Vol 10, No 2 (2015)


The influence of some local medicinal drugs on the hemoperfusion of the eye anterior segment in myopia

Gndoyan I.A., Petraevskiy A.V.


We study the condition of hemoperfusion of the anterior eye segment in patients with myopia and evaluate the impact on its quantitative indicators of certain ophthalmologic topical drugs with potential vasotropic activity. We Investigated quantitative indicators of the eye anterior segments’ hemoperfusion, the average hemodynamic pressure in the anterior ciliary arteries, intraocular pressure and perfusion pressure in anterior segment of the eye in 149 patients (298 eyes) with myopia of a weak, medium or high degree (aged 7-22 years) and 32 persons (32 eyes) with emmetropia (aged 10-20 years) in the initial state and under the influence of two drugs: 2,5% solution of phenylephrine and 2% solution of dorzolamide hydrochloride. The following results are obtained. Hypoperfusion in anterior segment of the eye caused by anterior ciliaryarteries hypotony was revealed in myopia patients with decreasing of mean hemodynamic pressure in anterior ciliary arteries and perfusion pressure in anterior eye segment. Hypohemoperfusion tendency increased with degrees of myopia. Phenylephrin worked positively as a vasotropic drug to improve in anterior eye segment hemoperfusion parameters in patients with mild and moderate degrees of myopia. After phenylephrin instillation elevations of mean hemodynamic pressure in anterior ciliary arteries and perfusion pressure in anterior eye segment were determined in that patients. Elevation of perfusion pressure after dorzolamide instillation in patients with mild and moderate degrees of myopia was caused mainly by its hypotensive activity. The reliable changes of anterior eye segment perfusion pressure was not revealed in high myopia patients after using of both drugs. Phenylephrin can be used in the anterior eye segment hypoperfusioncorrection in myopia patients. The use of dorzolamide, given its predominantly hypotensive effect, in this pathology is impractical.
Russian Pediatric Ophthalmology. 2015;10(2):5-9
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The results of YAG-laser surgery in children with vitreous body’s pathology

Katargina L.A., Arestova N.N., Kalinichenko R.V.


The article presents the analysis of the results YAG laser interventions on the structures of the vitreous body in 49 children (53 eyes) with various vitreal pathology, mostly congenital, rare consequence of uveitis, trauma and intraocular operations. Laser discission of the vitreous body commissures (vitreomembranotomy) was produced in 37 eyes, the destruction of the opacities of the vitreous body (vitreolysis) - in 13 eyes, dissection of the vitreocorneal adhesions (front adhesiotomy) - in 3 eyes. Laser surgery in most children (79,6%) was able to resolve the traction, in all cases it improved the status of the optical zone, in 42% of children it improved visual acuity. We found no major complications. Vitreomembranotomy was the most effective for cutting of the thin avascular commissure in cases of the persistent hyperplastic primary vitreous syndrome and scar phase retinopathy of prematurity. Laser vitreal destruction of the front vitreal opacities is justified in children in early postoperative period after cataract removal to accelerate vitreolysis and in obscurations amblyopia preventing. Both adults and children, laser vitreocorneal dissection is shown in the syndrome of Irvine-Gass, hyaloidotomy, and it is used to eliminate vitreal pupillary block.
Russian Pediatric Ophthalmology. 2015;10(2):10-14
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Best disease: clinical observation of a family case

Katargina L.A., Denisova E.V., Ryabtsev D.I.


The article presents a family case of Best vitelliform macular dystrophy (Best’s disease) - autosomal dominant macular dystrophy with typical clinical presentation and staging of the disease flow. A daughter and a mother had diagnosed Best’s disease with different localizations (central and eccentric) and stages (psevdogipopion and pseudocyst) of the disease in the right eye and the same (atrophic) - in the left eye. Apart from that, the daughter had the optic disc drusen. We proved descriptiveness of optical coherence tomography and fundus autofluorescence imaging for confirmation of Best’s disease diagnosis, determination of the stage of the disease and identification of changes that cannot be detected with ophthalmoscopy, in retina, pigment epithelium and Bruch's membrane.
Russian Pediatric Ophthalmology. 2015;10(2):15-19
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The dynamics of the anterior-posterior axis of the eye and refraction in children with pseudophakia after early surgery of the congenital cataract (preliminary report)

Katargina L.A., Kruglova T.B., Egiyan N.S., Trifonova O.B.


