The dissertation focuses on the solution to the problem of providing high-quality health care to young children, justifying the volumes and resource allocation pursuant to medical indications, domestic regulatory requirements, and economically sound recommendations.
The latest technologies and examination methods were found to be advisable for the diagnosis and management of ophthalmic pathology in young children. They include recoding brain impulses (visual evoked potentials), which can be indicative of functional and structural impairments of the visual analyser, fundus examination with the use of binocular ophthalmoscopy and ultrasound (A-/B-scan), and computed tomography with 3-dimensional reconstruction that makes it possible to determine the topographic, anatomical and pathophysiological properties, detect impaired patency of the lacrimal ducts and the entire lacrimal system, which conventional contrast X-ray diagnosis fails to do.
It is the first time that scientific information on the biomechanical properties of the fibrous tunic of the eye in young children has been obtained. This allows predicting the risks of refractive errors progression. The risk of myopia progression is increased with a coefficient of corneal rigidity KER ≥ (+) 5.5% and a coefficient of scleral rigidity (KES) ≥ (+) 1.5%; the risk of hyperopia rises if KER ≥ (+) 4.3% and KES ≥ (+) 1.5%; reduced accommodative ability of the eyes tends to arise with KER ≥ (+) 3.3% and KES ≥ (+) 1.4%. The inclusion of objective indicators, such as the corneal and scleral rigidity coefficients, in the standard ophthalmologic examination of pregnant women with myopia can contribute to a decrease in the number of surgical delivery for ophthalmology indications in myopic patients to 4.5% (versus 80.1%), which will reduce the risk of postpartum complications in neonates.
Scientific data on the criteria for the likelihood of the congenital pathology development and progression in young children in Ukraine were supplemented based upon comprehensive studies of functional, biometric and biomechanical changes in the visual analyser. The research enabled gaining a deeper scientific insight into the features of the congenital ophthalmic pathology course in young children. Vitreoretinal surgery in retinopathy of prematurity promotes improved anatomical characteristics of the eyeball, partially enhanced visual functions, and reduced number of late complications (secondary glaucoma, corneal opacity). A translimbal access ensures the control over the insertion and localization of vitreoretinal instruments in the vitreous cavity; it allows increased incidence of retinal adhesion from 0 to 28.1% (p <0.05) and partial retinal adhesion from 46.6% to 56.3 % (p <0.05). The use of radio wave surgery for congenital ptosis of the upper eyelid can reduce intraoperative blood loss from 2 to 5 ml (p <0.05), the duration of surgery from 60 ± 5 minutes to 40 ± 5 minutes (p <0.05). It also shortens the rehabilitation period twofold (from 14 ± 2.6 to 6 ± 2 days, p <0.05) and promotes are active healing with the formation of an inconspicuous scar.
Scientific information on a significant age-related decrease in the incidence of eye diseases in children from 17.15% (in the age group of children 0-6 years old) to 0.77% (in the age group 0-17 years old) (p <0.05) and the prevalence (18.37% and 3.03%, respectively) (p<0.05) was increased. The incidence rates were found to be high among children under 1 year old (51.76) versus 0-6 years old (39.19) (p<0.05) and 0-17 years old (43.46 per 1000 children of the corresponding age) (p<0.05). With a decrease in childhood vision disability by one third (-29.4%) (p<0.05), the nosological structure is represented by congenital malformations of the visual organ (24.4%), myopia (17.1%), fundus pathology (14.7%), which should be diagnosed at an early age.
It is the first time that the identified risk factors increasing the likelihood of ophthalmic pathology in young children have been evaluated and compared. Scientific information on changes in the quality of life indicator, which is an integral criterion for changes in the paediatric health, based on the subjective assessment of children physical, psychological and social well-being, has been increased. Visual impairments were found to affect the quality of children life. The average value of quality of life in the main group constituted 64.89 ± 1.01 points, which was 23.4% (p<0.001) lower than in the control group (84.67 ± 0.92 points). The major differences were revealed in the subscales of the effect on general vision (32.87%) and the family (28.12%), whereas the differences were minimal in terms of the impact on the personality formation (10.6%) and skills (17.13%). Early age is the period when medical intervention to restore visual functions allows preserving the quality of life with a minimum influence of visual defects on the formation of child personality
