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.

OBJECTIVE:To assess the morphological state of the visual analyzer in premature infants in long-term.MATERIAL AND METHODS:We examined 40 premature children (74 eyes) aged 10.3±2.92 years (gestational age (GA) 25-34 weeks, birth weight (BW) 690-2700 g). Twenty mature children (40 eyes), aged 10.8±3.05 years, were examined as a control group. The children underwent standard ophthalmologic examination, optical coherence tomography (OCT) and recording of visual evoked potentials (VEP).RESULTS:The thickness of retinal nerve fiber layer (RNFL) is less in preterm infants than in term infants, regardless of retinopathy of prematurity (ROP) and refraction (p<0.05). Thickness loss has an inverse proportion with the degree of hypoxic-ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) (p<0.05). Retinal thickness in fovea is significantly greater in preterm infants and has a direct proportionality with the degree of IVH and the number of days on artificial lung ventilation (p<0.05). Moderate organic changes were detected in conduction pathways in 43.08% of premature infants according to VEP data.CONCLUSION:The use of OCT and recording of VEP may improve the quality of comprehensive neuro-ophthalmologic diagnosis in preterm infants. The thickness loss of RNFL can be expected in premature infants with HIE and IVH.

Original article Assessment of foveal hypoplasia in premature infants as a prognostic factor in the formation of central vision R. Atamuradov, I.B. Astasheva, M.R. Guseva, V.V. Marenkov, Yu.A. Kyun, A.R. Baranova Pirogov Russian National Research Medical University, Moscow, Russian Federation Yudina City Clinical Hospital, Moscow, Russian Federation Morozov Children’s City Clinical Hospital, Moscow, Russian Federation Purpose. Assessment of foveal hypoplasia (FH) in premature infants as a prognostic factor in the formation of central vision. Material and methods. We’ve examined 61 patients (118 eyes) aged 8.83±3.5 years who were born prematurely (gestational age 24–34 weeks, birth weight 690–2,700 grams). Among the preterm infants, 22 (36%) had a history of spontaneous regression of retinopathy of prematurity (ROP), 31 (51%) had laser retinal photocoagulation for ROP and 8 (13%) preterm patients were without ROP. All children were assessed for the best corrected visual acuity (BCVA) according to the Sivtsev and Orlova tables, optical coherence tomography (OCT), and registration of visual evoked potentials (VEP). Results. We have noted 4 degrees of FH in preterm infants: 1st degree – no extrusion of plexiform layers, foveal depression is significant (BCVA on average 0.91±0.1); 2nd degree – mild foveal depression, no extrusion of plexiform layers (BCVA on average 0.83±0.2); 3rd degree – absence of foveal depression and extrusion of plexiform layers, elongation of photoreceptor outer segments and thickening of the outer nuclear layer were observed (BCVA on average 0.7±0.2); 4th degree – foveal depression, extrusion of plexiform layers and elongation of photoreceptor outer segments are absent, thickening of the inner nuclear layer is preserved (BCVA on average 0.4±0.2). A significant difference of BCVA from the norm was noted at 4th degree (p<0.05). Conclusion. Different degrees of FH have been identified, which can be used as a prognostic factor of visual acuity in premature infants. An uncorrectable decrease in visual acuity can be expected in children with 4th degree FH. Key words: foveal hypoplasia (FH), retinopathy of prematurity (ROP), optical coherence tomography (OCT), macula, visual evoked potentials (VEP)

Original article Assessment of some patterns of lipid peroxidation processes in uveitis in children O.S. Komarov, M.R. Guseva, S.A. Obrubov, N.M. Galkina Pirogov Russian National Research Medical University, Moscow, Russian Federation Uveitis is characterized by a variety of clinical forms, chronic and recurrent course, severe outcomes, and not always effective therapy. In addition, etiological diagnosis and treatment of patients require more subtle and advanced laboratory methods and deciphering the incompletely studied mechanisms of the pathogenesis of the disease. The work, based on significant clinical material, shows that the activation of polymorphonuclear leukocytes (PMN) in the blood is one of the main reasons for the increased processes of lipid peroxidation (LPO) in uveitis. The activity levels of PMN and LPO clearly correlate and reflect the degree of depth and dynamics of the inflammatory process in uveitis. These indicators more subtly characterize the course of the disease and the dynamics of recovery compared to traditional generally accepted criteria for assessing inflammation. Simultaneous study of the intensity of PMN and LPO on the one hand and assessment of the antioxidant activity (AOA) of the system makes it possible to predict the course of the disease, prescribe adequate therapy and judge the severity and completeness of the process. It has been proven that one of the main blood antioxidant proteins, ceruloplasmin, changes parallel to the clinical picture of uveitis, which can be used as a basis for prescribing antioxidant therapy or for assessing the effectiveness of treatment. Key words: uveitis, lipid peroxidation, antioxidants, ceruloplasmin, polymorphonuclear leukocytes

Purpose. Identification of antioxidant activity (AOA) in known pharmaceutical drugs used for eye treatment and comparative evaluation of their antioxidant properties. Material and methods. The experimental part of the work was carried out on a model system using a suspension of yolk lipoproteins. This model has several advantages: availability, ease of isolation, storage stability, and reproducibility. The clinical part of work consisted in inclusion of these drugs in the treatment course of patients with inflammatory eye diseases. Results. In this experiment, a high AOA of several drugs was found. As a result, it may be possible to expand their spectrum of applications in treatment of ophthalmic pathology. Conclusions. In several cases, the antioxidant activity of previously known and widely used in ophthalmological practice pharmaceutical drugs was found. The discovery of new properties in known drugs makes it possible to expand the spectrum of their application, considering the identified antioxidant properties. The inclusion of drugs with an antioxidant effect in the treatment course for patients with inflammatory eye diseases can reduce the duration of treatment and increase its effectiveness. Keywords: antioxidants; medicines; initiators of oxidation, lipoproteins

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.

