[Recurrent herpetic erosion of the cornea: diagnosis, treatment and prevention of recurrences]. / gerpeticheskaya retsidiviruyushchaya eroziya rogovitsy: diagnostika, lechenie i preduprezhdenie retsidivov.

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

[A method of treating purulent corneal ulcer in the eyes with neuroparalytical keratitis and lagophthalmos]. / Sposob lecheniia gnoinoi iazvy rogovitsy, razvivsheisia na glazakh s neirotroficheskim keratitom i lagoftal'mom.

PURPOSE: To develop a method for treatment of advanced purulent corneal ulcers in eyes with neurotrophic keratitis that developed as a complication of intracranial pathological processes or brain surgeries. MATERIAL AND METHODS: The study involved 13 patients (14 eyes) that underwent combined surgery - keratoplasty, autoconjunctival flap covering, partial tarsorrhaphy performed simultaneously. Before and after the surgery, patients received frequent instillations of antimicrobial agents and autologous serum. RESULTS: The organ of vision was preserved in all patients, visual function - in 50% of cases, it improved in 35.7% of cases from 0.07±0.05 to 0.26±0.11. Lagophthalmos has decreased from 6.11±0.99 to 2.78±0.62 mm. CONCLUSION: Patients with intracranial lesions and complicated by neurotrophic keratitis and lagophthalmos often develop advanced severe and progressive corneal purulent ulcers, which seldom respond to the most active conservative therapy. Simultaneous surgery that includes keratoplasty, auto conjunctival flap covering and partial superficial tarsorrhaphy is an effective treatment option that helps preserve visual function in such eyes.

[The role of infection foci in the onset and sustenance of inflammatory diseases of the eye]. / Rol' fokal'nykh ochagov infektsii v vozniknovenii i podderzhanii vospalitel'nykh zabolevanii glaz.

Numerous clinical observations indicate the importance of the role of 'focal sepsis' in the development and facilitation of inflammation in the anterior eye segment. The article describes possible routes of infection spread from various local foci to the eye. Studying the connection between local infection foci and inflammatory eye diseases will give ophthalmologists more opportunities for effective treatment and prevention of disease recurrences.

[The linkage of oral infection foci and inflammatory diseases of the eye]. / Vzaimosviaz' fokal'nykh odontogennykh ochagov infektsii i vospalitel'nykh zabolevanii glaza.

The paper presents a review of numerous clinical observations that indicate an important role of 'focal sepsis' in the development and persistence of the anterior eye segment inflammation. Possible routes of infection spread from local dental infectious foci to the eye are discussed.

[Surgery treatment of purulent corneal ulcers associated with neuroparalytic keratitis]. / Khirurgicheskoe lechenie gnoinykh iazv rogovitsy, razvivshikhsia na fone neiroparaliticheskogo keratita.

OBJECTIVE: The study objective was to develop a method for surgical treatment of advanced purulent corneal ulcer in the setting of neuroparalytic keratitis developed after acoustic neuroma removal and strokes. MATERIAL AND METHODS: The study included 12 patients (13 eyes). All patients underwent single-step keratoplasty, conjunctival autografting, and partial permanent tarsorrhaphy. RESULTS: The eye as an organ was spared in 100% of cases; vision was spared in 50% of cases and improved, from 0.09±0.05 to 0.21±0.13, in 29% of cases. Lagophthalmos was reduced from 5.86±1.35 to 3.01±0.75 mm. CONCLUSION: Patients with intracranial lesions complicated by neuroparalytic keratitis often develop progressive purulent corneal ulcers. The simultaneous use of surgery, including keratoplasty, conjunctival autografting, and partial (external) tarsorrhaphy, is an effective treatment that can preserve the visual function of these eyes.

[Severe bilateral pseudomonas sclerokeratitis in comatose patient (clinical case)]. / Razvitoi dvustoronnii sinegnoinyi sklerokeratit u patsientki v kome (klinicheskii sluchai).

