[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.

[Top-hat keratoplasty in surgical treatment of bullous keratopathy].

Outcomes of different modifications of top-hat keratoplasty were assessed in 48 patients (48 eyes) with bullous keratopathy. In the 1st group manual top-hat keratoplasty was performed in 7 patients. 30 patients of the 2nd group underwent manual half-top-hat keratoplasty. In the 3rd group femtosecond laser-assisted top-hat keratoplasty was performed in 11 patients. All keratoplasty techniques used in the study provide high rate of clear graft retention. Manual half-top-hat keratoplasty is technically easier compared to manual top-hat keratoplasty though having similar outcomes and does not require the use of any additional equipment. Femtosecond laser-assisted top-hat keratoplasty allows to achieve superior optical results, trephination is performed promptly and with minimal tissue trauma. This new keratoplasty technique is a promising procedure and requires further detailed investigations.

[The results of up-to-date techniques of automated endothelial keratoplasty].

The results of different techniques of automated endothelial keratoplasty (EKP) performed in 72 patients with bullous keratopathy are estimated. Automated EKP with superficial flap was performed in 18 patients (1st group), Descemet stripping automated EKP (DSAEK) - in 26 patients (2nd group), Descemet stripping automated EKP (DSAEK) with thin grafts - in 20 patients (3rd group), Descemet membrane automated EKP with stromal rim (DMAEK) - in 8 patients (4th group). According to our results DSAEK with thin grafts is indicated to elderly patients with severe ocular disease (ocular comorbidities, repeated surgery, advanced keratopathy). DSAEK is a promising surgical technique allowing to achieve the best functional results. Nevertheless this procedure is technically challenging and is good for relatively functionally "preserved" patient groups.

[Vital confocal microscopy in evaluation of efficacy of personalized cell therapy in management of early postoperative bullous keratopathy].

The results of vital confocal microscopy (VCM) of 5 patients with early postoperative bullous keratopathy after cataract phakoemulsification (PE) treated with author's technique of personalized cell therapy (PCT, intracameral injection of activated patient's leukocytes in autologous serum) are presented. In 3 of all presented cases endothelial loss after PE was more than 50%. Before PCT using of VCM was not possible due to corneal edema. After 2-3 PCT sessions corneal clarity recovery was observed and signs of regenerative processes in cornea were captured by VCM: activation of keratocytes (hyperreflective nuclei) and endothelial cells (multinucleated cells), descemet membrane folds smoothening, normalization of epithelium. Results of VCM correlate with biomicroscopic signs of corneal edema resolution, corneal clarity recovery, improvement of visual acuity after PCT.

[Anatomic and functional ocular characteristics and myopia development].

Literature data dealing with the main anatomic and physiological factors influencing myopia development are reviewed. They are as follows: activity of accomodation structures, haemo- and hidrodynamic changes, rigidity of fibrous tunic. A complex of different examination methods is essential for appropriate management of myopic patients because the degree of influence is variable for every factor and is still completely unknown.

[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.

[Painful bullous keratopathy treatment using anterior stromal puncture combined with amniotic membrane transplantation].

A case of painful bullous keratopathy (PBK) treated using author's procedure of anterior stromal puncture (ASP) combined with amniotic membrane transplantation (AMT) is presented. ASP combined with AMT can be effective option for pain relief and promotion of epithelial healing in patients with PBK and poor visual potential.

[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.

[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%.

[Potentialities of confocal microscopy in the evaluation of the cornea in the dry eye syndrome].

The purpose of the investigation was to study the potentialities of confocal microscopy in the evaluation of the corneal status in the dry eye syndrome (DES). Fifty-two patients (104 eyes) were examined and divided into 2 groups: 1) 32 patients with the verified diagnosis of DES of various etiology; 2) 20 healthy volunteers (a control group). Corneal confocal microscopy was made on a Confoscan-4 device (Nidek, Japan). The investigations ascertained that there was a direct relationship between the functional parameters, the degree of severity, rather than the etiology of DES and the changes in the corneal morphological pattern. Overall, corneal changes in patients with DES primarily involved the anterior epithelium and anterior stromal layers. The non-invasive and high informative value of confocal microscopy made it possible to study at the fundamentally new level the corneal structure that is always involved in the pathological process in DES.

[Bifocal contact lenses as a correction method in presbyopia]. / Bifokal'nye kontaktnye linzy kak metod korrektsii presbiopii.

A study aimed at assessing the efficiency of presbyopia correction by bifocal contact lenses (BCL) was undertaken; it envisaged a comprehensive evaluation of subjective data provided by patients and measurements of a number of functional parameters of the visual quality for far and near, including mono- and binocular measurements with BCL of different constructions versus a maximal sphero-cylindrical spectacle correction for far and for near. Soft Acuvue Bifocal BCL as well as soft and rigid BCL manufactured in the optical-and-mechanical laboratory of the Research Institute for Eye Disease of the Russian Academy of Medical Sciences and Russian-made and imported bifocal soft and rigid lenses, respectively, were made use of in the study. A reduced contrast sensitivity (mainly in high frequencies) to 7% with Russian-made BCL, to 12.5% with Acuvue Bifocal BCL, to 8.7% with monofocal BCL and to 13.4% with the "mono-vision" system was registered. A decreased visual working ability to 13% with soft bifocal Russian-made BCL, to 17.3% with Acuvue Bifocal BCL and to 20.7% with the "mono-vision" system was detected versus the spectacle correction. A reduction by 25% was noted in the stereoscopic vision indices with the "mono-vision" system. A study of sensitivity to dazzling did not show any statistically reliable differences between various correction types.

[Hyperplastic connective tissue syndrome in patients with high myopia]. / Izuchenie sindroma giperélastichnosti soedinitel'noi tkani u bol'nykh s miopiei vysokoi stepeni.

A conventional ophthalmologic and special somatic examination was carried out in 50 patients with myopia and 30 patients of the control group to determine hypermobility of joints by 9-point scale. Hypermobility of joints in patients with myopia was estimated at 5.95 points and in patients in the control group--2.7 points. All the patients with high myopia showed 12 various additional features of connective tissue hyperelasticity, on the average, with no more than 4 such features in the control group. It is suggested that hereditary predisposition to hyperelasticity of connective tissue determines a particular inclination of the sclera to overextension. This plays a definite role in appearance and progress of axial myopia.

[Significance of phospholipase activity in assessing the course of the wound process in children]. / Znachenie aktivnosti fosfolipaz v otsenke techeniia ranevogo protsessau detei.

On the basis of clinico-biochemical and cytological examinations of 90 children with clear, purulent and burn wounds the activation of A and C phospholipases was found in the blood and wound discharge which was proportional to the activity of inflammatory, destructive changes in the wound at the stage of their healing. It determined their pathogenetic, diagnostic value for control of the depth of skin damage, development of postoperative complications, preparedness of the granulating wound for plasty, efficiency of the treatment.