Эффективность композитного дренажа у детей с постувеальной глаукомой

PURPOSE: To evaluate the efficacy of trabeculectomy with Glautex drainage implantation in children with uveitic glaucoma (UG).METHODS: We analyzed the results of trabeculectomy with Glautex drainage implantation in 11 children with UG aged 4-15 years, including 4 children who already previously underwent glaucoma surgery.RESULTS: Qualified success rate 3, 12 and 24 months after the surgery (with and without hypotensive medications) amounted to 72.7, 54.5 and 45.4% respectively, absolute success — to 36.4, 27.3 and 27.3%. IOP decompensation in all cases was caused by excessive wound healing in the filtering bleb area. All patients with long-term glaucoma compensation Glautex drainage implantation was the first glaucoma surgery they underwent, and the efficiency of repeated operations was lower than that of primary ones. There were no significant differences in the efficacy of operations in phakic eyes and in cases of artiphakia or aphakia. The results also showed no clear dependence on systemic immunosuppressive therapy or lack thereof, and on uveitis etiology (rheumatoid, idiopathic). Postoperative adverse effects included 1 case of drainage eruption through the conjunctiva 3.5 weeks after the operation with conjunctival healing after the removal of the exposed drainage fragment followed by topical medical treatment, and 1 case of flat ciliochoroidal detachment, which reversed after medical treatment.CONCLUSION: Trabeculectomy with Glautex drainage implantation, especially if performed as a repeated hypotensive surgical intervention, is not effective enough in children with UG due to extremely intense excessive scarring in extrascleral and scleral areas of the surgical site. Further research is needed to find effective methods of surgical treatment and excessive proliferation prevention in children with UG.ЦЕЛЬ. Оценить эффективность синустрабекулэктомии (СТЭ) с имплантацией дренажа Глаутекс у детей с постувеальной глаукомой (ПУГ).МЕТОДЫ. Проведен анализ результатов СТЭ с имплантацией дренажа Глаутекс у 11 детей в возрасте от 4 до 15 лет с ПУГ, из них у 4 антиглаукоматозная операция была повторной.РЕЗУЛЬТАТЫ. Относительная эффективность операции (на фоне и без гипотензивных медикаментов) составила 72,7, 54,5 и 45,4%, абсолютная — 36,4, 27,3 и 27,3% в сроки 3, 12 и 24 месяца после вмешательства соответственно. Некомпенсация глаукомы во всех случаях была обусловлена рубцеванием в области фильтрационной подушки (ФП). У всех пациентов с длительной компенсацией глаукомы операция с дренажом Глаутекс была первым гипотензивным вмешательством, а эффективность повторных операций была меньше, чем первичных. Существенной разницы в эффективности операции в факичных глазах и в случаях артифакии или афакии у пациентов, получавших и не получавших системную иммуносупрессивную терапию, а также в зависимости от этиологии увеита (ревматоидный, неясной этиологии) выявлено не было. Нежелательными явлениями были: в 1 случае — прорезывание дренажа через конъюнктиву через 3,5 недели после операции с заживлением конъюнктивы на фоне медикаментозного лечения после удаления обнажившегося фрагмента дренажа, в 1 случае — плоская цилиохориоидальная отслойка, которая прилегла на фоне медикаментозной терапии.ЗАКЛЮЧЕНИЕ. СТЭ с имплантацией дренажа Глаутекс, особенно проведенная в качестве повторного гипотензивного вмешательства, недостаточно эффективна у детей с ПУГ в силу чрезвычайно интенсивного избыточного рубцевания в экстрасклеральной и склеральной зонах операции при данной форме глаукомы. Необходимы дальнейшие исследования с целью поиска эффективных методов хирургического лечения и профилактики избыточной пролиферации при ПУГ у детей

Epidemiological and clinical peculiarities of bronchial asthma among children in urban and rural regions(in example of St-Petersburg and Leningradsky region)

