[Morphological features of an optic nerve in premature infants according to the optical coherence tomography data]. / Morfologicheskie osobennosti zritel'nogo nerva u nedonoshennykh detei po dannym opticheskoi kogerentnoi tomografii.

OBJECTIVE: To assess the morphological state of the visual analyzer in premature infants in long-term. MATERIAL AND METHODS: We examined 40 premature children (74 eyes) aged 10.3±2.92 years (gestational age (GA) 25-34 weeks, birth weight (BW) 690-2700 g). Twenty mature children (40 eyes), aged 10.8±3.05 years, were examined as a control group. The children underwent standard ophthalmologic examination, optical coherence tomography (OCT) and recording of visual evoked potentials (VEP). RESULTS: The thickness of retinal nerve fiber layer (RNFL) is less in preterm infants than in term infants, regardless of retinopathy of prematurity (ROP) and refraction (p<0.05). Thickness loss has an inverse proportion with the degree of hypoxic-ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) (p<0.05). Retinal thickness in fovea is significantly greater in preterm infants and has a direct proportionality with the degree of IVH and the number of days on artificial lung ventilation (p<0.05). Moderate organic changes were detected in conduction pathways in 43.08% of premature infants according to VEP data. CONCLUSION: The use of OCT and recording of VEP may improve the quality of comprehensive neuro-ophthalmologic diagnosis in preterm infants. The thickness loss of RNFL can be expected in premature infants with HIE and IVH.

[Anatomo-functional state of the central retina in premature infants with intraventricular hemorrhage and retinopathy of prematurity]. / Anatomo-funktsional'noe sostoyanie tsentral'nykh otdelov setchatki u nedonoshennykh detei, perenesshikh vnutrizheludochkovye krovoizliyaniya i retinopatiyu nedonoshennykh.

OBJECTIVE: Assessment of the anatomo-functional state of the central retina in children with intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) in the long-term period. MATERIAL AND METHODS: We examined 51 patients (102 eyes) born 25-34 weeks' of gestation (birth weight 700-2290 g), aged 8.83±3.5 years, and 18 children (36 eyes) born prematurely aged 10.8±3.2 years. The children underwent standard ophthalmologic examination, optical coherence tomography (OCT) and visual evoked potentials (VEP). RESULTS: Retinal thickness (RT) and retinal volume (RV) in the fovea of premature infants with PH and/or IVH are significantly higher than in healthy full-term infants, which correlates with lower visual acuity (p<0.05). RT and RV in the fovea has an inverse proportional relationship with gestational age (GA), (p<0.05). According to the results of VEP, moderate organic changes in the conduction tract of the visual analyzer are noted in 45% of premature infants (p<0.05). CONCLUSION: The process of macula formation is affected by many perinatal and postnatal factors, namely: GA, birth weight, ROP, hypoxic-ischemic CNS diseases, and refractive disorders.

[Modern possibilities of diagnosing lesions of the visual analyzer in perinatal lesions of the central nervous system in full-term and premature infants]. / Sovremennye vozmozhnosti diagnostiki porazheniya zritel'nogo analizatora pri perinatal'nom porazhenii tsentral'noi nervnoi sistemy u donoshennykh i nedonoshennykh detei.

The article provides an overview of current neuro-ophthalmological diagnostic capabilities in patients with perinatal lesions. The main attention is paid to the diagnosis of patients with periventricular leukomalacia and peri- and intraventricular hemorrhages. The most relevant methods of neuro-ophthalmological diagnosis in hypoxic-ischemic CNS lesions are covered. The functions and peculiarities of blood supply of the germinal matrix are described. The importance of the use of optical coherence tomography and visual evoked potential recording in full-term and premature infants with visual pathway and/or visual cortex lesions in brain lesions is discussed. The conclusion emphasizes the need for an interdisciplinary approach in the examination of children with perinatal CNS lesions.

[The course of delayed intrauterine infection in children with residual manifestations of retinopathy of prematurity]. / Techenie otsrochennoi vnutriutrobnoi infektsii u detei s ostatochnymi proyavleniyami retinopatii nedonoshennykh.