Currently, it is possible to treat secondary progressive multiple sclerosis (SPMS). This is the most unfavorable type of multiple sclerosis (MS) and the article provides a medical and social analysis of MS course at this group of patients. There is evidence that these patients are highly socialized members of society, usually family members, so their non-participation in socially useful work significantly affects the whole life of society. Many of them receive pathogenetic treatment drugs that do not work at this stage of MS. That is, the large cost of purchasing medicines not only does not help these patients, but also is an irrational expenditure of public funds.

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 «+» 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.

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.

One of the promising areas in the pathogenetic treatment of multiple sclerosis (MS) is anti-B-cell therapy using ocrelizumab, an anti-CD20 monoclonal antibody. The drug is indicated for primary progressive MS (PPMS), secondary progressive MS (SPMS) and exacerbations, and highly active MS.Objective: to analyze the use of the drug in 32 patients with different types of MS in everyday neurological practice.Patients and methods. The investigation included 32 patients diagnosed with MS using the 2017 McDonald criteria: 12 patients with PPMS, 12 with highly active MS and 8 with SPMS and exacerbations. The median Expanded Disability Status Scale (EDSS) score was 4.0; the most severe course of the disease was observed in patients with SPMS. All the patients received a treatment cycle of 600-mg intravenous ocrelizumab injections (with an infusion pump) every 6 months; the initial dose was by 300 mg every 2 weeks. The follow-up period was 6 to 18 months.Results and discussion. During ocrelizumab therapy, the patients with PPMS showed stabilization of EDSS score; and 6 (50%) had even its slight decrease by 0.5–1.0 scores, which may be caused by compensation for the existing symptoms due to pathogenetic treatment. In highly active MS, only 1 of the 12 ocrelizumab-treated patients had an ongoing exacerbation of the disease. During a subsequent 6–18-month follow-up, magnetic resonance imaging revealed that none of the patients had manifestations of MS activity; the EDSS score decreased in all the patients, indicating their achievement of stable remission. Six (75%) of the 8 patients with SPMS and exacerbations also displayed a decrease in EDSS score in the absence of exacerbations. No adverse events, including infusion reactions, were recorded during drug administration. The drug has a good tolerance and safety profile and ease-to-use.Conclusion. Ocrelizumab therapy with will be able to improve the quality of treatment in patients with different types of MS, which is of great medical and social importance

One of the promising areas in the pathogenetic treatment of multiple sclerosis (MS) is anti-B-cell therapy using ocrelizumab, an anti-CD20 monoclonal antibody. The drug is indicated for primary progressive MS (PPMS), secondary progressive MS (SPMS) and exacerbations, and highly active MS. Objective : to analyze the use of the drug in 32 patients with different types of MS in everyday neurological practice. Patients and methods . The investigation included 32 patients diagnosed with MS using the 2017 McDonald criteria: 12 patients with PPMS, 12 with highly active MS and 8 with SPMS and exacerbations. The median Expanded Disability Status Scale (EDSS) score was 4.0; the most severe course of the disease was observed in patients with SPMS. All the patients received a treatment cycle of 600-mg intravenous ocrelizumab injections (with an infusion pump) every 6 months; the initial dose was by 300 mg every 2 weeks. The follow-up period was 6 to 18 months. Results and discussion. During ocrelizumab therapy, the patients with PPMS showed stabilization of EDSS score; and 6 (50%) had even its slight decrease by 0.5–1.0 scores, which may be caused by compensation for the existing symptoms due to pathogenetic treatment. In highly active MS, only 1 of the 12 ocrelizumab-treated patients had an ongoing exacerbation of the disease. During a subsequent 6–18-month follow-up, magnetic resonance imaging revealed that none of the patients had manifestations of MS activity; the EDSS score decreased in all the patients, indicating their achievement of stable remission. Six (75%) of the 8 patients with SPMS and exacerbations also displayed a decrease in EDSS score in the absence of exacerbations. No adverse events, including infusion reactions, were recorded during drug administration. The drug has a good tolerance and safety profile and ease-to-use. Conclusion . Ocrelizumab therapy with will be able to improve the quality of treatment in patients with different types of MS, which is of great medical and social importance

The review presents the data characterizing the mechanism of action of anti-B-cell therapy for multiple sclerosis (MS) and the results of clinical trials of ocrelizumab, the first drug of this group, which has been approved for use in MS. Multicenter randomized controlled studies have shown that this drug is effective in treating both MS with exacerbations and primary progressive MS. Currently ocrelizumab is the only drug that can be used as a pathogenetic treatment for this MS course type.

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.

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.

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.

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.