Analysis of the results of treatment of secondary glaucoma in children associated with retinopathy of premature

Аннотация

This article presents an analysis of the results of hypotensive surgery for secondary glaucoma in children after complex treatment of retinopathy of prematurity. The authors of the article analyzed the surgical treatment of 5 (10 eyes) children aged 1 month to 1 year in the eye department of the clinic of Tashkent Pediatric Medical Institute with ROP associated with glaucoma. When treating secondary glaucoma in children with early stages of ROP, it is preferable to use antiglaucomatous filtration operations. Keywords: retinopathy of prematurity; secondary glaucoma; Lenswitrschwartectomy. Actuality. Primary congenital glaucoma is a rare and severe genetically heterogeneous disease that leads to blindness and low vision. In the structure of childhood visual disability, congenital glaucoma makes up 10.1% [1,2,9]. The frequency of this pathology is steadily increasing and ranges from 17 to 34% among surviving premature infants [4,5,6,10]. During the intrauterine development of the fetus, on average, starting from the 28th week of gestation, a gradual separation of the iris and ciliary body from the trabecula occurs. At the 32nd week of gestation, mesodermal tissue is most pronounced in the anterior chamber angle (ACA), which completely resolves upon reaching the 36th week of gestation [3,5,11]. The pathogenesis of Parenteral viral hepatitis (PVH) remains unclear. “Immaturity” of the anterior chamber angle (ACA) is caused by a stop in the development of tissue-derived cells of the cranial neural crest in the third trimester of gestation. During the intrauterine development of the fetus, on average, starting from the 28th week of gestation, a gradual separation of the iris and ciliary body from the trabecula occurs. At the 32nd week of gestation, mesodermal tissue is most pronounced in the ACA, which completely resolves upon reaching the 36th week of gestation [3,5,6,7]. The anatomical features of the ACA in extremely premature children against the background of I-III degrees of cicatricial ROP are similar to those in congenital glaucoma in premature infants and are characterized by uneven anterior attachment of the iris root in combination with mesodermal tissue, which leads to an increase in intraocular pressure (IOP) [7 ,8,11], with the development of the form of congenital glaucoma, the biomechanical parameters of the eye increase according to the stages. At the same time, a decrease in the rigidity of the fibrous membrane indicates morphological changes in the tissues of the eye and the severity of the glaucomatous process [9,12]. Thus, according to some authors, the development of congenital glaucoma in early childhood is associated with ROP in 57% of cases [5]. The glaucomatous process in young children occurs in premature infants in more than half (57%) of cases. Among patients with glaucoma, children with a birth weight of 1450–1700 g predominate, as well as patients who received glucocorticosteroid drugs (or did not receive treatment at all) during the active period of RP. 113 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 3 ISSUE 7 JULY 2024 ISSN: 2181-3337 | SCIENTISTS.UZ Glaucoma in premature infants in most cases (72%) develops in both eyes and corresponds to stages I–III of ROP [1,3]. In the active phase of stages I–III of ROP, hypotensive surgery in the trabecular zone was used; in the cicatricial phase of stages IV–V of ROP, combined hypotensive surgery was used both in the trabecular zone and in the ciliary body area using autoscleral drainage [10]. The purpose of the study. To present an analysis of the results of hypotensive glaucoma surgery in children after complex treatment of retinopathy of prematurity. Material and research methods. Under our supervision in the eye department of the clinic of Tashkent Pediatric Medical Institute there were 5 (10 eyes) children aged from 1 month to 1 year with ROP complicated by secondary glaucoma (classification of secondary glaucoma in young children according to Shaffer-Weiss) [11]. Active ROP stage I-III “plus” phase was diagnosed in 3 (5 eyes) patients, stages 4-5 in 3 (5 eyes) patients. Taking into account the stages of the disease, all patients were divided into 2 groups, the first included 3 (5 eyes) children with stages I-III, the second - 3 children with stages IV-V of ROP. The gestational age at birth in the examined children was 21–36 weeks. The follow-up period was 18 months. Research methods included visometry, refractometry, ophthalmoscopy, determination of optic disc excavation (E/D), A-scan with registration of the anteroposterior axis of the eyeball (APA), B-scan, gonioscopy, tonometry, tonography. Developmental defects of the ACA were determined according to Jr. Hoskins developed for secondary glaucoma anatomical classification. [12,13,14]. Results and discussion. The body weight of the examined premature children at birth ranged from 1000 g to 2400 g (on average, 1700 g), at the time of examination from 2800-9800 g (on a