Vol 17, No 4 (2022)

AIM: To investigate the morphometric parameters of the macular zone in children with pseudophakia and different refractive states after congenital cataract extraction in infancy and their correlations with vision parameters.

MATERIAL AND METHODS: Thirty children (49 eyes) who underwent bilateral cataract surgery with primary intraocular lens (IOL) implantation, with a median age at surgery of 7.94±2.70 (2–12) months, were identified. These children were divided into two groups: group 1 with target refraction (n=18, 21 eyes) and group 2 with pseudophakic myopia (n=14,28 eyes). All patients were examined with the Nidek RS-3000 Advance two optical coherence tomography.

RESULTS: A significant reduction was found in the morphometric parameters in group 2 relative to that in group 1: foveal thickness (253.11±27.84 and 266.42±21.52 μm), average inner macula thickness (307.64±30.9 and 330.14±28.29 μm) and average outer macula thickness (281.17±22.51 and 298.78±28.23 μm), central choroidal thickness (221.87±79.04 and 311.94±68.38 μm), macular volume (7.99±0.71 and 8.76±0.49 mm³), and foveal volume (0.19±0.02 и 0,21±0.02 mm³). This can be due to axial elongation (24.72±2.18 and 21.28±1.55 mm). The correlation between the best-corrected visual acuity (BCVA) and macular volume was moderate in pseudophakic children (r=0.418; p <0.01).

CONCLUSION: The data indicate an impairment of the macular zone formation in children with pseudophakic myopia which to a certain extent can explain the decrease in functional prognosis.

AIM: Retinal and choroidal microvascular changes analysis in children with posterior and panuveitis using optical coherence tomography with angiography (OCTA) and determination of the possibility of using this method in activity assessment and disease monitoring.

MATERIAL AND METHODS: 24 children with uveitis were examined. The age of children was from 8 to 18 years old (38 affected eyes). All included patients were divided into two groups: with posterior uveitis (27 eyes) and with panuveitis (11 eyes). In each of the groups, subgroups with active and inactive uveitis were identified. In addition to the standard examination OCTA was performed. Foveal avascular zone (FAZ) area, perfusion density in the superficial and deep vascular plexuses of the retina (SVRP, DVRP) and also in the layers of choriocapillaries and large and medium vessels of the choroid were studied. The control group consisted of 10 paired healthy eyes.

RESULTS: Аll eyes with posterior and panuveitis were characterized by the irreversible decrease in perfusion density in DVRP. In eyes with active chorioretinitis was also detected the reversible decrease in perfusion density in SVRP, layers of choriocapillaries and large and medium vessels of the choroid. The formation of choroidal neovascular membranes (CNM) in patients with panuveitis with choroiditis was accompanied by the decrease in perfusion density at all levels studied. In eyes with chorioretinitis and CNM the decrease in perfusion density was detected in DVRP and the area of FAZ increased.

CONCLUSION: The features of microcirculation in the chorioretinal complex identified using OCTA in children with posterior and panuveitis can improve the diagnosis and monitoring of these diseases.

A clinical case is presented in a 62-year-old patient. Based on anamnesis, the patient had congenital dacryocystitis, for which repeated probing was performed at the age of 2–4 years. This treatment did not have a positive effect. Irregular conservative treatment and prolonged self-message of the lacrimal sac area resulted in complications: a significantly enlarged lacrimal sac, difficulty in moving the eyeball, double vision, and pronounced discomfort. Objectively, the patient had a tense moderately painful formation in the area of the inner corner of the eye slit, which displaced and deformed the lower eyelid. The right eye was deflected outward to 7°–8° Girshberg, its mobility was significantly limited in the inner and lower-inner part and slightly limited in the lower part. On computed tomography, the lacrimal sac significantly shifted into the orbit, the posterior part of the lacrimal sac was located behind the equator of the eyeball, and the size of the lacrimal sac was 1.5 times that of the eye. The enlarged lacrimal sac (dacryocele) induced the deviation of the eyeball outward with the appearance of diplopia. The lacrimal sac was removed by radio wave surgery: after the skin incision and separation of the fibers of the circular muscle, the lacrimal sac was opened, and 6.5 mL of liquid contents were evacuated from it. The walls of the bag were clamped, and delicately with the tip of the radio wave device, the lacrimal sac was completely isolated from the surrounding tissues. The wound was sutured in layers. After the operation, the patient received standard anti-inflammatory treatment. The postoperative course proceeded without complications, and all the symptoms (diplopia, eyeball deviation, impaired mobility, and discomfort) were resolved from the first days after the operation.

This literature review presents the antenatal risk factors for the development of retinopathy of prematurity (ROP). Despite advances in antenatal and neonatal therapeutic interventions, screening, and follow-up, ROP remains a potentially vision-threatening retinopathy that requires careful monitoring and timely intervention to prevent the progression of adverse visual impairment or blindness. ROP is a multifactorial disease. The main risk factors are low gestational age and low birth weight. Recent experimental and clinical data support the hypothesis that multiple antenatal factors are involved in the etiology and progression of ROP. These factors include the age of the mother, maternal diseases, pregnancy-associated maternal pathologies, use of drugs to correct these conditions, and inflammatory process. Their roles are ambiguous and often contradictory. The physiology of the mother and placenta can significantly influence the risk of ROP development in preterm infants. The placenta connects the mother’s body and the fetus, and it functions in the exchange of nutrients and oxygen between the mother and the fetus. Therefore, any pathological changes in the mother’s body entail changes in the placenta, which this directly affects the fetus. A sudden loss of placental support is detrimental to the development of infants in the immediate postnatal period. Thus, these factors should be taken into account when assessing the risk of ROP development to predict and prevent poor vision in children.