Measurement of corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer as potential new non-invasive methods in assessing a risk of cerebral edema in type 1 diabetes in children.

AIMS: Some patients with diabetic ketoacidosis develop cerebral edema (CE) in the course of type 1 diabetes mellitus (T1D), which may result in central nervous system disorders and high mortality. The imperfection of existing neuroimaging techniques for early recognition of CE forces us to search for the new and non-invasive methods. The aim of the study was to assess the usefulness of new methods (pachymetry, transorbital ultrasonography-USG, optical coherence tomography-OCT study) in the assessment of the risk of CE occurrence in children with newly diagnosed T1D. METHODS: The study group included 50 children with newly diagnosed T1D, 54 patients with long-term T1D as a reference group and 40 children without glucose tolerance disorders as controls. In all subjects, a corneal thickness (CCT) index with pachymeter, optic nerve sheath diameter (ONSD) using transorbital USG and retinal nerve fiber layer (RNFL) during OCT study were measured and compared with selected clinical parameters of T1D. RESULTS: In patients from a study group at onset of T1D, the higher CCT (p < 0.001) and ONSD (p < 0.001) values were observed as compared to the results obtained after 48 h of metabolic compensation. The ONSD correlated negatively with pH value (r = - 0.64; p < 0.001), BE (r = - 0.54, p < 0.001) and HCO3- (r = - 0.50; p < 0.001). A positive correlation between RNFL and Na+ levels (r = 0.47; p < 0.005) was also observed. CONCLUSIONS: Transorbital USG and pachymetry may serve as the potential promising methods for the non-invasive assessment of the increased risk of development of CE in patients with T1D.

Comparison of uveitis in the course of juvenile idiopathic arthritis with isolated uveitis in children - own experiences.

OBJECTIVES: Uveitis and juvenile idiopathic arthritis (JIA) relatively often coexist. Inflammatory changes in the anterior segment of the eye are the most common extra-articular symptom in children with JIA, and JIA is, in turn, the main systemic cause of anterior uveitis in children. The aim of our study was to compare the course of anterior uveitis accompanying JIA and isolated uveitis. MATERIAL AND METHODS: We analyzed 25 children with JIA and uveitis (group I) and 28 children with isolated uveitis (group II). The study population was retrospectively selected from the patients treated in our center in the years 1998-2016 through a search of the hospital database. All data were presented as descriptive statistics. RESULTS: In group I there was a higher percentage of girls than in group II (64% vs. 50%) and uveitis occurred at a significantly younger age (8.7 years vs. 11.6). Patients from group I more often presented with immunological abnormalities (positive antinuclear antibodies or HLA-B27 antigen). The majority of children from group I developed uveitis prior to (44%) or simultaneously with (20%) arthritis. In patients who first presented with uveitis, arthritis appeared on average after 28 months (median 12 months). In children in whom arthritis developed first, uveitis appeared on average after 51 months (median 36 months). In some patients the time interval between the involvement of these two organs was as long as 9-10 years. Four children from group I and three from group II were qualified for biological treatment. CONCLUSIONS: The results of our analysis indicate the need for constant cooperation between the pediatric rheumatologist and the ophthalmologist. Although the risk of uveitis in JIA decreases with the disease duration, in some cases this complication can develop after many years. Children with present antinuclear antibodies, at younger age and of female gender should be subject to particularly close observation.

Retinal thickness as a marker of disease progression in longitudinal observation of patients with Wolfram syndrome.