The article presents a clinical case of severe bilateral pseudomonas sclerokeratitis in a patient with occlusion hydrocephalus and intracranial hypertension, who was in a coma and on a ventilator for 20 days. At first examination (7 days after the onset of purulent keratitis, during which the process had been rapidly progressing), the clinical picture included lagophthalmos, severe purulent corneal ulcer, bilateral purulent scleromalacia, perforated cornea in the left eye. On the same day, in order to maintain eye integrity, urgent reconstructive penetrating sclerokeratoplasty with subsequent sclerocorneal coating was performed in both eyes right in the intensive care unit. Parts of the melted iris and ciliary body pars plana that were left in place were abundantly washed with BSS and moxifloxacin solutions - 150 µg/ml. Postoperative care included forced instillations of antibiotics and antiseptics. Two years after the first surgery, 2 more full-thickness corneal transplantations were performed in the patient's right eye aiming at restoration of its optical system. Thus, immediate sclerokeratoplasty with anterior segment irrigation and intraocular administration of highly diluted antibiotics appeared to be the only chance to save the vision in one eye. The fellow eye, where perforation occurred as a result of severe purulent sclerokeratitis and purulent iridocyclitis, despite all measures taken, lost its sight. After three surgeries (penetrating sclerokeratoplasty and two re-PK), visual acuity in the only seeing (right) eye was 0.1, which can be considered a satisfactory result.

[Surgical treatment of purulent corneal ulcers in eyes with neurotrophic keratitis and paralytic lagophthalmos]. / Lechebnaia keratoplastika pri gnoinykh iazvakh rogovitsy, razvivshikhsia na fone neirotroficheskogo keratita i paraliticheskogo lagoftal'ma.

AIM: to develop a surgical approach to the treatment of purulent corneal ulcer in eyes with neurotrophic keratitis with lagophthalmos after auditory neuroma removal or stroke. MATERIAL AND METHODS: A total of 12 patients (13 eyes) have been managed. All received combined surgery that included simultaneous keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy. RESULTS: Ocular integrity was preserved in all cases, and also vision - in half of them. In 29% of cases, visual acuity increased from 0.09±0.05 up tо 0.21±0.13. Lagophthalmos decreased from 5.86±1.35 mm down to 3.01±0.75 mm. CONCLUSION: Patients with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos often develop progressive purulent ulcers of the cornea. One-step keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy is an effective treatment that can help preserve visual function in such eyes.

[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.

[Treatment option for intralamellar corneo-scleral abscesses in the zone of tunnel incision after phacoemulsification].

The article provides data on clinical diagnosis (4 patients, 4 eyes) and early surgical treatment of corneal intralamellar abscesses (ICA) in the zone of corneo-scleral tunnel incision after phacoemulsification (PE). ICA developed via corneo-scleral incision was a relatively reliable biomicroscopic sign of the beginning chronic endophthalmitis. Despite of massive nonsurgical treatment (antibiotics, glucocorticoids, non-steroid anti-inflammatory agents etc.) inflammation was not arrested completely, it recurred within 2,5-6 months after PE. Reconstructive conjunctivo-sclerokeratoplasty resulted in arrest of inflammation and visual function recovery in 3 patients. In one patient this procedure was not possible to perform because of total loss of visual functions due to chronic endophthalmitis.

[Treatment for central corneal ulcer in the presence of lagophthalmos by autoconjunctivoplasty in combination with optic iridectomy and external blepharorrhaphy a clinical case].

The outcomes of keratitis in lagophthalmos occurring due to various causes despite therapeutic measures are generally poor. The influence of factors, such as drying of the cornea, impairment of its trophism, and infection, leads to the development of rough leukomas, and occasionally to eye death due to occurring endophthalmitis. The paper describes a clinical case of deep trophic central corneal ulcer on the single seeing eye with lagophthalmos, as well as ulcer treatment by the authors' procedure, by simultaneously affecting both elements of the pathology (lagophthalmos and trophic ulcerative keratitis of central localization) and creating an artificial pupil. This allows one to increase visual acuity, to cure keratitis, and to close a palpebral fissure.

[Recurrent herpetic corneal erosion: diagnosis and treatment].