The study was performed to determine the prevalence of bronchial asthma among children in St.-Petersburg and Leningradsky region and to research risk factors of this disease. It is carried out review 1502 children in St.-Petersburg and 1522 children in Leningradsky region. The analysis of the data has shown that the prevalence of bronchial asthma have made 7,4% in St.-Petersburg and 3,7% in Leningradsky region (p<0,001). Among children with bronchial asthma the boys are prevailed in both regions. This study confirmed that both genetic and environmental factors are associated with clinical asthma among children. The analysis of risk factors among children of urban and rural areas has shown, that the most important ones are: inheritable predisposition to asthma (OR=3,7-8,9 in St.-Petersburg and OR=8,2-13,6 in Leningradsky region), parents atopy (OR=3,9-5,5 in St.-Petersburg and OR=5,8-5,9 in Leningradsky region), presence of pets at home (OR=1,6 in St.-Petersburg and OR=2,8 in Leningradsky region). The results are received allow to improve planning health services of the children's population.Целью настоящего исследования явилось определение распространенности и факторов риска формирования бронхиальной астмы у детей, проживающих в Санкт-Петербурге и Ленинградской области. Проведено анкетирование 1520 детей, проживающих в Санкт-Петербурге и 1502 детей, проживающих в Ленинградской области. Анализ анкет показал, что распространенность бронхиальной астмы у детей в Санкт-Петербурге составила 7,4%, а в Ленинградской области 3,7% (р<0.001). В обеих изучаемых группах преобладали мальчики. Выявлены эндогенные и экзогенные факторы риска формирования бронхиальной астмы у детей. Анализ факторов риска заболевания у детей, проживающих в городском и сельском регионах показал, что ведущее значение имели: наследственная отягощенностъ по бронхиальной астме (OR=3,7-8,9 в Санкт- Петербурге и OR=8,2-13,6 в Ленинградской области): аллергические заболевания у родителей (OR=3,9-5,5 в Санкт-Петербурге и OR= 5,8-5,9 в Ленинградской области): содержание домашних животных (OR=1,6 в Санкт-Петербурге и OR=2,8 в Ленинградской области). Результаты исследования позволяют улучшить планирование лечебно-профилактических мероприятий в детской популяции

Шкала «Этиология и лечение воспалительной нейропатии» (Inflammatory Neuropathy Cause and Treatment, INCAT) для оценки степени инвалидизации у больных хронической воспалительной демиелинизирующей полинейропатией: лингвокультурная адаптация в России

Background. Chronic inflammatory demyelinating polyneuropathy (CIDP) is a treatable dysimmune polyneuropathy. An objective response for pathogenic therapy is essential in diagnosis and management of CIDP. For proper assessment of patient’s complaints and evaluation of disease progression, it is recommended to use validated scales and questionnaires. The paper presents the results of the first step of Inflammatory Neuropathy Cause and Treatment (INCAT) validation in patients with CIDP.Objective: the development of the Russian version of the INCAT scale and its linguocultural ratification.Materials and methods. 15 patients with definite CIDP (according to EFNS/PNS criteria) were enrolled. Linguocultural ratification was conducted according to the standard protocol.Results. The Russian version of the INCAT scale was developed.Conclusion. We conducted the first stage of INCAT scale validation in patients with CIDP.Введение. Хроническая воспалительная демиелинизирующая полинейропатия (ХВДП) относится к курабельным дизиммунным полинейропатиям. В основе диагностики и определения тактики ведения пациентов с ХВДП лежит наличие объективного положительного ответа на патогенетическую терапию. С целью объективизации жалоб пациента и оценки динамики его состояния рекомендуется использование валидированных шкал и опросников. В работе представлены результаты 1‑го этапа валидации шкалы Inflammatory Neuropathy Cause and Treatment (INCAT), предназначенной для оценки степени инвалидизации у пациентов с ХВДП.Цель исследования – проведение лингвокультурной адаптации шкалы INCAT у пациентов с ХВДП с разработкой ее русскоязычной версии.Материалы и методы. В исследование включено 15 пациентов с диагнозом ХВДП, соответствующим критериям EFNS/PNS. Лингвистическая ратификация оригинальной англоязычной версии шкалы INCAT проводилась согласно общепринятым рекомендациям.Результаты. Получена русскоязычная версия шкалы INCAT.Заключение. Проведен 1‑й этап валидации шкалы «Этиология и лечение воспалительной нейропатии» (INCAT) для оценки степени инвалидизации у больных ХВДП

Валидация шкалы суммарной оценки мышечной силы (MRC sum score) для использования у русскоязычных пациентов с хронической воспалительной демиелинизирующей полинейропатией

