[Acaricidal therapy in chronic demodex blepharitis and meibomian gland dysfunctions]. / Akaritsidnoe lechebnoe vozdeistvie pri khronicheskom demodekoznom blefarite i disfunktsii meibomievykh zhelez.

PURPOSE: The study comparatively evaluates the effectiveness of various approaches to acaricidal treatment in patients with chronic demodex blepharitis and meibomian gland dysfunctions. MATERIAL AND METHODS: The study included 40 patients with chronic blepharitis (CB) of demodicosis etiology in conditions of meibomian gland dysfunction (MGD) and dry eye (DE). The 1st group of patients (20 people) received acaricidal treatment as part of therapeutic eyelid hygiene (TEH; 2 times a day) involving the use of «Blefarogel ochishchenie¼, «Blefarolosion¼, «Blefarogel forte¼ (contains sulfur and metronidazole). Acaricidal treatment in the patients of the 2nd group involved applications of a product containing metronidazole (2 times a day) without TEH. Control points: 1) at inclusion in the study; 2) after a course of therapy (45 days). Evaluation included: patient acarograms, symptoms and signs of CB (points); OSDI; tear film break-up time (TBUT, sec), severity of meibomian gland dysfunction (S-MGD, points). Statistical analysis: calculation of M±SD, Mann-Whitney, and Wilcoxon tests. RESULTS: Acaricidal treatment was effective in both groups (reduction in demodex population, which was more pronounced in the 1st group). Symptoms and signs of CB were significantly less pronounced in the patients of the 1st group after therapy. The patients of the 1st group showed a significant decrease in S-MGD, OSDI and an increase in TBUT, the 2nd group - a significant decrease in OSDI and an increase in TBUT at the second control point. The positive OSDI and TBUT trends were significantly more pronounced in the 1st group. CONCLUSION: Acaricidal treatment as part of TEH showed a significantly more pronounced reduction in demodex population, relief of CB symptoms and sign, OSDI decrease and TBUT increase, compared to the 2nd group. Apparently, this was associated with combined acaricidal effect and significant S-MGD decrease in the patients of the 1st group.

[Therapeutic hygiene of eyelids in dry eye disease prior to cataract phacoemulsification]. / Terapevticheskaya gigiena vek pri sindrome «sukhogo glaza¼ pered provedeniem fakoemul'sifikatsii katarakty.

PURPOSE: The study evaluates the effectiveness of eyelid hygiene (EH) in correction of the ocular surface (OS) condition in patients with dry eye disease (DED) ahead of cataract phacoemulsification (CPE). MATERIAL AND METHODS: The study included 90 patients with cataract: the first group consisted of 45 DED patients with lipid deficiency, the second group - 45 DED patients with lipid/mucous deficiency. Prior to CPE, all patients were randomized into three subgroups of 15 people each. In subgroups 1.1 and 2.1 patients did not receive any treatment for correction of the state of ocular surface. Patients in subgroups 1.2 and 1.3 were instilled 0.18% sodium hyaluronate (SH); in subgroups 2.2 and 2.3 - fixed combination of 0.15% SH and 3% trehalose. In subgroups 1.3 and 2.3 EH was performed (with «Blefarogel cleansing¼, «Blefarolotion¼, «Blefarogel-1¼ two times a day for one month before CPE). The control points were: 1) at study inclusion; 2) after correction of the ocular surface condition; 3) 30 days after CPE. The following parameters were evaluated: OSDI, TBUT (Norn's test), severity of meibomian gland dysfunction (MGD), patient satisfaction with CPE (CPE-PS). Statistical analysis: M±SD calculation, Mann--Whitney, Kruskal-Wallis and Wilcoxon tests. RESULTS: At the second control point, a statistically significant more pronounced OSDI decrease and bigger increase in TBUT were observed in subgroups 1.3 and 2.3 compared to subgroups 1.2 and 2.2 (Mann-Whitney U-test). Apparently, this was associated with a reduction in MGD severity in patients who received EH. At the third control point, significant lower values of OSDI and MGD severity, higher TBUT values and greater CFE-PS were recorded in subgroups 1.3 and 2.3 (Kruskal-Wallis test, Wilcoxon two-sample test). CONCLUSION: Carrying out EH using the «Blefarogel cleansing¼, «Blefarolotion¼, «Blefarogel-1¼ and artificial tear in patients with DED and cataract can increase the efficiency of correction of ocular surface condition and improve patient satisfaction with the outcome of CPE.

[Ocular surface changes after cataract phacoemulsification]. / Izmeneniya glaznoi poverkhnosti posle fakoemul'sifikatsii.

