Vol 17, No 2 (2022)

AIM: Evaluate the visual adaptation and vision quality of glasses with Stellest lenses.

MATERIAL AND METHODS: A total of 35 children aged 8–13 years (average: 10.5±0.27 years) with mild and moderate myopia (average: 3.15±0.19 dpt) in glasses with Stellest lenses and 30 children aged 8–13 years (average: 10.4±0.3 years) with mild and moderate myopia (average: 2.66±0.2 dpt) in monofocal glasses as the control group. Refraction and visual acuity (OS) were assessed after the appointment of glasses. Ergonomic tests were conducted 3–4 months after the children started wearing them. At 3–4 weeks after they started wearing glasses, all patients filled out a questionnaire of 8 questions.

RESULTS: The monocular distance in the Stellest glasses averaged 1.17±0.02, and the specific values were 1.24±0.03 for binoculars, 1.09±0.02 for monofocal glasses, and 1.160.02 for binocular glasses. Near monocular OZ in Stellest glasses averaged 0.95±0.01 and 0.96±0.01 for binocular glasses; the values were 0.96±0.01 and 0.97±0.01 for monofocal glasses. The minimum mesopic contrast sensitivity in Stellest glasses was 3.76±0.04 (with a reference value of 4) and 3.44±0.1 in the trial frame (p <0.05). In the conditions of the glare effect, the values of 7.47±0.08 for the Stellest glasses (with a reference value of 8) and 6.76±0.2 for monofocal glasses were observed (p <0.01). In monofocal glasses, the corresponding indicators were 3.71±0.09 and 7.2±0.14. Under the conditions of the gler effect, the indicator was 0.84 higher than that of the trial frame (p <0.01). The tendency to lower ergonomic indicators in Stellest glasses has been revealed. The subjective assessment of the quality of vision was high in both groups

CONCLUSION: A preliminary assessment revealed highly functional and ergonomic performance and good portability of glasses with Stellest lenses.

AIM: To describe clinical cases of iris neoplasms in children and adolescents.

MATERIAL AND METHODS: The study was based on retrospective and prospective analyses of children and adolescents with iris neoplasia from January 2018 to April 2022. During this period, 44 children with suspected iris neoplasia, including 20 boys and 24 girls, applied to the outpatient department; their ages ranged from 6 months to 17 years (9.1±5 years). The diagnosis was based on a comprehensive examination of patients including clinical and instrumental methods. Biomicroscopy, ultrasound investigation including ultrasound biomicroscopy, and when necessary, optical coherence tomography of the anterior eye region were performed. When it was impossible to establish the diagnosis due to the child’s age, the examination was performed under general anesthesia in the ocular oncology and radiology department.

RESULTS: Of the 44 iris lesions, nevus was found in 32 (72.7%) patients, iris melanosis in 3 (6.8%), cysts in 5 (11.3%), heterochromia in 1 (2.3%), floccula in 1 (2.3%), hamartroma in 1 (2,3%), and melanocytoma in1 (2,3%). The majority of the patients with these lesions are observed in the outpatient department. From January 2018 to April 2022, six children with iris lesions were examined in the department of ophthalmo-oncology and radiology under general anesthesia; accordingly, two children received dynamic observation, two underwent iridectomy, and two others underwent YAG-laser cystotomy and cystodestruction. Two iridectomies were also performed among adolescents. Histological diagnosis was verified in four patients after iridectomy: iris stromal cyst, iris pigment epithelium cyst, melanocytoma, and iris spindle cell nevi were detected.

CONCLUSION: According to the observation data, iris nevi were most common (72.7%), followed by cysts (11.3%) and melanosis (6.8%) of the iris. Heterochromia, floccules, and hamartomas, and melanocytoma of the iris had equal frequency (2.3%).

AIM: To analyze the etiopathogenesis, clinical features, and treatment algorithm for chronic unilateral anterior nodular scleritis with local inflammation of the ciliary body to increase medical alertness to the herpetic etiology of the disease in the absence of extraocular manifestations of herpes infection, reduce the disease duration, and increase the effectiveness of treatment.

