CC BY
0ANALYSIS OF THE RESULTS OF TREATMENT OF SECONDARY GLAUCOMA IN CHILDREN ASSOCIATED WITH RETINOPATHY OF PREMATURE
1Khamroeva Y.A., 2Erkinova O.H.
1,2Tashkent 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 body 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 body 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.
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 body 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 body 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: Pt 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
(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.
REFERENCES
1. Abdolrahimzadeh S., Fameli V., Mollo R., et al. Rare disease leading to childhood glaucoma: epidemiology, pathophysiogenesis, and management. Biomed. Res.Int.2015;781294. doi:10.1155/2015/781294
2. Зерцалова М.А., Бржеский В.В. Особенности течения глаукомы у детей с ретинопатией недоношенных. Русский медицинский журнал.2007. 2007;4 (2):139.
3. [Zertsalova M.A., Brzheskiy V.V. Features of current glaucoma in children with retinopathy of prematurity. Klinicheskaya oftalmologiya. 2007;4 (2):139 (in Russian)].
4. Blencowe H., Lawn J.E., Vazquez T., Fielder A., Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatric research.2013;74 (1):35-49. https://doi/org/10.1038/pr.2013.205.
5. Джеймсон Р.В., Григ Д.Р. Клиническая эмбриология и развитие глаза. Детская офтальмология.-Т.1-М.: Панфилова;2015:12-20.
6. [Jameson R.V., Grigg J.R. Clinical embryology and eye development. Pediatric ophthalmology and strabismus. Vol.1 Moscow: Panphylova; 2015:12-22 (In Russ)].
7. Коникова О.А., Дисколенко О.В., Гайдар М.В., Бржеский В.В. Глакома у детей на фоне IV и V стадий ретинопатии недоношенных: особенности течения, исходы. Российская педиатрическая офтальмология. 2017;12(3). 122-126
8. [Konikova O.A., Diskolenko O.V., Gaidar M.V., Brzheskiy V.V. Glacoma in children against the background of IV and V stages of retinopathy of prematurity: features of the course, outcomes. Russian pediatric ophthalmology. 2017;12(3).122-126 (In Russ)].
9. Shields M B. Textbook of Glaucoma. -Baltimore: Williams &Wilkens,2008.244.
10. Макарова М.А., Панчишена В.М., Брусакова Е.В., Ершова Р.В., Сайдашева Э.И., Соколов В.О. Анатомические особенности угла передней камеры глаза у детей с глаукомой в зависимости от степени рубцовой ретинопатии недоношенных. Офтальмологические ведомости. 2019;1(12).21-26. https://doi.org/10.17816/OV12121-26.
11. [Makarova M.A., Panchishena V.M., Brusakova E.V., Ershova R.V., Saydasheva E.I., Sokolov V.O. Anatomical features of the angle of the anterior chamber of the eye in children with glaucoma depending on the degree of cicatricial retinopathy of prematurity. Ophthalmological records. 2019;1(12).21-26. https://doi.org/10.17816/OV12121-26 (In Russ)].
12. Щуко А.Г., Юрьева Т.Н. Классификация редких форм глаукомы, ассоциированных с альтерацией радужки. Глава 2. Редкие формы глаукомы. Иркутск. 2021. 31-37. [Shchuko A.G., Yurieva T.N. Classification of rare forms of glaucoma associated with iris alteration. Chapter 2. Rare forms of glaucoma. Irkutsk. 2021. 31-37 (In Russ)].
13. Хамроева Ю. А., Хамраева Л. С. Роль биомеханических параметров глаза в развитии врожденной глаукомы у детей //Российская педиатрическая офтальмология. - 2014. -№. 2. - С. 30-31.
14. Абдуллаев, Р. Н., Абдуллаева, М. А., & Собирова, М. Р. (2018). Интраоперационный метод лечения и профилактики спаечной болезни малого таза у пациенток с трубно-перитонеальным бесплодием. Москва. Проблемы науки,(11), 35.
15. Зияева, Э. Р., Рузиева, Н. Х., & Собирова, М. Р. К. (2022). СИНДРОМ ХРОНИЧЕСКОЙ ТАЗОВОЙ БОЛИ ПРИ ХРОНИЧЕСКОМ САЛЬПИНГООФОРИТЕ-СОВРЕМЕННЫЙ ВЗГЛЯД НА ПАТОГЕНЕЗ. Re-health journal, (2 (14)), 1-5.
16. Зияева, Э. Р., Абдуллаев, Р. Н., & Собирова, М. Р. (2018). ИЗМЕНЕНИЕ НЕСПЕЦИФИЧЕСКИХ ФАКТОРОВ ЗАЩИТЫ БОЛЬНЫХ ХРОНИЧЕСКИМ САЛЬПИНГООФОРИТОМ ПОД ДЕЙСТВИЕМ КОМПЛЕКСНОЙ ФИЗИЧЕСКОЙ РЕАБИЛИТАЦИИ. In Молодежь-практическому здравоохранению (pp. 415-418).
17. Alieva, M. A., & Sobirova, M. R. (2023). JINSIY A'ZOLAR PROLAPSI BO'LGAN AYOLLARNI JARROHLIK YO'LI BILAN DAVOLASHNI SAMARADORLIGI. Евразийский журнал медицинских и естественных наук, 3(4 Part 2), 65-70.
18. Нигматова, Г. М., & Кочиева, А. М. (2023). Влияние гистерэктомии в репродуктивном возрасте на качество жизни женщин (Doctoral dissertation, Современные подходы к стандартизации оказания медицинской помощи в акушерско-гинекологической практике).
19. Мохира, Т. (2015). ЖАНРА РАССКАЗА С ТОЧКИ ЗРЕНИЯ ИССЛЕДОВАТЕЛЕЙ И ЕГО ПРИМЕНЕНИЕ В ДЕТСКОЙ ЛИТЕРАТУРЕ. Вестник Таджикского национального университета. Серия филологических наук, (4-5), 201-206.
20. Хамраева Л.С., Хамроева Ю.А., Бузруков Б.Т. Хирургическое лечение детей с врожденной глаукомой, сочетанной с другими дефектами развития //Российский офтальмологический журнал. - 2014. - Т. 7. - №. 4. - С. 60-62.
21. Хамраева Л., Хамроева Ю.А., Алимджанова З.Р. Осложнения проникающих ранений органа зрения у детей //in Library. - 2014. - Т. 2. - №. 2. - С. 6-9.
22. Хамраева Л.С., Бузруков Б.Т., Хамроева Ю.А. Структура офтальмопатологии у детей грудного возраста по материалам клиники Ташкентского педиатрического медицинского института //Advanced Ophthalmology. - 2023. - Т. 2. - №. 2. - С. 84-87.
23. Хамраева Л. и др. Особенности течения послеоперационного периода у часто болеющих детей после экстракции врожденной катаракты //in Library. - 2020. - Т. 20. -№. 2. - С. 4-10.
24. Хамраева Л., Хамроева Ю. А., Хамидова Ш. Н. Социально значимые заболевания глаз у детей //in Library. - 2022. - Т. 22. - №. 2. - С. 7-9.
