The long-term influence of perinatal factors on macular morphology and vessel density in preterm children

BACKGROUND

Increased survival rate of extremely preterm children is associated with a higher risk of retinopathy of prematurity (ROP) and long-term sequelae, which implicate retinal changes.

PURPOSE

To assess an influence of perinatal characteristics on morphology and retinal vascularity of the macula in preterm children.

METHODS

A cohort of 123 preterm children at the age of 10.5 years (IQR: 8.12-12.77) was prospectively assessed. Optical coherence tomography angiography (OCTA) was performed using RTVueXR Avanti. Foveal thickness, parafoveal thickness, size of foveal avascular zone (FAZ), superficial and deep vessel density, central choroidal thickness (CCT) were analyzed. The associations between OCTA results and perinatal factors, including the presence of ROP and therapy requirements were assessed in preterm children.

RESULTS

Significantly smaller FAZ, higher foveal thickness and vessel density were noted in children with ROP, Respiratory Distress Syndrome, Bronchopulmonary Dysplasia, required erythropoietin, transfusion or steroids. Foveal thickness was increased in children with ROP (p < 0.001) and following laser treatment (p < 0.05). Thinner CCT was noted in children with a history of sepsis (p < 0.05) and ROP required treatment (p < 0.05). Pregnancy bleeding was associated with higher superficial foveal vessel density (p < 0.05) and smaller FAZ (p < 0.05).

CONCLUSION

Neonatal factors have a huge impact on retinal development, but the role of prenatal factors should not be neglected in preterm children.

Efficacy of intravitreal injections of melphalan in the treatment of retinoblastoma vitreous seeding

BACKGROUND

The introduction of intravitreal injections of melphalan (IVIM) has significantly improved the efficacy of retinoblastoma treatment and the prognosis for eye preservation.

OBJECTIVES

To evaluate the results of using IVIM to treat retinoblastoma vitreous seeding.

MATERIAL AND METHODS

This was a clinical, retrospective, single-center study. Twenty-six children (27 eyes) who met all of the following inclusion criteria qualified for the study: 1) active vitreous seeding at the time of retinoblastoma diagnosis; 2) IVIM performed between 1 January 2017 and 30 September 2020; and 3) a minimum follow-up period of 12 months since the last IVIM. Doses of 20-40 μg melphalan per injection were used.

RESULTS

The eye observation period from the last IVIM to the last ophthalmic examination averaged 32.41 months (median 30.00; range 13.00-56.00). Success (no active tumors in the vitreous body) was achieved in 24 eyes (88.9%), and a doubtful result (recurrence in the retina with a difficult-to-determine etiology) in 2 eyes (7.4%). In 1 eye (3.7%), despite treatment, active tumors were still present in the vitreous body. Out of all 27 eyes, 4 eyeballs were removed, but the direct cause of enucleation was not vitreous seeding. There were no complications in the form of intraocular inflammation, extraocular retinoblastoma or distant metastases. There was 1 case of anterior uveitis and 1 case of cataract.

CONCLUSIONS

The IVIM is a highly effective and safe form of treatment for retinoblastoma vitreous seeding.

Mapping the chemotactic landscape in NK cells reveals subset-specific synergistic migratory responses to dual chemokine receptor ligation

BACKGROUND

Natural killer (NK) cells have a unique capability of spontaneous cytotoxicity against malignant cells and hold promise for off-the-shelf cell therapy against cancer. One of the key challenges in the field is to improve NK cell homing to solid tumors.

METHODS

To gain a deeper understanding of the cellular mechanisms regulating trafficking of NK cells into the tumor, we used high-dimensional flow cytometry, mass cytometry, and single-cell RNA-sequencing combined with functional assays, creating a comprehensive map of human NK cell migration phenotypes.

FINDINGS

We found that the chemokine receptor repertoire of peripheral blood NK cells changes in a coordinated manner becoming progressively more diversified during NK cell differentiation and correlating tightly with the migratory response of the distinct NK cell subsets. Simultaneous ligation of CXCR1/2 and CX3CR1, synergistically potentiated the migratory response of NK cells. Analysis of 9471 solid cancers from publicly available TCGA/TARGET repositories revealed dominant chemokine patterns that varied across tumor types but with no tumor group expressing ligands for more than one chemokine receptor present on mature NK cells.

