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The medical industry is undergoing an active digital transformation, including the creation of electronic databases, cloud security systems, mobile health monitoring devices, and telemedicine tools. Artificial intelligence (AI), one of the most important technological achievements of the last decade, is gradually gaining momentum in various areas of practical medicine. The cutting edge of AI, neural networks, offers promising approaches to the improvement of clinical examination quality. The review presents data of studies focusing on the use of AI tools in the diagnosis of the most common ophthalmic diseases: diabetic retinopathy, macular degeneration, retinopathy of prematurity, glaucoma, cataracts, and ophthalmic oncology. We discuss both the advantages of neural networks in the diagnosis and monitoring of eye diseases, and outline the difficulties of their implementation, including ethical and legal conflicts.

Purpose: to determine the role of the systemic angiotensin II (AT-II) in the pathogenesis of retinopathy of prematurity (ROP) and assess its prognostic value.Material and methods. 34 premature infants at risk of developing ROP were examined according to the ophthalmological ROP screening protocol adopted in the Russian Federation. Retrospectively, the infants were divided into 2 groups: those without ROP (n = 15) and those with developed ROP (n = 19). The average gestational age of those without ROP was 28.12 ± 0.64 weeks, their average body weight at birth was 1164 ± 118.6 g. The respective values for the group with ROP were 27.8 ± 0.6 weeks and 1142.6 ± 108.4 g. The two groups had similar extent of general somatic burden. At 32–35 weeks and 36–39 weeks of post-conceptual age (PCA), the infants of both groups were tested for the concentration of AT-II in blood serum using the enzyme-linked immunosorbent assay (ELISA).Results: on the 32–35 week of PCA, the average level of AT-II in blood serum of premature infants of the ROP group was significantly increased as compared to that of the non-ROP group (p = 0.03), while on the 36–39 week of PCA no statistically significant difference between the AT-II levels in the examined groups was found (p = 0.73).Conclusion. We established that the systemic AT-II level has a trigger role in the development of ROP. A high level of this parameter found at the onset of ROP can be considered as an early prognostic criterion for the risk of ROP development.

The improvement in nursing routine of premature babies with low and extremely low body weight has increased their survival rate. Along with the growing number of such children, retinopathy of prematurity (ROP) occurs relatively less often and its outcome becomes more favorable. Modern approaches to the surgical treatment have led to a significant reduction in the incidence of blindness and visual disability caused by ROP. Yet, ROP remains one of the major issues in neonatal ophthalmology, often associated with refractive disorders.Purpose: to evaluate the refractive changes in children with ROP after transpupillary laser coagulation of the retina based by clinical experience.Materials and methods. We analyzed 5 clinical cases of children with ROP treated in Children's City Clinical Hospital No 1 during the period from 2013 to 2014. All patients underwent retinal transpupillary laser coagulation; its volume determined by the stage of ROP. Eye refraction data were noted at the age of 1 and 7 years. The quality of visual functions and the axial length of the eye were determined at the age of 7.Results. All patients had hyperopia of varying degrees at 1 years old. By the age of 7, one patient developed myopia, another one had emmetropia, while the rest of children had hyperopia of varying degrees. Regardless of the refractive error type, the axial length of the eye remained significantly below the age norm. The low quality of visual functions is due to the lack of full-time optical correction and irregular outpatient observation.Conclusions. Most often, hyperopia refraction in children with ROP is accompanied by a short axial length of the eye. Full-time optical correction should be prescribed, and spectacle wearing should be monitored by parents and ophthalmologists who observe the patients.

Purpose: to assess the efficacy of inhalation anesthesia with laryngeal mask in extremely premature infants with low or extremely low birthweight and somatic comorbidities during the surgery of retinopathy of prematurity (ROP) in the active phase of the disease. Materials and methods. 477 infants of 25 to 32 weeks’ gestational age were treated by delimiting retinal laser photocoagulation. Inductive anesthesia with Sevoflurane (BAXTER HEALTHCARE Corp, USA) was followed by placing a laryngeal mask. The delimiting retinal laser photocoagulation was performed using laser devices with an adapter on a binocular forehead ophthalmoscope Supra (Quantel Medical, France) and LachtaMylon (Lasermedservis, Russia,). After the surgery, the recovery from sedation and return of consciousness took 7 to 10 minutes. Results. An inhalation of Sevoflurane with the adoption of a laryngeal mask airway significantly decreases complications of anesthesia in premature infants with comorbidities and reduces the length of hospital stay. The quick clearance of Sevoflurane makes it possible to begin feeding the infant one hour after the surgery. Conclusion. Inhalation anesthesia with Sevoflurane is a method ensuring that preterm infants receive adequate anesthesia in the treatment of retinopathy of prematurity in its active phase.

Purpose: to study the state of blood flow in the ocular arteries of patients with various forms, stages and course types of active retinopathy of prematurity (ROP). Material and methods. Colour duplex scanning was performed by colour Doppler mapping and pulsed Doppler sonography for 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) without ROP signs. The children’s gestation age was 25 to 32 weeks, and the body weight at birth was 680 to1760 g. Blood flow was examined in the ophthalmic artery (OA), the central retinal artery (CRA) and the medial and lateral posterior short ciliary arteries (PSCA). Results. The ophthalmic artery revealed no significant differences between the children with ROP and without ROP, except for a significant increase in the peak systolic velocity (Vsyst) in an unfavorable course of stage III of ROP. The development of aggressive posterior ROP is accompanied by a statistically insignificant decrease in blood flow velocity of OA. Hemodynamic parameters of CRA indicate an increase in peripheral vascular resistance in children with an unfavorable course of ROP. A significant increase of Vsyst in the posterior short ciliary arteries was revealed in children with an unfavorable course of stages I–III of ROP and Vsyst, and Vdiast (diastolic blood flow velocity) in children with aggressive posterior ROP as compared with children without ROP. A pronounced impact of the ROP course (favorable or unfavorable) on the Vsyst, Vdiast, and PI indicators in the posterior short ciliary arteries was revealed. The most informative hemodynamic parameters in predicting the course of active ROP are Vsyst and Vdiast values in the ophthalmic artery and Vsyst in the posterior short ciliary arteries. The least informative were the hemodynamic parameters of the central retinal artery. Conclusion. The assessment of hemodynamic changes in eye arteries may be used as an additional diagnostic criterion in the early diagnosis of ROP.

Purpose: to evaluate the efficacy of Lucentis for the treatment of retinopathy of prematurity (ROP). Material and methods. 51 infants (102 eyes) with the gestational age between 24 and 33 weeks were given intravitreal injections of Lucentis, All patients selected had ROP stages I+, II+, III or III+ in zone 1, stage III+ in zone 2, or aggressive posterior ROP. The procedure was performed under general anesthesia; the dose, technique and the number of Lucentis injections conformed with the recommendations given in Lucentis instruction for use. If indicated, retinal laser photocoagulation was given after intravitreal injections using Supra (Quantel Medical, France) and Lachta-Mylon (Russia, Lasermedservis) laser equipment. Results. Clinical efficacy of intravitreal administration of Ranibizumab in infants with aggressive posterior ROP, zone 1 ROP, Stage III of zone 2 ROP was determined at 86.3 % (with no more than two injections). If ROP remains active after two injections, a change of therapy is recommended. Vascularization was noted to be complete in 51 % of cases. Conclusion. To achieve a maximum treatment effect of ROP with Lucentis, strict observation of indications criteria must take place.

