The main link in the treatment of congenital cataracts (VK) is the extraction of the lens with the
subsequent correction of ametropia by various methods, one of which is the implantation of an
intraocular lens (IOL). The aim of the study was to study the features of the course of the postoperative period in frequently ill children (FBI) after VC extraction. We examined 35 children
(59 eyes) with VK who are undergoing surgical treatment in the eye department of the clinic of the Tashkent Pediatric Medical Institute. A comparative analysis showed significant changes in the hydrodynamic parameters of the eyes and a high percentage of intra- (hyphema in 71%, fibrin
reaction in 59%, prolapse of the vitreous in 47% of cases) and postoperative complications (corneal
edema in 36 %, inflammatory exudative reaction in the anterior Chambers: 1+, 2+ in 64% of cases) in FWB compared to children who are not in the category of frequently ill. The revealed feature
indicates the need for adequate management of the preoperative and postoperative periods in
Frequently ill children
The study showed that 66 chi/dren aged from 8
months to 13 years with cataracts of different etiology
showed high efficiency in the primary implantation of
soft spherica/ monohlock intraoci1lar /ensf!S. Тhе high-
est rates of viziometry after treatment were observed in
chi/dren with congenital bl/ateral and traumatic cata-
racts. After _treatment, children with uveal and uni/at-
era/ congenital cataracts had relative/y /ow visua/ acu-
ity va/ues.
Cataract in children, which is one of the leading causes of primary blindness, is a clouding of the lens. The prevalence of cataracts in developed countries, as well as in Russia, is 1.6–2.4 per 100,000 children. Intraocular lens (IOL) implantation has become widespread in recent decades and is considered the most optimal method for correcting aphakia. Despite the introduction of new high-tech methods of surgical treatment of congenital cataracts, there is currently a fairly high percentage of complications. All of the above does not reduce the urgency of the problem of treating children with congenital cataract (CC) and requires further research.
For parents, a child of any age seems vulnerable, so adults take care of him, they want protection from all difficulties. Unfortunately, a person is not strong and some diseases are very dangerous for the life of children. Some pathologies pass quickly and affect the future life, otherwise others will significantly affect the future life of the child. In order to reduce the impact of pathologies on the child's body, it is possible to diagnose the disease in the early stages, it is necessary to identify and immediately begin treatment. Among these diseases are ophthalmic we can not do without the introduction of diseases. If a child has vision problems from an early age, it can lead to a delay in the development of the child in the future. Ophthalmic diseases the main part: eye injuries, glaucoma, cataracts, glaucoma, retinopathy, myopia, cataract diseases, etc. More than 20% of diseases in ophthalmological practice, depending on the injury, damage the orbit and the eyeball. From an eye injury, then in 13% of cases, subatrophy of the eye develops, in 25% anophthalmos may occur. As for the characteristics of injuries, 10% of children suffer from damage to the organ of vision. This leads to various pathologies of the eye, in 30-60% of cases it can lead to one- or two-sided blindness. The most important traumatic factors in children are: knives, bullets, stones and clubs, hockey sticks, spears, nails, wire, etc. Glaucoma is one of these diseases. The disease also requires special attention. Reason: Prevalence of glaucoma in children Occurs in 1:10,000-1:12,000 cases. Its share in eye pathology is 0.1%. enough. More than 75% of glaucoma cases are bilateral. In parallel, there was glaucoma in 5 to 15% among children, blind and non-blind schoolchildren. Blindness in children, the proportion of this pathology ranges from 2 to 15%. in the Russian Federation Congenital glaucoma accounts for 10.1% of childhood blindness.
Biochemical studies of blood and chamber moisture in children with congenital cataract
are of great clinical importance. Chamber moisture is an ultrafiltrate of blood plasma and can be
an indicator of various pathological conditions of the body as a whole, and the eye in particular.
