卷 20, 编号 2 (2025)

BACKGROUND: Despite the advances of high-tech treatments, congenital cataract still accounts for up to 17.3% cases of blindness and low vision. Meanwhile, secondary cataract remains a leading cause of poor visual acuity after congenital cataract removal, especially in early childhood.

AIM: To evaluate the efficacy of the developed method for laser treatment of secondary regenerative cataract with prevalent Elschnig pearls in children with pseudophakia after congenital cataract removal.

METHODS: It was an interventional, single-center, prospective, single-arm study. A total of 115 children (130 eyes) diagnosed with secondary cataract underwent surgery with the proprietary YAG laser method. Massive conglomerates of Elschnig pearls prevailed in the cataract morphology. The laser treatment method was based on combination of focused and defocused Nd:YAG laser irradiation. Earlier, the children underwent phacoaspiration of congenital cataract followed by intraocular lens implantation.

RESULTS: The children were aged 7 months to 14 years (mean: 65.2 ± 3.81 months). Full optic effect after YAG laser destruction was achieved in every case; both anterior and posterior surfaces of the intraocular lens were optically clean and free of signs of complications. In 3 months, the central optic zone was still fully clear in 96.1% cases. In 14.6%, Elschnig pearls recurred within 3 to 6 months was detected in 14.6% after 3 to 6 months and were successfully treated with the same laser technique.

CONCLUSION: The proposed method of laser treatment of secondary cataract allows effective and minimally extensive removal of massive clusters of Elschnig pearls from the anterior and posterior surfaces of the intraocular lens, rendering fully clear optic zone in the pupillary area with minimal laser energy parameters. This method features several advantages, including the lack of need for open-globe surgery and thus prevention of intraocular complications, the opportunity for anesthesia-free procedure, significantly improved visual acuity, minimal effect on corneal astigmatism, and lower recurrence rates (14.6%).

BACKGROUND: Retinopathy of prematurity is a vasoproliferative eye disease defined by disrupted retinal angio- and vasculogenesis caused by premature birth. However, vascular disorders associated with retinopathy of prematurity are considered to precede anatomical changes and contribute to retinal dystrophy, affecting its development and reducing visual functions.

AIM: The work aimed to study ocular blood flow in infants with cicatricial retinopathy of prematurity using laser speckle flowgraphy.

METHODS: An observational, single-center, cross-sectional study was performed. This study included the following three groups: children with history of active retinopathy of prematurity (study group); healthy children without the disease (control group); full-term children with moderate or high myopia (comparison group). In addition, the study group was divided into four subgroups by the degree of cicatricial retinopathy of prematurity of grade 0 (subgroup 1), grade 1 (subgroup 2), grade 2 (subgroup 3), and grade 3 (subgroup 4). Blood flow was studied in the area of the optic disk and macula using LSFG RetFlow in all patients.

RESULTS: The study enrolled 41 children (82 eyes). The study group included 26 children (52 eyes) aged 5–17 years (mean age 11 ± 4 years) with cicatricial retinopathy of prematurity (11 girls and 15 boys). The control group included 6 healthy children without any disease signs. The comparison group included 9 full-term children with moderate or high myopia. Blood flow was decreased in the temporal quadrant of the optic disk, with the greatest reduction in blood flow velocity in large vessels, which was noted in all study groups. This parameter decreased by 11.5% and 18.7% in subgroups 3 and 4, respectively, compared with the control, which indicated hemodynamic compromise associated with retinopathy of prematurity. A significant decrease in mean blood flow velocity in the optic disc microvessels was observed only in subgroup 4. In addition, these parameters decreased in the macular area, which suggested a deficiency of chorioretinal blood flow, which worsened with increasing severity of residual fundus changes in cicatricial retinopathy of prematurity.

CONCLUSION: Changes in blood flow parameters, observed even with minimal residual fundus changes, demonstrate the important role of hemodynamic abnormalities both in the pathogenesis of retinopathy of prematurity and in visual dysfunction, which highlights the need for further research.

To date, echography remains one of the important imaging methods in ophthalmology, especially in case of opaque ocular media when examination is challenging. The review provides information on various ultrasound methods, including A-scan, B-scan, and color flow Doppler, for assessing the posterior segment. Echography is highly effective in differential diagnosis of retinal detachment, posterior vitreous detachment, and vitreous pathological changes, including pseudomembranes and strands. There are multiple publications on comparative analysis assessing accuracy and objectivity of various instrumental methods for diagnosis of posterior segment pathologies, including ultrasound. These analyses have demonstrated high sensitivity and reproducibility of ultrasound in the diagnosis of retinal detachment, posterior vitreous detachment, retinal breaks, and vitreous strands. The main advantages of comprehensive ultrasound, including B-scan, color flow Doppler, and high-frequency grey-scale imaging, are detailed visualization of the central and peripheral eye structures, ability to differentiate vascular and avascular intraocular areas, and monitoring ocular media and membranes following various therapies of the posterior segment diseases.

The review discusses the factors affecting the development of retinopathy of prematurity, namely, the role of low platelet count in the pathogenesis of the disease and association with its severe forms. Recently, platelets have been revealed to play a key role in angiogenesis and the delivery of regulatory proteins. This pathogenetic association may be attributed to two factors. Firstly, children with retinopathy of prematurity and low platelet count develop disrupted delivery of regulatory proteins necessary to maintain optimal platelet count. Secondly, excess vascular endothelial growth factor A is absorbed incompletely, which contributes to overstimulation of endothelial cells, their proliferation, and hence retinopathy of prematurity. Thus, the main pathogenetic mechanisms of platelet count effect on the development of retinopathy of prematurity may be associated with the fact that they locally stimulate or inhibit angiogenesis. Low platelet count in peripheral blood slows down normal vasculogenesis of the peripheral retina. However, platelet transfusions and partial hemolysis result in release of bioactive substances regulating angiogenesis, including vascular endothelial growth factor and hypoxia Inducible factor, from platelet granules, which leads to abnormal vasoproliferation. That is why further studies of platelet count management are warranted to determine the preferred timing and quantities of infusion therapy, which can provide clinical benefit. The need for platelet transfusion in patients with retinopathy of prematurity and thrombocytopenia is still a matter for discussion.