INTRODUCTION: Dacryocystocele (hydrops of the lacrimal sac) is a rare variant of a congenital pathology caused by the obstruction of proximal and distal lacrimal ducts, followed by progressive distension of the lacrimal sac [1]. Given the accumulation of abundant contents in the lacrimal sac and nasolacrimal duct, the membrane that closes their outlet under the inferior turbinate can be stretched, and the prominence of such a membrane into the inferior nasal passage is in the form of the so-called nasolacrimal cyst [3]. Description of the clinical case. A 1.5-month-old girl was hospitalized in the ophthalmology department of the University. Below are the history data. At the 30th week of pregnancy, the fetus had a bilateral space-occupying lesion in the area of the inner canthus of the eye. At birth, the child had a dense swelling in the region of the left lacrimal sac but without discharge. From birth, he had difficulty in nasal breathing. RESULTS: According to the results of multislice computed tomography of the lacrimal ducts with contrast (Ultravist), cavity formations were found under the inferior turbinate on both sides with a contrast level. At the age of two months, the child, accompanied by an otolaryngologist, underwent surgery for the removal of nasolacrimal cysts on both sides and reconstruction of the lacrimal ducts and their intubation with a silicone thread on the left. After surgical treatment, the outflow of tears and nasal breathing were restored, and no signs of dacryocystocele were detected. The silicone thread was removed after 1 month, and no tear production was observed. DISCUSSION: Treatment of children with dacryocystocele involves the simultaneous reconstruction of lacrimal ducts by an ophthalmologist and excision of the nasolacrimal cyst by an otolaryngologist. CONCLUSION: When examining a child with dacryocystocele, the possible presence of a nasolacrimal cyst should be considered. The interaction of an ophthalmologist and an otolaryngologist at all stages of the treatment and diagnostic process enables the prevention of disease complications and unnecessary surgical procedures.
Laser photocoagulation of avascular retina remains the standard method for the treatment of retinopathy of prematurity (RP). At the same time, the outcomes of combined multi-stage surgical interventions on the patients presenting with this condition leave much to be desired. In the present review, we have undertaken the analysis of more than 50 articles related to the use of antibodies against the vascular endothelial growth factor (Anti-VEGF) that were published during the period from 2005 to 2015; the analysis included the use of the “off-label” medications as the potentially promising method for the treatment of retinopathy of prematurity. In the overwhelming majority of the studies, the use of anti-VEGF therapy as monotherapy or in the combination with conventional laser photocoagulation has been shown to be efficient for the treatment of stage III+ of the active period of retinopathy of prematurity. One of the important advantages of monotherapy is it does not cause the irreversible destruction of the peripheral retina, in contrast to the action of laser photocoagulation. Moreover, the intravitreal administration of the inhibitors of angiogenesis does not interfere with the growth of blood vessels in the peripheral retina as demonstrated by fluorescein angiography and electroretinography. At the same time, the results of certain published investigations give evidence of the important role played by the vascular endothelial growth factor in the processes of angiogenesis, glomerulogenesis, and alveolarization during the normal lung development. In addition, it has been demonstrated that bevacizumab can migrate from the vitreous body and penetrate into the systemic circulation where it causes the reduction of the serum VEGF levels in the infants presenting with retinopathy of prematurity. In connection with this, the majority of the authors emphasize the necessity of further investigations (based on the results of monitoring the concentration of serum VEGF) for the evaluation of the safety of such medications, their potential long-term effects on other organs and systems in the course of their development as well as possible adverse reactions they are likely to induce. Some problems related to the timing and dosage of the intravitreal administration of the inhibitors of angiogenesis remain a matter of controversy.
Objectives of publication:presentation of a rare clinical observation from our own practice.Key points:colobomatous orbital cyst with microphthalmos — rare anomaly of an embryonal development of an eyeball, it is formed owing to “filling” of an optic nerve with the intraocular liquid coming to him from a vitreous chamber through сoloboma of disk because of violation of hydrodynamics in a forward segment of an eye. Usually this anomaly is combined with microphthalmic eye, though cases of a colobomatous cyst with a normal size of an eyeball, and also with other anomalies of development of an eye (inferior uveoretinal coloboma, prepupillary membrane, corneal opacity) are described.Сlinical observation:during 2015 in our department there were two children to whom after the carried-out inspection the diagnosis of a colobomatous cysts of optic nerve has been exposed. Concerning the first child waiting tactics has been recognized expedient, at repeated surveys in 1 and 4 months of any dynamics in the ophthalmologic status it hasn’t been revealed. To the second child because of the expressed exophthalmos with lagophthalmia, with perforation threat, surgical intervention – a puncture and drainage of a cyst of an optic nerve is performed. After operation the correct situation and mobility of an eyeball were restored, xerotic changes of a cornea and conjunctiva have decreased.Conclusions:from the pathogenetic mechanism of cystous formation of an orbit, it is more logical to specify the clinical diagnosis a mention in him an optic nerve – “сolobomatous cysts of optic nerve”. Surgical treatment depends on the sizes of cyst, degree of exophthalmos and existence of complications.
BACKGROUND: In many types of pediatric glaucoma, there is no clear algorithm for surgical management. In these situations, the procedure of choice can be the implantation of various types of drainage devices. AIM: To evaluate the outcomes of Ahmed Glaucoma Valve implantation in refractory pediatric glaucoma. MATERIALS AND METHODS: The treatment results of 52 children (67 eyes) aged 1 month 17 years (6.6 0.6 years) with unsuccessfully operated primary congenital glaucoma, with glaucoma associated with congenital anomalies of the eyeball, with secondary glaucoma were analyzed. The surgery was considered to be effective when stable intraocular pressure (IOP) was achieved, there were no complications, and no need for repeated interventions. RESULTS: The effect of surgery was maintained for 6 months in 97% of patients, but after 1, 2 and 3 years it decreased to 91.8%, 82%, and 73.9%, respectively, and to 42.8% after 7 years. Postoperative complications included filtering bleb encapsulation (25.3%), iris retraction to the tube with pupil dislocation (4.5%); ciliochoroidal detachment (4.5%); cataract (3.0%), conjunctival erosion with tube eruption (4.5%), endophthalmitis (1.5%), retinal detachment (6.0%), tube retraction (1.5%), hyphema (3.0%). The risk factors for an unfavorable outcome of the procedure were: an increase in the anteroposterior axis of the eyeball length by 20% or more compared to the age norm, IOP at the time of the surgery higher than 32 mm Hg, as well as previous antiglaucoma filtering procedures. CONCLUSIONS: The implantation of the drainage device Ahmed Glaucoma Valve is indicated for refractory pediatric glaucoma in case of ineffectiveness of previous surgeries. However, it is necessary to take into account the decrease in the effectiveness of the device over time, which, combined with the possibility of complications, requires long-term follow-up of patients.
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