[Uveitis-associated HLA class 1 histocompatibility antigens]. / Uveity i ikh assotsiatsiia s antigenami gistosovmestimosti klassa 1.

AIM: to evaluate the diagnostic and prognostic significance of HLA class 1 histocompatibility antigens in the development of anterior uveitis. MATERIAL AND METHODS: A total of 137 patients with anterior uveitis followed up at the Research Institute of Eye Diseases in 2009-2016 were tested for HLA antigens (A and B loci). The average patient's age was 29±12.4 years. All patients underwent a thorough medical interview with clinical and laboratory assessment. In case of suspected association with systemic disease, the patients were referred for consultation at the V.A. Nasonova Research Institute of Rheumatology. HLA typing was performed using a standard microlymphocytotoxicity test with specific anti-HLA sera (production of Gisans CC, Saint Petersburg). Statistical processing was performed with Statistica 6.0 software by applying methods of descriptive and nonparametric statistics (Mann-Whitney test). RESULTS: The results of HLA class 1 typing indicated a significant positive association between uveitis and the HLA-B27 antigen (p<0.00001). Moreover, there was a trend toward decreased frequencies of В7, B12, and B21 antigens (p=0.1), however, the changes were not statistically significant as compared to the control group. Other HLA class 1 antigens also did not differ significantly in frequency between uveitis patients and the controls. CONCLUSION: The study has confirmed an association between certain histocompatibility antigens and systemic diseases. However, a statistically reliable relationship has been established only for the HLA-B27 antigen.

[Uveitis in spondyloarthritis patients and its association with HLA-B27 histocompatibility antigen: prospective study]. / Prospektivnoe issledovanie uveitov pri spondiloartritakh i ikh assotsiatsii s antigenom gistosovmestimosti HLA-V27.

AIM: to perform a prospective study of clinical presentation and course of uveitis in spondyloarthritis (SpA) patients as well as its association with the HLA-B27 histocompatibility antigen. MATERIAL AND METHODS: The study included 219 patients with uveitis, all tested for HLA-B27 antigen and various infections (viral, bacterial, and parasitic) as well as examined for locomotive system involvement. RESULTS: The presence of the HLA-B27 antigen was determined in 142 (64.8%) out of 219 patients, of them 87 were diagnosed with an entity of the SpA group. The remaining 77 (35.2%) patients appeared to be HLA-B27-negative, but 13 were still diagnosed with an entity of the SpA group. There were 10 (4.6%) patients with 2 or more diseases from the SpA group («clinical decussation¼). When comparing the two groups of HLA-B27-positive and negative patients having both SpA and uveitis, no statistically significant difference was found as to the age of onset, site, frequency of attacks, and uni- or bilateral involvement (p>0.05). We also performed a comparison of HLA-B27-positive and negative patients with no account to their SpA status and revealed a higher complication rate in those that were «negative¼ (p<0.0001), which can be explained by the fact that HLA-B27-negative patients often have autoimmune or infectious uveitis of different origin notable for long attacks and short remissions. CONCLUSION: Assessing the site and course of uveitis as well as HLA-B27 testing of uveitis patients has proved important for etiological diagnosis. Diseases of the SpA group have been shown to be 6.7 times more common in HLA-B27-positive patients as compared to HLA-B27-negative ones. Clinical presentation of uveitis in the presence of SpA in both HLA-B27-positive and negative patients resembles that of idiopathic uveitis - an independent HLA-B27-associated syndrome (р>0.05). Cases of «decussation¼ between entities of the SpA group are usually more severe in terms of clinical presentation and course of uveitis and are associated with a worse prognosis. Complications of uveitis are more likely to be found in non-SpA HLA-B27-negative patients (р<0.0001).

[Clinical presentation, diagnosis, and treatment of ocular manifestations of generalized and secondary focal yersiniosis].

The article describes possible clinical presentation, diagnosis, and treatment of ocular manifestations of generalized and secondary focal yersiniosis. Treatment experience of 32 patients (60 eyes) with episcleritis, scleritis, chorioretinitis, and anterior and posterior uveitis associated with generalized and secondary focal yersiniosis is reviewed. In order to clarify disease etiopathogenisis conventional ophthalmic assessment as well as clinical and immunological laboratory tests, including HLA typing, were performed. All patients also consulted an infectiologist, rheumatologist, urologist, gynecologist, etc. Treatment strategy implied the use of anti-infectious and anti-inflammatory agents, antisensitizers, and drugs capable of improving intracellular immunity, therapy staging, and providing a comprehensive effect on different components of the pathologic process. Due to polymorphism of yersiniosis, all patients with autoimmune eye diseases are to be tested for specific antibodies to Yersiniae.

