[Gold weight implants for lagophthalmos correction in chronic facial nerve paralysis (late results)].

UNLABELLED: Upper eyelid weigh gold implant is the widely accepted standard for the treatment of paralytic lagophthalmos (PL). AIM: To evaluate late outcomes of PL correction with chain gold implants. MATERIAL AND METHODS: Chain gold implants were inserted in the upper eyelids of 70 patients with lagophthalmos due to chronic facial paralysis. A comprehensive ophthalmic examination was performed prior to surgery and then at months 1, 3, 6, 12, 24, and 36. RESULTS: The results obtained prove the method highly effective. None of the patients developed any severe complications. Cases of implant removal were few. Some of the studied biometric parameters decreased significantly after surgery, while the upper eyelid excursion increased. The implant had no effect on the inner surface of the cornea and its peripheral thickness. CONCLUSION: Efficacy of the proposed eyelid implant has been convincingly demonstrated; late complications have been analyzed.

[Fluorescein angiography and optical coherence tomography findings in central fundus of myopic patients].

UNLABELLED: Myopia prevalence grows alike in many countries, including Russia, regardless of geographical and population conditions. AIM: to assess fundus changes in myopic patients at different ocular axial lengths by means of modern diagnostic tools. MATERIAL AND METHODS: The study enrolled 97 patients (194 eyes) aged 45 ± 20.17 years with myopia of different degrees. Besides a standard ophthalmic examination, all patients underwent fundus fluorescein angiography and optical coherence tomography. RESULTS: The occurrence of retinal pigment epithelium (RPE) atrophy (diffuse or focal) has been shown to increase with increasing ocular axial length. Only 27 eyes (28.1%) appeared intact. As myopia progression implies axial growth of the eye, it is associated with a more severe decrease in choroid, RPE, and photoreceptor layer thicknesses: the longer the anterior-posterior axis, the thinner the above mentioned fundus structures. Age-related changes in the fundus are also likely to be more pronounced in longer axes. Myopic traction maculopathy, which in our case appeared the main cause of increased retinal thickness, was diagnosed in 105 eyes, "outer" macular retinoschisis--in 40 eyes. CONCLUSION: Thus, modern diagnostic tools, such as fluorescein angiography and optical coherence tomography, enable objective assessment of the central fundus.

[Corneal examination in patients with bullous keratopathy before and after endothelial keratoplasty].

OBJECTIVE: To evaluate corneal status in patients with bullous keratopathy before and after endothelial keratoplasty. MATERIAL AND METHODS: A total of 16 patients (18 eyes) with bullous keratopathy were examined before and after DSAEK. Confocal microscopy ("Nidek", Japan) was used for corneal status evaluation. RESULTS: Follow-up examinations were performed 3, 6, and 24 months after the surgery. In all patients minor corneal opacity persisted for the whole follow-up period but tended to decrease. It is shown that visual acuity is most dependent on light scattering in the anterior stroma. CONCLUSION: Anterior stromal haze is shown to have greater impact on visual acuity than opacities, folds, and birefringent deposits within the host-donor interface. Duration of bullous keratopathy, patient's age, and comorbidity are the factors that influence anterior and deep stromal haze development and changes over time.

[Clinical significance of modern methods of corneal assessment].

The article observes the application experience of modern methods of corneal refraction and structure evaluation. Comprehension of computer-assisted videokeratography is high enough to diagnose corneal astigmatism, keratoconus, early-stage corneal dystrophies, and corneal topography changes resulting from a variety of factors. Scanning projecting keratography provides information on both anterior and posterior corneal topography and elevation, as well as corneal thickness in each point of central area. Aberrometry can be used for estimation of the impact of different factors on corneal optical properties and assess the possibility for correction of resultant disturbances. Confocal microscopy allows to evaluate morphological changes in keratoconus and corneal dystrophies and also diagnose acanthamoeba keratitis. Optical coherence tomography provides the possibility of whole cornea assessment, however, with much less magnification in comparison to confocal microscopy. Improved tearscopy with computed analysis of interference digital images ("Lacrima" software) enables evaluation of lipid layer thickness and structure in normal and impaired tear film (like in dry eye syndrome), as well as the influence of different factors and therapeutic measures. Topographical pachymetry data is the most valuable for diagnostics and monitoring of keratoconus.

[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.

[The value of methods for morphofunctional analysis of cornea in cataract surgery].

The characteristics of morphofunctional status of cornea after extracapsular cataract extraction and phakoemulsification with IOL implantation (30 and 58 operations respectively) were analyzed in detail using up-to-date diagnostic techniques. The results of examination using developed algorithm including study of light transmission, refraction and protective function of cornea show advantage of microinvasive ultrasound technique of cataract surgery in terms of minimal impact on corneal structure, optical and biomechanical characteristics.

[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.

[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.