Vol 19, No 4 (2024)

AIM: To investigate the role of proteolytic enzymes and their inhibitors in endogenous uveitis in children and develop new diagnostic criteria.

MATERIAL AND METHODS: A total of 76 children (135 eyes) aged 3 to 17 years with uveitis were examined. All children underwent standard ophthalmological examination, posterior segment optical coherence tomography (OCT) was performed if required. Location, course, and activity of uveitis were assessed as per criteria developed by the International Uveitis Study Group. All patients underwent tear and serum biochemistry analysis, aqueous humor was tested if surgical treatment was required. Alpha-2-macroglobulin (α2-MG), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), urokinase-type plasminogen activator (uPA), and plasminogen (PG) levels were determined. Concentrations of α2-MG were measured by an enzymatic method using a specific substrate Nα-benzoyl-DL-arginine 4-nitroanilide (DL-BAPNA). MMP-9, TIMP-1, uPA, and PG levels were determined using an enzyme linked immunosorbent assay (ELISA). A total of 64 children (84.2%) were followed-up. The analysis included 1143 tear, 283 serum, and 79 aqueous humor samples.

RESULTS: Active uveitis was found to be associated with activation of proteolytic enzymes and their inhibitors resulting in increased tear uPA levels, as well as increased uPA, MMP-9, and TIMP-1 levels in aqueous humor. Tear uPA level exceeds 80.7 pg/mL in active uveitis, ranges from 46.6 to 80.6 pg/mL in moderate/subactive disease, is less than or equal to 46.5 pg/mL in inactive phase/remission; it is one of the objective criteria to determine uveitis activity. In patients with panuveitis, tear MMP-9, PG, and α2-MG levels were higher compared to the children with anterior and peripheral uveitis.

CONCLUSION: New data on the role of the proteolysis system in the pathogenesis of endogenous uveitis in children have been obtained. New criteria for assessing uveitis activity and severity have been established based on proteolytic enzymes and their inhibitors levels in tear fluid. The obtained results can be used to develop targeted therapy.

Current methods to slow myopia progression based on the theory of peripheral defocus have shown their efficacy when used as spectacle, contact, and orthokeratology lenses. Spectacle lenses with highly aspherical microlenslets (Stellest®) were introduced into clinical practice in 2020, and their efficacy was rated highly in different studies.

AIM: To investigate peripheral defocus imposed by Stellest® spectacle lenses in myopic children.

MATERIAL AND METHODS: Peripheral refraction (PR) was evaluated in 42 children (84 eyes) with low-to-moderate myopia. Patients of Group 1 (42 eyes) were examined under cycloplegic conditions, without correction and with HAL spectacle lenses, in the primary position and different directions of gaze, 15° and 30° temporally (T) and nasally (N) from the fovea. Patients of Group 2 (42 eyes) were examined under mydriatic conditions, without correction and with HAL spectacle lenses, 5°, 10°, 15° nasally and temporally from the fovea, in the different directions of gaze. PR was measured using the Grand Seiko WAM-5500 open-field binocular autorefractor. To calculate peripheral defocus, central (axial) refraction was subtracted from the peripheral spherical equivalent taking into account the +/− sign.

RESULTS: HAL spectacle lenses reduced hyperopic defocus and imposed a myopic one in all tested areas of the near retinal periphery; the differences at N5 and N10 points were statistically significant (р < 0.05). At N15 point ocular movements imposed myopic defocus of −0.26 D (р < 0.05). There is also a trend towards a decrease in hyperopic defocus at T15 and N30 points.

CONCLUSION: The first study of peripheral refraction with HAL spectacle lenses (Stellest®) helped demonstrate that the lenses imposed myopic defocus on the retinal periphery, with the greatest defocus on the near nasal periphery.

AIM: To analyze etiopathogenesis, clinical features, and a treatment algorithm for acute anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis in order to increase medical awareness of herpes zoster in children.

RESULTS: Long-term exposure to rapid temperature changes contributed to varicella-zoster virus (VZV) reactivation in a child leading to herpes zoster rarely occurring in children, onset of anterior diffuse scleritis and hypopyon anterior uveitis. Corticosteroid therapy without causal treatment led to herpes virus reactivation in the patient’s cornea which contributed to herpes corneal ulcer.

CONCLUSION: Etiopathogenesis features were analyzed, characteristic clinical symptoms of anterior diffuse scleritis, herpes corneal ulcer, and hypopyon anterior uveitis caused by varicella-zoster virus (VZV) reactivation were described. Reactivation led to herpes zoster with skin eruption and herpes zoster ophthalmicus, such as injury of the ophthalmic branch of the trigeminal nerve without extraocular (skin) symptoms of herpes infection. The VZV etiological role was established based on high titers of anti-VZV IgG antibodies, the presence of anti-VZV-gE IgG antibodies (markers of active viral replication), and the efficacy of anti-herpes therapy. The described clinical symptoms of combined ophthalmic pathology contribute to the early diagnosis of ocular herpes for timely antiviral herpes therapy to prevent chronic disease and complications and to preserve and/or recover visual acuity.

Myopia is the most common cause of impaired distance vision. It can lead to pathological myopia and associated serious complications if progresses to a higher grade. Given the high prevalence of myopia among children and adolescents, it is becoming a medical and social problem. The paper provides a review of lectures and discussions of the 19th International Myopia Conference held in September 2024 in China. Conference papers show that scientists and clinicians are focused on comprehensive investigation of the mechanism of myopia development, identification of its predictors and genetic aspects. A lot of focus is on the elaboration of effective treatment and preventive measures for children of preschool age and older, particularly new pharmacological approaches and improved optical correction methods to control myopia.