Vol 19, No 3 (2024)

AIM: To evaluate the dynamics of maximally corrected visual acuity and retinoschisis height in children with congenital optic pit during dynamic observation and determine the terms and indications for surgical treatment.

MATERIAL AND METHODS: During the examination and follow-up of 22 patients (23 eyes), two groups were identified. Group 1 included 11 patients (11 eyes) who underwent surgical treatment because of the negative dynamics of BCVA (more than 0.1 in 6 months) and an increase in the formation of neuroepithelial detachment (NED) found in optical coherence tomography (OCT). Group 2 consisted of 11 patients (12 eyes) who had no significant deterioration in BCVA and had a stable OCT pattern for 6 months. The patients from group 2 were only under dynamic supervision. The dynamics of BCVA after surgery in the presence of indications and the stability of BCVA in the case of dynamic observation in the absence of negative dynamics were compared.

RESULTS: In the absence of a decrease in BCVA by more than 0.1 and without progression of neuroepithelial detachment, according to OCT data, only dynamic monitoring is required. Surgical treatment of complications with fovea should be performed according to indications. The treatment leads to gradual (up to 15–18 months) regression of retinoschisis and detachment of the retinal neuroepithelium and increases and stabilizes the BCVA.

CONCLUSION: If there are signs of progression of the process (decreased visual acuity, increased height and extent of detachment, edema, and separation of the retinal neuroepithelium), the patient should be referred to a vitreoretinal surgeon for surgical treatment 6 months after the initial examination, with a decrease in the maximum corrected visual acuity by more than 0.1 with concomitant negative dynamics according to optical coherent tomography in the form of increased detachment of the neuroepithelium.

AIM: The study aimed to assess the influence of combined optical and pharmacological effects on the anatomical and functional parameters of the eyes and changes in refraction in pediatric patients with progressive myopia.

MATERIAL AND METHODS: Bifocal soft contact lenses (BSCL) Prima BIO Bifocal were prescribed to 43 pediatric patients. At the start of the study, the average age of the children was 10.42±0.26 years, and the average myopia was 3.43±0.19 D. The effect of a combination of optical and medicinal products on the visual apparatus of children was evaluated, namely, bifocal SCLs that form peripheral myopic defocus and instillations of a combined drug containing 0.8% tropicamide and 5% phenylephrine. The combined eye drops, which contained 0.8% tropicamide and 5% phenylephrine, was prescribed once a day at night for 1 month to 23 pediatric patients after wearing the lenses for 1 month (group 1). In group 2 (n=20), patients did not receive any additional treatment, except for optical exposure.

RESULTS: The habitual tone of accommodation (HTA) slightly increased after 1 month of using BSCL. In group 1, the HTA decreased to the initial level after 6 and 12 months, whereas it remained high in group 2. Over the year, refraction increased by 0.39 D in group 1 and 0.18 D in group 2 (p >0.05). The annual progression gradient decreased by 2.3 times in group 1 and 5.2 times in group 2. Over the year, the anteroposterior axis increased by 0.13 mm in group 1 and 0.05 mm in group 2. Choroidal thickness increased by 19.09 and 24.77 µm, relative accommodation reserve increased by 0.98 and 1.24 D, and the accommodation amplitude increased by 1.28 and 1.05 D, respectively.

CONCLUSION: BSCLs contribute to the reduction of the annual gradient of progression (AGP) and increase in accommodation and choroidal thickness. Instillations of the drug while using BSCL help reduce the habitual tone of accommodation (HTA).

Retinopathy of prematurity (ROP) is one of the most common causes of visual disability in children born prematurely. Intravitreal injection of angiogenesis inhibitors (antivascular endothelial growth factor [VEGF] therapy) is considered one of the conservative methods of treating ROP.

Aim: This study aimed to present a clinical case of ROP reactivation after intravitreal injection of the antiVEGF drug ranibizumab (Lucentis).

MATERIAL AND METHODS: The course of retinopathy in a premature infant with extremely low birth weight was studied.

RESULTS: A patient diagnosed with ROP, a posterior aggressive form of both eyes, received intravitreal injections of an angiogenesis inhibitor at 36 postconceptional weeks. During subsequent follow-up, disease progression was noted, which necessitated repeated ranibizumab administrations to both eyes. Over time, tractional retinal detachment developed in the right eye, and the disease progressed more slowly in the left eye. At the age of 1 year, ROP rapidly progressed to stage 4B in the left eye. Lens vitrectomy was performed sequentially on the right and then on the left eye. At the age of 1.5 years, the patient had coarse preretinal adhesions in the posterior pole of both eyes and had no spatial vision, whereas light perception was preserved.

CONCLUSION: Intravitreal ranibizumab administration for posteriorly aggressive ROP does not exclude its reactivation both early and late after administrations. Further improvement in treatment methods for ROP is necessary.

Retinopathy of prematurity (ROP) is the leading cause of visual disability from early childhood. Foreign researchers and clinicians are focused on studying a new pharmacological method of treatment of active RN using anti-VEGF drugs, which was a reason that prompted updates in the International Classification of Retinopathy of Prematurity (ICROP) in 2021. The second part of the article presents new terms recommended by the Committee for the ICROP: “regression,” which refers to the involution and resolution of the disease, and “reactivation,” which denotes a recurrence of signs in the acute phase. Notably, the latest edition of the ICROP requires a deep understanding and accurate application by domestic specialists treating ROP. This contributes to the standardization of therapeutic and diagnostic processes, therefore, improving the quality of ROP treatment in Russia.

The article presents the results of the analysis of the dynamics of the main performance indicators of the pediatric ophthalmology service from 2014 to 2022. The number of ophthalmology offices (from 6.262 in 2014 to 6.037 in 2022) and children’s ophthalmology beds (from 2.,558 to 2.094) decreased, and the number of ophthalmologists decreased by 681 individuals, 7.3% of the total, in the Russian Federation. The provision of ophthalmologists and ophthalmology beds per 10,000 individuals in 2022 is presented for individual federal districts (FDs) of the Russian Federation. To date, North Caucasus FD and Southern FD received the lowest provision with ophthalmologists per 10,000 individuals (0.69 and 0.68, respectively), whereas Northwestern FD and Far Eastern FD received the highest provision (1.03 and 0.89, respectively). The number of visits to ophthalmologists by children, including for preventive purposes, decreased, and the efficiency of preventive examinations increased, which led to an increase in the proportion of diseases detected during routine examinations by nearly three times. The paper presents the detection rate of ophthalmological diseases during preventive examinations in children by FDs in 2022. On average, the coverage of regular medical check-ups of children with ophthalmological diseases in the Russian Federation has increased (from 25.5% in 2014 to 42% in 2023), and the values of this indicator in individual FDs in 2022 are indicated. The highest and lowest coverage of regular medical check-ups were noted in the Siberian FD (54.0%) and Far Eastern FD (33%), respectively. The indicators of overall and primary morbidity of ophthalmological diseases in general and individual nosological forms, blindness, low vision, and disability were analyzed. The dynamics of surgical activity indicators in the FDs of the Russian Federation are presented.