AIMS: Wolfram syndrome (WFS) is a recessively inherited monogenic form of diabetes coexisting with optic atrophy and neurodegenerative disorders with no currently recognized markers of disease progression. The aim of the study was to evaluate retinal parameters by using optical coherence tomography (OCT) in WFS patients after 2 years of follow-up and analysis of the parameters in relation to visual acuity. METHODS: OCT parameters and visual acuity were measured in 12 WFS patients and 31 individuals with type 1 diabetes. RESULTS: Total thickness of the retinal nerve fiber layer (RNFL), average retinal thickness and total retinal volume decreased in comparison with previous OCT examination. Significant decreases were noted for RNFL (average difference -17.92 µm 95% CI -30.74 to -0.10; p = 0.0157), macular average thickness (average difference -5.38 µm 95% CI -10.63 to -2.36; p = 0.0067) and total retinal volume (average difference -0.15 mm3 95% CI -0.30 to -0.07; p = 0.0070). Central thickness remained unchanged (average difference 1.5 µm 95% CI -7.61 to 10.61; p = 0.71). Visual acuity of WFS patients showed a strong negative correlation with diabetes duration (R = -0.82; p = 0.0010). After division of WFS patients into two groups (with low-vision and blind patients), all OCT parameters except for the RNFL value were lower in blind WFS patients. CONCLUSIONS: OCT measures structural parameters and can precede visual acuity loss. The OCT study in WFS patients should be performed longitudinally, and serial retinal examinations may be helpful as a potential end point for future clinical trials.

[Sclerotherapy of ocular venous malformation in small child--case report]. / Skleroterapia malformacji zylnej galki ocznej u malego dziecka--opis przypadku.

We present a case of a 4-year-old girl with ocular venous malformation in her left eye. Over a one-year follow up, the symptoms progressed and sclerotherapy with bleomycin was performed. The bleomycin solution was injected directly into the abnormal vessel under visual control, which lead to a complete obliteration of malformation in a long-term follow-up.

[Level of selected antibacterial tear proteins in children with diabetes type 1]. / Poziom wybranych bialek antybakteryjnych we lzach u dzieci z cukrzyca typu 1.

PURPOSE: Antibacterial immunity in diabetes is impaired, which increases the risk of general and local infections. The aim of the study was to evaluate non-specific local antibacterial immunity based on lactoferrin and lysozyme concentration in tears in children with diabetes type 1. MATERIAL AND METHODS: Children at the age of 10-18 years old were studied. Group 1. consisted of children without diabetes, group 2. included patients with new onset of diabetes and group 3. consisted of children with decade-long diabetes. Among all patients tears were collected from inferior coniunctival fornix with hematocrit glass capillaries in purpose to measure lactoferrin and lysozyme concentration. ELISA method was used in laboratory testing. RESULTS: Level of lactoferrin did not differ significantly among all groups. Concentration of lysozyme was statistically lower in group with decade-long diabetes (group 3.) compared to patients without diabetes. Mild correlation between lactoferrin and lysozyme levels was seen in individual patients in whole group of probands together. CONCLUSIONS: Diabetes type 1 in children is associated with significant changes in concentration of tear proteins, which contribute to antibacterial immunity.

[Sporadic aniridia and Wilm's tumor--a case report and review of recommendation for diagnostic approach in WAGR's syndrome]. / Aniridia sporadyczna i guz Wilmsa--opis przypadku i rekomendacje postepowania diagnostycznego u chorych z zespolem WAGR.

The current paper presents a case of 14 months old girl with WAGR's syndrome. This syndrome is a genetic disorder characterized by the deletion at 11p13 locus which gives clinical presentation of aniridia, Wilms' tumor, genitourinary anomalies and mental retardation. Although WAGR's syndrome is a rare disorder, knowledge of its presentation is helpful in early diagnosis of nephroblastoma and may have impact on clinical outcome of the patient. Since aniridia may be the first symptom of WAGR's syndrome, it is recommended that all neonates with aniridia need to be screened for deletion of WT1 on chromosome 11p13. These with deletions should be monitored regularly for tumor development.

[Analysis of some of the possible neonatal risk factors of development of retinopathy of prematurity]. / Analiza wybranych neonatalnych czynników ryzyka rozwoju retinopatii wczesniaków.

