The article describes a case of 7-year-old child with rare Axenfeld-Rieger syndrome demonstrating the effectiveness and safety of combined laser reconstructive surgeries - a non-invasive alternative to ordinary operations without needing anesthesia. The diversity of ophthalmic pathologies in this syndrome is the reason why the target, indications and optimal time for operation should be chosen individually. It is reasonable to suggest widening the indication spectrum for laser reconstructive surgery with consideration of surgeon experience and availability of high-tech equipment.
BACKGROUND: Relevant keratometric and biometric indicators are necessary for intraocular lens (IOL) power calculation, which is difficult to verify in young children. AIM: Evaluation of the accuracy of various ultrasound methods and optical biometry for axial length measurement in young children with congenital cataracts. MATERIAL AND METHODS: Forty-six children (74 eyes) with congenital cataracts (43 eyes) and pseudophakia (31 eyes) at the age of 6 months to 4 years were examined. Various methods measured the axial length: ultrasound A-scan under general anesthesia by US-4000, ultrasound B-scan without general anesthesia by Voluson E8, and optical biometry by AL-Scan in cases of transparent optics. RESULTS: The greater axial length difference was observed between A-scan and optical biometry (less by 0,78 mm) than between B-scan and optical biometry (more by 0,27 mm). The median axial length difference between A-scan and B-scan was equal for infants and young children with congenital cataracts (0,525 mm and 0,535 mm, respectively). CONCLUSION: Axial length should be measured by different methods in young children with their further comparison to obtaining more accurate biometric indicators for IOL power calculation. The decrease of 12 mm in axial length, which occurs during the A-scan, can lead to errors in the IOL calculation of 36 diopters and unplanned refraction in the long-term period.
Background. In recent years there is a tendency to more often admission in our institution children with multiple IOL damage caused by laser treatment of secondary cataract operated at local hospitals.Purpose. To analyze the causes of laser damage to IOL in children underwent YAG laser destruction of secondary cataract and find best ways to prevent them.Patients and methods. We analyzed the frequency of acrylic IOL damage after YAG-laser destruction in 593 children with congenital, posttraumatic and postuveal cataract at age from 6 months to 17 years (one third of patients were less than 3 years old). All laser operations were performed on identical YAG-laser, by the same protocol and by one surgeon.Results. We confirmed that main reliable prevention factor of damage to IOL in children is the precise focus of laser beam. In past 10 years in our institution, we managed to decrease frequency of laser damage to IOL in children with secondary cataract in 4.5 times due to performing operations under general anesthesia (43.8 % in 2007–2008, 65.8 % in 2018). Thus, decreasing frequency from 5.9 % to 1.3 % in the same age group of patients.Conclusion. To achieve the effective prevention of laser damage to IOL in cases of YAG laser destruction of secondary cataract it is essential to use general anesthesia in following conditions: children 5 or below age, non-contact children of older age, children with nystagmus, CNS pathology, psychomotor development delay. It is unacceptable to perform this operations without general anesthesia in children that can’t fix the gaze. Furthermore it is important to use contact lenses to fix the eyes of a child, select the individual less invasive method and technique of laser operation, utilize single short impulses with minimal effective energy, thoroughly follow standard safe energy modes (impulse energy shouldn’t be more than 2.4 mJ, impulse number should be not more than 100).
Based on many years of experience in laser ophthalmosurgery in children (from 1991 to 2019, 5376 YAG laser reconstructive surgeries were performed in children aged 2 months to 17 years in the department of eye pathology in children of the Federal State Budgetary Institution Helmholtz NMRCED(MRI)GB, improvement of laser technologies (traditional laser techniques are adapted for children, 14 proprietary techniques are patented), an expanded and detailed list of eye diseases in children has been developed and illustrated for practical pediatric ophthalmologists, for which YAG-laser reconstructive interventions are effective, for implementation into clinical practice of pediatric ophthalmology in the Russian Federation.
This article was designed to report of the analysis of the changes in the anterior layers of the vitreous body revealed during YAG laser-assisted ablation of secondary cataracts in 34 eyes of the children presenting with pseudophakia following extraction of congenital cataracts. The study has demonstrated clinical variants of congenital and postoperative opacity of the anterior layers of the vitreous body. The strategy and optimal energy parameters of the effective laser vitreolysis are proposed together with the rationale for the combined sequential (one-step) application of YAG laser destruction of secondary cataract and anterior vitreolysis of the revealed opacity.
The clinical manifestations and successful therapy of Irvine-Gass syndrome in a 12 year-old child are described. It was shown that Irvine-Gass syndrome can develop not only in the form of vitreo-corneal traction leading to macular oedema not infrequently with the formation of the cysts in the macula but can also be accompanied by the traction effect on the disk of the optic nerve as revealed by optical coherent tomography (OCT). The use of YAG laser irradiation for the dissection of the vitreo-corneal adhesions can eliminate traction Irvine-Gass syndrome without the surgical opening of the eye and result in the restoration of the normal anatomical structures of the eye with the improvement of visual acuity and the prevention of the development of macular degeneration leading to the irreversible loss of vision in a child.
The article presents the analysis of the results YAG laser interventions on the structures of the vitreous body in 49 children (53 eyes) with various vitreal pathology, mostly congenital, rare consequence of uveitis, trauma and intraocular operations. Laser discission of the vitreous body commissures (vitreomembranotomy) was produced in 37 eyes, the destruction of the opacities of the vitreous body (vitreolysis) in 13 eyes, dissection of the vitreocorneal adhesions (front adhesiotomy) in 3 eyes. Laser surgery in most children (79,6%) was able to resolve the traction, in all cases it improved the status of the optical zone, in 42% of children it improved visual acuity. We found no major complications. Vitreomembranotomy was the most effective for cutting of the thin avascular commissure in cases of the persistent hyperplastic primary vitreous syndrome and scar phase retinopathy of prematurity. Laser vitreal destruction of the front vitreal opacities is justified in children in early postoperative period after cataract removal to accelerate vitreolysis and in obscurations amblyopia preventing. Both adults and children, laser vitreocorneal dissection is shown in the syndrome of Irvine-Gass, hyaloidotomy, and it is used to eliminate vitreal pupillary block.
The clinical manifestations and successful therapy of Irvine-Gass syndrome in a 12 year-old child are described. It was shown that Irvine-Gass syndrome can develop not only in the form of vitreo-corneal traction leading to macular oedema not infrequently with the formation of the cysts in the macula but can also be accompanied by the traction effect on the disk of the optic nerve as revealed by optical coherent tomography (OCT). The use of YAG laser irradiation for the dissection of the vitreo-corneal adhesions can eliminate traction Irvine-Gass syndrome without the surgical opening of the eye and result in the restoration of the normal anatomical structures of the eye with the improvement of visual acuity and the prevention of the development of macular degeneration leading to the irreversible loss of vision in a child.
