Структура «детской» глаукомы – результаты 20-тилетнего наблюдения

In 2013, at the 9th Congress of the World Glaucoma Association, a new classification of childhood glaucoma was adopted.PURPOSE. This study analyzes the profile of childhood glaucoma in accordance with the new classification and evaluates the convenience of its use in clinical and research work.METHODS. We reviewed the retrospective data of 652 patients (1000 eyes) aged 0 to 18 years with childhood glaucoma who were under observation between 2002 and 2022. The mean follow-up period was 10.4±0.2 years.RESULTS. The majority of patients had bilateral glaucoma (53.4%). The most common are bilateral manifestations in primary congenital glaucoma (79.7%), juvenile glaucoma (95.8%), secondary glaucoma associated with nonacquired ocular anomalies (54%). The majority of patients in the study were male (363 patients; 56.7%). The most common diagnoses were secondary glaucoma associated with acquired conditions (42.6%), primary congenital glaucoma was diagnosed in 21% of cases. In the vast majority of cases (from 52% to 85%), the treatment of glaucoma was surgical. The maximum number of repeated hypotensive interventions (2.1 operations per eye) was required for patients with primary congenital glaucoma. The results of surgical treatment of secondary childhood glaucoma turned out to be more optimistic — one operation was enough to control glaucoma in 64.6% (62 eyes out of 96) of operated eyes with glaucoma associated with non-acquired ocular anomalies, in 70.7% of cases (29 eyes out of 41) in glaucoma associated with non-acquired systemic conditions, 66.8% in secondary glaucoma associated with acquired conditions (227 eyes out of 340), and in 68.4% of cases in glaucoma following cataract surgery (39 eyes out of 57). In the course of the observation period, 1239 glaucoma interventions were performed. The intervention of choice in all subgroups was filtering surgery. Cyclodestructive procedures were performed significantly more often (p<0.05) in the group with secondary glaucoma associated with acquired conditions. CONCLUSION. The use of a unified classification system is expected to greatly enhance the understanding of this disease, and consequently improve childhood glaucoma management approaches and standards of clinical care in rare types of this disease.>p<0.05) in the group with secondary glaucoma associated with acquired conditions.CONCLUSION. The use of a unified classification system is expected to greatly enhance the understanding of this disease, and consequently improve childhood glaucoma management approaches and standards of clinical care in rare types of this disease.В 2013 году  на 9 съезде Всемирной ассоциации глаукомы была принята единая классификация «детской» глаукомы.ЦЕЛЬ: проанализировать структуру «детской» глаукомы в соответствии с Международной классификацией и оценить удобство ее применения в клинической и исследовательской работе.МАТЕРИАЛ И МЕТОДЫ: Ретроспективно были проанализированы медицинские карты 652 детей  (1000 глаз) в возрасте от 0 до 18 лет, которые проходили обследование и лечение в период с 2002 по 2022 годы по поводу глаукомы. Средний период наблюдения составил 10,4 ± 0,2 лет.РЕЗУЛЬТАТЫ. У большинства пациентов была диагностирована двусторонняя глаукома (53,4%). Наиболее часто двустороннее поражение отмечалось при первичной врожденной глаукоме (79,7%), ювенильной глаукоме (95,8%), вторичной глаукоме на фоне глазных аномалий (54%). Большинство пациентов в исследовании были мальчики (363 пациента; 56.7%). Наиболее распространенной формой глаукомы оказалась глаукома на фоне приобретённых заболеваний (42,6%), первичная врожденная глаукома зафиксирована в 21% случаев. В подавляющем большинстве случаев (от 52% до 85%) лечение глаукомы было хирургическим. Максимальное количество повторных гипотензивных вмешательств (2,1 операции на 1 глаз) потребовалось пациентам с первичной врожденной глаукомой. Более оптимистичными оказались результаты хирургического лечения вторичной детской глаукомы – одной операции было достаточно для компенсации глаукомы на 64,6% (62 глаза из 96) прооперированных глаз при глаукоме на фоне врожденных аномалий развития, в 70,7% случаев (29 глаз из 41) – при глаукоме на фоне системных заболеваний, 66,8% - при глаукоме на фоне приобретенных состояний (227 из 340), и в 68,4% случаев – при афакической глаукоме (39 из 57). За период наблюдения было выполнено 1239 гипотензивных вмешательств. Операциями выбора во всех подгруппах были операции фильтрующего типа. Циклоанемизирующие операции достоверно чаще (р<0,05) проводились у детей с глаукомой, развившейся на фоне приобретенных заболеваний.ЗАКЛЮЧЕНИЕ. Использование унифицированной Международной классификационной системы позволит лучше стандартизировать будущие исследования по детской глаукоме, что даст возможность разработке эффективных схем лечения и ведения детей с редкими и сложными формами «детской» глаукомы