We present the results of a comprehensive ophthalmic examination including, along with the traditional methods, refractometry and biometry of 62 children (90 eyes) aged from 2 months to 7 years with congenital cataracts before and after surgery with intraocular lens implantation aged from 2 to 11 months. The optical power of the intraocular lens was determined by the formula SRK II. The value of hypocorrection was calculated on the projected emmetropic or slightly myopic refraction to preschool age. The study of the anterior-posterior axis’dynamics of the eye and refraction held at various times after extraction of congenital cataract in children with initially normal size of the eye, with microphthalmosof the 1st degree and microphthalmos of the 2-3rd degree. The results of the different anterior-posterior axis’ dynamics of the eye and refraction in children after early intraocular correction indicate the need for further study of the long-term results, which will allow differentiated and more accurate approach to determining the value of hypocorrection with intraocular lens implantation in children of the first year of life with different initial anatomical parameters of the eye.
Russian Pediatric Ophthalmology. 2015;10(2):20-24
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Inhalational and retrobulbar anesthesia in children with retinal detachment

Korobova L.S., Arestova E.S., Poduskov E.V., Legostaeva O.A., Balashova L.M.


The conducted research covered the analysis of anesthetic support during 72 surgical operations of 52 children with retinal detachment. A comparison of two groups - basic (38 anesthesia) and control (34 narcosis) has been made. In both groups, premedikation and induction were the same. The anesthetic support was administered through the inhalation of oxygen, nitrous oxide and sevoflurane, and intravenous bolus dosing of propofol. Central analgesia was maintained through fractional intravenous injection of fentanyl. Laryngeal mask was used for airway management.In the main group at the request of the anesthesiologist, ophthalmosurgeon administered retro-bulbar anesthesia solutionof 0.75% naropin. Heart rate, ASIST, Addict, BPA, ECG had been controlled intraoperatively. Hemodynamic parameters in the main group during the operation were stable. However, in traumatic moment (endolasecoagulationof retina) tachycardia was observed with the patients of the control group. There were no any complications of combined analgesia. Re-introduction of naropin at the end of the operation led to decrease of pain syndrome and allowed to refuse the use of analgesics in the postoperative period in most children.Thus, the use of combination inhalation-retrobulbar anesthesia with the use of naropin of 0,75% gives sufficient depth of anesthesia and expands the number of pain medications in anesthetic support in children with eye conditions.
Russian Pediatric Ophthalmology. 2015;10(2):25-27
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Retinopathy of prematurity: the course and results of treatment in children with gestational age less than 27 weeks

Saydasheva E.I., Gorelik Y.V., Buyanovskaya S.V., Kovshov F.V.


In the article we present the results of ophthalmologic observation of 90 preterm infants with gestational age less than 27 weeks who were nursing in the neonatal center "Children's city hospital №1" in St. Petersburg. Average birthbody weight was 793,8±210 g, the average gestational age was 24,9±2,1 weeks. We determined the course of retinopathy of prematurity among the surveyed children: high frequency of occurrence (99%) and disease progression to severe forms (42,2%), including the development of aggressive posterior retinopathy of prematurity in 34,2% of cases; low frequency (56%) spontaneous regression of the initial stages compared with newborns with gestational age of 27-32 weeks (90%). Indications for laser photocoagulation of the retina had 42,2% of patients, the frequency of repeated interventions was 42.1%. Retinopathy of prematurity adverse outcome, characterized by the development of IV-V stages detected in 3,3% of cases. The efficiency of laser photocoagulation is 92,1%.
Russian Pediatric Ophthalmology. 2015;10(2):28-32
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Peripheral defocus induced by «Perifocal-M» spectacles and myopia progression in children

Tarutta E.P., Proskurina O.V., Milash S.V., Ibatulin R.A., Tarasova N.A., Kovychev A.S., Smirnova T.S., Markosyan G.A., Khodzhabekyan N.V., Maksimova M.V., Penkina A.V.


