[The place of ciclosporin A cationic emulsion 0.1% in the therapy of xerophthalmia]. / Mesto kationnoi emul'sii tsiklosporina A 0,1% v terapii kseroftal'mii.

Dry eye disease (DED) is pathogenetically based on inflammation of the ocular surface. A step-by-step approach to DED treatment involves early initiation of anti-inflammatory therapy, including instillation of cyclosporine A (CsA). However, recommendations for the use of topical CsA in clinical practice are limited. This article presents an expert consensus on practical recommendations for the management of patients with DED, including indications, time of initiation and duration of CsA therapy, comparison of CsA forms currently registered in the Russian Federation, as well as issues of patient education.

[New possibilities for reparative therapy of dry eye syndrome]. / Novye vozmozhnosti reparativnoi terapii sindroma «sukhogo glaza¼.

In recent years, among artificial tear preparations that have additional metabolic properties, in addition to moisturizing the ocular surface, there has been a drug Optinol Soft Recovery (LLC JADRAN). In addition to 0.15% sodium hyaluronate, it contains 2% dexpanthenol, which stimulates reparative regeneration of the corneal epithelium, in particular in patients with dry eye syndrome (DES). PURPOSE: This study evaluates the clinical efficacy of the drug Optinol Soft Recovery in the treatment of patients with DES accompanied by xerotic changes in the corneal epithelium. MATERIAL AND METHODS: The study included 82 patients (15 children and 65 adults) with moderate and severe DES accompanied by the following corneal pathology: filamentous keratitis (20 patients, 33 eyes), persistent corneal erosion (28 patients, 49 eyes) and punctate keratopathy (34 patients, 68 eyes). RESULTS: All patients receiving fourfold instillations of the studied drug were observed already during the first 7 days to have increased stability of the tear film and decreased severity of staining of the cornea and conjunctiva with vital dyes (0.1% sodium fluorescein and 3% lissamine green, respectively). Further, as the patients were transferred to an individual instillation regimen, a progressive decrease in the Ocular Surface Disease Index (OSDI), an increase in corneal sensitivity and tear meniscus index were also recorded. The differences in most parameters of the course of xerosis compared to the initial ones were statistically significant starting from day 10-20 of therapy, depending on the initial severity of corneal xerosis (p<0.05-0.001). CONCLUSION: Patients with moderate DES complicated by punctate keratopathy were the most susceptible to therapy with the drug Optinol Soft Recovery, while patients with filamentous keratitis secondary to a severe clinical form of DES were the least susceptible.

[Risk factors, clinical features and indications for treatment of dry eye disease at a young age]. / Faktory riska, osobennosti klinicheskoi kartiny i pokazaniya k lecheniyu sindroma «sukhogo glaza¼ v molodom vozraste.

In recent decades, there has been an increase in the prevalence of dry eye disease (DED) not only in older people, but also in young people, which is potentially associated with the use of digital devices. Early detection of signs of DED and the appointment of preventive tear replacement therapy can help stabilize the tear film and slow down the progression of the disease. PURPOSE: To study risk factors, prevalence and clinical manifestations of DED in young people, to determine indications and evaluate the effectiveness of treatment with artificial tears. MATERIAL AND METHODS: The study included 91 patients aged 21 to 39 years (mean age 22.4±0.35 years), 63 (69.2%) women and 28 men (30.8%). All patients had tear film breakup time (TBUT) measured and underwent Schirmer I test, LIPCOF, ocular surface staining with vital dyes, lacrimal OCT-meniscometry and filled a questionnaire. To determine the effectiveness of the tear replacement therapy, 45 people prescribed sodium hyaluronate solution were randomly selected. RESULTS: The time that study subjects spend using devices ranged from 6 to 18 hours per day, amounting to 11.5±0.35 hours on average. According to the results of the Ocular Surface Disease Index (OSDI) questionnaire, 92.9% of study participants were revealed to have subjective symptoms of eye irritation. A decrease in TBUT was recorded in 30.8% of cases, the results of the Schirmer I test were decreased in 82.4% of the subjects. Significant changes in OSDI, Schirmer test and TBUT were obtained as the result of treatment. Changes in the indicators of staining and OCT meniscometry were not reliable. CONCLUSION: The most significant risk factor of developing DED at a young age is regular, prolonged visual work with digital screens. The main symptoms are subjective manifestations and TBUT.

[Long-term outcomes of anti-VEGF therapy for macular edema in retinal vein occlusion]. / Dolgosrochnye rezul'taty anti-VEGF-terapii makulyarnogo oteka pri okklyuzii ven setchatki.

