All articles - Ophthalmology

The clinical, functional and biomechanical properties of the fibrous membrane of the eye in children with
primary congenital glaucoma were studied using the method of elastotonometry. The results of a study of the
clinical, functional and biomechanical properties of the eyes in 57 children with primary congenital glaucoma and
in 11 healthy children aged 8 days to 7 years in the eye department of the clinic of the Tashkent Pediatric Medical
Institute are analyzed. Research methods included clinical and functional methods and special (to determine the
rigidity of the membranes of the eye). The results of the study showed that with an increase in elastopod values,
the indicators of corneal deformation decrease as a result of pronounced corneal edema; the level of IOP in the
advanced and terminal stages indicates the weak rigid properties of the fibrous membrane of the eye. Thus, the
elastotonometry method is an objective quantitative diagnostic criterion for assessing the biomechanical proper-
ties of the fibrous membrane of the eye in children with congenital glaucoma.

Evaluation of the effectiveness of our chosen approach in the treatment of this
disease, which is confirmed by the results obtained – a low percentage of relapses of the disease, a
reduction in the need for additional treatment, a reduction in the duration of the patient’s stay in the
hospital, as well as the feasibility of early aspiration of purulent contents through the skin, preventing
spontaneous opening of the abscess with subsequent probing and washing of the tear ducts.

The article presents a clinical case of observation of the reactive course of the
postoperative period in a child with a combined injury of the eyeball, who was on inpatient treatment
in the department of ophthalmology of the clinic of the Tashkent Pediatric Medical Institute. The
results of the study showed: adequate specialized surgical treatment of combined eye trauma in
combination with intensive therapy allowed to stop the exudative process in the eye chambers, in the
vitreous body, which allowed to stabilize the reactive course of the postoperative period, preserve the
eye as a functional organ and prevent the development of post-traumatic uveitis.

The most important medical and social problem in modern ophthalmology is the early diagnosis and treatment of glaucoma. Despite the known advances in the diagnosis and treatment of this disease, it remains one of the main causes of irreversible vision loss in people around the world. In the 70s of the last century, the total number of patients with glaucoma in the world was about 20 million (Nesterov A.P., 2007). At the moment, their number has increased to 105 million, and, according to WHO forecasts, by 2030. it can double (Kuroedov A.V., Gorodnichiy V.V., 2007). In Russia in 2003, about 800 thousand patients with glaucoma were registered (Kuroedov A.V., Gorodnichiy V.V., 2007). Glaucoma took the 1st place in the structure of blindness and primary visual disability (Libman E.S., Chumaeva E.A., 2004; Son I.M., Kalininskaya A.A., Sergeeva E.S., Chernenko E. .G., 2009).

The article describes the factors affecting the target refraction of pseudophakic eyes of children after extraction of congenital cat-
aracts. The factors include features of the echobiometric parameters of the eye, refraction, comorbidity of congenital cataracts and
ocular pathologies, margins of error in calculating strength of the intraocular lens, localization and structure of the artificial lens,
as well as correction of obscure or refractive amblyopia in pseudophakic eyes. Development of the algorithm for correction of re-
sidual refraction of pseudophakic eyes in children both before and after IOL implantation with consideration of each of those fac-
tors currently remains a relevant problem.

Biochemical studies of blood and chamber moisture in children with congenital cataract
are of great clinical importance. Chamber moisture is an ultrafiltrate of blood plasma and can be
an indicator of various pathological conditions of the body as a whole, and the eye in particular.
The study of the level of protein, glucose in the blood and chamber moisture of all the examined
children was carried out. As an indicator of inflammatory complications in the postoperative period,
the threshold value of total blood protein of 62.2±1.3 g/l and an increase protein content in chamber
moisture to 3.5±0.09 g/l can be used.

For parents, a child of any age seems vulnerable, so adults take care of him, they want protection from all difficulties. Unfortunately, a person is not strong and some diseases are very dangerous for the life of children. Some pathologies pass quickly and affect the future life, otherwise others will significantly affect the future life of the child. In order to reduce the impact of pathologies on the child's body, it is possible to diagnose the disease in the early stages, it is necessary to identify and immediately begin treatment. Among these diseases are ophthalmic we can not do without the introduction of diseases. If a child has vision problems from an early age, it can lead to a delay in the development of the child in the future. Ophthalmic diseases the main part: eye injuries, glaucoma, cataracts, glaucoma, retinopathy, myopia, cataract diseases, etc. More than 20% of diseases in ophthalmological practice, depending on the injury, damage the orbit and the eyeball. From an eye injury, then in 13% of cases, subatrophy of the eye develops, in 25% anophthalmos may occur. As for the characteristics of injuries, 10% of children suffer from damage to the organ of vision. This leads to various pathologies of the eye, in 30-60% of cases it can lead to one- or two-sided blindness. The most important traumatic factors in children are: knives, bullets, stones and clubs, hockey sticks, spears, nails, wire, etc. Glaucoma is one of these diseases. The disease also requires special attention. Reason: Prevalence of glaucoma in children Occurs in 1:10,000-1:12,000 cases. Its share in eye pathology is 0.1%. enough. More than 75% of glaucoma cases are bilateral. In parallel, there was glaucoma in 5 to 15% among children, blind and non-blind schoolchildren. Blindness in children, the proportion of this pathology ranges from 2 to 15%. in the Russian Federation Congenital glaucoma accounts for 10.1% of childhood blindness.

