Vol 17, No 1 (2022)

The clinical diagnosis of cytomegalovirus (CMV) eye pathology in children needs laboratory confirmation. The disadvantages of determining antibodies to CMV in serum in enzyme-linked immunosorbent assay (ELISA) include the presence of false positive and false negative results.

AIM: To determine the features of the synthesis of antibodies to the proteins of the tegument pp65, pp150, pp28 and the DNA-binding protein pp52 of cytomegalovirus, as well as to compare the diagnostic effectiveness of two laboratory methods of serodiagnostics of CMVI in children with uveitis and keratitis of different genesis: enzyme immunoassay and linear immunolysis.

MATERIAL AND METHODS: A total of 30 children (age 5–16 years) with uveitis (n=14) and keratitis (n=16) were included in the study. The IgM and IgG antibodies to the immediate early (IE) and late antigens of the virus (serological markers of primary, chronic, and reactivation of chronic infection) were determined in the ELISA. The IgG antibodies to individual recombinant CMV antigens containing only immunodominant protein fragments of viral antigens were studied in the line immunoassay (LIA): the main nonstructural IE protein, DNA-binding phosphoprotein p52, and phosphoproteins of the tegument p150, p65, and p28. The results of LIA were evaluated visually.

RESULTS: CMV infection (CMVI) in children with uveitis in ELISA was almost 2 times higher than that with keratitis (10/14%–71% vs. 6/16%–37.5%, p >0.05). Of the four positive results for detection of antibodies to IE antigen in ELISA, one was confirmed in LIA. In general, the discrepancy between the results of the determination of IgG antibodies to IE antigen in ELISA and LIA was noted in 13% of serum samples. LIA showed the increased frequency (p >0.05) and intensity (p <0.05) of antibody formation to viral antigens p65 and p52 in uveitis compared with keratitis, which confirmed the important role of CMVI in the pathogenesis of uveitis.

CONCLUSION: Both methods revealed a higher level of CMVI in children with uveitis than those with keratitis. IgG antibodies to IE-antigen serological markers of the reactivation of chronic CMVI have clinical importance because they serve as the basis for the appointment of antiviral therapy. Discrepancies between the results of ELISA and LIA in the detection of antibodies to IE antigen indicate the expediency of confirming the results of ELISA in LIA.

Thus, laboratory examination of sera in ELISA with subsequent analysis of antibodies to individual recombinant CMV antigens in LIA is an effective, highly sensitive, and highly specific method to verify CMVI and determine its activity. The most informative action is the determination of IgG antibodies to recombinant CMV antigens: IE antigens, p65, and p52.

AIM: On the basis of studying the causes of errors in finding the trabecular zone to be excised during trabeculectomy in children with congenital glaucoma, this study presents a proven and effective method for simple intraoperative localization of the trabecular area.

MATERIAL AND METHODS: The analyses of many years of experience in the examination and treatment of children with congenital glaucoma at the Department of Eye Pathology in Children of Helmholtz National Medical Research Center (100–200 children annually) revealed the anatomical and morphological features of the eyes of children with congenital glaucoma and the reasons for the insufficient effectiveness of trabeculectomy.

RESULTS: A retrospective gonioscopic analysis of the condition of the operation area and internal fistula after trabeculectomy in children with congenital glaucoma showed that erroneous choice of the area of the trabecular region to be excised during surgery is one of the reasons for the inefficiency of trabeculectomy, and it results from the incorrect determination of the projection location of the apex of anterior chamber angle (ACA) onto the sclera caused by the significantly distorted anatomical parameters of the child’s eye due to the softness and extensibility of the limbus and sclera. On the stretched eyes of children with congenital glaucoma, especially those with buphthalmos and cloudy cornea, accurate determination of the boundaries of the altered cornea, limbus, and projection of the ACA’s apex onto the sclera is visually impossible.

CONCLUSION: During trabeculectomy of the eyes of children with congenital glaucoma, for the accurate localized projection of the apex of the ACA’s onto the sclera and the trabecular zone to be excised, a simple and accessible method of clarifying diaphanoscopy intraoperatively must be used to correctly select the trabeculectomy zone, especially on stretched eyes.

