To the question of the most optimal method of anesthesiological aid for retinal laser coagulation in children with retinopathy of prematurity

2020 ◽  
pp. 214-215
Author(s):  
A.V. Konstantinov ◽  
◽  
S.V. Chistyakov ◽  
Keyword(s):  
Retinopathy Of Prematurity ◽  
Laser Coagulation ◽  
Optimal Method

Clinical-epidemiological and therapeutic aspects of prematurity retinopathy

2019 ◽  
pp. 26-36
Author(s):  
Sergey V. BELIKOV ◽  
Andrey P. GOYDIN ◽  
Oleg L. FABRIKANTOV ◽  
Pavel L. VOLODIN
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser System ◽  
Laser Coagulation ◽  
Laser Exposure ◽  
Medical Systems ◽  
Optimal Method ◽  
Advantages And Disadvantages ◽  
Long Term Treatment ◽  
Eye Retina

Relevance of the study . Blindness and hypovision due to retinopathy of prematurity dominate in the structure of the causes of visual impairment from childhood in both developed and developing countries, despite all the achievements of science and practical medicine. A huge role in preventing blindness from retinopathy of prematurity belongs to the effectiveness of treatment. The most discussed topic among global ophthalmology community is readings and the time of laser coagulation of the eye retina. Aim of the study . To evaluate the advantages and disadvantages of laser coagulation various methods in retinopathy of prematurity, to determine the most optimal method in the treatment of active phases of the disease. Materials and methods . We consider retinopathy of prematurity modern methods of diagnosis and treatment, also we carry out advantages and disadvantages comparative analysis. We consider the organization statistics of ophthalmic care for premature infants in the Tambov Region and the long-term treatment results of premature infants with retinopathy of prematurity. Results and discussion . The generally accepted standard methodology applied for screening examination, is the reverse binocular ophthalmoscopy (possible in humidicrib) when medication dilate pupils. If necessary, an examination is carried out using the retinal pediatric camera “RetCam Shuttle” (Clarity Medical Systems Inc., USA), which allows to document and save the survey results in a database. To date, timely and sufficient laser coagulation of the avascular zone of the retina is the only proven effective method of active retinopathy of prematurity treatment. The most modern method of retinal laser coagulation is the technology of pattern scanning laser coagulation, which automated the procedure for applying coagulants. The main trends in the retinopathy of prematurity treatment are earlier implementation of laser coagulation and over dosed coagulation, according to the ETROP recommendations. When using a pattern laser system, laser pulses are delivered in sequence at the highest speed. The result of the use of this technology is a high accuracy of coagulation, so that the eye retina receives the least energy impact, compared with the classical laser coagulation. Conclusion. 1. Timely and adequate laser coagulation of the avascular areas of the eye retina reduces the risk of severe anatomical and functional outcomes of active retinopathy of prematurity. 2. The use of the technology of transpupillary scanning pattern laser coagulation of the eye retina (PASCAL) can significantly reduce the duration of laser exposure and anesthesia for a premature baby, improve the efficiency and safety of treatment.

The first experience of application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of premature in URFO in SAHI of the Sverdlovsk region MСMC «Bonum»

2021 ◽  
pp. 360-362
Author(s):  
M.A. Kariakin ◽  
◽  
E.A. Stepanova ◽  
S.A. Korotkikh ◽  
N.S. Timofeeva ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Intravitreal Injection ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Laser Coagulation ◽  
Complete Regression ◽  
Complex Treatment ◽  
Partial Regression ◽  
Factor Inhibitor ◽  
Retinal Adhesion

Material and methods. The study included 16 patients (31 eyes). Types and terms of treatment. Stage I in the treatment of ROP, laser coagulation of the avascular areas of the retina was performed in three patients with aggressive posterior ROP (4 eyes, 12.9%). In all patients, the progression of the disease was noted. Intravitreal injection of ranibizumab was performed in the period from 8 to 16 weeks (10.5±2.0 weeks), PCV from 32.3 to 39.6 weeks (37.0±1.8 weeks). Result. After laser treatment and IVI of ranibizumab, 11 patients (31 eyes, 81.6%) showed regression of the disease. In 5 patients (6 eyes, 19.4%) - progression. If the ROP progressed, a 25G or 27G lenssparing vitrectomy was performed. Complete regression of ROP was achieved in one patient (1 eye, 16.7%). Partial regression was observed in two patients (2 eyes, 33.3%). In two patients (3 eyes, 50%), the disease progressed to stage 5 with the development of total retinal detachment. Conclusion. As a result of the complex treatment of severe forms of the active stage of retinopathy of prematurity in the regional children's ophthalmological center MKMC "Bonum" in Yekaterinburg, the following data were obtained: complete regression with retinal adhesion is observed in 12 patients (26 eyes, 83.4%), of which in one patient (1 eye, 3.2%) regression was achieved after vitrectomy. Partial regression with the formation of a peripheral retinal detachment after vitrectomy was achieved in two patients (two eyes - 6.5%). Progression of retinopathy of prematurity to stage V with the development of total retinal detachment in two patients (3 eyes, 9.6%). Complex treatment of severe stages of active ROP using laser treatment, IVI and vitrectomy allows to preserve vision in 90.4% of patients. Key words: retinopathy of prematurity; intravitreal injection; laser coagulation of the retina; vitrectomy.