A clinical case of familial congenital cataract in two patients is presented. born from consanguineous marriage. The studies were carried out in the department of ophthalmology clinics of the Tashkent Pediatric Medical Institute. Patients underwent standard laboratory and instrumental studies, as well as ophthalmological examination , including visometry , biomicroscopy , ophthalmoscopy . The a clinical case indicates the risk of having children from a closely related marriage with congenital cataract, optic nerve hypoplasia, which can further lead to visual impairment.

A clinical case of EYE MANIFESTATIONS of complications is presented in a teenager who has had COVID-19. The studies were carried out in the intensive care unit and intensive care unit (ICU) of the clinic of the Tashkent Pediatric Medical institute. The patient underwent standard laboratory and instrumental studies, as well as an ophthalmological examination, including visometry, biomicroscopy, ophthalmoscopy. This clinical case showed that COVID-19 infection was complicated polymorphic ophthalmic symptoms indicating involvement in the process lacrimal gland, mucous membranes of the eyeball and eyelids, cornea of the lacrimal sac, retrobulbar tissue, while from the side of the eyes these complications are expressed in dry keratoconjunctivitis (Sjögren's syndrome).

AIM: To analyze clinicofunctional and echobiometric indicators of the eyes in children with target refraction, pseudofacial myopia, and their mothers.

MATERIAL AND METHODS: In the eye department of the clinic of the Tashkent Pediatric Medical Institute, a correlation analysis of optical and echobiometric indicators was conducted in 30 children (30 eyes) with artifakia and their mothers (60 eyes). Visiometry, keratorefractometry, and ultrasound examination (A/В scan of the eyeball) were conducted. Children were examined 12-14 months after CC extraction with intraocular lens (I0L) implantation.

RESULTS: A strong direct correlation was determined between the optical power of lOLs in children and their mothers who were theoretically planned for I0L implantation of lOLs in the group that has achieved target refraction. This may indicate the possibility that the child has the same optical power as the mother and the optical power of lOLs in a child is the same as that in adults. No correlation was found between the optical power of the I0L in the eyes of children with pseudophakic myopia and maternal artificial lenses theoretically planned for implantation.

CONCLUSION: The direct strong correlations between the optical power of the I0L of children and the lenses of their mothers in the group with the target refraction achieved by this age make it possible to use the optical power of maternal lenses as a “guideline" when calculating the power of the I0L implanted in children to achieve the target refraction. The lack of correlation between the refractive powers of the I0L in children with pseudophakic myopia and the lenses of mothers may indicate that the SRKII formula with age-related hypocorrection is not adapted to calculate the I0L power in children at risk of excessive refractive enhancement after surgery.

Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the func­tional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant.

Purpose — to determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation.

Material and methods. The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL.

Results. The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were sub­jected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk fac­tors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed.

Conclusion. According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such in­dicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of 23.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of SI 80 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combi­nation of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patients parents, near-sight visual loads ot more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.

Purpose. An analysis of complications in case of penetrating injuries of visual organ in children and methods of their elimination.

Material and methods. There were in the follow-up 36 patients (36 eyes) aged from 6 to 14 years with various ocular injuries: boys - 70% of cases, girls - 30% of cases. All children underwent ophthalmic and clinical examinations.

Results. The primary surgical treatment (PST) was performed in all patients at the place of residence in different regions of the Republic. The secondary surgical treatment (SST) was carried out according to the following indications: swelling cataract, filtration of corneal and scleral injuries, local endophthalmitis, iris incarceration, hypotension, secondary glaucoma, sutures failure, torpid uveitis, deformation of eyelids, abruption of lacrimal canaliculi, non-sutured scleral wound, suspect intraocular foreign body, the destruction of the eyeball, suspected intraocular foreign body, the destruction of the eyeball. Causes of PST complications were: the severity of injuries (47.2%), an unskilled first aid (41.7%), a late appeal of patient (47.2%).

