Vol 19, No 2 (2024)

AIM: The study aimed to analyze the influence of various factors on the efficiency of trabeculectomy in pediatric patients with congenital glaucoma.

MATERIAL AND METHODS: The results of 945 trabeculectomies, including those with various modifications and the use of drains, in pediatric patients with congenital glaucoma were analyzed in the Department of Pediatric Eye Pathology of the Helmholtz National Medical Research Center for Eye Diseases for 1997–2023.

RESULTS: The efficiency of trabeculectomy in pediatric patients with congenital glaucoma was 91.9%–98.5% in the immediate period (up to 6 months) after surgery, 75.5%–86.5% in the long term (after 5 years), and 34.2%–42.1% with repeated surgeries (up to 3–4 surgeries) during follow-up up to 10 years, which is comparable with literature data.

CONCLUSION: The main factors that influence the efficiency of trabeculectomy in pediatric patients with congenital glaucoma include age at the time of detection and surgical treatment of congenital glaucoma, their somatic health, glaucoma stage, and severity of destructive changes in the eye, particularly the congenital ones, presence of repeated surgeries, erroneous choice of the trabecular site subject to excision during surgery, injury rate of trabeculectomy (quality of incision of the conjunctiva, sclera, injury rate of vessel coagulation during surgery, and skill of the surgeon), presence of intra- and postoperative complications, untimely detection and YAG laser elimination of the internal fistula fusion after trabeculectomy, and inadequate management of the postoperative period.

AIM: This study aimed to analyze retrospectively the status of closed-eye injuries in children based on clinic data of the Tashkent Pediatric Medical Institute (TashPMI) from 2018 to 2022.

MATERIAL AND METHODS: The study analyzed TashPMI clinic’s reporting records for 2018–2022.

RESULTS: During the reporting period, 5,938 patients with various diseases of the eye and its appendages were treated. Of these, 1,438 (24.2%) patients were diagnosed with eye traumas and their complications. Among complications of closed eye injury, retinal detachment and traumatic cataracts accounted for 8.3% and 7.5%, respectively. Closed eye injury were more common among boys (57.2%) aged 5–14 years (64.4%). From 2018 to 2022, the number of patients with post-contusion retinal detachment declined, despite a persistent upward trend in the number of hospitalized patients with blunt traumas. This decline was likely due to the timely diagnosis and treatment of these injuries in the acute period.

CONCLUSION: For 2018–2022 in TashPMI clinic, patients with closed-eye injuries accounted for 7% of the total number of hospitalized patients and 28.9% of the total number of injuries. The number of patients with closed-eye injuries tended to increase over 5 years, both in relation to the total number of hospitalized patients and the total number of patients with injuries and their complications for each year separately. The results of the retrospective analysis of closed-eye injuries in children based on TashPMI clinic data demonstrated the urgency of treating ophthalmic injuries in children, which requires prevention, prompt first aid, and specialized high-tech assistance.

AIM: This study aimed to analyze clinical cases of spontaneous macular hole (MH) closure in children and determine the optimal approach for managing patients with this disease.

MATERIAL AND METHODS: Data from 32 patients aged 6–17 years (average: 11.3 years) were evaluated, including 32 eyes with a full thickness macular hole and 1 eye with a lamellar macular hole. All patients were treated in the Department of Pediatric Ocular Pathology of the Helmholtz National Medical Research Center of Eye Diseases in 2013–2023. They underwent a comprehensive ophthalmological examination, including optical coherence tomography (OCT) of the macular area.

RESULTS: Spontaneous MH closure was observed in five eyes (15.2%) of five patients (15.6%). The etiological factor of the disease was ocular contusion in two cases, photodamage in one case, and an inflammatory process in the posterior segment of the eye in two cases. A small diameter MH (100–261 µm) and its overgrowth soon after formation were common to all patients, that is, less than 2 months in 3 of 5 children and within 6 months in all patients.

CONCLUSION: Spontaneous closure of MH with a small diameter and in the early stages after its formation is rare in pediatric patients. For MH with a diameter of up to 200 µm according to OCT and the absence of other indications for surgical treatment, a wait-and-see approach for 3 months with regular (once a month) examination is recommended. In cases with MH closure tendency, continued follow-up is crucial; if it persists after 3 months or increases at any period of follow-up, surgical treatment is indicated.

The literature review presents modern treatment aspects for anterior optic pathway gliomas (OPGs), which are low-grade brain tumors accounting for 20%–30% of childhood gliomas, can occur anywhere along the visual pathways and in the development of the surrounding structure, and are predominantly benign. The predominant histological type of tumor in this localization is piloid astrocytoma (PA), less commonly pilomyxoid astrocytoma (PMA). However, the course of anterior OPGs is unpredictable and varies from spontaneous regression to progression with severe visual, neurological, and endocrine disorders, affecting treatment and disease prognosis. Although there have been advances in clinical studies based on histological and molecular genetic analyses, no fundamental changes in survival rates and recurrence-free periods and improvements in functional outcomes have been achieved. Furthermore, no studies have comprehensively analyzed the functional results depending on the management tactics of pediatric patients with anterior visual pathway gliomas. Anterior optic pathway glioma treatment is challenging and complex problem, which depends on the patient’s age, clinical picture, localization, surgical resectability, and histological and molecular genetic study results. It includes surgical treatment, chemotherapy, radiation therapy, the use of targeted therapy drugs, and additional advanced techniques that are still under development and research. Optimal treatment of anterior optic pathway gliomas in children remains a topic of discussion in the current literature.