[Anatomo-functional state of the central retina in premature infants with intraventricular hemorrhage and retinopathy of prematurity]. / Anatomo-funktsional'noe sostoyanie tsentral'nykh otdelov setchatki u nedonoshennykh detei, perenesshikh vnutrizheludochkovye krovoizliyaniya i retinopatiyu nedonoshennykh.

OBJECTIVE: Assessment of the anatomo-functional state of the central retina in children with intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) in the long-term period. MATERIAL AND METHODS: We examined 51 patients (102 eyes) born 25-34 weeks' of gestation (birth weight 700-2290 g), aged 8.83±3.5 years, and 18 children (36 eyes) born prematurely aged 10.8±3.2 years. The children underwent standard ophthalmologic examination, optical coherence tomography (OCT) and visual evoked potentials (VEP). RESULTS: Retinal thickness (RT) and retinal volume (RV) in the fovea of premature infants with PH and/or IVH are significantly higher than in healthy full-term infants, which correlates with lower visual acuity (p<0.05). RT and RV in the fovea has an inverse proportional relationship with gestational age (GA), (p<0.05). According to the results of VEP, moderate organic changes in the conduction tract of the visual analyzer are noted in 45% of premature infants (p<0.05). CONCLUSION: The process of macula formation is affected by many perinatal and postnatal factors, namely: GA, birth weight, ROP, hypoxic-ischemic CNS diseases, and refractive disorders.

[Modern possibilities of diagnosing lesions of the visual analyzer in perinatal lesions of the central nervous system in full-term and premature infants]. / Sovremennye vozmozhnosti diagnostiki porazheniya zritel'nogo analizatora pri perinatal'nom porazhenii tsentral'noi nervnoi sistemy u donoshennykh i nedonoshennykh detei.

The article provides an overview of current neuro-ophthalmological diagnostic capabilities in patients with perinatal lesions. The main attention is paid to the diagnosis of patients with periventricular leukomalacia and peri- and intraventricular hemorrhages. The most relevant methods of neuro-ophthalmological diagnosis in hypoxic-ischemic CNS lesions are covered. The functions and peculiarities of blood supply of the germinal matrix are described. The importance of the use of optical coherence tomography and visual evoked potential recording in full-term and premature infants with visual pathway and/or visual cortex lesions in brain lesions is discussed. The conclusion emphasizes the need for an interdisciplinary approach in the examination of children with perinatal CNS lesions.

[The course of delayed intrauterine infection in children with residual manifestations of retinopathy of prematurity]. / Techenie otsrochennoi vnutriutrobnoi infektsii u detei s ostatochnymi proyavleniyami retinopatii nedonoshennykh.

Retinopathy of prematurity (ROP) is a severe vascular proliferative disease. The appearance of signs of intrauterine infection in the setting of ROP may aggravate the severity of the disease course and lead to development of complications. Two children with residual ROP effects were observe to have delayed manifestations of intrauterine infection. The first child had signs of toxoplasmosis in the period of regression of stage II ROP at 48 weeks of postmenstrual age (PMA). The second child had signs of cytomegalovirus infection in the period of induced regression of III «+¼ stage ROP at 47-48 weeks of PMA. At the time of manifestation of intrauterine infection, both children were noted to have exudative phenomena, and formed fibrous bridles that caused retinal detachment, which was visually very similar to the late stages of severe forms of ROP. However, the appearance of these symptoms in 47-48 weeks of the PMA in the setting of ROP regress excludes the activation of the disease. The course of uveitis with residual manifestations of ROP went according to the most severe scenario - with retinal detachment in the short term - within 7-10 days.

[The early diagnosis of congenital neuroinfections during ophthalmologic examination in children of the first months of life]. / Rannyaya diagnostika nekotorykh vrozhdennykh neiroinfektsii pri oftal'mologicheskom osmotre u detei pervykh mesyatsev zhizni.