Recurrent corneal erosion (CE) is a common anterior eye disease, which usually occurs after injury, substantially limits a patient's ability to work, and is intractable. The authors single out an individual form of CE herpetic CE (HCE) on the basis of immunofluorescence assay of a conjunctival scrape, which shows the high concentration of herpes simplex virus antigen in 53% of CE cases. Confocal microscopy revealed epithelocyte polymorphism and basement membrane defects. The treatment of patients with HCE involved 2 steps: 1) relief of acute signs of the disease via drug therapy, rapid local autocyte cinotherapy (RLACCT), or phototherapeutic keratectomy (PTK) and 2) prevention of recurrences. For this the authors developed a method based on the systemic use of a new composition of the intradermal herpes vaccine Vitaherpavac in combination with the subcutaneous interferon inducer Poludan. RLACCT was found to be the most effective medical treatment for CE and PTK was the most effective surgical one. Vaccination with the concurrent subcutaneous injection of Poludan is an effective method in preventing recurrent HCE. During a follow-up of 2 years or more, 81% of the patients achieved clinical resolution; there was a decrease in recurrence rates and severity in 15.1% and no effect in 3.8%.

[Complex treatment for decompensated edematous exophthalmos].

In endocrine ophthalmolopathy, there may be persistent dysfunction of the organ of vision due to corneal lesion or optical neuropathy. As an illustration of severe corneal lesion in edematous exophthalmos decompensation, the authors give their own observation that shows it necessary to use in such cases complex treatment comprising pulse therapy with glucocorticoids, followed by a long-term dosage reduction and switching over to its oral administration, as well radiotherapy and surgery.

[State and prospects of evidence-based medicine and occupational pathology].

According to foreign literature data, contemporary methods of evidence-based medicine are insufficiently limited in use by occupational pathologists both in this country and abroad. This is due to restrictions of Occupational Diseases Register, difficulties in adding new entities into it, medical and social practice to use functional parameters for disablement definition, employers' obstacles to reveal early stages of occupational diseases through active employees' examinations, patients' wish to receive governmental annuity and not to get rehabilitated.

Stimulating re-epithelialization after photorefractive keratectomy.

BACKGROUND: Re-epithelialization is usually complete in eyes 3 to 4 days following photorefractive keratectomy (PRK). However, this process is delayed in 0.5% of these eyes, leading to early development of haze. The authors investigated a method to stimulate re-epithelialization following PRK. METHODS: PRK was performed with the Nidek EC-5000 excimer laser. Following surgery, express-cytokinotherapy was applied. This method consisted of a single subconjunctival injection of 2.5 to 3.0 ml of ex juvanticus mixture of autoblood and immunomodulator Poludan. This mixture was then applied topically 4 times a day until re-epithelialization was complete. Poludan is an interferon inducer (complex polyA: polyU), stimulates expressed production of interferon and interleukin-2, and increases natural cytotoxicity. RESULTS: Thirty eyes of 30 patients with delayed re-epithelialization were treated with the described method. The average time to re-epithelialization was 7.00 + 0.64 days. Total epithelialization was complete on day 3 + 0.38 after beginning the cytokinotherapy (P < .05). Early haze developed in only 2 patients from this group. Occurrence of early haze in the control group of patients who had persistent epithelial defects 8 to 16 days postoperatively and were given traditional therapy--including corticosteroid and non-steroidal drugs--was reliably higher: 8 to 10 days (P < .01). CONCLUSION: Local express-cytokinotherapy appears to be an effective method to promote quick and complete epithelialization in eyes following PRK that experience delayed re-epithelialization. This treatment may be an important part of the prevention of early haze development and achievement of better visual acuity.

[Modern aspects in the treatment of ophthalmic herpes]. / Sovremennye aspekty lecheniia oftal'mogerpesa.

The author report about study results conducted in Russia during the recent 30 years and dedicated to the treatment of ocular pathologies caused by the virus of herpes simplex. Three high-efficiency directions took shape during the mentioned period: 1. Non-specific antiviral therapy based on the local and systemic administration of interferon inductors (poludan--complexes of poly A, poly U etc.) possessing an extensive spectrum of the antiviral and immune-modeling actions; 2. Antirecurrent therapy, including the application of herpetic vaccine against the virus of herpes simplex, types I and II, combined with immune-modeling agents. A focal allergic test with herpetic vaccine was offered, it made it possible, for the first time, a non-invasive diagnostics of intraocular herpes. 3. A system of sparing microsurgical methods adapted to the treatment of an active herpetic keratitis and its outcomes. A synergistic effect of interferon inductors and acyclovir was proven both experimentally and clinically; a method of local autocytokinotherapy (based on poludan), which turned out to be most effective in the treatment of severe lesions at the cornea and of intraocular herpes, was worked out. The authors believe that the methods and means offered for the treatment of ophthalmoherpes contribute, to a great extent, to handling with the ocular herpes viral infection.