Conclusion. As a SST result the inflammatory response was stopped and the eyes were maintained as an anatomical organ in 99.6% of cases, visual functions were preserved in 67.4% of cases. It is necessary to intensify educational work among the population, to improve the quality of emergency eye care and the adequate rehabilitation of patients.

The main link in the treatment of congenital cataracts (VK) is the extraction of the lens with the
subsequent correction of ametropia by various methods, one of which is the implantation of an
intraocular lens (IOL). The aim of the study was to study the features of the course of the postoperative period in frequently ill children (FBI) after VC extraction. We examined 35 children
(59 eyes) with VK who are undergoing surgical treatment in the eye department of the clinic of the Tashkent Pediatric Medical Institute. A comparative analysis showed significant changes in the hydrodynamic parameters of the eyes and a high percentage of intra- (hyphema in 71%, fibrin
reaction in 59%, prolapse of the vitreous in 47% of cases) and postoperative complications (corneal
edema in 36 %, inflammatory exudative reaction in the anterior Chambers: 1+, 2+ in 64% of cases) in FWB compared to children who are not in the category of frequently ill. The revealed feature
indicates the need for adequate management of the preoperative and postoperative periods in
Frequently ill children 

Objective: To study the dynamics o f the nosological structure o f eye diseases in children based on the materials o f the ophthalmological department o f the clinic o f the Tashkent Pediatric Medical Institute. Material and methods: A
retrospective analysis o f the reporting medical documentation o f the work o f the ophthalmological department o f the
TashPMI clinic in 2018-2021 was carried out. Results: For 4 years in the structure o f diseases, the leading positions (from 10 to 33.15%) were occupied by diseases o f the lens, injuries, pathologies o f the oculomotor apparatus and intra­ocular pressure. Analysis o f the dynamics o f each nosological group during 2018-2021 revealed a steady upward trend in the number o f children with congenital cataracts (from 23.7 to 30.57%) and congenital glaucoma (from 17.25 to 34.05%), a slight decrease in thefrequency o f injuries (from 29.02 to 21.77%), the number ofpatients with strabismus, which, after a sharp decrease to 10.31% in 2020, increased again to 26.82% in 2021. Conclusions: The obtained data should be taken into account in order to optimize the planned and emergency children’s ophthalmological service in
the regions o f the republic, improve the screening o f congenital and genetic diseases, and prevent childhood injuries.

This clinical example shows the progressive nature of the course of a combined eye injury: contusion and thermochemical
burn as a result of the explosion of the “New Year’s firecracker”, which led to the development of cicatricial, degenerative
processes in the tissues of the eyeball and eyelids. After the injury, the patient underwent three stages of emergency (according
to vital indications for the eye) surgical treatment, as a result of which it was possible to preserve the structures of the eyeball
and visual functions. At the same time, the rehabilitation period has not yet been completed. These injuries, unfortunately, are
one of the causes of low vision and blindness in children and require constant monitoring and treatment.

The study showed that 66 chi/dren aged from 8
months to 13 years with cataracts of different etiology
showed high efficiency in the primary implantation of
soft spherica/ monohlock intraoci1lar /ensf!S. Тhе high-
est rates of viziometry after treatment were observed in
chi/dren with congenital bl/ateral and traumatic cata-
racts. After _treatment, children with uveal and uni/at-
era/ congenital cataracts had relative/y /ow visua/ acu-
ity va/ues.

Congenital cataracts occupy a significant place in the structure of blindness and low vision and are one of the main causes of visual disability since childhood. Currently , cataract in children is one of the urgent problems of pediatric ophthalmology , given its fairly high prevalence and significant role in the structure of blindness and low vision . Due to clouding of the lens, the development of the visual analyzer is disrupted and amblyopia is formed, the treatment of which requires significant and lengthy efforts on the part of ophthalmologists and parents. Among the causes of blindness in children, the share of congenital cataracts varies from 7.5% (in developed countries) to 27.4% (in socially disadvantaged regions). The prevalence of cataracts in developed countries, as well as in Russia, is 1.6-2.4 per 100,000 children [25.].

The article presents the results of the clinical efficacy of the calculation formula with the correction factor of the optical force of the intraocular lens in children with congenital cataracts at risk of development of pseudophakic myopia. Personalized Rm corrective coefficient in the formula for calculating the force of IOL in children with risk of development of pseudophakic myopia makes it possible to achieve target refraction in 83.3% cases and reduce the development of reduce myopic refraction.