PURPOSE: The aim of the study was to evaluate some of the possible risk factors for retinopathy of prematurity (ROP) treated with laser photocoagulation or cryocoagulation. MATERIAL AND METHODS: The study comprised 71 preterm infants with ROP needing treatment and 118 prematures without ROP or with ROP requiring no treatment, as a control group. All infants were born with gestational age < or = 32 weeks and birth weight < or = 1500g. The perinatal variables, including some of clinical data, the length of mechanical ventilation as well as continous positive airway pressure (CPAP), duration of total parenteral nutrition and some of laboratory data were analyzed, to evaluate their correlation with the development of ROP. RESULTS: Gestational age before 28 weeks (OR = 5.11), episodes of convulsiones (OR = 2.15), mechanical ventilation for more than 20 days (OR = 5.86) and > 30 days (OR = 7.47), CPAP for more than 5 days (OR = 4.15) and > 10 days (OR = 2.84), total parenteral nutrition for more than 10 days (OR = 7.84) and > 20 days (OR = 9.02) and elevated peak of alanine aminotransferase (AIAT) levels (OR = 3.17) were significant risk factors for ROP requiring treatment. CONCLUSIONS: The opthalmic examination for retinopathy of prematurity requiring laser photocoagulation or cryocoagulation should be obligatory for prematures born < or = 32 weeks of gestational age, with birth weight < or = 1500 g. The frequency of the consecutive ophthalmic examinations depends on the severity of prematurity and on the presence and intensification of the risk factors for ROP.

[The dry eye syndrome in children with juvenile idiopatic arthritis]. / Zespól suchego oka w przebiegu mlodzienczego idiopatycznego zapalenia stawów.

PURPOSE: The aim of the study was to evaluate the dry eye syndrome in children with juvenile idiopathic arthritis (JIA), and its relation to the immunological markers of the JIA (antynuclear antybodies ANA and rheumatoid factor RF). MATERIAL AND METHODS: The study included 62 children with JIA. The age of patients during the first ophthalmic examination ranged from 9 to 18 years (62 children). A control group consisted of 49 healthy children. The time of observation was 18 months during which the children and adolescents were subjected to complex ophthalmic examinations (including a history of eye discomfort and Schirmer and BUT tests), in the intervals of 9 months. The diagnosis towards dry eye syndrome was made (including a history of eye discomfort and Schirmer and BUT tests). RESULTS: The majority of children with JIA complained of discomfort in the eyes. The difference appeared to be statistically significant between the group of children with JIA and the control group in the range of 5 features. The results of Schirmer test were found to be inadequate in 7 children (13%) and of BUT test in 9 children (15%). In total, inadequate results of Schirmer and/or BUT tests and a high score of discomfort evaluation were detected in 11 patients (17.7%). CONCLUSIONS: 1. The dry eye syndrome may occur in the course of JIA in children without any distinct clinical signs, resulting in subjective symptoms and decreasing the quality of life. 2. No correlation between immunological markers of the JIA and ocular changes was observed.

[Condition of organ of vision in children and adolescence with juvenile idiopathic arthritis]. / Stan narzadu wzroku u dzieci i mlodziezy z mlodzienczym idiopatycznym zapaleniem stawów.

PURPOSE: Among numerous complications pertaining to the internal organs in the course of inflammatory systemic diseases of the connective tissue, including juvenile idiopathic arthritis (JIA), eye lesions are of considerable significance. The aim of the study was to determine changes in the eyes in JIA children and adolescents. MATERIAL AND METHODS: The study included 76 children with JIA. The age of patients during the first ophthalmologic examination ranged from 3 to 18 years. The children were treated in the Outpatients' Rheumatologic Department at the University Hospital No. 4 in Lodz and Department of Pediatric Ophthalmology at the Medical University of Lodz. A control group consisted of 60 healthy children. In this study the time of observation was 18 months during which the children and adolescents were subjected to complex ophthalmologic examinations in the intervals of 9 months. RESULTS: The presence of various ocular changes were significantly more frequently found in children with JIA. The difference appeared to be statistically significant between the group of children with JIA and the control group, in the range of such diseases as conjunctivitis and pigment changes in the retina. CONCLUSIONS: In JIA patients ophthalmologic lesions are more frequent than in healthy children, especially it concerns conjunctivitis (in 34% of children) and pigment changes in the retina (in 14% of children).

[Choristoma of visual organ in children]. / Choristoma narzadu wzroku u dzieci.