RESULTS: Features of etiopathogenesis were analyzed. The characteristic clinical symptoms of chronic nodular scleritis, local anterior cyclitis, and pars planitis caused by the varicella-zoster virus (VZV) were described. The etiological role of VZV has been established based on high levels of VZV-IgG antibodies, presence of VZV-gE-IgG antibodies (markers of active virus replication), and effectiveness of antiherpetic therapy.

DISCUSSION: The surgical removal of a melanocytic skin nevus with skin autotransplantation in the paraorbital region of the left eye, in the zone of innervation of the first branch of the trigeminal nerve, contributed to the reactivation of the ophthalmic herpes and the development of anterior nodular scleritis of the left eye. An intensive long-term ineffective therapy with corticosteroids and antibacterial drugs in the absence of etiotropic treatment caused a chronic course of anterior nodular scleritis, spread of the inflammatory process to the ciliary body, and development of local anterior cyclitis and pars planitis of herpetic etiology in a 17-year-old child.

CONCLUSION: Maximum medical alertness and early and accurate clinical differential diagnosis between scleritis associated with immunoinflammatory rheumatic diseases and herpesvirus infections are necessary since the expansion of the range and number of anti-inflammatory drugs used in the absence of positive dynamics from their use leads to a chronic disease course, damage not only to deep layers of the sclera but also the spread of inflammation to the deeper layers of the eyeball, a decrease in visual acuity, undesirable effects of local glucocorticoid therapy, and an increase in intraocular pressure and development of cataracts. With any scleritis resistant to conventional treatment, the likelihood of a herpetic etiology of the inflammatory process and laboratory diagnosis of ophthalmic herpes should be considered. In the absence of a specialized laboratory, for etiological diagnosis, the possibility of ex juvantibus antiviral therapy should be considered. The described clinical symptoms of chronic nodular scleritis with local lesions of the ciliary body contribute to the early diagnosis of ophthalmoherpes, which allows the timely initiation of antiviral therapy with an antiherpetic effect, prevents the development of a chronic disease course, occurrence of complications, and preservation and/or restoration of visual acuity.

Changes in the macular zone of the retina, which have different etiopathogenesis, can occur with a similar ophthalmoscopic picture.

AIM: To present the clinical case of a child with a congenital the optic disc pit, complicated by retinal detachment in the macular zone, who received long-term treatment for chorioretinitis.

RESULTS: A 13-year-old child was referred to the Helmholtz National Medical Research Center for a diagnosis of an idiopatic chorioretinal inflammation in the right eye. For 2 years at home, the child received inpatient treatment, including anti-inflammatory, desensitizing, and antibacterial therapy, without changes in visual acuity, ophthalmoscopy, and optical coherence tomography (OCT) data. Based on a comprehensive assessment of OCT results of the macular area and the optic nerve head (presence of a peripapillary slit-like detachment of the neuroepithelium in the superior temporal and inferior temporal quadrants, detachment of the neuroepithelium in the macula), anamnesis (lack of a “response” to ongoing anti-inflammatory therapy), biomicroscopy, and ophthalmoscopy (on the right, the optic disc is oval, horizontally elongated, decolorized, along the horizontal meridian it is made of glial tissue, in the area of the papillomacular bundle and in the macula, there is a rough redistribution of pigment. On the left, the optic disc is oval, horizontally elongated, decolorized, the macula and the periphery without pathology), the diagnosis was made: a congenital anomaly in the development of the optic disc (optic disc pit) in both eyes complicated by retinal detachment in the macula on the right. The child underwent transpupillary laser coagulation of the retina in the parapapillar zone in the upper and lower temporal quadrants of the right eye. Upon further observation after 1 and 2 months, OCT data revealed positive dynamics of resorption of the subretinal fluid in the macular zone, and an increase in visual functions was noted.

CONCLUSION: Сompetent interpretation and integration of the results of clinical and instrumental examinations and thorough analysis of anamnestic data make it possible to identify the pathology underlying structural disorders of the macular zone, which is of key importance in choosing the right treatment techniques and maintaining visual functions.