[Penetrating keratoplasty in high-risk children: prevention of graft rejection].

Purpose: To evaluate the efficacy of prolonged courses of systemically administered subtherapeutic Metipred and cyclosporine in prevention of graft rejection in high-risk children.

Material And Methods: The study included 27 children at high risk of graft rejection due to re-keratoplasty (n = 8), limbo-keratoplasty for corneal staphyloma (n = 4), or transplantation into vascularized corneal bed (n = 15). All patients were divided into two groups--the study group (n =11) and the control group (n = 16).

[Congenital glaucoma and thymomegaly: clinical and immunological characteristics].

A comprehensive examination of children with thymomegaly and congenital glaucoma revealed systemic and local humoral immunological disorders mainly as immunodeficiency, a family history of the disease, susceptibility to infections and allergic diseases, the presence of malformations, severe glaucoma, and a complicated postoperative period, which are suggestive of the defective state of the immune system, which should be kept in mind while making a surgical treatment and using an immunomodulator therapy, by exercising a great caution. Such children require observations by a pediatrician, an oculist, and an immunologist and consultations given by other specialists.

[Possibilities for prevention and treatment of blindness and impaired vision in children caused by congenital eye diseases].

Blindness, disability, and impaired vision present important medicosocial problems. According to the WHO, there are 1.5 million blind children in the world.

[Combined laser instrumental extraction of congenital cataracts in children].

The authors have developed a new method for removal of congenital cataract in children, by taking into account its clinical forms, namely, combined laser instrumental extraction including YAG-laser anterior capsular rhexis, followed by removal of lens debris by the aspiration-irrigation technique. A differential technology of YAG-laser anterior capsular rhexis has been developed, by taking into account of age-specific features of the lens and eyes in children. The optimum energy modes and techniques have been defined for different clinical forms of congenital forms of congenital cataracts.

[Problems and outlooks for the preventive treatment of retinopathy in prematures].

The immediate and remote (up to 7 years) results of preventive cryo- and/or lasercoagulation of avascular retinal zones made in 390 children with active progressing retinopathy of prematures (RP) were analyzed. The efficiency of cryocoagulation in processes localized in zones 2-3 of the eye bottom made 92%, and that of the combined technique (laser- and cryocoagulation) with lesions in zones 1-2 and with plus-diseases was up to 80%. The preventive treatment is indicated for the 3d threshold (ordinary clinical course) and before-threshold (with plus-disease and localization zone 1) stages.

[Polypeptide bioregulators in the treatment of different-type abiotrophy of the retina].

The efficiency of retinalamin was studied in 33 patients, aged 4 to 7, with 5 types of retinal abiotrophy. The experimental group comprised children with retinal abiotrophy of Franceschetti type (36%) and mixed type (39%). The pathological process was stabilized during 18 months in all cases of developed disease.

[Experience in penetrating keratoplasty in children: graft survival, functional results and risk factors].

Penetrating keratoplasty in children is related with a labor-consuming process of follow-up and care as well as with a high risk of graft rejection and a moderate vision improvement. Nonetheless, keratoplasty has been and still remains a surgery of choice due to a lack of an alternative procedure; its technique and results have been gradually promoted in practice. The authors analyzed 112 keratoplasties in childhood-age corneal opacifications of different types.

[Complications of trabeculectomy in congenital glaucoma in children].

Presently, trabeculectomy is being widely used for congenital glaucoma in children. The authors established, after examining 92 children, that the efficacy of surgical treatment was on the average affirmed in 98.7% of cases during the early observation period, and in 89.

[Postoperative complications of penetrating subtotal keratoplasty in children].

Accordingly to experience of corneal transplantations during 1981-2001 in the children's clinic of the Helmholz Moscow Research Institute of Ocular Diseases the authors present the clinical picture, rate, prognostic value and modes of correction of postoperative complications after keratoplasty. A retrospective study analyzed the incidence of complications after 94 penetrating keratoplasties performed in 82 children aged from 10 months to 14 years in 89 eyes for congenital corneal opacity (n = 22) or corneal opacity caused by trauma (n = 40) or inflammation (n = 20). 60 (73%) within 1 year after operation developed different reactions and complications due to transplant failure in 41 (44%) cases.

[Features of retinopathy of prematurity, progressing as "plus-disease"].

"Plus-disease" is a particular grave form of retinopathy of premature babies found in 7% of extremely premature and somatically loaded children. The following criteria are indicative of "plus-disease": location of pathological changes in the central zone of eye fundus (zone 1-2), marked vascular activity and hemorrhages in the center and on the periphery of the retina, pupil regidity, iris vasodilatation and fulminant (3 days-3 weeks) progression of the process from initial signs up to signs of extraretinal growth or exudative amotio retinae without forming premature stages typical for retinopathy (torus lines). Upon revealing the first signs of "plus-disease" ophthalmological examinations should be carried out with the interval of 2-3 days.