PURPOSE: The aim of this study was to present the clinical and histopathological characteristics of choristoma tumors of the eye in children and to estimate the surgical treatment. MATERIAL AND METHODS: The study comprised 23 children with choristoma of visual organ including 10 girls (43.5%) and 13 boys (56.5%) in age between 2 months and 16 years, hospitalized in Department of Pediatrics Ophthalmology between 1999 and 2005. Complete ophtalmological examination and ultrasonography of eyeballs and orbital cavity was performed. In each case surgical procedure was implemented and the operated neoplastic changes were verified histopathologically. RESULTS: The tumors were placed within the eyeball in 10 children (43.5%) including corneal limbus placement in 4 children (40%), epibulbar placement with orbital cavity penetration in 5 children (50%) and one patient was diagnosed with lacrimal caruncule tumor (10%). Periorbital choristoma was diagnosed in 13 children (56.5%), while in 9 of them (69.2%), the tumor was placed within the upper lid and in case of 3 (23.1%), the tumor crossed orbital cavity septum and in one patient (7.6%) penetrated towards temporal cranial fossa. The eyeball tumors were entirely removed in 6 children (60%). In 4 children (40%) the surgical procedure was limited to excision of anterior parts of the changes protruding to the orbital cavity. The excision of palpebral, palpebral-orbital and palpebral-cranial tumors was complete (100%). Histopathological examination showed dermoids in 17 children (73.9%), including epidermal cyst in 13 patients (76.5%) and dermoid cyst in 4 patients (23.5%). Additionally, dermolipoma tumors were diagnosed in 6 children (26.1%). CONCLUSIONS: Choristoma tumors are characteristically placed within the organ of vision and have characteristic clinical picture. Both therapeutic and cosmetic results of surgical treatment of choristoma in children were satisfactory.

[Evaluation of therapy outcome in congenital nasolacrimal duct obstruction in own material]. / Ocena leczenia wrodzonej niedroznosci dróg lzowych w materiale wlasnym.

UNLABELLED: The inborn nasolacrimal duct obstruction is common ocular disease in new-borns and infants. There are still doubts concerning the timing of the operating procedure. Probing of the lacrimal ducts is the therapeutic method for this condition. PURPOSE: To evaluate the therapy outcome in congenital nasolacrimal duct obstruction in authors' own material. MATERIAL AND METHODS: In retrospective study of 3950 medical records of children from our Outpatient's Clinic, we distinguished 192 children with nasolacrimal duct obstruction. Then, we evaluated the outcome of implemented treatment in correlation with their age and timing of the nasolacrimal duct probing. RESULTS: All children with nasolacrimal duct obstruction had mucopurulent discharge in the lacrimal sac and lacrimation. After the conventional treatment, the disease resolved in 23% of our group, whereas, in the rest of the patients probing of the nasolacrimal duct was implemented. The probing was successful in all children, but it was necessary to repeat the procedure twice in 13 children and three times in 5 children. The success rate of single probing was as follows: 91% in the group of children 1 - 3 months old, 83% in both groups: 3 - 6 and 6 - 12 months old and 71% in the oldest group of children - above 1 year of age. CONCLUSIONS: In majority of children the nasolacrimal duct obstruction did not resolve spontaneously. Early probing within first few months of child's life increased the success rate of this procedure.

Evaluation of blood flow in the ophthalmic artery and central retinal artery in children with retinopathy of prematurity.

PURPOSE: To evaluate blood flow parameters in the ophthalmic artery and central retinal artery in children with retinopathy of prematurity (ROP). MATERIAL AND METHODS: The study comprised 57 premature children born between 24 and 33 weeks of gestation, with birth weight from 600 g to 1660 g, including 42 preterm children with retinopathy in stage 1, 2, 3 and 3 "plus" and 15 preterm children without retinopathy. Color Doppler ultrasonography (USG-CD) was used to measure in the studied vessels maximal systolic velocity (Vmax), end-diastolic velocity (Vmin) and resistance index (RI). RESULTS: Statistically significantly (p < 0.05) higher values of Vmax were seen in the ophthalmic artery and central retinal artery in preterm children with retinopathy in stage 2 and 3, as compared with other children. In preterms with dilation and tortuosity of posterior blood vessels in stage 3 "plus" ROP Vmax in both studied vessels was lower and was comparable to that in stage 1 ROP and in children without retinopathy. RI in the ophthalmic artery in children with ROP in stage 2 and 3 was statistically significantly higher (p < 0.05) from its values seen in other groups, and for the central retinal artery RI did not differ statistically significantly. CONCLUSIONS: The conducted USG-CD measurements revealed that in children with retinopathy of prematurity haemodynamic parameters of blood flow in the ophthalmic artery and central retinal artery differ in relation to disease stage of advancement, and in relation to the status of blood vessels in the eye fundus. The clinical implications of these results, however, need to be confirmed in long term studies, in order to determine the sensitivity, specificity and repeatability of this method, as well as to establish the diagnostic standards.

