[Oxidative stress correction in the treatment of severe keratoconjunctivitis sicca in patients with Sjorgen's syndrome]. / Korrektsiia oksidativnogo stressa v lechenii tiazhelykh form sukhogo keratokon''iunktivita pri sindrome Shegrena.

PURPOSE: To evaluate the antioxidative effect of artificial tears in the treatment of keratoconjunctivitis sicca (KCS). MATERIAL AND METHODS: The study included 43 patients (60 eyes) with severe KCS: 38 women (50 eyes) and 5 men (10 eyes) aged from 27 to 76 years (in average 52 years). Patients were randomly divided into 2 groups; all patients used therapeutic silicone hydrogel soft contact lens (SCL) and instillations of 0.05% Cyclosporin A (CyA) 2 times a day. Patients of the first group (22 people, 30 eyes) used 0.15% hyaluronic acid. In the second group, patients (21 people, 30 eyes) used a tear substitute with similar surface-active component, but with antioxidant properties. The results of the treatment were evaluated using basic and additional research methods at 1, 3, 6 and 12 months. RESULTS: Corneal epithelialization was achieved after 1 month of conservative treatment in all patients who wore SCLs and were treated with instillations of 0.05% CyA and artificial tears. Then the lenses were removed and the patients were switched to instillations of CyA and artificial tears. Comparative analysis of the results showed that higher functional indicators were achieved in the second group, where patients used Artelac Rebalance drops with antioxidant properties. CONCLUSION: Improvement of clinical and functional parameters in the treatment of severe forms of KCS was achieved by direct action on both links of pathogenesis with minimal amounts of the drugs and the frequency of their use. Subsequent supportive therapy contributed to stabilization of the results and further increase of the functional parameters.

[New approaches to the treatment of keratoconjunctivitis sicca]. / Novye podkhody k lecheniiu sukhogo keratokon''iunktivita.

A new method has been developed for the treatment of severe forms of keratoconjunctivitis sicca (KCS) that involves the use of an original cyclosporine A (CyA) saturated soft contact lens (SCL) together with preservative-free artificial tears therapy. AIM: to evaluate the effectiveness of the newly developed treatment for KCS based on the use of medical SCL saturated with 0.05% CyA. MATERIAL AND METHODS: The patients (43 men, 60 eyes) with severe KCS were divided into 2 groups. Group 1 included 21 patients (30 eyes), who received artificial tears and wore 0.05% CyA-saturated silicone-hydrogel SCLs. Group 2 included 22 patients (30 eyes), who wore unsaturated original SCLs and received CyA instillations 2 times daily and, also, artificial tears. Apart from a standard ophthalmic examination, the assessment included Schirmer's test, Norn's test, vital eye stain tests, tear osmometry, laser confocal tomography of the cornea, optical coherence tomography of the anterior segment with meniscometry, impression cytology of the conjunctiva, tear pH measurement, plating of the content of the conjunctival cavity, measurement of the width of the palpebral fissure, and calculation of the ocular surface disease index. Treatment results were followed up at 1, 3, 6, and 12 months. RESULTS: The use of 0.05% CyA-saturated SCLs allows to halve treatment time for patients with severe KSC (down to 1 week - 1 month) as compared to unsaturated original SCLs in combination with 0.05% CyA instillations and to reduce it 5 times as compared to 0.05% CyA instillations only. CONCLUSION: The new method of KSC treatment that involves the use of medical SCL of original design (ensures even distribution of 0.05% CyA across the ocular surface) and preservative-free artificial tears has demonstrated high therapeutic effectiveness as compared to existing methods.

[Effectiveness of soft contact lenses in severe keratoconjunctivitis sicca treated with local immunosuppressive therapy]. / Effektivnost' lechebnykh myagkikh kontaktnykh linz pri immunosupressivnoi terapii sukhogo keratokon''yunktivita.

AIM: To study the effectiveness of soft contact lenses in severe keratoconjunctivitis sicca (KCS) treated with local immunosuppressive therapy. MATERIAL AND METHODS: We have examined 41 patients (60 eyes) with severe KCS, including 3 men (4 eyes) and 38 women (56 eyes) aged from 27 to 76 years. Group 1 consisted of 22 persons (30 eyes) who were prescribed cyclosporine А 0.05% instillations 2 times daily, artificial tears, and soft contact lenses. Group 2 consisted of 19 patients (30 eyes) who received instillations of cyclosporine А 0.05% 2 times daily for no less than 6 months and artificial tears. Apart from the standard ophthalmic examination, the assessment included Schirmer's test, tear break-up time test, fluorescein eye stain test, tear osmometry, Heidelberg tomography of the cornea, optical coherence tomography of the anterior segment with meniscometry, impression cytology of the conjunctiva, tear pH measurement, plating of the content of the conjunctival cavity for its microflora, measurement of the width of the palpebral fissure, and calculation of the ocular surface disease index (OSDI). Treatment outcomes were evaluated at 1, 3, 6, and 12 months. RESULTS: In group 1, complete re-epithelialization of the cornea (confirmed by all the methods used) was achieved rather shortly, in 1-3 months, while in group 2 - in 6 months. CONCLUSION: The use of soft contact lenses in addition to cyclosporine A instillation therapy promotes restoration of corneal and conjunctival epithelium, reduces treatment time, and improves quality of life for patients, thus, proving itself a safe and effective treatment of autoimmune KCS.