INTERPRETATION

The finding that chemokine stimulation can elicit a synergistic migratory response in NK cells combined with the identified lack of naturally occurring pairs of chemokines-chemokine receptors in human cancers may explain the systematic exclusion of NK cells from the tumor microenvironment and provides a basis for engineering next-generation NK cell therapies against malignancies.

FUNDING

The Polish Ministry of Science and Higher Education, the National Science Centre, Poland, The Norwegian Cancer Society, the Norwegian Research Council, the South-Eastern Norway Regional Health Authority, The Swedish Cancer Society, the Swedish Children's Cancer Foundation, The Swedish Research Council, The Center of Excellence: Precision Immunotherapy Alliance, Knut and Alice Wallenberg Foundation and National Cancer Institute.

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.

Methods

We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.

Findings

The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).

Interpretation

This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.

Funding

Queen Elizabeth Diamond Jubilee Trust.

Morphology and Vessel Density of the Macula in Preterm Children Using Optical Coherence Tomography Angiography

Background: Retinal morphology changes may be associated with prematurity and can lead to visual impairment. Optical coherence tomography angiography may contribute to understanding the pathomechanism of structural and vascular retinal impairment in premature children. The aim of this study was to assess an influence of prematurity, neonatal clinical characteristics, and a history of retinopathy of prematurity (ROP) on the morphology and retinal vascularity of macula in children. Methods: A case−control study of 123 preterm children and 86 full-term children was performed. The age of the subjects was 10.45 years (IQR: 8.12−12.77), while the age of the control group was 11.78 years (IQR: 8.81−13.79). Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA, angio-OCT) were performed using RTVueXR Avanti (Optovue, Fremont, CA, USA). Ganglion cell complex (GCC), foveal thickness (FT), parafoveal thickness (PFT), size of foveal avascular zone (FAZ) in superficial plexus, superficial capillary vessel density (sVD), deep capillary vessel density (dVD), central choroidal thickness (CCT), and presence of macular hypoplasia were analyzed. The association between OCT/angio-OCT results and clinical characteristics including the degree of ROP and therapy requirements was assessed in preterm infants. Results: Foveal morphology was affected in preterm children with high incidence of foveal hypoplasia (24.77%). GCC was thinner in preterm children compared to controls: avgGG 93 μm vs. 100 μm, p < 0.001. No associations between GCC and gestational age (R = −0.085; p = 0.228) and birth weight (R = −0.054; p = 0.446) were found. FAZ in preterm group was smaller than in controls (0.13 ± 0.09 vs. 0.22 ± 0.09; p < 0.001). FAZ area correlated with gestational age (R = 0.456; p < 0.001) and birth weight (R = 0.472; p < 0.001). Deep vessel density in the fovea was higher in preterm children than in control group (p < 0.001). PFT was significantly lower in preterm children compared to control group. However, increased thickness in the fovea was noted in preterm children (p < 0.001). FT was inversely correlated with gestational age (R = −0.562; p < 0.001) and birth weight (R = −0.508, p < 0.001). CCT was lower in preterm children (312 μm vs. 337.5 μm, p < 0.001) Parameters of GCC and FT were higher in patients with ROP required treatment compared to patients without ROP and spontaneously regressed retinopathy. FAZ was smaller in patients with retinopathy than in preterm children without ROP. Conclusion: Prematurity has a significant negative impact on GCC, macular morphology, and vascularization. In premature children, decreased FAZ, increased FT, and vessel density were strongly associated with gestational age, birth weight, Apgar score, ROP stage, and treatment requirement. Optical coherence tomography angiography is a useful tool for detecting retinal changes in premature children.

Choroidal thickness changes in children with chronic heart failure due to dilated cardiomyopathy

PURPOSE

To evaluate choroidal thickness (CTh) in children with chronic heart failure (CHF) secondary to dilated cardiomyopathy (DCM) using spectral domain optical coherence tomography (SD-OCT) and to compare their values to those of healthy children.

METHODS

Sixty eyes of thirty children (mean age 9.9 ± 3.57 years) with chronic heart failure (left ventricular ejection fraction, LVEF ≤ 55%) due to DCM lasting for over 6 months were prospectively enrolled. The control group consisted of 30 age- (mean age 10.16 ± 3.42 years) and sex-matched healthy children. All participants underwent transthoracic echocardiography with LVEF measured using the Simpson method and had the blood serum level of N-terminal-pro-brain natriuretic peptide marker (NT-proBNP) determined. All children underwent SD-OCT and had subfoveal choroidal thickness (SFCTh) and CTh measured at 1500 µm (μm) nasally, temporally, superiorly and inferiorly from the fovea in both eyes by two investigators.

