[Immunomorphological aspects of post-traumatic subatrophy of the eyeball]. / Immunomorfologicheskie aspekty posttravmaticheskoi subatrofii glaznogo yabloka.

PURPOSE: The study attempts to characterize immunomorphological disorders at different degrees of post-traumatic subatrophy of the eyeball. MATERIAL AND METHODS: The study included 123 patients with blind and unpromising eyes, eyeball subatrophy of various degrees, who were divided into three groups (1, 2 and 3) depending on the degree of eyeball subatrophy. RESULTS: The greatest risk of autoimmune inflammation was observed in patients with degree I subatrophy. Contusion injury of the eye was proven to not exclude the course of post-traumatic autoimmune uveitis. The development of post-traumatic subatrophic process is associated with activation of systemic organ-specific immunity, shift of balance in main regulatory subpopulations. CONCLUSION: The study showed that the most severe clinical course of chronic post-traumatic uveitis is observed in patients as a result of penetrating trauma to the eyeball. The contusion nature of such ocular injury does not exclude the development of autoimmune inflammation.

[Change of priorities when selecting the method of eye removal: enucleation versus evisceration]. / Smena prioritetov v vybore metoda udaleniia glaza: énukleatsiia ili évistseratsiia.

The development and evolution of conservative and surgical methods of treating patients with various ocular pathologies influence the priorities when selecting the method of eye removal. PURPOSE: To perform comparative analysis of eye removal methods based on the results of own studies over a long period. MATERIAL AND METHODS: The study analyses eye removal surgeries performed in Helmholtz Moscow Research Institute of Eye Diseases over the period of 1991 to 2016 and investigates the reasons of selecting enucleation and evisceration methods. RESULTS: Over the period of 1991 to 2001, there were 968 eye removal surgeries performed in the department of traumatology, with reasons listed as trauma aftermath - 884 (91.3%) cases, outcomes of various diseases - 85 (8.7%) cases. From 2002 to 2016, a total of 2529 eye removal surgeries have been performed due to non-oncological reasons, of which 1337 (52.9%) were enucleation surgeries and 1190 (47.1%) - evisceration surgeries. However, over the last 15 years, there has been a clear tendency for changing priorities when selecting the method of eye removal: from 2002 to 2016, the number of eviscerations has increased by 4.2 times (from 16 to 66.6%), while the percentage of enucleations has decreased from 84 to 33.4%. The rise in frequency of eviscerations was noted in post-traumatic pathologies, including post-traumatic uveitis and preatrophy, and buphthalmos. CONCLUSION: Analysis of clinical and statistical data accumulated over more than 10 years showed positive dynamics in the decrease of eye removal cases and changes in priority when selecting the method towards evisceration, which causes fewer complications, has better functional and esthetic results - especially considering the ongoing development of new evisceration techniques.

[Radio-wave surgery in the treatment of dacryocystitis]. / Radiovolnovaia khirurgiia v lechenii dakriotsistita.

By improving the existing surgical technologies for dacryocystitis, one enhances the effectiveness of patient rehabilitation. AIM: To evaluate the effectiveness of radio-wave surgery in the treatment of dacryocystitis and lacrimal sac abscesses. MATERIAL AND METHODS: The clinical group consisted of 207 patients ranging in age from 7 to 89 years (the mean age of 41±7.3 years). For 39% of patients this was a repeated treatment, while 9.3% had undergone 4-5 surgical interventions. The following types of surgical interventions were performed: dacryocystorhinostomy with external approach and lacrimal stent placement - 128, dacryocystectomy for stenosing dacryocystitis with lacrimal stent placement - 21, dacryocystectomy without lacrimal stent placement in somatically complicated patients after repeated dissection of the abscess who developed fistula and granulation - 23, and lacrimal sac abscess drainage - 35. In all patients, the treatment involved high-frequency radio-wave surgery (3.8 to 4 MHz). The article contains a detailed description of the four types of interventions and provides an explanation of the choice of electrode, mode and power level. RESULTS: Positive changes were observed in all cases of chronic dacryocystitis and lacrimal sac abscess. The patency of the lacrimal system, including canalicular and nasolacrimal tests, was assessed 6 months after dacryocystorhinostomy. The results were judged positive in all cases despite slowed dye evacuation in 11 cases. The severity of epiphora (Munk scores) decreased from 3.45±0.7 at baseline to 1.0±0.7 (p<0.05). In 5 dacryocystorhinostomy patients the stoma occluded. CONCLUSION: Positive characteristics of radio-wave surgery help increase the effectiveness of surgical treatment of dacryocystitis, improve surgical performance, reduce duration of the procedure and postoperative care, reduce the number of complications, and achieve a better cosmetic effect.