Purpose: to assess the organizational effectiveness of ophthalmic observation of premature infants in pediatric follow-up in St. Petersburg. Material and methods. We analyzed the reports submitted by city interdistrict ophthalmological facilities for retinopathy of prematurity (ROP) and the observation department for premature infants for the period from July 1, 2018 to July 1, 2021 available at the children's multidisciplinary hospital. Results. In St. Petersburg, 6 interdistrict ophthalmological facilities perform regular monitoring of ROP children and a daytime in-patient clinic offers interdisciplinary treatment and early rehabilitation of infants with perinatal pathology accompanying severe prematurity. The data on the frequency of ROP and other visual disorders in children born prematurely are presented. Conclusions. Interdistrict observation facilities are a modern form of regular ophthalmic follow-up of premature infants of risk groups or ROP infants who live in conditions of a large city. A promising observation model of children with combined perinatal pathology and severe prematurity is the setting of a department (daytime in-patient facility) in the children's multidisciplinary hospital. This allows assessing the general health of this critical group of population" and ensure a timely start of combined interdisciplinary treatment and medical rehabilitation.

Despite the improvement of algorithms of preterm infants’ management, methods for predicting, diagnosing and treating ROP remains a vital issue. Purpose: to improve the diagnostics of retinopathy of prematurity based on the assessment of vascular system configuration, using Key to Diagnosis I software. Material and methods. 279 patients with ROP were divided into 6 groups: group 1 included 152 patients (304 eyes) with stage I; group 2 — 45patients (90 eyes) with stage II; group 3 — 8patients (12 eyes) with stage III; group 4 — 7 patients (8 eyes) with stage IVA; group 5 — 7 patients (14 eyes) with posterior aggressive ROP; control group 6 — 60patients (120 eyes) diagnosed with immature retina who have no ROP signs. 28 eyes were analyzed using wide-field imaging, while 400 eyes were analyzed by separate images. The presence o f“mute” zones, macula localization, traction index of the macular zone (Tm), zone and span of pathological changes, fractal dimension (Df) and complexity of vascular system (СVS) were assessed on automatically created wide-field images, obtained by Ret-Cam Shuttle. Results. We revealed strong correlation between Df and stages (p = 0.85, p = 0.01); moderate negative correlation of Тm and stages (p = 0.62, p = 0.01), except for posterior aggressive ROP; strong positive correlation between CVS and stages ( p = 0.91, p = 0.001). Diagnostic modules of the software have been developed to create wide-field fundus imaging in infants, localize the macula as a marker for morphometry, and isolate the vascular system using deep convolutional neural networks. Conclusions. The developed algorithm for multivari­ate analysis of the retinal vascular system reduces the risks of subjective assessment of retinal changes.

Macular diseases are traditionally a serious issue in ophthalmology, which has great social impact due to widespread occurrence and significant vision loss, often irreversible. Over the past few decades, the possibilities for the diagnosis and treatment of pathologies of the retina and choroid have been significantly expanded. Randomized clinical trials provided ophthalmologists with valuable information on the natural course and treatment strategies of common retinal diseases from the viewpoint of evidence-based medicine. However, due to the large number of trials conducted, it is often difficult to make an adequate choice of data to be used in daily practice. In this review, we systematize the most valuable randomized clinical trials. To this end, we selected 42 randomized clinical studies conducted between 1979 and 2019 and focused on the treatment of age-related macular degeneration (AREDS 1, AREDS 2, ANCHOR, MARINA, PrONTO, CATT, IVAN, VIEW 1, VIEW 2, EVEREST II, PLANET, SEVEN-UP, ALTAIR, HAWK, HARRIER), choroidal neovascularization of multiple etiology (myopic, post-inflammatory, angioid-streak-related, etc. — RADIANCE, REPAIR, MYRROR, MINERVA), diabetic eye lesions (diabetic retinopathy and diabetic macular edema — ETDRS, DRCR.net Protocols B, I, S and T, RISE, RIDE, VIVID-DME, VISTA-DME, MEAD, FAME), retinal vein occlusions (BVOS, CVOS, SCORE-CRVO, SCORE-BRVO, BRAVO, CRUISE, GALILEO, COPERNICUS, VIBRANT), as well as retinopathy of prematurity (CRYO-ROP, ETROP, RAINBOW). The review summarizes the main results of these studies, which confirm the effectiveness and safety of such treatment methods as antiVEGF and photodynamic therapy, retinal laser photocoagulation, cryotherapy, corticosteroids and nutraceuticals from the viewpoint of evidence-based medicine. For greater clarity, we provide a table summarizing information on each of the randomized clinical trials considered.

Retinopathy of prematurity (RP) is a complex pathology among prematurely born children, which requires a comprehensive approach, including both prevention of the development of more severe stages of the disease, leading to poor vision and irreversible loss of visual functions, and the organization of dispensary observation and rehabilitation. Modern organization of dispensary observation, which is based on a detailed study of the etiology, pathogenesis, as well as the interaction of local and systemic factors on visual functions, can significantly reduce the visual disability of children as a result of this disease.

Data from sources of domestic and foreign literature for 2016–2019 is presented in the review of literature. This data concerned of applying the method of optical coherent tomography-angiography in pediatric ophthalmic practice. OCT-A is a non-invasive research method, without the use of fluorescent dyes. The procedure is performed relatively quickly, with the possibility of additional repetition. The method allows to conduct visualization of the vascular network of the retina layer-by-layer, perform its quantitative analysis: to evaluate the density of the microvascular bed and measure the area of non-perfusion zones. Having appeared as a result of a qualitative modernization of OCT, a new method of visualization of vessels OCT-A is actively used in the diagnosis of pathologies such as glaucoma, diabetic retinopathy, post-thrombotic retinopathy, age-related macular degeneration, central serous chorioretinopathy, etc. In present time OCT-A being performed in adult medicine, it is actively used in various areas of pediatric ophthalmology. Presently, pediatric patients with diabetes mellitus, sickle cell anemia, amblyopia, retinal artery occlusion, and coats disease have been performed with OCT-A studies. Retinopathy of prematurity (ROP) is required a special attention among children’s eye diseases. However, mentioning about OCT angiographic studies in patients with ROP are quite rare in the literature. Nevertheless, the available data indicate the enormous diagnostic potential of OCT-A in this severe vasoproliferative disease. The method give possibility for fully control the pathological process, to evaluate the effectiveness of the treatment and timely prevent the development of severe stages of ROP. Due to the information and diagnostic potential, it is necessary to continue research on the possibilities of the OCT-A method in the diagnosis, analysis of treatment results and prediction of ROP.

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.