RESULTS

CTh at all locations was statistically significantly lower in children with DCM compared to the control group. Mean CTh in the group with CHF compared to the control group were (304.03 vs. 369.72 μm, p < 0.05) at the subfoveal location, (245.87 vs. 284 μm, p < 0.05) 1500 μm nasally from the fovea, (291.5 vs. 355.95 μm, p < 0.05) 1500 μm temporally from the fovea, (303.98 vs. 357.58 μm, p < 0.05) 1500 μm superiorly from the fovea and (290.92 vs. 344.96 μm, p < 0.05) 1500 μm inferiorly from the fovea. The average difference CTh between the study groups ranged from 38.13 to 65.69 μm at individual locations. In both groups, CTh was the thickest at subfoveal location (304.03 vs. 369.72 μm, p < 0.05) and the thinnest was 1500 μm nasally from the fovea (262.37 vs. 336.87 μm, p < 0.05). There was no correlation between CTh and age, gender, biometry and refractive error. No correlation was found between CTh and LVEF and NT-proBNP.

CONCLUSION

Patients with CHF due to DCM had a thinner CTh at all measured locations. The results of our research indicate that CHF affects CTh and this parameter may be very helpful in monitoring the clinical course of the disease in children with DCM.

The effect of coexisting autoimmune thyroiditis in children with Type 1 diabetes on optical coherence tomography results

OBJECTIVE

To assess the influence of thyroid hormones status and coexistence of autoimmune thyroiditis on optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) results in children with Type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS

In the prospective, observational study (n = 175) we analyzed the impact of thyroid hormones on OCT results and the differences between the matched groups of children with T1D (n = 84; age = 13.14 ± 3.6; diabetes duration = 5.99 ± 3.3 years) and the children with T1D and autoimmune thyroiditis (AT) (n = 20; age = 13.94 ± 3.6; diabetes duration = 6.7 ± 4 years). We analyzed the following parameters: fovea avascular zone (FAZ), foveal thickness (FT), parafoveal thickness (PFT), ganglion cell complex (GCC), loss volume (global-GLV, focal-FLV), capillary vessel density: superficial (whole-wsVD, foveal-fsVD, parafoveal-psVD), and deep (whole-wdVD, foveal-fdVD, parafoveal-pdVD. The differences between the groups were tested by the unpaired t-Student test, Mann-Whitney U test as appropriate, whereas p level .05 was recognized as significant.

RESULTS

We detected the significant correlations between thyroid-stimulating hormone (TSH) level and PFT (r = -0.14; p < .05), psVD (r = -0.18; p < .005). The level of free triiodothyronine (FT3) was correlated with psVD (r = -0.14; p < .05). We found significant correlation between free thyroxine (FT4) and fsVD (r = -0.17; p < .01). In the studied T1D and AT groups there were statistical differences in FT (p < .005), PFT (p < .03), GCC (p < .01), and GLV (p < .003). We did not observe any significant differences in the FAZ area between the groups.

CONCLUSIONS

In our patients the co-occurrence of T1D and AT worsens the status of retinal parameters. Further studies are necessary to observe these relations and their potential influence on the occurrence of diabetic retinopathy (DR).

Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome

Background

Cohen syndrome (Q87.8;ORPHA:193; OMIM#216550) is an autosomal recessive inherited genetic disorder caused by mutation in the VPS13B/COH1 gene. It is characterized by variable clinical symptoms such as deformity of the head, face, hands and feet, eye abnormalities, abdominal obesity, neutropenia and nonprogressive intellectual disability. The typical lesions in the eyeball in Cohen syndrome include high myopia, retinal dystrophy, strabismus, maculopathy and lens subluxation. The present study describes the coexistence of bilateral macular edema with pale optic disc in a patient with a homozygous deletion in the VPS13B/COH1 gene.

Material and methods

A 6-year-old Caucasian girl with facial dysmorphism, microcephaly, prominent upper incisors, narrow hands with slender fingers, congenital heart defect and ophthalmic symptoms was subjected to genetic testing. The genetic evaluation revealed a homozygous deletion on the long arm of chromosome 8 encompassing 20-25 exons of the VPS13 gene, as confirmed by Cohen syndrome. She underwent a full ophthalmological examination with the assessment of slit lamp examination of anterior segment and fundoscopy, refraction error, biometry, central corneal thickness and additionally electroretinography, optical coherence tomography and fundus photography.

