[Neuroretinitis in children--independent observations]

INTRODUCTION

Neuroretinitis in children is a rarely occurring entity that is characterized by optic disk edema, macular hard exudates, peripapillary subretinal exudates and the presence of posterior vitreous cells. Neuroretinitis' etiology can be infectious or non-infectious. The non-infectious causes include: systemic diseases, vascular diseases, diabetes, cancer. Most cases of neuroretinitis are idiopathic. Other forms can have an infectious cause: from animal, bacterial, viral, fungal. It occurs usually as a benign complication of pediatric infectious diseases, cat scratch disease (bartonellosis), tuberculosis. Relaminar vasculitis is responsible for the clinical picture of neuroretinitis as opposed to the primary demyelination seen in optic neuritis. Exudate from the optic nerve head resulted from leakage of the disc capillaries that had extended into the macular area along the plane of the outer plexiform layer.

MATERIAL AND METHODS

The examination of 5 girls aged 8-12, hospitalized in the Ophthalmology Clinic of The Children's Memorial Health Institute in Warsaw in 2006-2007 revealed the intrabulbar neuroretinitis-type changes. Each patient was interviewed in detail and underwent full ophthalmologic examination.

RESULTS

All patients suffered from the loss of vision, 2 of them had ocular pain when looking at the sides. There was a marked afferent pupillary defect and the changes in the visual field were also reported. Fluorescein angiogram showed leakage of disk vessels; there was no leakage of other retinal vessels. In case of each girl, a vast differential diagnostics of infectious and systemic diseases was applied.

CONCLUSION

Despite significant diagnostic difficulties in this age group, 2 girls were recognized with non-pulmonary tuberculosis as the cause of neuroretinitis. The application of tuberculosis treatment significantly improved recovery.

[Problems in surgical management of persistent hyperplastic primary vitreous in children]

PURPOSE

To evaluate the surgical techniques that allows safe, effective removal of lens and retrolenticular fibrotic membranes in eyes with PHPV in children.

MATERIAL AND METHODS

A total of 31 children (18 boys and 13 girls) with PHPV and cataract in one eye were divided into 2 groups, according to treatment modality. High frequency ultrasonography were used to identify anatomic correlates in the eyes--before operation. Limbal cataract extraction combined with vitrectomy and removalof embryonic remnants was carried out in 17 eyes, and a posterior pars plana approach in 14 eyes.

RESULTS

In group with anterior approach, the most serious complication was corneal decompensation, in the next group--retinal detachement.

CONCLUSIONS

The anterior and the posterior surgical technique to remove cataract and tenacious retrolenticular membranes was effective but associated with high risk of intraoperative and postoperative complications. Although the surgical intervention is necessary to prevent progressive pathologic changes and to obtain the best possible visualresults in some cases.