First Author: O.Kolenko RUSSIA
Co Author(s): A. Khudiakov A. Vasiliev 0 0 0 0 0 0 0 0 0
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the analysis of clinical efficiency, features of surgical treatment and outcomes at the PHPV various clinical forms.
The Khabarovsk branch of the State Institution Eye Microsurgery Complex named after S.N. Fyodorov, Khabarovsk, Russia
Monitoring of 13 cases (13 eyes) of PHPV in children aged from 3 months till 2 years was carried out. Boys – 6, girls – 7. The 1st degree of PHPV was in 4 eyes, the 2nd – in 4 cases, the 3rd – in 3 eyes, the 4th degree – in 2 cases. In all cases this pathology was combined with the congenital cataract (CC) of different stages. At the 1st degree HA was fixed to a posterior capsule of lens. Full and filmy CC was found at the 2nd degree, also it was acoustically identified a dense band from area of an optic nerve disk (OND) to a lens. In 6 cases at the 2nd and 3rd degrees the diagnosis of PHPV was established only in previous operation for CC. At the time of PHPV treatment in 4 cases the artiphakia took place and in 2 cases - aphakia. Length of an eye varied from 15.5 to 17 mm. Its indicators were lower than on a pair eye on 1-2 mm. To all patients a transciliary 3-ports vitrectomy with removal of proliferative tissue was executed. The term of supervision made from 3 months to 5 years.
Surgery at the 1st and 2nd degrees of PHPV and CC included: CC aspiration in 4 cases, excision of filmy CC - 3 cases. IOL was implanted in 6 cases. At the 3rd and 4th degrees of PHPV we removed fibrovascular retrolental membrane bimanually. Fibrous tissue on the extended ciliary appendages was removed carefully. The dosed transciliary 3-ports vitrectomy – in all cases. Ectomy of HA was carried out up to the height of 1.5 mm from OND. For hemorrhage prevention (8 eyes) HA proximal part was exposed previously to a diatermocoagulation. In 5 eyes – disproportion of intensity of proliferative process in anterior and posterior eye segment. So, in 4 eyes we revealed the reduced HA during operation, without observing thus anatomic retinal violations. In 2 cases when fibrovascular band took the central retina, causing its tractional detachment, we carried out its full separation from a retina. 6-12 months later in all cases the gradual growth of an eye was noted. Courses of amblyopia treatment were appointed to all patients. In 7 cases visual acuity was estimated, as “perception and tracking”. At one 4-year-old child visual acuity reached 0.3. In other cases it wasn’t possible to define visual acuity.
Modern methods of vitreoretinal surgery allows to carry out anatomic reconstruction of anterior and posterior segment of an eye at PHPV. Our experience shows that for decrease in risk of hemorrhagic and proliferative complications it is necessary to remove HA most fully with a careful diatermocoagulation of its remains. The combination of the expressed retrolental fibroplasia with anterior microphthalmia is not always accompanied by retina pathology. Even existence of the 4th degree of PHPV with condition of the kept transparency of a cornea shouldn't be contraindication for surgical rehabilitation of the patient.