Results

In the ophthalmologic examination, the girl had bilateral astigmatism accompanied by myopia and a marked reduction in central corneal thickness. Fundus examination showed pale optic nerve discs and "salt and pepper" retinopathy. Bilateral cystic macular edema was revealed in handheld optical coherence tomography. Electroretinography showed a reduced response amplitude of cones and rods.

Conclusion

In a patient with high myopia, macular edema, pale optic disc and facial dysmorphism, Cohen syndrome should be considered in the differential diagnosis. The severity of individual clinical features in patients with Cohen syndrome varies. It can be assumed that the type of mutation affects the occurrence and severity of individual symptoms.

Influence of Metabolic Parameters and Treatment Method on OCT Angiography Results in Children with Type 1 Diabetes

AIM

To evaluate the influence of metabolic parameters and the treatment method in children with type 1 diabetes (T1D) on the optical coherence tomography angiography (OCTA) results as early markers of diabetic retinopathy (DR). Material and Methods. This prospective study enrolled 175 consecutive children with T1D. OCTA was performed using AngioVue (Avanti, Optovue). Whole superficial capillary vessel density (wsVD), fovea superficial vessel density (fsVD), parafovea superficial vessel density (psVD), whole deep vessel density (wdVD), fovea deep vessel density (fdVD), parafovea deep vessel density (pdVD), foveal thickness (FT), parafoveal thickness (PFT), and foveal avascular zone (FAZ) in superficial plexus were evaluated and analyzed in relation to individual characteristics, i.e., sex, weight, height, body mass index (BMI), and metabolic factors: current and mean value of glycated hemoglobin A1c (HbA1c). Furthermore, the analysis concerned the diabetes duration, age at the T1D onset, and type of treatment-multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII).

RESULTS

In the study group, we did not identify any patient with DR in fundus ophthalmoscopy. Age at the onset of diabetes correlated negatively with FAZ (r = -0.17, p < 0.05). The higher level of HbA1c corresponded to a decrease of wsVD (r = -0.13, p < 0.05). We found significantly lower fsVD (32.25 ± .1 vs. 33.98 ± .1, p < 0.01), wdVD (57.87 ± .1 vs. 58.64 ± .9, p < 0.01), and pdVD (60.60 ± .2 vs. 61.49 ± .1, p < 0.01) and larger FAZ area (0.25 ± .1 vs. 0.23 ± .1, p < 0.05) in the CSII vs. MDI group.

CONCLUSION

The metabolic parameters, age of the onset of diabetes, and treatment method affected the OCTA results in children with T1D. Further studies and observation of these young patients are needed to determine if these findings are important for early detection of DR or predictive of future DR severity.

Optical coherence tomography angiography of superficial retinal vessel density and foveal avascular zone in myopic children

Purpose

To assess the superficial retinal vessel density (SRVD) and foveal avascular zone (FAZ) in myopic children using optical coherence tomography angiography (OCTA).

Methods

174 eyes of 89 subjects with myopia and 101 eyes of 54 age-matched, emmetropic volunteers (control group) were enrolled in this study. The mean age of the subjects and controls was 13.9 (SD ± 2.3) and 13.1 (SD ± 2.4), respectively. Myopia was defined as spherical equivalent <– 1.0 diopter. Emmetropic subjects were defined as having spherical equivalent from + 0.5 to − 0.5 diopter. The mean axial length (AL) in myopic patients was 24.58 mm (SD ± 1.22) and 22.88 mm (SD ± 0.65) in the controls. Every patient underwent a complete ophthalmological examination and OCTA, using AngioVue (Optovue). The FAZ area and superficial retinal vessel density, including whole SRVD, fovea SRVD and parafovea SRVD, were analyzed. Foveal thickness (FT) and parafoveal thickness (PFT) were also taken into consideration.

Results

Whole SRVD, parafovea SRVD and PFT were significantly higher in controls than in the myopic subjects (p < 0.001, p = 0.007, p < 0.01, respectively). The FAZ area was significantly larger in the myopic group compared to the controls (p = 0.010). Fovea SRVD and FT did not differ significantly between the groups (p = 0.740, p = 0.795 respectively). In overall subjects we found significant correlation between axial length and all the investigative parameters: age, FAZ area, whole SRVD, parafovea SRVD, fovea SRVD, PFT, FT (p < 0.001, p = 0.014, p = 0.008, p < 0.005, p = 0.014, p = 0.010, p = 0.024, respectively). Analyzing only myopic group we confirmed that AL was significantly correlated with age, whole SRVD and parafovea SRVD (p < 0.001, p = 0.014, p = 0.009, respectively). Similarly, in this group the spherical equivalent also correlated with age, whole SRVD and parafovea SRVD (p < 0.001, p = 0.007, p = 0.005, respectively). Such correlations were not confirmed in the non–myopic group.

