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Vol 16, No 1 (2021)

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Clinical studies

The effectiveness of subtenon triamcinolone injection for the treatment of macular edema in children with retinitis pigmentosa

Katargina L.A., Denisova E.V., Khrabrova M.A., Osipova N.A.


Aim: This study aimed to assess the functional and anatomical results of subtenon triamcinolone injections in children with retinitis pigmentosa (PR) and cystic macular edema (CME), refractory to local carbonic anhydrase inhibitors.

Material and methods: We examined 11 children (9 girls, 2 boys) aged 9 to 17 years who underwent subtenon injections of triamcinolone (22 eyes). The follow-up period ranged from 1.6 to 33.1 months (average 9.7±11.6 months), the number of triamcinalone injections ranged from 1 to 11, averaging 3. Before and after injection, best corrected visual acuity (BCVA), the thickness and structure of the retina in the macular zone (optical coherence tomography [OCT] was performed by using the NIDEK RS-3000, Japan or the Spectralis, Heidelberg Engineering, Germany), and intraocular pressure (IOP) were assessed.

Results: The CME height at the end of the observation period decreased in 10 cases (45.5%), and the average central retinal thickness decreased from 70 to 594 μm (on average, 219.1±183.4 μm). In 12 eyes (54.5%), the CME height at the end of the observation period did not change significantly. BCVA improved in two eyes (9.1%) and did not change in the other cases. Two children (18%) developed ophthalmic hypertension in both eyes after two injections of triamcinalone. In one child, IOP returned to normal on the background of hypothetical therapy. In another child, due to non-compensation of IOP at the maximum hypotensive mode, sinus trabeculectomy was performed in both eyes, and IOP normalization was achieved.

Conclusion: Subtenon injection of triamcinolone in children with CME against a background of PR is in most cases is an effective and safe method of treatment and can be recommended if carbonic anhydrase inhibitors are ineffective at reducing/ resorbing edema and maintaining or improving visual function. Considering that the action of triamcinolone is short lived, and its repeated injection is required, and the resorption of CME and an increase in visual acuity are not always achievable, it is necessary to continue the search for more effective treatment methods.

Russian Pediatric Ophthalmology. 2021;16(1):5-12
pages 5-12 views

Correlation analysis of some functional and anatomical parameters of the visual analyzer in nystagmus and amblyopia of various origins

Khubieva R.R., Tarutta E.P., Apaev A.V., Markosyan G.A.


Aim: To conduct a correlation analysis of the parameters of visual fixation, light sensitivity of the retina in the central region, and the thickness of the central region of the retina and choroid with the best corrected visual acuity (BCVA), refraction (SER), and axial length of the eye (AL) in nystagmus and amblyopia of various origins.

Material and methods: The study included 45 patients aged 5–44 years (mean 11.2±6.14 years). All patients were divided into six groups depending on the type of amblyopia and associated conditions (with nystagmus). The retinal photosensitivity and fixation parameters were studied using an MP-3 Nidek microperimeter (Japan). Chorioretinal parameters were studied using an RS-3000 Advance 2 spectral optical coherence tomograph (Nidek, Japan). The axial length of the eye was measured using a Galilei G6 Scheimpflug analyzer. Correlation analysis was performed using the linear Pearson correlation coefficient (r).

Results: In nystagmus, refractive and dysbinocular amblyopia, a strong direct correlation was found between the indicators of BCVA and the characteristics of fixation. In the groups associated with congenital myopia, relationships were found between BCVA, retinal thickness, and light sensitivity of the retina in the central region. There was no relationship between the subfoveal choroidal thickness and functional parameters of the eyes.

Conclusions: In nystagmus and amblyopia associated with strabismus and hyperopic refraction, the primary amblyogenic factor is a decrease in the density and amplitude of fixation. In relative amblyopia due to congenital myopia, the decrease in visual acuity correlates with the photosensitivity of the retina and does not correlate with fixation parameters, which indicates the partially organic nature of relative amblyopia. No relationship was found between the choroidae thikness and the degree of amblyopia, which does not cofine its participation in the pathogenesis of the disease.

