Vision screening. Planning screening in pediatric ophthalmology

Ophthalmology uses instrumental research methods based on the achievements of modern science, allowing for early diagnosis of many acute and chronic diseases of the organ of vision. Leading research institutes and eye clinics are equipped with such equipment. However, an ophthalmologist of various qualifications, as well as a general practitioner, can, using a non-instrumental research method (external (external examination) of the organ of vision and its adnexal apparatus), conduct express diagnostics and make a preliminary diagnosis for many urgent ophthalmological conditions.

Diagnosis of any eye pathology begins with knowledge of the normal anatomy of the eye tissues. First you need to learn how to examine the organ of vision in a healthy person. Based on this knowledge, the most common eye diseases can be recognized.

The purpose of an ophthalmological examination is to assess the functional state and anatomical structure of both eyes. Ophthalmological problems are divided into three areas according to the place of occurrence: the adnexa of the eye (eyelids and periocular tissues), the eyeball itself and the orbit. A complete baseline survey includes all of these areas except the orbit. For its detailed examination, special equipment is required.

General examination procedure:

1. visual acuity test - determination of visual acuity for distance, for near with glasses, if the patient uses them, or without them, as well as through a small hole if visual acuity is less than 0.6;
2. autorefractometry and/or skiascopy - determination of clinical refraction;
3. intraocular pressure (IOP) study; when it increases, electrotonometry is performed;
4. study of the visual field using the kinetic method, and according to indications - static;
5. determination of color perception;
6. determination of the function of extraocular muscles (range of action in all fields of vision and screening for strabismus and diplopia);
7. examination of the eyelids, conjunctiva and anterior segment of the eye under magnification (using loupes or a slit lamp). The examination is carried out using dyes (sodium fluorescein or rose bengal) or without them;
8. examination in transmitted light - the transparency of the cornea, chambers of the eye, lens and vitreous body is determined;
9. fundus ophthalmoscopy.

Additional tests are used based on the results of anamnesis or initial examination.

These include:

1. gonioscopy - examination of the angle of the anterior chamber of the eye;
2. ultrasound examination of the posterior pole of the eye;
3. ultrasound biomicroscopy of the anterior segment of the eyeball (UBM);
4. corneal keratometry - determination of the refractive power of the cornea and the radius of its curvature;
5. study of corneal sensitivity;
6. examination of fundus parts with a fundus lens;
7. fluorescent or indocyanine green fundus angiography (FAG) (ICZA);
8. electroretinography (ERG) and electrooculography (EOG);
9. radiological studies (x-ray, computed tomography, magnetic resonance imaging) of the structures of the eyeball and orbits;
10. diaphanoscopy (transillumination) of the eyeball;
11. exophthalmometry - determination of the protrusion of the eyeball from the orbit;
12. pachymetry of the cornea - determination of its thickness in various areas;
13. determining the condition of the tear film;
14. mirror microscopy of the cornea - examination of the endothelial layer of the cornea.

T. Birich, L. Marchenko, A. Chekina

IN Within the walls of our clinic, we often encounter situations when, having heard one or another ophthalmological diagnosis, parents ask the question: “ How long have we had this problem??”, and are very surprised when they hear in response: “This problem is not three weeks old, or even several months old, this is a congenital pathology" And often we see the amazed and confused look of moms and dads. And when we start asking when they visited an ophthalmologist, we get many answer options, such as:

- “Why do this before school?”
- “We were - we were told that everything will pass with age.”
- “We were assured that it is impossible to examine a child under 3 years old,” and so on.

U us in the center Children are examined by an ophthalmologist at any age. Already at the age of up to 1 year, our specialist can confidently say: the child has or does not have a congenital pathology whether his visual system is delayed in development, whether there is a threat of strabismus, etc.

How do we quickly and easily check the vision of babies under 1 year old?

T now in our center in Kharkov, thanks to the device “Plusoptix, Gemany” we can with high precision scan the child’s visual system as early as 3 months.
The verification procedure is very simple and does not require any effort from the child.

IN The doctor takes measurements with the Plusoptix device within 15-30 seconds. At this time, the child is in the arms of his parents, we attract his attention with a special sound. Depending on the screening result, the doctor gives further recommendations and gives the patient the examination result.

Why is ophthalmological screening in infancy so important?

ABOUT The peculiarity of eye diseases is that they are not accompanied by painful sensations (except for injuries) , so the child is not able to realize that he sees poorly and cannot tell her parents about it.

P The first visit to an ophthalmologist should be planned at 3-4 months. It is at this age that the correct position of the eyes is established and possible pathologies are already visible. The doctor evaluates the condition of the optic nerve and retinal vessels, which are an indicator of cerebral vascular tone. In this age signs of such serious diseases are visible How:

V congenital glaucoma (increased intraocular pressure),

To ataract (clouding of the lens),

P tosy (drooping of the upper eyelid),

h malignant neoplasms requiring urgent surgical intervention.

E If we also add paralytic strabismus and some developmental anomalies of refraction, which can already be not only diagnose, but also successfully correct before the age of one year, it becomes obvious how Early ophthalmological screening is important.

Abstract of the dissertationin medicine on the topic Selective screening to detect ophthalmopathology in full-term newborns

As a manuscript

MOLCHANOVA Elena Vyacheslavovna

SELECTIVE SCREENING FOR DETECTION OF OPHTHALMOPATHOLOGY IN FULL-TERM NEWBORNS

Moscow - 2008

The work was carried out at the Federal State Institution "Scientific Center for Obstetrics, Gynecology and Perinatology of Rosmedtekhnologii"

Scientific supervisors:

Doctor of Medical Sciences, Professor Lyudmila Pavlovna Ponomareva Doctor of Medical Sciences, Professor Olga Vladimirovna Paramey

Official opponents:

Doctor of Medical Sciences, Professor Galina Viktorovna Yatsyk

Doctor of Medical Sciences, Professor Lyudmila Anatolyevna Katargina

Leading organization: Moscow Regional Scientific-

Obstetrics and Gynecology Research Institute

The dissertation defense will take place in 2008 at

meeting of the dissertation council D 001.023.01. at the State Scientific Center for Children's Health of the Russian Academy of Medical Sciences

At the address: 119991, Moscow, Lomonosovsky Prospekt, 2/62.

The dissertation can be found in the library of the Research Institute of Pediatrics of the State Institution NCCH RAMS.

Scientific Secretary of the Dissertation Council, Candidate of Medical Sciences

Timofeeva A.G.

General characteristics of the work Relevance of the problem

The relevance and prospects of the work on selective neonatal screening in newborns are justified by literature data that there are currently 150 million people in the world who have significant visual impairments. Of these, 42 million are blind, every 4th of whom lost their sight in childhood. The level of children's visual disability is 5.2 10 000 (Libman E.S., 2002).

The main problem is that the pathology of the visual analyzer, which already exists in a newborn child, is diagnosed extremely late, when chronic and often irreversible changes have already formed

According to studies conducted by ophthalmologists in Moscow, almost every second blind child (45.1%) and every third child out of all visually impaired children (36.8%) were perinatally injured. In the nosological structure of the causes of blindness, the leading pathologies are the pathology of the retina (29.6%) and the optic nerve (26.8%). Among the causes of low vision, diseases of the optic nerve took first place (34.8%) (Paramey O.V., 1999)

However, most ophthalmological studies are devoted to a narrowly focused study of one or another pathology of the perinatal period, while in perinatally affected children there is a combination of several of its types. Often the work is carried out from an ophthalmological point of view without taking into account the neonatal status of the child; studies are predominantly devoted to retinopathy in premature infants, while works devoted to the pathology of the organ of vision in full-term children are sporadic and do not reflect the statistics and nature of ophthalmopathology in the period of early neonatal adaptation.

Among the stages of the perinatal period that are important for the occurrence of visual impairments leading to low vision and blindness/

The most significant, according to researchers, are the pre- and postnatal periods of a child’s life. The formation of the visual analyzer does not end with birth: in the postnatal period, the subcortical structures of the visual analyzer (lateral geniculate bodies) actively mature, the cellular elements of the visual cortex differentiate with the formation of cortical visual analyzers, the associative parts of the cortex involved in the formation of visual perception mature, the macular and foveolar zones are formed retina, myelination of nerve fibers ends (Barashnev Yu.I., 2002; Somov E.E., 2002).

Deprivation - restriction of visual experience - is dangerous because... leads not only to a decrease in visual functions, but also to a decrease in the level of psychomotor development (Sergienko E.A.; 1995, Filchikova L.I., Vernadskaya M.E., Paramey OJ3.; 2003 Hubel D., 1990). Taking into account the fact that the development of the visual analyzer occurs most intensively in the first six months of a child’s postnatal life, early identification of children at risk for ophthalmopathology and timely provision of assistance to them will prevent the development of blindness, low vision and reduce the number of visually impaired people from childhood (Avetisov E.S., Khvatova A.V.; 1998, Kovalevsky EI., 1991).

In this regard, various programs for ophthalmological screening of newborns have been proposed in world practice. However, none of them provides a sufficient level of timely detection of congenital visual defects (Tailor D, Hoite S., 2002). This is largely due to insufficient study of the role of perinatal and neonatal factors in the genesis of the formation of congenital and early visual disorders, which requires clarification of their role in order to identify the most significant ones. Thus, the relevance of assessing known and newly identified risk factors for the formation of congenital ophthalmopathology and the problem of reducing the volume of research by conducting selective screening in a subpopulation of newborns remains relevant.

The purpose of the study was to develop a screening program for the early diagnosis of ophthalmopathology and create conditions for the active prevention of visual impairment in full-term newborns

Research objectives:

2. Assess the significance of perinatal risk factors in the occurrence of visual lesions in newborns and form risk groups of children for the development of ophthalmopathology

4. Develop an optimal eye examination regimen for newborns

Scientific novelty

For the first time, the feasibility of conducting selective ophthalmological screening in a perinatal center for full-term newborns at perinatal risk in the early postnatal period has been substantiated.

New data were obtained on the frequency and nature of eye pathology in newborns using modern diagnostic technologies, and a methodology for examining children in various departments of the center was developed.

The significance of most ante-, intra- and postnatal risk factors for the occurrence of eye pathology has been studied for the first time

For the first time, the diagnostic significance of the retinal venous pulse in newborns, indicating hemolytic fluid dynamics disorders, has been demonstrated.

Practical significance As a result of the research, modern diagnostic instrumental methods have been justified and introduced into practice in neonatal departments, and guidelines have been developed for their use within the framework of selective ophthalmological screening

BASIC PROVISIONS FOR DEFENSE

1. Neonatal ophthalmological screening in a perinatal center allowed us to determine the frequency and nature of ocular changes in full-term newborns.

2. Risk factors for the development of ophthalmopathology in newborns are:

maternal-fetal

High-risk pregnancy and childbirth, namely: complicated pregnancy (gestosis, feto-placental insufficiency, exacerbation of chronic and the presence of acute infection), labor anomalies during spontaneous labor, large fetus, birth asphyxia);

The use of reproductive technologies in women with a burdened obstetric and gynecological history (in vitro fertilization and embryo transfer)

neonatal

Perinatal damage to the central nervous system;

Infectious diseases of the newborn.

3. Selective neonatal screening made it possible to identify a group of children with persistent eye changes who need early correction and prevention of severe complications.

Implementation into practice

The results of research and assessment of ophthalmopathology in children, the methodology of ophthalmological examination using modern diagnostic equipment are introduced into the practical work of neonatal departments of the Federal State Institution Scientific Center for Obstetrics, Gynecology and Perinatology of Rosmedtekhnologii (FGU NTsAGiP Rosmedtekhnologii).

Approbation of dissertation material

The main provisions of the dissertation were reported and discussed at an interclinical conference of employees of neonatal departments of the Federal State Institution Scientific Center for Aging and Preventive Medicine of Rosmedtekhnologii on March 29, 2007. and at a meeting of the approbation commission of the Federal State Institution NTs AGiP Rosmedtekhnologii on April 29, 2007

Reported at the international scientific and practical conference “Neurology from birth to old age” in Tbilisi on October 4-6, 2003, at the X International Congress on Rehabilitation in Medicine and Immuno-Rehabilitation in Athens on October 19-25, 2005, at the VII Russian Forum “Mother and child" October 11-14, 2005, at the 1st regional scientific forum "Mother and Child" March 20-22, 2007 in Kazan.

