Vol 5, No 2 (2010)

The article presents the organizational and diagnostic opportunities of the retinopathy early detection and treatment under the conditions of the Territory Perinatal Center. The essential risk factors of the visual analyzers pathology including the retinopathy risk factors were emphasized. The basic trends for prevention of this pathology development in children of the early age in the period of active introduction of perinatal technologies in the Territory were suggested.

We examined 165 premature infants, 100 of them developed retinopathy of prematurity (RP). Open arterial duct (OAD) without registered disturbances of central and regional hemodynamics was detected in 59 infants. In 12 cases according to echocardiography data a hemodynamically significant functioning arterial duct (HSFAD) was determined. It was established that RP development is mostly related to the lower mass of a body and gestation age of infants for the moment of birth. Disturbances of the central and organ hemodynamics accompanied by the shift of the blood gas indices contribute to RP development. OAD without registered disturbances of central and regional hemodynamics has no influence on the incidence of RP development. HSFAD is accompanied by the high incidence of severe RP forms development. Premature infants with HSFAD belong to the high risk group of RP development requiring special attention of ophthalmologists.

The authors evaluated the efficiency of Irifrin 10% and Tropicamid 1% in treatment of children with chronic overtension of accommodation. We examined 60 children (120 eyes) with chronic overtension of accommodation. All patients were divided into 2 groups. In the 1st group (30 children, 60 eyes) daily single instillations of Irifrin 10% solution were applied during 14 days; in the 2nd group (30 children, 60 eyes) Tropicamid 1% solution during the same period. The efficiency of treatment was evaluated according to the dynamics of the essential accommodation parameters and asthenopic events before and after the above medications therapy course. Efficiency of Irifrin 10% in treatment of children with chronic overtension of accommodation was established according to the therapy results. The clinical follow-up data correlate with the functional methods of accommodation study.

In the article we analyzed efficiency of various methods of surgical rehabilitation of children with congenital and acquired defects of the eyelids. The clinical group consisted of 65 patients at the age from 1 to 18 with congenital and acquired defects of the eyelids that underwent totally 101 surgical interventions. All children were divided into 3 groups depending on the method of compensation of the eyelids and periorbital tissues deficiency. Into the 1st group 10 patients with facial clefts and pronounced deformation of the eyelids were included; they were operated with use of modified wide bucco-zygomatic skin graft unilaterally or bilaterally. The 2nd group made 17 children with coloboma of the eyelids or extensive scarry deformation of the eyelids and periorbital area with soft tissues deficiency that was replaced by rotation flap from the forehead. Into the 3rd group were united 38 children that had scarry deformation with local skin deficiency on one or both eyelids, or ectropion eliminated by autotransplantation of the free skin flap taken from the interior surface of the auricle. In all three groups clinical and CT-signatures were described in details as well as the surgical technique. We managed to obtain good stable results in all cases in long-term period. Thanks to the timely performed and efficient complex treatment maximal aesthetic rehabilitation of the children with congenital oblique facial clefts was achieved to the age of 14-16, in cases of the acquired deformations of the eyelids and tissues of periorbital area - during 1-1.5 years from the moment of patient's apply to the clinic. Differentiated approach to application of wide rotation bucco-zygomatic and frontal flaps and techniques of free skin and mucous tunic auto-grafting with simultaneous strengthening of the supporting palpebral structures allow to significantly extend the opportunities of reconstructive surgery in pediatric practice, increase the efficiency of treatment and obtain early medical and social rehabilitation of the patients with congenital and acquired deformations and defects of the eyelids.

Various methods of treatment for secondary squint with partial atrophy of the optic nerve (PAON) were analyzed in 183 patients at the age from 3 to 12. In the main group (82 children) the complex method of treatment was applied, in two control groups (44 and 57 children) patients were treated according to classical methods of the secondary squint treatment. The patients of the main group underwent a simultaneous surgical correction of squint and POAN irrigation therapy into the Tenon's space with electrostimulation. Patients of the control group underwent delayed POAN treatment after surgical treatment of squint. It was established that maximal effect was obtained in the main group with use of a new complex method of treatment including simultaneous surgical correction of deviation and conduction of irrigation POAN therapy.

The article presents the data on the comparative study of efficiency of medications penetration and accumulation in the eye under the effect of a new method of infrasonic phonophoresis in retrobulbar and anterior non-injection way of radiopharmaceuticals administration with the following infrasonic impact on the eye during 10 minutes with frequency 4 Hz, power 173 dB in the live pressure mode of operation. The study was performed in 40 chinchilla rabbits (80 eyes). The obtained data is an evidence that under the impact of infrasound a significant accumulation of radiopharmaceuticals occur inside the eye in the anterior non-injection method of bringing medications to the eye (application of medication on cotton wool in conjunctival cavity of the eye), and in posterior way (retrobulbar injection) as well with their following distribution in the tissues of the eyeball. Infrasound improves pharmacokinetics in the eye contributing to the preservation of medicinal depot in the orbit and the eyeball, increasing the level of medication both in vascular and avascular structures of the eye.

A case of ophthalmic toxocariasis in a child with visceral form in 4.5 years after arresting of the active process is described. The eye disease was detected in the stage of the complications development (retinal detachment). Toxocariasis etiology was established on the basis of anamnestic (geophagy, visceral toxocariasis), clinical (granulomatous chorioretinitis) and laboratory findings (presence of antibodies to Toxocara in blood serum and subretinal fluid in dilution 1:400). The children with visceral form of toxocariasis need to be followed-up by ophthalmologist on a regular basis for early detection of possible eye disease.