Purpose. To study the feature of the condition of the vessels of the iris according to fluorescence iris fluorescein angiography in various forms, stages and types of the cour se of active retinopathy of prematurity.Material and methods. Fluorescence iris fluorescein angiography was performed in 25 eyes (15 children). Children were born at 25–31 weeks of gestation. Children’s weights were 680–1550 g. Children were 7–11 weeks old. 4 children (7 eyes) had a favorable type of course of 1–2 stages. 7 children (12 eyes) had an unfavorable type of course of 2–3 stages. 4 children (6 eyes) had aggressive posterior retinopathy of prematurity. The study was also performed on 5 premature babies without signs of retinopathy of prematurity who had been born at 30–31 weeks of gestation, weighing 1000–1900 g, at the age of 5–10 weeks. Analysis of the obtained angiograms was performed using descriptive and temporal characteristics.Results. Depending on the stage of the disease, various structural changes in the vascular system of the iris were revealed in prematurity: expansion and increased tortuosity of the vessels; their pathological course; increased permeability or desolation of the capillary bed of the pupil zone; uneven filling of the arterioles of the ciliary zone; newly formed vessels in the pupil in the form of a network shunts; the phenomena of pronounced hyperfluorescence. It was determined that changes in the vascular system in the iris developed in parallel with disorders of the retinal angioarchitectonics. These changes are essentially identical, but less distinct in the iris due to differences in the anatomical structure and angioarchitectonics of the iris and r etina of the eye.Conclusion. Further studies are required being used fluorescence iris fluorescein angiography in children with retinopathy of prematurity with using of large quantities of clinical material to obtain new information about vascular changes in the anterior segment of the eye, since this problem is still unexplored.

The multifactorial nature of the retinopathy of prematurity (ROP) pathogenesis, makes the thorough study of the mechanism of pathological retinal neovascularization actual. However recently the attention of scientists has been attracted by the participation of renin-angiotensin system (RAS) in the development of retinal vasoproliferative diseases. Purpose: to study the role of AT-II in the pathogenesis of experimental ROP (EROP) in the original model of the disease. Material and methods. To reproduce EROP Wistar rats (n = 15) were exposed to the oxygen concentration varying from 60 to 15% every 12 hours for 14 days from the first day after birth followed by room air for 7 days. Throughout the experiment, the room maintained a constant temperature (+26 °C) and light regime (12 hours a day, 12 hours a night) modes. Control rats (n = 12) were born and kept under normal oxygen content (21 %). Batches of EROP (n = 5) and control (n = 4) rats were sacrificed on 7, 14 and 21 days. All rats underwent binocular enucleation, after which every eyeball was opened on the limb, the cornea and lens were removed with the remains of a persistent vascular bag and a hyaloid artery. Retinas were isolated, homogenized and stored at -20 °C. Angiotensin-II (AT-II) in homogenates was measured using the IFA kit. Results. On the 7th day of the experiment, the level of AT-II in the retina of the experimental group rats was 0.19 ± 0.02 pg/mg protein that was significantly higher than in controls (0.12 ± 0.01 pg/mg protein). On the 14th and 21st days concentrations of AT-II in EROP and control groups had no significant difference. Conclusion. On the 7th day of the experiment, i.e. at the period corresponding to the existence of avascular retinal zones in both groups concentration of AT-II in the retinas of rats with EROP was significantly higher than in controls. This fact indicate the role of this proangiogenic factor in the induction of pathological neovascularization in ROP. Possible prognostic function of this parameter during the period before ROP manifestation has undoubted practical significance.

In recent publications, positive results have been reported with the use of glasses with red protective filters in prematurely born infants with low body weight, which were presumably associated with a decrease in the levels of illumination of the environment of the child. However, to date, it has not been proven that a decrease in the amount of light reaching the retina of the newborn affects the frequency and severity of retinopathy of prematurity (RP). The analysis of the literature on the therapeutic effect of various modes of red and near infrared radiation on the retina is presented, which allowed a different look at the protective mechanisms of glasses-filters in premature babies. It has been suggested and substantiated that the observed effect may relate to the phenomenon of pre-conditioning photostimulation, which reduces the risk of developing RP and reduces the severity of the disease due to the induction of adaptive plastic reactions in the retina.

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.

The quality of newborns’ health, especially premature babies has the particular importance in the context of declining fertility. Retinopathy of prematurity (ROP) is a severe vasoproliferative disease affecting the immature vascular system of the retina in premature infants. This is one of the main reasons leading to irreversible vision loss in young children now. Since 2012, based on the State budgetary institution of Rostov region “Regional children’s clinical hospital” organized active screening, diagnosis and treatment of ROP. Since 2016, based on this institution, as well as the Perinatal center of the Rostov region, measures for the prevention of retinopathy of prematurity using red protective filter glasses have been applied. In 2016, the effectiveness of surgical laser treatment was 89 %, due to the increased number of children with aggressive posterior ROP and lightning-fast course of the disease and the lack of preventive measures in most departments of nursing premature babies. In 2017, the effectiveness of surgical laser treatment was 88 %, the relative decrease was due to an increase in the threshold stages. In 2018, the operational effectiveness of laser treatment was 93 %, because of the timely surgical treatment, to improve the quality of nursing preterm infants, active application of measures of prevention with the use of red filter protective in many branches the care of premature infants. The use of red filter protective glasses is a simple and affordable method of preventing retinopathy of prematurity, which reduces the need for surgical laser treatment and the number of adverse outcomes of the disease.

Purpose: to study the features of the anatomical and topographic relationships of the eye’s anterior segment structures in children with stage 5 ROP in the cicatricial period with the method of ultrasound biomicroscopy and optical coherent tomography of the anterior segment and to evaluate the possibility of using the data to optimize the surgical treatment of ROP.Patients and methods. For the period 2015–2018 in the Kaluga branch of the Fyodorov Eye Microsurgery, 68 children (118 eyes) with 5 cicatricial ROP stages were examined and treated. Gestational age at birth varied from 24 to 31 weeks, body weight at birth — from 630 to 1600 grams. Age at the time of the survey ranged from 5 to 15 months. All children underwent the complex diagnostic examination, which included biometrics, tonometry, ultrasound ophthalmoscanning in B-mode, as well as UBM and OCT of the anterior segment of the eyeball. The extent of fixation of retrolental opacities to the posterior lens capsule, the presence of cystic cavities and retinal folds at the periphery, traction detachment of the ciliary body were determined. OCT of the eye anterior segment was performed in the presence of iridocorneal contact in order to clarify its length. As a result, a comprehensive detailed assessment made it possible to clarify or reject the characteristics identified by UBM, as well as determine the phasing and develop an individual plan of the operation in each case.Conclusion. The use of complex diagnostic examinations, including UBM and OCT of the eye anterior segment in patients with 5 cicatricial PH stages, allows to optimize the tactics of surgical treatment in the advanced stages of the disease.

Purpose: to determine the incidence and clinical course of retinopathy of prematurity (ROP) in modern developmental care conditions as based by the data of a level III perinatal center.Material and methods. A retrospective study of 920 premature infants of the ROP at-risk cohort managed by the Neonatology department of Moscow Regional Perinatal Center over the 2-year period of 2017–2018 was performed. Retinopathy was graded and treated following the respective Federal clinical guidelines.Results. Of the 920 infants who met the screening criteria, ROP was detected in 193 (28.5 %) infants; 49 infants (7.2 %) required treatment. Of all general somatic factors, the duration of artificial ventilation of lungs showed the strongest correlation with the frequency of development and severity of ROP. In infants with birth weight > 1000 g, the incidence of severe forms of ROP correlated with the presence of necrotizing enterocolitis and intraventricular hemorrhages, while in children with a lower body weight at birth no such correlation was detected. Bronchopulmonary dysplasia was not found to affect the development of ROP. In groups of infants with birth weight of 1000–1499 g and 500–999 g, the frequency of transfusions of washed red blood cells with depleted leukocyte and thrombocyte levels was generally higher in children with ROP, both with spontaneous and induced regression, but showed no difference between the two subgroups.Conclusion. Severe somatic pathology does not always accompany the progression of ROP to the threshold stage. So, in order to optimize ROP screening, it is necessary to search for new more accurate criteria for ROP development and progression risk.