Publications

Structure and volume of the dissertation The work is presented on 182 pages of typewritten text and consists of an introduction, eight chapters, conclusions, practical recommendations and a list of references. The work is illustrated with 54 tables and 15 figures. The bibliographic index includes 169 literary sources, of which 94 are works by domestic authors and 75 by foreign ones.

In the process of neonatal screening from 2003 to 2006, 1400 eyes were examined in 700 newborn children who were in the departments of the Research Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences (director - academician of the Russian Academy of Medical Sciences, professor [Kulakov V.I.; head of the department of newborns - Doctor of Medical Sciences, Professor L.P. Ponomareva, Head of the Department of Newborn Pathology - Doctor of Medical Sciences, Professor N.I. Kudashev). Children of the follow-up group (44 perinatally affected children aged 4.5-5.5 years) were examined at the children's eye consultation clinic (Head of the clinic - L. N. Averkieva) at the Morozov City Children's Clinical Hospital (Chief physician - academician of the Russian Academy of Natural Sciences, professor MA. Kornyushin) in the period from 2003 to 2005. An analysis of the anamnestic data of pregnancy and childbirth of their mothers and the course of the period of early neonatal adaptation of newborns, an assessment of the ophthalmological status in the postnatal period was carried out

Of the 700 newborns we examined, we identified several groups with the most common pathology of the perinatal period and ophthalmological changes

The group of children with hemorrhagic syndrome included: 171 children with retinal hemorrhages, 14 children with intracranial hemorrhages, 22 children with cephalohematomas, 96 children with cutaneous hemorrhagic syndrome

The group of children with perinatal damage to the central nervous system included 175 newborns with structural changes in the brain, cerebral ischemia, and transient syndromic pathology of the central nervous system.

The group of children born through in vitro fertilization and embryo transfer included 48 newborns

The group with intrauterine infection included 60 newborns.

The follow-up group included children aged 4.5-5.5 years of life, observed in the neonatal period™ in the 8th maternity hospital in Moscow and examined by an ophthalmologist at the second stage of nursing at the age of 2 days to 2 months of life.

To accomplish our tasks, clinical and special research methods were used in our work:

General clinical research methods included the study of maternal medical history, the course of pregnancy and childbirth, assessment of the condition of newborns, their somatic and neurological status. Hemodynamic monitoring and thermometry were also carried out.

Anthropometric data were assessed in accordance with percentile tables (Interregional standards for assessing body length and weight, head and chest circumference for children from 0 to 14 years old / Guidelines of the USSR Ministry of Health, 1990).

Consultations with specialists (surgeon, geneticist, neurologist, cardiologist, etc.) were carried out according to indications

Special research methods:

Ophthalmological examination

We carried out an ophthalmological examination in the departments of newborns, mainly from the 1st to the 5th day of the child’s life, and included: visometry, assessment of the adnexa of the eye, examination in transmitted light, biomicroscopy, ophthalmoscopy in conditions of mydriasis. In the department of pathology of newborns, children were examined later , at the age of 12-30 days of life.

When examining children as part of a follow-up examination at the age of 4.5-5.5 years, an ophthalmological examination included: visometry, determination of the nature of vision using the four-point Belostotsky color test, determination of the magnitude of the strabismus angle, determination of clinical refraction using skiascopy and automatic refractometry (canon autorefractometer) , Japan), keratometry, biomicroscopy, ophthalmic and

ophthalmochromoscopy. Visometry was carried out using Orlova and Sivtsev-Golovin tables.

Instrumental research methods

Neuroimaging methods of examination included ultrasound (USG) and MRI.

Ultrasound was performed by employees of the functional diagnostics department of the Federal State Institution NTsAGiP Rosmedtekhnologii using a Hewlett Packard ultrasound system equipped with a 5 MHz sensor.

MRI was performed on a Magneton Harmony tomograph from Siemens (Germany) with a superconducting magnet field direction of 1.0 T.

Statistical research methods

Statistical analysis of the data was carried out by employees of the Department of Medical and Biological Cybernetics of the State Educational Institution of Higher Professional Education RSMU Roszdrav using the original program for a personal computer developed by them (candidate of medical sciences Kilikovsky V.V. and candidate of medical sciences Olimpeva S.P.), which allows for comparison of organized user of data groups using statistical nonparametric tests that do not depend on the nature of the distribution - Fisher's exact method and the chi-square test (the Student's t-test for normally distributed variables, traditionally used in biomedical research, was also calculated in parallel).

RESEARCH RESULTS AND THEIR DISCUSSION

Ophthalmological changes in the neonatal period were found in more than half of full-term children. When calculating the frequency of ophthalmopathology in children, we took into account only obviously pathological changes in the eyes and minor developmental anomalies, which were found in a total of 437 (62.4%) of 700 newborns (Table 1.).

From the data presented in the table it follows that there were pathological changes in the appendage apparatus of the eye, its anterior segment, but the predominant pathology was changes in the fundus of the eye.

Table 1

Spectrum of ophthalmological changes in newborns aged 1-32 _days of life_

Ophthalmopathology Number of children (n = 437)

absolute number %

Adnexa of the eye

■ congenital obstructions 10 1.5

nasolacrimal ducts

■ epicanthus 15 2.0

"nystagmus 11 1.5

* blepharophimosis 2 0.2

■ congenital conjunctivitis 26 4.0

■ hemorrhages (petechiae) in the skin of the eyelids 96 13.7

Anterior segment of the eye

* microcornea 2 0.1

■ megalocornea 3 0.1

■ corneal edema 6 1.0

■ iris coloboma 1 0.1

■ remnants of the pupillary membrane 48 7.0

■ opacification of the lens 1 0.1

■ vitreous opacification 6 1.0

■ hemorrhages under the conjunctiva 103 15.0

■ conjunctival lipodermoid 1 0.1

Ocular fundus

* inflammatory foci of the retina 6 1.0

■ dystrophic lesions of the retina 5 1.0

* retinal angiopathy 211 30.0

■ retinal hemorrhages 171 24.0

■ avascular zones of the retina 2 0.2

» retinal coloboma 1 0.1

« retinal edema 178 26.0

« swelling of the optic disc 23 3.0

■ gliosis of the optic disc 10 1.4

■ optic disc hypoplasia 11 1.4

■ coloboma of the optic disc 1 0.1

TOTAL 437 62.4

¡3 healthy eyes £3 ophthalmopathology

Fig.1. The frequency of ophthalmopathology in newborns, revealed during an ophthalmological examination from 1 to 30 days of life.

37.6% O eyes are healthy

Sh transient

changes ■ persistent

changes

Fig.2. Proportion of transient and persistent ophthalmological changes in newborns

However, it should be noted that in the majority of newborns, ophthalmological changes were transient in nature - 387 (55.3%), and only 49 (7.1%) newborns had persistent structural changes in the anterior segment and adnexa 16 (2.3%) , retina and

Combined changes in the fundus were observed in the majority of newborns. In 80 (20.9%) of them, the only symptom was angiopathy in the form of an increase in the caliber of the veins, venous stasis, and increased tortuosity of the venous vessels. As can be seen from Table 2 below, retinal edema in combination with venous stasis was observed in 67 (17.3%) newborns, retinal edema and optic disc - in 7 (1.8%). Hemorrhages against the background of peripapillary retinal edema and venous stasis - in 126 (32.5%), against the background of dilated veins, retinal edema and optic disc in 3 (0.8%). The largest number of children with combined pathology were included in groups B and O. Therefore, it was in these groups that it was interesting to analyze and correlate the neonatal status of the child with changes in the fundus. In newborns belonging to group B, significantly more often (P<0,05) период новорожденности сопровождался наличием кожного геморрагического синдрома 27 (40 %), кефалогематом 8 (12%) и синдромом повышенной церебральной возбудимости ЦНС 29 (43%).

ONH 34 (4.8%).

table 2

Number of children with various types of pathology in the fundus

Changes in the fundus (n=387)

Vein dilation Vein dilatation + retinal edema retinal edema + optic disc edema retinal edema + retinal hemorrhages Vein dilatation + retinal edema + optic disc edema + retinal hemorrhages

abs h % abs h % abc % abc % abc %

81 20,9 67 17,3 7 1,8 126 32,5 3 0,8

Among newborns of group B, almost every fifth child was born with asphyxia 26 (20.6%), every fourth in the early neonatal period had cutaneous hemorrhagic syndrome - 30 (23.8%) with hemorrhages under the skin of the eyelids - 41 (32.5 %) and conjunctiva - 45 (35.7%)

Ophthalmological changes in children of group C were combined in one case with hydrocephalus (14.3%), in two cases with brain cysts (29%), in two cases with the syndrome of increased neuro-reflex excitability of the central nervous system (28.5%), in one case with cerebral ischemia (14.3%), with cutaneous hemorrhagic syndrome (14.3%). Children in this group were also characterized by a long anhydrous interval of 500 +.107.8 minutes

Thus, the most common pathology in children with combined ophthalmological changes was perinatal damage to the central nervous system, hemorrhagic syndrome, asphyxia at birth, often caused by anomalies of labor.

Factors contributing to the occurrence of retinal hemorrhages are shown in Fig. 3 and Table 3. The following factors, in descending order of importance, had the greatest significance in the genesis of retinal hemorrhages in newborns. fetal weight during spontaneous birth is more than 3338g, exacerbation of chronic and presence

acute viral infection in the mother in the 2nd-3rd trimester, anomaly of labor (increase in the duration of the first and second stages of labor, anhydrous interval), fetal asphyxia during childbirth, entanglement of the umbilical cord around the fetal neck.

□ gr. comparisons

Ш gr. with retinal hemorrhages

\ \ \ ъ о, "//

Fig.3. Risk factors for retinal hemorrhages in full-term newborns.

Almost half of the children (45%) with retinal hemorrhages have

fundus there was concomitant pathology in the form of skin

hemorrhagic syndrome (CHS) and cephalohematomas (Fig. 4).

Rice. 4. Frequency of retinal hemorrhages in children with cutaneous hemorrhagic syndrome and cephalohematomas.

Table 3

Clinical and anamnestic indicators that significantly differ in frequency of occurrence in groups of children with and without retinal hemorrhages

Factors Groups of children Significance of differences

COURSE OF PREGNANCY

Exacerbation of infection in the 3rd trimester 30% 25% ** *

Exacerbation of infection in the first trimester 15% 10% ♦

ARVI in the P-III trimester 13% 7% ** *

COURSE OF LABOR

Long second stage of labor (more than 20 minutes) 20.18+5.9 34% 17.9+6.1 28% * -

Long first stage of labor (more than 7 hours/420 min) 418.60+139 34% 390+130 27% ** -

Asphyxia at birth 22% 155 ** *

Umbilical cord entwined around the fetal neck 28% 19% ** *

Anhydrous period more than 6 hours 10% 3.5% * -

Table Clinical and anamnestic indicators that reliably distinguish the group of children with and without retinal hemorrhages in terms of frequency of occurrence.

Risk factors GROUPS OF CHILDREN Significance of differences

With retinal hemorrhages Without retinal hemorrhages TMF CI-q

INDICATORS AT BIRTH

Body weight 3338.11+465.7 3225.5+728 ** *

Body length 51+2.09 50.5+3.09 * -

RELATED PATHOLOGICAL CONDITIONS

Cephalohematoma 45% 2.4% *** *

KGS 43% 10.4% »** *

Note: Significance levels of differences according to Fisher (TMF) **p<0,01, *р<0,05

Significance levels of differences according to chi-square **p<0,01, *р<0,05

An analysis of the age composition, health status, anamnestic data, and characteristics of the current pregnancy and childbirth in 175 mothers and their newborn children with various neurological pathologies of the perinatal period showed a high level of virus carriage in mothers of the study group (CMV-34%, HSV-61%), exacerbation of chronic and the presence of acute infection in the gestational period (41%), anomaly of labor (quick and rapid labor), acute fetal hypoxia during childbirth. A high frequency of eye changes was noted in children with perinatal central nervous system lesions (50%), the nature of which varies depending on the type and severity of neurological pathology. The incidence of hemorrhagic syndrome (20%), exceeding that in the comparison group (12%), confirms the role of the traumatic-mechanical factor in the process of childbirth, influencing the formation of neurological pathology. The results of the analysis showed that changes in the fundus in the form of dilation of the retinal veins, edema retina and optic disc, retinal hemorrhages were found in the majority of children with neurological problems. The frequency and severity of changes in the fundus increased parallel to the progression of neurological symptoms. As can be seen from Table 5, a normal picture of the fundus was visualized in approximately a third of children with CNS hyperexcitability syndrome 42 (33%) and the presence of intracranial hemorrhages 4 (28%), in almost half of children with muscular dystonia syndrome 13 (44%) and structural changes brain 14 (40%). Among children with cerebral ischemia, 11 (50%) newborns had a normal fundus picture. Among the changes in the fundus, manifestations of edema and venous stagnation predominated, which occurred with a frequency of 35% to 75%.