[A modified implant for upper eyelid ptosis correction in frontalis suspension surgery]. / Primenenie modifitsirovannogo implantata dlia ustraneniia ptoza verkhnego veka podveshivaniem.

AIM: to develop a modified implant to correct ptosis through brow suspension and to evaluate its effectiveness. MATERIAL AND METHODS: The clinical group consisted of 20 patients (29 eyes) aged 23 to 69 years (45±5.3 years on the average) and the comparison group - of 20 patients (33 eyes) aged 19 to 77 years (47±9.5 years on the average). All patients were operated on for severe ptosis of the upper eyelid, which implied stitching their eyelids to the eyebrows. In the main group, an original implant was introduced as suspensory material - a 200 µm thick porous polytetrafluoroethylene tape, length 13 cm, width 6 mm, round staggered perforation pattern, 1.5 mm holes, 3.5 mm pitch. In the comparison group, Mersilene mesh strips were used. The article contains a detailed description of the surgical technique. Checkups were performed at 1, 6, and 12 months. Follow-up periods were up to 4 years (1.7 years on the average) in the main group and up to 7 years (5.1 years on the average) - in the controls. RESULTS: Were evaluated by the width of the palpebral fissure at raised eyebrows, marginal reflex distance (MRD, which is the distance between the center of the pupil and the upper eyelid margin), presence and depth of the upper eyelid crease, and residual lagophthalmos. Examinations held at months 1, 6, and 12 after surgery showed that the results were positive and stable in all cases. Neither signs of recurrence, nor statistically significant differences between the groups were found. CONCLUSION: The use of the original modified implant during frontalis suspension surgery provides high and stable cosmetic result and expands the possibilities of ophthalmic plastic surgery.

[The potential of ectoprosthetics in rehabilitation of patients with orbital pathology]. / Vozmozhnosti éktoprotezirovaniia v reabilitatsii patsientov s patologiei orbity.

AIM: rectification of indications and contraindications for ectoprosthetics and exploration of its potential as a modern rehabilitation modality. MATERIAL AND METHODS: Here are summarized the results of 89 cases of facial reconstruction with prosthetic means in trauma patients and those who had had congenital or oncological pathology and in whom other methods of rehabilitation were unable to remedy the defect within the orbital region. RESULTS: The indications and contraindications for facial prosthetics as well as the conditions, under which this type of medical and social rehabilitation can be carried out, were clarified. The authors also explained the process of creating an epiprosthesis and how it should be attached to the orbit to have the maximum effect on the existing defects of both the bone and auxiliary apparatus (including eyelid soft tissues, eyelashes, etc.). Because modern ectoprostheses are made of silicone and held in place with magnets, they provide an optimal cosmetic result, so that, regardless of patient's age, no rough defects can be detected on the affected side at a 2-m distance. CONCLUSION: As the production technology develops, the cosmetic appearance of epiprostheses improves and their use broadens.

[Clinical and anatomical features of congenital microphthalmia and anophthalmia in children and conservative methods of rehabilitation]. / Kliniko-anatomicheskie osobennosti vrozhdennogo mikroftal'ma i anoftal'ma u detei i konservativnye metody reabilitatsii.

AIM: To develop a comprehensive classification system of distinctive clinical and anatomical features of congenital microphthalmia and anophthalmia in children and to specify indications, contraindications, and optimal timing of the primary and subsequent prosthetic treatment. MATERIAL AND METHODS: A total of 70 patients with congenital micro- or anophthalmia aged from 1 month to 12 years were examined. Besides the routine ophthalmic examination, all patients underwent eye and orbit ultrasound (axial length measurement and B-scan), computed tomography of the orbits and skull, and immunological tests for infectious diseases (enzyme-linked immunosorbent assays). RESULTS: Basing on the examination RESULTS: we have determined the common types of congenital micro- and anophthalmia in children. We have also developed a stepwise prosthetic treatment aimed at better cosmetic rehabilitation. Indications and contraindications for the use of ocular prostheses in children with congenital micro- and anophthalmia have been identified. CONCLUSION: The proposed method of stepwise prosthetics is the principal option for conservative rehabilitation of children with congenital micro- or anophthalmia.