OBJECTIVE: To characterize the possibilities of early diagnosis of congenital neuroinfections during an ophthalmological examination in children in the first months of life. MATERIAL AND METHODS: Five children with congenital neuroinfection, including 2 children with congenital toxoplasmosis and 3 children with congenital cytomegalovirus infection (CMVI), were studied. All babies were born prematurely (25 to 31 weeks of gestation (27.2±0.94)), with birth weight from 680 to 1610 g (1120±110.1). During the examination, binocular ophthalmoscopy and examination on a wide-field retinal pediatric camera were used. A blood testing for immunoglobulins and a polymerase chain reaction of blood were performed. To assess the state of the brain, neurosonography and magnetic resonance imaging were used. RESULTS AND CONCLUSION: Ophthalmic signs of intrauterine infection appeared at the age of 4-5 months (at 47-51 weeks of postmenstrual age). In all children (in 4 in one eye, in 1 in both eyes), apparent exudative-proliferative changes in the retina and vitreous body appeared on the periphery with the formation of epiretinal membranes that exert a traction effect on the retina. In two children with CMVI, multiple preretinal hemorrhages in different parts of the retina in both eyes were revealed. Central chorioretinal foci in the fundus were detected in children with toxoplasmosis. A positive dynamics, such as a decrease of exudative phenomena, a partial fit of the retina, complete resorption of hemorrhages, was noted in children during treatment. It has been concluded that signs of intrauterine neuroinfection can appear delayed, only by the development of chorioretinitis, 4-5 months after birth and manifest with severe exudative-proliferative changes in the retina and vitreous body.

[Cerebral structural characteristics in children with unilateral amblyopia: a MRI study]. / Strukturnye osobennosti golovnogo mozga rebenka pri odnostoronnei ambliopii: MRT-issledovanie.

AIM: To study the mechanism of the development of amblyopia using the analysis of brain grey matter parameters. The areas primarily associated with visual cortex in children with amblyopia were analyzed. MATERIAL AND METHODS: The study group comprised 8 right-handed children with left-sided amblyopia. MRI images were obtained by 1.5T Toshiba scanner with 3D MP-RAGE. T1-images were processed with FreeSurfer (5.3.0 version, http://surfer.nmr.mgh.harvard.edu/). RESULTS AND CONCLUSION: No significant interhemisphere differences by cortical thickness were identified in all tested regions of interest. In correlation analysis, only the positive correlation between visual acuity in the left eye and cortical thickness in the left pericalcarine as well as the positive correlation between visual acuity in the left eye and cortical thickness in the left V1 area obtained using another anatomical atlas survived multiple comparison correction. The findings support the hypothesis that pathological ontogenetic processes in children with amblyopia lead to the structural abnormalities of the primary visual cortex.

[The improvement of quality of life of patients with multiple sclerosis over 15-year period]. / Uluchshenie pokazatelei kachestva zhizni bol'nykh rasseiannym sklerozom za 15-letnii period.

In this article, the authors compared the results of the studies on quality of life (SF-36 questionnaire) of large groups of patients with multiple sclerosis conducted in 2000-2003 and 2012-2016 years.

[Issues of the current terminology in multiple sclerosis]. / Voprosy sovremennoi terminologii pri rasseiannom skleroze.

New terminology used by neurologists with multiple sclerosis (MS). The current use of terms 'definite' MS, 'MS signs', 'retrobulbar neuritis' and 'optic neuritis', 'relapse and exacerbation, types of MS course, criteria of effectiveness of MS therapy, NEDA, NEP, NEPAD; the classification therapy methods - 'escalation', 'induction' and therapy of immune reconstitution (TIR), therapy of maintenance/escalation (TME) and discussed.

[Neurological disorders in preterm children with neuropathy]. / Nevrologicheskie narusheniia u nedonoshennykh detei s retinopatiei.

AIM: To establish the correlation between the frequency and severity of hypoxic CNS lesions in preterm children with neuropathy and improve the early diagnosis of lesions of the brain structures based on clinical ophthalmologic results. MATERIAL AND METHODS: The authors examined 712 premature infants with body mass <1500 g born before 30 weeks of gestation during 2006-2016. Ophthalmological monitoring of retinopathy (RP), an analysis of medical history, neurological examination and neurosonography were performed. RESULTS AND CONCLUSION: RP was found in 367 (51.5%) children. In 255 children, the disease regressed naturally. One hundred and twelve (15.7%) children, underwent laser coagulation of the avascular retina due to the severity of RP. Signs of intraventricular hemorrhages (IVH) were noted in 434 (61%) children in the neonatal period. IVH were found in 285 (77.6%) children with RP. RP with the regression after laser coagulation was combined with IVH in 98% of cases, with the higher frequency (55.3%) of IVH, 3rd degree. Periventricular leucomalation (PVL) was found in 10% of children without RP, in 22.3% of children with RP with naturally regression and in 51,7% of children with RP with laser coagulation of the retina. In 70 children, neurosonographic signs of ischemia of the head of caudate nucleus were identified on the 14-15th days of life. In this group, RP developed in 54 (77%) children, 27 (38.5%) children needed laser coagulation of the retina. The correlation found between the severity of RP and hypoxic CNS lesions in highly preterm infants might allow the prognosis of visual and neurosomatic disturbances in the early age and timely effective rehabilitation.