Table 5

Various types of changes in the fundus of newborns with perinatal damage to the central nervous system

Pathology of the central nervous system Number of children Without pathology Pathology of the eye two

Diffusion of retinal veins Peripapillary retinal edema Swelling of the optic disc Retinal hemorrhages

Abs Abs Abs % Abs % Abs % Abs %

CNS hyperexcitability syndrome 124 42 29 23 31 25 10 8 33 26

Muscular dystonia syndrome 30 13 3 10 20 66 1 3 9 30

Convulsive syndrome 4 1 2 50 3 75 1 25 1 25

Structural changes in the brain 35 14 11 27 17 48 3 8 15 36

Intracranial hemorrhages (SAH, SEC, IVH) 14 4 3 21 5 35 1 7 3 21

Cerebral ischemia 22 I 2 9 10 45 1 4.5 4 18

Retinal hemorrhages accompanied intracranial hemorrhages in almost every fifth child (21%), in every fourth (25-26%) they were accompanied by CNS hyperexcitability syndrome and convulsive syndrome, and were observed in every third newborn with muscular dystonia syndrome and structural changes in the brain. Swelling of the optic disc was less common: only 7-8% of cases in newborns with intracranial hemorrhages, structural changes in the brain, and central nervous system hyperexcitability syndrome. But it is these children who are at risk for the development of CAP due to possible damage to the postgenic visual pathways. Since almost all of the above conditions have a direct impact on the state of hemocerebrospinal fluid dynamics of the brain, we were interested in monitoring the presence or absence of spontaneous retinal vein pulsation (SRVS) in these groups. In total, in our observation, 325 newborns were examined for the presence of a venous pulse, of which 137 were children with perinatal lesions

CNS. The general spectrum of pathology of children examined for the presence of spontaneous retinal venous pulse (SPV C) is presented in Table 6

Table 6

Frequency of detection of spontaneous retinal vein pulsation in children with various types of neurological pathology

Types of neurological pathology Number of measurements of SPVS(abs) Presence of venous pulse

yes no asymmetrical

Abs% Abs% Abs%

Hyperexcitability syndrome 69 44 63.7 25 263 16 23.1

Convulsive syndrome 4 3 75.0 1 25.0 - -

Structural changes 27 12 44.4 15 55.6 b 22.2

Intracranial hemorrhages (SAH, SEC, IVH) 8 4 50.0 4 50.0 2 25.0

Cerebral ischemia 22 13 59.1 9 40.9 4 18.1

Muscular dystonia syndrome 19 9 47.4 10 52.6 5 26.3

The disappearance of spontaneous venous pulsation was observed in every second child with neurological problems, even with transient neurological disorders, such as cerebral hyperexcitability/depression syndrome of the newborn, muscular dystonia syndrome

Children of the IVF group (48 newborns) had significant differences with the comparison group in terms of the age composition of their mothers, the presence of obstetric and gynecological pathologies, and, accordingly, a more severe course of pregnancy. However, thanks to closer monitoring and clear and timely correction of pathological conditions, as well as a gentle method delivery (caesarean section was performed in 85% of women in the IVF and PE group), the majority of their children were born and were in satisfactory condition during the period of early neonatal adaptation. Ophthalmological changes in children of the IVF group were noted in 22 (45%) cases. Frequency of ophthalmological changes in the form of venous stasis ,

peripapillary edema of the retina and optic nerve in children of this group did not have significant differences with the comparison group.

Fig.5. Congenital coloboma of the iris in a child born through IVF and ET

However, the identified gross congenital defect of the ocular analyzer in the form of bilateral colobomas of the iris, retina and optic disc in one child from the group (2%), causing profound visual impairment from childhood, obliges an ophthalmological examination of all children born through IVF and ET (Fig. 5. ).

An analysis of the health status of newborns from the IUI group (60 children) revealed a number of clinical features indicating a tense state of adaptation mechanisms. They were more likely than the comparison group to have prematurity (25%), lower body weight and IUGR (12%), and a higher percentage of asphyxia at birth (29%). These children were characterized by a high incidence of perinatal central nervous system damage, in particular structural changes in the brain, and persistent cerebral ischemia.

The main difference between the mothers of the IUI group and the mothers of the comparison group was the lack of adequate anti-inflammatory therapy throughout the entire gestational period.

Inflammatory eye changes were more common in the IUI group: congenital chorioretinitis was diagnosed in 5% of newborns versus 0.4% in the comparison group. Changes in the anterior segment of the eye in the form of conjunctivitis (16%), dilatation of the vessels of the iris 20% also

often accompanied by infectious and inflammatory pathology of newborns. The presence of congestion in the form of venous stasis 30%, peripapillary retinal edema 25% in children of the IUI group was diagnosed without significant differences with similar changes in the comparison group. The presence of congenital ocular pathology of an inflammatory nature (congenital chorioretinitis) with an unfavorable prognosis for visual function in 5% of children in this group indicates the desirable inclusion of children in the IUI group in the group of selective screening for ophthalmopathology. We should also not forget about the unfavorable prognosis for visual functions in children of the IUI group with severe structural lesions of the central nervous system, which often cause damage to the postgenic visual pathways.

During a follow-up examination conducted at the age of 4.5 - 5.5 years, ocular pathology was detected in 20 (45%) of 44 perinatally affected children.

12 (27%) children had anomalies of clinical refraction of the eye, among which, as can be seen from Table 7, myopia and hypermetropic astigmatism predominated.

Table 7

Clinical refraction of perinatally affected children aged 4.5-5.5

Clinical refraction Number of children (n=44)

Hypermetropia (weak) 24 54.5

Emmetropia 7 16.0

Myopia 2 4.5

Myopic astigmatism 2 4.5

Hypermetropic astigmatism 6 13.6

Myopic-hypermetropic astigmatism (mixed) 2 4.5

No reflex 1 2D

7 (16%) healthy children with a margin of hypermetropic refraction and emmetropia were classified as at risk for the development of myopia. U 3

(6.8%) children had convergent strabismus associated with damage to the postgeniculate visual pathways - in 2 (4.5%) children, regressed grade II retinopathy and amblyopia in 1 (2.2%) child. Amblyopia was registered in 2 (4.4%) children, one of whom in the perinatal period had structural changes in the brain in the form of expansion of the ventricles of the brain.

Partial atrophy of the optic nerve was detected in 1 (2.2%) child with perinatal damage to the central nervous system in the form of cerebral ischemia, hypertensive-hydrocephalic syndrome and subependymal hemorrhage that occurred after birth

After analyzing anamnestic data and comparing them with the state of the organ of vision at 5 years of age in children of the follow-up group, we identified the main perinatal risk factors in the occurrence of ocular pathology - complicated pregnancy (threat of premature birth (94%), gestosis in the second half of pregnancy (45%) , chronic intrauterine fetal hypoxia (68%), complicated labor (discoordination of labor, acute fetal hypoxia during labor (34%), entanglement of the umbilical cord around the fetal neck (19%)).

It should be noted that if in the period of a newborn “! in perinatally affected children, changes were observed mainly in the retina (edema (55.3%), the presence of avascular zones (18.1%), changes in the caliber of blood vessels (38.2%) and, as a consequence, edema (12.7% ) and blurred optic disc boundaries (38%)), then at 5 years of age the proportion of refractive errors increased (27%)

The high percentage of ocular morbidity (45%) among perinatally affected children with predominantly refractive disorders reflects the negative impact on the organ of vision of cerebral ischemia (66%), structural changes in the brain (40%), prematurity and morpho-functional immaturity. Almost every fourth (27%) child among perinatally affected children had refractogenesis disorders by the age of five

1 Ophthalmological screening showed that changes in the visual analyzer are recorded in 62.4% of newborns. Most of them showed transient changes (55.3%) mainly in the form of hemorrhages under the conjunctiva of the eyeball (15%), retinal angiopathy (30%), peripapillary retinal edema (26%) and papilledema (3%), retinal hemorrhages (24.4%) Persistent structural changes are found in 7.1% of children. Of these, in 4.8% there are changes in the retina and optic nerve, in 2.5% there are changes in the anterior segment and adnexa of the eyes.

Complicated course of pregnancy (threat of miscarriage - 27-30%, acute infection and exacerbation of chronic infection in the P-III trimesters - 13-30%, lack of adequate anti-inflammatory therapy in the mother during the gestational period);

Pathological deviations during labor (long 1-P period - 28%, asphyxia at birth - 22%, umbilical cord entanglement around the child's neck -28%)

3. The risk group for the development of ophthalmopathology includes

newborns:

With intrauterine infection;

With hemorrhagic syndrome;

4. It was revealed that changes in the eyes are especially often (50-75%) observed in children with neurological disorders: hypoxic-

ischemic brain damage, syndrome of cerebral excitability or central nervous system depression, structural changes in the brain, intracranial hemorrhage

7 The frequency of ophthalmological changes in the IVF and PE group did not differ significantly from the group of children from spontaneous pregnancy. However, congenital malformations of the eyes detected in 2% of cases dictate the need for mandatory ophthalmological examination of all children in this group.

8. The main methods for detecting ophthalmic pathology in newborns are external eye examination and ophthalmoscopy, which are advisable to carry out from the 1st to the 5th day of the child’s life, after 30-40 minutes. after feeding while awake Repeated examination is carried out depending on the detected pathology

9 A follow-up examination of the state of the visual organ in perinatally affected children aged 4.5-5.5 years showed a high frequency of ophthalmological changes (45%), among which refractogenesis disorders predominated (27%) in the form of an increase in the proportion of myopia and myopic astigmatism (23 %).

Neonatologists

Taking into account the frequency and nature of detected eye pathology in newborns, recommend an examination by an ophthalmologist for groups of high-risk newborns.

Children with congenital developmental defects

A contraindication to an ophthalmological examination of newborns is the extremely severe general condition of the newborn.

Timely inform parents of newborns about detected ocular changes and the importance of dynamic ophthalmological monitoring,

If necessary, refer the child to specialized children's institutions (eye departments of a clinic, hospital)

For ophthalmologists

To include a contingent of children who in the neonatal period suffered hemorrhagic syndrome with retinal hemorrhages, cerebral ischemia and intracranial hemorrhages with damage to postgenicular

visual pathways in dispensary control groups due to the possibility of visual impairment in preschool and school age.

1 Molchanova E.V., Ponomareva L.P. Modern diagnostic technologies in determining damage to the organ of vision in newborns // Mat. V Russian Scientific Forum “Maternal and Child Health 2003”, - M., 2003 - P. 176-177.

2 Ponomareva L.P., Paramey O.V., Molchanova E.V. Features of ophthalmological examination of children in the early neonatal period //Material of the V Russian Forum “Mother and Child”. - M., 2003. - P.543.

3. Paramey O V., Ponomareva L.P., Molchanova E.V. Ophthalmological findings in newborns with hypoxic-ischemic damage to the central nervous system in the first week of life//Mat. VIII Moscow Scientific and Practical Neuro-ophthalmological Conference “Current Issues of Neuro-Ophthalmology”, - M., 2004. - From 136.

4. Ponomareva L.P., Molchanova E.V., Shirina N.S. Perinatal risk factors in the genesis of dysfunction of the auditory and visual analyzer // Proceedings of the 36th annual congress of the society of obstetricians and gynecologists on the study of the pathophysiology of pregnancy and the organization of gestosis. -M., 2004. - P 179-180

5 Ponomareva L.P., Molchanova E.V., Paramey O.V. Frequency and nature of ophthalmological changes in newborns with cutaneous hemorrhagic syndrome // Mat. VI Russian Forum “Mother and Child”. - M, 2004. - P.580.