[Custom-made artificial parts for improving functional and cosmetic results of ocular prosthetics]. / Ispol'zovanie individual'nykh form protezov v tselyakh povysheniya effektivnosti funktsional'no-kosmeticheskikh rezul'tatov glazoprotezirovaniya.

UNLABELLED: Aim - to justify the use of custom-made ocular prostheses aimed at better functional and cosmetic outcomes. MATERIAL AND METHODS: Cosmetic outcomes in 520 patients operated for either anophthalmia (89.1%), or ocular subatrophy (6.7%), or congenital micro-/anophthalmia have been analyzed. General and ophthalmic assessment was performed. RESULTS: Relationships were investigated between the results obtained in a particular patient, on the one hand, and primary etiology in his/her case, eye removal technique, postoperative management details, complications, treatments, and preventive measures, on the other. It has been found that, if aiming to avoid the development of anophthalmic syndrome, the choice of surgical technique should be done most carefully so that a muscle stump could be formed and primary prosthesis inserted. Indications for the use of complexly shaped ocular prostheses have been identified. We have also explored the possibilities for correction of cosmetic defects associated with the use of modified stock prostheses. Moreover, in this article particular attention is paid to the importance of cooperation between the oculoplastic surgeon and the ocularist in order to ensure timely orbital reconstruction. CONCLUSION: Indications for the use of custom-made ocular prostheses of complex shapes have been identified. The range of complications that may arise from their irrational use are discussed.

[Aging eyelid: clinical, morphological manifestations and peculiarities of microcirculation].

Morphological study of eyelid biopsy tissues with varying degrees of age-related changes revealed sclerosis, infiltration, expansion and the convoluted configuration of the walls of blood vessels, stasis, reflecting microcirculation disturbance in the skin. Decrease in elasticity, elasticity and skin turgor in aging eyelids is largely due to the thinning, randomly distributed bundles of collagen and a decrease in the number or total absence of elastic fibers. In 31 patients with blepharohalasis laser Doppler flowmetry revealed a failure in the neuromuscular regulation of vascular tone, which is a manifestation of chronic stagnation in the microcirculatory bed. Revealed changes in the morphological structure of eyelid skin and microcirculatory bed confirm the trophic disturbances and congestion occurring in the skin of eyelids with aging.

[Primary reconstruction in a case of total eyelid avulsion].

Authors took clinical case of primary surgical reconstruction in total eyelid avulsion as an example to discuss possible mistakes of surgical technique and implant choice. Besides, prognosis for different eyelid tissues retention in total eyelid avulsion and subsequent reconstruction are analyzed. Laser Doppler flowmetry is a method for dynamic evaluation of retention and prognosis of autotissue rejection, it clearly demonstrates decrease of microcirculation in the sites of worse tissue retention.

[A case of inadequate surgery tactics in the use of an unstandard orbital implant].

By analyzing a clinical case with inadequate surgery tactics in the use of an unstandard orbital implant, the authors discuss possible errors in surgical techniques and in the choice of an implant. Furthermore, by analyzing problems in the use of various implants, including those unstandard ones, they discuss possible causes of complications, consider the optimal time for resurgeries, and propose the ways of solving the problems associated with the occurrence of complications, including treatment policy.

[Exposure of orbital implants: causes and treatment].

The paper provides the results of a 15-year following-up of 91 patients with exposed orbital implants made from synthetic and biological materials. Surgery was made in the patients treated at different health care facilities. The authors analyze the causes of implant exposure in different periods. Early after surgery the most common causes of implant exposure are surgical equipment failure (inadequate implant coating with adjacent tissues), a too large implant arching the tissues, and mismatch of an artificial eye. In the late period, the more common cause is secondary infection or the toxic properties ofa material itself, which cause a persistent chronic inflammatory reaction. Moreover, the authors consider the mechanism of implant exposure and rejection depending on the material of an implant. The paper describes medical and surgical treatments in patients of this group.

[Histological studies of carbon felt (carbotextim M) in late periods after its orbital implantation].

The authors performed histological studies of a grown carbon felt implant and its adjacent tissues in late postoperative studies. During planned operations (cavity or stump correction), pieces of a grown implant with its adjacent tissues were taken for examination from 25 patients in whom carbon had been earlier implanted during enucleation and delayed stump plastic repair. Morphological studies indicated that mature connective tissue had grown between the fibers of the implant, that a connective tissue capsule had formed around the whole implant, and that there was no inflammatory reaction in both the implant itself and its adjacent tissues. By taking into account the fact that there is a good tissue basis and vascularity, the authors present the results of additional simulation of an implant in late postoperative periods and those of additional correction of the implant's volume.

