In premature babies, plastic changes develop in the neural retina, which, depending on the severity of retinopathy of prematurity (ROP), are a manifestation of adaptive or non-adaptive plasticity. In various experimental studies on animal ROP models, the conditioning effects of intermittent white light stimulation and various mechanisms of the positive effect of red and ultraviolet radiation on the plasticity of the retina have been demonstrated, which allows phototherapy to be considered as a promising modifying treatment for ROP supplementing the main therapy. Taking into account that light-dependent processes are involved in the pathogenesis of ROP, we also hypothesize that fractal phototherapy with complex-structured optical stimuli, as a method of activating adaptive neuroplasticity, can be most effective in the complex of methods for preventing and treating ROP.
Visual functions in children after retinopathy of prematurity depend not only on the degree of residual clinical changes in the fundus and structural features of the retina, but also on the state of the pathways and higher parts of the visual analyzer, which can be investigated by recording visual evoked potentials. This examination method involves recording the overall response of large populations of cortical neurons to the synchronous flow of impulses coming to them, arising in response to an afferent stimulus and reflecting mainly the electrical activity of the macular area. The registration of visual evoked potentials in the retinopathy of prematurity has an important diagnostic value for identifying the level and degree of damage to the pathways and higher parts of the visual analyzer. This literature review presents the data of foreign and domestic authors on the state of the pathways and higher parts of the visual analyzer in premature babies and children with retinopathy of prematurity using the registration of visual evoked potentials. It has been noted that the magnocellular system, which is activated in response to motor stimuli, is affected to a greater extent in preterm infants than the parvocellular system, which functions in response to pattern stimuli. A comprehensive ophthalmological examination with the registration of visual evoked potentials on the presentation of pattern-reversing stimuli and/or on a flash stimulus should be carried out in children with cicatricial stages of retinopathy of prematurity, in order to identify and confirm the concomitant pathology of the optic nerve. It has been established that the frequency of registration of pathologically altered visual evoked potentials as the severity of retinopathy of prematurity increases, indicating an increase in pathway dysfunction. The effect of laser coagulation of the retina and the volume of its implementation in retinopathy of prematurity on the functional state of the visual analyzer was studied.
115 children (159 eyes) examined 1 to 11 years after the extraction of bilateral or unilateral СС at the age of 2-11 months. Optical power of the implanted IOL had been calculated using SRKII formula for hypercorrection to result in emmetropic or weak myopic refraction by the time the eye growth finishes. The subjects underwent autorefractometry on Retinomax K-Plus 3 device and ultrasonic biometry on Humphrey 835 A/B-scan system. Results. The incidence of unplanned refraction in children aged 1 to 3 years was 61.2%, aged 3 years to 5 years 11 months-24.4%, and in children of 6-11 years-50.0%; it was associated with pronounced unplanned eye growth in 48.6% of cases with bilateral СС and in 27.3% of cases with unilateral СС. Conclusion. The main cause of unplanned refraction in pseudophakic eyes in children with СC is unpredictable increase of the length of anteriorposterior axis after surgery.
Purpose: to analyze the clinical manifestations, course, and results of treatment of Coats disease in children. Materials and methods. We performed a retrospective analysis of medical records of 59 patients with Coats retinitis (83 % were boys) who had been comprehensively examined and treated between 2018 and 2021. After the diagnosis was verified, the children were hospitalized for treatment. Retinal laser coagulation was performed on 61 eyes, angiogenesis inhibitors were administered on 1 eye, and 5 eyes received microsurgical interventions. Results. At the time of disease detection, the children’s age varied from 1 to 16 years. In 97 % of cases, the process was unilateral. An improvement of the anatomical condition and the eye-preserving effect were achieved in 87 %. Visual acuity could only be increased in 19 eyes (31.1 %), all with the initial or the advanced stages of Coats retinitis. Proceeding from our experience, the analysis of polymorphism of clinical manifestations, functional prognosis and differentiated approach to treatment depending on the prevailing clinical symptoms, we suggest a new variant of clinical classification of Coats retinitis. Conclusion. In order to ensure a timely diagnosis of the disease, a very thorough examination of patients in the first decade of life is required. Only an early diagnosis and timely treatment can help achieve not only an eye-preserving effect but also functional results.
Gyrate atrophy is a rare genetic metabolic disease with an autosomal recessive inheritance that causes progressive chorioretinal atrophy, fundus manifestations, and decreased visual function. The prognosis of the disease largely depends on the development and progression of complications (macular changes and cataracts) as well as concomitant neurological and somatic pathology. AIM: To describe three clinical cases of hypertension. MATERIAL AND METHODS: We examined three children with gyrate atrophy at 4, 10, and 15 years old. All patients underwent a comprehensive ophthalmological examination, including modern diagnostics, visualization, and electrophysiological studies. RESULTS: Although older patients have more pronounced changes in the fundus with involvement of the macular zone in the pathological process, a 4-year-old child has pronounced functional retinal disorders detected during electroretinogram registration, indicating an earlier manifestation of the pathological process. Gyrate atrophy was combined with foveoschisis and ornithinemia in older patients (10 and 15 years old). The differential diagnosis of gyrate atrophy should be carried out with high myopia with areas of dystrophy of the cobblestone pavement type on the periphery of the fundus, resembling foci of chorioretinal changes in hypertension. CONCLUSION: Patients with gyrate atrophy require an interdisciplinary approach that includes not only ophthalmologists but also pediatricians, medical geneticists, and other specialists with comorbidities.
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