Vol 18, No 1 (2023)

AIM: This study aimed to evaluate the clinical features of internal fistula obliteration after trabeculectomy (TE) in children with congenital glaucoma and the possibility of laser treatment.

MATERIAL AND METHODS: The study included 73 eyes of 56 children with congenital glaucoma who underwent TE between 3 months and 16 years. Yttrium aluminum garnet (YAG) laser refistulization was performed postoperatively because gonioscopy results revealed a complete or partial block of the internal fistula. In addition, a patented technique was utilized that combines the use of defocused and focused YAG laser radiation.

RESULTS: The internal fistula was more often blocked by the iris root. YAG laser refistulization eliminated the block in 97.3% of cases, and in two cases, planar splices that had existed for >6 months could not be dissected. Laser removal of the internal fistula block in 97.3% of cases led to a normalization of the intraocular pressure (IOP) immediately after surgery and in 80.7% of cases in the subsequent year. Early refistulization (up to 3 months after TE) reduced the risk of IOP decompensation by 2.6 times by the annual follow-up.

CONCLUSION: In children with congenital glaucoma, internal fistula obliteration (both complete and partial) by the iris root, iridotrabecular or iridocorneal contact, fusion, or pigment may occur at the earliest stages after TE, which is an indication of laser refistulization. When the internal fistula is overgrown after TE in children with congenital glaucoma, YAG laser refistulization allows restoring the lumen of the internal fistula in 97.3% of cases. Therefore, for timely detection and elimination of the blockade, gonioscopic monitoring of the internal fistula is necessary both at the earliest possible time and in the long term after TE.

AIM: To develop a method for evaluating peripheral spatial contrast sensitivity and to use it in comparative studies of peripheral spatial contrast sensitivity in children with myopia under correction conditions with glasses with a highly aspherical lenslet (HAL) and single vision lenses (SVL).

MATERIAL AND METHODS: A method for evaluating peripheral spatial contrast sensitivity was developed, in which visual control was carried out with the patient’s gaze fixed in the forward direction using a remote binocular autorefractometer, and the test image was sent to the selected area of the retina periphery. The SVL values were evaluated in three ranges of spatial frequencies, namely, low (0.5–2.0 cycle/deg), medium (4.0 to 8.0 cycle/deg), and high (11.31–16.0 cycle/deg). Peripheral spatial contrast sensitivity was examined descriptively in 20 patients with low and moderate myopia. The age of the patients ranged from 8 to 13 (average, 11.4±1.5) years, and the degree of myopia ranged from −1.0 to −3.75 (average, −2.66±1.5 D). The patients were examined in glasses with HAL and in a trial frame with SVL correction.

RESULTS. In HAL, which induces volumetric myopic defocus on the periphery of the retina, the peripheral spatial contrast sensitivity was lower than that in the SVL. This decrease was most pronounced at medium and high spatial frequencies, where it reached 30–50%. The revealed differences in the peripheral spatial contrast sensitivity at high frequencies (8; 11.31 and 16 cycles/deg) were statistically significant: 7.5 and 10.8 at the frequency of 8 cycles/deg, 5.8 and 9.05 at the frequency of 11.31 cycles/deg, and 4.4 and 9.2 at the frequency of 16 cycles/deg, respectively.

CONCLUSION: The peripheral spatial contrast sensitivity in glasses with rings of HAL, compared with the peripheral spatial contrast sensitivity in SVL, is significantly reduced at high spatial frequencies.

AIM: To evaluate the effectiveness of combined anti-inflammatory and local dehydration therapy for CME in children with retinitis pigmentosa or uveitis of different etiologies.

MATERIAL AND METHODS: The study included two groups of children with cystic macular edema. In Group 1 CME developed against the background of retinitis pigmentosa, in group 2 against the background of uveitis. All children underwent subtenon injection of a prolonged steroid and instillations of carbonic anhydrase inhibitors 4 times a day. The results were evaluated after 1 month.

RESULTS: As a part of the ongoing therapy, all children received subtenon injections of long-acting corticosteroids and 4-times/day instillation of a carboanhydrase inhibitor for 1 month. Based on the present results, a tendency to increase the BCVA by 1–2 lines was noted in children with CME because of retinitis pigmentosa and in those with CME with uveitis. When assessing the thickness of the macular zone using optical coherence tomography, a significant difference was recorded relative to children with CME because the uveal process responded significantly better to the therapy. Thus, a significantly higher rate of resorption was demonstrated in macular edema.

CONCLUSION: The present results emphasize the importance of understanding the etiology of CME. The treatment of such children should be strictly pathogenetically directed. The combination of topical anti-inflammatory and dehydration therapy is the preferred choice of treatment for children with CME due to uveitis. This approach helps reduce cytokine inflammatory reactions, the activity of the inflammatory process, and the amount of fluid in the retina. In retinitis pigmentosa, the effect of photoreceptor decay products is weakly affected by anti-inflammatory therapy, and the dehydration therapy is short-term. Therefore, it is worthwhile to search for other ways to normalize the profile of the macular zone.

Premature newborns have a high risk of developing visual impairments. This study presents the experience of an organization dispensary ophthalmological observation as a stage of providing medical care to premature children in St. Petersburg and the prospects for its development.

AIM: To analyze the effectiveness of the organizational model of dispensary ophthalmological observation of premature children in St. Petersburg for 2020–2022.

MATERIAL AND METHODS: Reporting forms of the activities of interdistrict ophthalmological cabinet and reporting forms of medical and social expertise of Rosstat No. 7D were used.

RESULTS: In 2010, a system of specialized ophthalmological care for premature infants at the hospital stage was organized in St. Petersburg (screening and laser treatment of active ROP using telemedicine technologies; surgical treatment of late disease stages). In 2018, for the subsequent dispensary observation of premature children aged up to 3 years, six inter-district ophthalmological cabinets of follow-up were organized. A developed routing scheme for children at risk and with active and cicatricial ROP in St. Petersburg and preliminary results of ROP incidence were presented.

CONCLUSION: The activities of specialized inter-district follow-up cabinets primarily ensure continuity between hospital and outpatient services in the dynamic monitoring of children at risk and children with active ROP. In addition, professional competencies allow ophthalmologists to avoid mistakes in diagnosing the stage, monitoring the ROP course, and promptly referring patients for emergency treatment (laser or anti-VEGF therapy).