scholarly journals Visual Functions in Children in Remote Postoperative Period after Laser Treatment of Threshold Stages of Retinopathy of Prematurity

2018 ◽  
Vol 15 (2S) ◽  
pp. 18-23
Author(s):  
M. V. Pshenichnov ◽  
O. V. Kolenko ◽  
V. V. Egorov ◽  
E. L. Sorokin
Keyword(s):  
Visual Acuity ◽  
Postoperative Period ◽  
Retinopathy Of Prematurity ◽  
Vision Loss ◽  
State Institution ◽  
Laser Coagulation ◽  
Visual Functions ◽  
Functional Changes ◽  
Continuous Sampling ◽  
High Degree

Purpose.Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP. 

Аnatomical and functional features of eyes in children with the second stage of cicatricial retinopathy of prematurity after laser coagulation

2021 ◽  
pp. 39-42
Author(s):  
M.V. Pshenichnov ◽  
◽  
O.V. Kolenko ◽  
◽  
Keyword(s):  
Evoked Potentials ◽  
Anterior Chamber ◽  
Visual Evoked Potentials ◽  
Retinopathy Of Prematurity ◽  
Retinal Thickness ◽  
Main Group ◽  
Laser Coagulation ◽  
Macular Area ◽  
Functional Features ◽  
Visual Evoked

Purpose. To evaluate anatomical and functional features of eyes in children with the 2nd stage of cicatricial retinopathy of prematurity (ROP) in long-term period after underwent laser coagulation (LC) of threshold stages of ROP. Material and methods. 18 children with the 2nd stage of cicatricial ROP, who in 2008–2009 underwent LC of retina of threshold stages of ROP (the main group). Selection criterion is absence of traction changes in macular area. In patients aged 8–9 years we studied visual evoked potentials (VEP), performed optical coherence tomography in macular area, and ocular biometry. The control was healthy children of similar age. Results. In the main group we revealed: statistically significant differences in increase of foveal thickness; tendency to reduction of retinal thickness in all segments of macular area; in 89% of cases pathological changes were observed in VEP, despite visually intact optic disc and macula. Conclusion. The features of eyes in children with 2nd stage of cicatricial ROP who underwent LC of retina of threshold stages of ROP, were: increase retinal thickness in fovea, uniform decrease in retinal thickness in other sectors in macular area, more smaller anterior chamber of the eye and narrow anterior chamber angle, than healthy peers. Key words: cicatricial retinopathy of prematurity, retinal thickness, anterior chamber of the eye, visual evoked potentials.

scholarly journals New opportunities in management of patients with retinopathy prematurity (literature review and analysis of own data)

2020 ◽  
Vol 13 (4) ◽  
pp. 70-74
Author(s):  
L. A. Katargina ◽  
E. N. Demchenko
Keyword(s):  
Retinopathy Of Prematurity ◽  
Randomized Study ◽  
Clinical Effectiveness ◽  
Posterior Pole ◽  
Peripheral Retina ◽  
Laser Coagulation ◽  
Type I ◽  
Degree Relative ◽  
Anti Vegf ◽  
Increased Risk

Insufficient effectiveness of laser coagulation of the avascular retinal areas in retinopathy of prematurity (ROP) plus-disease in zone I and aggressive posterior retinopathy of prematurity (APROP) requires new treatment approaches, based on the regulation of retinal angiogenesis and anti-VEGF drugs use. The BEAT-RAP study, which was the first major randomized study of anti-VEGF therapy in ROP, revealed a higher effectiveness of bevacizumab compared to retinal laser coagulation in stage 3 plus-disease of zone I. A prospective randomized trial, RAINBOW, demonstrated the effectiveness of ranibizumab in plus-disease stages 1, 2 and 3 in zone I and stage 3 in zone II and in APROP, so that the drug may be recommended for use in children with ROP. The demonstrated high effect of anti-VEGF therapy in ROP is consistent with our own data. Anti-VEGF therapy opens up new possibilities in the treatment of a particular class of ROP forms. The advantages of anti-VEGF therapy include higher clinical effectiveness of treatment of ROP type I with localization in the posterior pole (I and posterior II zone), absence of "blockage" of the peripheral retina, lower frequency of myopia development and degree, relative fastness of the procedure, the acceptability for patients whose fundus is difficult to visualize, and somatically burdened patients who are contraindicated for prolonged anesthesia used for retinal laser coagulation. When using anti-VEGF drugs in the post-threshold stages of the disease, one should take account of an increased risk of proliferation progression and retinal detachment development. Premature infants with retinopathy regression after anti-VEGF therapy require a longer duration of regular and frequent follow-up (up to 70 weeks of postmenstrual age) due to the risk of relapse and extraretinal proliferation in future.