6 Molchanova E.V., Ponomareva L.P., Anisimova E.S. The role of perinatal risk factors in the development of ophthalmopathology in newborns //Mat. V Congress of the Russian Association of Perinatal Medicine Specialists* Modern approaches to the identification, treatment and prevention of perinatal pathology - M., November 14-15, 2005. - P.132-133.

7. Molchanova E.V. Ophthalmological screening of newborns II Mat. X Congress of Pediatricians of Russia. - M, February 8-10, 2005. - P.354-355.

8. Ponomareva L.P., Shirina N.S., Molchanova E.V. Prevention of hearing and vision impairment in newborns //Mat. X International Congress on Rehabilitation in Medicine and Immunorehabilitation - Greece, Athens, 2005. Vol. 6 - No. 3 - P. 399.

9. Molchanova E.V., Ponomareva L.P. Perinatal risk factors for ophthalmological disorders in full-term newborns // Mat. VII Russian Forum “Mother and Child”. - M, 2005. - P.580.

Yu.Molchanova E.V., Ponomareva L.P. Risk factors for ophthalmological disorders in newborns with intrauterine infection // Mat. I International Seminar “Infection in Obstetrics and Perinatal Diseases”. - M, April 36, 2007. - pp. 106-107

11 Molchanova E3. Features of the state of the organ of vision in children born through in vitro fertilization and embryo transfer // Ross. Pediatric ophthalmology. - 2007. - No. 4. - pp. 31-33.

Signed for publication on January 23, 2008.

Screen printing

Order No. 346

Circulation: 150 copies.

Printing house LLC "Petrorush" INN 7704668277 Moscow, st. Palikha-2a Tel. 250-92-06 www.postator.ru

INTRODUCTION

CHAPTER I (Literature Review). OPHTHALMOPATOLOGY B

PERINATAL PERIOD.

1.1. Changes in the organ of vision in hypoxic ischemic conditions.

1.2. Changes in the organ of vision due to birth trauma.

1.3. Changes in the organ of vision during perinatal lesions

1.4. Changes in the organ of vision in children with intrauterine infection.

1.5. Changes in the organ of vision in premature infants.

1.6. Congenital eye diseases.

1.7. Condition of the organ of vision in children born through in vitro fertilization and embryo transfer.

CHAPTER II. MATERIALS AND METHODS OF RESEARCH.

2.1. General clinical characteristics of the examined children.

2.2. Research methods.

CHAPTER III. RESULTS OF OPHTHALMOLOGICAL SCREENING.

CHAPTER IV. OPHTHALMOLOGICAL CHANGES IN NEWBORNS WITH HEMORRHAGIC SYNDROME.

4.1. Clinical characteristics of mothers of examined newborns with hemorrhagic syndrome.

4.2. Clinical characteristics of newborns with hemorrhagic syndrome.

CHAPTER V. OPHTHALMOLOGICAL CHANGES IN NEWBORNS WITH PERINATAL CNS LESION.

5.1. Clinical characteristics of mothers of examined newborns with perinatal lesions of the central nervous system.

5.2. Features of the period of early neonatal adaptation in newborns with perinatal damage to the central nervous system.

5.3. Changes in the organ of vision in newborns with perinatal damage to the central nervous system.

CHAPTER VI. FEATURES OF THE CONDITION OF THE VISUAL ORGAN IN CHILDREN BORN BY INTRACORPORAL FERTILIZATION AND EMBRYO TRANSFER.

6.1. Clinical characteristics of mothers of examined children born through in vitro fertilization and embryo transfer.

6.2. Features of the period of early neonatal adaptation of children born through in vitro fertilization and embryo transfer.

6.3. Ophthalmological changes in children born through in vitro fertilization and embryo transfer.

CHAPTER VII. OPHTHALMOLOGICAL CHANGES IN NEWBORNS WITH INTRAuterine INFECTION.

7.1. Clinical characteristics of mothers of examined children with IUI.

7.2. Features of the period of early neonatal adaptation of newborns with IUI.

7.3. Ophthalmological changes in children with IUI.

CHAPTER VIII. RESULTS OF FOLLOW-UP

EXAMINATIONS OF PERINATALLY AFFECTED CHILDREN.

8.1. Clinical characteristics of perinatally affected newborns.

8.2. Ophthalmological changes in perinatally affected children.

Introduction of the dissertationon the topic "Pediatrics", Molchanova, Elena Vyacheslavovna, abstract

Relevance of the problem. In conditions of low birth rate in Russia, a successful outcome of each pregnancy is the most important task of both obstetricians-gynecologists and neonatologists, i.e. Obstetrics is increasingly acquiring a perinatal character. Negative trends in the health of pregnant women and newborns have become sustainable. In pregnant women, the number of anemia (42.9%), gestosis (21.4%), and pathologies of the cardiovascular system and kidneys increases (1.5 times). Normal births account for 25-31.1%.

Taking into account the difficult demographic situation, one of the most important tasks of perinatal medicine is to preserve the life and health of the newly born. In connection with the improvement of reproductive technologies and nursing systems in recent years, it has been possible to significantly reduce perinatal losses, which in turn has led to an increase in perinatally affected children (twice over the last ten years) and children with VIR, often associated with severe somatic and neurological pathology. The proportion of premature newborns remains at the same high level. High-risk pregnancy and childbirth account for 10% of the population frequency.

The high frequency of perinatal complications in newborns determined the need to study the characteristics of ophthalmopathology in perinatally affected children and develop methods for its timely diagnosis.

The organization of ophthalmopediatric care for this population of children is one of the reserves for reducing the level of blindness and low vision from childhood. Ophthalmological care for children began to acquire a more or less unified scientific, practical and organizationally sound character in our country from 1960-1963.

This happened in connection with the creation of the Center for Pediatric Ophthalmology, headed by professors E.S. Avetisov and A.V. Khvatova, the organization of the Department of Pediatric Ophthalmology at the II MOLGMI under the leadership of Professor E.I. Kovalevsky, publication of the first textbooks, monographs and methodological recommendations.

Since 1968, the full-time position of “pediatric ophthalmologist” has been included in the list of specialties of the outpatient and inpatient network. At the same time, specialized kindergartens, sanatoriums, advisory eye clinics and eye departments in specialized and general somatic hospitals began to be created. Thanks to the interaction of these structures, the level of eye pathology among children was determined for the first time. To solve the issues of combating low vision and blindness, which were the consequences of congenital eye pathology (7-10% of children under 3 years of age), the active assistance of obstetricians, pediatricians and ophthalmologists was required.

Attempts at eye screening in perinatally affected children in the neonatal period were repeatedly made by Perititskaya V.N., Tron E.Zh., Nizheradze R.I., Mityukov V.A., Birich T.V., Katsnelson A.B., Dubilei O .V., Kaisarova A.JL, Silyaeva N.F., Paramey O.V., Sidorenko E.I. and etc. .

Thanks to these fundamental works, significant knowledge on pediatric ophthalmopathology has been accumulated in recent years. Domestic and foreign ophthalmologists have come to a unanimous opinion about the important role of the pathology of pregnancy, childbirth and the postpartum period in the occurrence of congenital eye pathology. However, most of the research is devoted to a narrowly focused study of one or another pathology of the perinatal period, while in perinatally affected children there is a combination of several of its types. Often the work is carried out from an ophthalmological point of view without taking into account the neonatal status of the child. In educational manuals and directive documents there are no clear instructions on the timing and frequency of diagnostic eye examinations in children, on the criteria for prognosis and risk for the development of eye pathology.

Neonatologist clinicians do not know how to examine the organ of vision in newborns, which has certain specifics. Not all large urban perinatal centers and maternity hospitals, not to mention regional ones, have a full-time ophthalmologist. These are the tasks that in the near future will have to be solved by a new direction in perinatology - perinatal ophthalmology.

It is important to study eye pathology in children with hypoxic-ischemic brain lesions, infected with potentially ophthalmotropic infections, born prematurely, conceived using IVF and with other nosological risk factors.

Taking into account the fact that the development of the visual analyzer occurs most intensively in the first six months of a child’s postnatal life, early identification of children at risk for ophthalmopathology and timely provision of assistance to them will prevent the development of blindness, low vision and will reduce the number of disabled people from childhood. In connection with the above, the introduction of perinatal screening for ophthalmopathology in maternity institutions is of great importance.

Screening can be defined as the careful identification of subclinical signs of disease. When conducting screening, you must adhere to the following rules:

1. The disease being screened for must represent an important health problem.

2. Features of the clinical course of the disease must be known.

3. There must be an effective method of treating this pathology.

4. Tests used in screening must be technically simple, accessible for mass use, do not contain invasive manipulations and do not require expensive equipment.

5. When screening, effective tests are used that have an appropriate level of specificity and sensitivity.

6. A complete diagnostic service and adequate therapeutic treatment must be available for the disease for which screening is being carried out.

7. Early intervention in the pathological process should have a beneficial effect on its outcome.

8. Screening programs do not have to be expensive.

9. Screening programs should be ongoing.

Screening performed at birth: effective in identifying gross pathology. Ophthalmoscopy helps to identify opacities of the optical media, changes in the anatomical structures of the eye and its adnexa. Changes in refraction during this period are unreliable.

Most studies are aimed at the pathology of premature newborns, as the most vulnerable group of children. To detect retinopathy of prematurity, screening is carried out on all premature newborns weighing less than 1500 g and gestational age less than 32 weeks.

Screening is also appropriate in groups of children at high risk of developing the disease. For example, with a hereditary predisposition to cataracts, glaucoma, retinoblastoma, etc.

The issue of screening to identify infectious processes in the neonatal period remains controversial.

To resolve the issue of forming groups for ophthalmological screening, it is necessary to study and clarify statistical data on ocular pathology among a contingent of full-term newborns with various pathologies of the perinatal period.

PURPOSE OF THE STUDY

To develop a screening program for the early diagnosis of ophthalmic pathology and the creation of conditions for the active prevention of functional visual impairment in full-term newborns.

RESEARCH OBJECTIVES

1. To identify the frequency and nature of ophthalmopathology in full-term newborns.

2. Assess the significance of perinatal risk factors in the occurrence of visual lesions in newborns and form groups at risk for the development of ophthalmopathology in children.

3. Determine markers of early visual impairment and their prognostic significance.

4. Develop an optimal regimen for eye examination in newborns.

SCIENTIFIC NOVELTY

For the first time, the feasibility of conducting selective ophthalmological screening in a perinatal center for full-term newborns in the early postnatal period has been substantiated.

Based on the use of modern diagnostic instruments (Skepens binocular ophthalmoscope and panoramic ophthalmoscope

Panoptics" company "WelchAllyn", USA) determined the frequency and nature of eye pathology in newborns.

It has been established that changes in the visual analyzer during the neonatal period are recorded in 62.4% of children. However, most of them are transient in nature; persistent disorders are found in 11% of children. Especially often, changes in the eyes are found in children born to women with a pathological pregnancy and who had central nervous system disorders in the perinatal period.

For the first time, the diagnostic significance of spontaneous retinal venous pulse in newborns has been demonstrated.

PRACTICAL SIGNIFICANCE As a result of the research, modern diagnostic instrumental methods have been justified and introduced into practice in neonatal departments, and guidelines have been developed for their use within the framework of mass ophthalmological screening.

Ophthalmological screening creates the basis for timely correction of eye pathology (amblyopia, refractogenesis disorders, partial atrophy of the optic nerve, etc.). The introduction of the developed ophthalmological screening program into the activities of regional perinatal centers will reduce disability from childhood.

PROVISIONS FOR PROTECTION:

1. Neonatal ophthalmological screening in a perinatal center allowed us to determine the level and nature of eye pathology among full-term newborns.

2. Risk factors involved in the formation of eye pathology have been established:

Maternal-fetal:

High-risk pregnancy and childbirth (complicated pregnancy (preeclampsia, feto-placental insufficiency, exacerbation of chronic and the presence of acute infection), incoordination of labor during spontaneous birth, large fetus, asphyxia at birth, umbilical cord entanglement)).