[The study of biochemical autoregulation of blood flow in the vascular basin of the inner carotid artery in premature children].

OBJECTIVE: Despite the importance of blood flow regulation (BFR) in cerebral vessels, in particular, during organism development, there is no studies in children in the first weeks of life. We studied biochemical autoregulation of blood flow in infants born at 24-25 weeks of gestation. MATERIAL AND METHODS: Eighteen infants with body mass 763±138 g were included in the study. RESULTS: There was a high frequency of intraventricular hemorrhages (77%, 14 infants), including those of III stage (50%) with ventriculomegalia (9 infants). Cystic periventricular leukomalacia developed in 50% (9 infants). Retinopathy of premature children with localization in the posterior pole of eyeball developed in 100% of cases. Results of capillary blood gas analysis (pO2, pCO2 and parameters of resistance index of anterior cerebral artery measured using Doppler ultrasound) were studied from 25 to 30 weeks of gestation. In the first weeks of life, spastic character of blood flow in the anterior cerebral artery against the background of hypoxemia and relative hypocapnia was found. No data on the hyperoxic autoregulation of blood flow was obtained. The hypercapnic mechanism of autoregulation had developed earlier and emerged from the 28th week of gestation. Conclusion. The dramatic increase in hypercapnia leads to the blood inflow to tissues and finally to the early development of retinopathy, periventricular leukomalacia and intraventricular hemorrhages.

[Analysis of efficacy of prevention and antioxidant therapy in premature infants].

282 (564 eyes) premature infants born at mean 27 +/- 2,5 weeks of gestation with birth weight 914+/- 247g were enrolled in the study. Comparative study showed preventive treatment with histochrome in infants with risk of retinopathy of prematurity (RP) to decrease the incidence of RP compared to infants treated with emoxipine and no antioxidant therapy. Incidence of RP in infants preventively treated with combination antioxidant agents (dicynon and emoxipine) was significantly lower compared to the group without preventive antioxidant treatment. Use of histochrome in treatment of RP via periocular injections and forced instillations promoted more favorable outcome of the disease.

[A case of diagnosis of gyrate atrophy in infancy].

The authors describe a case of gyrate atrophy detected in a one-month baby born at 34 weeks post-conception age. Up to 2 months of life, the disease progressed--an increase in the number of foci of atrophy of the choriod and retinal pigment epithelium, there was a trend towards their fusion. The condition stabilized after the use of vitamin B6.

[Clinical rationale for the efficiency of using the domestic antioxidant agent Histochrome].

The objective of the study was to evaluate the efficacy of the Russian drug Histochrome in the treatment of 554 children at different ages who had intraocular hemorrhages of various degrees and sites in relation to the route and time of its administration. Histochrome therapy was shown to reduce the time of resorption of hyphemas and hemophthalmos by two times and retinal hemorrhages to 2 weeks. There was a positive effect in increasing visual acuity by 0.2 or more in 70.3% of cases.

[Neuropeptides in the treatment of optic nerve atrophy in children].

The study aimed at investigating the therapeutic effect of the cerebrolysin on partial optic nerve atrophy in children. Six hundreds and forty-six children aged from 8 weeks to 18 years have been studied. Cerebrolysin was injected intramuscularly in dose 0,1 ml per 1 kg of body mass daily and retrobulbar in dose 0,3-0,5 ml; an irrigation system was used to treat a posterior segment of the eye. The illness duration was 10-15 days. The positive effect of the drug, in particular with the following optic nerve stimulation, has been shown. Peculiarities of action of cerebrolysin depending on the initial vision acuity and etiology of disease are emphasized.

[TLR9 and HBD-2 gene expression by conjunctival and corneal cells in children with dendriform herpetic keratitis].