scholarly journals Comparative analysis of some methods of surgical treatment of vasomotor rhinitis

2019 ◽  
pp. 42-48
Author(s):  
Saifutdin Arifov ◽  
Alexey Rasulov
Keyword(s):  
Surgical Treatment ◽  
Nasal Cavity ◽  
Postoperative Period ◽  
Mucociliary Clearance ◽  
Laser Coagulation ◽  
Nasal Breathing ◽  
Vasomotor Rhinitis ◽  
Optimal Method ◽  
Nasal Concha ◽  
Inferior Nasal Concha

Among chronic forms of rhinitis of great importance is vasomotor rhinitis, which is the most common form of chronic non-allergic rhinitis and the clinician has to deal with it constantly. Treatment of vasomotor rhinitis is a complex and largely unresolved problem, which puts this disease among the important problems of modern rhinology. The variety of methods used in the treatment of patients with vasomotor rhinitis confirms the complexity of the task of choosing the optimal method for clinicians and the difficulty of obtaining a sustainable result from the chosen method. Surgical treatment of patients with of patients with various forms of chronic rhinitis is sometimes the only effective. Currently, the arsenal of methods and means of surgical treatment of the nasal concha is quite wide and varied. The purpose of this study – to study in a comparative aspect the functional state of the nasal cavity after carrying out some methods of surgical treatment ofvasomotor rhinitis. Materials and Methods: The study was conducted in the clinic of the Department of Otorhinolaryngology of the Tashkent institute of postgraduate medical education on 43 patients with vasomotor rhinitis in age from 20 to 46 years, average age 28,0±1,3 years. All patients with BP included in our study, after collecting complaints and anamnesis, underwent an endoscopic examination of the nasal cavity and nasopharynx, a computerized tomogram of the nose and paranasal sinuses, standard laboratory tests and microscopy of a smear from the nasal cavity on eosinophils.Investigated the respiratory (computer rhinopneumocotachometry), transport (saccharin test) functions of the nasal mucosa, performed an adrenaline test and the Flour test (determination of the consistency of inferior nasal concha and the response to pushing with a push-button probe). Results: Studies have shown the highest efficiency of laser coagulation with vasomotor rhinitis. After laser surgery, a long-lasting and sustained improvement in the functions of the nasal cavity was noted, while there was no adverse effect on the mucous membrane of the nasal cavity, which was reflected in the recovery rates of both nasal breathing and mucociliary clearance. Given the well-tolerated laser coagulation, the lack of the need for observation and care of the nasal cavity in the postoperative period, the possibility of outpatient treatment, allows us to recommend this type of exposure as the method of choice in the surgical treatment of patients with vasomotor rhinitis. The simplicity of submucosal vasotomy, the availability of instruments for carrying out, the restoration of free nasal breathing and the positive effect on the functional state of the nasal cavity, although slower than laser coagulation, minimal side effects put it on a par with the laser effect. The need to use tampons after surgery reduces the quality of life of patients, hospital stays and the need to monitor patients in the early postoperative period makes this operation strictly inpatient. Electrocautery of inferior nasal concha demonstrated in our study a negative effect on the function of the nasal cavity, although, of course, there was a definite improvement in nasal breathing, but the severity and speed of improvement was significantly less than during laser exposure and submucosal vasotomy. The slowest and most incomplete restoration of the mucociliary clearance of the nasal cavity once again underlines the disadvantage of this method. Conclusion: Evaluation of the long-term results of surgical treatment based on the combination of effects on the respiratory and transport functions of the nasal cavity, as well as on the clinical manifestations of BP, makes it possible to recommend laser coagulation as the most optimal method providing a long-lasting effect in treating patients with vasomotor rhinitis. Alternatively, you can take a submucosal vasotomy of the inferior nasal concha.

scholarly journals Clinical Course and Results of Anti-VEGF Therapy of Retinopathy of Prematurity

2021 ◽  
Vol 18 (1) ◽  
pp. 136-142
Author(s):  
L. A. Katargina ◽  
E. N. Demchenko ◽  
L. V. Kogoleva
Keyword(s):  
Retinopathy Of Prematurity ◽  
Functional Outcomes ◽  
Clinical Course ◽  
Repeated Administration ◽  
Additional Treatment ◽  
Research Centre ◽  
Peripheral Retina ◽  
Laser Coagulation ◽  
Anti Vegf

