Vol 17, No 3 (2022)

AIM: This study aimed to investigate the effectiveness of retinal laser coagulation in children with Coats’ disease.

MATERIAL AND METHODS: The study included 118 patients who were examined and treated from January 2017 to December 2021; 102 of them were boys (86.6%) and 16 were girls (13.4%). All children had unilateral disease. All children underwent a comprehensive ophthalmological examination. Laser coagulation was performed in 113 patients using a green laser (532 nm). The number of retinal laser coagulation sessions ranged from 2 to 13 (on average 5.2±2.36) with intervals from 1.5 to 6 months (on average 2.01±0.46).

RESULTS: Generally, retinal laser coagulation was effective in CD in 85.8% of cases (in 97 of 113 children). Effectiveness was 100% for vascular malformations and exudates outside the macula, 97.3% for vascular and exudative retinal changes involving the macular zone, 92.3% for local retinal detachment, 90.5% for widespread retinal detachment, 60.0% for subtotal retinal detachment, and 30.0% for total. Only those who had peripheral Coats’ disease symptoms were found to have visual acuity of 0.6 or above, both before and after treatment. Visual acuity did not exceed 0.1 in 92% of patients with vascular and exudative changes in the periphery and in the macula and in 94% with local and widespread retinal detachment. After successful retinal laser coagulation, 11 children (13.4%) had visual acuity of 0.4 or higher, 13 children (15.9%) had visual acuity between 0.1 and 0.3, 45 children (54.9%) had finger count of 0.09, and 13 children (15.9%) lack objective vision.

CONCLUSION: Retinal laser coagulation using a laser with a wavelength of 532 nm is an effective method for treating CD at all stages, including cases of the disease with the development of retinal detachment.

AIM: This study aimed to investigate the efficacy and safety of micropulse cyclophotocoagulation (MP-CPC) in the treatment of various types of glaucoma in children.

MATERIAL AND METHODS: The study included 14 children (15 eyes) with uncompensated glaucoma of various etiologies, who underwent MP-CPC using the Cyclo G6 laser system (IRIDEX, USA). The intervention was considered absolutely effective when IOP reached 8 to 25 mm Hg without medications and without signs of progression of glaucoma, relatively effective, when the same criteria are achieved with hypotensive medications.

RESULTS: The average age of children at the time of intervention was 8.5±1.5 yr (from 7 months to 17 yr). The average level of IOP before surgery was 28.5±1.1 mm Hg, 3 days after MP-CPC (18.87±1.04 mm Hg), while the absolute efficiency was 14.3%, relative — 100%. By the end of the observation period (1–6 months; on average, 2.5±0.4 months), the average IOP was 24.4±1.31 mm Hg (average decrease, 14.3%), with absolute efficiency of 0% and relative of 66.7%. The average number of hypotensive medications received in instillations did not change significantly before and after MP-CPC and amounted to 3.45±0.22 and 2.91±0.39, respectively (p=0.167). Complications after MP-CPC were detected in six eyes (40%); in all cases, the appearance or increase of the inflammatory reaction in the anterior chamber was observed. In addition, in two eyes (13.3%). In addition, a slight mydriasis (4–5 mm) developed.

CONCLUSION: MP-CPC is a safe and effective treatment for glaucoma in children with various etiologies. Further research is needed to evaluate the effectiveness of intervention in the long term and the safety of repeated procedures to achieve normal IOP and to develop individual schemes of MP-CPC.

Choroidal effusion syndrome is a rare idiopathic condition that occurs predominantly in middle-aged man with hyperopia and is characterized by ciliochoroidal detachment (CD), followed by exudative retinal detachment. To present a clinical case of postoperative choroidal detachment in a child with Sturge–Weber–Crabbe syndrome after microinvasive non-penetrating glaucoma surgery.

RESULTS: This article presents the clinical case of postoperative choroidal detachment in a child with Sturge–Weber–Crabbe syndrome after microinvasive non-penetrating glaucoma surgery. Against the background of the existing anomalies in the development of an optic disc after antiglaucomatous intervention for decompensated glaucoma, after the normalization of IOP, the patient developed choroid detachment with exudative retinal detachment the next day of operation. After conservative therapy involving bed rest and double instillation of mydriatics for 1 month, the situation was completely resolved and his vision was restored to 1.0.

DISCUSSION: The atypicality of our clinical case of CD lies in the overly pronounced exudative component. In addition to the classic CD vesicles, we observed high exudative retinal detachment as well as high retinoschisis, which is extremely atypical for classical CD. Considering the characteristics of congenital syndrome, it is necessary to accurately differentiate atypical CCA from the rare choroidal effusion syndrome, which also includes CCA with retinal detachment, but does not present with retinoschisis. Against the background of conservative therapy with bed rest and two instillations of mydriatics for 1 month, the situation was completely resolved, and the patient’s vision was restored to 1.0. In the treatment of such patients, it is always necessary to consider their individual anatomical features as well as to understand the detailed pathogenesis of the complications that arise before rushing to repeat surgery.

In a review of the literature, maternal preeclampsia has been considered a risk factor for the development and severity of retinopathy of prematurity (RP). Preeclampsia is a complication that occurs in the second half of pregnancy (after 20 weeks), and it is diagnosed when arterial hypertension first appears (BP ≥140/90 mm Hg), proteinuria (≥0.3 g/L in daily urine), edema (not always), multiple organ/multisystem dysfunction/insufficiency, which are based on the dysfunction of the vascular endothelium. ROP remains a potentially vision-threatening condition that requires careful monitoring and timely intervention to prevent the progression of adverse visual impairment or blindness. RP initially presents with delayed physiological retinal vascular development, which is followed by pathological vasoproliferation; this condition is highly correlated with extreme prematurity and poor postnatal growth. This article discusses the possible mechanisms of influence of maternal preeclampsia on the development and severity of ROP in premature babies. A special role is attributed to circulating antiangiogenic factors in the preeclamptic maternal environment, which can influence the development of fetal retinal vessels and predispose premature infants to ROP. Рreeclampsia increases the risk and severity of preterm birth, which are closely related to the risk of ROP. These results are contradictory, as some authors consider preeclampsia as a risk factor for the development of ROP, while others have not yet identified any connection between these processes. However, several authors consider preeclampsia as a protective factor in relation to the development of ROP. Dysregulation of circulating angiogenic factors plays an important role in the pathogenesis of both preeclampsia and ROP. Preeclampsia should therefore be studied further and considered along with other risk factors for ROP.