Visual symptoms in McCune-Albright syndrome--case report.

McCune-Albright syndrome is a rare complex genetic disorder. It is diagnosed on the basis of bone lesions--fibrous dysplasia, accompanied by at least one additional symptom: hyperactivity of endocrine glands or cafe au lait skin spots. We present symptoms, clinical picture and diagnostic procedure in a 15-year-old patient with visual disorders in the course of McCune-Albright syndrome. The ophthalmic disturbances were the part of described syndrome. The active behaviour of the ophthalmologist in multidisciplinary diagnostic procedure led to the establishment of a proper diagnosis and optimal treatment.

[Assessment of the ocular changes in children with juvenile idiopathic arthritis]. / Ocena zmian w narzadzie wzroku w przebiegu mlodzienczego idiopatycznego zapalenia stawów.

PURPOSE: To analyse the frequency of uveitis and other ocular changes in children with juvenile idiopathic arthritis. MATERIAL AND METHODS: We carried out ophthalmologic examination in children and adolescents with juvenile idiopathic arthritis, in age between 3 and 20 years. During the examination we evaluated vision acuity, refraction, anterior and posterior part of the eye and intraocular pressure. RESULTS: A total of 48 (68%) girls and 22 (32%) boys participated in our study, whose mean age was 13.2 years (SD = 3.8). The most frequent onset of juvenile idiopathic arthritis was oligoarticular form of the disease (62%). Only in 42% of the studied group there were no significant abnormalities of the ocular system. Anterior uveitis was diagnosed in 5 patients (7%) including 4 (5.7%) girls and 1 (1.4%) boy. Complications appeared in 2 children in the form of cataract and band keratopathy which both resulted in considerable impairment of visual acuity. Mean duration of juvenile idiopathic arthritis before the onset of uveitis was 5.2 years. There were other ocular changes in the studied group, among which the most common were: conjunctivitis--24%, abnormalities of the retina--11%, glaucoma--4% and other changes. CONCLUSIONS: In majority of the children with juvenile chronic arthritis different abnormalities of the eyes were diagnosed. All the patients with juvenile idiopathic arthritis should be under close surveillance of the ophthalmologist, irrespective of the disease duration.

Causes of visual disability in children and young adults.

PURPOSE: Blindness and visual disability is a great problem all over the world. Loss of visual acuity in children requires special attention. The aim of the study was to determine the causes of uni- and bilateral low vision in children and young adults. Patients were from our clinic and from the School for the Blind and Visually Impaired in Lodz. MATERIAL AND METHODS: The study group included 271 patients aged from 3 months to 21 years, visually disabled and with uniocular reduction of visual acuity to 25% or less. RESULTS: The commonest cause of low visual acuity in the group was optic nerve atrophy (22%) due to perinatal hypoxia. Other important causes were retinopathy of prematurity (17%) and congenital abnormalities of the eye globe (11%). The main causes of uniocular low vision were anisometropia and strabismus. CONCLUSIONS: The main cause of visual impairment and disability in the study group from our region was optic nerve atrophy. Retinopathy of prematurity was also frequently seen in the handicapped children and was responsible for severe visual loss. Anisometropia and strabismus were predominant causes of uniocular visual deterioration, but not of visual disability.

Blood flow parameters in the arteries of the eye in premature children.

