[Intracorneal selective stromal transplantation]. / Vnutrirogovichnaya transplantatsiya stromy.

Deep anterior lamellar keratoplasty or penetrating keratoplasty are currently considered the optimal methods of surgical treatment of stromal dystrophies and corneal degeneration. Despite certain advantages and benefits of these methods, they also have significant limitations: involvement of superficial corneal layers in the surgery, need for suturing, development of post-keratoplasty astigmatism etc. PURPOSE: This study aimed to test and describe the new method of closed sutureless keratoplasty (intracorneal selective stromal transplantation), which was indicated in isolated dystrophic and degenerative pathology of the stroma. MATERIAL AND METHODS: Intracorneal selective stromal transplantation was performed in a 62-year-old patient with stromal degeneration and intact corneal layers between the altered stroma and the Descemet's membrane posteriorly, and the Bowman's layer anteriorly. The patient also had immature senile cataract. Corneal stroma was removed and replaced with a graft in the optical center of the lens, while the endothelium, the Descemet's membrane and the Bowman's layer remained intact. RESULTS: The proposed technique of intracorneal selective stromal transplantation makes it possible to replace only the pathologically altered stroma through closed surgical approach, without affecting the anterior and posterior surfaces of the cornea. Best-corrected visual acuity has increased in the patient from 0.01 to 0.6, while mean endothelial cell density has not changed in the course of 24-months follow-up. CONCLUSION: The proposed keratoplasty method can be used in patients with dystrophy or degeneration of the corneal stroma and preserved endothelial cells, intact Descemet's membrane and Bowman layer. Since the superficial corneal layers are not involved during the surgery, intracorneal selective stromal transplantation combined the advantages of both deep anterior lamellar keratoplasty and endothelial keratoplasty. The biologically favorable result in this first clinical case allows a preliminary conclusion on the technical possibility and functional effectiveness of the proposed method, but further long-term observation and more clinical cases are required.

[Descemet membrane endothelial keratoplasty after implantation of glaucoma drainage devices]. / Vozmozhnosti transplantatsii endoteliya s destsemetovoi membranoi posle implantatsii antiglaukomnogo drenazha.

Secondary decompensation of corneal endothelium, including transplanted, is a frequent long-term complication of glaucoma drainage surgery. According to literature data, after implantation of a glaucoma drainage device into the anterior chamber, the speed of endothelial cells density (ECD) loss increases significantly. PURPOSE: To study the possibility of performing modified Descemet membrane endothelial keratoplasty (DMEK) with maximum graft diameter, and to assess its short-term effectiveness in the treatment of bullous keratopathy (BK) in the presence of a glaucoma drainage device in the anterior chamber. MATERIAL AND METHODS: Modified surgery 3/4-DMEK was performed in 9 eyes of 7 patients with BK and Ahmed glaucoma drainage using graft of maximum diameter (11±1 mm). Average follow-up time was 15.3±2.5 months (12 to 18 months). RESULTS: No intraoperative or postoperative complications were observed. Mean ECD after 12 months amounted to 1664±346 cells/mm2, which corresponds to ECD reduction of 34±9.6% (24 to 49%) in comparison to preoperative values. Mean best corrected visual acuity 12 months after surgery increased from 0.04±0.03 (0.01 to 0.1) to 0.3±0.2 (0.04 to 0.7). The last follow-up examination revealed all corneas to have preserved transparency and stable pachymetry measurements (from 488 to 548 µm). CONCLUSION: Performing 3/4-DMEK with a mega graft for treatment of BK after drainage surgery is technically possible. Absence of Descemet membrane (DM) donor and preservation of DM recipient in the drainage tube plane eliminates its contact with the endothelium. Maximum graft diameter should in the long term help prolong the effectiveness of the surgery.

Effect of hrWnt7a on Human Retinal Pigment Epithelial Cells In Vitro.