Retinopathy of prematurity (ROP) is still one of the main causes of blindness and low vision from early childhood in developed countries and therefore remains the focus of attention of researchers and clinicians. The International Classification of Retinopathy of Prematurity (ICROP) was initially adopted in 1984, expanded in 1987, amended in 2005, and revised in 2021. Part 1 of this article discusses the new edition of the ICROP3. The reasons for updating the ICROP3 and the composition of the International Committee, which was specially organized for this purpose, are indicated. The new and third edition retains the current definitions (zone, stage, and extent of the disease). The main updates in ICROP3 include the improved classification of indicators, two of which, in the author’s opinion, are most significant for the acute stages of the disease. The definition of posterior zone II region and the recognition that retinal vascular changes in ROP represent a continuous spectrum from normal to preplus- and plus disease, with images demonstrating this range. In conclusion, the new edition of the ICROP3 requires a deep reading and discussion between domestic experts and must be introduced to clinical practices and the educational process. The next article will continue the discussion on the remaining additions/updates to ICROP3.

INTRODUCTION: Dacryocystocele (hydrops of the lacrimal sac) is a rare variant of a congenital pathology caused by the obstruction of proximal and distal lacrimal ducts, followed by progressive distension of the lacrimal sac [1]. Given the accumulation of abundant contents in the lacrimal sac and nasolacrimal duct, the membrane that closes their outlet under the inferior turbinate can be stretched, and the prominence of such a membrane into the inferior nasal passage is in the form of the so-called nasolacrimal cyst [3].

Description of the clinical case. A 1.5-month-old girl was hospitalized in the ophthalmology department of the University. Below are the history data. At the 30th week of pregnancy, the fetus had a bilateral space-occupying lesion in the area of the inner canthus of the eye. At birth, the child had a dense swelling in the region of the left lacrimal sac but without discharge. From birth, he had difficulty in nasal breathing.

RESULTS: According to the results of multislice computed tomography of the lacrimal ducts with contrast (Ultravist), cavity formations were found under the inferior turbinate on both sides with a contrast level. At the age of two months, the child, accompanied by an otolaryngologist, underwent surgery for the removal of nasolacrimal cysts on both sides and reconstruction of the lacrimal ducts and their intubation with a silicone thread on the left. After surgical treatment, the outflow of tears and nasal breathing were restored, and no signs of dacryocystocele were detected. The silicone thread was removed after 1 month, and no tear production was observed.

DISCUSSION: Treatment of children with dacryocystocele involves the simultaneous reconstruction of lacrimal ducts by an ophthalmologist and excision of the nasolacrimal cyst by an otolaryngologist.

CONCLUSION: When examining a child with dacryocystocele, the possible presence of a nasolacrimal cyst should be considered. The interaction of an ophthalmologist and an otolaryngologist at all stages of the treatment and diagnostic process enables the prevention of disease complications and unnecessary surgical procedures.

The article is devoted to reviewing the problems that were discussed in the section «Pediatric ophthalmology», organized for the first time within the Russian scientific and practical conference with international participation in «Laser intraocular and refractive surgery». The conference was held on December 10–11, 2021 in St. Petersburg and organized by the St. Petersburg branch of S. Fyodorov «Eye Microsurgery» Federal State Institution with the support of the Society of Ophthalmologists of Russia and North-Western State Medical University named after I.I. Mechnikov. In the pediatric section, 11 reports were made by leading Russian and foreign experts, and the topics were mainly related to the use of laser technologies in ophthalmopediatric practice. The discussion focused on the issues of diagnosis and laser treatment of premature retinopathy and other retinal diseases, modern approaches and results of surgical and contact correction of ametropias (keratoconus, hypermetropia, and progressive myopia) in childhood, and clinical cases of the effectiveness of complex treatment of bilateral retinoblastoma. In conclusion, an overview of new portable technologies for visualization of the state of anterior and posterior eye parts was presented, which is especially important for pediatric ophthalmologists.