Vol 18, No 3 (2023)

AIM: To analyze the etiology and pathogenesis and identify clinical and diagnostic features, development of a diagnostic algorithm, and personalized treatment of scleritis in children.

MATERIALS AND METHODS: Twelve children with mono- and bilateral scleritis with disease duration of 3–9 months were observed. Biomicroscopy, ophthalmoscopy, and ultrasonography of the eyes were performed. The examination plan included consultations with a rheumatologist, otorhinolaryngologist, and dentist and laboratory blood analysis in the enzyme immunoassay to detect the presence of IgG and IgM antibodies to herpes viruses and markers of their reactivation.

RESULTS: Chronic scleritis in 58.4% of the patients was associated with immunoinflammatory rheumatic diseases: 41.7% with juvenile idiopathic arthritis and 16.7% with psoriatic arthritis. In some cases scleritis was associated with chickenpox, surgical treatment of congenital pigmented nevus of the skin of eyelids,n on the conjunctiva and oculomotor muscles, otogenic neuritis of the facial nerve. Сlinical features of anterior deep scleritis and symptoms of bacterial scleritis are described. Personalized schemes for the diagnosis and treatment of scleritis in children have been developed. Conservative treatment included instillation of glucocorticoids and non-steroidal anti-inflammatory drugs. In addition, to anti-inflammatory therapy, antibacterial drugs are prescribed only in the presence of clinical signs of bacterial scleritis; in other cases, their use is inappropriate. The indications for antiviral therapy included laboratory confirmation of herpes infection reactivation. Personalized etiotropic therapy made it possible to achieve remission of scleritis in 9–14 days.

CONCLUSION: This study analyzed the etiopathogenesis of scleritis, described the characteristic clinical features of anterior deep scleritis in children, and developed personalized diagnostic and treatment schemes.

AIM: This study aimed to evaluate the density parameters of the superficial and deep plexuses of the retina, choriocapillary layer, and avascular zone in eyes with amblyopia of various origins and paired fellow eyes.

MATERIAL AND METHODS: The study included 40 patients aged 6–16 (mean, 8.72±3.04) years. All patients were divided into 2 groups: group 1 included amblyopic, dysbinocular, and anisometropic eyes (n=48), and group 2 (control group) included paired fellow eyes without amblyopia (n=32). The density of the superficial and deep vascular plexuses of the retina, choriocapillary layer, and avascular zone parameters (area, perimeter, and circumference) were evaluated using spectral optical coherence tomography (RS-3000 Advance 2, Nidek, Japan). Correlation analysis was performed using Pearson’s linear correlation coefficient (r).

RESULTS: No significant differences were found in the density of the superficial and deep retinal vessels, choriocapillary layer, and avascular zone parameters of the retina in eyes amblyopia of various origins compared with paired fellow eyes (p >0.05). No correlation was found between retinal perfusion data and functional and anatomical parameters of amblyopic eyes.

CONCLUSION: No relationship was noted between the vascular parameters of the posterior pole of the eye and the maximally corrected visual acuity, which confirms the absence of changes in retinal perfusion in amblyopia and excludes its role in the pathogenesis.

Eye drops that affect dynamic refraction and pupil width can enhance the effect of optical treatment by forming relative peripheral myopic defocus on the refractogenesis of children with myopia.

AIM: To evaluate the effect of combined optopharmacological effects on the dynamics of central and peripheral refraction, accommodation, visual function, and choroid thickness in children with progressive myopia.

MATERIAL AND METHODS: The study involved 40 children aged 8–13 years with myopia from 1.75 to 6.37 dptr. These children were given glasses forming peripheral myopic defocus for the first time. Of these, 20 children, after 1 month, were prescribed combined eye drops containing 0.8% tropicamide and 5% phenylephrine.

RESULTS: One month from the start of wearing glasses, the monocular visual acuity with glasses was 0.94±0.02. After the eye drop application, the visual acuity with glasses significantly increased to 1.06±0.02 (p <0.01). This was explained by a significant decrease in the usual tone of open-field accommodation (PTA-OP) to +0.01±0.04. A clinically significant (p <0.05) increase in relative accommodation reserves (ZOA) by 0.71 dptr was revealed, and opto-pharmacological effects were not observed on mesopic contrast sensitivity and peripheral refraction. Choroid thickness increased by 4.7%.

CONCLUSION: During the observation period, accommodation tended to normalize, and the thickness of the choroid increased clinically significantly. Further observations are needed to evaluate the effectiveness of combined optopharmacological treatment in comparison with optical exposure.

The incidence of mucormycosis, an opportunistic infection, has been increasing worldwide in recent years. This is primarily due to the spread of coronavirus disease 2019 and the increase in the number of at-risk populations. Risk groups include patients with conditions or diseases, such as diabetes, neutropenia, organ or stem cell transplantation (on immunosuppressive therapy), trauma and burns, hematological disorders, and steroid therapy. The basis of successful treatment includes early diagnosis based on the detection of the first nonspecific signs of the disease in patients at risk, rapid verification of pathogens, earliest possible start of etiotropic therapy, and prompt and aggressive surgical treatment (necrectomy). This study presents a clinical case of rhino-orbital mucormycosis in a child at risk. The patient had Alagille syndrome and was followed up from the age of 2 years. The syndrome is characterized by an insufficient number or the small diameter of the intrahepatic bile ducts that remove bile from the liver and lead to the development of liver cirrhosis. Liver transplantation is the only radical treatment method for liver cirrhosis in the absence of gross defects. By the age of 8 years, the syndrome led to liver cirrhosis, and in 2020, hepatectomy was performed, including orthotopic transplantation of a liver fragment from a related donor (aunt). The patient subsequently received immunosuppressive therapy. The article also described the changes in the clinic and imaging methods and stages of treatment by day. Clinical manifestations of mucormycosis appeared on day 6 of hospitalization, that is, edema of the left lower eyelid. The severe general condition of the child did not allow for early surgical treatment with the excision of necrotic tissues. Unfortunately, the patient died. Thus, possible errors in diagnosis and treatment were analyzed.