[Current possibilities for the diagnosis and treatment of pterygium]. / Sovremennye vozmozhnosti diagnostiki i lecheniya pterigiuma.

Pterygium is a common inflammatory-proliferative disease characterized by the invasion of degeneratively altered fibrovascular tissue into the cornea. This literature review analyzes the etiological factors and pathogenetic concepts of its development, describes modern methods of diagnostics and surgical treatment of pterygium, and pays particular attention to the assessment of structural and functional changes in the cornea occurring during the growth of pterygium and after its excision.

[Modern techniques and features of selective keratoplasty]. / Sovremennye tekhnologii i vozmozhnosti selektivnoi keratoplastiki.

Selective keratoplasty involves replacing the affected layers of the cornea with similar donor tissue. In case of pathological changes in the middle and posterior stroma, deep anterior lamellar keratoplasty (DALK) is performed. Chronic corneal edema caused by endothelial dysfunction is an indication for endothelial keratoplasty - Descemet membrane endothelial keratoplasty (DMEK) or Descemet Stripping Endothelial Keratoplasty (DSAEK). Compared to penetrating keratoplasty (PK), these operations are characterized by a low risk of damage to intraocular structures and a relatively short rehabilitation period. Complications of selective keratoplasty include the formation of a false chamber between the lamellar graft and the recipient's cornea, ocular hypertension during anterior chamber air tamponade. Persistent epithelial defect can be a sign of primary graft failure in DALK, DSAEK and DMEK. Selective keratoplasty is characterized by a lower incidence of immune rejection than PK. In some cases, DALK can be complicated by corneal changes related to suture fixation of the graft. Long-term postoperative use of topical glucocorticoids can cause ocular hypertension and cataracts.

[Purulent scleritis following penetrating keratoplasty for acanthamoeba keratitis]. / Gnoinyi sklerit posle skvoznoi keratoplastiki po povodu akantamebnogo keratita.

The problem of treating purulent scleral infections, rare but extremely severe complication of ophthalmic surgeries, remains unresolved. This article presents a case of successful surgical treatment of purulent scleritis - interlamellar scleral abscess - that developed in a patient after repeat penetrating keratoplasty performed due to infectious lysis of the transplant. Although the first keratoplasty was performed for acanthamoeba keratitis, there were no signs of acanthamoeba invasion in the transplant at the time of the second surgery. Scleritis manifested as an infiltrate with pus penetrating the anterior chamber and development of keratoiridocyclitis. During surgery, the abscess cavity was opened, irrigated with an antiseptic solution, and drained into the subconjunctival space; the anterior chamber was irrigated with balanced salt solution through a separate paracentesis. No infection recurrences were noted in the postoperative period and the corneal transplant remained clear.

[Options for contact correction after keratoplasty]. / Vozmozhnosti kontaktnoi korrektsii posle keratoplastiki.

Keratoplasty is a radical surgical method for treating various corneal pathologies. Today, there are many types of keratoplasty, each aiming to restore the integrity and transparency of the cornea. However, keratoplasty-induced ametropia often prevents achieving high visual acuity and makes impossible the use of conventional optical correction methods such as glasses or soft and traditional rigid contact lenses. In this regard, the use of scleral contact lenses is the most optimal method for optical correction of postoperative refractive anomalies, ensuring successful visual rehabilitation and preventing the need for additional keratorefractive interventions.

[Corneal changes in Fuchs endothelial corneal dystrophy and bullous keratopathy]. / Izmeneniya rogovitsy pri endotelial'noi distrofii Fuksa i vtorichnoi bulleznoi keratopatii.

OBJECTIVE: Evaluation of structural and immunohistochemical features of cornea in Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK). MATERIAL AND METHODS: Group 1 - 44 patients (46 eyes) with FECD, group 2 - 42 patients (42 eyes) with BK. All patients underwent keratoplasty. Preoperative anterior segment optical coherence tomography (AS-OCT, RTVue-100, Optovue, USA) was performed. Endothelium-Descemet membrane (EDM) complexes, corneal buttons were obtained intraoperatively. Morphological (H&E staining) and immunohistochemical (primary antibodies to pancytokeratin, vimentin, fibronectin) studies were performed at the light microscope level (Leica DM-2500, Leica Application Suite V4.8, Leica Microsystems, Switzerland). RESULTS: A direct correlation is found between the results of DM analysis in vivo with OCT and ex vivo with light microscopy. DM thickness (AS-OCT) was significantly greater in FECD (23.0 [19.0; 27.0] µm), than in BK (13.0 [12.0; 14.0] µm). Morphological study of EDM and corneal buttons showed similar difference in DM thickness: 17.9 [16.1; 20.0] µm in FECD and 11.9 [11.3; 13.0] µm in BK. Irregular optical density of stroma is a feature of edema and local fibrosis. In FECD and BK pancytokeratin is expressed in epithelial and endothelial cells, vimentin - in keratocytes, macrophages and vascular endothelium, fibronectin - in DM. In FECD, vimentin is expressed in endothelial cells. CONCLUSION: FECD and BK are associated with different DM' and endothelium' abnormalities, which lead to similar changes of stroma and epithelium. AS-OCT is a useful method of FECD and BK in vivo diagnostics and the selection of treatment option.

[Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation)]. / Glubokaya perednyaya posloinaya keratoplastika pri ekstruzii nepolnogo intrastromal'nogo kol'tsa (klinicheskoe nablyudenie).