[Clinical informative value of new methods of ultrasonic examination in the differential diagnosis of various forms of congenital diseases of the eyes in children].

Clinical informative value of computer echography for the differential diagnosis of severe intrauterine uveitis (68 children, 96 eyes), retinopathy neonatorum (37 children, 74 eyes), Coats' retinitis (35 children, 35 eyes), and retinoblastoma (17 children, 26 eyes) was studied in a group of 157 children (231 eyes) with opaque refracting media. Ultrasonic diagnostic equipment with a high level of computer support essentially improved the resolving capacity of echography and detected accessory acoustic signs of some congenital ocular diseases.

[Clinical variants and immunologic features of rheumatoid uveitis in children of different age].

Variability of clinical manifestations of rheumatoid uveitis, possibility of an atypical course (peripheral or panuveitis), and greater severity and specific features of the disease in case of its early (before the age of 3 years) manifestation are demonstrated on the basis of observations of 79 patients with rheumatoid uveitis. Despite systemic therapy with corticosteroids and cytostatics, no manifest post-steroid immunodeficiency was observed. Moderately expressed gammapathies were detected in 60% cases; hypoimmune states predominated, which were more often detected in children aged under 6 years.

[Prevalence and clinical significance of active cytomegalovirus infection in patients with inflammatory ophthalmopathy].

A total of 374 patients with different inflammatory diseases of the eyes were examined (227 children and 147 adults). For detecting active cytomegalovirus (CMV) infection, sera were tested for antibodies to nonstructural intact CMV proteins. Antibodies were detected in 26 of 147 adults (17.

[Cytomegalovirus infection in children with endogenous uveitis].

A total of 405 children aged 3 months to 15 years with uveitis of different origin and localization and 50 mothers of children with intrauterine uveitis were tested for cytomegaloviruses (CMV). Chronic CMV infection was detected in 79% children and 88% mothers. Active CMV infection was diagnosed in 7.

[Results of optic reconstructive interventions in children with ocular injuries].

Optic reconstructive interventions were carried out in 36 children with ocular injuries aged 3-14 years. Perforating keratoplasty was combined with measures aimed at repair of the normal anatomic status of the eye and the transparency of its optic media. Microsurgical interventions were performed for penetrating corneal wounds in 27 cases, for penetrating corneoscleral injuries in 8, and for eye contusion in 1 case.

[Efficacy and indications for YAG laser optico-reconstructive surgery on the anterior eye segment in children].

Efficacy of YAG laser surgery is analyzed in 486 children treated at the Helmholtz Institute of Ocular Diseases. Indications and contraindications for YAG laser correcting opticoreconstructive surgery on the anterior segment of the eye are defined for children with secondary cataracts, some congenital, traumatic, and complicated cataracts, anterior and posterior synechias, goniosynechias, ectopic and pinhole pupil, pupil block, anterior chamber cysts, vitreous adhesions, and some consequences of intraocular lens implantation. Optimal terms of laser intervention are defined, improving its efficacy and decreasing the risk of complications.

[Enteroviral persistence in eye infections in monkeys (postuveitis syndrome)].

Follow-up (5.5 years) of monkeys with a history of acute enterovirus uveitis (AEU) after intraocular infection with ophthalmotropic ECHO 11 and ECHO 19 strains showed progressive changes in the infected eye; destruction of the iris, formation of films in the anterior chamber of the eye, deformation of the pupil, and signs of cataract and glaucoma. A short (1-30 days) stage of active reproduction of infective virus (up to 10(10) TCD50/g tissue in the first days postinfection) was followed by the second very long stage of limited specific multiplication of virus in ocular tissues.

[Persistence of ophthalmotropic enteroviruses in ocular tissues after enterovirus uveitis].

Thirteen monkeys were infected with ophthalmotropic strains of ECHO11 and ECHO19 in the anterior chamber of one eye. Echovirus antigens were detected by direct immunofluorescence in the membranes of the infected and paired eyes in various periods after inoculation (from 3 days to 5 years 8 months). Virus antigen was detected both in the infected and intact eyes.

[Clinical and experimental parallels in children with enterovirus uveitis].

Clinical features of acute and remote periods of experimental enterovirus uveitis were studied. The disease was induced in 22 monkeys by inoculation of ECHO 11 and ECHO 19 strains in the anterior chamber. The animals were followed up for 3 months to 5 years 8 months.

[Remote results of surgical treatment rhegmatogenous retinal detachment in children].

The results of surgical treatment of 53 children (55 eyes) with rhegmatogenous detachment of the retina complicated with proliferative vitreoretinopathy (PVR) are assessed. The patients were followed up for 10 months to 6 years. Complete adhesion of the retina after surgery was attained in 85.