Vol 13, No 1 (2018)

Objective. To study a method of prophylaxis of retinopathy at the stage of nursing of premature baby and evaluate the results. Material and methods. This method has been applied during the year on the basis of the Perinatal center of the Rostov region and the ophthalmic branch of the Rostov regional children’s clinical hospital. For this study were selected two groups of patients 50 children (100 eyes) from 26.5 to 36 weeks gestational age (GW) and with birth weight from 650 to 2650 grams. All the children were divided into two groups - study and control of 25 children (50 eyes) each. In the main group since birth to full maturation of the retina or regression of the disease after surgical laser treatment used safety glasses. Results. Preliminary data showed that the application of protective red glasses while observing the basic rules of nursing preterm infants, reduced the development of PH 16% and the need for laser treatment by 20%. Conclusions. Occlumeny sitefinity method is the first method of ophthalmic prevention of occurrence and development of retinopathy of prematurity, keeping the retina intact, allowing it to develop in light conditions close to natural in utero from the moment of premature to the natural time of birth of the child.

The purpose. to assess the potential of OCT-angiography in studying pathogenesis, diagnosing and monitoring macular telangiectasias of various genesis in children and adolescents. Material and methods. We examined and treated 4 children (5 eyes) aged from 12 to 17 years with idiopathic macular telangiectasias (2), developed against the background of Coat’s disease (1) and diabetic retinopathy (1). The examination included standard ophthalmologic inspection, as well as optical coherence tomography and OCT-angiography (RS-3000 Advance AngioSca, Nidek, Japan). Two children underwent transpupillary laser coagulation of telangiectasias (2 and 3 sessions), two received an intravitreal injection of an inhibitor of angiogenesis. Results. Ophthalmoscopically in all children microaneurysms were localized in the macular and paramacular zones and were accompanied by the development of retinal edema. According to OCT-angiography, all children had pathological structural changes (microaneurysms, vascular artery abnormalities, changes in the density of the vascular pattern) of superficial and to a greater extent deep retinal capillary plexuses. As a result of the treatment, 3 children (4 eyes) had clinically noted decrease in the number of microaneurysms. According to the data of optical coherence tomography, there was positive dynamics in decrease of the height of the retinal edema from 49 to 320 μm, аccording to OCT angiography, showed a decrease in the number of microaneurysms in the superficial and especially in the deep plexus, and in a child with diabetic retinopathy there was also a slight increase in the vascular density of the deep capillary plexus. Сonclusion. According to OCT-angiography, development of macular telangiectasias in children is accompanied by preferential changes in the deep capillary plexus, which indicates the pathogenetic significance of microcirculatory disturbances at this level. The method also reveals its value in monitoring the disease.

Aim. The objective of the present study was the analysis of the changes in the length of the antero-posterior axis of the eye (AL) in the children and adolescents presenting with hyperopia and anisometropia in 3 years after femtolaser-assisted in situ keratomileusis (FS-LASIK). Material and methods. The study included 33 patients at the age from 5 to 16 years divided into two groups. Group 1 was comprised of the patients having initially the mean spherical refractive equivalent (SE) +3.69 D. Those of group 2 had initial SE +5.88 D. In all the patients, FS-LASIK was carried out at the amblyopic eye in the absence of the positive results of the conventional conservative treatment. Results. During three years after FS-LASIK, AL of the treated patients in the first group increased by 0.41 mm and reached the mean value of 22.41 mm while the spherical refractive equivalent became equal to 0.25 D. During the same period, AL in the contralateral eye increased by 0.92 mm and became equal to 23.47 mm on the average with SE equaling +0.81 D. AL of the patients in the second group increased by 0.29 mm and reached the mean value of 21.59 mm while the spherical refractive equivalent became equal to 0.25 D. During the same period, AL in the contralateral eye increased by 0.97 mm and became equal to 23.32 mm on the average with SE equaling +0.62 D. Conclusion. During three years after hyperopic S-LASIK, the minimal growth of the antero-posterior axis of the eye was documented in the children presenting with hyperopia (+5 D) whereas its length increased by more than 0.29 mm. In the children with hyperopia of less than +5 D, it increased by 0.41 mm. It is concluded that prognosis of the results of femtosecond laser-assisted in situ keratomileusis leading to the alteration of the refraction in the amblyopic eye with the initially moderate or high-degree hyperopia should be made taking into consideration that AL continues to change in the cource of further growth of the child.

Аim. Тo assess the effectiveness of surgical treatment of consequences of burn injury of adnexa in children. Material and methods. The analysis of clinical material over the past 10 years. The clinical group consisted of 59 patients (44 - male, 15 - female) with the consequences of burn injury of adnexa in age from 2 months to 18 years (m = 9.17 ±3.23 years). The burn trauma were the following: thermal (flame, hot objects, gas explosion) - 43, chemical (acid, alkali) - 11, combined (melted lead/glass) - 5. The time that has passed after the burn until the first stage of surgical treatment ranged from 1 month to 2 years (m= 9.7 ± 5.1 months). The author describes in detail the clinical picture, noting that significant lagophthalmos is dominated by the consequences of thermal burns, the consequences of chemical burns occurred entropion, symblepharon, leucoma. 11 patients had anophthalmos. In all, 121 operations were performed in 59 patients (1 to 4 stages, m = 2,1±1,1) with an interval from 3 to 12 months (m=8.3 months): removal of lagophthalmos with method of local plastics or free skin grafting; elimination of symblepharon or reconstruction of the conjunctival cavity with lips/cheeks’ mucous grafting; the strengthening of the eyelids’ edges, eyelashes plastic. The technics of the operation is described. Follow up period for patients from 6 months to 13 years (m=6,7±2,1). Results. Wound healing in all cases took place in the usual time. Skin sutures were removed after 7-9 days, traction sutures in 3 weeks, blepharorophy in 1-6 months. Engraftment of the transplanted free skin and mucous’ grafts was without a significant reduction. Visual function were preserved and improved in all the cases (44 patients). Cosmetic contact lenses were chosen in 4 patients with Vis = 0. A stable position of the prosthesis achieved in patients with anophthalmos. Conclusion. Consequences of burn injury of adnexa in children are diverse and require a differentiated approach to the choice of timing, priority, and methods of surgical treatment. Eyelid plasty is advisable to perform in the “cold” period after the completion of processes of scar tissue formation in the absence of threats to the condition of the eye.. Reconstruction should be performed at any time to prevent the development of ulcers or perforation of the cornea in the presence of the inversion of eyelids, symblepharon, significant lagophthalmos causing suffering of cornea.

A clinical case of observation of patient B-go K., was presented, 9 years old with the main diagnosis: OU-spastic eversion of the eyelids. OS-purulent corneal ulcer. Shortening ofthe upper eyelid and upper arch of the conjunctival cavity; concomitant diagnosis: vulgar ichthyosis. From the side of theeye changes were associated with hyperkeratosis,which led to the contraction of the facial skin resulting in cicatrical eversion of eyelids, xerosis, leading to abscess and ulcer of the cornea. As a result of the complex treatment (antibacterial, trophic therapy, plastic surgery of the eyelids) it was possible to achieve a positive result.