Intrastromal corneal ring segments (ICRS) of in various shapes are used to correct structural changes in the cornea and improve visual acuity in keratoconus (KC). The most serious complications of the technology infection, vascular ingrowth, and extrusion. In this study a 44-year-old patient underwent deep anterior lamellar keratoplasty (DALK) 5 years after implantation of ICRS in the shape of an incomplete ring to treat its extrusion of up to 30%, vascular ingrowth into the cornea and corneal syndrome. The following DALK technique was used: excision of the free part of the corneal segment, removal of the remaining part of the corneal segment, excision of 80% of thickness of the corneal block with a 8.5-mm trepan, pneumatic dissection of the stroma down to the Descemet membrane (DM), removal of the remaining stroma on the viscoelastic pillow, laying and suture fixation of the donor graft. There were no complications during the postoperative period, the graft remained transparent for up to 10 months. Uncorrected visual acuity (UCVA) increased from 0.01 to 0.4, best corrected visual acuity (BCVA) increased from 0.3 to 0.7. The number of endothelial cells decreased from 2980 to 2670 cells/mm2 (10.4%). This clinical case demonstrates that DALK surgery can be a reliable method of patient rehabilitation in cases of extrusion of ICRS in the shape of an incomplete ring and vascular ingrowth.

[Salzmann nodular degeneration: pathogenesis, clinical characteristics and treatment]. / Uzelkovaya degeneratsiya Zal'tsmana: osobennosti patogeneza, klinicheskoi kartiny i lecheniya.

Salzmann nodular degeneration (SND) is a rare non-inflammatory disease observed primarily in middle-aged women. The disease generally occurs in patients with chronic inflammation of the anterior ocular surface. Its etiopathogenesis remains poorly investigated. This literature review describes clinical manifestations, risk factors and diagnostic methods, evaluates the effectiveness of different therapeutic and surgical treatment methods. Understanding of the pathogenetic mechanisms, precise diagnosis and identification of the risk factors can help clinical physicians make the optimal choice of treatment strategy and achieve the best clinical outcomes.

[On the tactics for surgical treatment of keratoconus in significantly altered corneal thickness]. / K voprosu o taktike khirurgicheskogo lecheniya keratokonusa pri sushchestvennykh izmeneniyakh tolshchiny rogovitsy.

PURPOSE: To evaluate the clinical and functional outcomes of bandage therapeutic-optical keratoplasty (BTOK) surgery in patients with keratoconus (KC) and significant changes in corneal thickness. MATERIAL AND METHODS: Surgical treatment was performed in 15 patients (15 eyes) with stage IV KC aged from 22 to 51 years (mean age - 32.61±7.94 years). The follow-up period lasted 3 years. All patients underwent BTOK surgery using an interlamellar graft with a thickness of 320 to 350 µm. RESULTS: Uncorrected and best corrected visual acuity increased in all patients after BTOK surgery and did not change statistically significantly during the entire follow-up period (3 years), amounting to 0.47±0.12 and 0.53±0.13, respectively. Keratometric parameters also remained stable by that observation time point and amounted to: Kmax - 53.01±2.30 D; Kmin - 41.63±2.24 D; Km - 47.32±1.91 D. CONCLUSION: The BTOK surgery helps achieve long-term (3 years) visual, optical and strengthening outcomes in stage IV KC patients when the use of other known techniques (corneal collagen crosslinking, corneal segments) is technically impossible because of the risk of complications due to significantly thinned cornea (less than 400 µm).

[On the issue of allocating the pre-Descemet's layer in the corneal structure]. / K voprosu o vydelenii predestsemetovogo sloya v strukture rogovitsy.

Selective keratoplasty is known to be based on surgical manipulations aimed at dosed isolation of layered grafts in the corneas of the donor and the recipient. Some technological features of obtaining transplants have served as the basis for expanding the understanding of the corneal structure. Thus, analysis of the process of corneal stroma pneumodissection for isolation of the Descemet's membrane led to a suggestion that there was another layer in the cornea, it was designated as the pre-Descemet's layer. This article discusses the practicability of separating the pre-Descemet's layer from the perspective of structural, functional and surgical anatomy.

[Opto-functional results in keratoconus patients after intrastromal keratoplasty]. / Optiko-funktsional'nye rezul'taty posle intrastromal'noi keratoplastiki pri keratokonuse.

Intrastromal keratoplasty with allograft implantation can stop the progression of keratoconus (KC) and improve visual acuity (VA). Although optimization of keratometric parameters and an increase in VA improve the quality of vision (QoV), there are other indicators that affect the QoV and the quality of life (QoL) of patients and require further study. PURPOSE: Analysis of quantitative and qualitative characteristics of vision in patients with stage II and III keratoconus who underwent intrastromal allokeratoplasty. MATERIAL AND METHODS: The study included 15 patients (15 eyes) with stage II-III KC (Amsler-Krumeich classification) aged 17 to 38 years old (28.8±6.2). All patients underwent intrastromal keratoplasty with implantation of an allograft in the form of a wide incomplete ring. The following parameters were assessed before and 6 months after surgery: distance VA with and without correction, near VA with and without correction, VA with glare effect, high-order aberrations (HOA), thickness of the tear film lipid layer, spatial contrast sensitivity (SCS) under photopic and mesopic conditions with light filters, reading speed. RESULTS: VA without correction increased from 0.15 to 0.7; with correction from 0.35 to 0.7. The glare effect with varying degrees of illumination did not affect VA either before or after surgery. Statistically significant changes were observed when comparing the aberrations «coma¼, «spherical¼, «trefoil¼ before and after the intervention, they became inverted. The thickness of the tear film lipid layer did not change significantly when comparing pre- and postoperative data. The use of light filters (orange, yellow) did not lead to significant changes in the VA and SCS under photopic and mesopic conditions. CONCLUSION: The use of a wide intrastromal allograft to correct deformity and stabilize the cornea in keratoconus improves the patients' quality of vision and visual performance.