Antiangiogenic therapy (anti-VEGF) is the standard in the treatment of many retinal vascular diseases, including macular edema associated with retinal vein occlusion (RVO). A large evidentiary basis has been collected, consisting of randomized clinical trials in which anti-VEGF therapy demonstrated a significant advantage over laser photocoagulation and placebo in patients with RVO. However, in everyday clinical practice the results are not always comparable to randomized clinical trials. This review presents an analysis of the current studies based on actual clinical practice. Their results helped identify the main aspects of antiangiogenic therapy that could improve the treatment outcomes for patients with RVO. Additionally, the article discusses the predictive factors for therapy outcomes and the effect of anti-VEGF therapy on the development of neovascular complications in patients with ischemic RVO.

Optical coherence tomographic patterns in patients with retinal vein occlusion and macular edema treated by ranibizumab: a predictive and personalized approach.

PURPOSE: To establish the morphological and functional parameters to predict the effectiveness of intravitreal injections (IVI) of ranibizumab in macular edema due to retinal vein occlusion and to develop a mathematical model for personalized treatment algorithms. MATERIAL AND METHODS: This is a retrospective study of 98 patients (98 eyes) with macular edema, who received IVI of ranibizumab and were followed up for 12 months. Spectral optical coherence tomography scans and best corrected visual acuity (BCVA) assessments were conducted every 3 months. Treatment outcome predictors were calculated based on logistic regression analysis. RESULTS: The most significant prognostic factors for the long-term BCVA were baseline BCVA (OR 11.1, p = 0.001), foveal volume (OR 10.8, p = 0.001), destruction of external limiting membrane (OR 15.8, p = 0.001), photoreceptor inner/outer segments (OR 11.1, p = 0.001) and retinal pigment epithelium (OR 9.1, p = 0.001). It has also been discovered that post-treatment BCVA correlated with the height of serous retinal detachment (SRD) (r = -0.4, p = 0.001), ganglion cell complex thickness (r = + 0.3, p = 0.01) and focal loss of ganglion cells (r =-0.3, p = 0.005). Patients without SRD required fewer ranibizumab injections (3.8 ± 1.1) for macular edema fluid resorption compared to those with SRD (5.7 ± 1.2, p = 0.03). A mathematical model for predicting and personalized approach therapy of ranibizumab has been obtained (accuracy of 89%). CONCLUSION: The effectiveness of IVI of ranibizumab depends on baseline morphological and functional changes. The obtained mathematical model allows for predicting the outcomes of therapy, determining individualized algorithms to increase the treatment effectiveness and to prevent low vision that corresponds to the principles of predictive, preventive, and personalized medicine.

[Application of high-resolution optical coherence tomography for visualization of eye structures in uveitis of different localization]. / Primenenie opticheskoi kogerentnoi tomografii vysokogo razresheniya v vizualizatsii struktur glaznogo yabloka pri uveitakh razlichnoi lokalizatsii.

The article presents an analysis of publications in main Russian and foreign journals devoted to the use of optical coherence tomography in intravital visualization of the structures of the eye for diagnosis, assessment of the changes during relapses, recovery and remission stages, as well as the effectiveness of treatment for uveitis of different localization. It describes in detail the results of studies conducted using spectral optical coherence tomography, changes in the anterior chamber and cornea in uveitis of the anterior localization, morphological changes in the vitreous body, vitreomacular interface, retina, choroid and optic disc in the anterior and posterior localization of inflammation, and presents the features of OCT diagnosis in a number of nosological forms of uveitis based on the literature data.

[Cytokine profile changes in children with juvenile idiopathic arthritis-associated uveitis]. / Izmenenie tsitokinovogo profilya u detei s uveitom, assotsiirovannym s yuvenil'nym idiopaticheskim artritom.

AIM: to identify the differences between serum cytokine profiles in juvenile idiopathic arthritis (JIA) with or without uveal tract inflammation. MATERIAL AND METHODS: Serum cytokine profiles were studied in two groups of patients: 20 children with JIA and JIA-associated uveitis and 33 children, who had no signs of uveitis under basic therapy for their JIA. All the patients showed drug remission of articular syndrome. Inflammation of the choroid took the form of chronic anterior uveitis. The process was active in 95% of cases. The control group consisted of 35 children without rheumatic disease or other acute condition at the time of examination. Groups were comparable in terms of age and sex. Serum levels of TNF-α, IFN-γ, IL-17, IL-10 were measured by the enzyme multiplied immunoassay technique. RESULTS: A statistically significant increase in TNF-α, IFN-γ, IL-17, and IL-10 levels was found in all patients as compared to the control group. A comparison drawn between serum cytokine levels of JIA patients and those, who also suffered from JIA-associated uveitis, revealed a decrease in IFN-γ and an increase in IL-10 in the latter group. There was also a statistically significant positive correlation between TNF-α and IFN-γ serum levels in patients with JIA-associated uveitis. CONCLUSION: Development of uveitis in patients with drug remission of JIA occurs on the background of cytokine imbalance in the serum, in particular, increased concentrations of proinflammatory TNF-α and IL-17 cytokines along with reduced IFN-γ and increased IL-10 levels. This may be regarded as risk factors for ocular inflammation and should be taken into account when making treatment decisions.