The current views of the role of innate immunity in protecting the organ of vision from viral infection offer scope for a search for new approaches to diagnosing and treating viral keratitis. TLR9 and HBD-2 gene expression in the conjunctiva and cornea was studied in children with dendriform herpetic keratitis. The latter showed a significant (more than 20-fold) increase in TLR9 gene expression as compared in healthy children. Conventional antiviral therapy for herpetic keratitis resulted in a significant decrease in the level of TLR9 gene expression (by more than two orders of magnitude). The use of the immunomodulator Superlymph in complex treatment normalized the level of TLR9 gene expression in the conjunctiva and cornea; moreover, there was a rapid relief of inflammation signs, an increase in visual acuity, and a reduction in the duration of treatment in patients with herpetic keratitis.

[Cytokine therapy in the regulation of corneal reparative processes: an experimental and clinical study].

Cytokine monotherapy with Superlymph used in combination with the keratoprotector Applicoll in the treatment of superficial corneal layer defect resulted in rapidly alleviated inflammatory reactions, accelerated reparative processes, more qualitative epithelial defect recovery, by forming a finer scar, without opacity whereas the traditional treatment led to long-term healing and keratoleukoma in an experiment. The use of cytokine therapy with Superlymph in the complex treatment of corneal injuries and inflammation in children promoted a prompt and stable arrest of a local inflammatory process, accelerated epithelization, reduced opacity intensity, higher visual acuity, and shorter treatment.

[Pathophysiological mechanisms of hemorrhagic stroke and the ways of differential therapy].

The changes developing in the perifocal area of hematoma and perspectives of antioxidant and chelate therapy were studied on the model of experimental hemorrhagic stroke and in clinical conditions. Microcirculatory, ischemic and inflammation disturbances with a certain time sequence were found in the perifocal areas. These changes, along with hypostasis and oxidative stress, form the pathobiochemical cascade of changes in hemorrhagic stroke and are potential therapeutic targets. Administering of an antioxidant and chelate drug histochrome reduces the intensity of changes in the perifocal area in the experimental conditions. In clinical conditions, it accelerates the dynamics of brain and meningeal symptoms regression and improves the blood rheological properties.

[The specific features of penetration of the antioxidant histochrome across the blood-ocular barrier: an experimental study].

Analysis of intraocular fluid and the vitreous body in 7 rabbits (14 eyes) by high performance liquid chromatography reveals histochrom metabolic products and, possibly, histrochrom itself during intravenous and subconjunctival injections and retrobulbar administration of histochrom through the irrigation system on models of experimental rabbit hyphema and hemophthalmia, which suggests that histochrom is able to penetrate across the blood-ocular barrier.

[Systemic enzyme therapy in the treatment of children with lower orbital wall fractures].

Wobenzim, a drug for systemic enzyme therapy, was used in 26 children with lower orbital wall fractures as monotherapy in early periods (on days 1 to 7) after brain injury to improve healing conditions and to minimize the formation of scar tissues in the fractural area. A control group comprised 24 patients who received systemic dehydration and vessel-strengthening therapy. Systemic enzyme therapy with Wobenzim could reduce the attenuation time of inflammatory manifestations of injury, prevent complications, such as strangulation of the musculus rectus inferior in the fractural area and development of strangulated orbital soft tissue hernia, and substantially decrease the number of patients having indications for surgical plastic repair of the orbital wall, as compared with the control group.

[The efficiency of the use of cerebrolysin in optic nerve diseases in children of different age].

The purpose of the study was to evaluate the efficiency of cerebrolysin used in partial atrophies of the optic nerve in relation to the method of drug injection and to whether treatment was used in combination with percutaneous electrostimulation of the optic nerve. The study was based on the results of clinical and electrophysiological studies of 646 children (810 eyes) aged 8 weeks to 18 years. All the examinees were divided into 4 groups: 1) patients in whom cerebrolysin was administered as retrobulbar injections made once daily; 2) those in whom cerebrolysion was injected in combination with microcirculation-improving agents through the irrigation system into the retrobulbar and Tenon space; 3) patients who received cerebrolysin only through the irrigation system; 4) those in whom the agents affecting the microcirculatory bed in the optic nerve system were administered through the irrigation system. Cerobrolysin has turned out to be highly effective as a drug that improved the outcomes of percutaneous stimulation of the optic nerve due to the use of two-stage treatment of children with partial atrophy of the optic nerve of various genesis, involving irrigation therapy supplemented by cerebrolysin and vascular agents at the first stage and percutaneous stimulation of the optic nerve at the second one.