PURPOSE: To assess the effects of phacoemulsification cataract surgery (PCS) and its pharmacological support on the prevalence of dry eye (DE) type ocular surface changes. MATERIAL AND METHODS: The study included 550 patients with age-related (369 patients) or complicated (181 patients) cataracts (247 men, 303 women; mean age 71.6±7.3 years) who were assessed using the Ocular Surface Disease Index (OSDI), tear break-up test (TBUT), Shirmer-1 test, lipid interference test, OCT meniscometry, examined for xerosis indicators and «lid vipers¼ symptom in order to detect DE before PCS, as well as on days 1, 7, 30 after PCS. Meibomian gland dysfunction (MGD) was determined by the Norn compression test, which was performed before PCS. The significance of differences was assessed using Pearson χ2 test. RESULTS: Before PCS the prevalence of DE was 51.1%, asymptomatic subclinical DE - 28.9%. MGD was detected in 79.4% of DE patients and in 50.3% subclinical DE patients. After PCS, an increase in DE prevalence was noted (due to increase in the prevalence of mild DE): on the 1st day - up to 58% (χ2=5.295; p=0.022; p<0.05), on the 7th day after surgery - up to 63.1% (χ2=16.165; p=0.001; p<0.01), on the 30th day - up to 55.6% (χ2=2.283; p=0.131; p>0.05). CONCLUSION: The study revealed a trend towards an increase in DE prevalence after PCS (due to an increase in the proportion of hypersecretory mild DE), which was statistically significant on days 1 and 7 after the operation and statistically insignificant by the 30th day after surgery. Apparently, it could be associated with aggravation of "background" asymptomatic ocular surface changes. From our point of view, the high prevalence of DE and subclinical DE in cataract patients before PCS makes it advisable to carry out preoperative preparation aimed at normalizing the condition of ocular surface. At the same time, the high prevalence of MGD in DE and subclinical DE patients determines one of the directions of preoperative treatment - eyelids hygiene.

[Eyelid hygiene in preparing dry eye patients for cataract surgical treatment]. / Gigiena vek v podgotovke patsientov s sindromom «sukhogo glaza¼ k operativnomu lecheniyu katarakty.

PURPOSE: To evaluate the effectiveness of complex treatment, including eyelid hygiene, on the condition of ocular surface in dry eye patients before cataract surgery. MATERIAL AND METHODS: The study included 56 female age-related cataract patients (64±4.3 years old) with dry eye caused by Meibomian gland dysfunction (MGD). The main group patients (n=28) underwent eyelid hygiene therapy (2 times a day, 1 month) that involved Blefarogel cleansing, Blefarolotion, Blefarogel-1. The main and control (n=28) group patients performed (during the month): «fat-water¼ type nanoemulsion instillation (3 times a day); preservative free vitamin-A application (at night). Methods included dry eye symptoms assessment (OSDI scale); TBUT; Shirmer-1 test; lissamine green vital staining with xerosis indicator calculation (van Bijsterveld scale); "lid wipers" symptom evaluation; Norn compression test. Statistical evaluation included: mean and standard deviation calculation (M±s); significance of differences assessment (Mann-Whitney U-test; Wilcoxon's T-test). RESULTS: The main group patients (artificial tear, keratoprotection, eyelid hygiene) showed a statistically significant more pronounced decrease in OSDI (from 33.2±3.1 points to 15.2±1.8 points) and a significantly more pronounced increase in TBUT (from 4.8±0.5 s to 6.9±0.4 s) than in control group patients (artificial tear, keratoprotection; respectively, from 32.7±3.2 to 20.8±3.1 points and from 4.85±0.5 to 5.8±0.4 s; p<0.05). Apparently, this was associated with a significantly more pronounced relief of the MGD signs in main group patients (from 2.1±0.1 to 1.1±0.2 points; p<0.05) as a result of eyelid hygiene. In the control group, the dynamics of MGD severity (from 2.08±0.3 to 2.11±0.5 points) was statistically insignificant. CONCLUSION: Eyelid hygiene (based on Blefarogel cleansing, Blefarolotion, Blefarogel-1) increases the effectiveness of dry eye treatment in MGD patients, compared with isolated tear substitution and keratoprotection.

[Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery]. / Gigiena vek v podgotovke k lazernoi refraktsionnoi khirurgii.

AIM: To evaluate the effectiveness of eyelid hygiene in patients with chronic allergic blepharoconjunctivitis (ABC) as a part of their preparation for laser refractive surgery. MATERIAL AND METHODS: The study involved 32 patients (12 males and 20 females aged 25-42 years) with refractive errors, namely, compound myopic astigmatism (23 patients) and hyperopic astigmatism (9 patients) suffering from chronic ABC and secondary dry eye syndrome (DES). All the patients initially received a standard treatment for ABC and DES, that is olopatodin hydrochloride instillations - 1 mg/ml 2 times daily, preservative-free hyaluronic acid preparation - 1 mg/ml 3 times daily, and polyacrylic acid and dexpanthenol gel at night for one month. The scheme, however, appeared not effective enough. Hence, the patients were prescribed eyelid hygiene (Blepharolotion or Blepharosalfetka plus Blepharogel-1 2 times daily) to relive meibomian gland dysfunction (MGD). They also underwent a conventional ophthalmic examination, allergy tests, evaluation of ABC and DES signs and symptoms, tear film break-up time test, Schirmer's test, meibomian glands evaluation, optical coherence tomography with meniscometry, xerosis index evaluation, and lissamine green staining for lid wiper epitheliopathy. RESULTS: At the beginning of the study signs and symptoms of MGD-associated DES were predominant in all patients. Chronic ABC signs were mild. In 2-3 months, meibomian gland function and tear film break-up time improved significantly in most patients, while xerosis index decreased and lid wiper epitheliopathy resolved. Laser refractive surgery (LASIK) was performed in 81.25% of patients, all of whom were satisfied with the results. CONCLUSION: Inclusion of eyelid hygiene into preoperative management of patients with chronic ABC and DES allows to achieve optimum conditions for laser refractive surgery in most cases.