[Recurrent herpetic erosion of the cornea: diagnosis, treatment and prevention of recurrences]. / gerpeticheskaya retsidiviruyushchaya eroziya rogovitsy: diagnostika, lechenie i preduprezhdenie retsidivov.

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

[A method of treating purulent corneal ulcer in the eyes with neuroparalytical keratitis and lagophthalmos]. / Sposob lecheniia gnoinoi iazvy rogovitsy, razvivsheisia na glazakh s neirotroficheskim keratitom i lagoftal'mom.

PURPOSE: To develop a method for treatment of advanced purulent corneal ulcers in eyes with neurotrophic keratitis that developed as a complication of intracranial pathological processes or brain surgeries. MATERIAL AND METHODS: The study involved 13 patients (14 eyes) that underwent combined surgery - keratoplasty, autoconjunctival flap covering, partial tarsorrhaphy performed simultaneously. Before and after the surgery, patients received frequent instillations of antimicrobial agents and autologous serum. RESULTS: The organ of vision was preserved in all patients, visual function - in 50% of cases, it improved in 35.7% of cases from 0.07±0.05 to 0.26±0.11. Lagophthalmos has decreased from 6.11±0.99 to 2.78±0.62 mm. CONCLUSION: Patients with intracranial lesions and complicated by neurotrophic keratitis and lagophthalmos often develop advanced severe and progressive corneal purulent ulcers, which seldom respond to the most active conservative therapy. Simultaneous surgery that includes keratoplasty, auto conjunctival flap covering and partial superficial tarsorrhaphy is an effective treatment option that helps preserve visual function in such eyes.

[The role of infection foci in the onset and sustenance of inflammatory diseases of the eye]. / Rol' fokal'nykh ochagov infektsii v vozniknovenii i podderzhanii vospalitel'nykh zabolevanii glaz.

Numerous clinical observations indicate the importance of the role of 'focal sepsis' in the development and facilitation of inflammation in the anterior eye segment. The article describes possible routes of infection spread from various local foci to the eye. Studying the connection between local infection foci and inflammatory eye diseases will give ophthalmologists more opportunities for effective treatment and prevention of disease recurrences.

[The linkage of oral infection foci and inflammatory diseases of the eye]. / Vzaimosviaz' fokal'nykh odontogennykh ochagov infektsii i vospalitel'nykh zabolevanii glaza.

The paper presents a review of numerous clinical observations that indicate an important role of 'focal sepsis' in the development and persistence of the anterior eye segment inflammation. Possible routes of infection spread from local dental infectious foci to the eye are discussed.

[Surgery treatment of purulent corneal ulcers associated with neuroparalytic keratitis]. / Khirurgicheskoe lechenie gnoinykh iazv rogovitsy, razvivshikhsia na fone neiroparaliticheskogo keratita.

OBJECTIVE: The study objective was to develop a method for surgical treatment of advanced purulent corneal ulcer in the setting of neuroparalytic keratitis developed after acoustic neuroma removal and strokes. MATERIAL AND METHODS: The study included 12 patients (13 eyes). All patients underwent single-step keratoplasty, conjunctival autografting, and partial permanent tarsorrhaphy. RESULTS: The eye as an organ was spared in 100% of cases; vision was spared in 50% of cases and improved, from 0.09±0.05 to 0.21±0.13, in 29% of cases. Lagophthalmos was reduced from 5.86±1.35 to 3.01±0.75 mm. CONCLUSION: Patients with intracranial lesions complicated by neuroparalytic keratitis often develop progressive purulent corneal ulcers. The simultaneous use of surgery, including keratoplasty, conjunctival autografting, and partial (external) tarsorrhaphy, is an effective treatment that can preserve the visual function of these eyes.

[Surgical treatment of purulent corneal ulcers in eyes with neurotrophic keratitis and paralytic lagophthalmos]. / Lechebnaia keratoplastika pri gnoinykh iazvakh rogovitsy, razvivshikhsia na fone neirotroficheskogo keratita i paraliticheskogo lagoftal'ma.

