[Morphological changes in the cornea of patients with recurrent corneal erosion after diamond burr polishing of Bowman's membrane]. / Morfologicheskie izmeneniia rogovitsy pri sindrome retsidiviruiushchei érozii posle shlifovki boumenovoi membrany almaznym borom.

PURPOSE: To evaluate morphological changes in the cornea of patients with recurrent corneal erosion (RCE) using laser confocal microscopy before and after abrasive polishing of Bowman's membrane with a diamond burr (APBMDB). MATERIAL AND METHODS: The study included 17 patients (20 eyes) with established RCE diagnosis; they underwent laser confocal microscopy on HRT III device with Rostock Cornea module (Heidelberg Engineering GmbH, Germany). Morphological analysis of epithelial cells, nerve fibers, stroma and corneal endothelium was conducted. After that, all patients underwent APBMDB. Patient examination was repeated after 1, 3, 6, and 12 months. RESULTS: Superficial epithelium was intact before treatment in almost all cases. Islets of hyper-reflective cells, drop-shaped arrangements and stripes characterizing abnormal basal membrane were found in basal epithelium layer. Activated keratocytes and anomalous extracellular matrix were observed in the anterior stroma. No changes could be found in the posterior stroma or endothelium. Subbasal nerve plexus had changes in the form of short and atypically formed corneal nerve fiber funiculi, reduced amount of long corneal nerve fiber funiculi, as well as their tendency for forming closed round shapes. Increase in the amount of Langerhans cells was observed. One month after the procedure, pathological changes in the epithelium and basal membrane were absent, reduction in the amount of Langerhans cells and activated keratocytes was observed. Three months after the polishing, continued reduction of the amount of Langerhans cells was noted. Regeneration of nerves partially restored after 6 months; after 12 months, confocal microscopy results were comparable to healthy volunteers. CONCLUSION: Confocal laser microscopy of the cornea of patients with RCE showed presence of changes in basal epitheliocytes, basal membrane, anterior stroma and corneal nerve fibers, as well as positive dynamics of these changes after abrasive polishing of Bowman's membrane with a diamond burr.

[Mushroom keratoplasty in rosacea keratitis complicated by corneal perforation (a clinical case)]. / Gribovidnaia keratoplastika pri rozatsea-keratite, oslozhnennom perforatsiei rogovitsy (klinicheskii sluchai).

Rosacea is a polyethiologic chronic inflammatory disease with varying clinical manifestations. It is primarily a dermatologic disease, which often manifests in the eyes affecting eyelids, cornea and conjunctiva. The leading role in the pathological process belongs to disruption of regulatory mechanisms in the vascular, immune and nervous systems. It is accompanied by increased levels of metalloproteinases and vascular endothelial growth factor (VEGF). Treatment depends on the severity of the disease and may vary from hygiene of the eyelid margins and use of artificial tears for dry eye disease management, to antibiotics and anti-inflammatory agents in moderate cases, and surgical treatment in severe or neglected state. A clinical case of severe rosacea shows that keratoplasty with mushroom-shaped profile of the surgical incision helps achieve good functional results and reduce the post-operative rehabilitation time, while significantly reducing the risk of postsurgical complications. Anti-VEGF therapy significantly reduces the risk of histoincompatibility reaction typical for rosacea keratitis.

[Polishing of Bowman's membrane with diamond burr in the treatment of recurrent corneal erosion syndrome]. / Abrazivnaia shlifovka boumenovoi membrany almaznym borom v lechenii retsidiviruiushchei érozii rogovitsy.

PURPOSE: To study the effectiveness of polishing Bowman's membrane with a diamond burr (DBPBM) in the treatment of recurrent corneal erosion syndrome (RCES). MATERIAL AND METHODS: The study included 22 patients (22 eyes) with RCES aged 20-56 years who underwent our original modification of DBPBM. All patients had keratotopography examined, endothelial cell density measured, and optical coherence tomography (OCT) of the cornea taken before and after the procedure. Additionally, conjunctival scraping, blood test for types I and II herpes (fluorescent antibody method) were performed before the surgery. Post-operative treatment included 1-2 weeks of anti-inflammatory and anti-bacterial steroid therapy, and 6 months of artificial tear Cationorm usage. RESULTS: Rehabilitation of all patients after the procedure went quickly, and no relapses were noted during the follow-up. Complete epithelialization of the area of surgical intervention under soft contact lens occurred over 2-3 days. Epithelial thickness was measured with OCT including epithelial mapping; after the surgery, it was almost even over the entire corneal surface. No complications such as induced post-operative refractive error or corneal haze were registered during the course of the study. Disruption of basal epithelial layer and epithelial basal membrane in the area of erosion relapse detected with scanning electron microscopy confirmed the need for their removal in the course of the surgery. CONCLUSION: Conservative treatment of RCES rarely yields results. Removal of inadequate epithelium and following DBPBM using our original method is a highly effective and accessible procedure for RCES treatment with low risk of complications and relapse.

[Corneal degenerations]. / Degeneratsii rogovitsy.

Degeneration is the process of change occurring in cells, their parts or intracellular matter that happens due to external factors affecting the life of an organism and results in gradual disruption of normal condition of the tissue or the organ, and possibly complete loss of its functionality. Corneal degenerations may be caused by age-related physiological changes, associated with a certain systemic disease or local inflammations, or be the consequence of chronic toxic action of unhealthy environmental factors on the eye. Unlike dystrophies, corneal degenerations cannot be inherited and do not onset early. When corneal degenerations significantly affect visual acuity, the treatment should aim at alleviating the primary disease before inducing changes in the cornea. The existence of such pathology is important to remember and timely differentiate from acute inflammatory processes of various etiology that require immediate treatment. The right diagnosis is the key factor in choosing effective treatment strategy and thus achieving positive clinical results.

[Corneal dystrophies]. / Distrofii rogovitsy.

The article reviews modern clinical, morphological, and genetic aspects of corneal dystrophies based on the most recent international classification updated in 2015. Corneal dystrophies is a group of slow progressing, non-inflammatory corneal pathologies, most of which are characterized by variability of the associated traits. The existence of such pathologies makes important their differential diagnosis from acute inflammatory processes of various etiology, which require urgent therapy. Conservative treatment suitable for dystrophies is usually associated with disorders of the anterior corneal surface and employ symptomatic tactic (lubricants, epithelizing agents, soft contact lenses). No effective etiopathogenetically targeted treatment is currently known. In cases with significant visual acuity decrease, it is possible to perform phototherapeutic keratectomy, abrasive polishing of Bowman's membrane with diamond bur and various types of keratoplasty depending on the depth of involvement.