Retinopathy of prematurity (ROP) is a severe vascular proliferative disease. The appearance of signs of intrauterine infection in the setting of ROP may aggravate the severity of the disease course and lead to development of complications. Two children with residual ROP effects were observe to have delayed manifestations of intrauterine infection. The first child had signs of toxoplasmosis in the period of regression of stage II ROP at 48 weeks of postmenstrual age (PMA). The second child had signs of cytomegalovirus infection in the period of induced regression of III «+¼ stage ROP at 47-48 weeks of PMA. At the time of manifestation of intrauterine infection, both children were noted to have exudative phenomena, and formed fibrous bridles that caused retinal detachment, which was visually very similar to the late stages of severe forms of ROP. However, the appearance of these symptoms in 47-48 weeks of the PMA in the setting of ROP regress excludes the activation of the disease. The course of uveitis with residual manifestations of ROP went according to the most severe scenario - with retinal detachment in the short term - within 7-10 days.

[The early diagnosis of congenital neuroinfections during ophthalmologic examination in children of the first months of life]. / Rannyaya diagnostika nekotorykh vrozhdennykh neiroinfektsii pri oftal'mologicheskom osmotre u detei pervykh mesyatsev zhizni.

OBJECTIVE: To characterize the possibilities of early diagnosis of congenital neuroinfections during an ophthalmological examination in children in the first months of life. MATERIAL AND METHODS: Five children with congenital neuroinfection, including 2 children with congenital toxoplasmosis and 3 children with congenital cytomegalovirus infection (CMVI), were studied. All babies were born prematurely (25 to 31 weeks of gestation (27.2±0.94)), with birth weight from 680 to 1610 g (1120±110.1). During the examination, binocular ophthalmoscopy and examination on a wide-field retinal pediatric camera were used. A blood testing for immunoglobulins and a polymerase chain reaction of blood were performed. To assess the state of the brain, neurosonography and magnetic resonance imaging were used. RESULTS AND CONCLUSION: Ophthalmic signs of intrauterine infection appeared at the age of 4-5 months (at 47-51 weeks of postmenstrual age). In all children (in 4 in one eye, in 1 in both eyes), apparent exudative-proliferative changes in the retina and vitreous body appeared on the periphery with the formation of epiretinal membranes that exert a traction effect on the retina. In two children with CMVI, multiple preretinal hemorrhages in different parts of the retina in both eyes were revealed. Central chorioretinal foci in the fundus were detected in children with toxoplasmosis. A positive dynamics, such as a decrease of exudative phenomena, a partial fit of the retina, complete resorption of hemorrhages, was noted in children during treatment. It has been concluded that signs of intrauterine neuroinfection can appear delayed, only by the development of chorioretinitis, 4-5 months after birth and manifest with severe exudative-proliferative changes in the retina and vitreous body.

[A case of diagnosis of gyrate atrophy in infancy].

The authors describe a case of gyrate atrophy detected in a one-month baby born at 34 weeks post-conception age. Up to 2 months of life, the disease progressed--an increase in the number of foci of atrophy of the choriod and retinal pigment epithelium, there was a trend towards their fusion. The condition stabilized after the use of vitamin B6.

[Laser coagulation in the treatment of different-type retinopathy of prematures].

Laser coagulation of the retina was made in 126 children (238 eyes) with retinopathy of prematures (RP) by an 810 nm diode laser ophthalmocoagulator. The methods of transscleral, transpapillary and combined coagulation were applied. As for children who needed coagulation, 39.9% of them had classical RP and 60.1%--fulminant RP (plus-disease). Stabilization in CRP was registered in 97.9% (the threshold process stage was an indication for surgery), and in FRP (plus disease) it was registered in 56.6%. The best effect from surgery in FRP was observed, when patient were operated on in FRP, stage 1 (process localization in zone 1) and stage 2 (process localization in zone 2), whereas, when the procedure was made at stage 3, the process was stabilized only in 37%. The authors elaborated a combined method of laser coagulation (including transscleral and transpupillary techniques), which brought up the rate of stabilization in FRP (plus-disease) to 75.8%. The results did not depend on a coagulation technique in CRP.

[Fluorescence angiography in the diagnosis of pathology of the fundus oculi in children]. / Fliuorestsentnaia angiografiia v diagnostike patologii glaznogo dna u detei.

Fluorescent diagnostics examinations were undertaken by the authors in different-age 410 children. The peroral fluorescent angiography (FAG) was used to examine 20% of cases, and the intravenous FAG was applied to 80% of cases. We offered the differential approach to dosing the solution, while making the peroral FAG examinations, which reduces the frequency rate of unfavorable reactions. The dosage ranged from 20 to 25 mg/kg with regard for purposes of examinations. The use of fluorescein did not cause any serious complications; nausea and a short faintness state were registered only in 10% of children. An examination of angiography images demonstrated that the phases of tinting of healthy tissue were identical to those tinted at the intravenous FAG. The below peculiarities of the child eye fundus were established: a weaker, as compared to the adults, pigmentation of the eye fundus, an insufficient differentiation of the macular zone and an immature peripheral retina in children during the neonatal period. Indications for FAG at congenital and acquired eye pathologies are specified.