Background. The use of rating scales and questionnaires is essential in an evaluation of disease course, treatment response, the disability level and quality of life in patients with chronic inflammatory demyelinating polyneuropathy. The Medical Research Council (MRC) scale and its modification Medical Research Council sum score (MRCss) are widely used for measurement of motor deficit in patients with neuromuscular disorders. However, its usage is limited by the absence of the validated version for Russian-speaking patients.Aim. To validate MRCss scale in patients with chronic inflammatory demyelinating polyneuropathy with development of a Russian version.Materials and methods. We enrolled 50 patients with chronic inflammatory demyelinating polyneuropathy (25 with typical chronic inflammatory demyelinating polyneuropathy and 25 with Lewis–Sumner syndrome). At the first step we conducted linguocultural ratification according to the standard protocol. At the second step the psychometric parameters were evaluated, such as reliability, validity and sensitivity.Results. The developed Russian version of MRCss scale demonstrated the high level of reliability, validity and sensitivity.Conclusion. As a result, we developed a validated Russian version of MRCss scale, recommended for clinical practice and research. Введение. Использование международных шкал и опросников является неотъемлемой частью работы с пациентами с хронической воспалительной демиелинизирующей полинейропатией и позволяет объективно оценивать динамику состояния пациента, ответ на терапию, степень инвалидизации и качество жизни. Шкала Medical Research Council для оценки мышечной силы (MRC Muscle Scale) и ее модификация Medical Research Council sum score (MRCss) широко используются у пациентов с поражением периферического нейромоторного аппарата для оценки степени выраженности двигательного дефицита. Однако применение шкалы в Российской Федерации ограничено отсутствием русскоязычной, валидированной версии.Цель исследования – провести валидацию шкалы MRCss у пациентов с хронической воспалительной демиелинизирующей полинейропатией с разработкой русскоязычной версииМатериалы и методы. В исследование включено 50 пациентов с хронической воспалительной демиелинизирующей полинейропатией (25 пациентов с типичным вариантом заболевания, 25 – с синдромом Льюиса–Самнера). Первым этапом проведена лингвистическая ратификация оригинальной англоязычной версии шкалы согласно общепринятым рекомендациям. На 2-м этапе валидации проведена оценка психометрических показателей разработанного русскоязычного варианта шкалы: надежности, содержательной валидности, чувствительности.Результаты. Получена русскоязычная версия шкалы MRCss, которая продемонстрировала высокий уровень надежности, чувствительности и валидности.Заключение. По результатам проведенной работы представлена валидированная, русскоязычная версия шкалы MRCss, рекомендованная для клинической и научно-исследовательской работы у русскоязычных пациентов.

Валидация опросника для оценки качества жизни пациентов с хронической приобретенной полинейропатией (Chronic Acquired Polyneuropathy – Patient Reported Index, CAP-PRI) в России

Background. Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common immune‑mediated polyneuropathy. CIDP is characterized by a long‑term progressive or recurrent course of the disease and the development of neurological deficits and disability, it is important to assess the quality of life of patients. The paper presents the results of the first and second steps of validation of the Chronic acquired polyneuropathy – Patient Reported Index (CAP‑PRI) questionnaire designed to assess quality of life in patients with immune‑mediated polyneuropathy.Aim. To develop the Russian version of the CAP‑PRI questionnaire.Materials and methods. 85 patients with CIDP (according to EAN / PNS 2021 criteria) were enrolled. At the first step we conducted linguocultural validation according to the standard protocol. Two Russian‑speaking professional translators in the field of medicine performed direct translation of the original English‑language questionnaire, and the back translation was performed by native speakers with a medical background. At the second step the psychometric parameters were evaluated.Results. The developed Russian version of the CAP‑PRI questionnaire demonstrated a high level of reliability, validity and sensitivity.Conclusion. The Russian version of the CAP‑PRI questionnaire is recommended for clinical practice and research. In addition, the relationship between improved quality of life and the reduction of neurological deficits, disability and fatigue (as assessed by the IRODS, NIS and FSS scales) has been shown.Введение. Хроническая воспалительная демиелинизирующая полинейропатия (ХВДП) – самая частая из иммуноопосредованных полинейропатий. Для ХВДП характерны многолетнее прогрессирующее или рецидивирующее течение, развитие неврологического дефицита и инвалидизации, в связи с чем важен мониторинг качества жизни пациентов. Представлены результаты 1‑го и 2‑го этапов валидации русскоязычной версии опросника Chronic Acquired Polyneuropathy – Patient Reported Index (CAP‑PRI) для оценки качества жизни у пациентов с иммуноопосредованными полинейропатиями.Цель исследования – проведение валидации опросника CAP‑PRI у пациентов с ХВДП с разработкой его русскоязычной версии.Материалы и методы. В исследование было включено 85 пациентов с ХВДП, диагностированной на основании критериев EAN / PNS 2021. На 1‑м этапе проведена лингвистическая валидация оригинальной англоязычной версии опросника согласно общепринятым рекомендациям: 2 русскоязычными профессиональными переводчиками в сфере медицины выполнен прямой перевод оригинальной англоязычной шкалы, обратный перевод осуществлен носителями языка с медицинским образованием. На 2‑м этапе валидации проводилось исследование психометрических показателей разработанного русскоязычного варианта.Результаты. Разработана русскоязычная версия опросника CAP‑PRI с высоким уровнем надежности, содержательной валидности и чувствительности.Заключение. Представленная официальная русскоязычная версия опросника для пациентов с хронической приобретенной полинейропатией (CAP‑PRI) рекомендована для отечественной клинической практики и научно‑исследовательской работы с целью оценки качества жизни пациентов. Дополнительно показана связь между улучшением качества жизни и уменьшением выраженности неврологического дефицита, степени инвалидизации и утомляемости (по результатам оценок по шкалам IRODS, NIS и FSS)