The study of the level of protein, glucose in the blood and chamber moisture of all the examined
children was carried out. As an indicator of inflammatory complications in the postoperative period,
the threshold value of total blood protein of 62.2±1.3 g/l and an increase protein content in chamber
moisture to 3.5±0.09 g/l can be used.
Congenital cataracts occupy a significant place in the structure of blindness and low vision and are one of the main causes of visual disability since childhood. Currently , cataract in children is one of the urgent problems of pediatric ophthalmology , given its fairly high prevalence and significant role in the structure of blindness and low vision . Due to clouding of the lens, the development of the visual analyzer is disrupted and amblyopia is formed, the treatment of which requires significant and lengthy efforts on the part of ophthalmologists and parents. Among the causes of blindness in children, the share of congenital cataracts varies from 7.5% (in developed countries) to 27.4% (in socially disadvantaged regions). The prevalence of cataracts in developed countries, as well as in Russia, is 1.6-2.4 per 100,000 children [25.].
AIM: To analyze clinicofunctional and echobiometric indicators of the eyes in children with target refraction, pseudofacial myopia, and their mothers.
MATERIAL AND METHODS: In the eye department of the clinic of the Tashkent Pediatric Medical Institute, a correlation analysis of optical and echobiometric indicators was conducted in 30 children (30 eyes) with artifakia and their mothers (60 eyes). Visiometry, keratorefractometry, and ultrasound examination (A/В scan of the eyeball) were conducted. Children were examined 12-14 months after CC extraction with intraocular lens (I0L) implantation.
RESULTS: A strong direct correlation was determined between the optical power of lOLs in children and their mothers who were theoretically planned for I0L implantation of lOLs in the group that has achieved target refraction. This may indicate the possibility that the child has the same optical power as the mother and the optical power of lOLs in a child is the same as that in adults. No correlation was found between the optical power of the I0L in the eyes of children with pseudophakic myopia and maternal artificial lenses theoretically planned for implantation.
CONCLUSION: The direct strong correlations between the optical power of the I0L of children and the lenses of their mothers in the group with the target refraction achieved by this age make it possible to use the optical power of maternal lenses as a “guideline" when calculating the power of the I0L implanted in children to achieve the target refraction. The lack of correlation between the refractive powers of the I0L in children with pseudophakic myopia and the lenses of mothers may indicate that the SRKII formula with age-related hypocorrection is not adapted to calculate the I0L power in children at risk of excessive refractive enhancement after surgery.
Prevention of visual disability should begin in childhood. To plan high-tech specialized ophthalmic care for young patients, it is necessary to monitor the structure of ophthalmopathology in infants in leading domestic children's medical institutions. Purpose of the study. The study of the structure of eye diseases in infants based on the materials of the department of ophthalmology of the clinic of the Tashkent Pediatric Medical Institute (TashPMI). Material and methods. A retrospective analysis of statistical coupons of case histories of 685 patients aged 0 to 1 years who were hospitalized in the ophthalmological department of the TashPMI clinic for 2018-2021 was carried out. Results and conclusion. The spectrum of nosological units revealed the predominance of glaucoma (41.3%) and lens diseases (30.4%). At the same time, it was noted that eye injuries (10.5%), diseases of the eyelids, lacrimal ducts (phlegmon of the lacrimal sac) and orbit (9.2%), although they did not occupy a leading position, nevertheless represented severe acquired lesions, which could have been prevented. Age-related aspects of nosologies are due to the timing of clinical manifestations, diagnosis and treatment of pathologies, the anatomical and physiological characteristics of the child's body, and a decrease in parental control over children.
Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the functional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant.
Purpose — to determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation.
Material and methods. The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL.
Results. The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were subjected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk factors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed.
Conclusion. According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such indicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of 23.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of SI 80 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combination of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patients parents, near-sight visual loads ot more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.