The use of reproductive technologies in women with a burdened obstetric and gynecological history (IVF and PE)

Neonatal:

Perinatal CNS damage

Infectious diseases of the newborn (IID)

3. Selective neonatal screening made it possible to identify a group of children with persistent eye changes who need early correction and prevention of severe complications

IMPLEMENTATION INTO PRACTICE

The results of research and assessment of ophthalmic pathology in children, the methodology of ophthalmological examination using modern diagnostic equipment are introduced into the practical work of neonatal departments of the Federal State Institution Scientific Center for Obstetrics, Gynecology and Perinatology of Rosmedtekhnlogii (FGU NTsAGiP Rosmedtekhnlogii).

Publications of research results: 11 printed works were published on the topic of the dissertation.

STRUCTURE AND SCOPE OF THE DISSERTATION

The work is presented on 186 pages of computer text and consists of an introduction, eight chapters, conclusions, practical recommendations and a list of references. The work is illustrated with 54 tables and 15 drawings. The bibliographic index includes 169 literary sources, of which 94 are works by domestic authors and 75 by foreign ones.

Conclusion of the dissertation researchon the topic "Selective screening to detect ophthalmopathology in full-term newborns"

1. The ophthalmological screening showed that changes in the visual analyzer are recorded in 62.4% of newborns. Most of them showed transient changes (55.3%) mainly in the form of hemorrhages under the conjunctiva of the eyeball (15%), retinal angiopathy (30%), peripapillary retinal edema (26%) and papilledema (3%), retinal hemorrhages (24.4%). Persistent structural changes are found in 7.1% of children. Of these, 4.8% are changes in the retina and optic nerve, 2.5% are changes in the anterior segment and adnexa of the eyes.

2. Risk factors for the occurrence of ophthalmological disorders in newborns should be considered:

Use of assisted reproductive technologies (IVF and ET);

Complicated course of pregnancy (threat of miscarriage - 27-30%, acute infection and exacerbation of chronic infection in the 1st-3rd trimesters - 13-30%, lack of adequate anti-inflammatory therapy in the mother during the gestational period);

Pathological deviations during labor (long G-II period -28%, asphyxia at birth - 22%, entanglement of the umbilical cord around the child's neck -28%).

3. The risk group for the development of ophthalmopathology includes newborns:

With a body weight during spontaneous birth of more than 3340 g;

With perinatal damage to the central nervous system;

With intrauterine infection;

With hemorrhagic syndrome;

Conceived using assisted reproductive technology.

4. It was revealed that changes in the eyes are especially common (50-75%) in children with neurological disorders: hypoxic-ischemic brain damage, cerebral excitability syndrome or central nervous system depression, structural changes in the brain, intracranial hemorrhages.

5. It was found that the frequency of changes in the organ of vision in children with IUI reached 43%, among which the frequency of inflammatory changes in the form of acute conjunctivitis was 16%, chorioretinitis - 5%, congenital uveitis - 1.6%.

6. Markers of retinal hemorrhages are various manifestations of hemorrhagic syndrome (cephalohematomas, cutaneous hemorrhagic syndrome), accompanying them in 45% of cases.

Spontaneous retinal venous pulse, the disappearance of which is noted in almost every second patient with central nervous system damage, is a marker of neurological pathology.

7. The frequency of ophthalmological changes in the IVF and PE group did not differ significantly from the group of children from spontaneous pregnancy. However, congenital malformations of the eyes detected in 2% of cases dictate the need for mandatory ophthalmological examination of all children in this group.

8. The main methods for detecting ophthalmic pathology in newborns are external eye examination and ophthalmoscopy, which are advisable to carry out from the 1st to the 5th day of the child’s life, after 30-40 minutes. after feeding while awake. A repeat examination is carried out depending on the identified pathology.

9. A follow-up examination of the state of the organ of vision in perinatally affected children aged 4.5-5.5 years showed a high frequency of ophthalmological changes (45%), among which refractogenesis disorders predominated (27%) in the form of an increase in the proportion of myopia and myopic astigmatism ( 23%).

Neonatologists

Taking into account the frequency and nature of detected eye pathology in newborns, it is recommended to examine an ophthalmologist for groups of high-risk newborns:

Children born using assisted reproductive technologies (IVF and ET) by mothers who had pathological abnormalities during pregnancy and childbirth;

Children born to mothers whose pregnancy occurred against the background of acute and exacerbation of chronic infections;

Children with congenital developmental defects;

Children who have suffered hypoxia and have neurological disorders (cerebral ischemia, intracranial hemorrhage, cerebral dysfunction, structural changes in the brain).

A contraindication to an ophthalmological examination of newborns is the extremely severe general condition of the newborn.

To comply with the stages of observation it is necessary:

Timely inform parents of newborns about detected ocular changes and the importance of dynamic ophthalmological monitoring;

Promptly notify your local pediatrician and ophthalmologist about any changes identified;

If necessary, refer the child to specialized children's institutions (eye departments of clinics, hospitals).

For ophthalmologists

To include a contingent of children who suffered hemorrhagic syndrome with retinal hemorrhages, cerebral ischemia and intracranial hemorrhages with damage to the postgenicular visual pathways in the neonatal period into dispensary control groups due to the possibility of visual impairment in preschool and school age.

List of used literaturein medicine, dissertation 2008, Molchanova, Elena Vyacheslavovna

1. Avetisov E.S., Kovalevsky E.I., Khvatova A.V. Guide to pediatric ophthalmology - M., 1998. - P. 218.

2. Avetisov E.S., Khvatova A.V. The main causes of blindness and low vision in children, ways to prevent them, the role of pediatricians in protecting children’s vision // Modern problems of pediatrics: prevention: Mat. 8th Congress of Pediatricians of Russia. M., 1998. - P.218.

3. Aznabaev M.T., Kazakbaev A.G., Saydasheva E.I. and others. Anatomical and biometric parameters of the eyes of newborns // Age-related changes in the organ of vision in normal conditions and in pathology: Collection of scientific works. Vol. 4. - M., 1992. - P.47-48.

4. Albansky V.G. State and dynamics of anatomical and optical parameters in full-term and premature children of the first year of life: Abstract of thesis. dissertation of doctor of medical sciences. -M., 1986. -34 p.

5. Aksenova I.I. Changes in the organ of vision in premature infants // Current issues in pediatric ophthalmology: Mat. scientific-practical conf. (November 25-27, 1997). M.: Moscow Research Institute of Eye Diseases named after. Helmholtz. - 1997. - P.102-103.

6. Alieva H.B. Features of the ophthalmoscopic picture in normal full-term newborns and with borderline changes in the central nervous system // Kazakh Republican Congress of Children's Doctors. - Alma-Ata: Ministry of Health of the Kazakh SSR, 1984. - P. 16-18.

7. Avkhadeeva S.R. Clinical and genetic features of congenital cataracts in the Republic of Bashkortostan: Abstract of thesis. dis. Ph.D. honey. Sciences.- Ufa. 2001. - P.22.

8. Astasheva I.B. Retinopathy of prematurity: abstract. dissertation candidate of medicine Sci. -RGMU. M., -2002. - 26s.

9. Akhtanina E.A., Burmistrova G.I., Medvedeva T.O. and others. Diagnosis and treatment of natal spinal injuries in newborns //Perinatal neurology: Mat. 2nd Congress of RASPM. M., 1997. -S. 61.

10. Z. Baranov A.A. The state of children's health in modern socio-economic and environmental conditions //Ecological problems of pediatrics: Sat. lectures for doctors. - M.: Intl. mother and child health fund. 1997. - P.5-15.

11. M. Baranov A.A. The state of health of children and adolescents in modern conditions. Problems, solutions //Russian Pediatric Jury. -1998. -No. 1. P.5-8.

12. Barashnev Yu.I. Perinatal neurology. M.: Triada-X, 2001. -640 p.

13. Bezmaternykh T.V. Cephalohematoma as a natal injury to the fetus // Perinatal neurology: Mat. 2nd Congress of RASPM.-M., 1997. -P.64-65.

14. Berezina T.G. About myopia in children with pathology of the nervous system //Perinatal neurology: Abstracts of the 3rd Republic. conference on child neurology. Kazan: Kazan Institute of Usov, doctors. - 1983. -P.138-139.

15. Birich T.V., Peretitskaya V.N. Changes in the fundus of the eye in newborns during normal and pathological childbirth. - Minsk, Belarus, 1975.- 175 p.

16. Boyko I.G., Silyaeva N.F. Pathomorphology of the visual organ in the perinatal period // Arch. pathol. - 1991. - T.53, No. 8. - P.30-35.

17. Golenkov A.K. Venous pulse of the retina // Kaluga. - 1992. 110 p.

18. Drozdova M.V. On the issue of hemorrhages in the retina of the eyes of newborn children: Dissertation of Candidate of Medical Sciences J1., 1947. - 168 p.

19. Dubiley O.V. Possibilities of early diagnosis of natal damage to the central nervous system and the role of the study of the 2nd pair of medical sciences. in their recognition: Author's abstract. dis. Candidate of Medical Sciences Kazan, 1993. - 23 p.

20. Dubiley O.V., Kaisarova A.I. The relationship of ophthalmological and neurological changes in newborns with natal trauma //Ophthalmological Journal. 1989. - No. 3. - pp. 169-171.

21. Zabolotskikh N.V. Ophthalmodynamometry of the central retinal vein: anatomical, physiological and methodological aspects.// Petrozavodsk: Inteltek, 2003. - 640 p.

22. Ignatieva R.K., Kagramanov V.I. Dynamics of processes of reproduction of the population of the Russian Federation in modern conditions. Medical and demographic analysis. Statistical Bulletin. M.: Intl. Maternal and Child Health Foundation. -1997.-84s.

23. Kasparov A.A. Ophthalmoherpes. M.: Medicine, 1994. - 223 p.

24. Katargina J1.A. Endogenous uveitis in young children. Clinical, functional and immunological features, prevention and treatment of complications: Abstract of thesis. dissertation of doctor of medical sciences. -M., 1992.-39p.

25. Katsnelson A.B. Developmental anomalies and eye diseases in early childhood. L.: Medgiz, Leningrad branch, 1957. -182 p.

26. Keshishyan E.S., Vetrova E.V., Kogoleva L.V., Belova O.N. Retinopathy of prematurity // Russian Med. magazine. 1998, - N4. - P.42-45.

27. Kisteneva L.B., Martynov K.A., Khizhnyakova T.M., Cheshik S.G. Cytomegalovirus infection in pregnant women. Diagnostics, interpretation of examination results // Issues. virology. 2001, -№b. -WITH. 4-8.

28. Kovalevsky E.I. Ocular manifestations of general pathology in children //Modern problems of pediatrics: Mat. 8th Congress of Pediatricians of Russia.-M., 1998. -P.21-22.

29. Kovalevsky E.I. Prevention of blindness and low vision in children. -M.: Medicine, 1991.-224 p.

30. Kovalevsky E.I. The important role of obstetricians and gynecologists in the prevention of eye pathology in newborns // Russian Western Obstetrics, Gynecology. 2001. - No. 4. - P.59-60.

31. Krichevskaya G.I., Angelov V.O., Katargina L.A., Khvatova A.V., Denisova E.V., Zvonarev A.Yu., Kulyakhina M.N., Zaitsev I.Z. Cytomegalovirus infection in children with endogenous uveitis // Bulletin of Ophthalmology. -1999. No. 5. - pp. 23-26.

32. Kudashov N.I., Pomelova V.G., Zubkov V.V. Clinical and immunological criteria for the diagnosis of herpesvirus infection in newborns // Russian West. Perinatol. and pediatrician. -1998. T.43. -No. 5. -P.12-18.

33. Kudashov N.I. Cytomegalovirus infection in newborns: diagnosis and treatment // Attending physician. -2006. No. 4.-P.73-78.

34. Kulakov V.I. Development of perinatal obstetrics (Problems and solutions) //Mother and Child: Mat. IV Russian Forum. M., 2002. - Part I. - P.6-8.

35. Letneva I. A. Lesions of the visual system in children with periventricular leukomalacia: Abstract of thesis. dis. Candidate of Medical Sciences -M., 2004.-p.25.

36. Lozovskaya L.S., Konopleva T.N., Ledina A.V. and others. The significance of chronic Coxsackie virus infection in the pathogenesis of recurrent miscarriage // Akush. and gin. -1996. -No. 4. -WITH. 18-21.

37. Lozovskaya L.S., Okhotnikova I.M., Paramey O.V., Sidorenko E.I. The significance of congenital mixed viral infection in the pathogenesis of retinopathy of prematurity // Bulletin of Ophthalmology. -2001. No. 4. -T.117. - P.15-19.