In premature babies, plastic changes develop in the neural retina, which, depending on the severity of retinopathy of prematurity (ROP), are a manifestation of adaptive or non-adaptive plasticity. In various experimental studies on animal ROP models, the conditioning effects of intermittent white light stimulation and various mechanisms of the positive effect of red and ultraviolet radiation on the plasticity of the retina have been demonstrated, which allows phototherapy to be considered as a promising modifying treatment for ROP supplementing the main therapy. Taking into account that light-dependent processes are involved in the pathogenesis of ROP, we also hypothesize that fractal phototherapy with complex-structured optical stimuli, as a method of activating adaptive neuroplasticity, can be most effective in the complex of methods for preventing and treating ROP.

Purpose. To study the effect of bright sunlight on immature retina of a premature baby at different periods of solar activity.Material and methods. The study involved two groups of premature babies: 32 babies (64 eyes) in 2016 and 50 babies (100 eyes) in 2017. Both groups were tested using a retinal camera (RetCam Shuttle, USA) on the 3rd or 4th week after birth. In cases of threshold stages of retinopathy of prematurity (ROP) binocular ophthalmoscopy were performed. In such cases, laser coagulation of the retina was performed using "ALOD 01" (ALCOM Medica, Russia).Results. The greatest number of ROP with the greatest number of surgical interventions and adverse outcomes that required vitreoretinal surgery were revealed in the second seasonal period (May — August), which experienced the highest solar activity. In 2016, the amount of ROP cases diagnosed in this period amounted to 59 %, which is comparable with the corresponding amount revealed in 2017 (61.1 %).Conclusions. Stronger solar activity and its longer periods increase the risk of ROP; consequently, to prevent this pathology, the eyes of the newborn should be protected from the negative effects of daylight and artificial light, including that emitted by diagnostic equipment.

Purpose. To study the involvement of dopamine and noradrenaline in the pathogenesis of retinopathy of prematurity (ROP) on an original rat model of the disease.Material and methods. The study was conducted on 41 newborn Wistar rats (82 eyes), divided into 2 groups: experimental (EROP, rats with experimental ROP, n = 21) and control (n = 20). The rats were taken out of the experiment on the 7th, 14th, 23rd and 28th days of life. All rat pups were given binocular enucleation at the indicated times, whereupon the eyeballs were dissected along the limbus and the cornea, lens, hyaloid system, and vitreous were removed. The retina was isolated from the eye cup. The isolated retinal samples were homogenized in 10 volumes of 0.1 n HClO4 containing 50 pmol/ml (or more) of 3,4-dihydroxybenzylamine (DBA), using an ultrasonic homogenizer (Labsonic M, Sartorius), centrifuged at 2000g for 20 minutes, and the norepinephrine, dopamine and precursor of dopamine — L-3,4 dihydroxyphenylalanine (L-DOPA) were determined in the resulting supernatant. The contents of substances were measured using reverse phase high performance liquid chromatography with electrochemical detection (Amperometric detector LC-4B, Bioanalytical Systems, USA) set at the potential of 850 mV.Results. On the 7th day, on which avascular retinal zones in both groups of animals existed, no significant differences were found in the content of monoamines in the retina of rats with EROP and in the control group. On the 28th day, the content of noradrenaline, dopamine and L-DOPA in the retina of the experimental group was significantly increased compared with the control. On day 23, corresponding to the peak of neovascularization in the EROP model applied, the level of norepinephrine in the retina of experimental group rats was significantly higher, while the level of L-DOPA was significantly lower compared to the control group. The dopamine level was comparable in both study groups and similar to the level of L-DOPA in the control group. On the 28th day, corresponding to the beginning of EROP regression accompanied by vascular activity decrease, the content of dopamine and L-DOPA remained lower than in the control group.Conclusion. During the development of pathological neovascularization of rat pup retina with EROP, the level of noradrenaline is growing, revealing a peak corresponding to the period of pronounced pathological growth of retinal vessels within the applied model, which indicates to the fact of noradrenalin proangiogenic properties and its direct participation in the pathogenesis of ROP. The level of dopamine and its predecessor, L-DOPA, increased towards the 14th day as compared to its level detected on the 7th day, which may be due to the maturation of the amacrine cells producing, and then, on the day 23. i. e. during the period corresponding to the maximum peak of angiogenesis, its relative decrease of L-DOPA was noted. It can be assumed that the lack of this monoamine, and hence insufficient manifestation of its anti-angiogenic properties contributes to the development of uncontrolled neovascularization of the retina.

On April 4–5, 2019, the Russian Helmholtz National Medical Research Center of Eye Diseases held a scientific and practical conference with international participation «Retinopathy of prematurity and retinoblastoma 2019». The conference, which became a platform for discussion of the most acute and burning issues of pediatric ophthalmology, was a great success. The proceedings reflect the state-of-the-art in the treatment of infants and children with retinopathy of prematurity and retinoblastoma, new technical and methodological solutions, controversial issues, and future prospects.

The purpose of the study is to increase the efficiency of delivering high-tech eye care to the infants of Orenburg and the Orenburg region.Material and methods. An algorithm has been developed to deliver specialized care for retinopathy of prematurity. Recently purchased «RetCam3» pediatric retinal camera made it possible to conduct dynamic screening and monitoring of preterm infants who were prematurely born at risk of retinopathy. The examination was prescribed to children at risk (gestation age up to 35 weeks, birth weight up to 2500 g). The time frame for fundoscopy varied from 3 to 7 weeks after birth depending on the infant physical condition. The number of examinations at 3th–4th weeks of life was 63 %, at 5th–6th weeks – 29 %, at 6th–7th weeks – 8 %. Screening examinations were carried out in the perinatal centre with intervals, depending on the stage of retinopathy of prematurity: preretinopathy, stage I and II from 1 to 2 weeks, III and more severe stages from several days to a week. 60 initial examinations were performed in 6 months, laser treatment was provided for 13 patients (21.7 %).Results and discussion. For 6 months, 60 initial examinations were performed; laser treatment was performed in 13 patients (21.7 %). We observed positive changes for all the infants after laser treatment, which proves high efficiency of the developed algorithm of treatment premature infants with retinopathy, which is the prevention of blindness and low vision from infancy. Repeated monitoring after laser coagulation was carried out after 2, 4 and 8 weeks.Conclusions. Thus, screening contributes to the identification of this pathology at an early stage, dynamic monitoring of the fundus changes is carried out using retinal camera, which contributes to timely laser treatment. The developed algorithm improves the quality of specialty care for premature infants at risk of developing retinopathy of prematurity, and, accordingly, improves the quality of their life.