The paper presents the results of extraction of congenital cataract with IOL implantation in 50 (86 eyes) children aged 7 months to 12 years. In the examined patients, intraoperative complications were noted, such as posterior capsule rupture (8%), hyphema (6%), postoperative: fibrin effusion on the IOL (7%) and corneal edema (4.6%). With congenital bilateral cataracts after treatment, visual acuity increased on average from pr.l.certae to 0.1; with unilateral - from pr.l.certae to 0.01.

The article presents the result of a survey of 35 patients after extracapsular extraction cataract with IOL implantation at the age of 8 months to 13 years.Patients underwent: viziometry, biomicroscopy, keratorefractometry,  skiascopy,  A,  B-scan  ultrasound,  ophthalmoscopy,  consultation  of  related specialists. The calculation of the optical power of IOL was performed using the SRK II formula. Refraction in the early postoperative period in children from 8 months to 6 years corresponded to the age range, from 6 to 13 years was presented in the form of ametropia.According to the authors , ametropia is a consequence of post-traumatic scarring of the cornea, tension of the stitches , swelling of the cornea and mistakes made at the calculation of the power of the IOL according to the formula SRK II.

Purpose of the study. To study risk factors for the development of complications in pseudophakic eyes. Material and methods. We carried out a retrospective and prospective analysis of the case histories of 65 children (65 eyes) diagnosed with pseudophakia, who were in the hospital in the eye department of the clinic of the Tashkent Pediatric Medical Institute over the past 5 years. The results of the study showed that the most significant risk factors for the development of intra- and postoperative complications are the following factors: FAI, neutrophil- leukocyte index (0.94±0.5), true intraocular pressure 20.5±1.2 mm Hg. Art., thickness of the choroid 1.02 ± 0.33 mm, protein in the CV above 3.5 ± 0.09 g/l, and in the blood below 62 ± 1.3 g/l

To study the results of IOL implantation in children with frequent respiratory diseases - conditionally frequently ill children (FCCI) taking into account the parameters of the composition of the chamber moisture of the eye. Material and methods: A retrospective and prospective analysis of the case histories of 50 children (50 eyes) aged from 1 to 5 years, who were treated in the eye department of the TashPMI clinic, was carried out. All patients underwent ophthalmological, clinical and laboratory studies: biochemical studies of blood and chamber moisture of the eye (EC). Results: The children were divided into 2 groups: the 1st group - 28 UCBD, the 2nd group (control) - 22 patients with no pathology from the somatic status. In patients of the 1st group, intraoperative complications occurred 1.8 times more often than in patients of the 2nd group, postoperative complications - 2.5 times more often. Of the late postoperative complications in patients of the 1st group, there was fibrosis of the posterior lens capsule (61%), poste-rior synechia (18%), and IOL dislocation (14%), which were indications for repeated surgical interventions. Conclu-sions: UCBD has a higher percentage of early postoperative inflammatory and late proliferative reactions. In patients of the 1st group, a significant increase in the protein content in the chamber moisture and a significant decrease in the protein level in the blood before cataract extraction were also revealed.

The article points out the issues associate with combination of pharmaco-physiologic methods of treatment in complex treatment of glaucomatous optic neuropathy in condition with compensate intraocular pressure. There was informationabout main conceptions of neuroprotection and the role of retinalamin as a main biogenic stimulator from the citomedin group. It should be noted that, these days, hypotensive therapy is not enough effectively retain process of the progression of GON. It is more reasonable to use drugs directed to improve a blood supply in the optic nerve area, mainly via targeted delivery with a help of endonasal electrophoresis and percutaneous electrostimulation with ESOM apparatus that considerably improve a quality of patient`s life by retaining atrophic process

The aim of the study was to assess the level and depth of various types of anesthesia by studying the BIS-index in intraocular operations in children.
The data of the study of the dynamics of the BIS-index and, accordingly, the depth of sedation indicated the effectiveness of the anesthesia options used, including the use of inhaled anesthetics sevoflurane and isoflurane in the anesthetic support of intraocular operations. The following combinations were used to provide anesthetic protection in 46 children with intraocular surgery: fentanyl with sevoflurane (group 1), fentanyl with isoflurane (group 2). At the stage of basic anesthesia in patients of group 1, the BIS index was in the range of 45,8-57,4, in group 2, the BISindex was in the range of 37,61- 53,6.
All the proposed options of anesthesia provide a sufficient level of sedation of patients during intraocular operations and can be used in practice. Thus, conducting anesthesia using BIS-monitoring allows you to reduce the doses of drugs used, reduce the amount of excessively deep and superficial anesthesia, and reduce the time of recovery of consciousness after the end of the operation