Conclusions

Our results suggest that superficial retinal vessel density is decreased and FAZ area is enlarged in the entire group of the myopic children compared to emmetropic subjects. Longitudinal observation of these young patients is needed to determine the relevance of the microvascular alterations in future.

Choroidal Thickness and Ganglion Cell Complex in Pubescent Children with Type 1 Diabetes without Diabetic Retinopathy Analyzed by Spectral Domain Optical Coherence Tomography

AIM

To assess the retinal and choroidal thickness and ganglion cell complex (GCC) in pubescent children with type 1 diabetes (T1D) without diabetic retinopathy (DR), using spectral domain optical coherence tomography (SD-OCT).

MATERIALS AND METHOD

Sixty-four right eyes of 64 subjects with T1D and 45 right eyes of 45 age-matched healthy volunteers (control group) were enrolled in this study. The mean age of the subjects and controls was 15.3 (±SD = 2.2) and 14.6 (±SD = 1.5), respectively. SD-OCT was performed using RTVue XR Avanti. Ganglion cell complex (GCC), GCC focal loss volume (FLV), GCC global loss volume (GLV), choroidal thickness (CT), foveal (FT) and parafoveal thickness (PFT), and foveal (FV) and parafoveal volume (PFV) data were analyzed.

RESULTS

There was no significant difference between subjects and controls in the CT in the fovea and nasal, temporal, superior, and inferior quadrants of the macula. There were no significant correlations between CT, duration of diabetes, and HbA1C level (p = 0.272 and p = 0.197, resp.). GCC thickness did not differ significantly between the groups (p = 0.448), but there was a significant difference in FLV (p = 0.037). Significant differences between the groups were found in the PFT and PFV (p = 0.004 and p = 0.005, resp.). There was a significant negative correlation between PFT, PFV, and HbA1C level (p = 0.002 and p = 0.001, resp.).

CONCLUSIONS

Choroidal thickness remains unchanged in children with T1D. Increased GCC FLV might suggest an early alteration in neuroretinal tissue. Parafoveal retinal thickness is decreased in pubescent T1D children and correlates with HbA1C level. OCT can be considered a part of noninvasive screening in children with T1D and a tool for early detection of retinal and choroidal abnormalities. Further OCT follow-up is needed to determine whether any of the discussed OCT measurements are predictive of future DR severity.

Orbital tumor as an initial manifestation of Wegener's granulomatosis in children: a series of four cases

BACKGROUND

Wegener's granulomatosis (WG) is a rare idiopathic disease in which small and medium-sized arteries are affected by necrotizing granulomatous inflammation. It is associated with a triad of pulmonary (cavitating granulomatous lesions with hemoptysis, cough, and dyspnea), renal (glomerulonephritis with hematuria, proteinuria), and head (otitis media, recurrent sinusitis, eye or orbital involvement) manifestations.

CASE REPORT

Four children aged 7-11 years diagnosed with WG between 1995-2008 initially presented with unilateral proptosis and ptosis due to orbital tumor. CT or MRI, orbital lesion biopsy, and laboratory tests (ERS, CRP, ANCA) were part of the diagnostic workup. The diagnoses were based on correlation between clinical presentation and diagnostic findings. All four patients had orbital lesions on contrast-enhanced CT and MRI. Two had lesions of the temporal pyramid. Orbital tumor biopsies showed granulomatous lesions in two patients, necrotizing vasculitis with leukocytoclasia in three, and an orbital pseudotumor in one. ESR and CRP were positive in all. ANCA positivity was variable (c-ANCA did not allow WG diagnosis or there were atypical ANCAs). All had blood and protein in the urine, but only one had advanced renal involvement. All were treated with oral steroid and immunosuppression; remission was successful.

CONCLUSIONS

WG is often more difficult to diagnose in children than in adults due to frequent absence of its signature features. The absence of the classic triad and atypical laboratory or biopsy findings do not exclude a diagnosis of WG. Orbital demonstration helps achieve early diagnosis and treatment of this potentially fatal rheumatologic disease.