[Computed tomography in diagnosing and determining treatment policy in patients with posttraumatic pathology of the eye and orbit].

The paper analyzes the diagnostic value of computed tomography (CT) in posttraumatic lesion of the eye socket, ball, and appendage and identifies the basic groups of patients in whom CT is an essential study. In 2004, the Department of Traumatology, Reconstructive Surgery, and Eye Prosthesis, Helmholtz Research Institute of Eye Diseases, performed CT in 323 patients (18.2% of the inpatients and 3.4% of the outpatients). Analyzing all CT images identified the basic groups of patients in whom this study was essential. The CT scans characterizing examples from each group of patients are given. The studies could extend indications in patients with posttraumatic lesion of the eye and orbital area for CT. The latter is an important and essential study in patients with traumatic pathology of the eye with multiple and hard-to-reach foreign bodies and with trauma of the soft and osseous structures of the orbit, which makes it possible to determine not only the possibility, but also pattern and scope of a surgical intervention and to assess its long-term result.

[Impact of the quality of surgical treatment of subconjunctival ruptures of the sclera on their outcome].

The paper deals with the analysis of the outcome of severe eye contusion in scleral ruptures that are subject to none or inadequate debridement. In 2004, a group of 85 patients undergone enucleation due to severe posttraumatic changes was examined to analyze the outcomes of misdiagnosis of ruptures of the scleral capsule of the eye in its contusions and penetrating wounds. Examination of the eyeball after its removal revealed different defects of the optic scleral capsule in 6 (8.2%) cases of the 85 patients undergone enucleation. Each case pointing to the undiagnosed pathology of the eye during primary debridement and surgical treatment of these patients or to the partial debridement of scleral wounds is noteworthy. It should be noted that a primary care involving debridement was delivered to virtually all patients in different ophthalmological facilities. The paper gives a detailed account of each case, by describing its history data, the state of the eye, the performed studies and operation, and presents photos demonstrating each case. In eye contusion, it is necessary to adequately evaluate its severity and to reveal the whole complex of injuries and also to pay attention to the quality of debridement of wounds since adequate containment of a wound of the eye and adaptation of its edges can preserve the eye as an organ in most given cases.

[Sympathetic ophthalmia. Clinical and morphological study in 6 cases after penetrating injury and subsequent repeated vitreoretinal operations].

The paper outlines the clinical and morphological picture of 6 sympathizing eyes enucleated in 1996 to 2003 after vitrectomy and other endovitreal interventions into early injured or operated eyes. Resurgery was attempted early after wounds or a primary operation on the average following 20 days. Sympathetic ophthalmia (SO) generally occurred in the posterior uveal tract as panuveitis or posterior uveitis and diagnosed in the late periods. Specific granulomatous inflammation in the uveal tract was observed in all eyes and the morphological feature of sympathizing eyes was the spread of an inflammatory process to the retina with the development of the latter's epithelioid-cell granulomas and adhesive chorioretinitis. The authors also discuss the possibility of additional antigenic stimulation accompanied by a progressive autoimmune process in the eye and by the generalization of a granulomatous inflammation, as well as the role of retinal minor lesions in this process as a source of additional autoantigens during repeated vitreoretinal operations. The latter, as the authors believe, are a risk factor of SO. In this connection, when repeated vutreoretinal interventions should be made in the presence of an uncompleted wound process in the eye and when they should be conducted under the conditions of active immunosuppressive therapy gain in great importance.

[Current aspects of surgical treatment in anophthalmia]. / Sovremennye aspekty khirurgicheskogo lecheniia pri anoftal'me.

The purpose of this work was to determine the main trends in surgical rehabilitation of patients with anophthalmia and define the principles of treating patients with poor ocular prostheses. A total of 3345 interventions on the orbital cavity and eye appendages were carried out at plastic surgery and ocular prosthesis department in 1991-2000. Of these, 1535 patients (45.8%) were with anophthalmia. Analysis of disease structure in anophthalmia helped determine the priority trends of surgical rehabilitation of this group of patients: enucleation with plasty of the supporting motor stump, 36.6%; postradiation atrophy of orbital tissues after enucleation for retinoblastoma, 22.6%; anophthalmic syndrome, 11.7%; cicatricial deformation of the cavity, 11.5%; anophthalmia with concomitant eyelid deformation, 6.1%; anophthalmia with orbital deformation, 3.1%; denudation of orbital implants, 2.6%; congenital anophthalmia, 2.5%; prolapse of the inferior vault and upper eyelid ptosis, 1.8 and 1.4%, respectively. Individual methods of treatment and main rehabilitation principles were developed for each group of patients.