Russian Pediatric Ophthalmology. 2021;16(1):13-22
pages 13-22 views

Case reports

Treatment of corneal ulcers and endophthalmitis caused by yeast fungi

Kovaleva L.A., Krichevskaya G.I., Balackaya N.V., Markelova O.I.


Aim: To analyze the pathogenesis, clinical features, and treatment algorithm of fungal corneal ulcer with endophthalmitis to increase medical alertness and reduce the unjustified use of antibacterial and corticosteroid therapy in corneal diseases of various etiologies, leading to the development of secondary ophthalmomycosis.

Results: The pathogenesis was analyzed, and the characteristic clinical symptoms of severe fungal corneal ulcer and endophthalmitis caused by Candida albicans were described. Intensive, long-term, unjustified antibacterial and corticosteroid therapy caused a prolonged course of herpetic corneal ulcer, as well as the addition of a secondary bacterial infection, and led to the development of severe corneal ulcer and fungal endophthalmitis in a 13-year-old child.

Conclusion: The required maximum medical alertness and early, accurate clinical differential diagnosis between bacterial and fungal corneal ulcer, as well as the rapid flow of ophthalmomycosis and false-negative results of sowing content conjunctival sac entail expansion of the range and quantity of antibacterial drugs used in the absence of positive dynamics of antibiotic therapy and an increased frequency of secondary fungal infection.

The clinical symptoms of a severe fungal corneal ulcer with endophthalmitis described in this report contribute to the early diagnosis of ophthalmomycosis before the type of pathogen is identified by laboratory methods, which makes it possible to start antifungal therapy earlier and avoid corneal perforation and eye loss. In most countries, due to the lack of an ocular form of antifungal drugs, for local treatment of corneal candidiasis, a 0.2% solution of fluconazole intended for intravenous administration is installed in the eyes.

Russian Pediatric Ophthalmology. 2021;16(1):31-38
pages 31-38 views

Clinical cases of laser-induced macular damage in children

Kogoleva L.V., Bobrovskaja J.A., Kokoeva N.S.


Purpose: To study the features of the clinical and functional state of the eyes in children after laser damage to the retina.

Material and methods: We examined six patients who incurred retinal photodamage (nine eyes) after using a laser pointer.

Results: It was shown that laser-induced damage to the macula led to a decrease in vision in five of the nine eyes, which correlated with changes in the parameters of the rhythmic and macular electroretinogram. The main pathognomonic symptom of photo damage to the macula is the presence of signs of local destruction of the pigment epithelium and the ellipsoid zone of the retina, according to optical coherence tomography (OCT). In two cases, after a macular burn, a neovascular membrane formed, which led to an irreversible decrease in vision.

Conclusion: Uncontrolled use of household laser devices (pointers) by children can lead to severe visual impairment. For this reason, the main priority should be prevention, conducting active sanitary and educational work, informing teachers, parents, and children about the potential harm, and timely detection and treatment of retinal photodamage.

Russian Pediatric Ophthalmology. 2021;16(1):39-46
pages 39-46 views

Retinoblastoma in children

Saidasheva E.I., Fomina N.V., Iova A.S., Buyanovskaya S.V.


This article is devoted to the description of three clinical cases of retinoblastoma, two in young children and one in a fetus, from our own ophthalmology practice.

Russian Pediatric Ophthalmology. 2021;16(1):47-52
pages 47-52 views

Clinical recomendations

Ptosis of the upper eyelid: diagnosis and choice of a surgical treatment

Filatova I.A., Shemetov S.A., Mohammad I.M., Trefilova M.S.


This article discusses a topical problem in ophthalmology, ptosis of the upper eyelid, highlighting the key points of diagnosis, choice of a surgical treatment, and postoperative patient management. The main causes of the development of ptosis of the upper eyelid are considered, and the key biometric parameters of the eyelids are described, which make it possible to make a pathogenetically determined choice of surgical treatment. The most common diseases leading to secondary ptosis of the upper eyelid, or pseudoptosis, and methods of their detection are considered.

Russian Pediatric Ophthalmology. 2021;16(1):23-30
pages 23-30 views

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