Possibilities of a differentiated approach to the treatment of congenital and acquired myopia

Abstract

Aim: The aim of this investigation is to study the pathogenetic, clinical, and functional differences between congenital and acquired myopia for creating differentiated strategies of treatment and preventing complications in various forms of myopia.

Materials and methods: This study included 377 patients, aged 2.5 to 43 years. It involved performing 120 operations (120 eyes) on 90 patients according to our methods, using a sealant by the Snyder-Thompson method. The observation period was from 3 to 8 years. The ophthalmic examination included visometry, autorefractometry for conditions of cycloplegia, biomicroscopy, ophthalmoscopy, echobiometry, and an examination on the analyzer of biomechanical properties of the eye. The level of cortisol in the serum and the vegetative Kerdo index (KI) were determined according to a known technique.

Results: We have established that the characteristic features of congenital myopia are relatively higher when compared with acquired high myopia, the values of corneal hysteresis (CG), and acoustic sclera density (APS), a less pronounced hormonal imbalance, and a narrower range of vibrations of the KI. Scleral reinforcement surgery sealed the posterior pole and had a 100% stabilizing effect for one year, 95.2% for three years, and 90.5% for six to eight years. A decrease in the frequency of high degree amblyopia was revealed in patients with soft contact lenses (62.8%), with a bioptic correction type of 70%, and in patients with toric MKL (TQCL) by 72%.

Conclusions: The proposed additional diagnostic criteria for congenital and acquired myopia allow the verification of the diagnosis. They should be considered in predicting the course and choosing appropriate treatment strategies for various forms of myopia. The developed technique of scleral reinforcement treatment of complicated high myopia by sealing the posterior pole of the eye with an implant from a biologically active synthetic plastic material that does not undergo biodegradation. This makes it possible to improve the metabolism of the tissues of the posterior pole, stabilize the myopic process effectively, increase visual functions, and inhibit the development of ocular complications. An optimal correctional tactic was developed for increasing visual acuity in patients with congenital nearsightedness above 10.0 Dpt., and myopic astigmatism of medium and high degrees, which consisted of the combination of MKL with spectacular correction of the astigmatic component (bioptics).

Keywords

congenital myopia / acquired myopia / treatment of complicated myopia / correction of high myopia / cortisol / Kerdo index

References

[1] Avetisov ES. Myopia. Moscow: Meditcine. 1999. (in Russian)

[2] Аветисов Э.С. Близорукость. М.: Медицина; 1999.

[3] Libman ES. Clinical features of progressive myopia. In: Myopia: Collection of scientific articles. Riga; 1979:32-5. (in Russian)

[4] Либман Е.С. Клинические черты прогрессирующей близорукости. В кн.: Миопия: Сборник научных статей. Рига; 1979:32-5.

[5] Neroev VV. New aspects of the problem of pathology of the retina and optic nerve. Vestnik oftal’mologii. 2000;116(5):14-6. (in Russian)

[6] Нероев В.В. Новые аспекты проблемы патологии сетчатки и зрительного нерва. Вестник офтальмологии. 2000;116(5):14-6.

[7] Tarutta EP. Complicated myopia as a cause of disability and the possibility of prevention in children. In: Eliminating Avoidable Blindness: A WHO World Initiative. Elimination of Childhood Blindness: Proceedings of the 2nd Russian Interregional Symposium. Moscow; 2004:92-9. (in Russian)

[8] Тарутта Е.П. Осложненная близорукость как причина инвалидности и возможности ее профилактики в детском возрасте. В кн.: Ликвидация устранимой слепоты: всемирная инициатива ВОЗ. Ликвидация детской слепоты: Материалы 2-го Российского межрегионального симпозиума. М.; 2004:92-9.

[9] Iomdina EN. Biomechanical and biochemical disorders of the sclera in progressive myopia and correction methods. In: Avetisov SE, Kashchenko TP, Shamshinova AM, ed. Visual function and its correction in children. Moscow: Meditsina; 2005:163-83. (in Russian)

[10] Иомдина Е.Н. Биомеханические и биохимические нарушения склеры при прогрессирующей близорукости и методы их коррекции. В кн.: Аветисов С.Э., Кащенко Т.П., Шамшинова А.М., ред. Зрительные функции и их коррекция у детей. М.: Медицина; 2005:163-83.

[11] Curtin BJ. Physiologic vs pathologic myopia: genetics vs environment. Ophthalmology. 1979;86(5):681-91. Doi: 10.1016/s0161-6420(79)35466-5.

[12] Curtin B.J. Physiologic vs pathologic myopia: genetics vs environment. Ophthalmology. 1979;86(5):681-91. Doi: 10.1016/s0161-6420(79)35466-5.

[13] Katargina LA, Mikhaylova LA. The current stage of the ophthalmological care service in the Russian Federation (2012-2013). Russian Pediatric Ophthalmology. 2015;10(1):5-10. (in Russian)

[14] Катаргина Л.A., Михайлова Л.А. Состояние детской офтальмологической службы в Российской Федерации (2012-2013 гг.). Российская педиатрическая офтальмология. 2015;10(1):5-10.