[Role of impaired immune response regulatory processes in the pathogenesis of uveitis associated with rheumatic diseases].

The study was undertaken to define a role of immunological damage reactions in the pathogenesis of uveitis in the presence of rheumatic diseases on the basis of an in-depth analysis of the immunological characteristics of the disease. A complex immunological study was made in 76 rheumatic patients with uveitis in the acute phase of eye diseases. Among the patients, the males and females were 67.1 and 32.9%, respectively; their mean age was 41+/-6.4 years. The authors made CD typing of lymphocytes, by evaluating the processes of their activation and apoptosis, estimated the amount of the cytokines IL-4, IFN-gamma, TNF-alpha, and soluble TNF-alpha receptor in the serum and tear. The authors have established the following characteristics of an immune response in rheumatic patients with uveitis: a predominant impairment of cellular immunity with an increase in the processes of positive activation of lymphocytes and a reduction in the processes of their apoptosis; formation of Th1 deviation of systemic and local immune responses; elevated levels of the proinflammatory cytokine TNF-alpha in the blood and in the tear in particular. Humoral immunity was found to be activated with a rise in the levels of immunoglobulins of all classes and circulating immune complexes.

[Distribution of HLA class I antigens in patients with uveitis in the presence of rheumatic diseases].

Uveitis associated with rheumatic diseases (RD) is one of the symptoms of an autoimmune lesion. A great role in the etiology of the latter is assigned to genetic predisposition, HLA antigens in particular. Twenty-four HLA class I antigens were histotyped, by applying the Terasaki microlymphocytotoxic test in 83 patients with uveitis in the presence of different types of RD. All the patients and 701 healthy donors making up a control group were Caucasians. The results were statistically processed. There was a significant increase in the incidence of the antigens of HLA B27 (RR = 10.04; p < 0.01) and A2 (RR = 1.84; p < 0.05) and a decrease in that of the antigens of HLA A10, B5, B10, and B13 (p < 0.05). There was evidence for that there was an association of the antigen of HLA B27 with acute anterior uveitis and that of the antigens B 8 and B 35 with posterior and generalized uveitis in RD. The specific features of the association of antigens and their haplotypes in individual nosological entities of RD are presented.

[Immunologic peculiarities of uveitis concurrent with systemic pathologies]. / Immunologicheskie osobennosti uveitov pri sistemnykh zabolevaniiakh.

Immunologic examinations were performed in 111 patients with uveitis concurrent with a variety of systemic pathologies, including 85 males and 26 females, mean age--32.4 +/- 5.8. A higher IL-6 content in blood serum (BS) and in lachrymal fluid (LF) was detected in all patients. The IL-4 content was lower in uveitis associated with ankylosing spondylitis and with Reuter's disease, whereas, it was higher in juvenile rheumatoid arthritis. The systemic immunity changes were related with the hemostasis impairments in the phagocytic, humoral and cellular chains: an enhanced functional activity of phagocyte cells, a lower absolute quantity of T-lymphocytes, a higher count of B-cells, a reduced concentration of IgM and of circulating immune complexes (CIC), and a diminished general hemolytic activity of the complement in BS. A reduced concentration of the secretory fraction of IgA, IgG and IgM concurrent with higher concentrations of IgA, C3- and C4 complement components, CIC and of lysozyme activity in LF was detected in the local immunity system.

[Clinical features of HLA-B27 positive and negative uveitis]. / Klinicheskie osobennosti HLA-B27 polozhitel'nykh i otritsatel'nykh uveitov.

A total of 147 patients with uveitis concomitant with spondyloarthritis were examined. HLA-B27 histocompatibility antigen was detected in 75.5% patients. Men, mainly young and middle-aged, suffering from sacroileitis, developed the disease 2.5 times more often. Involvement of the uveal tract manifested by acute anterior fibrinous plastic uveitis (83.7%), rarely by anterior serous uveitis (16.3%). Bilateral uveitis occurred in 46.8% patients. HLA-B27-associated uveitis was characterized by a frequently relapsing course. On the other hand, fundus oculi abnormalities were detected in 12.6% patients with anterior uveitis; this abnormality occurs 4 times more often in subjects with negative HLA-B27 antigen, peripheral uveitis occurring 7 times more often. Complications were observed in 29.5% patients, their frequency and severity did not depend on the presence of HLA-B27 antigen.