[Combination surgery for wet age-related macular degeneration and chronic peripheral uveitis].

AIM: To develop a combination surgery for wet age-related macular degeneration and concurrent chronic peripheral uveitis that would include intravitreal injection of Lucentis and cryocerclage of the peripheral retina. MATERIAL AND METHODS: A total of 75 patients were examined and divided into 2 groups: the main group (37 patients) and the controls (38 patients). Patients from the main group underwent the new combination surgery, while the controls received intravitreal Lucentis alone (peripheral uveitis was managed therapeutically). RESULTS: It has been found that the new combination method provides a significant and stable improvement in visual acuity (by a factor of 10) and a decrease in the area of central scotoma (by a factor of 2.95) in the postoperative period. The period needed for recovery in the central retinal thickness is also 1.6 times shorter. CONCLUSION: The new combination surgery for wet age-related macular degeneration and concurrent chronic peripheral uveitis provides rapid reduction of inflammation in the extreme periphery of the fundus and a 1.5 times faster (as compared to traditional methods) primary restoration of topographic anatomy of the retina in the macular region.

[Up-to-date tendency of pharmacological treatment of corneal ulcers].

The review of literature is devoted to up-to-date tendency of pharmacological treatment of corneal ulcers. Depending on cause of corneal inflammation treatment should be effective using appropriate etiotropic and pathogenetic treatment. Evaluating the literature data it is obvious that a number of questions is still should be studied. Thereby a search of new effective pharmacological treatment options with minimal side effects is essential. In case of progressing ulceration with threatened corneal perforation an urgent surgery is essential.

[Retinal detachment surgery: state of art].

This review analyzes the state of the art of the retinal detachment surgery. The main pathogenesis-based surgical options (scleral buckling, vitrectomy, complex) as well as indications for surgery and possible intra- and postoperative complications are considered.

[Use of autologous blood mononuclear cells in the complex treatment of corneal ulcers].

A new method was developed to treat corneal ulcers with instillations of autologous blood mononuclear cells during traditional pharmacotherapy. Clinical trials showed a significantly more arrest of an exudative-destructive reaction: the time of ulcerative defect debridement from necrotic masses reduced by 1.5-2 times, resolution of a perifocal edema and infiltration by 1.6 times. There was simultaneously an acceleration of transition of inflammation to a phase of reparation with the formation of corneal opacity of less intensity and dimension. Instillations of autologous blood mononuclear cells showed a 4.4-fold reduction in the total number of complications as compared with the controls.

[Structural changes of the retina and corpus vitreum in the model of proliferative vitreoretinopathy in alloxan diabetes].

The present study was conducted to determine the role of blood mononuclear cells in a morphogenesis of proliferative vitreoretinopathy (PVR) and to detect the peculiarities of PVR development in hyperglycemia. Experiments were performed in 75 mature male Wistar rats. In animals of group 1, the model of PVR was reproduced by injection of mononuclear cells into the corpus vitreum. In animals of group 2, alloxan diabetes was induced 6.5 weeks prior to intravitreal injection of mononuclear cells. The material obtained was studied using the methods of light and electron microscopy. Development of PVR by intravitreal injection of mononuclear cells in diabetic rats was found to be associated with more severe destructive and proliferative changes. Considering the integrative role of blood mononuclear cells in the intercellular networks, it is suggested that these cells are involved in the pathogenesis of PVR.

Morphofunctional characteristics of blood mononuclear cells during in vitro culturing under dynamic conditions.

The primary culture of human blood mononuclear cells was incubated on fibrous membranes under a constant directional flow of the nutrient medium modulating intraocular fluid flow. Incubation was performed for 24, 48, and 72 h. Intracellular enzyme activity of mononuclear cells increased under dynamic conditions. Differentiation of blood monocytes and circulating fibroblast precursors into macrophageal cells and mature cells, respectively, was accelerated.

[Pathomorphological features of proliferative vitreoretinopathy in intravitreal administration of blood mononuclear cells (experimental study)]. / Patomorfologicheskie osobennosti proliferativnoi vitreoretinopatii pri intravitreal'nom vvedenii mononuklearov krove (éksperimental'noe issledovanie).

The role of blood mononuclears in the pathogenesis of proliferative vitreoretinopathy (PVR) was studied on 25 Wistar rats (200-250 g). Intravitreal injections of 0.05 ml normal saline containing mononuclears (3000/mm@3) into one eye and 0.05 ml normal saline into the other were made through the flat part of the ciliary body under ether narcosis. Mononuclears were isolated using the ficoll-hypaque gradient. Indirect ophthalmoscopy was carried out on days 1, 3, 5, 7, 14, and 21 after injection. After each ophthalmoscopy (except day 1) 5 animals were sacrificed and both eyes were removed. The material was fixed for optic and electron microscopy. Ophthalmoscopic and histological studies showed the development of preretinal adhesions, the main sign of PVR. Bearing in mind the unidirectional flow of liquid in ocular tissues, created by the pressure gradient, the authors suggest that blood mononuclears are involved in the development of vitreoretinal proliferation.

[The role of the osmotic pressure of the blood in the pathogenesis of diabetic changes in the retina]. / Rol' osmoticheskogo davleniia krovi v patogeneze diabeticheskikh izmenenii setchatki.

Based on the regularities of circulation mechanics, the authors hypothesize the role of osmotic pressure in the development of diabetic changes in the retina. A mathematical model of tissue fluid movement based on this hypothesis shows that transmural pressure in choriocapillaries is higher than in exchange vessels of the retina, and therefore unidirectional fluid flow from choriocapillaries to these vessels develops. A sharp increase in glucose concentration is paralleled by an increase in osmotic pressure, which, in turn, creates a negative hydraulic pressure in retinal tissue and leads to overstretching of exchange vessels and appearance of microaneurysms. One of pathogenetically based therapeutic effects of laser coagulation in diabetic retinopathy is creation of "fenestrae" in the retinal pigmented epithelium, facilitating tissue fluid movement.

[Local mechanisms of relationship between colloid-osmotic pressure and ophthalmic tone in patients with diabetes mellitus]. / Lokal'nye mekhanizmy vzaimosviazi kolloidno-osmoticheskogo davleniia i oftal'motonusa u bol'nykh sakharnym diabetom.

Forty-two patients (84 eyes) aged 35-73 were examined, 11 of these with type I diabetes mellitus and 31 with type II diabetes. All examinees were in the sub- and decompensation phase. Time course of glycemia and intraocular pressure was followed up (check-ups on an empty stomach and 1 h after eating). An increase of blood sugar level 1 h after eating is paralleled by a decrease of intraocular pressure. The main mechanism of inverse changes of ophthalmic tone under conditions of hyperglycemia is dehydration of ocular tissues.