[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.

[Subfamily of betaherpesviruses as a cause of epithelial and stromal keratitis]. / Podsemeistvo beta-gerpesvirusov kak prichina epitelial'nykh i stromal'nykh keratitov.

PURPOSE: This article presents the first clinical results of intravital morphological verification of epithelial and stromal keratitis associated with betaherpesviruses. MATERIAL AND METHODS: The study group included 12 patients (12 eyes) diagnosed with herpetic keratitis. During the initial visit to the clinic, each patient underwent a standard ophthalmological examination, as well as a number of laboratory tests: immunochemical analysis of blood, molecular diagnostics, and confocal microscopy. Histological study of the cornea was additionally performed in cases indicated for surgical treatment (2 patients). RESULTS: According to enzyme-linked immunoelectrodiffusion essay (ELISA), acute-phase immunoglobulins of class M (Ig M) to cytomegalovirus (CMV) were detected in only one clinical case. Class G immunoglobulins (Ig G) to both CMV and human herpes virus type 6 (HHV-6) were detected in the majority of cases. Quantitative polymerase chain reaction (qPCR) revealed CMV DNA in tears (2 patients) and in saliva (4 patients). The HHV-6 genome was found in tears (2 patients) and in saliva (3 patients). According to the results of confocal microscopy, owl's eye cells were found in 8 patients of the group. Histological examination of the cornea helped identify pathognomonic cells in one case. Thus, 8 patients of the group were diagnosed with keratitis associated with the betaherpesvirus subfamily. CONCLUSION: Results of observation of the study patients suggest the possibility of developing keratitis associated with the subfamily of betaherpesviruses with localization in the superficial layers of the cornea. Confocal microscopy can be useful for identification of pathognomonic owl's eye cells in the corneal tissues and confirmation of the diagnosis of betaherpesvirus-associated keratitis. Investigation of the etiological factor of superficial and stromal viral keratitis is important for determining the further tactics of pharmacotherapy.

[Ocular manifestations of coronavirus infection COVID-19 (clinical observation)]. / Glaznye proyavleniya koronavirusnoi infektsii COVID-19 (klinicheskoe nablyudenie).

This paper describes possible clinical ocular manifestations of novel coronavirus infection COVID-19. Two clinical cases of conjunctivitis are examined. Due to the lack of ophthalmological approaches to the treatment of such patients, different management tactics are given based on the severity of local and systemic disease manifestations. Our research and practical management of these conditions showed the toxic and allergic nature of ocular surface manifestations in patients with COVID-19. Such cases are proposed to be treated similar to the conjunctivitis of "unclear origin" with components from antiviral and anti-allergic therapies.

[Results of enzyme-linked immunoassay of the blood serum in patients with infectious and inflammatory diseases of the anterior segment of the eye]. / Rezul'taty immunofermentnogo analiza syvorotki krovi pri infektsionno-vospalitel'nykh zabolevaniyakh perednego segmenta glaza.

PURPOSE: To evaluate the clinical significance of the data obtained during enzyme-linked immunosorbent assay (ELISA) of the blood serum of patients with inflammatory diseases of the anterior eye segment compared to a group of healthy volunteers. MATERIAL AND METHODS: A retrospective analysis of the results of serum ELISA of 200 patients with chronic keratoconjunctivitis and keratouveitis was performed using the solid-phase IFA method in order to detect the presence of antibodies to herpes simplex viruses of 1 and 2 types (HSV 1, 2), cytomegalovirus (CMV), Chlamydia trachomatis and Toxoplasma gondii. The control group consisted of 34 healthy volunteers with no signs of inflammation of the eye tissue. RESULTS: There were no significant differences in the frequency of detection of both «acute-phase¼ IgM and «chronic¼ IgG to HSV and CMV between patients of the main group and healthy volunteers (ρ≥0.05). The levels of IgG to Toxoplasma gondii in the study group were three times higher than in the control group (ρ≤0.05). A comparative analysis of the frequency of detection of antibodies to Chlamydia trachomatis showed statistically significant differences between the groups and more frequent detection of immunoglobulins classes A, G and M in patients with inflammatory eye diseases (ρ≤0.05). CONCLUSIONS: The absence of statistical differences with the control group in the frequency of detection of active HSV and CMV infections in patients with inflammatory diseases of the anterior eye segment when using ELISA allows to recommend the use of additional methods of examination such as polymerase chain reaction (PCR) and real-time PCR (RT-PCR) with identification of pathogen genetic material in the available biological secretions. The increase in IgG titers to toxoplasma in patients of the main group apparently indicates a cross-stimulation of antibody synthesis against the background of a chronic inflammatory process. Significant differences in the frequency of detection of all types of antibodies to chlamydiae suggests a significant etiological role of this pathogen in the development and maintenance of chronic inflammation in the anterior eye segment.

[Prevalence and severity of dry eye syndrome in myopic candidates for laser in situ keratomileusis]. / Rasprostranennost' i tiazhest' sindroma sukhogo glaza u patsientov s miopiei, planiruiushchikh lechenie metodom LASIK.