[Clinical and molecular genetic analysis of hereditary optic neuropathies].

DNA samples of 50 patients with optic neuropathy (ON) associated with congenital cataract were studied to find 3 major mt-DNA mutations (m.11778G>A, m.3460G>A, m.14484T>C), mutations in "hot" regions of OPA 1 gene (exons 8, 14, 15, 16, 18, 27, 28) and in the entire coding sequence of OPA3 gene for molecular genetic confirmation of diagnosis of hereditary Leber and autosomal dominant ON. Primary mutations of mtDNA responsible for hereditary Leber ON were found in 16 patients (32%). Pathogenic mutations of OPAl gene (c.869G>A and c. 2850delT) were identified in 2 patients (4%), these mutations were not found in the literature. OPA3 gene mutations were not revealed.

[Features of clinical manifestations of the globe, adnexal and orbital sarcoidosis].

86 patients with verified diagnosis of sarcoidosis with globe, adnexa and orbit manifestations were observed. The age of the patients ranged from 21 to 43 years old (average 35,1+/-1,2 years), among them 25 males and 61 females with disease duration from 1 month till 12 years and 15 years follow-up. The study is based on different variants of globe, adnexal and orbital sarcoidosis. In our practice we observed sarcoidosis as a combination of several manifestations simultaneously. In 32 patients of 38 patients examined HLA-B-7, B-8, DR-2, DR-3, DR-15 were detected, that confirms genetic predisposition to sarcoidosis and determines the course of the disease. In 27 patients cellular and humoral immunity disbalance was found, that confirms the immune etiology of sarcoidosis as well. However the treatment of patients was pathogenic as the etiology of sarcoidosis is still unknown.

[Optimization of complex treatment in ocular toxoplasmosis and concurrent infections].

137 patients (177 eyes) with verified toxoplasmic uveitis, retinitis, chorioretenitis were observed. Among them 65 patients had concurrent infections: tuberculosis, herpes simplex and chlamydia. Routine ophthalmologic, clinical and laboratory examination was performed. The results of intensive treatment in acute and chronic phases are presented, the staged drug pathogenic treatment including methods of specific therapy, based on differential approach to anti-inflammatory agents use, was provided. Early diagnosis and appropriate management including combined treatment of concurrent infections improves treatment efficacy and allows to achieve excellent results.

[Diagnosis and treatment of HLA-B27-associated uveitis].

The purpose of the present investigation was to diagnose and to treat HLA-B27 antigen-associated uveitis in 102 patients (118 eyes) with anterior and posterior uveitis. HLA antigens were typed to specify the etiopathogenesis of uveitis. Along with this, the patients were examined by a rheumatologist, a rontgenologist, an immunologist, an urologist, a dermatovenereologist, a dentist, and an otorhinolaryngologist. The conventional ophthalmological study and eye B-scanning were also performed. After complex therapy, there were improvements in the ocular state and overall somatic condition, as confirmed by the results of clinical studies. In 81 patients, the time of relapses reduced and the duration of remissions increased; persistent remission occurred in 15 patients. The course of the disease was unchanged in 7 cases. The pathogenetic role of B-27 antigen in the development of uveitis, as well as ankylosing spondylarthritis, seronegative spondylarthropathy, and other types of spondyloarthritis has not been explained so far. Notwithstanding this, the joint efforts of an oculist, a rheumatologist, and, not rarely, other specialists and the specific features of a clinical approach could provide a pronounced positive effect in treating the patients with HLA-27-associated uveitis.

[Differential diagnosis of treatment of episcleritis and scleritis].

The purpose of the present investigation was to develop an optimal approach to rehabilitating patients with episcleritis and scleritis of various etiology. The paper summarizes the results of examination and treatment in 128 patients (142 eyes) with the acute chronic course of the diseases. To specify the etiopathogenesis of a disease, the patients were examined by a rheumatologist, an immunologist, a virologist, a phthisiatrician, an ENT specialist, and a roentgenologist. Rhinofrequency ultrasound biomicroscopy was made in the diagnosis of scleral inflammatory diseases. Ultrasound studies (ultrasound biomicroscopy and B-scanning of the eye) were additionally conducted. Complex therapy produced a marked positive clinical effect in 124 patients (138 eyes). During 5 years, immunological parameters improved in all the examined. Thus, episcleritis and scleritis are an overall immunological disorder and frequently associated with infections. Current laboratory clinical and instrumental studies considerably enhance the efficiency of the diagnosis and, hence, treatment of these diseases.

[Modern aspects in the treatment of ophthalmic herpes]. / Sovremennye aspekty lecheniia oftal'mogerpesa.

