[Value of eye haemodynamics examination in surgery of traumatic retinal detachment].

Literature on eye microhaemodynamics in patients with traumatic retinal detachment is reviewed. The main noninvasive methods of eye microhaemodynamics examination and potentials of their use in traumatic retinal detachment are analyzed

[Posterior approach for foreign body removal from optic nerve head. Case report].

A technique of foreign body removal from optic nerve head performing an external approach and optic nerve transection is described. After 3 months of follow-up cosmetic result is satisfactory and there are no surgery related complications.

[An experience of dried cornea transplantation].

Sometimes an urgent lamellar keratoplasty remains the only treatment option for corneal defect closure. When fresh donor tissue is absent as it is regular in recent years dried cornea transplantation becomes reasonable. In recent years in ocular trauma department 320 transplantations of dried on silicagel cornea were performed. Analysis of results allows to conclude that use of dried cornea is a promising surgical procedure to preserve the globe and in some cases to prepare the eye with severe trauma for subsequent optic surgery.

[Rehabilitation of patients with burn injury to the eye].

Based on the analysis of the results of treatment in patients with severe and particularly severe burn injuries to the eye, the authors developed principles in the rehabilitation of such patients. The rehabilitation period was divided into 4 stages: 1) treatment of burn injury (removal of necrotic tissues; revascularization of the outer membrane of the eyeball; prevention of cicatricial deformity of the eyelids); 2) treatment of burn disease complications (blood blepharorrhaphy, soft contact lenses, maximum antihypertensive therapy, treatment of cataract and glaucoma); 3) reconstruction of the eyelids, conjunctival vaults, eyeball surface (transplantation of autologous skin flaps, oral mucosa, fixation of leukoma with the automucosa, autocartilage); 4) functional rehabilitation (limbic transplantation, keratoplasty, keratic replacement with a Fedorov-Zuyev prosthesis). The use of the scheme in clinical practice can achieve a considerable reduction in the time of rehabilitation and the rate of functional and anatomic death of the injured eye and improve the functional outcomes of treatment in patients with severe and especially severe burn injury to the eye.

[Impact of xenotransplantation of multipotent mesenchymal stem cells of the bone marrow on the recovery of the structural organization and functional activity of the retina in its damage].

Among the potential sources of cells for transplantation, the most promising autologous material for cell therapy and tissue engineering are multipotent mesenchymal stem cells (MMSC). The authors carried out an experiment dealing with MMSC xenotransplantation into the rabbit suprachoidal space on a model of laser retinal coagulation. For objective assessment of the magnitude and pattern of changes in the functional activity of different retinal cellular elements and the efficiency of MMSC transplantation, they performed electroretinographic and histological studies. The study indicated that MMSC transplantation into the suprachoroidal space is a safe and effective procedure for cell incorporation in order to treat retinal diseases. Electroretinography provided evidence that single MMSC transplantation better preserved the function of photoreceptors (a-wave). Histomorphometric studies demonstrated that the inserted cells stimulated reparative processes in the laser-induced damaged retina.

[Contemporary achievments in ophthalmotraumatology].

The paper presents the results of research work carried out in Eye Trauma Department during the last 30 years, covering in particular new issues in penetrating wound management and astigmatism prevention, original methods of foreign body removal, some approaches to eye transplantation, the pathogenesis and treatment of eye burn disease, surgical treatment of close eye injury, and research performed in collaboration with the center of disaster medicine Zaschita.

[Limbic transplantation in the surgical rehabilitation of patients with prior severe ocular burns].

The paper provides the results of limbic transplantations in 21 patients with varying postburn leukomas. Autolimbic (n = 6; 28.6%) and limbic (n = 15; 71.4%) transplantation was performed 34.27 +/- 13 months after injury. Limbic transplantation with removal of the fibrovascular pannus resulted in improved visual acuity in all cases with the relatively transparent corneal stroma (Group 1; n = 10). In some cases, limbic transplantation could circumvent the problems associated with corneal graft epithelization after further corneal transplantations in Group 2 patients (n = 8) with turbid corneal stroma. In Group 3, surgery was made to prevent corneal changes occurring when the bulbar conjunctiva was removed during plastic repair of mucosal fornices from the lip. Postoperative recurrent corneal conjunctivization and epithelial erosion were observed only in 4 patients. The findings are of value in defining the site and indications for limbic transplantations in the surgical rehabilitation of patients who have experienced severe eye burns.

[Injuries to the organ of vision. Issues to be further developed].

