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ANALYSIS OF THE RESULTS OF TREATMENT OF
SECONDARY GLAUCOMA IN CHILDREN ASSOCIATED
WITH RETINOPATHY OF PREMATURE
1
Khamroeva Y.A.,
2
Erkinova O.H.
1,2
Tashkent Pediatric medical institute
https://doi.org/10.5281/zenodo.13125757
Abstract. This article presents an analysis of the results of hypotensive surgery for
secondary glaucoma in children after complex treatment of retinopathy of prematurity. The
authors of the article analyzed the surgical treatment of 5 (10 eyes) children aged 1 month to 1
year in the eye department of the clinic of Tashkent Pediatric Medical Institute with ROP
associated with glaucoma. When treating secondary glaucoma in children with early stages of
ROP, it is preferable to use antiglaucomatous filtration operations.
Keywords: retinopathy of prematurity; secondary glaucoma; Lenswitrschwartectomy.
Actuality. Primary congenital glaucoma is a rare and severe genetically heterogeneous
disease that leads to blindness and low vision. In the structure of childhood visual disability,
congenital glaucoma makes up 10.1% [1,2,9]. The frequency of this pathology is steadily
increasing and ranges from 17 to 34% among surviving premature infants [4,5,6,10]. During the
intrauterine development of the fetus, on average, starting from the 28th week of gestation, a
gradual separation of the iris and ciliary div from the trabecula occurs. At the 32nd week of
gestation, mesodermal tissue is most pronounced in the anterior chamber angle (ACA), which
completely resolves upon reaching the 36th week of gestation [3,5,11].
The pathogenesis of Parenteral viral hepatitis (PVH) remains unclear. “Immaturity” of the
anterior chamber angle (ACA) is caused by a stop in the development of tissue-derived cells of
the cranial neural crest in the third trimester of gestation. During the intrauterine development of
the fetus, on average, starting from the 28th week of gestation, a gradual separation of the iris and
ciliary div from the trabecula occurs. At the 32nd week of gestation, mesodermal tissue is most
pronounced in the ACA, which completely resolves upon reaching the 36th week of gestation
[3,5,6,7].
The anatomical features of the ACA in extremely premature children against the
background of I-III degrees of cicatricial ROP are similar to those in congenital glaucoma in
premature infants and are characterized by uneven anterior attachment of the iris root in
combination with mesodermal tissue, which leads to an increase in intraocular pressure (IOP) [7
,8,11], with the development of the form of congenital glaucoma, the biomechanical parameters
of the eye increase according to the stages. At the same time, a decrease in the rigidity of the
fibrous membrane indicates morphological changes in the tissues of the eye and the severity of the
glaucomatous process [9,12].
Thus, according to some authors, the development of congenital glaucoma in early
childhood is associated with ROP in 57% of cases [5]. The glaucomatous process in young children
occurs in premature infants in more than half (57%) of cases. Among patients with glaucoma,
children with a birth weight of 1450–1700 g predominate, as well as patients who received
glucocorticosteroid drugs (or did not receive treatment at all) during the active period of RP.
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Glaucoma in premature infants in most cases (72%) develops in both eyes and corresponds to
stages I–III of ROP [1,3].
In the active phase of stages I–III of ROP, hypotensive surgery in the trabecular zone was
used; in the cicatricial phase of stages IV–V of ROP, combined hypotensive surgery was used both
in the trabecular zone and in the ciliary div area using autoscleral drainage [10].
The purpose of the study. To present an analysis of the results of hypotensive glaucoma
surgery in children after complex treatment of retinopathy of prematurity.
Material and research methods. Under our supervision in the eye department of the clinic
of Tashkent Pediatric Medical Institute there were 5 (10 eyes) children aged from 1 month to 1
year with ROP complicated by secondary glaucoma (classification of secondary glaucoma in
young children according to Shaffer-Weiss) [11]. Active ROP stage I-III “plus” phase was
diagnosed in 3 (5 eyes) patients, stages 4-5 in 3 (5 eyes) patients. Taking into account the stages
of the disease, all patients were divided into 2 groups, the first included 3 (5 eyes) children with
stages I-III, the second - 3 children with stages IV-V of ROP. The gestational age at birth in the
examined children was 21–36 weeks. The follow-up period was 18 months.
Research methods included visometry, refractometry, ophthalmoscopy, determination of
optic disc excavation (E/D), A-scan with registration of the anteroposterior axis of the eyeball
(APA), B-scan, gonioscopy, tonometry, tonography. Developmental defects of the ACA were
determined according to Jr. Hoskins developed for secondary glaucoma anatomical classification.
[12,13,14].
Results and discussion. The div weight of the examined premature children at birth
ranged from 1000 g to 2400 g (on average, 1700 g), at the time of examination from 2800-9800 g
(on average, 6300 g).
Secondary glaucoma was diagnosed in all patients: in 1 (10%) eye - the initial stage, in 4
(40%) eyes - the advanced stage, in 3 (30%) eyes - the advanced stage, in 2 (20%) eyes - the
terminal stage. After medical and surgical treatment, compensation was achieved in 3 (30%) eyes,
subcompensation in 6 (60%) eyes, and stabilization of the process in 1 (10%) eye.
Three patients (6 eyes) aged 2 to 6 months with stages I-III of ROP received appropriate
treatment for the underlying disease (instillation of glucocorticosteroid drugs, transpupillary or
transscleral laser coagulation of avascular zones of the retina, transscleral cryoretinopexy). In 2
patients (4 eyes) at the age of 6 months, with cicatricial stages IV–V of ROP, a
lensvitreoshwartectomy was performed.
In the first group, isolated trabeculodysgenesis was detected in 6 eyes, which included
anterior attachment of the iris in 3 (50%) eyes and posterior attachment of the iris also in 3 (50%)
eyes, respectively. In the second group, aniridia was diagnosed in 4 eyes, of which 2 eyes (50%)
had anterior stromal iris defects.
Taking into account echobiometric and gonioscopic characteristics, the type and extent of
surgical treatment was determined. Filtering aniglaucomatous operation: ab externa
sinusotrabeculotomy was performed in the first group, ab externa sinusotrabeculotomy and
cyclodialysis, cycloretraction with autoscleral drainage - in the second group.
Observations of patients for 18 months after antiglaucomatous surgery showed the
following results: P
t
in two groups in 6 (50%) eyes remained within the normal range of 20.08 ±
0.8 mm Hg, while in 2 (25%) eyes eyes, its decrease to 13.08±0.5 mmHg was noted. PPV of the
eye in 6 (50%) cases remained within the normal range corresponding to age of 0.2±0.1 mm, in 2
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(25%) eyes a moderate increase was noted to 0.8±0.1 mm, in 2 (25%) eyes the POV of the eyeball
was below the corresponding age norm by 3.2±1.1 mm. E/D indicators in 6 (50%) eyes were
reduced in volume and depth by 0.2±0.5%, in 4 (25%) eyes they remained unchanged.
Thus, the results of surgical treatment showed that in the early stages of ROP combined
with secondary glaucoma, the chosen method of antiglaucomatous filtration surgery leads to
stabilization of the glaucomatous process in 77% of cases.
Conclusion. When treating secondary glaucoma in children with early stages of ROP, it is
preferable to use antiglaucomatous filtration operations.
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