[Effects of reconstructive operations on the development of systemic autosensitization in patients with anophthalmos]. / Vliianie rekonstruktivnykh operatsii na razvitie sistemnoi autosensibilizatsii u patsientov s anoftal'mom.

The role of systemic autoimmune reactions to organ-specific antigens (DNA and collagen) was studied in patients with anophthalmia before and after interventions on the stump and conjunctival cavity making use of autotransplants and synthetic implants. A total of 220 analyses of the serum were performed in the main group and 50 in the control. Autosensitization was detected in 10 (18.2%) patients. The data were processed using Statistica software. A series of previous reconstructive operations is a factor promoting the development of systemic autosensitization to collagen. A trend to an increase in the levels of antibodies to DNA and collagen was observed in the presence of cicatricial changes in adjacent tissues, foreign bodies, cartilaginous implants, and fistulas causing a latent fibrous reaction. The type of intervention (use of implants or autotransplants) does not affect the level of antibodies to DNA and collagen.

[Postradiation atrophy of anophthalmic orbit after treatment of retinoblastoma. System of surgical rehabilitation]. / Postluchevaia atrofiia anoftal'micheskoi orbity posle lecheniia reinoblastomy. Sistema khirurgicheskoi reabilitatsii.

A system of surgical treatment of patients with radiation atrophy of orbital tissues has been developed in order to attain a stable position of the prosthesis in the cavity and improve the patients' appearances. A total of 366 interventions were performed in 242 patients. The operations were as follows: formation of conjunctival cavity by autotransplants of the mucosa from the lips (242), delayed plasty of the stump (81), contour plasty of the temple and external edge of the orbit (32), correction of eyelids (11). Single-stage treatment was carried out in 156 patients and 2-7 stages in 86 patients. Positive results were attained in all cases: the depth of the vault increased, lagophthalmos decreased, falling-in defect of prosthesis, eyelids, and temple were reduced, and stable position of the prosthesis in the cavity was attained. Surgical treatment of this condition differs greatly from plastic repair for other diseases because of changes in tissues after radiotherapy. Functional and cosmetic rehabilitation of patients with postradiation atrophy of orbital tissues after treatment of retinoblastoma with good effect can be attained only by staged surgical treatment.

[Resection of the levator with transposition via Whitnall's ligament]. / Rezektsiia levatora s peremeshcheniem cherez sviazku Uitnalla.

The paper deals with the treatment of severe congenital upper lid ptosis. In cases with the minimal mobility of the upper lid suspending operations are usually resorted to, those with suspending to Whitnall's ligament, among other things. Maximal resection of the levator muscle brought about encouraging results. The present paper describes the results of a modified operation: maximal resection of the levator with transposition of the muscle through Whitnall's ligament. A peculiar feature of surgical technique consists in preserving the intactness of the transverse ligament of the upper lid, crossing the lateral horns of the levator through the entire height, and transposition of the resected levator above Whitnall's ligament, this followed by suturing to the tarsal plate. The results of surgery were good. A better cosmetic and functional effect was attained than after common maximal resection of the levator; moreover, a lesser resection of the levator is needed in cases with the same degree of ptosis.

[Surgical treatment of traumatic madarosis]. / Khirurgicheskoe lechenie travmaticheskogo madaroza.

Traumatic madarosis is a cosmetic and anatomo-functional problem. Besides the repair of the eyelashes proper, the clinical status of the patient requires repair of the carcass of the damaged eyelid in order to prevent lagophthalmos. The technique of transplanting a free hairy graft from the eyebrows is described. The results of treatment were assessed by the following parameters: the flap taking in, thickness and direction of the new lashes growth, and stability of the eyelid. Complete healing of the graft and stability of the eyelid were attained in all the cases. Good thickness of the eyelashes and the ideal direction of their growth were more difficult to achieve. The causes of failures are discussed. Despite the shortcomings, the method of treating traumatic madarosis proved to be effective and is recommended for clinical use.