The clinical course of active retinopathy after anti-VEGF therapy, the possibility and timing of recurrence of the disease, anatomical and functional outcomes of treatment are widely discussed in the press, not fully studied and relevant.Purpose: to study the clinical course of active retinopathy of prematurity after anti-VEGF therapy and clinical and functional outcomes.Patients and Methods. Children with active retinopathy of prematurity, who turned to the Helmgoltz National Medical Research Centre of Eye Diseases after anti-VEGF therapy, examined by indirect binocular ophthalmoscopy and digital retinal camera (RetcamShuttle). Children were monitored from 1.5 to 6 years (average 2.94 ± 1.47). All children underwent routine examination, 4 children older than 3 years underwent optical coherence tomography.Results. In all cases, after anti-VEGF therapy, there was a decrease in vascular activity and continued vascularization of the retina. Recurrence of the disease requiring additional treatment, were detected in 11 (42.3 %) eyes within 6–22 weeks (in average 13.33 ± 5.57) after intravitreal anti-VEGF therapy. Laser coagulation of the retina was carried out in 4 children (7 eyes) and repeated administration of anti-VEGF drug — 2 children (4 eyes), which led to regression of the disease. In the long-term period, all 13 (100 %) children had successful outcomes.Conclusion. Anti-VEGF therapy is effective in plus-zone 1 disease and posterior aggressive retinopathy of prematurity. Its advantages include the ability to treat retinopathy in zone 1 posterior, the absence of “blockade” of the peripheral retina with the possibility of continued growth of blood vessels to the periphery, lower frequency and severity of myopia. The disadvantages include the possibility of recurrence of the disease, which requires long-term regular monitoring.

Systematic review and meta-analysis of the negative outcomes of retinopathy of prematurity treated with laser photocoagulation

2018 ◽  
Vol 29 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Jing Liang
Keyword(s):  
Confidence Interval ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Odds Ratio ◽  
Laser Photocoagulation ◽  
Meta Analysis ◽  
Anterior Chamber Depth ◽  
Mean Difference ◽  
Laser Coagulation ◽  
Spherical Equivalent

Introduction: Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes. Methods: Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible. Results: This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference −2.53, 95% confidence interval: –5.23 to 0.18, I2 = 96%, P < 0.00001), anterior chamber depth (mean difference −0.52, 95% confidence interval: −0.76 to −0.28, I2 = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I2 = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I2 = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference −0.01, 95% confidence interval: –0.28 to 0.27, I2 = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I2 = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity. Conclusion: This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.

scholarly journals Application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity

2021 ◽  
Vol 16 (3) ◽  
pp. 5-10
Author(s):  
M. A. Kariakin ◽  
E. A. Stepanova ◽  
S. A. Korotkikh ◽  
N. S. Timofeeva ◽  
S. I. Surtaev
Keyword(s):  
Growth Factor ◽  
Retinopathy Of Prematurity ◽  
Medical Center ◽  
Laser Coagulation ◽  
Complete Regression ◽  
Complex Treatment ◽  
Gestation Age ◽  
Complex Therapy ◽  
Factor Inhibitor

AIM: To conduct a retrospective study of the application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity in Ural State children`s ophthalmological center at State Autonomic Health Institution of the Sverdlovsk Region Multiprofile Clinical Medical Center BONUM in Yekaterinburg. MATERIAL AND METHODS: The study included 17 patients (33 eyes). The gestation age was from 23 to 30 weeks (mean: 26.51.7 weeks), birth weight was from 600 to 1850 g (mean: 867229 g). 8 patients (47%) had APROP, and 9 patients (53%) had ROP stage III, type 1, plus disease. Laser coagulation of the avascular areas of the retina as the start in ROP therapy was performed in three patients with APROP (4 eyes, 12.1%). Intravitreal injection of the anti-VEGF ranibizumab was performed in 17 patients (33 eyes), including patients with previous laser coagulation. The age of the patients at the time of injection was from 7.7 to 15.6 weeks (10.51.9 weeks), PCA from 32.3 to 39.6 weeks (37.01.8 weeks). Patients with stage IVa ROP (5 patients, 6 eyes) underwent 25G or 27G lens sparing vitrectomy. RESULTS: As a result of the complex treatment of ROP, the following results were obtained: complete regression in 13 patients (28 eyes, 84.8%). Partial regression in two patients (2 eyes, 6.1%). ROP progression to stage V in two patients (3 eyes, 9.1%). CONCLUSION: Complex treatment of severe stages of active ROP with laser treatment, IVI injections, ranibizumab, and vitrectomy made it possible to preserve vision in 90.9% of patients.

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