[Impairments of Neurocognitive Mechanisms of Decision-Making in Depression.]

A multidisciplinary clinical-psychological-neurophysiological study has been performed in 28 depressive patients (females, aged 18-56) and 50 healthy volunteers (females, aged 18-55) in order to analyze the relationships between the impairments of neurocognitive mechanisms of decision-making based on logics and considerations or on emotional experience (emotional learning) in uncertain situation and clinical and neurophysiological signs of depression. The severity of depression was assessed quantitatively using Hamilton's Depression Rating Scale (HDRS-17). Tests "10 words", Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT) were used for quantitative assessment of cognitive functions. Multichannel resting EEG was recorded in all depressive patients in order to assess the brain functional state. Neurocognitive deficit was observed in all the patients; its pronounce correlated positively with the severity of depression. The ability to make decisions based on both logic and considerations (in WCST), which is associated with EEG signs of hypofrontality, and on emotional learning (in IGT) was impaired. Only in depressive patients reduced ability to make rational decisions based on logics and considerations resulttd in a compensatory shift towards decision-making based on emotions, which led to relatively higher results of emotional learning. The data suggests that hypofrontality causes difficulties in making decisions that requires logical reasoning and the disinhibition of subcortical (including hippocampal) brain structures, the activation of which provides better results of emotional learning.

[Gold weight implants for lagophthalmos correction in chronic facial nerve paralysis (late results)].

UNLABELLED: Upper eyelid weigh gold implant is the widely accepted standard for the treatment of paralytic lagophthalmos (PL). AIM: To evaluate late outcomes of PL correction with chain gold implants. MATERIAL AND METHODS: Chain gold implants were inserted in the upper eyelids of 70 patients with lagophthalmos due to chronic facial paralysis. A comprehensive ophthalmic examination was performed prior to surgery and then at months 1, 3, 6, 12, 24, and 36. RESULTS: The results obtained prove the method highly effective. None of the patients developed any severe complications. Cases of implant removal were few. Some of the studied biometric parameters decreased significantly after surgery, while the upper eyelid excursion increased. The implant had no effect on the inner surface of the cornea and its peripheral thickness. CONCLUSION: Efficacy of the proposed eyelid implant has been convincingly demonstrated; late complications have been analyzed.

[Corneal examination in patients with bullous keratopathy before and after endothelial keratoplasty].

OBJECTIVE: To evaluate corneal status in patients with bullous keratopathy before and after endothelial keratoplasty. MATERIAL AND METHODS: A total of 16 patients (18 eyes) with bullous keratopathy were examined before and after DSAEK. Confocal microscopy ("Nidek", Japan) was used for corneal status evaluation. RESULTS: Follow-up examinations were performed 3, 6, and 24 months after the surgery. In all patients minor corneal opacity persisted for the whole follow-up period but tended to decrease. It is shown that visual acuity is most dependent on light scattering in the anterior stroma. CONCLUSION: Anterior stromal haze is shown to have greater impact on visual acuity than opacities, folds, and birefringent deposits within the host-donor interface. Duration of bullous keratopathy, patient's age, and comorbidity are the factors that influence anterior and deep stromal haze development and changes over time.

[Fluorescein angiography and optical coherence tomography findings in central fundus of myopic patients].

UNLABELLED: Myopia prevalence grows alike in many countries, including Russia, regardless of geographical and population conditions. AIM: to assess fundus changes in myopic patients at different ocular axial lengths by means of modern diagnostic tools. MATERIAL AND METHODS: The study enrolled 97 patients (194 eyes) aged 45 ± 20.17 years with myopia of different degrees. Besides a standard ophthalmic examination, all patients underwent fundus fluorescein angiography and optical coherence tomography. RESULTS: The occurrence of retinal pigment epithelium (RPE) atrophy (diffuse or focal) has been shown to increase with increasing ocular axial length. Only 27 eyes (28.1%) appeared intact. As myopia progression implies axial growth of the eye, it is associated with a more severe decrease in choroid, RPE, and photoreceptor layer thicknesses: the longer the anterior-posterior axis, the thinner the above mentioned fundus structures. Age-related changes in the fundus are also likely to be more pronounced in longer axes. Myopic traction maculopathy, which in our case appeared the main cause of increased retinal thickness, was diagnosed in 105 eyes, "outer" macular retinoschisis--in 40 eyes. CONCLUSION: Thus, modern diagnostic tools, such as fluorescein angiography and optical coherence tomography, enable objective assessment of the central fundus.

[Clinical significance of modern methods of corneal assessment].