38. Lopatina E.V. Developmental anomalies and eye diseases in the neonatal period // New technologies for family health: Sat. scientific tr. -Ivanovo, 1997. P.237-239.

40. Markova I.V., Shabalov N.P. Clinical pharmacology of newborns. St. Petersburg: SOTIS, - 1993.

41. Marchenko L.A. Genital herpetic infection in women (clinic, diagnosis, treatment): abstract. dis. doc. honey. Sciences, M., 1997. -41 p.

42. Mityukov V.A. Ophthalmoscopic observations and indicators of cerebrospinal fluid pressure in newborns born with the umbilical cord entwined around the neck // Mater. 1st Congress of Obstetrics and Gynecology. Armenia. -Yerevan, 1971. P.477-480.

43. Mozherenkov V.P., Prokofieva G.L. Chlamydia of the eye //Med. help. -1999. -№1.- pp. 17-19.

44. Mosin I.M. Delayed visual maturation in young children: differential diagnosis and management tactics // Bulletin of Ophthalmology - 2001. No. 5. - P.6-11.

45. Nagibina N.S., Nesterenko O.S., Geppe N.A. and others. Intrauterine infections in the formation of malformations of the central nervous system // Modern problems of pediatrics: Mat. 8th Congress of Pediatricians of Russia, - M., 1998. -P.314.

46. ​​Naumov M.P. On some pathological and anatomical changes in the fundus of the eyes in newborns: Dissertation of Candidate of Medical Sciences. Sci. - St. Petersburg, 1890. -56s.

47. Nizheradze R.I., Gabunia N.P., Voskanova N.S. On the issue of the condition of the fundus and its clinical significance in newborns. //Tr. I Congress of Children's Doctors of Armenia. - Yerevan, 1965. P.59-62.

48. Paramey O.V. Eye diseases in children with pathology of the perinatal period: abstract. dis. doc. honey. Sci. -M., 1999 47 p.

49. Paramey O.V., Sidorenko E.I. The state of the visual organ of children born as a result of in vitro fertilization. //Vestn: ophthalmology. 1997. - No. 2. -T.113. - P.23-25.

50. Peretitskaya V.N., Kosach E.I. Retinal hemorrhages in newborns //Healthcare of Belarus. 1965. - P.1-46.61. Peretitskaya V.N., Kosach E.I. Fundus of the eye in asphyxia of newborns //Healthcare of Belarus. -1967. -No. 2. -S. 4849.

51. Petrukhin A.S. Perinatal neurology. Subject, objectives, development prospects //Perinatal neurology: Mat. 2nd Congress of RASPM. -M., 1997.-S.Z-4.

52. Ratner Yu.A. Late complications of birth damage to the nervous system. Kazan: Kazan Publishing House. Univ., 1990. - 31 Os.

53. Revta A.M., Chumakova G.N., Andronov A.G. Diagnosis and treatment of retinopathy of prematurity in the active stage // New technologies of eye microsurgery: Mat. XI scientific-practical conf. ophthalmologists - Orenburg, 2000. pp. 191-194.

54. Rumyantsev A.G., Delyagin V.M., Gerberg A.M. Pathology of blood vessels of the head and neck in children and adolescents // Mat. All-Russian Symposium September 19-20, 2003, M.: - MAKS Press, 2003. -S. 3-10.

55. Rychko S.E. Changes in the fundus of newborns with cephalohematomas //Materials of the conference of pediatric ophthalmologists of Ukraine. Kyiv, - 2003, - pp. 157-159.

56. Saydasheva E.I. Risk factors, prognosis, early diagnosis and prevention of retinopathy of prematurity: Abstract of thesis. dis.cand. honey. Sci. - Ufa. 1998. - 23 p.

57. Saydasheva E.I., Somov E.E., Fomina N.V. Selected lectures on neonatal ophthalmology. St. Petersburg: Nestor-History, - 2006, -272 p.

58. Sakharova E.V. Neuro-ophthalmological symptoms in children with consequences of perinatal encephalopathy // Coll. scientific tr. the first congress of neurologists, neurosurgeons, psychotherapists and clinical psychologists of the south of Russia. - Stavropol, 1998. T.2. -P.92-94.

59. Sakharova E.V. Clinical and ecological comparison of damage to the visual analyzer in children with perinatal pathology // Health - systemic quality of human life: Sat. Art. - Stavropol, 1999.-S. 163-165.

60. Silyaeva N.F. Pathomorphology of the organ of vision in the perinatal period: Author's abstract. dis. Dr. med. Sci. Kharkov, 1990. - 27 p.

61. Sergienko E.A. The influence of early visual deprivation on intersensory interaction // Psychological Journal. 1995. -T. 16. -No. 5. P. 32-48.

62. Sennikova M.K. health status and postnatal development of newborns born using assisted technologies (IVF, ICSI) // Abstract. dis. Ph.D. honey. Sci. M., 2001.-25s.

63. Sidorenko E.I., Paramey O.V. Condition of the organ of vision in 3-year-old children with a burdened perinatal history //Ros. honey. magazine. -2001. -No. 3.-P.27-30.

64. Somov E.E. Anatomy of the organ of vision //Eye diseases and injuries. - St. Petersburg: Med. publishing house, 2002. P.4-30.

65. Teplinskaya J1.E., Mazanova E.V. Some questions of the clinic, pathogenesis, diagnosis and treatment of congenital glaucoma in children // West, ophthalmology. 1999. - No. 5. - P.39-42.

66. Throne E.Zh. Diseases of the visual pathway. JL: Medicine, 1968. - 551 p.

67. Faver G.L., Veksler D.B. Changes in the brain and retina of the eye with intracranial birth injuries in fetuses and newborns // Pediatrics. 1965. - No. 6. - P.62.

68. Filatova E.V., Gerasimenko M.Yu. An integrated approach to the treatment of patients with myopia. M.: MAKS Press, 2003. -S.

69. Filippova L.A., Filippov G.I. Condition of the fundus in newborns // Book: Obstetrics and gynecology, practice in Transbaikalia, Chita, 1965. - P. 3-42.

70. Filchikova L.I., Vernadskaya M.E., Paramey O.V. Visual impairment in young children. Diagnostics and correction: methodological manual. M.: Polygraph service, 2003. - 176 p.

71. Khvatova A.V., Katargina L.A., Ruzmetov M.S. and others. Prevention of blindness and low vision in children // Mat. All-Russian scientific-practical conf. pediatric ophthalmologists. -M., 1996. P.105-108.

72. Khvatova A.V., Katargina L.A., Dementieva G.M., Kogoleva L.V., Frolova M.I., Skripets P.P. Effective detection and preventive treatment of retinopathy of prematurity // West, ophthalmology. 2000. - T. 116 - No. 5. - P.34-37.

73. Khukhrina JI.P. Some data on the state of the organ of vision in newborns // West, ophthalmology. -1968. No. 5. - P.57-61.

74. Cherednichenko N.L. //Clinical and functional characteristics of the visual analyzer in children with perinatal damage to the central nervous system: Abstract of thesis. dis.cand. honey. Sci. Stavropol, 1997. -35 p.

75. Shamshinova A.M. Hereditary and congenital diseases of the retina and optic nerve. M., 2001, -528 p.

76. Sharapova O.V. State and prospects for the development of obstetric and gynecological care // Mat. IV Russian Forum “Mother and Child” M., 2002 -41. - P. 3-6.

77. Yusaytene G.V. The significance of changes in the fundus of newborns in the diagnosis of brain injuries //Tr. scientific conf. honey. Faculty of Vilnius University. Vilnius, 1971. - p. 103-109.

78. Yatsyk G.V. Vegetative-visceral disorders in newborns with perinatal brain lesions // Attending physician - 1998. -No. 3.-P.45-48.

79. Yatsyk G.V. Premature babies: history, modernity, future: Actual speech / Research Institute of Pediatrics of the Russian Academy of Medical Sciences of the USSR. -M., 1989. -19 p.

80. Anteby I., Lee V., Noetzel M., Tychsen L. Variants of congenital ocular motor apraxia: associations with hydrocephalus, pontocerebellar tumor, and a deficit of vertical saccades //J AAPOS. -1997. -V.l. No. 4. - P. 201208.

81. Akisu M., Ozkinay F. et al. The CHARGE association in a newborn infant // Turk. J. Pediatr. 1998.-V. 40. - No. 2.- P.283-287.

82. Bailey R., Duong T., Carpenter R., Wittle H., Mabey D. The duration of human ocular Chlamydia trachomatis infection is age dependent //J. Epidemiol. Infect. 1999. -V.123. - No. 3. -P. 479-486.

83. Bart D.J., Lueder G.T. Orbital hemorrhage following extracorporeal membrane oxygenation in a newborn // J. Pediatr. Ophthalmology strabismus. 1997. - V.34. - No. 1. - P. 65-67.

84. Beazly D.V., Egerman R.S. Toxoplasmosis // Seminar. In perinatal. -1998. - V.22. - No. 4. - P.332-338.

85. Bermejo E., Martinez-Frias M.L. Congenital eye malformations: clinical-epidemiological analysis of 1, 124, 654 consecutive births in Spain // Am. J. Med. Genet. 1998. - V.75. - No. 5. - P. 497-504.

86. Bremer D., Palmer E., Fellows R. et al. Strabismus in premature infants in the first year of life /Arch. Ophthalmol. 1998. - V.l 16. - No. 3. -P.329-333.

87. Brecelj J., Stirn-Kranjc B. Visual electrophysiological screening in diagnostic infants congenital nystagmus // Clin. Neurophysiol. 2004. -V.l 15. -№2.-P. 461-470.

88. Brodsky M.C., Fray K.J., Glaysier C.V. Perinatal cortical and subcortical visual loss: mechanism of injury and associated ophthalmologic signs// J.Ophtalmologe. -2002. V. 109. - No. 1. - P. 85-94.

89. Casteels I., Demaerrel P., Spileers W., Lagae L. et al. //Cortical visual impairment following perinatal hypoxia: clinicoradiologic correlation using magnetic resonance imaging //J. Pediatr. Ophthalm. Strabismus. -1997. No. 34. - P.297-305.

90. Coats DK., Demmler G.J., Paysse E.A., Du L.T., Libby C. Ophthalmologic findings in children with congenital cytomegalovirus infection //J. FFPOS. 2000. -V.4. -No. 2. -P. 110-116.

91. Centers for Disease Control and Prevention (CDC). Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment - United States, 2003.

92. Cesar R. Rubella and rubeola // Semin. in perinatol. 1998. - V. 22. - No. 4. - P.318-322.

93. Clark M.P., Mitchell K.W., Gibson M. The prognostic value of flash visual evoked potentials in the assessment of non-ocular visual impairment in infancy.//Eye. 1997. - V.l 1. - Pt.3. - P. 398-402.

94. Davis P.C., Hopkins K.L. Imaging of pediatric orbit and visual pathways: computed tomography and magnetic resonance imaging // Neuroimaging Clin. N Am. 1999. - V.9. - No. 1. - P.9-13.

95. Denne C., Kasmann-Kellner V., Ruprecht K.W. Prevalence of optic atrophy and associated ocular and systemic diseases in a department of pediatric ophthalmology // Klin. Monatsbl. Augenheilkd. 2003. - V.220. -N11. - P.767-773.

96. Dobson V., Quinn G., Siatkowski R. et al. Agreement between gratifying acuity at age 5.5 years in preterm child. Cryotherapy for retinopathy of prematurity Cooperative group //Invest. Ophthalmol. 1999. -V.40. - No. 2. -P.496-503.

97. Enders G.A.T. Infections of the fetus and neonate //in: Collier LH (ed) Topley & Wilson's Microbiology and Microbial Infections, 9th edn, Chap.41 Arnold, London.N Engl J. Med. 1998. - 326(10). - P.663-667.

98. Ellenberger S., Ronyan T.E. // Holoprosencephaly with hypoplasia of optic nerves, and agenesis of septum pellucidum // Amer. J. Ophthal. 1980. - V.70. - P.96.

99. Enns G.M., Roeder E., Chan R.T., Ali-Khan Catts Z., Cox V.A., GolabiM. Apparent cyclophosphamide(cytoxan) embriopathy: a distinct phenotype? //Am. J.Med.Genet. 1999. - V.86. - No. 3. - P.237-241.