YAG-laser refistulization of internal fistula after trabeculectomy in children with post-uveal glaucoma

Purpose. To develop a method for YAG-laser refistulization in a blockade of internal fistula after trabeculectomy (TE) in children with post-uveal glaucoma (PUG), to evaluate its efficiency, to determine indications and optimal timing of its conduction.Material and methods. The study included 54 children aged from 2 to 16 years with PUG in 71 eyes after 78 TEs which underwent the YAG-laser refistulization (128 sessions) because of a detection of complete or partial block of internal fistula during gonioscopy. Laser interventions were performed: within 1 month after TE - in 65.4% of cases, 1-3 months - in 16.7%, 3-12 months - in 10.2%, 1-4 years - in 7.7%. We used a patented technique of combination of the focused (to dissect adhesions) and defocused (to separate the iridotrabecular contact and to decrease exudate) radiation from an YAG-laserResults. Internal fistula was more often blocked by the root of the iris, rarer - by exudate, pigment, fibrous membrane, blood clot. In all cases YAG-laser refistulization eliminated the block, in most cases (82.3%) - in one session. Recurrences of adhesions were observed in 12.7% of cases and were also successfully eliminated by YAG-laser YAG-laser operations proceeded without serious complications. Micro-hemorrhages, that occurred during the separation of iridocorneal adhesions (13.2%), were stopped by lens compressions.Conclusion. The developed method of YAG-laser refistulization after TE, which combines defocused and focused radiation, is highly effective and atraumatic. Laser release of the lumen of the internal fistula ensures its normal functioning and prevention of secondary (ascending) scarring of the created outflow pathway. For the timely detection and elimination of blockade, a gonioscopic control of the internal fistula is necessary both at the earliest and long- term periods after the TE

Peculiarities of surgical technique using a capsule ring for intra-capsular fixation of IOL in children with congenital subluxation of the lens

The aim of the work is to develop a differentiated method of surgical treatment of children with congenital ectopia of the lens using a capsule ring and intra — capsule fixation of IOL.Material and methods. 15 children (28 eyes) at the age of 5–8 years with congenital ectopic lens I–III degree with the syndrome of Marfan, Weil — Marchesani, homocystinuria and isolated pathology were operated. The lens was removed after the introduction of the capsular ring by the method of phakoaspiration and aspiration — irrigation using viscoelastics. One-pieces models of the Acrysof IOL SN60AT and Hoya iSert model 251 were implanted. Anterior capsulorhexis was performed manually (сystotomy, needle, collet tools) and/or using an YAG laser. After hydrodissection of the lens masses, the ring was injected in the capsular bag using the injector, and then removed the lens masses and implanted a one-piece IOL.Results. The technique of performing individual stages was determined by the lens ectopia degree. At I–II degree of ectopia, manual or YAG-laser circular anterior capsulorhexis was performed. Limited anterior vitrectomy was performed in the zone of lens displacement at the III degree of ectopia and the presence of vitreous body. Visual acuity before surgery was from 0.04 to 0.1–0.15, after surgery — 0.1–0.15 — 0.6.Conclusion. The use of differentiated methods of different stages of surgery and the intra — capsule ring in congenital ectopia of the lens allows intra-capsular IOL implantation with high functional and anatomical results at a low level of intra-and postoperative complications

The role of the pediatrician in the treatment of children with congenital cataracts

The purpose of the report is to acquaint obstetricians-gynecologists, neonatologists and pediatricians with the etiological and clinical manifestations, tactics and results of treatment for timely diagnosis and referral to an ophthalmologist. The article presents modern data on the etiology and clinical manifestations of congenital cataracts in children, the particularities of the development of the visual analyzer. The article substantiates the need for the removal of full forms of congenital cataracts in the sensitive period of the child’s development – in the first six months of life for high functional results. The authors note an important role of the pediatrician in the early detection of pathology and timely visit to ophthalmologist to determine treatment tactics