[15] Libman ES, Shakhova EV. Blindness, low vision and visual disability in the Russian Federation. In: Eliminating Avoidable Blindness: A WHO World Initiative. Elimination of Childhood Blindness: Materials of the 1st Russian Interregional Symposium. Ufa; 2003:38-42. (in Russian)

[16] Либман Е.С., Шахова Е.В. Слепота, слабовидение и инвалидность по зрению в Российской Федерации. В кн.: Ликвидация устранимой слепоты: всемирная инициатива ВОЗ. Ликвидация детской слепоты: Материалы 1-го Российского межрегионального симпозиума. Уфа; 2003:38-42.

[17] Khvatova AV. The main directions of elimination of removable childhood blindness. In: Eliminating Avoidable Blindness: A WHO World Initiative. Elimination of Childhood Blindness: Materials of the 1st Russian Interregional Symposium. Ufa; 2003:53-9. (in Russian)

[18] Хватова А.В. Основные направления ликвидации устранимой детской слепоты. В кн.: Ликвидация устранимой слепоты: всемирная инициатива ВОЗ. Ликвидация детской слепоты: Материалы 1-го Российского межрегионального симпозиума. Уфа; 2003:53-9.

[19] Samatova PP. Development of methods for the prognosis and treatment of progressive myopia in children. [dissertation abstract] St. Petersburg; 2010. (in Russian)

[20] Саматова P.P. Разработка методов прогноза и лечения прогрессирующей миопии у детей: Автореф. дис. ... канд. мед. наук. СПб.;2010.

[21] Iomdina EN, Smirnova TS, Tarutta EP, Vakhidova LT. Study of some indicators of hormonal status in adolescents with progressive myopia. In: Russian National Ophthalmological Forum: a collection of proceedings of a scientific and practical conference with international participation. Moscow; 2009;Pt.1:365-70. (in Russian)

[22] Иомдина Е.Н., Смирнова Т.С., Тарутта Е.П., Вахидова Л.Т. Изучение некоторых показателей гормонального статуса у подростков с прогрессирующей миопией. В кн.: Российский общенациональный офтальмологический форум: сборник трудов научно-практической конференции с международным участием. М.; 2009;ч.1:365-70.

[23] Volkova EM. The influence of the tone of the autonomic nervous system on the functional state of accommodation in myopia. [dissertation abstract] St. Petersburg; 2007. (in Russian)

[24] Волкова Е.М. Влияние тонуса вегетативной нервной системы на функциональное состояние аккомодации при миопии: Автореф. дис. ... канд. мед. наук. СПб.; 2007.

[25] Kvaratskheliya NG. Comparative study of the anatomical and functional features of the eyes with hyperopia and myopia in children. [dissertation abstract] Moscow; 2010. (in Russian)

[26] Кварацхелия Н.Г. Сравнительное изучение анатомо-функциональных особенностей глаз с гиперметропией и миопией у детей: Автореф. дис. ... канд. мед. наук. М.; 2010.

[27] Tarutta EP. Sclero-strengthening treatment and prevention of complications of progressive myopia in children and adolescents. [dissertation abstract] Moscow; 1993. (in Russian)

[28] Тарутта Е.П. Склероукрепляющее лечение и профилактика осложнений прогрессирующей близорукости у детей и подростков: Автореф. дис. … док. мед. наук. М.; 1993.

[29] Tarutta EP, Iomdina EN, Kruzhkova GV, Markosyan GA. Method for Sclero-reconstructive Treatment of High Myopia. Patent RF №2367394; 2009. (in Russian)

[30] Тарутта Е.П., Иомдина Е.Н., Кружкова Г.В., Маркосян Г.А. Способ склерореконструктивного лечения высокой близорукости. Патент РФ на изобретение № 2367394 от 20.09.2009.

[31] Shkurenko SI, Efimova NV, Iomdina EN, et al. Transplant for Plastic Surgery. Patent RF №2239421; 2004. (in Russian)

[32] Шкуренко С.И., Ефимова Н.В., Иомдина Е.Н., Тарутта Е.П., Антонова М.Д., Маркосян Г.А. и др. Трансплантат для пластической хирургии. Патент РФ №2239421; 2004.

[33] Iomdina E N, Tarutta EP, Kuryleva IM, et al. Method for Differential Diagnosis of Early Acquired and Congenital Progressive Myopia. Patent RF №2495420; 2013. (in Russian)

[34] Иомдина Е.Н., Тарутта Е.П., Курылева И.М., Маркосян Г.А., Иващенко Ж.Н., Аксенова Ю.М. и др. Способ дифференциальной диагностики раноприобретенной и врожденной прогрессирующей миопии. Патент РФ №2495420; 2013.

[35] Iomdina EN, Tarutta EP, Markosyan GA, et al. Method for the Diagnosis of Disorders of the Sclera Support Function in Children and Adolescents with Myopia. Patent RF №2541756; 2015. (in Russian)

[36] Иомдина Е.Н, Тарутта Е.П., Маркосян Г.А., Иващенко Ж.Н., Смирнова Т.С., Аксенова Ю.М. Способ диагностики нарушений опорной функции склеры при близорукости у детей и подростков. Патент РФ №2541756; 2015.

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