The paper analyzes the topical problems of injuries to the organ of vision. It mentions the basic trends in the pattern of ocular traumatism. The ways of further studies of a number of issues of eye traumatology are defined. The significance of basic studies in solving the problems of eye traumatology is shown.

[Priority trends in the sphere of eye injuries]. / Prioritetnye napravleniia v probleme glaznogo travmatizma.

Comprehensive recent research of eye traumatism is described, aspects related with changes in the trauma structure are defined and advanced methods of diagnostics as well as of therapeutic and surgical treatment in eye trauma are elucidated in the paper. It is pointed out that the above study results are valuable for rehabilitation of victims during peacetime, in emergency situations and in calamities; the contribution of civil ophthalmologic institutions to rendering a specialized medical care to victims of military conflicts is equally important. The case study comprises extensive research findings that can be used in the below cases requiring a specialized medical care: penetrating eye injuries, contusion, burn injuries of the eye, splintered trauma etc.; the current micro-surgery standards must be adhered to and the latest technologies must be used. Finally, the important role of and valuable contributions to the above research made by the Calamity Medicine Center ("Zashchita") are underlined.

[Basic trends in the organization of ocular prosthetics service]. / Osnovnye napravleniia organizatsii sluzhby glaznogo protezirovaniia.

The key issues related with rendering the ocular prosthetic aid to patients with anophthalmos and with cosmetically inferior, i.e. a smaller-size, blind eye, are in the focus of attention. Around 320,000 persons need ocular prostheses in the territory of the Russian Federation, hence adequate prosthetic measures are taken to cope with the cosmetic, medical and social rehabilitation of patients. The ocular prosthetics service deals with issues related with prostheses manufacturing technologies as well as with other therapeutic and surgical aspects which call for working out a unified policy with its subsequent commissioning into the practice of ophthalmologic institutions.

[An experimental substantiation of nitric-oxide containing gas flow in the treatment of eye traumas]. / Eksperimental'noe obosnovanie primeneniia oksida azota v gazota v gazovom potoke dlia lecheniia travm glaza.

The hypothesis on the biostimulating effect of exogenous nitric oxide (NO) was made use of to develop a new method to stimulate the healing of wounds through treating them by a NO saturated gas flow. The above gas flow is generated by air-plasma unit "Plazon". The experimental and clinical studies confirmed that the NO-therapy is a highly effective treatment method for different lesions of the skin and soft tissues. We tried to use the above method in ophthalmology. A comprehensive experimental study was carried out to assess the impact of the NO-containing gas flow on the eyeball structures. An optimal mode was designed, which does not exert any influence on the intraocular pressure, Ph of the lachrymal fluid, antioxidative activity and on the proteinase-inhibitor balance in tears; no morphological changes occurred in the ocular tissue structures. The mentioned morphological and biochemical studies confirmed that the application of the NO-containing gas flow speeds up the healing, process of both an experimental cornea erosion and penetrating corneal wounds. Optimal modes of NO-therapy were defined for both types of lesions.

[New modification of autoconjunctival plastic surgery in urgent corneal surgery]. / Novaia modifikatsiia autokon''iunktival'noi plastiki i neotlozhnoi khirurgii rogovitsy.

A new modification of plastic repair of deep defects of the cornea was performed: autoconjunctival plasty of the cornea with a flap on a pedicle with its rigid fixation in the corneal bed. The operation was carried out in 30 patients with infectious, trophic, and autoimmune involvement of the cornea, 24 of these with perforation of the cornea. The patients were observed for 1 year after the operation. The conjunctival-corneal complex formed in 24 cases, dislocation of the flap without its necrosis occurred in 2 cases, and necrosis of the flap in 4 cases. This modification of conjunctival plasty of the cornea can serve as the operation of choice in urgent ophthalmic surgery in cases when transplantation material is unavailable.

[The diagnostic and surgical characteristics of gunshot nonmagnetic intraocular fragments]. / Osobennosti diagnostiki i khirurgii ognestrel'nykh amagnitnykh vnutriglaznykh oskolkov.

Results of treatment of 42 patients with a magnetic intraocular fragments (balls, pistons, capsules) are analyzed and indications for various surgical interventions for removal of fragments with the minimal injury for the eye are defined. The role of echo diagnosis (together with x-ray diagnosis and computer-aided tomography) in the selection of operative access to a foreign body and, specifically, echolocation on the operative table during surgery is shown. Combination of informative diagnostic methods with advanced surgical technologies helps save the organ and attain functional results in this extremely grave posttraumatic pathology.