Human recombinant protein Wnt7a (hrWnt7a) inhibits cell proliferative activity and triggers cell polarization. Although cell polarization process was maintained only over a short time, probably via microenvironmental stimuli, hrWnt7a is involved in the transformation of the retinal pigment epithelium. Analysis of Wnt signaling pathway and its regulation will help to understand the processes in retinal pigment epithelial cells under pathological conditions, which can be useful in developing new generation drugs.

[PCR study of the human herpes virus type 6 and other viruses of the herpes group in eye diseases].

To study the role of the HHV-6 type in the development of eye diseases PCR tests of blood (152), cornea biopsies (61), and intraocular fluids (11) for HHV-6 and other viruses of the herpes group (HSV type 1 and 2, CMV, EBV) were conducted. It was found that the HHV-6, along with other representatives of the Herpesviridae, can be detected in patients with different clinical forms of ophthalmopathology (174 patients were surveyed). Viral DNA was detected in blood, cornea, and in the anterior chamber fluid. The obtained data allow that the HHV-6 to be suggested as a possible cause of the ophthalmic herpes along with the other viruses of this group. It makes finding the virus DNA an essential step towards setting the etiologic diagnosis of the ophthalmological patients.

[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.

Selective induction of apoptosis in glioma tumour cells by a Gynostemma pentaphyllum extract.

At low concentration H(2)O(2) is an important signal molecule in proliferation of tumour cells. We report about a study investigating the effect of an ethanolic extract from Gynostemma pentaphyllum on proliferation of C6 glioma tumour cells and cellular H(2)O(2) concentration. The proliferation of these cells was maximal at about 1 muM extracellular H(2)O(2). HPLC-finger prints of the extract revealed a set of saponines as essential components. In C6 glioma cells the extract caused increase in super oxide dismutase (SOD) activity, in the amount of SOD protein, and in cellular H(2)O(2) concentration. It inhibited cell proliferation and induced activation of caspase 3 as indication of apoptosis. No effect of the extract was observed on the proliferation of astrocytes of a primary cell culture. From these findings we suggest that the ethanolic extract from Gynostemma pentaphyllum may selectively shift the H(2)O(2) concentration to toxic levels exclusively in tumour cells due to increased SOD activity. It may have a high potency in cancer therapy and cancer prophylaxis.

[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.

[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.

[Surgical strategy in the treatment of severe and extremely severe eye burns. 2]. / K khirurgicheskoi taktike lecheniia tiazheloi i osobo tiazheloi ozhogovoi travmy glaz (soobshchenie 2).

The author presents the results of using his own surgical strategy in multiple-modality treatment of 76 patients with severe and extremely severe burns of the eyes. He proves that active surgical strategy during the early period of burn process notably decreased the incidence of complications, preserved the eyeball for further reconstructive operations, and thus improved the functional outcomes of severe burns of the eyes.

[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.

[Cytotoxic effect of energy supply system inhibitors on cells from Ehrlich ascite carcinoma]. / Tsitotoksicheskoe deistvie ingibitorov sistem énergoobespecheniia na kletki astsitnoi kartsinomy Erlikha.

It was shown that inhibitors of oxidative phosphorylation (cyanide, rotenone, and oligomycin) and very low concentrations of exogenous prooxidants exerted a pronounced cytotoxic effect on Ehrlich ascites carcinoma cells. We propose that cell injury by reactive oxygen forms is the cause of the cytotoxic effect of the studied inhibitors. It was shown via flow cytometry that inhibitors of oxidative phosphorylation and exogenous prooxidants block cell progress in the cell cycle and induce appearance of cells with reduced DNA content.

Intracellular distribution and characteristics of Ca(2+)-transporting systems in cells of ciliate protozoan Tetrahymena pyriformis.

A significant digitonin-sensitive calcium pool has been shown to exist in Tetrahymena pyriformis cells. In the presence of exogenic energy sources, calcium released from the digitonin-sensitive pool can be accumulated by mitochondria or endoplasmic reticulum. The kinetic characteristics of the mitochondrial and reticulum systems of Ca2+ transport and their sensitivity to various inhibitors were studied.