AIM: to develop a surgical approach to the treatment of purulent corneal ulcer in eyes with neurotrophic keratitis with lagophthalmos after auditory neuroma removal or stroke. MATERIAL AND METHODS: A total of 12 patients (13 eyes) have been managed. All received combined surgery that included simultaneous keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy. RESULTS: Ocular integrity was preserved in all cases, and also vision - in half of them. In 29% of cases, visual acuity increased from 0.09±0.05 up tо 0.21±0.13. Lagophthalmos decreased from 5.86±1.35 mm down to 3.01±0.75 mm. CONCLUSION: Patients with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos often develop progressive purulent ulcers of the cornea. One-step keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy is an effective treatment that can help preserve visual function in such eyes.

[Severe bilateral pseudomonas sclerokeratitis in comatose patient (clinical case)]. / Razvitoi dvustoronnii sinegnoinyi sklerokeratit u patsientki v kome (klinicheskii sluchai).

The article presents a clinical case of severe bilateral pseudomonas sclerokeratitis in a patient with occlusion hydrocephalus and intracranial hypertension, who was in a coma and on a ventilator for 20 days. At first examination (7 days after the onset of purulent keratitis, during which the process had been rapidly progressing), the clinical picture included lagophthalmos, severe purulent corneal ulcer, bilateral purulent scleromalacia, perforated cornea in the left eye. On the same day, in order to maintain eye integrity, urgent reconstructive penetrating sclerokeratoplasty with subsequent sclerocorneal coating was performed in both eyes right in the intensive care unit. Parts of the melted iris and ciliary body pars plana that were left in place were abundantly washed with BSS and moxifloxacin solutions - 150 µg/ml. Postoperative care included forced instillations of antibiotics and antiseptics. Two years after the first surgery, 2 more full-thickness corneal transplantations were performed in the patient's right eye aiming at restoration of its optical system. Thus, immediate sclerokeratoplasty with anterior segment irrigation and intraocular administration of highly diluted antibiotics appeared to be the only chance to save the vision in one eye. The fellow eye, where perforation occurred as a result of severe purulent sclerokeratitis and purulent iridocyclitis, despite all measures taken, lost its sight. After three surgeries (penetrating sclerokeratoplasty and two re-PK), visual acuity in the only seeing (right) eye was 0.1, which can be considered a satisfactory result.

[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.

[Treatment option for intralamellar corneo-scleral abscesses in the zone of tunnel incision after phacoemulsification].

The article provides data on clinical diagnosis (4 patients, 4 eyes) and early surgical treatment of corneal intralamellar abscesses (ICA) in the zone of corneo-scleral tunnel incision after phacoemulsification (PE). ICA developed via corneo-scleral incision was a relatively reliable biomicroscopic sign of the beginning chronic endophthalmitis. Despite of massive nonsurgical treatment (antibiotics, glucocorticoids, non-steroid anti-inflammatory agents etc.) inflammation was not arrested completely, it recurred within 2,5-6 months after PE. Reconstructive conjunctivo-sclerokeratoplasty resulted in arrest of inflammation and visual function recovery in 3 patients. In one patient this procedure was not possible to perform because of total loss of visual functions due to chronic endophthalmitis.

[Treatment for central corneal ulcer in the presence of lagophthalmos by autoconjunctivoplasty in combination with optic iridectomy and external blepharorrhaphy a clinical case].

The outcomes of keratitis in lagophthalmos occurring due to various causes despite therapeutic measures are generally poor. The influence of factors, such as drying of the cornea, impairment of its trophism, and infection, leads to the development of rough leukomas, and occasionally to eye death due to occurring endophthalmitis. The paper describes a clinical case of deep trophic central corneal ulcer on the single seeing eye with lagophthalmos, as well as ulcer treatment by the authors' procedure, by simultaneously affecting both elements of the pathology (lagophthalmos and trophic ulcerative keratitis of central localization) and creating an artificial pupil. This allows one to increase visual acuity, to cure keratitis, and to close a palpebral fissure.