[Significance of laser confocal tomography in diagnosis and monitoring of keratoconjunctivitis sicca].

UNLABELLED: Laser confocal tomography of the cornea enables studying ultrathin sections of corneal layers, which provides additional reliable information on tissue changes in keratoconjunctivitis sicca (KCS). AIM: To assess the significance of laser confocal tomography of the cornea in the diagnosis and monitoring of KCS. MATERIAL AND METHODS: We investigated 38 eyes of 30 patients with severe KCS. The patients were divided into two groups. Group 1 (15 patients, 19 eyes) was prescribed cyclosporine А 0.05% instillations 2 times daily, artificial tears, and soft contact lenses. Group 2 (15 patients, 19 eyes) received only instillations of cyclosporine А 0.05% 2 times daily and artificial tears. Besides standard ophthalmic examination, additional tests were performed, namely Schirmer's test, tear break-up time test, fluorescein eye stain test, tear osmolarity test (TearLab System, USA), and Heidelberg retinal tomography of the cornea (HRT, Heidelberg Engineering GmbH, Germany). RESULTS: HRT findings revealed a 3 times shorter epithelization period and faster recovery of corneal transparency in group 1 as compared to group 2 (1.5 and 4.5 months, respectively). There was also an evident reduction in the number of immune cells in the cornea, most pronounced in group 1 at 3 months, which is indicative of inflammation termination. CONCLUSION: The use of HRT of the cornea in KCS patients allows real-time cellular level observation of corneal changes, which together with clinical findings and diagnostic tests not only confirms the diagnosis but also determines treatment effectiveness. It has been also found that soft contact lenses accelerate epithelization of the cornea and relieve inflammation of the ocular surface in KCS patients under cyclosporine A 0.05% instillation therapy. Transparency of financial activity: the authors have no financial interest in the submitted materials and methods.

[Study of risk factors of laser irradiation-induced intraocular lens damage].

The rate of distant damages to intraocular lens (IOL) was studied in relation to its material and manufacture procedure (punching or turning), and its posterior lens capsular position in 120 patients (125 eyes) who had undergone laser secondary cataract discussion. The resistance of lenses made from silicone, polymethylmethacrylate (PMMA), and acryl to YAG laser irradiation (1.076 microm) was studied in an experiment. The findings suggest that the risk for distant IOL damaged in YAG-capsulotomy is higher in PMMA lenses made by punching and silicone IOL. Artificial acryl lenses show a high resistance to YAG laser irradiation. The nature and depth of IOL damages are not entirely determined by the physical properties of a lens material and they are also associated with the distance of a lens and an irradiated structure. If there are specific posterior capsular changes as jelly-like thickening and if convex-designed lenses are implanted, then there is no safe distance between the capsule and IOL, which permanently leads to its damage by YAG-laser irradiation.

[Bifocal contact lenses as a correction method in presbyopia]. / Bifokal'nye kontaktnye linzy kak metod korrektsii presbiopii.

A study aimed at assessing the efficiency of presbyopia correction by bifocal contact lenses (BCL) was undertaken; it envisaged a comprehensive evaluation of subjective data provided by patients and measurements of a number of functional parameters of the visual quality for far and near, including mono- and binocular measurements with BCL of different constructions versus a maximal sphero-cylindrical spectacle correction for far and for near. Soft Acuvue Bifocal BCL as well as soft and rigid BCL manufactured in the optical-and-mechanical laboratory of the Research Institute for Eye Disease of the Russian Academy of Medical Sciences and Russian-made and imported bifocal soft and rigid lenses, respectively, were made use of in the study. A reduced contrast sensitivity (mainly in high frequencies) to 7% with Russian-made BCL, to 12.5% with Acuvue Bifocal BCL, to 8.7% with monofocal BCL and to 13.4% with the "mono-vision" system was registered. A decreased visual working ability to 13% with soft bifocal Russian-made BCL, to 17.3% with Acuvue Bifocal BCL and to 20.7% with the "mono-vision" system was detected versus the spectacle correction. A reduction by 25% was noted in the stereoscopic vision indices with the "mono-vision" system. A study of sensitivity to dazzling did not show any statistically reliable differences between various correction types.

[Ametropia correction with bifocal contact lenses]. / Opyt korrektsii ametropii bifokal'nymi kontaktnymi linzami.

Indications for the prescription of bifocal contact lenses have been defined, the technology of making such lenses of various designs developed, and specific features of the choice of these lenses analysed. The authors discuss the tentative choice of lenses, tentative and regular wearing of the lenses made at the optic mechanic laboratory of the institute. The results of correction of ametropia combined with presbiopia by bifocal and multifocal contact lenses are presented. Segmented and concentric (soft and rigid) bifocal contact lenses were employed; the authors come to a conclusion on the good prospects for the use of concentric lenses.