Purpose: to study the role of cellular immunity in the development of retinopathy of prematurity (ROP).Material and methods. 87 children were tested, including 60 with III — V stage ROP and posterior aggressive retinopathy that had gestational age from 25 to 32 weeks at birth, aged 1 month to 1 year (study group) and 27 healthy children of the same age (control group).Results. No statistically significant differences of immunological parameters were revealed within the groups of children aged 1 to 3 months, 3.5 to 6 months, and 6.5 to 12 months. The gestational age at birth had no effect on the parameters studied. With increasing severity of ROP amid reduced indicators of T-regulatory cells, the number of B-cells (CD19 +) grew, T-natural killer cells (CD3 -/CD16 +CD56 +) reduced significantly (p < 0.05), and the number of CD4+ T-cells reduced showing the significance of (p < 0.01–0.05).Conclusion. The obtained data testify to the emergence of autoimmune reactions and a decrease in the level of regulatory T-cells in a premature child, more pronounced in severe stages of ROP.

Purpose – to analyze the effectiveness of the algorithm used to monitor and treat premature infants. Material and methods. 903 premature babies were under the supervision of ophthalmologists from our clinic over the past 4 years (2014–2017). Retinopathy of prematurity was revealed in 302 patients. The laser photocoagulation was required in 78 cases. Repeated interventions were performed in 13 patients. Induced regression of the disease occurred in 72 children. The development of the 4–5 stage of the active phase of retinopathy of prematurity occurred in 6 patients. In 4 cases, the development of the 4–5 stage of the active phase of retinopathy of prematurity occurred in the case of posterior aggressive retinopathy. Results and discussion. The teamwork of ophthalmologists and neonatologists, timely and complete examination, reveals early signs of retinopathy of prematurity. Timely laser photocoagulation reduces the risk of disability, development of blindness and low vision. Reducing the number of laser photocoagulation carried out with an unchanged number of examinations, a low number of patients with terminal stages of the disease testify to the high effectiveness of monitoring and treatment of children with retinopathy of prematurity.

The literature review provides information regarding the use of the fluorescein angiography of the fundus (FFA) in retinopathy of prematurity (ROP). Sanctified security issues FFA treatments in children; the use of FFA in the screening, diagnosis and determining the course of management of patients with ROP, data usage FFA in the assessment of treatment efficacy in ROP, and the role of FFA in detailing clinicalmorphometric classification of ROP. According to the data presented in domestic and foreign literature, the FFA is a highly informative method of research in preterm children with active stages of ROP. It can detect the degree of vascular disorders and prevalence of pathological process, including in cases when pathological changes are still not made available to other ophthalmic research.

Purpose: to assess the level of catecholamines norepinephrine and dopamine in rat retina with experimental retinopathy of prematurity (EROP) at a time corresponding to the peak of neovascularization. Material and methods. The study was performed on 41 infant Wistar rats (82 eyes). The rats were divided into 2 groups: the experimental group (with EROP, n = 21) and the control group (n = 20). In order to reproduce the EROP, the newborn rats were placed for 14 days in the incubator together with their mother. Every 12 hours, the oxygen concentration in the incubator ranged from 60 to 15 %. The control group consisted of pups who were held in conditions with a normal oxygen content (21 %) from the moment of birth. The pups were withdrawn from the experiment on the 10th, 14th, 23rd and 28th day, whereupon they were subjected to binocular enucleation followed by histological examination, in addition, the content of noradrenaline and one of the metabolites of dopamine (L-DOPA) was determined in retinal samples of the eyeballs obtained on the 23rd day by highly effective liquid chromatography technique with electrochemical detection.Results. Histological examination showed that in our EROP model the neovascularization peak occurs on the 23rd day of the experiment. At this time rat pups with EROP showed a significantly lower retinal L-DOPA level as compared to the control values (13.99 ng/g and 30.5 ng/g, respectively), and the norepinephrine level significantly exceeded such values (63.7 ng/g and 7.69 ng/g, respectively).Conclusion. A relative deficiency of dopamine and a relative excess of norepinephrine of the rat pups with EROP is noted at the time of the highest vascular activity of the retina. The obtained data confirm anti-angiogenic properties of dopamine and pro-angiogenic properties of noradrenaline in the second phase of EROP development.

Studying immunological aspects of pathogenesis of retinopathy of prematurity (ROP) helps develop new approaches to prevention, rational diagnosis and increase of the effectiveness of treatment of the disease. Purpose: to analyze the level of growth factors in blood serum of premature infants belonging to the group of ROP risk at the pre-clinical stage and find out how this level is related to further development and course of the disease. Material and methods. 85 prematurely born infants of the ROP risk group were examined. The average gestational age at birth was 27.7 ± 2.2 weeks, the average birth weight - 1086.1 ± 266.1 g. The examination included dynamic ophthalmoscopy and determination of the content of VEGF-A in blood serum (using a flow cytometer BD FACS Canto II) and TGF- β1, IGF-I, IGF-II (by enzyme-linked immunosorbent assay (ELISA) using a c-test system Bender MedSystems, Austria). Results. During the first ophthalmoscopic examination, i.e. before the clinical manifestation of the disease, blood serum of children who later developed ROP that subsequently required laser coagulation of avascular retinal areas, was found to have relatively higher concentrations of VEGF-A (above 1300 pg/ml) and IGF-II (above 140 pg/ml) and lower IGF-I concentrations (below 24 pg/ml) and TGF- β1 (below 8000 pg/ml) as compared with the groups of "safe" children. A dynamic study of VEGF-A content and, simultaneously, TGF- β1 content showed uniform changes in the concentration of these growth factors at all observation times. Conclusion. It was shown for the first time that high IGF-II and low TGF- β1 concentrations revealed before the clinical manifestation of the disease can be viewed as prognostically unfavorable as far as subsequent development of severe ROP is concerned. Uniform changes of TGF- β1 and VEGF-A level in blood serum during ROP development may indicate to the synergistic participation of these growth factors in the pathological vasoproliferation. Further studies are required to determine the details of how this mechanism works // Russian Ophthalmological Journal, 2017; 1: 20-5. doi: 10.21516/2072-0076-2017-10-1-20-25

An experimental study was performed to reproduce the model of oxygen-induced retinopathy (OIR) in young rats. This model is promising for the study of the pathogenesis of retinopathy of prematurity (ROP) and for the search of new approaches to the prevention and treatment of the disease. It was found that the total protein content in the vitreous was increased during OIR at all observation times, with a maximum reached on the day 14. The phasal character was revealed in the changes of the level of antioxidant activity (AOA): on the day 7 AOA of rats with OIR is no different from the control, on the day 14, it becomes 6.4 times higher than the reference level, and on the day 18 (when the oxygen is no more active) it is falling but still remains higher than the norm. These findings suggest that the permeability of the blood-retinal barrier is damaged during OIR, and confirm the important role of oxidative stress in the pathogenesis of ROP, the advisability of the correction of its parameters by introducing antioxidants in the combined treatment of ROP, and the need for a differentiated approach to the times of their application Russian Ophthalmological Journal, 2016; 1: 68-72.