[Electrophysiological methods for examining preterm children and diagnosis of retinopathy of prematurity]. / Elektrofiziologicheskie metody issledovaniia v obsledovanii nedonoshennykh detei i diagnostike retinopatii nedonoshennykh.

The first stage of the study was devoted to registration of visual evoked potentials (VEP) in 14 full-term and 27 preterm children without signs of neonatal retinopathy (NR) at the age of 6-7 months. The authors conclude that VEP in preterm children without signs of NR, born at different terms of gestation, reach the values of full-term children by the age of 6 months. These data should be taken account of when examining preterm babies for timely diagnosis of pathological changes in the visual analyzer and treatment. The second stage of the study was developed to registration of VEP and electroretinogram (ERG) in 36 children aged 4-12 years with cicatricial forms of NR. Changes in the central compartments of the retina were responsible for low visual functions in children with the cicatricial stages of NR. This abnormality is caused by displacement of the macular zone, impairment of its electrogenesis and topographic anatomic relationships. Examination of the marginal retinal periphery (superior external quadrant) once a year is obligatory for patients with cicatricial stages of NR in order to timely detect inapparent local fixed detachments or prevent them by timely prophylactic laser coagulation of the retina.

[Fulminant retinopathy of prematurity ("plus-disease"): incidence, risk factors, diagnostic criteria, and variations in course]. / Molnienosnaia retinopatiia nedonoshennykh ("plius-bolezn'"): rasprostranennost', faktory riska, kriterii diagnostiki i varianty techeniia.

The authors examined 363 premature children with retinopathy. The fulminant form PH ("plus-disease") was found in 21.5% of cases. The authors determined risk factors of this PH form, diseases of mother during pregnancy, pregnancy pathology, infectious diseases of a new-born child with development of sepsis and pneumonia, grave hypoxic and ishemic affection of central nervous system with intraventricular hemorrhage of III-IV degree, and also exposure of children to artificial lung ventilation for more than 7 days and estimation by Apgar scale at less than 6 points. There were the following ophthalmologic prodromes of fulminant PH in early neonatal period: gray color of the optic disk, gray-yellow background of the eye fundus, coiled arteries and varicosity in retina center, coiled vessels on periphery of the eye fundus, total retina edema, multiple hemorrhages at the eye fundus, a wide avascular zone. There are the following absolute signs of this form: rigidity of the pupil, iris vasodilatation, localization of process in I-II zone of the eye fundus, a significant varicosity in center of eye fundus, a coiled way of central arteries, vasodilatation and sharply coiled vessels at the border with avascular zone, exudative and proliferative changes both at site of peripheric torus and at other sections of the eye fundus. To estimate process gravity, forecast and more pathogenetically substantiate treatment, the following forms of fulminant PH are singled out: hemorrhagic (11.5%), exudative (21.8%), neovascular (14.1%) and mixed (52.6%).

[Use of ultrasonic method of examination in the diagnosis of retinopathy of prematurity]. / Primenenie ul'trazvukovogo metoda issledovaniia v diagnostike retinopatii nedonoshennykh.

A total of 164 children (328 eyes) aged 2 months to 3 years with stages L-V retinopathy neonatorum (RN) were examined. Ultrasonic examination of children with RN is an important accessory method in complex examination of the eyes in children with RN with exudative and fibrous changes of the vitreous and massive hemorrhages. Indications for the use of ultrasonic method of examination in children with RN are defined in order to evaluate the need in preventive laser or for kryocoagulation of the retina or diagnosis of retinal detachment in RN, particularly before surgery. This method helps predict the disease course and evaluate the time course of the process.

[Organ of vision in preterm infant]. / Osobennosti organa zreniia nedonoshennogo rebenka.

Examinations of the organ of vision in 79 preterm infants showed lack of sensitivity of the conjunctiva and cornea, unstable precorneal membrane, and insufficient lacrimal production; these features may promote the development of diseases of the anterior segment of the eyeball. Decreased reaction to a light stimulus and lack of the pupil reaction to light are characteristic features of a preterm infant. The position of the baby lying in an incubator and poor transparency of ocular media impedes the ophthalmological examination and require special training of the physician. Pathological changes in the fundus oculi of a preterm baby should be regularly checked up by an oculist during the postnatal period.