Peripheral defocus plays a significant role in refraction development. Spectacle lenses «Perifocal-M» allows to perform a correction of the central and peripheral refraction in the horizontal meridian differentially. The purpose was to determine the effect of «Perifocal-M» spectacles on the wave front aberrations, peripheral refraction and myopia development in children. 75 myopic children aged 9-14 with spherical equivalent cycloplegic refraction between -1,0 D and -6,0 D took part in the clinical prospective parallel cohort open study. Patients were randomly assigned to wear «Perifocal-M» or monofocal spectacles. It is noted that «Perifocal-M» spectacles form relative peripheral myopic defocus in the eye or decrease peripheral hyperopic defocus significantly, as well as induce positive spherical aberration. Decrease of the eye growth on 0,05mm, decrease of the myopic shift manifest refraction on 0,19 D, cycloplegic refraction on 0,11 D as compared to the control group were revealed after 6 months wearing of «Perifocal-M» spectacles. Decrease of the eye growth on 0,07mm, decrease of the myopic shift manifest refraction on 0,3 D, cycloplegic refraction on 0,27 D as compared to the control group were revealed after 12-18 months wearing of «Perifocal-M» spectacles. No one case of heterophoriadecompensation occurred while wearing «Perifocal-M» spectacles. «Perifocal-M» spectacles arrest the myopia progression in children.
Russian Pediatric Ophthalmology. 2015;10(2):33-37
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The influence of the fibrous capsule main parameters on the results of different methods of ophthalmotonometry in children

Tugeeva E.E., Vorontsova T.N., Brzheskiy V.V., Zaytseva M.V.


The comparison of the results of ophthalmometry performed using the Icare tonometer, transpalpebral tonometer TVGD-01, pneumotonometry and Maklakov tonometer in healthy children and patients with congenital glaucoma. We examined 20 children (40 eyes) with compensated congenital glaucoma at the age of 5-17 years, the control group consisted of 43 patients (86 eyes) - healthy children and children with mild myopia. The cornea radius of curvature in children with congenital glaucoma was 8,24±0,08 mm, in healthy children - of 7,68±0,03 mm Hg. Central corneal thickness in 52,5% of patients was 599,20±8,07 pm, 47,5% of patients had 508,90±7,28 pm, while children in the control group had 562,46±4,00 pm. The average intraocular pressure (Po), obtained by tonometry using Icare was 15,3±1,04 mm Hg in children with congenital glaucoma, 18,26±0,46 mm Hg in children of the control group, pneumotonometry was 16,23±2,07 mm Hg and 17,48±0,34 mm Hg respectively. Indicators transpalpebral tonometry (PT) in children with congenital glaucoma - 16,90±0,50 mm Hg, children in the control group - 18,60±0,48 mm Hg, Maklakov tonometry - 18,14±0,58 mm Hg and 18,98±0,24 mm Hg respectively. Positive direct correlation between Icare tonometry and corneal curvature radius (r=0,79) and between central corneal thickness and IOP on Maklakov (r=0,93). A negative correlation between the value of the anteroposterior size of the eye and results transpalpebral tonometry (r=-0,47). Interpretation of intraocular pressure measurementresultsin children with congenital glaucoma should be based on the modified properties of the cornea in these patients.
Russian Pediatric Ophthalmology. 2015;10(2):38-40
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Clinical case of the patient with an abnormality of the oculomotor muscles combined with perinatal central nervous system damage

Khamraeva L.S., Mavlyanov M.S., Bobokha L.Y.


We present a clinical case of the patient with a diagnosis «OU - atypical congenital strabismus. Abnormal development of the eye muscles. OD - moderate hyperopia with astigmatism, moderate amblyopia». The patient underwent two-step surgery with an interval of 4 years. During the first phase, it was discovered the absence of the lower and outer muscles on his right eye and was therefore carried out transposition of the internal rectus muscles to the projection of the bottom line. The second phase of the operation included: recession of the superior rectus muscle to 7.0 mm on the right eye; recession of the lateral rectus muscle of 10.0 mm on the left eye. During surgery it was discovered the following: in the right eye muscle fibers of the superior oblique muscle and the superior rectus muscle are in the same fascia and spliced. On the left eye outer rectus has an abnormal direction with respect to a limb: from the bottom up at an angle of 300. After surgery, the deviation amounted to (-)15 prism diopters, vertical component was removed.
Russian Pediatric Ophthalmology. 2015;10(2):41-43
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Quantitative indicators of the blood flow in the vertebral arteries of schoolchildren with acquired myopia

Yastrebtseva T.A., Smirnova L.A., Morotskaya M.E.