100. Ewart-Toland A., Yankowitz J., Winder A., ​​Imagire R. et al. Oculoauriculovertebral abnormalities in children of diabetic mother // Am. J. Med. Genet. 2000. - V.90. - No. 4. p.303-309.

101. Fanaroff A.A., Martin R.J. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant.7" th edition // Morsby. 2000. - V.2. - P.676-732

102. Flynn J.T., Cory R.P. Maternal intrauterine herpes simplex infection leading to persistent fetal vasculature //Arch, ophthalmol. 2000.-V.l 18. -№6. -P.837-840.

103. Gilliland M.G., Luckenbach M.W. Are retinal hemorrhages found after resuscitation attempts? A study of the eyes of 169 children //Am. J. Forensic Med. Pathol. -1993. V. 14. - No. 3. - P. 187-192.

104. Gonzalez de Dios J., Moya M. Perinatal asphyxia, hypoxic-ischemic encephalopathy and neurological sequelae in full-term newborns. II/ Description and interrelation//Rev. Neurol. -1996. V.24. -No. 132. - P. 969-976.

105. Gregg T., Lueder M.D. Retinal Hemorrhages in accidental end nonaccidental injury //Pediatrics. -2005. -V. 115. -No. 1. -P. 192.

106. Guerzider V., Bron A. Infectious uveitis // Rev. prat. -1999. V.49. -No. 18. - P.2009-2013.

107. Horwood A., Williams B. Does neonatal ocular misalignment predict later abnormality // Eye. 2001. -V. 15. - No. 4. - P.485-491.

108. Iroha E.O., Kesah C.N., Egri-okwaji M/T., Odugbemi T.O. Bacterial eye infection in neonates, a prospective study in neonatal unit //West. Afr. J. Med. 1998. - V. 17. - No. 3. - P. 168-172.

109. Jacobson L., Dutton G.N. Periventricular leucomalacia: an important causes of visual and ocular motility dysfunction in children // Surv. Ophthalmology 2000. - V.45. -No!.- P. 1-13.

110. Kvarnstrom G., Jacobson P., Lennerstrand G. Visual screening of Swedish children: an ophthalmological evaluation //Acta. Ophthal. Scand. -2001. V.79. - No. 3. - P.240-244.

111. Lambert S.R., Drack A.V. Infantile cataracts // Surv. Ophthalmol. -1996. V.41. - No. 4. - P.427-458.

112. Lee T.W., Skelton R.E., Skene C. Routine neonatal examination: effectiveness of trainee pediatrician compared with advanced neonatal nurse practitioner //Arch. Dis. Child Fetal Neonatal Ed 2001. -V. 85. -№2.-P. 100-104.

113. Luna V., Dobson V., Scher M.S., Guthrie R.D. Grating acuty and visual field development in infants following perinatal asphyxia //Dev. Med. Clin. Neurol. 1995: - V.37. - No. 4. - P.330-344.

114. Matsumura F., Ito Y. Petechial hemorrhage of conjunctiva and histological findings of the lung and pancreas in infantile asphyxia evalution of 85 cases // Kurume Med. J. -1996. -V.43. No. 4. - P.259-266.

115. Maniscalco J., Habal M. Microanatomy of the optic canal //J. Neurosurg. -1978.-V.48. -P.402.

116. Marr J.E., Halliwell-Ewen J., Fisher B., Soler L., Ainsworth J.R. Associations of high myopia in childhood.//Eye. -2001. V.15. - Pt.l. -P.70-74.

117. McCulloch D.L., Taylor M.J., Whyte H.E. Visual evoked potentials and visual prognosis following perinatal asphyxia // Arch.Ophthalmol. -1991. -V.109. No. 2. -P. 229-233.

118. McMahon C.L., Braddock S.R. Septo-optic dysplasia as a manifestation of valproic acid embryopathy // Teratology. 2001. -V.64. No. 2. - P.83-86.

119. Mercuri E., Atkinson J., Braddick O. et al. Visual function and perinatal focal cerebral infarction //Arch. Dis. Child Fetal Neonatal Ed -1996. -V. 75.-No.2.-P. 76-81.

120. Mills M.D. The eye in childhood // Am. Fam. Physician. -1999. -V.60.-No.3.-P.907-918.

121. Peyron F., Wallon M., Bernardoux S. Long-term follow-up of patients with congenital ocular toxoplasmosis //N. Engl. J. Med. -1996. - V.334. -No. 15.-P. 993-994.

122. Pennefather P., Tin W. Ocular abnormalities associated with cerebral palsy after preterm birth//Eye.- 2000.-Vol.l4.-P.78-81.

123. Powls a., Botting N., Cooke R.W. et al. Visual impairment in low birthweight children // Arch. Dis. Fetal Neonatal Ed. 1997. - V.76. - No. 2. -P.82-87.

124. Robinson B.E. Factors associated with the prevalence of myopia in 6-year-olds //Ophthalm. Vis. Sci. 1999.-V.76. - No. 5. - P.266-271.

125. Robinson J.S., Owens J.A. - Pathophysiology of intrauterine growth failure // Pediatrics and Perinatology. Ed. By Gluckman P.D., Heyman M.A., Arnold. -1996. -P.284-289.

126. Salpietro C.D., Bisignano G., Fulia F. et al. Chlamydia trachomatis conjunctivitis in the newborn //Arch. Pediatr. -1999. -V.6. -No. 3. -P.317-320.

127. Salati R., Borgatti R., Giammari G., Jacobson L. Oculomotor dysfunction in cerebral visual impairment following perinatal hypoxia // Dev. Med. Child Neurol. 2002. - V.44. - No. 8. - P.542-550.

128. Sanchez P.J., Wendel G.D. Syphilis in pregnancy // Clin, perinatol. -1997. V. 24. - No. 71. - P.90.

129. Screening for toxoplasmosis during pregnancy//Arch. Disease in childhood. -1998. V.68. - P.3-5.

130. Schalij-Delfos N.E., de Graaf M.E., Trefers W.F., Engel J. Long term follow up of premature infants: detection of strabismus, amblyopia, and refractive errors // Br. J. Ophthalmol. 2000. - V.84. - No. 9. -P.963-967.

131. Shaikh S., Fishman M.L., Gaynon M., Alcorn D. Diffuse unilateral hemorrhagic retinopathy associated with accidental perinatal strangulation//Retina/ 2001. - V.21. - No. 3. -P.252-255.

132. Shawkat f.s., Kingsley D., Ktndall V., Russel-Eggitt I., Taylor D.S., Harris C.V. Neuroradiological and eye movement correlates in children with intermittent saccade failure: “ocular motor apraxia” // Neuropediatrics. 1995.-V. 26. - No. 6. - P.298-305.

133. Simon J.W., Kaw P. Commonly missed diagnoses in the childhood eye examination //Fm. Fam. Physician. 2001. V.64 - No. 4. -P.623-628

134. Sow S., Chew S. Myopia in children born premature or with low birth weight //Acta Ophthalmol. Scand. -1997. -V.75. -No. 5. -P.548-550.159. (Tailor D., Hoite S.) Taylor D., Hoyt K., Pediatric ophthalmology. -M., 2002.

135. Teller D.Y. First Glances: The Vision of infants // Investigative Ophthalmology and visual Science. -1997. V.38. - No. 11. - P.2183-2201.

136. Tsagaraki D.P., Evangeliou A.E., Tsilimbaris M. et al. The significance of ophthalmologic evaluation in the early diagnosis of inborn errors of metabolism: the Cretan experience //BMC Ophthalmol. 2002. -V.2. - No. 1. - P. 2-3.

137. Tuppurainen K., Herrgard E., Vartikainen A. Et al. Ocular findings in prematurely born children at 5 years of age //Grade's Arch. Clin. Exp. Ophthalmol. 1998. - V.231. - P.261-266.

138. Van Bogaert L.J. Ophthalmia neonatorum revisited // Afr. J. Reprod, Health. 1998. - V.2. - No. 1. - P.81-87.

139. Weinstock V.M., Weinstock D.J., Kraft S.P. Screening for childhood strabismus by primary care physicians // Can. Fam. Physician.-1998. -No. 44.-P.337-343.

140. Wong A.M., Lueder G.T., Burchalter A., ​​Tychsen L. Anomalous retinal correspondence: neuroanatomic mechanism in strabismus monkeys and clinical findings in strabismus children // J AAPOS. - 2000. V.4. -No. 3. - P. 168-174.

141. Yasuhara A., Hori A., Hatanaka T. at al. Prediction of the prognosis in neonatal asphyxia by photo-evoked eyelid microvibration // Brain. Dev. -1991. - V.13. No. 2. -P.82-86.

142. Yamanaka H., Yamanaka J., Okazaki K., Hayakawa E. et al. Cytomegalovirus infection of newborns infected with HIV-1 from mother // Jpn. J. Infect. Dis. -2000. V.53. - No. 5. - P.215-217.

143. Zhang W., Qi Y.S., Li P.Y., Guo Y.L., Dong Y.R. et al.//Flash visual evoked potentials on newborns and infants Article in Chinese. //Zhonghua Yi Xue Za Zhi. 2004. -V. 84. - No.2. - P. 111-114.

144. Wolker W. Hemolytic disease of the newborn //In: Gainer-Hull Recent Advances in Paediatrics. Churchill. London. -1971.- P. 157-160.r

After all, many people believe that this disease can go away on its own? Any glaucoma, its treatment is not at the level of home medicine, but professional.

Yes! It's a must! More than one and a half million people in the United States suffer from glaucoma. In the list of diseases that cause blindness, glaucoma ranks second.

The most widespread (approximately 90% of all cases) is the open-angle form of glaucoma (OAG), characterized by gradual progress until the onset of complete blindness. Other types of glaucoma - congenital, angle-closure and secondary - are also dangerous, but less insidious.

Of course, statistics are always conditional, therefore, when mentioning patients with open-angle glaucoma and poor vision, sources claim: blindness progresses in 65% of people over 20 years.

In addition to deteriorating visual acuity, OAG can provoke the appearance of other concomitant diseases. A special case is impaired peripheral vision.

Glaucoma is associated with advanced age and racial criteria. Thus, people of European descent after 50 years of age experience glaucoma relatively rarely. Elderly people complain about it much more often, and in old age more than 3% of all patients in ophthalmology clinics suffer from it. Blacks are considered a special risk group for glaucoma, and most cases of blindness in Negroids are caused by this disease.

Causes of glaucoma

In addition to age data and characteristics of racial origin, for the development of glaucoma are of particular importance

• myopia;
• diabetes;
• heredity, when someone in the family already has glaucoma;

Features of screening tests for glaucoma

There are many tests to determine glaucoma, but the most commonly used in practice are tonometry, ophthalmoscopy and perimetry.

The choice of tonometry as a test method for glaucoma rests entirely with the doctor. In some cases, it is clinically advisable for people at risk (under the age of 70) to be examined for glaucoma by an ophthalmologist.

To measure the level of intraocular pressure, various types of tonometers are used - applanation and impression. When using any tonometer, it is generally accepted by definition that the patients' eyes have similar rigidity, corneal thickness, and similar blood flow. The results of tonometry depend on the choice of device model, the severity of the disease and the qualifications of the ophthalmologist.

Problems with the use of tonometry are related to the properties of ocular pressure. This refers to a level of intraocular pressure greater than 21 mmHg. Art. Despite the fact that eye hypotension often precedes a reduction in the visual field due to glaucoma and is considered an additional risk factor (glaucoma is observed 5-6 times more often than normal when IOP exceeds 21 mm Hg), slight eye hypotension occurs in patients not suffering from glaucoma.

Moreover, the number of people suffering from glaucoma is approximately 1% of the total population, which is much less than the number of patients with hypotensive eyes (about 15%). A quarter of all elderly people have hypotension. Hypotension is not associated with glaucoma. In approximately 80% of patients with GG, glaucoma was never diagnosed and did not progress.

A high level of intraocular pressure, on the contrary, is important for the risk of glaucoma. Initial value of 35 mmHg. Art. much less sensitive in predicting glaucoma. Open-angle glaucoma can progress in patients with normal intraocular pressure.

Ophthalmoscopy is the second type of screening for open-angle glaucoma. Ophthalmoscopy is necessarily present in a standard examination by an ophthalmologist, being one of the most important components in the diagnosis of eye diseases. During this procedure, using an ophthalmoscope, it is possible to examine the fundus of the eye, assess the condition of the vessels of the fundus, optic nerve head and retina.