TFOS European Ambassador meeting: Unmet needs and future scientific and clinical solutions for ocular surface diseases

The mission of the Tear Film & Ocular Surface Society (TFOS) is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface. Fundamental to fulfilling this mission is the TFOS Global Ambassador program. TFOS Ambassadors are dynamic and proactive experts, who help promote TFOS initiatives, such as presenting the conclusions and recommendations of the recent TFOS DEWS II™, throughout the world. They also identify unmet needs, and propose future clinical and scientific solutions, for management of ocular surface diseases in their countries. This meeting report addresses such needs and solutions for 25 European countries, as detailed in the TFOS European Ambassador meeting in Rome, Italy, in September 2019

Latest artificial tears drugs in the treatment of patients with dry eye syndrome

Recently, the interest of national ophthalmologists to drug therapy of dry eye syndrome has been growing. In proportion to the growing relevance of the issue, there has been an increase in incidence of dry eye syndrome (DES) and expansion in the range of artificial tears which are the basis for therapy of patients with DES [1, 2, 6]

On the prevalence of vernal keratoconjunctivitis and current possibilities of treatment

The importance of vernal keratoconjunctivitis (vernal conjunctivitis, or vernal catarrh) is not so much due to its level of prevalence (today its occurrence amounts to 1.25-11.29 per 10 000 population of European countries), but rather to the severity of its clinical course. Especially significant is its tarsal form, which is complicated in 3-11 % of vernal keratoconjunctivitis patients by the development of corneal ulcers. Such patients are normally treated by antiallergic agents, which offer both antihistamine and mast cell-stabilizing action. Primarily, the medicines used are 0.1 % olopatadine and 0.025 % ketotifen, which can also reduce the activation of eosinophils and the production of pro-inflammatory cytokines. The therapy of resistant forms of the disease is successfully supplemented with instillations and / or ointment forms of glucocorticoids, cyclosporine-A, tacrolimus and mitomycin-C. Giant papillae that cause gravitational ptosis or are combined with the torpid current of the disease require surgical treatment. They are excised (or cryodestructed) with intraoperative treatment of the tarsal conjunctiva with 0.02 % mitomycin-C and subsequent instillations of cyclosporine-A. There is a need to further develop and introduce into clinical practice new pathogenetically oriented medicinal preparations which provide both relief of clinical symptoms of the disease and the prevention of its relapses. For citations: Brzheskiy V.V. On the prevalence of vernal keratoconjunctivitis and current possibilities of treatment. Russian ophthalmological journal. 2017; 10 (4): 74-81. doi: 10.21516/2072-0076-2017-10-4-74-81 (in Russian)

Key areas of drug-based therapy in patients with corneoconjunctival xerosis

In recent years, dry eye syndrome has attracted an increasing attention from ophthalmologists all over the world. This is largely due to the prevalence of the disease: the average number of people suffering from the disease is 14--15% of the adult population of the developed countries and up to 45% of patients first visiting ophthalmologist [2]. The other reason is severity of the clinical course and outcomes of some clinical types of the dry eye syndrome

Microflora of conjunctiva in children and its sensitivity and resistance to antibacterial drugs

Purpose: Investigation of microflora of conjunctiva and its resistance to antibacterial drugs in healthy children and patients with various inflammatory eye diseases.Methods: We examined 402 children (421 eyes) in the age from 1 month till 17 years: 62 healthy children (70 eyes) and 340 pa- tients with different inflammatory diseases of anterior segment of eye (351 eyes). the smear was done in all children for plating and definition of sensitivity of microflora to antibacterial drugs by method of diffusion to agar.Results: the plating was positive even in 72.9% of healthy children who entered the hospital for the planned surgery. Most often we revealed Staphylococcus epidermidis (44.3%), Staphylococcus aureus (12.8%), Streptococcus faecalis (5.7%) and Enterobacter (2.9%). In children with inflammatory diseases Staphylococcus epidermidis and Staphylococcus aureus (62.6%) were found fre- quently. the analysis of data showed high level of resistance of all microflora to aminoglycosides (neomycin 37.8% and tobramycin 32.7%) and chloramphenicol — 37.1%. the lowest resistance of all microflora was registered to levofloxacin (11.1%) and ciprofloxacin (10.5%). In gram-negative microflora we revealed the maximal sensitivity to ciprofloxacin, in gram-positive — to levofloxacin.We detected the maximal resistance of microflora to ampicillin (66.1%), and minimal — to cephalosporines (4.5%) among the antibiotics of systemic application.Conclusion: the findings allow us to recommend drops containing levofloxacin (Signicef) for clinical practice in pediatric ophthalmology

