relationship between the tested factors demonstrating predictability of the anterior-posterior axis and its growth at different age intervals after congenital cataract surgery in infancy.

CONCLUSION: Thus, models (formulas) have been developed which demonstrate mathematical relationship between certain factors and anterior-posterior axis growth after bilateral or unilateral congenital cataract surgery. In most cases, the models were highly informative and significant, allowing predicting changes in the anterior-posterior axis in infants based on individual characteristics.

BACKGROUND: Neovascularization is a hallmark of many retinal diseases, including diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. Nevertheless, optimal criteria for quantifying the retinal status are currently being searched to help decide whether to initiate and continue anti-angiogenic therapy or perform retinal laser photocoagulation.

AIM: The study aimed to identify the selective criteria for treatment methods based on the type of pathological vasculogenesis in retinopathy of prematurity, vision quality, visual field indices, and morphological and structural parameters in patients with age-related macular degeneration and diabetic retinopathy.

METHODS: A single-center, prospective, cohort study was conducted. The study enrolled patients with diagnosed retinopathy of prematurity (group 1), diabetic retinopathy (group 2), or age-related macular degeneration (group 3). The analysis included data of automated perimetry (mean deviation [MD] and pattern standard deviation [PSD]), optical coherence tomography, including optical coherence tomography angiography, and visual acuity measurement using the revised ETDRS (Early Treatment of Diabetic Retinopathy Study) chart with Russian optotypes for patients in groups 2 and 3. In addition, fractal analysis (Df) was performed and the complexity of retinal vascular networks (RVN) was assessed in all groups.

RESULTS: The study included 219 children (428 eyes) with retinopathy of prematurity in group 1, 70 patients (140 eyes) with diabetic retinopathy in group 2, and 64 patients (109 eyes) with neovascular age-related macular degeneration in group 3. Control groups included 60 patients (120 eyes) for group 1 and 16 patients (32 eyes) for groups 2 and 3 each. Retinopathy of prematurity in group 1 regressed after retinal laser photocoagulation and anti-angiogenic therapy (23 patients [38 eyes] were followed-up), therefore the Df and ΔRVN values can be used as criteria for treatment success. For example, ΔDf of < 0.06 ± 0.015 in stage 3 plus disease and < 0.08±0.02 in aggressive posterior retinopathy of prematurity and ΔRVN of < 0.43 ± 0.08 and < 0.4 ± 0.04, respectively, can be predictors of the need for repeated anti-angiogenic injections or switch to retinal laser photocoagulation. Retinal vascular network parameters in group 2 did not change significantly after retinal laser photocoagulation, which is probably explained by slow regression of pathological changes. Optical coherence tomography angiography revealed that Df tended to increase with a decrease in macular neovascularization activity from 1.5871 ± 0.05 to 1.6462 ± 0.08 (p = 0.13) in patients with neovascular age-related macular degeneration.

CONCLUSION: Df and retinal vascular network parameters can be used to evaluate the effectiveness of retinal laser photocoagulation in patients with retinopathy of prematurity and diabetic retinopathy and to assess activity of the choroidal neovascular membrane in age-related macular degeneration.

BACKGROUND: Pterygium is a degenerative disorder of the conjunctiva characterized by a high recurrence rate. Currently, Sulfacrylate adhesive is used in various medical fields to reduce surgery time and improve the treatment effectiveness. For pterygium treatment, the resorption rate of the adhesive film and its ability to completely resorb are important. To objectively monitor this process and the eye mucosa condition, ultrasound biomicroscopy should be used.

AIM: The study aimed to perform clinical ultrasound monitoring of the results of pterygium surgery using Sulfacrylate medical adhesive.

METHODS: A single-center, uncontrolled clinical study involved patients with recurrent and active primary pterygium. All the participants underwent surgery which included resection of pterygium and conjunctival autograft transplantation with graft fixation using Sulfacrylate medical adhesive. Follow-up was performed on postoperative days 3 and 7, at weeks 3, 6, 12, and month 18. Ultrasound biomicroscopy was performed in all patients at postoperative week 3 and months 6 and 12 to objectively assess changes in the sulfacrylate adhesive layer over time.

RESULTS: The clinical study included 5 patients (5 eyes) aged 30 to 50 years with diagnosed pterygium. A week after surgery, complete epithelialization of the defect was achieved in all patients. By month 6 of follow-up, complete engraftment of the transplanted conjunctival flap was observed. Ultrasound biomicroscopy confirmed resorption of the adhesive film used to fix the flap. Examination at postoperative months 12 and 18 revealed no cases of pterygium recurrence.

CONCLUSION: Sulfacrylate medical adhesive is promising in pterygium surgery to prevent relapses during a 18-month follow-up. Ultrasound biomicroscopy is highly effective in postoperative assessment of the anterior segment tissues after pterygium surgery.

Keratoconus is a progressive degenerative corneal condition, characterized by disrupted and disorganized structure of the collagen matrix, which leads to corneal thinning and ectasia. The combined impact of genetic, hormonal, and environmental factors underlie the pathogenesis. The peak manifestation of the condition is usually observed in adolescence and at a young age (15–30 years). However, there are cases of earlier onset, including at a preschool age (the authors had a case in a 5-year-old child), which highlights the need for early detection and timely treatment to prevent irreversible vision loss. Given specific features of children, early diagnosis and timely treatment are critical for preventing severe complications and subsequent need for keratoplasty.

The article reviews current data on the clinical presentation, diagnostic approaches, and treatment strategies for pediatric keratoconus, with a focus on corneal cross-linking as the most effective way to stabilize the condition. The article also discusses the standard Dresden protocol and its modifications, including transepithelial, partial, and accelerated cross-linking, and methods used in case of the thinned cornea.

The article is available at https://ruspoj.com/1993-1859/article/view/689563

Changes have been made on pages 164, 165, and 167: the trade name of the drug product Midrimax® (Sentiss Pharma Pvt. Ltd., India) has been added. This correction was necessary because the previously stated international nonproprietary name (INN)—0.8% tropicamide solution + 5% phenylephrine solution—applies to many drugs approved in the Russian Federation and therefore does not fully reflect the aim of the study.

The correction does not affect the conclusion in the article. The correction has also been made to its online version.