Vol 18, No 2 (2023)

AIM: To determine the content of plasminogen and urokinase activator of plasminogen in tears and blood serum and to identify correlations between the studied parameters and the clinical picture of uveitis.

MATERIAL AND METHODS: One hundred thirty-three eyes with uveitis were examined in 74 patients aged 3 to 17 yr (average 10.45±3.35 yr). The content of the urokinase activator of plasminogen (UPA) was studied in 188 tear samples and 22 blood serum samples. The dynamics of UPA in tears were studied in 28 patients (51 eyes). The plasminogen content of 86 tear samples and 34 blood serum samples was studied. The dynamics of plasminogen in tears were studied in five patients (nine eyes). The concentrations of UPA and plasminogen were measured using the ELISA method and the kits “ELISA kit for plasminogen activator, urokinase (UPA)/ELISA Kit for Plasminogen”, Cloud-Clone Corp., USA).

RESULTS: An increase in the content of UPA in the tears of children with uveitis was associated with higher inflammatory activity (p=0.04). An increase in the content of UPA in tears was associated with an increase in the degree of proliferative changes (p=0.04). An increase in the content of UPA and plasminogen in tears was found 1–2 months after surgery. There was an increase in the content of UPA (p=0.0001) and plasminogen in tears (p=0.009) and blood serum (p=0.09) with age.

CONCLUSION: The content of UPA in tears increased significantly when severe uveitis was compared with inactive uveitis. An increase in the content of UPA in tears was associated with an increase in the degree of proliferative changes, which reflects the severity of the uveitis course. The content of UPA and plasminogen in tears and blood serum increased with age. An increase in UPA and plasminogen was observed within 1–2 months after surgery, with both returning to preoperative values by the third month of the postoperative period, which reflects the normal course of the wound healing process.

Gyrate atrophy is a rare genetic metabolic disease with an autosomal recessive inheritance that causes progressive chorioretinal atrophy, fundus manifestations, and decreased visual function. The prognosis of the disease largely depends on the development and progression of complications (macular changes and cataracts) as well as concomitant neurological and somatic pathology.

AIM: To describe three clinical cases of hypertension.

MATERIAL AND METHODS: We examined three children with gyrate atrophy at 4, 10, and 15 years old. All patients underwent a comprehensive ophthalmological examination, including modern diagnostics, visualization, and electrophysiological studies.

RESULTS: Although older patients have more pronounced changes in the fundus with involvement of the macular zone in the pathological process, a 4-year-old child has pronounced functional retinal disorders detected during electroretinogram registration, indicating an earlier manifestation of the pathological process. Gyrate atrophy was combined with foveoschisis and ornithinemia in older patients (10 and 15 years old).

The differential diagnosis of gyrate atrophy should be carried out with high myopia with areas of dystrophy of the “cobblestone pavement” type on the periphery of the fundus, resembling foci of chorioretinal changes in hypertension.

CONCLUSION: Patients with gyrate atrophy require an interdisciplinary approach that includes not only ophthalmologists but also pediatricians, medical geneticists, and other specialists with comorbidities.

AIM: To investigate the etiopathogenesis and clinical features of dry eye syndrome in children, methods for diagnosing the disease, and the treatment algorithm.

MATERIAL AND METHODS: One hundred eighty-seven children with dry eye syndrome aged 3 to 17 yr were examined. To diagnose dry eye syndrome in children, the following research methods were used: biomicroscopy of the anterior part of the eye under diffuse illumination and with a cobalt filter after instillation of vital dyes; examination of the height of the lacrimal meniscus; identification of a characteristic discharge in the conjunctival sac, xerosis of the ocular surface; and evaluation of tear production (Schirmer I test) and stability of the tear film.

RESULTS: We found that the links in the pathogenesis of dry eye syndrome in children were as follows: diseases of the ocular surface and appendage of the eye, contact correction of ametropia, and surgical operations on the conjunctiva and oculomotor muscles; otogenic neuritis of the facial nerve; rheumatoid arthritis; endocrine ophthalmopathy; lagophthalmos; and thermal and chemical burns. It is now always possible to evaluate tear production and tear film stability in preschool and primary school-aged children. In this case, the main diagnostic method is biomicroscopy. We identified objective clinical symptoms of dry eye syndrome in children using biomicroscopy. Dry eye syndrome was classified into four degrees of severity: mild, moderate, severe, and extremely severe. The subjective and objective clinical signs of each disease severity are described.

An individual approach and personalized therapy are required to treat dry eye syndrome in children, focusing on the individual tolerability and effectiveness of the drug. Maximum medical alertness and early and accurate clinical differential diagnosis between dry eye syndrome and infectious inflammatory pathology of the anterior part of the eye are required.

CONCLUSION: The features of the etiopathogenesis of dry eye syndrome in children with various nosologies are examined, and the characteristic clinical symptoms and severity of dry eye syndrome, diagnostic methods, and algorithm for treating dry eye syndrome in children are described. The clinical and diagnostic features of dry eye syndrome in children described by us contribute to its early diagnosis, allowing for the initiation of personalized tear replacement and reparative therapy on time, preventing the development of a chronic course of the disease, the occurrence of complications, and the preservation and/or restoration of visual acuity.