[Recurrent herpetic corneal erosion: diagnosis and treatment].

Recurrent corneal erosion (CE) is a common anterior eye disease, which usually occurs after injury, substantially limits a patient's ability to work, and is intractable. The authors single out an individual form of CE herpetic CE (HCE) on the basis of immunofluorescence assay of a conjunctival scrape, which shows the high concentration of herpes simplex virus antigen in 53% of CE cases. Confocal microscopy revealed epithelocyte polymorphism and basement membrane defects. The treatment of patients with HCE involved 2 steps: 1) relief of acute signs of the disease via drug therapy, rapid local autocyte cinotherapy (RLACCT), or phototherapeutic keratectomy (PTK) and 2) prevention of recurrences. For this the authors developed a method based on the systemic use of a new composition of the intradermal herpes vaccine Vitaherpavac in combination with the subcutaneous interferon inducer Poludan. RLACCT was found to be the most effective medical treatment for CE and PTK was the most effective surgical one. Vaccination with the concurrent subcutaneous injection of Poludan is an effective method in preventing recurrent HCE. During a follow-up of 2 years or more, 81% of the patients achieved clinical resolution; there was a decrease in recurrence rates and severity in 15.1% and no effect in 3.8%.

[Complex treatment for decompensated edematous exophthalmos].

In endocrine ophthalmolopathy, there may be persistent dysfunction of the organ of vision due to corneal lesion or optical neuropathy. As an illustration of severe corneal lesion in edematous exophthalmos decompensation, the authors give their own observation that shows it necessary to use in such cases complex treatment comprising pulse therapy with glucocorticoids, followed by a long-term dosage reduction and switching over to its oral administration, as well radiotherapy and surgery.

[State and prospects of evidence-based medicine and occupational pathology].

According to foreign literature data, contemporary methods of evidence-based medicine are insufficiently limited in use by occupational pathologists both in this country and abroad. This is due to restrictions of Occupational Diseases Register, difficulties in adding new entities into it, medical and social practice to use functional parameters for disablement definition, employers' obstacles to reveal early stages of occupational diseases through active employees' examinations, patients' wish to receive governmental annuity and not to get rehabilitated.

[Results of a multi-year use of combined laser-surgical treatment in tumors of the epibulbar and limbocorneal localizations]. / Rezul'taty mnogoletnego opyta ispol'zovaniia kombinirovannogo lazerno-khirurgicheskogo lecheniia opukholei épibul'barnoí i limborogovichnoí lokalizatsii.

Fifty-five patients (55 eyes) were followed up. The "Romashka-2" CO2-laser plant was used for treatment of epithelial and epibulbar tumors (41 patients, 41 eyes). Microsurgical interventions with subsequent lamellar or penetrating keratoplasty were made in 14 patients (14 eyes). The experimental group of patients was followed up from 3 to 10 years. Relapses were registered in 4 eyes (4 patients). The CO2-laser treatment had a number of advantages before surgery or cryotreatment in removing the epibulbar tumors without growth in the cornea. Ablasticity, minimal trauma to tissues and evaporation of diffusive neoplasms can be named among such advantages. In cases of growth of epibulbar tumors in the cornea, there were direct indications for keratoplasty with preliminary barrage of CO2 irradiation on the sides of the mucous tunic of epibulbar tumor. Tumors were surgically removed with subsequent lamellar or penetrating keratoplasty being made with respect to a tumor type. The perfection of surgical technique consists in that one transplant of a bigger diameter is used instead of a corneoscleral transplant.