[Retinopathy of prematurity]

Retinopathy of prematurity is a noteworthy problem in the ophthalmology of children. This paper presents current views on epidemiology, risk factors, pathogenesis and treatment of this disease.

[Optic nerve atrophy--the main cause of visual impairment in children and young adults]

Blindness and visual disability are a very significant problem all over the world. Inflammation, metabolic disorders, tumours, hereditary optic neuropathies may all lead to visual impairment. The main cause of visual impairment and disability in children and young adults is optic nerve atrophy. THE AIM of the paper is the presentation of clinical features and treatment of nerve atrophy in children. Patients with optic nerve disorders should receive effective refraction and amblyopia treatment.

[Evaluation of the results of treatment orbital rhabdomyosarcoma in children]

PURPOSE

To estimate the state of the vision organ in the children treated for orbital rhabdomyosarcoma. Rhabdomyosarcoma (RMS) is the most common primary malignant orbital tumor in children. RMS usually manifest clinically as rapidly progressive exophthalmus and displacement of the globe. The diagnosis is based on biopsy, CT and MR images. The treatment includes radiation, chemotherapy, and surgery.

MATERIAL AND METHODS

The retrospective review of data of 14 children between 0 and 11 years old with rhabdomyosarcmoa of orbit. After a biopsy, with precedent CT or MRI, all patients were treated with chemotherapy including or not including radiotherapy.

RESULTS

3 children died, orbital exentaration was necessary because of tumor recurrence in 3 cases, 8 children remained healthy (without recurrent disease).

CONCLUSIONS

Fast diagnosis using CT, MRI and the result of biopsy, have a positive influence on the effect of neoplastic treatment and prognosis.

[Conservative treatment in patients with unilateral retinoblastoma]

THE AIM of our study was to evaluate results of conservative treatment of patients with unilateral retinoblastoma.

MATERIAL AND METHODS

Twenty one patients, 11 boys and 10 girls aged 2 months to 4, 5 years (median age 1 year) were studied. Local disease advancement according to Reese-Elsworth was defined in all patients. Neoadjuvant chemotherapy consisting of Vincristine, Etoposide and Carboplatin was administered. After every 2 courses tumour response was evaluated. Sixteen patients were treated with chemotherapy alone. Local treatment including brachytherapy, thermochemotherapy and cryotherapy was implemented and the choice of the method depended on the tumour's localization, size and response to chemotherapy. Statistical analysis using demographic data and survival curves were performed.

RESULTS

On completion of treatment all patients achieved tumour regression. Eleven patients are progression free with a follow-up from 10 months to 6 years 4 months (median--2 yrs 5m). In 10 patients relapse was observed. A total of seven enucleations were performed in the examined group. In histopathological examination viable tumour cells were present in all removed eye balls. Distant metastases were not observed in any of these patients. All patients are alive with a follow-up from 10 months to 9 yrs 6 months (median--4 yrs 7 months) from diagnosis. Disease free survival and ocular survival is 44% and 54% respectively.

CONCLUSION

Neoadjuvant chemotherapy in unilateral retinoblastoma allows to avoid enucleation in some patients.

[Influence of intraoperative complication on intraocular rigid lens fixation in pediatric cataract surgery]

PURPOSE

This paper presents the intraoperative complications in pediatric cataract surgery with IOL implantation and their influence on fixation place.

MATERIAL AND METHODS

384 eyes of 276 children undergone operative procedure for cataract. Anterior capsulorhexis, lens cortical aspiration, primary posterior capsulorhexis with anterior vitrectomy and IOL implantation were done in all eyes. The place of IOL implantation was capsular sac or ciliary sulcus.

RESULTS

There were no serious intraoperative complications but in cases with large anterior (5.2%) and posterior (14.6%) radial capsule tears, vitreous loss (12.3%), and hemorrhage (5.5%) to anterior and posterior chamber the IOL was fixated at ciliary sulcus (in 37.5%).

CONCLUSIONS

The surgical procedure is useful and safe in the management of pediatric cataract. Location of an IOL in the ciliary sulcus in a child, is acceptable. To avoid decentration in this cases, we recommend rigid PMMA IOLs.

