ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2016-4-260-264ophthalmology-336Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHСовременные тенденции лечения косоглазия у детейModern Tendencies in the Treatment of Strabismus in ChildrenМарковаЕ. Ю.MarkovaE. Yu.

д.м.н., заведующая отделом микрохирургии и реабилитации глаза у детей, профессор кафедры офтальмологии

MD, head of the of microsurgery and rehabilitation of the eye in children

markova_ej@mail.ruФедеральное государственное бюджетное учреждение «Межотраслевой научно-технический комплекс «Микрохирургия глаза» имени академика С.Н. Федорова» Министерства здравоохранения Российской Федерации»РоссияThe S. Fyodorov Eye Microsurgery Federal State InstitutionRussian Federation201621122016134260264Copyright © Маркова Е.Ю., 20162016Маркова Е.Ю.Markova E.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/336

РЕЗЮМЕ    Нарушения рефракции являются одной из наиболее актуальных проблем детской офтальмологии. Несвоевременная и неполноценная коррекция аномалий рефракции приводит к развитию амблиопии, нарушению формирования бинокулярного зрения, содружественному косоглазию. Являясь грубым косметическим дефектом и сочетаясь с нарушением зрительных функций, косоглазие у детей представляет как психофизическую, так и социальную проблему, затрудняя налаживание социальных связей, нередко становясь препятствием в приобретении желаемой профессии. Особенно сложной проблемой являются несодружественные формы косоглазия: паралитическое, алфавитные (V, A, X) и другие синдромы (Дуейна, Брауна DVD и т.д.), при которых вовлечены в патологический процесс не только мышцы горизонтального и вертикального действия, а одной из причин являются функциональные расстройства. При синдроме «V» и сходящемся косоглазии угол отклонения уменьшается при взгляде вверх и увеличивается при взгляде вниз; при расходящемся косоглазии девиация больше при взгляде вверх и меньше при взгляде вниз. Тщательное обследование, комплексное персонализированное лечение, включающее плеопто-ортопто-диплоптику, тренировку аккомодации и конвергенции позволяет восстановить зрительные функции и бинокулярное зрение, а также избежать возникновения вторичной девиации. Применение одномоментного хирургического вмешательства при комбинированном горизонтально-вертикальном косоглазии с гиперфункцией нижней косой мышцы на горизонтальных и  вертикальных группах мышц является эффективным методом лечения, позволяет повысить результативность проведенного хирургического лечения, сократить кратность наркоза, уменьшить количество повторных операций. Проведение в послеоперационном периоде функционального лечения является неотъемлемой составляющей коррекции косоглазия и позволяет добиться стабильных бинокуляр-ных функций, а в дальнейшем и стойкой ортофории.

Refractive error is one of the most actual problems of pediatric ophthalmology. Late and incomplete correction of refractive errors leading to amblyopia, the disruption of the formation of binocular vision, strabismus friendly. As a gross cosmetic defect and combined with violation of visual functions, strabismus in children presents as a psychophysical and social problem, making it difficult to establish social ties, often becoming an obstacle in acquiring the desired profession. A particularly difficult problem is forms of strabismus: paralytic, alphabetical (V, A, X) and other syndromes ( Duane, brown DVD, etc.) in which involved in the pathological process not only the muscles of the horizontal and vertical actions, but also one of the causes are functional disorders. In the syndrome of “V” and converging strabismus, the angle of deflection decreases when you look up and increases when looking down; in case of divergingstrabismus, the deviation is more when you look up and less when looking down. A thorough examination of a comprehensive personalized treatment, including pleopto-orthope-diploptic, training accommodation and convergence allows to restore visual function and binocular vision and to avoid secondary deviance. One-stage surgical intervention in combined horizontal-vertical strabismus with hyperfunction of the lower oblique muscle on horizontal and vertical muscle groups is an effective method of treatment allows to increase the effectiveness of surgical treatment to reduce the frequency of anesthesia, to reduce the number of repeated operations. Appointment postoperative functional treatment is an integral component of the strabismus correction and allows to achieve stable binocular functions, and further stand orthophoria.