[The validation of and approaches to the use of immunocorrective agents in contusive eye trauma]. / Obosnovanie i podkhody k primeneniiu immunokorrigiruiushchikh sredstv pri kontuzionnykh travmakh glaza.

Patients with contusions of the eye of different severity were examined. The concentrations of cytokines (interleukin 1 beta, alpha-interferon, tumor necrosis factor-alpha), levels of immunoglobulins and circulating immune complexes were measured and organ-specific immunity was studied. Severe and medium-severe contusions of the eyeball were associated with immune shifts at a local and systemic levels. Shifts regarded as adaptation compensatory immune response were detected in medium-severe contusions. Severe contusions involve immunity disorders which are characteristic of developing secondary immunodeficiency. Postcontusion hemorrhages are a clinical factor of risk of pathogenetically unfavorable autoimmune reactions. The efficiency of immunocorrective drugs is discussed.

[Department of Traumatology, Reconstructive and Plastic Surgery and Ocular prosthetics, Gel'mgol'ts Moscow Institute of Ocular Diseases: four recent decades]. / Otdel travmatologii, rekostruktivnoi, plasticheskoi khirurgii i glaznogo protezirovaniia Moskovskogo NII glaznykh boleznei im. Gel'mgol'tsa - poslednie 40 let.

Main trends in research and practical activities of the department are reviewed: treatment of injuries, removal of foreign bodies, introduction of new microsurgical technologies and equipment, development of reconstructive laser operations, development of concept of pathogenesis of burn disease, and ophthalmoplasty.

[New priority trends in ocular traumatism]. / Novye prioritetnye napravleniia v probleme glaznogo travmatizma.

Types of ophthalmic traumas subject to change at present are enumerated: communal, criminal, war traumas, and injuries resultant from emergency situations (disasters). The changes are discussed. Main factors which should be borne in mind when investigating the problem of ocular injuries are determined. Priority trends of research in ophthalmic traumatology are defined.

[Impact of assessing the mental status in rehabilitation of patients with eye injuries]. / Znachenie otsenki psikhicheskogo statusa v reabilitatsii bol'nykh s travmoi organa zreniia.

The authors discuss the significance of the mental status of patients with ocular injuries in effective medical rehabilitation of this category of patients. The most incident variants of mental status of such patients are enumerated. Special attention is paid to the probable exacerbation of the underlying mental disorders. Psychopathological conditions are to be treated by general practitioners, specifically, by ophthalmologists. Main trends of treatment are outlined.

[Clinical aspects of injury to the eye inflicted with gas pistols for self-defense]. / Klinicheskie aspekty porazheniia glaz gazovym ognestrel'nym oruzhiem samooborony.

The clinical picture of an injury inflicted with gas pistols represents polymorphous changes and severe injury to the organ of vision, involving not only the anterior segment, but the deep structures as well. Analysis of the status of the damaged eyes and the mechanism of injury permitted us to distinguish 3 clinical groups in terms of the intensity of exposure to this or that factor: 1) chemical burn of the cornea and conjunctiva (65 patients); 2) chemical burn with elements of thermal involvement and impregnation of tissues with particles of gunpowder that failed to burn and slight or medium-severe contusion of the eyeball (31 patients): and 3) severe thermochemical burn with grave contusion of the eyeball, sometimes with rupture of membranes (6 patients). Hence, we may conclude that the consequences of using gas weapons differ from those described in the Status of Gas Weapons Application and in advertising materials by a much greater severity, and in 11.7% cases such injuries led to complete irreversible loss of vision. Obviously the shortest distance from which it may be allowed to shoot from gas pistols should be increased to 1 meter.

[Epidemiological characteristics and risk factors of sympathetic ophthalmia]. / Epidemiologicheskie osobennosti i faktory riska simpaticheskoi oftalmii.

Clinical factors of risk of sympathic ophthalmia (SO) determined by the type of injury, methods of surgical and drug treatment, and supported by published data were distinguished as a result of treating 158 patients with SO at the Helmholts Research Institute of Ophthalmic Diseases from 1965 to 1994. Special attention is paid to the possibility of SO development during steroid therapy of posttraumatic uveitis. In such cases SO develops in case of 1) sudden discontinuation of a course of steroids; 2) discontinuation of a short course of steroid therapy in the presence of persisting signs of posttraumatic uveitis; and 3) in surgery on the traumatized (operated on) eyes and low steroid doses.