The article observes the application experience of modern methods of corneal refraction and structure evaluation. Comprehension of computer-assisted videokeratography is high enough to diagnose corneal astigmatism, keratoconus, early-stage corneal dystrophies, and corneal topography changes resulting from a variety of factors. Scanning projecting keratography provides information on both anterior and posterior corneal topography and elevation, as well as corneal thickness in each point of central area. Aberrometry can be used for estimation of the impact of different factors on corneal optical properties and assess the possibility for correction of resultant disturbances. Confocal microscopy allows to evaluate morphological changes in keratoconus and corneal dystrophies and also diagnose acanthamoeba keratitis. Optical coherence tomography provides the possibility of whole cornea assessment, however, with much less magnification in comparison to confocal microscopy. Improved tearscopy with computed analysis of interference digital images ("Lacrima" software) enables evaluation of lipid layer thickness and structure in normal and impaired tear film (like in dry eye syndrome), as well as the influence of different factors and therapeutic measures. Topographical pachymetry data is the most valuable for diagnostics and monitoring of keratoconus.

[Personalized cell therapy for early postoperative bullous keratopathy (experimental proof and clinical results)].

The article presents the results of a long-term research on development and clinical application of personalized cell therapy (PCT) for treatment of early postoperative (manifesting within the first 3 months after surgery) bullous keratopathy (BK). The method of intracameral PCT implies in vitro incubation of the patient's blood sample with poly(A:U) stimulator, separation of the serum with activated leukocytes, and injection of the final cell preparation into the anterior chamber. The fundamental part of the research was aimed at a detailed description of the cell preparation and investigation of its possible mechanisms of action. Cytokine and growth factor level in the cell preparation suggested that its high clinical efficacy might be due to its ability to improve regeneration of damaged corneal endothelium. The clinical study was conducted on a group of 52 patients with early BK. A significant effect (smoothing of the Descement's membrane folds, complete resorption of corneal edema, improvement of corneal transparency, reduction of corneal thickness and increase of visual acuity by 0.49 +/- 0.27) was achieved in 44.2% of patients, while partial effect was seen in 21.1% of patients. There was no clinical effect in 34.6% of patients. In those patients who developed significant or partial clinical effect after the PCT, many endotheliocytes appeared to have multiple nuclei (2 and more). In some patients polyploid nuclei persisted for 3-5 years after the treatment. Polyploidy results from incomplete mitosis which might be due to regenerative processes in the endothelium stimulated by the PCT. Obviously, high efficacy and relative simplicity of the method should promote its further clinical introduction.

[Possible complications of orthokeratology in myopia correction].

Clinical cases representing complications (refractive, infectious and trophic) of orthokeratologic lenses (OKL) use are described. These clinical cases show that complications of OKL use can be both similar to those of routine contact correction and caused by features of mechanism of corneal refraction change as a result of OKL wear. In our opinion efficacy and safety of this option is directly depends on the correct lens fitting, patient's compliance and regular monitoring of corneal changes.

[The value of methods for morphofunctional analysis of cornea in cataract surgery].

The characteristics of morphofunctional status of cornea after extracapsular cataract extraction and phakoemulsification with IOL implantation (30 and 58 operations respectively) were analyzed in detail using up-to-date diagnostic techniques. The results of examination using developed algorithm including study of light transmission, refraction and protective function of cornea show advantage of microinvasive ultrasound technique of cataract surgery in terms of minimal impact on corneal structure, optical and biomechanical characteristics.

[Current approaches to evaluating the anatomic and functional status of the cornea].

The review provides data on current methods for evaluating the anatomic and functional status of the cornea (light refraction, light transmission, and biomechanical properties, in particular). It analyzes the main advantages and disadvantages of basic (biomicroscopy, endothelial microscopy, ophthalmometry, topography, and pachymetry) and special (confocal microscopy, optical coherence tomography, ultrasound biomicroscopy, aberrometry, bidirectional corneal applanation, and keratoesthesiometry) studies.

Conjunctival nevus and melanoma.

The conjunctival nevus is one of the most common benign tumors of the ocular surface. Melanomas are rare; they can arise without a preexisting conjunctival nevus, or due to malignant transformation in case of PAM (primary acquired melanosis). The retrospective study analyzed 70 patients with pigmented lesion of the conjunctiva in period 1996-2006 at the Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, with the aim to determine the frequency of change in size and pigmentation of these benign lesions. Epibulbar pigmented lesions are rare, recognition of their precursors lesions at an early stage is important. Surgical excision is usually effective in eradicating these lesions. Extensive cases of flat primary acquired melanosis with atypia may be managed with mitomycin C. Multifocal and advanced melanoma, especially showing intraocular or orbital invasion, may require exenteration and/or radiotherapy to adequately extirpate the neoplasm locally. However, systemic metastases might have already develop in patients with advanced stage of disease (Fig. 7, Ref 13). Full Text (Free, PDF) www.bmj.sk.

[Cognitive functions, social functioning and self-esteem in young male patients with adolescence onset schizotypal disorder].

The results of psychological examination of 33 male patients with a diagnosis of schizotypal disorder (SD), mean age 22 years, with age at onset in adolescence and 20 healthy young men are presented. Cognitive performance in patients with SD did not differ from healthy people on all measures, with the exception of social adaptation. There was a trend towards the change of normative responses and, respectively, estimation of the results of psychological techniques. The data suggest that personality deficits play a more significant role in the social maladaptation of patients with SD than cognitive impairment.