косоглазиерефракцияамблиопияплеопто-ортопто-диплоптикаStrabismusrefractionamblyopiapleopto-ortopto-diploptik treatmentReferencesChicherin L. P., the Leading problem of health of children and adolescents. Bulletin of the National Institute of Public Health of the RAMS. 2011;2:1720.Chicherin L. P., the Leading problem of health of children and adolescents. Bulletin of the National Institute of Public Health of the RAMS. 2011;2:1720.Baranov A. A., Albitsky V. Yu., Terletskaya R.N. [The concept of reducing the preliminary loss of health]. Kontseptsiya sokrashcheniya predvaritel’nykh poter’ zdorov’ya. [Issues of modern Pediatrics]. Voprosy sovremennoy pediatrii. 2010;9(5):510. (in Russ.).Baranov A. A., Albitsky V. Yu., Terletskaya R.N. [The concept of reducing the preliminary loss of health]. Kontseptsiya sokrashcheniya predvaritel’nykh poter’ zdorov’ya. [Issues of modern Pediatrics]. Voprosy sovremennoy pediatrii. 2010;9(5):510. (in Russ.).Neroev V. V. [Organization of ophthalmologic aid to the population of the Russian Federation]. Organizatsiya oftal’mologicheskoy pomoshchi naseleniyu Rossiyskoy Federatsii. [Annals of ophthalmology]. Vestnik oftal’mologii. 2014; 30(6):812. (in Russ.).Neroev V. V. [Organization of ophthalmologic aid to the population of the Russian Federation]. Organizatsiya oftal’mologicheskoy pomoshchi naseleniyu Rossiyskoy Federatsii. [Annals of ophthalmology]. Vestnik oftal’mologii. 2014; 30(6):812. (in Russ.).«Diagnosis and treatment of concomitant strabismus» Federal clinical practice guidelines ed Katargina L. A., «Diagnosis and treatment of concomitant strabismus». Federal clinical practice guidelines 99-121, 2014. (in Russ.).«Diagnosis and treatment of concomitant strabismus» Federal clinical practice guidelines ed Katargina L. A., «Diagnosis and treatment of concomitant strabismus». Federal clinical practice guidelines 99-121, 2014. (in Russ.).Avetisov S. E. [Modern approaches to correction of refractive disorders]. Sovremennye podkhody k korrektsii refraktsionnykh narusheniy. [Annals of ophthalmology]. Vestnik oftal’mologii. 2006;1:3-8. (in Russ.).Avetisov S. E. [Modern approaches to correction of refractive disorders]. Sovremennye podkhody k korrektsii refraktsionnykh narusheniy. [Annals of ophthalmology]. Vestnik oftal’mologii. 2006;1:3-8. (in Russ.).Avetisov E. S., Kovalevskiy E. I., Khvatova A.V. [Guidance for pediatric ophthalmology]. 1986, 476 p. (in Russ.).Avetisov E. S., Kovalevskiy E. I., Khvatova A.V. [Guidance for pediatric ophthalmology]. 1986, 476 p. (in Russ.).Guseva M. R., Nikiforov A. S. [Ophthalmoplegia]. M.: GEOTAR-Media; 2014. (in Russ.).Guseva M. R., Nikiforov A. S. [Ophthalmoplegia]. M.: GEOTAR-Media; 2014. (in Russ.).Sidorenko, E. I. [Problems and prospects of pediatric ophthalmology]. Problemy i perspektivy detskoy oftal’mologii. [Annals of ophthalmology]. Vestnik oftal’mologii. 2006;122(1):41-42. (in Russ.).Sidorenko, E. I. [Problems and prospects of pediatric ophthalmology]. Problemy i perspektivy detskoy oftal’mologii. [Annals of ophthalmology]. Vestnik oftal’mologii. 2006;122(1):41-42. (in Russ.).Kornyushina T. A., Kashchenko T. P., Ibragimov A. V. [Stereoscopic vision and methods of its study]. Stereoskopicheskoe zrenie i metody ego issledovaniya // [Ophthalmosurgery]. Oftal’mokhirurgiya. 2013;1:76-79. (in Russ.).Kornyushina T. A., Kashchenko T. P., Ibragimov A. V. [Stereoscopic vision and methods of its study]. Stereoskopicheskoe zrenie i metody ego issledovaniya // [Ophthalmosurgery]. Oftal’mokhirurgiya. 2013;1:76-79. (in Russ.).Markova E. Yu., Kurganova O. V., Venediktov V. L., Bezmelnitsin L. Y. [Medicosocial role of ametropia correction in children]. Mediko-sotsial’naya rol’ korrektsii ametropiy u detey. [Ophthalmology]. Oftal’mologiya. 