PURPOSE: of the study was to evaluate blood flow in the arteries of the eye in preterm neonates. MATERIAL AND METHODS: Color Doppler imaging (CDI) of ophthalmic artery, central retinal artery and posterior ciliary arteries was performed in 36 preterm infants and 19 full-term infants. Maximal systolic velocity, end-diastolic velocity, resistance index--RI and pulsatility index--PI were assessed for the studied vessels. RESULTS: There were no significant differences in ophthalmic artery blood flow between preterm and normal newborns. End-diastolic velocity in central retinal artery and posterior ciliary arteries in preterm infants was significantly lower and resistent index and pulsatility index was higher. The Doppler color ultrasonography is a non-invasive technique which can be useful for the estimation of the hemodynamic parameters in the arteries of the eye in the prematures. CONCLUSIONS: The recorded changes in the ultrasound measurements of the blood flow in the eye arteries in premature children comparing to the normal newborns, can be the evidence for the immaturity of the vessel system in the preterm born neonates.

Applicability of ultrasound in ocular tumors in children and adolescents.

PURPOSE: Evaluation of the applicability of ultrasound in children diagnosed for neoplasm of the eye. Evaluation of Doppler ultrasound in visualizing blood vessels within the lesion in eye ball, eye socket and eye lids. Establishing the value of the obtained data concerning the image of vessels and blood flow for the diagnosis, monitoring the course of disease and results of treatment. MATERIAL AND METHODS: The study comprised 80 patients diagnosed and treated for neoplasm of the eye. The study group included 48 girls and 32 boys aged 2 weeks to 18 years. All the patients were subject to full ophthalmologic examination, ultrasound and other imaging techniques. RESULTS: Echogenicity of lesions, focality of growth and the comparison of echostructure did not allow for establishing the degree of malignancy. The presence of vessels in tumor mass and blood flow in tumors were useful for differentiation between malignant and benign tumors. CONCLUSIONS: Ultrasound methods used significantly improve diagnostic possibilities in orbital tumors in children. The obtained pictures of vessels and flow character are typical for some tumors, which together with histopathology of tumors enables establishing of correct diagnosis. CD/PD ultrasound is helpful in monitoring treatment of selected orbital tumors, enables evaluation of biological evolution of capillary hemangioma and assessment of vascularization degree of tumors treated with chemo- and radiotherapy.

[The relation between the clinical state of the premature and the development of 3rd stage of retinopathy of prematurity]. / Stan kliniczny dziecka przedwczesnie urodzonego a rozwój 3. stadium retinopatii wczesniaków.

The aim of the study was to determine the prognostic value of some pathologies related to prematurity in the development of stage 3 ROP in children with extremely low birth-weight. The group of 35 prematures with diagnosed 3rd stage ROP and 64 prematures without ROP was examined. The presence of the respiratory distress syndrome (RDS), persistent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular haemorrhages (IVH) were analyzed. RDS was more frequent in prematures with 3rd stage ROP (p=0.005, OR=3.59). There was significant difference between the frequency of IVH in both groups (p = 0.03), but the odds ratio was significantly high only in the children with the 3rd stage IVH (OR=2.42). PDA was diagnosed more frequently in children with 3rd stage ROP but the difference was not statistically significant (p= 0.1 52, OR=1.80). There was significant difference between the groups when comparing the incidence of NEC (p=0.03, OR=3.34). The pathologies of the prematurity such as RDS, NEC and grade III IVH are the predictive factors for the development of stage 3 ROP (p=0.03, OR=3.34).

[Ocular complications in leukemias and malignant lymphomas in children]. / Powiklania okulistyczne w bialaczkach i chloniakach zlosliwych u dzieci.

PURPOSE: The aim of the study was to determine the prevalence and types of ocular abnormalities in children with leukemias or lymphomas. MATERIAL AND METHODS: We have studied 39 children (age 0.5-17 years) with leukemia or lymphoma. Ocular manifestations were present in 54% of study group (21 children). The most frequent ocular findings were seen in conjunctiva (33.4%). 15.4% patients presented with posterior segment findings, without loss of ocular acuity. Other symptoms were dry eye syndrome and proptosis. CONCLUSIONS: Children treated for leukemia or lymphoma should be systematically examined by ophthalmologist. Ophthalmic complications can be results of basic disease, treatment or manifestations of relapse.