[Bilateral optic nerve sheath meningioma (ONSM) --diagnostic and therapeutic problems]

The authors describe the case of bilateral optic nerve sheath meningioma /ONSM/ in 14 years old girl. When being hospitalized at the Neurology Clinic with paresis n.VII, the patient was examined by ophthalmologist. The diagnosis was made on the basis of clinical and characteristic changes revealed by USG, CT and MRI. The very first ophthalmologic examination confirmed a visual acuity 5/5 OD and hand movements OS, associated with papilloedema OD and edematous optic atrophy OS. The use of USG, CT and MRI revealed bilateral tubular thickening of the optic nerves (8mm), with calcification. After the period of one year, clinical progression was observed. The intracranial tumor extended. It was shown in diagnostic imaging. The patient was operated on by neurosurgeons with histopathology verification. In the later stage she underwent radiotherapy. The case has been described because of its diagnostic and therapeutic difficulties.

[Lens subluxation as a sign of medulloepithelioma in 13 years boy--case report]

The paper presents the case of the 13 years old boy with the deterioration of vision acuity of the right eye, caused by lens subluxation. The condition was caused by tumour of ciliary body. Additional tests: USG, UBM, CT did not resolve diagnostic doubts. After the biopsy medulloephitelioma was diagnosed and the decision of the eye enucleation was made. Histopathological examination confirmed the diagnosis.

[Screening for retinopathy of prematurity--qualification criteria on the basis of our experience]

Retinopathy of prematurity is a serious disease which may cause blindness. Modern laser treatment is effective but must be done in right time. The aim of the work is to answer the question: what principles should be used in ophthalmic screening in Poland. 267 premature newborn with 3rd stage of ROP treated with laser coagulation were taken into account. Birth weight of treated children ranged from 490 to 1980 grams, gestation age ranged from 23 to 34 weeks. Laser photocoagulation was carried out between 25 and 147 days of life. Analysis of the above data leads to the following conclusions: compulsory screening for ROP in Poland should be limited to all children born before or in 34 week of gestation and children with birth weight less than 2000 grams; first examination should take place in the 4th week of life.

[Evaluation of results of enucleations with orbital implant in children and adolescents]

PURPOSE

The aim of the research is the assessment of results of enucleation with orbital implant in children.

MATERIAL AND METHODS

Examinations included the group of 99 children between 6 months and 19 years of age. The examined group consisted of 39 boys (39.4%) and 60 girls (60.6%). 96 eyes were removed because of non-regressive retinoblastoma (despite applied treatment), two eyes with buphtalmus (with no light perception), as a result of glaucoma, and one case of medulloepithelioma. The applied implants were: Castroviejo--in 28 patients, Medpor--in 24 patients, Hydroxyapatite--46 patients. In one patient was applied Baush and Lomb orbital implant.

RESULTS

In 91 patients (91.9%) no significant complications occurred. In 2 patients (2%), the hemorrhage occurred during the surgery. Postoperative complications included: in 6 patients (6.1%) exposition of orbital implant was observed; in one patient the exposition was enlarging which led to removal of the implant; in 2 patients with implant exposition (2%) inflammatory granuloma occurred on the edge of the exposition. In one patient (1%) cyst of conjunctiva in the postoperative scar area occurred 3 months after operation.

CONCLUSIONS

Enucleation with orbital implant enables normal development of the orbit and improves cosmetic effect. The frequency of complications depends on type of applied orbital implant.

[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.

[The results of treatment of retinopathy of prematurity by laser photocoagulation]

PURPOSE

The subject of paper was to assess: 1. The child's age, when the threshold retinopathy is diagnosed. 2. To estimate the correlation between gestational, corrected and chronological age of the child at the time of the ophthalmologic surgery. 3. To estimate the effect of the treatment on the ROP's regress and to find the risk factors of the progress of retinopathy despite of the treatment.

MATERIAL AND METHODS

We studied 103 children treated because of the retinopathy of prematurity. The mean chronological age at the time of the surgery was 74,8 day +/- 18,3 and corrected age was 37,7 Hbd +/- 3,2. To assess the risk factors of the progress of the ROP despite the treatment we formed the group I- 57 children with the retinopathy's regress after the surgery and group II- 23 children with unfavorable outcome of the disease (i. e. partial or complete retinal detachment at least unilaterally).

RESULTS

Fetal age correlated with corrected age at the time of the surgery (r=0,57, p<0,0001) and there was a negative correlation between gestational and chronological age at the time of the surgery (r = -0,23, p=0,02). Statistical significance was achieved by the stage of ROP before the surgery and the effects of the treatment (chi2=43,8, p<0,0001).