New Possibilities of Antibiotic Therapy in Pediatric and Adult Ophthalmology

The problems of resistance to modern antibiotics and fluoroquinolones naturally stimulate interest in the development of eye dosage forms based on antiseptics. Today, their list has successfully supplemented the domestic drug Okomistin eye, ear, nasal drops (0.01 % — benzyldimethyl-myristoylamino-propylammonium), the manufacturer of Infamed-K. Numerous clinical studies performed, however, on adult patients, indicate a high therapeutic efficacy of the drug Okomistin®. However, with respect to children, the efficacy of Okomistin® remains unclear, although the drug has been approved for use by children from birth today. Objective. To evaluate the effectiveness of the Okomistin® in the treatment of children with bilateral bacterial conjunctivitis. Patients and Methods. Material research consisted of 30 children aged 3–16 years with bilateral acute bacterial conjunctivitis. 15 of them (26 eyes) received six-time instillations of the Okomistin® and 15 (24) — 0.05 % — Рicloxidin. All were subjected to traditional clinical examination and examination of the microflora of the conjunctival cavity with the determination of its sensitivity to antibiotics using the disk method. Results. In the spectrum of microflora found in the examined children, Staphylococcus Аureus dominated (14 eyes (53.8 %) — in the group of patients receiving Okomistin® and 13 (54.2 %) — Picloxidin), and Еpidermal Staphylococcus — 12 (46, 2 %) and 12 (50.0 %), respectively. Against the background of six-fold instillations of the compared drugs, a pronounced positive dynamics was established in relation to the relief of objective and subjective clinical symptoms of bacterial conjunctivitis already in the first week of treatment. At the same time, on the 7th day of therapy, in both groups of children, a significant decrease in the frequency of detection of microflora in the conjunctival cavity was noted, and on the 10th day, all the examined people underwent the contents of the conjunctival cavity to be sterile. Conclusion. The clinical efficacy of the Okomistin®, in combination with the absence of side effects of the drug and the affordable cost, allows recommending it for widespread practical use in pediatric and adult ophthalmology in the treatment of eye diseases of a bacterial nature. It seems promising to study the effectiveness of the drug in order to reorganize the conjunctival cavity in infants with dacryocystitis

New Opportunities for Complex Therapy in Patients with Dry Eye Syndrome of Various Etiologies

The purpose: to evaluate the effectiveness of the Delfanto® in the complex therapy of patients with dry eye syndrome of various etiologies and severity of the clinical course.Patients and methods. 114 patients (228 eyes) with dry eye syndrome of various etiologies were examined: 72 patients with chronic meibomian blepharitis and dysfunction of the meibomian glands (xerosis due to increased evaporation of the tear film), 33 women with perimenopause (a mixed form of xerosis with a predominant decrease in the production of components of the tear film) and 9 persons with Syegren syndrome (xerosis due to a pronounced decrease in tear production). All patients received individually selected tear replacement therapy over the past weeks and the drug was not replaced throughout the study. At the same time, patients with mild and moderate clinical course of SSG for 30 days received Delfanto® at a dosage of 60 mg, and with severe course — 120 mg per day.Results. All patients on the background of complex therapy showed a significant decrease in the severity of subjective manifestations of the dry eye syndrome, an increase in the of the tear film stability and indicators of tear production. At the same time, the dynamics of changes in these parameters of the course of the xerotic process increased as the therapy continued, reaching a maximum by the 30th day. The maximum effect of Delfanto® in the complex therapy of patients with dry eye syndrome was observed in patients with chronic meibomian blepharitis. Moreover, patients with a mild clinical course of cornealconjunctival xerosis were the most susceptible to the therapy.Conclusion. The effectiveness of the complex therapy for patients with dry eye syndrome can be significantly increased by prescribing Delfanto® in a daily dose of 60 mg for mild and moderate xerosis and 120 mg — for severe disease. Delfante® can be recommended for widespread clinical use in complex treatment of patients with various clinical and pathogenetic forms of dry eye syndrome