Surgical tactics and peculiarities of intraocular correction in children of the first year of life with congenital cataracts

Purpose. The optimization of microsurgical tactics in case of the primary IOL implantation in children of the first year of life with congenital cataracts. Material and methods. There were examined 230 children (264 eyes) with congenital cataracts (CC), in general anesthesia conditions, who underwent in age from 2 to 5 months (109 eyes, 41.3%) and 6-11 months (155 eyes, 58.7%) cataract extraction with implantation of intraocular lens «Acrysof» SN60AT and Hoya iSert model 251. The optical power of the IOL was 27.0-41.0D, the value of hypo-correction was from 6.0 to 12.0D. Microphthalmia of degree 1-2 with a decrease in the anterior-posterior axis of the eye by 1-2mm was revealed in 18.7% of cases (49 eyes), the size of 23 eyes (8.9%) exceeded the age norm (the «myopia» group), posterior lenticonus with diameter from 2.5 mm to 5.0 mm was detected in 31 eyes (11.8%) and persistent hyperplastic primary vitreous syndrome (PHPV) was in 17 eyes (6.4%). Early and long-term late postoperative complications were studied. Results. The analysis of clinical material allowed to formulate the optimal technique to perform various phases of the surgery (opening of the anterior capsule, removal of lens masses, the approach to posterior capsule, in the presence of posterior lenticonus and the PHPV syndrome), taking into account the clinical polymorphism of congenital changes of the lens and the eye, allowing to create a stable capsular bag, that is necessary for long-term stable IOL fixation in the growing eye of the child. Inflammatory reactions in the form of fibrinous-plastic iritis with the formation of a single pigment and stromal irido-capsular adhesions and deposits on the anterior surface of the IOL were noted in the structure of early postoperative complications in 29 eyes (10.9%). Secondary cataracts (209 eyes, 79.2%) in the form of Adamuk- Elschnig’s balls (178 eyes, 67.4%), fibrosis of the posterior lens capsule (147 eyes, 55.7%) alone or their combinations (56 eyes, 21.2%) dominated in the longterm follow-up period. Exudative-proliferative reactions with formation of irido-capsular adhesions, development of pre-lens «fibrinous» membrane, precipitates on the IOL were observed in 7 children (13 eyes, a 4.9%). Conclusion. The developed microsurgical tactics of CC extraction in children of the first year of life allows to create optimal conditions for intra-capsular IOL implantation, its long-term stable fixation in a fastgrowing eye of the child, to avoid a development of intraoperative and postoperative complications in the majority of children, to obtain good anatomical and optical results

The Results of Morphometric Assessment of the Macular Zone in Congenital Cataract

Purpose: to study the morphological characteristics of the macular zone using optical coherence tomography to assess its development in congenital cataract. Patients and methods: a comprehensive ophthalmological examination was performed in 147 children (269 eyes) aged 1 to 15 years, including, along with traditional methods, optical coherence tomography on the Spectralis HRA + OCT instrument, Heidelberg Engineering. Of these, 193 eyes were with pseudophakia after the removal of congenital cataracts in children aged 2 months to 14 years, 18 eyes with aphakia after the removal of congenital cataracts in children aged 2 months to 11 years, 20 unoperated eyes with partial forms of congenital cataracts and 38 paired conditionally healthy eyes in children with unilateral congenital cataracts. Visual evaluation of linear tomograms, measurement of 5 parameters of the central zone of the fundus and calculation of the macular index were performed. Results: various features of the macular zone were revealed: changes in the macular contour, lamellar structure of the retina, thinning of the choroid, and elements of epiretinal fibrosis. Evaluation of retinal differentiation with the help of a macular index, calculated on the basis of morphometric characteristics, revealed its violations in 52.8 % of cases, which was not always revealed in the visual analysis of tomograms. The best morphometric parameters of the central zone of the fundus are noted in the eyes with pseudophakia in comparison with aphakia (p &lt; 0.05). Conclusion: there is a variability in the state of the macula. In patients with congenital cataracts. Better indicators of the central zone of the fundus in front of the eye with pseudophakia in comparison with aphakia justify the feasibility of performing surgical treatment of congenital cataracts simultaneously with the implantation of the intraocular lens, including in infants. Thinning of the choroid in the subfoveiolar zone with congenital cataract may indicate a violation of trophism and exert additional influence on the physiological development of the macular zone