Purpose: to study the pathogenesis of retinopathy of prematurity.Patients and methods. 642 preterm infants born before 30 weeks gestation with the weight less 1500 grams were examined. The study included: indirect ophthalmoscopy; digital retinoscopy; calibrometry of retinal vessels; dopplerography; analysis of partial pressure of oxygen and carbon dioxide in the capillary blood. Results. The first phase of retinopathy of prematurity (ROP) occurred due to the immaturity of the mechanisms of autoregulation of the blood flow and the inadequate reaction of immature retinal vessels to oxygen. It was established: the less gestational age of a child, so there are less mechanisms of autoregulation of hemodynamics. The perverse reaction of autoregulation leads to pronounced arteriospasm, increasing the zone of hypoxia, and triggering pathological angiogenesis. In morphologically immature children, arteriospasm of retina vessels is more often detected, and narrowing degree of vessels is higher. Arteriospasm is defined in 82 % of children born at the age of gestation from 25 to 27 weeks, in 67 % — at a period from 28 to 29 weeks, in 54 % — from 30 to 32 weeks. In children with ROP in the preclinical period of the disease, retinal angiospasm is noted at values of pO2 in capillary blood less then 40 mm Hg or exceeding the upper limit of the norm values of pCO2 (the norm values of pO2 are 40–60 mmHg, pCO2 are 35–45 mm Hg). Autoregulation of blood flow is immature and inadequate. In the group before 30 weeks of post-conceptual gestational age without development of ROP, a spastic reaction of retinal arteries was revealed at the background of subnormal pO2 values in capillary blood. Biochemical autoregulation of blood flow is still immature. But from the 30 week of post-conceptual gestational age arteriospasm of retina is formed at values of pO2 of 45 mm Hg or higher (p < 0.05). The normal caliber of retinal arteries in children without development of ROP is revealed at the background of mean values of pO2 below 45 mm Hg and values of pCO2 below 42 mm Hg before 30 weeks of post-conceptual gestational age, and above 45 mm Hg from the 30th week of post-conceptual gestational age. In children without ROP from 30 weeks of gestational age biochemical autoregulation of blood flow functions. It is important the degree of an angiospasm for the development of ROP. Dopplerographic critical index of blood flow disturbance in the ophthalmic and anterior cerebral arteries has been established — the index of resistance (IR) exceeding 0.8. It is a precursor of the development of ROP and pathological angiogenesis. In the group of children with ROP, the IR of the anterior cerebral artery is 0.84 ± 0.02 (in av.). The IR of the ocular artery was 0.83 ± 0.03. In higher index (up to 0.9–1), the process in the eye was more active.

The purpose is to determine the features of different stages of active retinopathy prematurely according to fluorescent angiography data.Patients and methods. In 2011–2017, 271 angiographic studies were performed in 207 premature infants born at 25– 33 weeks of gestation with 710–1980 grams weight at birth, with different stages of active ROP in age of live 3–12 weeks (30– 39 weeks of post-conceptual age). A voluntary informed consent to perform the examination was received from the legal representatives of all patients. FAG was performed using retinal pediatric digital video system «RetCam-3» with built-in angiographic unit under mask anesthesia, in the presence of anesthesiologist-resuscitator, under the monitor control of the respiratory and cardiovascular systems of the child.Results. Unfavorable types of active ROP are characterized by the specific manifestations that are not defined by the standard ophthalmologic methods: early flat neovascularization, the presence of small tortuous peripheral vessels with signs of leakage, reperfusion areas with an apparent lack of capillaries and shunts. This opens up the opportunities for early detection of stages of the disease requiring therapeutic measures. The aggressive posterior ROP is distinguished by a variety of angiographic patterns, the most important feature is the massive loss of the retinal capillary bed in the vascularized retina. FAG data about latent neovascularization and ischemic zones of the retina represent the particular value in the prediction of active ROP course.Conclusion. The obtained results could allow to make the most differentiated approach to the management of children with active ROP, timely and effectively predict the course of the disease and to performed adequate treatment based on objective indications.

The purpose is to analyze the stages of ophthalmological healthcare system’s evolution in premature children on the basis of Kaluga branch of FGAU «MNTK “Eye Microsurgery” named after acad. S.N. Fedorov».Methods. In 2003, on the basis of Kaluga branch of MNTK “Eye Microsurgery” the system of ophthalmological care for premature children had been created. The specialists of children’s ophthalmologic department of the branch had started regular field screening examinations of premature infants from risk group of ROP in neonatal care unit in 4 regions of the Central Federal district. In parallel, new diagnostic methods and technologies of laser and surgical treatment of active PH stages had been actively developed and introduced.Results. From 2003 to 2018 approaches for detection, diagnostics and treatment of ROP had been evolved substantially. At the initial stage, there were no uniform data about the optimal timing for early detection of active stages ROP, and quantitative markers of ROP progression were not determined. The effective management and treatment algorithms for the patients with active ROP had not been implemented yet. To the date vast experience had accumulated: more than 15 thousand infants with ROP risk had been screened, more than 750 on-site examinations in the neonatal care units and perinatal centers had been performed. High-tech methods of diagnostics, laser and surgical treatment of ROP had been developed and are actively used now. Multicenter clinical studies evaluating the possibilities of anti-VEGF therapy for active ROP have being performed. Over 3000 laser and more than 1.300 surgical operations for different stages of ROP had been performed.Conclusion. Many-years experience of ophthalmological healthcare system in premature children functioning have demonstrated its consistency and effectiveness. The system includes interrelated stages, providing continuity between the perinatal centers and specialized ophthalmic institution, with complying the common approaches to early screening and diagnostic monitoring, including through telemedicine, as well as technologies of laser and surgical treatment of ROP.

The purpose: to determine the features of different stages of active retinopathy prematurely according to fluorescent angiography data.Patients and methods. In 2011–2017, 271 angiographic studies were performed in 207 premature infants born at 25–33 weeks of gestation with 710–1980 grams weight at birth, with different stages of active ROP in age of live 3–12 weeks (30-39 weeks of post-conceptual age). A voluntary informed consent to perform the examination was received from the legal representatives of all patients. FAG was performed using retinal pediatric digital video system “RetCam-3” with built-in angiographic unit under mask anesthesia, in the presence of anesthesiologist-resuscitator, under the monitor control of the respiratory and cardiovascular systems of the child.Results. Unfavorable types of active ROP are characterized by the specific manifestations that are not defined by the standard ophthalmologic methods: early flat neovascularization, the presence of small tortuous peripheral vessels with signs of leakage, reperfusion areas with an apparent lack of capillaries and shunts. This opens up the opportunities for early detection of stages of the disease requiring therapeutic measures. The aggressive posterior ROP is distinguished by a variety of angiographic patterns, the most important feature is the massive loss of the retinal capillary bed in the vascularized retina. FAG data about latent neovascularization and ischemic zones of the retina represent the particular value in the prediction of active ROP course.Conclusion. The obtained results could allow to make the most differentiated approach to the management of children with active ROP, timely and effectively predict the course of the disease and to performed adequate treatment based on objective indications.

