The early diagnosis of congenital neuroinfections during ophthalmologic examination in children of the first months of life

OBJECTIVE: To characterize the possibilities of early diagnosis of congenital neuroinfections during an ophthalmological examination in children in the first months of life. МАТЕРИАЛ И МЕТОДЫ: Наблюдали 5 детей с врожденной нейроинфекцией (2 ребенка с врожденным токсоплазмозом и 3 ребенка с врожденной цитомегаловирусной инфекцией — ЦМВИ). Все дети родились недоношенными на сроке от 25 до 31 нед гестации (27,2±0,94 нед), с массой тела при рождении от 680 до 1610 г (1120±110,1 г). При обследовании использовали бинокулярную офтальмоскопию, осмотр на широкопольной ретинальной педиатрической камере. Проводили исследование в крови содержания иммуноглобулинов, определение возбудителя при помощи полимеразной цепной реакции. Для оценки состояния головного мозга применяли нейросонографию, магнитно-резонансную томографию. RESULTS AND CONCLUSION: Ophthalmic signs of intrauterine infection appeared at the age of 4-5 months (at 47-51 weeks of postmenstrual age). In all children (in 4 in one eye, in 1 in both eyes), apparent exudative-proliferative changes in the retina and vitreous body appeared on the periphery with the formation of epiretinal membranes that exert a traction effect on the retina. In two children with CMVI, multiple preretinal hemorrhages in different parts of the retina in both eyes were revealed. Central chorioretinal foci in the fundus were detected in children with toxoplasmosis. A positive dynamics, such as a decrease of exudative phenomena, a partial fit of the retina, complete resorption of hemorrhages, was noted in children during treatment. It has been concluded that signs of intrauterine neuroinfection can appear delayed, only by the development of chorioretinitis, 4-5 months after birth and manifest with severe exudative-proliferative changes in the retina and vitreous body.