The author report about study results conducted in Russia during the recent 30 years and dedicated to the treatment of ocular pathologies caused by the virus of herpes simplex. Three high-efficiency directions took shape during the mentioned period: 1. Non-specific antiviral therapy based on the local and systemic administration of interferon inductors (poludan--complexes of poly A, poly U etc.) possessing an extensive spectrum of the antiviral and immune-modeling actions; 2. Antirecurrent therapy, including the application of herpetic vaccine against the virus of herpes simplex, types I and II, combined with immune-modeling agents. A focal allergic test with herpetic vaccine was offered, it made it possible, for the first time, a non-invasive diagnostics of intraocular herpes. 3. A system of sparing microsurgical methods adapted to the treatment of an active herpetic keratitis and its outcomes. A synergistic effect of interferon inductors and acyclovir was proven both experimentally and clinically; a method of local autocytokinotherapy (based on poludan), which turned out to be most effective in the treatment of severe lesions at the cornea and of intraocular herpes, was worked out. The authors believe that the methods and means offered for the treatment of ophthalmoherpes contribute, to a great extent, to handling with the ocular herpes viral infection.

[Therapy of fundus oculi vascular pathology by solcoseryl]. / Primenenie solkoserila dlia lecheniia sosudistoi patologii glaznogo dna.

Long (for more than 17 years) therapy of 2331 patients (3122 eyes) with vascular conditions of the fundus oculi by a retinotropic drug solcoseryl showed its high efficacy as a monotherapy and in complex with other traditional and symptomatic treatments. Solcoseryl improved the visual function and hemodynamics of retinal vessels, promoted a more stable and longer stabilization of the treatment results, and accelerated the rehabilitation of patients.

[Impact of focal allergic test with herpetic vaccine in diagnosis of ophthalmic herpes]. / Znachenie ochagovoi allergicheskoi proby s gerpeticheskoi vaktsinoi v diagnostike vnutriglaznogo gerpesa.

Clinical and immunological studies were carried out in 697 patients (913 eyes) for a more accurate diagnosis of herpetic involvement of the posterior segment of the eye by the focal allergic test (FAT) based on the delayed type hypersensitivity phenomenon. FAT consists in detection of the focal reaction in the eye, regularly developing after 2-3 intracutaneous injections of herpetic vaccine to types I and II herpes simplex virus in a dose of 0.2 ml every other day. The reaction is assessed by clinical and functional methods: visometry, campimetry, biomicroscopy, 9-point test, Amsler network, Hedinger's phenomenon, photocolor stress test, Rabkin's polychromatic tables, fluorescent angiography of the fundus oculi, electrophysiological methods, critical frequency of flash fusion, reflection microscopy of the corneal endothelium, and color campimetry realized on an IBM-compatible computer before and after vaccination of patients with suspected herpetic involvement of the eye. FAT was positive in 395 (56.6%) patients in 568 (62.2%) eyes. Examination of the threshold relative brightness sensitivity before and after FAT revealed positive results in 70% of patients. FAT is an accurate non-invasive method for the diagnosis of various manifestations of intraocular herpes. Relative safety of FAT recommends it for clinical practice to be used in the diagnosis of herpetic involvement of the posterior segment of the eye.

[Tactics in choosing a vascular collector and drug administration method in intra-arterial infusion therapy of organs of vision]. / Taktika vybora sosudistogo kollektora i sposoba vvedeniia lekarstvennykh veshchestv v metodike vnutriarterial'noi infuzionnoi terapii organov zreniia.

Anatomical variants of the direction and diameter of the supraorbital artery revealed by the authors and the clinical variants of the intensity and direction of periorbital bloodstream shown by doppler studies helped optimize the selection of a facial artery for inserting an infusion system for drug delivery to the vascular system of the eye. The advantages of intraarterial infusion of drugs in the system of ocular blood supply using an automated thermo-infusion dispenser vs. the traditional methods are demonstrated: no side effects on the intraocular and regional hemodynamics, purposeful delivery of drugs to the site of ocular blood supply with a simple and convenient device. This method for the choice of a collector for intraarterial infusions and the method of drug infusion were clinically tried in 2 groups of patients: with retrobulbar intoxication neuritis and partial atrophy of the optic nerve (a total of 21 patients, 23 operations for implantation of infusion system; control group consisted of 11 patients). 120-Hour infusion therapy with, alternately, trental and actovegin resulted in improvement of the vision acuity from 0.03-0.06 to 0.3-0.8 in virtually all group 1 patients. Moreover, central scotomas disappeared and the conductivity of the axial bundle of the optic nerve recovered from 28-32 to 38-40 Hz. In group 2 defects in the visual field disappeared and its peripheral borders widened. In controls no improvement of the visual function was observed.