[Local express auto-cytokine therapy (a complex of cytokines) in the treatment of viral and nonviral eye lesions]. / Lokal'naia ékspress-autotsitokinoterapiia (kompleks tsitokinov) v lechenii virusnykh i nevirusnykh porazhenii glaz.

The method of local express-autocytocinetherapy (LEACCT) consists in using an experimentally tested autologous complex of cytokines (alpha- beta- gamma-interferons, interleukins 2.8, tumor necrosis factor gamma etc.), which is produced by joining the autoblood of patients with immune-modulator poludan (complex poly A:poly U). The external LEACCT and the intrachamber LEACCT are distinguished. The former presupposes the administration (subconjunctivally and in installations) of the autoblood-poludan mixture. This method is used in herpes- and adenovirus keratoconjunctivitis, slow re-epithelization after laser keratectomy and in eye burns (178 patients). The latter comprises, apart from the external LEACCT procedures, a 1-4-time introduction of the mentioned mixture into patient's anterior chamber. It was used in endothelial herpetic keratoiridocyclitis, initial bullous keratopathy, severe keratoconus and in injuries of the anterior lens capsule (117 patients). The clinical-study results (main group--295 patients) show that the designed method based on poludan has pronounced anti-inflammatory and regenerative effects in different viral and virus-free lesions of the eye tissues; it is simple and can be applied in clinical settings. An increased visual acuity ranging from 0.05 to 1.0 was registered in 85% of cases. The action of the complex of cytokines is as close as possible to the physiological mechanism, which provides for avoiding the side-effects and for applying the treatment scheme in situations when the administration of other drugs is limited or their efficiency is not sufficient.

[Conduit drainage and preserved amnion in pathologies of the cornea concomitant with glaucoma]. / Trubchatye mikrodrenazhi i konservirovannyi amnion pri patologiiakh rogovitsy, sochetaiushchikhsia s glaukomoi.

The authors improved the anterior-chamber bypass technique implemented simultaneously with reconstructive penetrating keratoplasty or with trabeculotomy in order to enhance the efficiency of antiglaucomatous drainage surgeries in organic lesions of the anterior segment of the eye combined with active inflammatory processes in it and concomitant with secondary glaucoma. The use of conduit drainage was supplemented with wrapping the distal end with conserved amnion, which prevented the postoperative obstruction of drainage or its heading in the outward direction. Amnion, exceeding the size of the scleral flap, was placed in trabeculotomy with active inflammatory signs between scleral strata, thus, preventing an excessive postoperative scarring. A total of 45 patients were operated on with the follow-up reaching 3 years. The efficiency of antiglaucomatous interventions made up 88-93% of cases. The suggested new drainage techniques with conserved amnion can be successfully used surgeries combined with keratoplasty as well as in independently in secondary glaucomas of various etiologies and in primary refractive glaucoma.

[Penetrating keratoplasty in keratoconus by using the method of intraoperative corneal compression]. / Skvoznaia keratoplastika pri keratokonuse s ispol'zovaniem metoda intraoperatsionnoi korneokompressii.

The authors suggested the method of intraoperative dot-type keratocompression to localize the zones of ectasia in keratoconus. Corneocompression is made before corneal transplantation under the monitoring of the operation microscope by a special corneocompressor (from the keratoconus top to its periphery). The sagging degree of the examined corneal portion proportionate to its thinning is in the focus of attention. Simultaneously, the ectasia zone is marked by a 1% solution of brilliant green, after which a decision is made on the possibility of its radical incision by trepans of various sizes, ranging from 7.5 to 11 mm. Penetrating keratoplasty was made by using this method in 116 patients (147 eyes) with keratoconus of degrees III-IV according to Amsler. Better refractive results, including a higher visual acuity and a lower degree of postoperative astigmatism in long-term follow-ups ranging from 2 to 12 years, were ensured in the main group (77 patients, 93 eyes) versus the control group (39 patients, 54 eyes). Finally, the authors suggested, on the basis of their own experience, an operational classification of keratoconus.

[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.