[Clinical and immunological criteria of the activity of inflammatory reaction and autolymphokine therapy in penetrating wounds of the eye]. / Kliniko-immunologicheskie kriterii aktivnosti vospalitelnoi reaktsii i autolimfokinoterapiia pri pronikaiushchikh raneniiakh glaza.

Clinical and immunological criteria of an unfavorable course of posttraumatic process were defined and the efficacy of autolymphokine therapy in the postoperative treatment of patients with penetrating wounds to the eye assessed. A total of 119 patients were examined. Autolymphokine therapy supplemented the traditional postoperative treatment in 38 of them. An unfavorable course of the posttraumatic period was associated with high levels of tumor necrosis factor-alpha and interleukin-1-beta in the blood serum and lacrimal fluid, with accumulation and long persistence of high titers of antibodies to lens antigens and retinal S-antigen in the lacrimal fluid, with intensive cellular immune response to these antigens in the leukocyte migration inhibition test, and with a deficit of tissue-specific anticorneal antibodies in the lacrimal fluid during the first 3-4 weeks after the injury. In the event of a favorable outcome the cytokines were detected in the minimal amounts, and antibody titers were moderate. Autolymphokine therapy 2 to 3 times decreased the concentration of cytokines in the lacrimal fluid, maintained the moderate level of autoantibodies in the lacrimal fluid, decreased the incidence of the leukocyte migration inhibition and the duration of its detection, and shortened the period of autoantibody detection in the blood serum.

[Characteristics of reversible and irreversible Ca2+-induced efflux of Ca2+ from mitochondria in permeabilized Ehrlich ascites carcinoma cells]. / Kharakteristiki obratimogo i neobratimogo Ca2+-indutsirovannogo vykhoda Ca2+ iz mitokhondrii permeabilizirovannykh kletok astsitnoi kartsinomy Erlikha.

The Cyclosporin A-sensitive mitochondrial permeability transition in Ehrlich ascites tumour cells has been investigated. It was shown that Ca2+ ions induce both the self-reversible and irreversible mitochondrial permeability transition. ADP effectively inhibits the reversible but has no effect on the irreversible permeability transition. Bromophenacyl bromide, a potent inhibitor of phospholipase A2, effectively inhibits both the reversible and irreversible permeability transition. Accumulation of phosphatidylcholine and phosphatidylethanolamine lysoforms in mitochondria during Ca(2+)-induced Ca2+ release from mitochondria was found. The role of lysophospholipids in the formation of the non-selective pore in inner mitochondrial membranes during the mitochondrial permeability transition was postulated.

[Subdiaphragmatic abscesses in children]. / Poddiafragmalnye abstsessy u detei.

At the clinic of pediatric surgery of the Sverdlovsk Medical Institute 30 children aged from 3 to 14 years were treated for subdiaphragmatic abscesses in 1979-1989. In 27 of them the abscesses occurred in 6 days to 6 months after an emergency operation. The largest group (19 children) was formed of patients who underwent operation for destructive appendicitis and peritonitis. The subdiaphragmatic abscess was found on the left side in 16 (53.3%) and on the right side in 14 (46.6%) cases. In 11 (36.6%) patients in was combined with abscesses of other localization. X-ray and ultrasonic studies and, occasionally, computed tomography were used along with clinico-laboratory methods in establishing the diagnosis of subdiaphragmatic abscesses. Operations were performed on 29 patients. One patient was treated by puncture followed by drainage of the abscess after Seldinger. The choice of the approach was determined by the localization of the abscess. The intraperitoneal approach was used in 11 cases (36.6%), Klermon's extraperitoneal approach in 16 (53.3%), Melnikov's extrapleural approach in 2, and the posterior retropleural approach in one case. Complex intensive therapy was applied in the postoperative period. Among the 30 patients one died from sepsis and developed polyorganic insufficiency.