2015;12(2):83-87. (in Russ.).Markova E. Yu., Kurganova O. V., Venediktov V. L., Bezmelnitsin L. Y. [Medicosocial role of ametropia correction in children]. Mediko-sotsial’naya rol’ korrektsii ametropiy u detey. [Ophthalmology]. Oftal’mologiya. 2015;12(2):83-87. (in Russ.).Markova E. Yu., Kurganova O. V., Venediktov V. L., Bezmelnitsin L. Y. [Retrospective analysis of patients with strabismus]. Retrospektivnyy analiz patsientov s kosoglaziem. [Cataract and Refractive Surgery]. Kataraktal’naya i refraktsionnaya khirurgiya. 2015;15(2):47-50. (in Russ.).Markova E. Yu., Kurganova O. V., Venediktov V. L., Bezmelnitsin L. Y. [Retrospective analysis of patients with strabismus]. Retrospektivnyy analiz patsientov s kosoglaziem. [Cataract and Refractive Surgery]. Kataraktal’naya i refraktsionnaya khirurgiya. 2015;15(2):47-50. (in Russ.).Tarutta E. P., Proskurina O. V., Markova E. Yu. [Violations of accommodation, the question of terminology]. Narusheniya akkomodatsii- k voprosu o terminologii». [10th Congress of Ophthalmologists of Russia: collection of scientific works]. 10 S'ezd Oftal’mologov Rossii. 2015:128. (in Russ.).Tarutta E. P., Proskurina O. V., Markova E. Yu. [Violations of accommodation, the question of terminology]. Narusheniya akkomodatsii- k voprosu o terminologii». [10th Congress of Ophthalmologists of Russia: collection of scientific works]. 10 S'ezd Oftal’mologov Rossii. 2015:128. (in Russ.).Markova E. Yu., Sidorenko E. E. [Surgical treatment of anisometropia caused by hyperopia in children]. Khirurgicheskoe lechenie anizometropiy, obuslovlennykh gipermetropiey u detey. [Russian pediatric ophthalmology]. Rossiyskaya pediatricheskaya oftal’mologiya. 2009;4:35- 37. (in Russ.).Markova E. Yu., Sidorenko E. E. [Surgical treatment of anisometropia caused by hyperopia in children]. Khirurgicheskoe lechenie anizometropiy, obuslovlennykh gipermetropiey u detey. [Russian pediatric ophthalmology]. Rossiyskaya pediatricheskaya oftal’mologiya. 2009;4:35- 37. (in Russ.).Alain Pechereau, Daniele Denis, Claude Speeg-Schatz. Strabismus, 2013. p. 14-16.Alain Pechereau, Daniele Denis, Claude Speeg-Schatz. Strabismus, 2013. p. 14-16.Rozemblyum Y. Z. [Optometry]. Moscow: Medicine, 1991. (in Russ.).Rozemblyum Y. Z. [Optometry]. Moscow: Medicine, 1991. (in Russ.).Kashchenko T. P., Raigorodsky Yu. M., Kornyushina T. A. [Functional treatment of strabismus, amblyopia, disorders of accommodation. Methods and devices]. Moscow-Saratov, 2016. (in Russ.).Kashchenko T. P., Raigorodsky Yu. M., Kornyushina T. A. [Functional treatment of strabismus, amblyopia, disorders of accommodation. Methods and devices]. Moscow-Saratov, 2016. (in Russ.).Kashchenko T. P., Kornyushina T. A., Bazarbaeva A. R. [Method of restoration of binocular vision based on laser speckles in the diplomatic treatment of concomitant strabismus]. [Annals of ophthalmology]. Vestnik oftal’mologii. 2014;130(5):48-52. (in Russ.).Kashchenko T. P., Kornyushina T. A., Bazarbaeva A. R. [Method of restoration of binocular vision based on laser speckles in the diplomatic treatment of concomitant strabismus]. [Annals of ophthalmology]. Vestnik oftal’mologii. 2014;130(5):48-52. (in Russ.).Strakhov V. V. [Biomechanical and physiological aspects of accommodation of the eye Clinical physiology of vision]. M.: Nauchno-med. firm MBN-2006:462-487. (in Russ.).Strakhov V. V. [Biomechanical and physiological aspects of accommodation of the eye Clinical physiology of vision]. M.: Nauchno-med. firm MBN-2006:462-487. (in Russ.).Vorontsova T. N., Brzeski V. V., Efimova E. L., Markova E. Y. [«Methods of correction and treatment of disorders of accommodation». Accommodation: a Guide for physicians. ed. by L. A. Katargina]. M: April, 2012: 94-110. (in Russ.).Vorontsova T. N., Brzeski V. V., Efimova E. L., Markova E. Y. [«Methods of correction and treatment of disorders of accommodation». Accommodation: a Guide for physicians. ed. by L. A. Katargina]. M: April, 2012: 94-110. (in Russ.).Von Noorden G. K., Jenkins R. H., Rosenbaum A. L. Horizontal transposition of the phenomena of there. Vertical rectus muscles for treatmens of ocular torticollis. J. Pediatr. Ophthalmol. Strabismus. 