Purpose. To identify significant risk factors for the «threshold» retinopathy of prematurity (ROP) in children born from multiple pregnancies.Material and methods. The paper is based on a retrospective analysis of case histories of premature infants with a gestational age (GA) at birth ≤34 weeks and weighing ≤2000 grams. The study group comprised 174 children born from multiple pregnancies, a control group included 130 children from a single pregnancy, the groups were comparable in average GA and birth weight (p>0.05). Taking into account the morbidity and severity of ROP, there was analyzed the significance of the sequence of birth (first, second), the type of conception (natural pregnancy and pregnancy as a result of in vitro fertilization), the type of placentation (mono- and bichorial), the presence of severe intrapartum asphyxia, artificial ventilation lung for more than 7 days, total oxygen therapy for more than 21 days, intraventricular hemorrhages of grade III-IV, hemodynamically significant heart defects, neonatal sepsis, early anemia of prematurity (hemoglobin

The literature review provides information on the use of special research and clinical tool – telemedicine in ophthalmology. The importance of telemedicine services for the early detection and timely treatment of such diseases as retinopathy of prematurity (ROP) is shown based on the data of a number of studies.Many studies indicate the value of retinal pediatric system RetCam and digital images of the fundus obtained with their help for screening, diagnosis and tactics of patients with ROP via telemedicine technologies. This, according to many researchers, promotes the timely detection of children with the stages of the disease, requiring the consultation of ophthalmologists, treatment, and referring them to specialized clinics. Thereat this demonstrates a high accuracy of the interpretation of fundus images during the telemedicine screening.Foreign authors note a significant economic efficiency of ROP telemedicine compared with the standard diagnostic methods, such as the indirect binocular ophthalmoscopy during the direct consultation of the patient by an ophthalmologist, they also noted that the use of this technology promotes to reduce time-consuming of ophthalmologists involved in the management of patients with ROP.According to various authors, the incidence of ROP worldwide continues to grow, and the use of telemedicine for screening, diagnosis, and training of medical personnel will become increasingly important in the organization of eye care in preterm infants.Nowadays the subject of ROP telemedicine is reflected in the national pediatric ophthalmology only in a few publications. However, this trend begins to develop rapidly and is one of the most promising tools to solve the problem of retinopathy of prematurity in Russian pediatric ophthalmic practice.

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

Objective: Assessment of the anatomo-functional state of the central retina in children with intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) in the long-term period., Material and Methods: We examined 51 patients (102 eyes) born 25-34 weeks' of gestation (birth weight 700-2290 g), aged 8.83±3.5 years, and 18 children (36 eyes) born prematurely aged 10.8±3.2 years. The children underwent standard ophthalmologic examination, optical coherence tomography (OCT) and visual evoked potentials (VEP)., Results: Retinal thickness (RT) and retinal volume (RV) in the fovea of premature infants with PH and/or IVH are significantly higher than in healthy full-term infants, which correlates with lower visual acuity ( p <0.05). RT and RV in the fovea has an inverse proportional relationship with gestational age (GA), ( p <0.05). According to the results of VEP, moderate organic changes in the conduction tract of the visual analyzer are noted in 45% of premature infants ( p <0.05)., Conclusion: The process of macula formation is affected by many perinatal and postnatal factors, namely: GA, birth weight, ROP, hypoxic-ischemic CNS diseases, and refractive disorders.

Purpose. To study anatomical-topographical features of the anterior segment of the eye at different stages of retinopathy of prematurity (ROP) based on the ultrasound biomicroscopy, to determine criteria of disease progression and to assess the possibilities to use the obtained data for an optimization of the laser and surgical treatment.Material and methods. Ultrasound biomicroscopy (UBM) was performed in 217 eyes of 123 premature babies in the gestation terms of 26-34 weeks, of them: at the ROP stage I – 44 eyes (20%) 25 newborn children, at the stage II – 35 eyes (16%) 21 newborn babies, at the stage III – 42 eyes (19%) 24 newborns, at the stage IV – 49 eyes (22.5%) 28 newborns, at the stage V – 47 eyes (21.7%) 25 newborns. the control group consisted of 20 premature babies (40 eyes) without ROP signs and other eye diseases aged from 1 to 4 months.Results. The conducted research allowed to calculate angular and linear parameters for premature babies with no ROP signs, and also for babies of the ac tive ROP stages III, IV and V. Specificity of spatial correlations in structures of the anterior segment of the eye was defined for children with different ROP stages.Сonclusion. Specific structural violations were revealed by the UBM method in the area of the far retinal periphery, as well as in the postzonular and retrolental spaces in case of the ROP stages IV and V. The use of ultrasound biomicroscopy data in the ROP case allows to optimize the parameters of laser irradiation in the ROP stages III and II with adverse types of ROP course, to clarify the volume of surgical intervention at ROP stage IV, identify the optimum area of an operational access at ROP stage V.

Purpose. To show the basic regulations of the complex retinopathy of prematurity (ROP) treatment with use of retinal pattern scanning laser coagulation and early vitrectomy. Material and methods. Pascal pattern scanning retina laser coagulation of (RLC) was performed in children for stage 2 ROP type 2, stage 3 ROP type 2 and subclinical stage and early clinical stage of aggressive posterior ROP according to the classification developed at the Kaluga Branch of the S. Fyodorov Eye Microsurgery State Institution. Early 3-ports 25G vitrectomy was carried out in case of ROP progressing 2-4 weeks after the laser treatment. Results. Between 2003 and 2011 total 823 different surgical interventions for infants with active ROP was performed: 737 retinal laser coagulations, 3-port lens preserving vitrectomy – 72, 3-ports lensvitrectomy – 14. Treatment efficacy was in classical ROP course 98.6% for stage 2 and stage 3 ROP (regress of the disease occurred in 557 of 565 eyes), and 74.4% for aggressive posterior ROP (regress of the disease occurred in 128 of 172 eyes). The total efficacy of the complex treatment was 92.9% (regress of the disease occurred in 685 of 737 eyes). Conclusion. The basic regulations of the complex ROP treatment are an early, within first 6 weeks of chronologic age, photocoagulation to delay progression of the retinal detachment and to stabilize vascularity, and an early vitrectomy in case of ROP progressing after the laser treatment.

Based on dynamic monitoring of 163 premature infants (326 eyes) with aggressive posterior retinopathy of prematurity (ROP), digital retinoscopy and computer morphometry the disease clinical and morphometric features were revealed and systematized, and their consecutive replacement was fixed. As a result the separate classification of aggressive posterior disease was worked up. In aggressive posterior ROP course the next consecutive stages were marked out: subclinical, early clinical appearances stage, manifestation stage, advanced, far-advanced and terminal stages. The peculiarity of early clinical appearances stage and manifestation stage is the presence of such course types: favorable and unfavorable.

Purpose. To develop the vitrectomy technique under the air medium in case of progressive retinopathy of prematurity (ROP) after the laser treatment with a formation of local traction retinal detachment.Material and methods. The clinical material consisted of 30 ROP patients (42 eyes) aged 7-11 weeks of life (post-conceptual age – 37-43 weeks), in which 2-3 weeks after laser treatment for the ROP stage III (29 eyes) and aggressive posterior ROP (13 eyes) signs of further progression of the disease was observed, that was expressed in increased vascular activity in the posterior pole of the eye, intensity of retinal edema in the fovea area, the growth of fibrovascular tissue along the shaft and into the vitreous body with the formation of vitreoretinal tractions, the formation of local tractional retinal detachment with extent not more than 4-hour meridians. All patients underwent an early lens-sparing 3-port vitrectomy using the 25g systems of the Constellation device (Alcon, USA).Results. In the postoperative period the anatomic results of the early vitrectomy was estimated by the retinal attachment. The full retinal attachment was achieved in 40 eyes (95.2%), partial – 2 (4.8%). The regression of the disease was characterized by the absence of extra-renal proliferation. Positive dynamics of the process was confirmed by a fixed and statistically significant normalization of morphometric criteria. During the analysis of surgical treatment results the indications for an early vitrectomy were determined when signs of ROP progression after retinal coagulation.Conclusion. In accordance with the obtained data, it was found that the optimal period to carry out the early lens-sparing vitrectomy is 2-3 weeks after laser coagulation of the retina in case of signs of disease progression, which ensures a maximum efficiency of surgical treatment.