The length parameter of anterior-posterior axis is compared for children’s hyperopic eyes (302 eyes, hyperopia of 0.5 to 3.0 D). 109 eyes (109 children) with unilateral congenital cataract (UCC), and 132 eyes (90 children) with congenital glaucoma, aged 1 month to 15 years. Extended observation of anterior-posterior axis growth and refraction in eyes with artifakia showed a partial tendency to myopisation (3— 7%), which requires additional research of the pathogenetic process and should be taken into account when calculating the optical power of 1OL. The analysis of data on age-related growth of the anterio-posterior axis of eyes with congenital glaucoma showed the agreement with average figures for the developed and advanced stages of the condition. In contrast, terminal and advanced glaucoma (in children aged 2 to 3) the obtained data showed a reliable increase as compared to previously published values
To assess the clinical efficacy of the SRK II formula with a correction factor Rm in children with congenital cataracts who are at risk of pseudophakic myopia. Material and methods. A complex examination of 48 children (86 eyes) with congenital cataracts involved visometrics, tonometry, tonography, biomicroscopy, keratorefractometry, ophthalmoscopy, ultrasonography, and pachymetry. To determine the IOL power, we used the SRK II formula supplemented with the individual correction factor Rm, proposed by the authors. The examined children were divided into 2 groups. The main group 1 included 22 patients (42 eyes), for which the IOL power was calculated with the Rm factor. The control group 2 consisted of 26 patients (44 eyes) for which the IOL power was calculated according to the traditional SRK II formula using age-related hypocorrection of refraction but without the Rm coefficient. Results. The correction factor Rm, allowed us to achieve the targeted refraction in children who were at risk of developing pseudophakic myopia in 83.3 % of cases of the main group (versus 45.4 % of the control group cases) and reduce the development of high age-related refraction) by 37.9 %. In children of the main group, visual acuity reached, on average, 0.5 ± 0.001, while in the control group it was also higher but only reached 0.200 ± 0.001. Conclusion.The method of calculating the IOL optical power involving an individual correction factor Rm, according to the formula: SRK II – R – Rm can be recommended for clinical practice focused on children at risk of abnormal refractogenesis.
Purpose. An analysis of complications in case of penetrating injuries of visual organ in children and methods of their elimination.
Material and methods. There were in the follow-up 36 patients (36 eyes) aged from 6 to 14 years with various ocular injuries: boys - 70% of cases, girls - 30% of cases. All children underwent ophthalmic and clinical examinations.
Results. The primary surgical treatment (PST) was performed in all patients at the place of residence in different regions of the Republic. The secondary surgical treatment (SST) was carried out according to the following indications: swelling cataract, filtration of corneal and scleral injuries, local endophthalmitis, iris incarceration, hypotension, secondary glaucoma, sutures failure, torpid uveitis, deformation of eyelids, abruption of lacrimal canaliculi, non-sutured scleral wound, suspect intraocular foreign body, the destruction of the eyeball, suspected intraocular foreign body, the destruction of the eyeball. Causes of PST complications were: the severity of injuries (47.2%), an unskilled first aid (41.7%), a late appeal of patient (47.2%).
Conclusion. As a SST result the inflammatory response was stopped and the eyes were maintained as an anatomical organ in 99.6% of cases, visual functions were preserved in 67.4% of cases. It is necessary to intensify educational work among the population, to improve the quality of emergency eye care and the adequate rehabilitation of patients.