1993;(30)1:8-14.Von Noorden G. K., Jenkins R. H., Rosenbaum A. L. Horizontal transposition of the phenomena of there. Vertical rectus muscles for treatmens of ocular torticollis. J. Pediatr. Ophthalmol. Strabismus. 1993;(30)1:8-14.Safarov, J. O. [Dissociated vertical deviation in children and its clinical-diagnostic feature]. Eurasian Union of Scientists № 10-1 2015 C 116-117. (in Russ.).Safarov, J. O. [Dissociated vertical deviation in children and its clinical-diagnostic feature]. Eurasian Union of Scientists № 10-1 2015 C 116-117. (in Russ.).G. K. von Noorden. Strabismus. Arch. Ophthalmol. 1969;82(3):393-114.G. K. von Noorden. Strabismus. Arch. Ophthalmol. 1969;82(3):393-114.Babayev S. A., Kadirova A. M., Yusupov A. A., Bekturdiev S., Sabirova D. B. [Оur experience of surgical repair of secondary divergent strabismus in children]. Nash opyt khirurgicheskogo lecheniya vtorichnogo raskhodyashchegosya kosoglaziya u detey. [East-West]. Vostok-Zapad. 2016;3:124-126. (in Russ.).Babayev S. A., Kadirova A. M., Yusupov A. A., Bekturdiev S., Sabirova D. B. [Оur experience of surgical repair of secondary divergent strabismus in children]. Nash opyt khirurgicheskogo lecheniya vtorichnogo raskhodyashchegosya kosoglaziya u detey. [East-West]. Vostok-Zapad. 2016;3:124-126. (in Russ.).Tereshchenko A.V., Belyy Yu. a., Trifanenkova I. G., Vydrina A. A. [New approach to surgery for vertical strabismus. Point of view]. East-West. 2016;2:179-182. (in Russ.).Tereshchenko A.V., Belyy Yu. a., Trifanenkova I. G., Vydrina A. A. [New approach to surgery for vertical strabismus. Point of view]. East-West. 2016;2:179-182. (in Russ.).Nakamura T., Awaya S., Miyake S. Insertion anomalies of the horizontal muscles and dysfunction of the oblique muscles in the A-V patterns. Acta Soc. Ophthalmol. Jpn. 1991;95:698.Nakamura T., Awaya S., Miyake S. Insertion anomalies of the horizontal muscles and dysfunction of the oblique muscles in the A-V patterns. Acta Soc. Ophthalmol. Jpn. 1991;95:698.Avetisov E. S., Kashchenko T. P. [Binocular vision. Clinical research methods and recovery. [Clinical physiology of vision]. Moscow,1993. (in Russ.).Avetisov E. S., Kashchenko T. P. [Binocular vision. Clinical research methods and recovery. [Clinical physiology of vision]. Moscow,1993. (in Russ.).Puzyrevskiy K. G., I. L. [Median dublicator new surgical technique for the treatment of strabismus]. M., 2007;374. (in Russ.).Puzyrevskiy K. G., I. L. [Median dublicator new surgical technique for the treatment of strabismus]. M., 2007;374. (in Russ.).Kushner B. J., Taylor D., Hoyt C. S. [A, V, and other alphabet pattern strabismus]. Pediatr. Ophthalmology and Strabismus. L., 2005;922-931.Kushner B. J., Taylor D., Hoyt C. S. [A, V, and other alphabet pattern strabismus]. Pediatr. Ophthalmology and Strabismus. L., 2005;922-931.Knapp P. A. and V Patterns. Symposiumon strabismus. Transactions of the New Orleans Academy of Ophthalmology. St. Louis, 1971.Knapp P. A. and V Patterns. Symposiumon strabismus. Transactions of the New Orleans Academy of Ophthalmology. St. Louis, 1971.Zhukova O. V. [Surgical treatment of patients with strabismus on the basis of the morphological aspects of its pathogenesis]. Samara 2012. (in Russ.).Zhukova O. V. [Surgical treatment of patients with strabismus on the basis of the morphological aspects of its pathogenesis]. Samara 2012. (in Russ.).Zhukova O. V., Zolotarev A.V. [Surgical access to the extraocular muscles: the advantages and disadvantages]. Khirurgicheskie dostupy k glazodvigatel’nym myshtsam: preimushchestva i nedostatki. [Ophthalmosurgery]. Oftal’mokhirurgiya. 