Purpose. To define diagnostic morphometric parameters for temporal and nasal arcades in the fundus central zone, the 2nd order vessels and peripheral vessels beyond avascular retina for each type of ROP active stages. Material and methods. There were examined 155 premature children (310 eyes) with the I, III stages of the ROP who were hospitalized for treatment at the Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution between 2010 and 2012. The patients were divided according to types of ROP active stages (type 1 – with a low risk of ROP progression, type 2 – with a high risk of ROP progressinon). Morphometric analysis of digital RetCam 120 and RetCam 3 fundus photos was made using the original software «ROPMORPHOMETRY».Results. Retinal vessels diameter, and tortuosity index increasing in the type 2 (unfavorable) as compared with the type 1 (favorable) (p

Purpose. Quantification of morphometric parameters of segments of retinal vessels of the central fundus zone, vessels of the 2nd order and peripheral vessels in the vicinity of the avascular zone to detect early signs and dynamics of stage II and III regression in retinopathy of prematurity (ROP) in different periods after laser treatment (LT).Material and methods. There were examined 50 preterm infants (100 eyes) with the type 2 (a high risk of progression) of the ROP stage II and III before and in different periods after pattern laser photocoagulation. The morphometric analysis of obtained digital images of the retina in children with ROP was performed using the retinal camera «RetCam 3» (Clarity Medisal Systems, Inc.,USA) in mode of the software «ROP-MORRNOMETRY».Results. Statistically significant differences in the diameter of retinal vessels throughout their length and the tortuosity factor of arteries in the central fundus zone in the follow-up of 1 and 2 months after laser treatment were not revealed, indicating a robust ROP regression.Conclusions. Clinical applications of data obtained in the performed study allows to optimize the postoperative monitoring of premature infants with ROP, minimizing the quantity of repeated diagnostic tests.

Purpose. To evaluate the long-term anatomical and functional outcomes of surgical treatment of the terminal stage of retinopathy of prematurity (ROP).Material and methods. The analysis of long-term anatomical and functional results lensvitrshvartectomy (LVSHE) at the ROP stage V was performed at the Leningrad Regional Pediatric Clinical Hospital in 92 patients (180 eyes) aged from 2 to 17 years (mean 4.0±0.2). A method for an anatomical evaluation of efficiency for surgical treatment of retinal detachment is proposed on the basis of calculation of the retinal attachment coefficient (Cf), as the ratio of the area of the digital image of the attached retina to the total area of digital fundus images.Results. The complete anatomical success was achieved in 35.6% (64 eyes of 53 patients), partial – in 37.2% of cases (67 eyes, 51 children), total retinal detachment was inoperable in 27.2% (49 eyes, 42 children). In the first group of patients (mean age for the LVSHE – 3.9±0.2 months) the Cf was 0.5±0.04, in the second group (age – 7.9 ±0.1 months.) – 0.6±0.03, in the third group (age – 17.1±1.52 months) – 0.4±0.02. In the groups 1 and 2 indices were statistically not significantly different, while the area of retinal attachment in the group 3 of patients was significantly lower (p

Purpose. To study possibilities of fluorescein angiography (FA) in the diagnosis and treatment tactics for retinopathy of prematurity (ROP) in case of active stages.Material and methods. Between December 2011 and March 2013 there were performed 71 fluorescent angiographies in 48 premature children with different stages of active ROP. Voluntary informed consents for the diagnostic examination were received from all the parents. The examination was carried out by the retinal pediatric digital video system «RetCam-3» equipped with a built unit for the FA.Results. The peculiarity of the retinal circulation in children with different ROP stages is a pronounced difference between vascularized and avascular retina and a clearly visualized boundary between them. It is revealed a possibility of detailed visualization of the retinal vasculature, which is not always clearly visible on the digital images. The FA allows to identify an early flat neovascularization in unfavorable forms of ROP course, which is not defined in the standard diagnostic methods.Conclusion. The FA is important additional method for children with ROP examination. The FA role in the ROP management and the control of treatment efficiency and ROP regression is invaluable.

The system of blindness prevention and visual impairment in children with retinopathy of prematurity is a multidisciplinary medical problem, and includes the prevention of the preterm birth, the correction of terms of caring for premature babies, early detection, monitoring, and treatment of retinopathy of prematurity, as well as the organization of the long clinical supervision. Patients with retinopathy of prematurity need a comprehensive approach to the prevention of the visual impairment in order to ensure high functional outcomes and improve their quality of life.

Purpose: To define diagnostic morphometric parameters for temporal and nasal arcades in fundus central zone, 2nd order vessels and peripheral vessels beyond avascular retina for each type of ROP active stages.Methods: 155 premature children (310 eyes) with I, II, III stages of ROP. The patients were divided according to types of ROP active stages (type 1 — with low risk of ROP progressing, type 2 — with high risk of ROP progressing). Morphometric analysis of digital «RetCam 120» and «RetCam 3» fundus photos was made by means of original soft «ROP-MORPHOMETRY».Results: Renal vessels diameter, and tortuosity index increasing at type 2 (unfavorable) as compared with type 1 (favorable) (pConclusion: The given retinal vessels quantitative morphometric parameters might be the precise criteria for high and low risk of ROP progressing determination within each ROP stage.

Based on dynamic monitoring of 133 premature infants (266 eyes) with aggressive posterior retinopathy of prematurity (ROP), digital retinoscopy and computer morphometry the disease clinical and morphometric features were revealed and systematized, and their consecutive replacement was fixed. As a result the separate classification of aggressive posterior disease was worked up. In ag- gressive posterior ROP course the next consecutive stages were marked out: subclinical, early clinical appearances stage, manifesta- tion stage, developed, advanced and terminal stages. the peculiarity of early clinical appearances stage and manifestation stage is thepresence of types: favourable and unfavourable.

Purpose: Functional results analysis of ophthalmologic help system for premature infants, which includes the full cycle of early revelation, treatment and regular medical check-up activities for patients with ROP in Central region of Russia.Methods: Fields for ROP screening were performed in premature infants medical care units by clinic specialists. Infants with re- vealed ROP were directed to Kaluga Branch of IRtC «Eye Microsurgery» for detailed diagnostic examination and subsequent treatment and monitoring.Results: In 2003-2011 454 fields in Kaluga, tula, Bryansk, and Orel regions were made. 8861 infants were examined. ROP was found in 1834 infants (20.7%). 823 different interventions for infants with active ROP were performed: 737 retinal lasercoagulations, 3-ports vitrectomy — 72, lensvitrectomy — 14. the total efficacy of the treatment was 92.9%.Conclusion: the ophthalmologic help system for premature infants in Central region of Russia combines all directions from de-tailed diagnostic to hich-technology treatment. It allows to reproduce one all over the Russian Federation territory.