The length parameter of anterior-posterior axis is compared for children’s hyperopic eyes (302 eyes, hyperopia of 0.5 to 3.0 D). 109 eyes (109 children) with unilateral congenital cataract (UCC), and 132 eyes (90 children) with congenital glaucoma, aged 1 month to 15 years. Extended observation of anterior-posterior axis growth and refraction in eyes with artifakia showed a partial tendency to myopisation (3— 7%), which requires additional research of the pathogenetic process and should be taken into account when calculating the optical power of 1OL. The analysis of data on age-related growth of the anterio-posterior axis of eyes with congenital glaucoma showed the agreement with average figures for the developed and advanced stages of the condition. In contrast, terminal and advanced glaucoma (in children aged 2 to 3) the obtained data showed a reliable increase as compared to previously published values
To study the results of IOL implantation in children with frequent respiratory diseases - conditionally frequently ill children (FCCI) taking into account the parameters of the composition of the chamber moisture of the eye. Material and methods: A retrospective and prospective analysis of the case histories of 50 children (50 eyes) aged from 1 to 5 years, who were treated in the eye department of the TashPMI clinic, was carried out. All patients underwent ophthalmological, clinical and laboratory studies: biochemical studies of blood and chamber moisture of the eye (EC). Results: The children were divided into 2 groups: the 1st group - 28 UCBD, the 2nd group (control) - 22 patients with no pathology from the somatic status. In patients of the 1st group, intraoperative complications occurred 1.8 times more often than in patients of the 2nd group, postoperative complications - 2.5 times more often. Of the late postoperative complications in patients of the 1st group, there was fibrosis of the posterior lens capsule (61%), poste-rior synechia (18%), and IOL dislocation (14%), which were indications for repeated surgical interventions. Conclu-sions: UCBD has a higher percentage of early postoperative inflammatory and late proliferative reactions. In patients of the 1st group, a significant increase in the protein content in the chamber moisture and a significant decrease in the protein level in the blood before cataract extraction were also revealed.
Характерной особенностью врождённых катаракт является многообразие клинических форм в зависимости от локализации, вида и степени помутнения хрусталика. Полиморфизм клинических форм врождённых катаракт гребует неоднозначного подхода к лечебной тактике в каждом конкретном случае.
The paper presents the results of extraction of congenital cataract with IOL implantation in 50 (86 eyes) children aged 7 months to 12 years. In the examined patients, intraoperative complications were noted, such as posterior capsule rupture (8%), hyphema (6%), postoperative: fibrin effusion on the IOL (7%) and corneal edema (4.6%). With congenital bilateral cataracts after treatment, visual acuity increased on average from pr.l.certae to 0.1; with unilateral - from pr.l.certae to 0.01.
The aim of the study was to study the etiological and morphological features of large macular ruptures. The present study included 200 eyes (188 patients) who were diagnosed with a large macular rupture at initial examination. 96 eyes (48%) were diagnosed with stage 3, the remaining 104 eyes (52%) were diagnosed with stage 4 macular rupture. Large macular tears in 55.5% of cases are due to vitreomacular traction syndrome, in 24.5% of cases - myopia and in 20% of cases - eye trauma. Macular tears of various etiologies do not differ in visual acuity, intraocular pressure, diameter and stage of the rupture, duration of the disease. Macular rupture is associated with cataract in 51.5% of cases.
Actuality. Prevention of visual disability should begin in childhood. To plan high-tech specialized ophthalmic care for young patients, it is necessary to monitor the structure of ophthalmopathology in infants in leading domestic children's medical
institutions. Purpose of the study. The study of the structure of eye diseases in infants based on the materials of the department of ophthalmology of the clinic of the Tashkent Pediatric Medical Institute (TashPMI). Material and methods. A retrospective analysis of statistical coupons of case histories of 685 patients aged 0 to 1 years who were hospitalized in the ophthalmological department of the TashPMI clinic for 2018-2021 was carried out. Results and conclusion. The spectrum of nosological units revealed the
predominance of glaucoma (41.3%) and lens diseases (30.4%). At the same time, it was noted that eye injuries (10.5%), diseases of the eyelids, lacrimal ducts (phlegmon of the lacrimal sac) and orbit (9.2%), although they did not occupy a leading position, nevertheless represented severe acquired lesions that could be prevent. Age-related aspects of nosologies are due to the timing of clinical manifestations, diagnosis and treatment of pathologies, the anatomical and physiological characteristics of the child’s body,
and a decrease in parental control over children.