2010;6:33-36. (in Russ.).Zhukova O. V., Zolotarev A.V. [Surgical access to the extraocular muscles: the advantages and disadvantages]. Khirurgicheskie dostupy k glazodvigatel’nym myshtsam: preimushchestva i nedostatki. [Ophthalmosurgery]. Oftal’mokhirurgiya. 2010;6:33-36. (in Russ.).Zhukova O. V., Zolotarev V. A. , And Yamshchikov N. In. Nikolaev G. A. [Individual approach to the choice of tactics of surgical treatment of friendly convergent strabismus in children on the basis of histological data on the pathogenesis of the disease]. Individual’nyy podkhod k vyboru taktiki khirurgicheskogo lechenii skhodyashchegosya sodruzhestvennogo kosoglaziya u detey na osnove gistologicheskikh dannykh o patogeneze zabolevaniya. [Russian pediatric ophthalmology]. Rossiyskaya pediatricheskaya oftal’mologiya. 2014;4:10-21. (in Russ.).Zhukova O. V., Zolotarev V. A. , And Yamshchikov N. In. Nikolaev G. A. [Individual approach to the choice of tactics of surgical treatment of friendly convergent strabismus in children on the basis of histological data on the pathogenesis of the disease]. Individual’nyy podkhod k vyboru taktiki khirurgicheskogo lechenii skhodyashchegosya sodruzhestvennogo kosoglaziya u detey na osnove gistologicheskikh dannykh o patogeneze zabolevaniya. [Russian pediatric ophthalmology]. Rossiyskaya pediatricheskaya oftal’mologiya. 2014;4:10-21. (in Russ.).Mahkamova H. M. [Anatomical and topographical features of the exterior muscles of the eye]. Anatomo-topograficheskie osobennosti naruzhnykh myshts glaza. [Annals of ophthalmology]. Vestnik oftal’mologii. 1970;3:78-80. (in Russ.).Mahkamova H. M. [Anatomical and topographical features of the exterior muscles of the eye]. Anatomo-topograficheskie osobennosti naruzhnykh myshts glaza. [Annals of ophthalmology]. Vestnik oftal’mologii. 1970;3:78-80. (in Russ.).Jampolsky A. Management of exodeviations. Strabismus Ophthalmic Symposium. St. Louis. 1962. p. 140-146.Jampolsky A. Management of exodeviations. Strabismus Ophthalmic Symposium. St. Louis. 1962. p. 140-146.Zhukova O. V., Markova, T. A., Zolotarev A.V. [To the question about dosing of the effect of the surgery in the surgical treatment of convergent strabismus in children]. Samara, 2007. p. 644-647. (in Russ.).Zhukova O. V., Markova, T. A., Zolotarev A.V. [To the question about dosing of the effect of the surgery in the surgical treatment of convergent strabismus in children]. Samara, 2007. p. 644-647. (in Russ.).Kenneth W. Wright, Yi Ning J. Strube. Color Atlas Of Strabismus Surgery – Strategies and Techniques. 2015:89-90.Kenneth W. Wright, Yi Ning J. Strube. Color Atlas Of Strabismus Surgery – Strategies and Techniques. 2015:89-90.Antsiferova N. G., Puzyrevskiy K. G., Plisov I. L. [Surgical treatment esophoria complicated with V syndrome without interest lower oblique muscles]. Odessa, 2012, p. 266. (in Russ.).Antsiferova N. G., Puzyrevskiy K. G., Plisov I. L. [Surgical treatment esophoria complicated with V syndrome without interest lower oblique muscles]. Odessa, 2012, p. 266. (in Russ.).Safarov, J. O. [Dissociated vertical deviation in children and its clinical-diagnostic feature]. Eurasian Union of Scientists No. 10, 2015, C 116-117. (in Russ.).Safarov, J. O. [Dissociated vertical deviation in children and its clinical-diagnostic feature]. Eurasian Union of Scientists No. 10, 2015, C 116-117. (in Russ.).Villaseca A. The A and V Syndromes. Am. J. Ophthalmol. 1961;52:172.Villaseca A. The A and V Syndromes. Am. J. Ophthalmol. 1961;52:172.Tereshchenko A.V., Belyy Yu. a., Trifanenkova I. G., Vydrina A. A. [New approach to surgery for vertical strabismus]. East-West. No. 2 2016, 179-182. (in Russ.).Tereshchenko A.V., Belyy Yu. a., Trifanenkova I. G., Vydrina A. A. [New approach to surgery for vertical strabismus]. East-West. No. 2 2016, 179-182. (in Russ.).

The authors declare that there are no conflicts of interest present.