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The purposeis to analyze the stages of ophthalmological healthcare system’s evolution in premature children on the basis of Kaluga branch of FGAU «MNTK “Eye Microsurgery” named after acad. S.N. Fedorov».Methods. In 2003, on the basis of Kaluga branch of MNTK “Eye Microsurgery” the system of ophthalmological care for premature children had been created. The specialists of children’s ophthalmologic department of the branch had started regular field screening examinations of premature infants from risk group of ROP in neonatal care unit in 4 regions of the Central Federal district. In parallel, new diagnostic methods and technologies of laser and surgical treatment of active PH stages had been actively developed and introduced.Results. From 2003 to 2018 approaches for detection, diagnostics and treatment of ROP had been evolved substantially. At the initial stage, there were no uniform data about the optimal timing for early detection of active stages ROP, and quantitative markers of ROP progression were not determined. The effective management and treatment algorithms for the patients with active ROP had not been implemented yet. To the date vast experience had accumulated: more than 15 thousand infants with ROP risk had been screened, more than 750 on-site examinations in the neonatal care units and perinatal centers had been performed. High-tech methods of diagnostics, laser and surgical treatment of ROP had been developed and are actively used now. Multicenter clinical studies evaluating the possibilities of anti-VEGF therapy for active ROP have being performed. Over 3000 laser and more than 1.300 surgical operations for different stages of ROP had been performed.Conclusion. Many-years experience of ophthalmological healthcare system in premature children functioning have demonstrated its consistency and effectiveness. The system includes interrelated stages, providing continuity between the perinatal centers and specialized ophthalmic institution, with complying the common approaches to early screening and diagnostic monitoring, including through telemedicine, as well as technologies of laser and surgical treatment of ROP.

The purpose: to determine the features of different stages of active retinopathy prematurely according to fluorescent angiography data.Patients and methods. In 2011–2017, 271 angiographic studies were performed in 207 premature infants born at 25–33 weeks of gestation with 710–1980 grams weight at birth, with different stages of active ROP in age of live 3–12 weeks (30-39 weeks of post-conceptual age). A voluntary informed consent to perform the examination was received from the legal representatives of all patients. FAG was performed using retinal pediatric digital video system “RetCam-3” with built-in angiographic unit under mask anesthesia, in the presence of anesthesiologist-resuscitator, under the monitor control of the respiratory and cardiovascular systems of the child.Results. Unfavorable types of active ROP are characterized by the specific manifestations that are not defined by the standard ophthalmologic methods: early flat neovascularization, the presence of small tortuous peripheral vessels with signs of leakage, reperfusion areas with an apparent lack of capillaries and shunts. This opens up the opportunities for early detection of stages of the disease requiring therapeutic measures. The aggressive posterior ROP is distinguished by a variety of angiographic patterns, the most important feature is the massive loss of the retinal capillary bed in the vascularized retina. FAG data about latent neovascularization and ischemic zones of the retina represent the particular value in the prediction of active ROP course.Conclusion. The obtained results could allow to make the most differentiated approach to the management of children with active ROP, timely and effectively predict the course of the disease and to performed adequate treatment based on objective indications.

32 ISSN 1816-5095 (print); ISSN 2500-0845 (online) DOI: 10.18008/1816-5095-2017 Ранняя витреальная хирургия в лечении задней агрессивной ретинопатии недоношенных На основании данных комплексного офтальмологического обследования, учитывая прогрессирование заболевания, после ЛКС в контрольной группе и исходно тяжелое течение задней агрессивной РН в основ-ной группе при идентичной с контрольной клинической картине, пациентам обеих групп было выполнено раннее витреальное хирургическое вмешательство. В основной группе -после офтальмологического обследования, в контрольной -через 8-16 дней после ЛКС. результаты. В основной группе через 6 месяцев в 15-ти глазах (75%) сформировался правильный витреома-кулярный интерфейс, в 5-ти случаях (25%) была диагностирована сглаженность фовеолярной ямки за счёт уплотнения внутрен-ней пограничной мембраны без признаков отёка сетчатки. В контрольной группе через 6 месяцев на 6-ти глазах (30%) сфор-мировался правильный макулярный интерфейс, на 11-ти (55%) -определялась сглаженность или отсутствие фовеолярной ямки без признаков отёка сетчатки. На 3-х глазах (15%) во 2-й зоне сохранялась локальная отслойка сетчатки. заключение. Первичная витрэктомия, выполненная по разработанным показаниям, позволяет оптимизировать лечение пациентов с задней агрессивной РН в случаях заведомой неэффективности ЛКС. Она является альтернативной и патогенетически обоснованной техникой, которая по результативности не уступает традиционному подходу, включающему проведение ЛКС с последующей витреальной хирургией. ключевые слова: задняя агрессивная ретинопатия недоношенных, прогрессирование заболевания, лазеркоагуляция сет-чатки, первичная витреальная хирургия для цитирования: Терещенко А.В., Белый Ю.А., Сидорова Ю.А., Трифаненкова И.Г., Терещенкова М.С., Ерохина Е.В., Исаев С.В. Ранняя витреальная хирургия в лечении задней агрессивной ретинопатии недоношенных.

The goal is to evaluate the effectiveness of the developed technique of the gradual forming of the internal limiting membrane (IML) fragment in the treatment of large macular holes (MH) in comparison with the standard methodol-ogy (using classical maculorhexis and rapprochement of MH edges by using of vacuum aspiration). Materials and methods: we observed 137patients (103women, 34men) aged from 54 to 78years with large MH (over 400μm). Duration of MH ranged from 3 to 60months. All the patients were divided into groups: 1 (new methodology) and 2 (standard method), and sub-groups: 1a and 2a – patients with MH with a minimum diameter 400–650μm; 1b and 2b – patients with MH with a minimum diameter more than 650μm. The new technique is performed in several stages, during which several series of ILM “petals” removal are made, leaving an intact area on the MH edge. The last ILM “petal” or fragment is inverted and placed on the MH. Results: In subgroup 1a, there was a statistically significant increase in best corrected visual acuity (BCVA) during all follow-up with the most pronounced growth in the first 6 months (from 0.15±0.06 to 0.55±0.14) (p<0.05). In subgroup 1b a statistically significant increase in mean values of BCVA was also observed especially during first 6month (from 0.13±0.06 to 0.36±0.12) (p<0.05). In group2 (a, b) BCVA was significantly lower (p<0.05). Conclusion: the new technique allows to reach higher functional-anatomical results in surgical treatment of MH.