The objective of the present study was to elucidate the characteristics of the blood flow in vertebral arteries of the 13-16 year-old schoolchildren presenting with acquired myopia of varying degree. A total of 65 children were divided into several groups. Group 1 was comprised off 11 schoolchildren with emmetropia (controls) whereas other groups contained 35 patients with low-degree myopia, 10 ones with moderate-degree myopia, and 9 with high-degree myopia. Progressive myopia was diagnosed in 14 schoolchildren. The children with moderate and high-degree myopia were eventually united into one single group. The blood circulation was studied with the use of the Philips HD7 TD - 5-12 MHz ultrasonic diagnostic system. The patients were examined in the supine position. The linear systolic speed (Vmax, m/s), the linear diastolic blood velocity (Vmin, m/s), resistance index (RI), and the diameter of the vertebral artery (D, cm) were calculated. The measurements were made both at the right and at the left sides of the body at the level of the first segment before the entrance to the bone channel (V1), the second segment inside the bone channel (V2), and the third segment between the exit from the bone channel and the entrance to the cranial cavity (V3). The study has demonstrated asymmetry in the diameter of the vessel and the blood flow velocity at the V1, V2, and V3 levels. The data obtained were treated with the use of the Student's t-test for small samples with the 95% confidence interval. Ultrasound diagnostics of the blood circulation was performed by the «blind method». It was shown that asymmetry of the vessel diameter and the linear systolic blood flow velocity in the extracranial portion of the vertebral arteries of the schoolchildren differing in the intensity and clinical progression of myopia was more pronounced in comparison with that in the control children with emmetropia.
Russian Pediatric Ophthalmology. 2015;10(2):44-48
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Dynamics of the incidence of retinoblastoma in children in Kuzbass

Yanchenko T.V., Gromakina E.V.


We studied the dynamics of the retinoblastoma incidence in children of the Kemerovo region. There is a tendency to increased morbidity, including bilateral form. During the thirty-year period (1984-2013) the incidence rate in the region increased from 4,02 in the first study period (1984-1993) to 8,50 in the third period (2004-2013) per 100 thousand newborn babies. The frequency of such cases in the last decade was 1 to 11999 newborns. In the first decade of research bilateral lesion was observed in 16,7% of all cases, in the third - 41,4%. Gender ratio for the entire study period was as follows: boys - 55,2%, girls - 44,8%. In the age aspect the children of the first year of life were leading - 48,28%. Retinoblastoma had been diagnosed before the age of three years in 91,38 % of patients.
Russian Pediatric Ophthalmology. 2015;10(2):49-52
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Acute retinal necrosis in the children: the clinical manifestations and the results of the treatment

Denisova E.V., Katargina L.A., Krichevskaya G.I., Gvozdyuk N.A., Starikova A.V.


We investigated the clinical manifestations and the results of the treatment of acute retinal necrosis in 9 children at the age from 6 to 16 (mean 11.2) years. The clinical course of the disease was characterized by severe and often unilateral panuveitis with the typical peripheral chorioretinal lesions spreading circularly and rapidly progressing in the absence of antiviral therapy. Recularity of the disease in children was a more aggressive clinical course with severe vitriitis and membrane formation in the vitreous body and the absence of vaso-occlusion. The serological study revealed the markers of the type 2 herpes simplex virus and cytomegalovirus activation in 8 and 5 children respectively. This fact may be regarded as indirect evidence of the etiological role of this pathogens in the development of acute retinal necrosis. The combined antiviral and anti-inflammatory treatment allowed to achieve the remission of the disease; however, in 6 children developed traction-regmatogenous retinal detachment. Vitrectomy with retinal endolaser coagulation and tamponade of the vitreal cavity using the silicone oil resulted in retinal reattachment in all the four patients treated by this method. It is concluded that early diagnostics, active combined therapy and preventive laser photocoagulation of the peripheral chorioretinal lesions after active retinitis create the necessary prerequisites for the successful treatment of acute retinal necrosis.
Russian Pediatric Ophthalmology. 2015;10(2):53-55
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Federal clinical recommendations «Diagnostics and treatment of comitant strabismus»

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Russian Pediatric Ophthalmology. 2015;10(2):56-63
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