Also, ophthalmoscopy makes it possible to detect areas affected by atrophy that can cause the formation of new foci of the disease, to find places of retinal breaks and to find out their number. Research can be done in direct and reverse form, with a wide and narrow pupil.

Along with eye diseases, ophthalmoscopy is used in the diagnosis of other pathologies, such as diabetes, arterial hypertension, etc.

The third method of examination for OAG is perimetry, a procedure that allows you to determine the boundaries of the visual fields. Perimetry is characterized by greater accuracy than tonometry or ophthalmoscopy. The volume of the visual field makes it possible to determine the acuity of peripheral vision, which influences the patient’s state of vital activity.

• glaucoma;
• retinal dystrophy;
• retinal disinsertion;
• hypertension;
• eye burns;
• oncological diseases of the eye;
• bleeding into the retina;
• trauma, optic nerve ischemia.

Tereshchenko A.V., Bely Yu.A., Trifanenkova I.G., Volodin P.L., Tereshchenkova M.S.

Kaluga branch of the Federal State Institution “MNTK “Eye Microsurgery” named after Academician S.N. Fedorov

Rosmedtekhnologii", Kaluga

INNOVATIVE APPROACH TO OPHTHALMOLOGICAL SCREENING OF PREMATURE INFANTS

The use of the mobile retinal pediatric video system “RetCam Shuttle” allows not only to examine in detail all parts of the fundus of the eye, but also to register the data obtained for subsequent analysis of changes in the state of the retina over time and determining treatment tactics.

Key words: ophthalmological screening, mobile retinal pediatric video system “RetCam Shuttle”

Relevance

Retinopathy of prematurity (ROP) belongs to a group of diseases that require the most high-tech approaches to diagnosis. This is due to the high specificity of its clinical manifestations, its early onset (the first weeks of a premature baby’s life) and its rapid course.

The standard method for diagnosing ROP is screening examinations of premature infants in preterm care units using an indirect binocular ophthalmoscope. The main disadvantages of this approach are the subjectivity and controversial interpretation of research results.

In 1999, the first report of the use of the retinal digital pediatric video system "IeVat" for screening premature infants appeared. Currently, ophthalmological care for premature infants abroad is organized in such a way that when retinoscopic signs indicating the severity of ROP are detected with the help of “IeUat”, children are transferred from the nursing department to a specialized ophthalmological center for appropriate treatment.

In the Russian Federation, there are no nationwide screening programs for ROP, which leads to serious shortcomings in identifying this pathology and an increase in the number of children with severe and advanced forms of the disease.

In 2003, on the basis of the Kaluga branch of the Federal State Institution “MNTK “Eye Microsurgery” named after. Academician S.N. Fedorov Rosmedtekhnologii" an interregional service was created, uniting into a single centralized system

mu activities for early screening, clinical observation and treatment of children with ROP, based on the introduction of new diagnostic and treatment methods into clinical practice.

Purpose of the study

Assessing the capabilities of the mobile retinal pediatric video system “RetCam Shuttle” in improving the quality of screening examinations of children in preterm care units.

Material and methods

Screening examinations of premature infants were carried out in the preterm nursing departments of children's hospitals in Kaluga, Bryansk, Orel and Tula using an indirect binocular ophthalmoscope and a RetCam Shuttle.

A total of 259 children were examined initially, and 141 were examined again. The percentage of use of the “RetCam Shuttle” during the initial examination was 35.8% (93 children), and during repeated examinations - 54.3% (77 children).

The frequency of examinations of children in each department was once every 1-2 weeks. During one examination, 20 to 50 infants were examined. Screening was carried out starting in the second week of life, with special attention paid to children with a gestational age of less than 30 weeks and a birth weight of less than 1500 grams. The examination was carried out under conditions of drug-induced mydriasis (double installations of atropine sulfate 0.1%).

The first stage was indirect binocular ophthalmoscopy; if ophthalmoscopic criteria characteristic of an unfavorable course of ROP were identified, digital ophthalmoscopy was performed.

XX Russian Scientific and Practical Conference “New Technologies of Eye Microsurgery”

retinoscopy using "RetCam Shuttle". We included the following ophthalmoscopic criteria requiring retinoscopy:

1) demarcation line, shaft, extraretinal proliferation in any area of ​​the fundus;

2) sharp narrowing of the great vessels during vascularization in the 1st and posterior parts of the 2nd zone;

3) a sharp expansion of the great vessels during vascularization in the 1st-3rd zones of the fundus;

4) expansion and increased tortuosity of the vessels located at the border with the avascular retina.

The study on the “RetCam Shuttle” was carried out under local anesthesia (installation of a 0.4% inocaine solution into the conjunctival cavity). 7 fields-circles of the fundus were recorded: central, covering the macular zone and the optic nerve head with vascular arcades, nasal, superior nasal, inferior nasal, temporal, superior temporal, inferior temporal.

Interpretation of the results of digital retinoscopy was carried out on the basis of the classification we developed for the early stages of ROP, which reflects the nature of the course of each stage depending on the morphometric parameters of the retina (with a high or low risk of progression) and allows us to determine the features of monitoring for various courses of the disease, as well as on the basis of a unified international classification PH, revised in 2005.

Depending on the results obtained, the tactics for further monitoring and treatment were determined. When stages 2 and 3 of ROP with a high risk of progression were detected, as well as posterior aggressive ROP, in agreement with neonatologists, the children were transferred to the Kaluga branch of the Federal State Institution MNTK "Eye Microsurgery" for laser coagulation of the retina.

Results and discussion

Preretinopathy was initially registered in 84 children (32.4%), with a high risk of further progression in 46 children (17.8%) (of which 11 (23.9%) were at risk of developing posterior aggressive ROP), 1 -I stage

The disease was registered in 63 infants (24.3%), stage 2 - in 28 (10.8%), stage 3 - in 10 (3.9%), aggressive posterior ROP - in three children (1.2 %).

When children were re-examined after 2 weeks, the distribution by stages of the process changed: preretinopathy was recorded in 44 (31.2%) children (with the risk of developing posterior aggressive ROP and vascularization of only the 1st zone of the fundus - in 5 (11.4%)) , the development of the 1st active stage of ROP from preretinopathy occurred in 17 children (20.2%), from the 1st stage to the 2nd stage the disease passed in 15 children (23.8%), from the 2nd stage to 3- y - in 11 children (39.3%). The transition of pre-retinopathy to posterior aggressive ROP with initial clinical manifestations was noted in 4 children (4.8%).

As a result, the idea of ​​the timing of the onset and duration of the stages of the disease has changed. Thus, in children with a gestational age of 26-28 weeks, preretinopathy was registered already in the 2nd week of life. In children with a gestation period of 30 weeks or more, stage 1 ROP was detected at the 2nd week of life (Fig. 1 a, b, color insert), and progression to stage 2 occurred within 1-1.5 weeks. In this case, the demarcation line was initially noted not in the temporal segment, but in the upper and lower segments (Fig. 2, color insert), while in the temporal segment only the breakage of blood vessels and increased tortuosity of the terminal vessels at the border with the avascular zone were visualized. Of particular interest was the development of posterior aggressive ROP from preretinopathy within 2 weeks (in children on average at 4-5 weeks of life and with the localization of the process within the 1st zone of the fundus) (Fig. 3 a-d, 4 a-c, color insert).

The data obtained led us to the need to revise the timing of retinal laser coagulation (RLC). Thus, in 5 children with stage 2 with a high risk of progression of LCS, an average of 3.7 weeks of life was performed, in 12 children with stage 3 with a high risk of progression of LCS - at 4.8 weeks of life, in 3 - x children with posterior aggressive ROP of the UCL - at 5.6 weeks of life. Previously, these periods averaged 5.1, 6.3, 7.1 weeks, respectively.

The timing of disease regression also shifted downward: at stage 2, complete regression was observed on average at 5.8 weeks of life, at stage 3 - at 6.3 weeks. In 3 children

Tereshchenko A.V. and etc.

An innovative approach to ophthalmological screening..

(6 eyes) with posterior aggressive ROP, signs of stabilization of the process were detected on average at the 7th week; at 9.2 weeks of life, in 5 eyes (83%) there was a complete regression of ROP (Fig. 4 d) (with standard terms of LCS regression observed in 66%), in one case early vitreal surgery was required.

In the technological aspect, when comparing the methods of binocular ophthalmoscopy and digital retinoscopy, the following was revealed. It takes an average of 4-5 minutes to examine one child using an indirect binocular ophthalmoscope. In this case, it is not possible to examine all areas of the fundus: visualization of the periphery of the retina in the upper and lower segments is extremely difficult. In addition, the border between the vascularized and avascular retina is not clearly visible in early manifestations of the disease.

Using the “RetCam Shuttle” allows you not only to examine in detail all parts of the fundus of the eye, but also to register the data obtained for subsequent analysis of changes in the state of the retina over time and determining treatment tactics. On average, the examination takes up to 5-6 minutes, and half of the time is entering information about the child into the device’s database. The examination is possible both on the changing table and in the incubator (in case of a severe somatic condition of the child). Visualization of the fundus occurs in real time; mothers can observe the examination and see changes in the child’s fundus, which makes it easier for them to understand the pathology and orient them to the need for treatment.

Compared to indirect binocular ophthalmoscopy, “RetCam Shuttle” allows you to more accurately localize the process according to the fundus zones and obtain more informative examination results.

Conclusion

In the course of the studies, it was revealed that two methods - indirect binocular ophthalmoscopy and photo registration using the "RetCam Shuttle" - complement and expand each other.

The timing of the onset and duration of the course of ROP depending on the gestational age of the child has been revised, and based on this, the timing of laser coagulation of the retina has been revised.

In the conditions of the interregional service for providing ophthalmological care to premature infants created in the Kaluga branch of the Federal State Institution MNTK "Eye Microsurgery", the use of indirect binocular ophthalmoscopy during mass screening examinations is convenient and effective. The use of "RetCam Shuttle" is also necessary for in-depth diagnosis of complex cases in field work conditions with the ability to more accurately predict the course of the disease.

It seems most appropriate to universally equip departments for the care of premature babies with retinal video systems “RetCam” and train specialists to work with them. The use of innovative digital technologies will contribute to early detection, timely treatment and reduction of the incidence of retinopathy of prematurity.

List of used literature:

1. Tereshchenko A.V. Early diagnosis and monitoring of retinopathy of prematurity / Tereshchenko A.V., Bely Yu.A., Trifanenkova I.G.; Edited by H.P. Takhchidi. - Kaluga, 2008. - 84 p.

2. Tereshchenko A.V., Bely Yu.A., Trifanenkova I.G. Retinal pediatric system “RetCam-130” in the interpretation and analysis of fundus changes in children with retinopathy of prematurity // Ophthalmosurgery. - 2004. - N»4. - P. 27-31.

3. Tereshchenko A.V., Bely Yu.A., Trifanenkova I.G., Volodin P.L., Tereshchenkova M.S. Organization and significance of the interregional service for providing ophthalmological care to premature babies in the Central region of Russia // Questions of practical pediatrics. - 2008. - T. 3. - N5. - P. 52.

4. Tereshchenko A.V., Bely Yu.A., Trifanenkova I.G., Tereshchenkova M.S. Working classification of the early stages of retinopathy of prematurity // Ophthalmosurgery. - 2008. - N1. - pp. 32-34.

5. American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Screening examination of premature infants for retinopathy of prematurity // Pediatrics. - 2001. - Vol. 108. P. 809-810.

6. Ells A., Holmes J., Astle W. et al. Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study // Ophthalmology. - 2003. - Vol. 110. - N. 11. P. 2113-2117.

7. Gilbert C. Retinopathy of prematurity as a cause of blindness in chidren: Abstract Book World ROP Meeting. - Vilnius, 2006. - P.24.

8. International committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited // Arch. Ophthalmol. 2005; 123(7):991-9.

9. Lorenz B., Bock M., Muller H., Massie N. Telemedecine based screening of infants at risk of retinopathy of prematurity // Stad Heals Technol Inform. - 1999. - Vol. 64. - R. 155-163.

10. The Committee for the Classification of retinopathy of prematurity // Arch. Ophthalmol. 1984; 102: 1130-4.