[Development of a suppository form of the interferon inducer poludan and potentiation of its action by hyaluronic acid]. / Razrobotka svechevoi formy induktora interferona poludan i potentsirovanie ego deistviia gialuronovoi kislotoi.

A promising dosage form of interferon inductor poludan has been developed for the treatment of patients with genital herpes and ophthalmic herpes: suppositoria. High interferon-producing and antiviral activity of poludan in suppositoria is potentiated by hyaluronic acid and antioxidants.

[Mechanisms for the therapeutic effect of herpes polyvaccines in chronic ophthalmic herpes and genital herpes]. / Mekhanizm lechebnogo éffekta gerpeticheskoi polivaktsiny pri khronicheskom oftal'mogerpese i gerpes genitalii.

Commercial inactivated culture polyvaccine against herpes simplex viruses (types 1 and 2) developed at D. I. Ivanovsky Institute of Virology promoted cessation of viremia. During the first vaccination viremia coincided with appearance of a focal allergic test on the retina, which is proposed for the diagnosis of herpetic involvement of the posterior compartment of the eye. T-cellular immunity normalized after a course of vaccination. Experimental immunization of rats and vaccination of patients with chronic ophthalmic and genital herpes demonstrated the therapeutic activity of inactivated herpetic polyvaccine in suppositoria.

[Evaluation of the carcinogenic hazard in the manufacture of graphite articles]. / Otsenka kantserogennoi opasnosti proizvodstva grafitovykh izdelii.

As a result of complex hygienic, clinical and cancer epidemiologic studies, dust proved to be a major occupational hazard. Coke and graphite dust absorbs polycyclic aromatic hydrocarbons, including benz(a)pyrene in concentrations exceeding maximum permitted levels. Screening of 746 graphite workers followed by clinical examination established increased incidence of diseases of the upper respiratory tract (chronic rhinitis pharyngitis, laryngitis, etc.), bronchi and lungs (chronic bronchitis or pneumonia) and skin (hyperkeratosis, naevi, etc.). Among respiratory diseases were hypertrophic laryngitis, papillomatous bronchitis and angiofibroma of the larynx which are now considered to be precancer. Cancer epidemiologic studies referred graphite workers to a group of high risk of cancer.

[Antiglaucoma drainage operations in the reconstruction of the anterior eye segment]. / Antiglaukomatoznye operatsii drenirovaniia v rekonstruktsii perednego otdela glaza.

Two new methods for antiglaucoma draining surgery are suggested, consisting in perforating keratoplasty with elements of partial or complete reconstruction of the anterior segment of the eye in cases with combined injuries to the cornea and other structures, associated with secondary glaucoma. The first of these methods consists in conducting an 'active' draining tube, made of silicone, via the trabeculectomy site into the anterior chamber, the draining tube then being fixed to the iris in the ciliary zone; the drainage tube has an extra opening on its proximal end. The other method implies the creation of two new special routes for intraocular fluid discharge; a cyclodialysis opening is formed, through which a capillary drainage is introduced into the anterior chamber, that is fixed to the iris. To prevent over growing of the distal end of the drainage tube with tissues of the operated on eye it was placed in some patients under a silicone explant (sponge). Forty-five patients (45 eyes) were operated on making use of the former method and 23 patients (23 eyes) were operated on with the use of the latter method. The results were followed up for up to 3 years; intraocular pressure compensation was attained in 91.1% of cases, transparent and semitransparent taking in of perforated keratotransplants in 75.6%, vision acuity improvement from the right light projection up to 0.3 diopters and higher was observed in 62.2% of patients.

[Possibilities of immunosuppressive therapy in reconstructive keratoplasty (experience gained in the use of cyclosporin)]. / O vozmozhnostiakh immunosupressivnoi terapii pri rekonstruktivnoi keratoplastike (opyt primeneniia preparata tsiklosporin).

Cyclosporin was used for preventing the graft rejection reaction after reconstructive operations on the anterior segment of the eye. Analysis of the results of surgical treatment of patients with vascularized corneal leukomas of different etiology in 23 patients (25 eyes) who received postoperative oral cyclosporin therapy and in 25 patients to whom this drug was instilled showed that cyclosporin promoted transparent healing of the keratotransplant and its use was not associated with serious side effects.