CONCLUSIONS

The risk of the threshold retinopathy before 36 week of corrected age increases with decreased gestational age. There is positive correlation between corrected age and gestational age. The laser photocoagulation performed in appropriate time stops progression of ROP. The photocoagulation of the retinopathy is a very important risk factor of the severe vision impairment when it is made too late (more than 3rd stage of ROP). The progress of ROP despite of laser therapy is more likely in the most premature babies with small weight gain.

[Visual and auditory impairment in children with congenital cytomegalovirus and Toxoplasma gondii infection]

Intrauterine infections are an important cause of hearing and visual impairment in children. The aim of this paper was to evaluate the character and frequency of hearing and visual disturbances in children with congenital toxoplasmosis and cytomegalovirus infection. 38 out of 54 children with congenital toxoplasmosis as well as 34 out of 403 children with congenital human cytomegalovirus disease, with visual/auditory impairment, hospitalized in Infant Department in Children's Memorial Health Institute between 1995-2001 were enrolled in this study. Visual impairment was observed in all children with toxoplasmosis (with visual dysfunction rate of 74%), but there was no deafness found. Vision impairment had been observed in 18% of children with congenital cytomegalovirus infection compared to 35% of children with auditory impairment (bilateral deafness had been found in half of them). Neurological deficits' rate was much higher in children with toxoplasmosis (52% vs. 4%). Because of common hearing impairment in children with congenital cytomegalovirus infection and vision impairment in children with congenital toxoplasmosis, it is essential to start the prophylaxis to decrease the percentage of handicapped children.

[Treating retinopathy of prematurity with laser diode photocoagulation]

AIM

The purpose of the study was to assess the outcomes of the diode laser in the treatment of retinopathy of prematurity and to discuss the up-to-date possibilities of treating of active phase of this disease.

MATERIAL AND METHODS

96 children (185 eyes) treated with diode laser retinal photocoagulation for active stage 3 of ROP in our department in years 1996-2000.

RESULTS

Favorable structural outcome was observed in 83.8% of treated eyes. In the remaining eyes the disease progressed despite of the treatment and falciform retinal fold (5.4%), partial retinal detachment (6.5%) and total retinal detachment (4.3%) developed. No serious complications were observed after the treatment.

CONCLUSIONS

Diode laser retinal photocoagulation is a safe and effective procedure for treating active stage 3 of retinopathy of prematurity. It has been especially useful for treatment of changes in zone 1 and 2 of the disease. Diode laser photocoagulation is now the preferred method of treating active stage 3 of ROP in our department.

[Experimental toxocariasis in rabbits: immunological markers of ocular infections]

Rabbits were infected with an oral dose of 50 000 eggs of Toxocara canis or with an intracarotid injection of the second stage larvae of the parasite in order to develop ocular toxocariasis. Serum and ocular fluid samples were collected from the rabbits after 1, 3 and 6 months after infection and examined for specific toxocaral antibodies and circulating parasite antigen. Furthermore, an ophthalmoscopic examination was performed at the time of sampling. None of the infected animals showed the signs of ocular involvement, however, toxocaral IgG antibodies and circulating parasite antigen were present in the anterior chamber fluid samples.

[Examination of ocular lesions in drug abusers in Poland]

The authors present ocular symptoms in 116 drug abusers. They have observed optic atrophy and defects in visual field in 9 cases, reduced convergence in 8 cases, slow pupillary reaction in 9 cases, ptosis in 3 cases, nystagmus in 2 cases, retinal haemorrhages in the nerve fibre layer in 2 cases, myopia in 45 cases and blepharoconjunctivitis in most of cases. The authors want to indicate the principal ocular signs in drug abusers in our country.

[Experimental studies on the influence of millimeter radiation on light transmission through the lens]

The influence of microwave radiation in millimetre range on the eye has not been investigated so far. However, it is known that microwaves of different wave-length can induce the development of the cataract. Therefore the purpose of the study was to investigate light transmission through the lens after exposure to microwave radiation in millimetre range. The studies were carried out on 22 rats exposed to microwave radiation of 5.6 mm length and power per unit area 10 mW/cm2 or 1 mW/cm2 during 58 days. Light transmission through the isolated lenses was measured spectrophotometrically. Transmission through the lenses was significantly decreased (about 33%) in the rats exposed to microwave radiation of 10 mW/cm2. The results of the study indicate that also microwave radiation in millimetre range can induce changes in the lens, predisposing to cataract development.