PURPOSE: To assess the prevalence and severity of dry eye syndrome (DES) in patients with myopia being evaluated for laser in situ keratomileusis (LASIK). MATERIAL AND METHODS: The prospective, non-interventional, cross-sectional study involving 9 Russian ophthalmic centers included 400 patients with myopia (aged 29.7 years in average). Among them, 145 (36.2%) wore contact lenses, and 81 (20.2%) used locally administered drugs for treatment of DES. The examination included Shirmer I test, tear film break-up test (TBUT), staining with lissamine green and fluorescein (Oxford scale), Ocular Surface Disease Index (OSDI) questionnaire, and classification of the disease according to dry eye workshop (DEWS). RESULTS: Average Shirmer test result was 15.2 mm; 36.5% of patients had signs of tear deficiency (Shirmer test ≤10 mm). Average TBUT was 11.7 seconds; the tear film of 10.1% of patients was unstable (TBUT <5 seconds). Lissamine green staining was classified as insignificant or higher (degree ≥I) in 62.3% of patients and mild or higher (degree ≥II) - in 22.8%. Mean score of the OSDI questionnaire was 20.4 indicating mild vision impairment. Dry eye severity according to DEWS classification was mild/episodic in 66.2%, moderate - in 29.5%, and severe - in 4.3% of patients. No clear correlation was evident between the Schirmer/TBUT scores and the lissamine green/OSDI scores. CONCLUSION: The prevalence of dry eye in this population was estimated at approximately 10% to 40% (based on clinical signs) and 40% to 55% (based on symptoms); dry-eye severity was predominantly mild/episodic. The proportion of patients requiring dry-eye therapy (based on OSDI and DEWS severity findings) was almost 2 times higher than the proportion receiving treatment.

[Mixed infections and inflammatory ophthalmic diseases: clinical and laboratory observations]. / Mikst-infektsii i vospalitel'naia oftal'mopatologiia: kliniko-laboratornye nabliudeniia.

In recent years, all medical specialists, including ophthalmologists, have been facing the problem of mixed infections. Recurrent inflammation in the anterior and posterior eye segments is often a result of infection by more than one variety of pathogens. MATERIAL AND METHODS: Over the period 2013-2016, 34 patients (14 men and 20 women) with different inflammatory processes in the eye who appeared DNA-positive for mycoplasmas (Mycoplasma hominis, Ureaplasma urealyticum) and/or chlamydiae (Chlamydia trachomatis) (PCR testing of tear fluid and/or urine) were followed up. All patients were examined for intensive production of herpesvirus, adenovirus, and enterovirus DNA in biological fluids. After being consulted by related specialists, all the patients started local and systemic (antibacterial and antiviral) therapy. In the end of the latter, laboratory tests were repeated. RESULTS: Among all the clinical forms, anterior segment inflammation (i.e. of conjunctiva, cornea, and the anterior vascular tract) prevailed - 76%. In most patients, mycoplasmas and/or chlamydiae formed associations with herpesviruses (n=19; 56%). Bacterial DNA alone (mycoplasma and/or chlamydia) was detected in 12 cases (35%). In 4 cases, mycoplasma and/or chlamydia DNA was detected in tear fluid, in 19 patients - in urine, and in 10 patients - in both secreta. Local and systemic causal treatment enabled resolution of the complaints and symptoms and yielded negative results of follow-up laboratory tests. CONCLUSION: More than a half of the patients demonstrated concomitant viral-bacterial infection (22 cases). The presence of bacterial/viral DNA in biological secreta, as revealed by PCR, reflects the systemic nature of the infection process and, thus, necessitates engagement of related specialists (dermatologists, urologists, gynecologists).

[Clinical and immunological comparisons of therapeutic regimens for corneal infiltrates secondary to adenoviral keratoconjunctivitis].

UNLABELLED: The problem with post-adenoviral corneal infiltrates is that they cause a significant and persistent decrease in visual function, while corticosteroids in monotherapy bring only temporary improvement. AIM: to perform a comparative evaluation of topical corticosteroids and 0.05% cyclosporine A efficacy in the treatment of post-adenoviral corneal infiltrates on the basis of clinical presentation and local cytokine status. MATERIAL AND METHODS: The study involved two groups of patients after adenoviral keratoconjunctivitis: group 1 (25 patients, 45 eyes) were prescribed a diminishing regimen of corticosteroid eye drops for 12 weeks and corneal protectors; group 2 (24 patients, 42 eyes) received the same treatment as described above plus topical 0.05% cyclosporine A for 6 months. The follow-up period was from 6 to 12 months. Visual acuity measurements, biomicroscopy, and pneumatic tonometry were performed at months 1, 3, and 6. Local cytokine status was assessed by studying cytokine gene expression in cell culture from conjunctival scrapings and cytokines levels in the supernatant. The tests were done before the beginning of the treatment in both groups, at month 1 in group 1, at month 4 in group 2 (i.e. in a month after the cessation of dexamethasone) and also in a group of healthy volunteers (30 persons, 30 eyes). RESULTS: Long-term combined anti-inflammatory therapy with corticosteroids and 0.05% cyclosporine A in patients with post-adenoviral corneal infiltrates has yielded positive clinical results, including a persistent increase in visual acuity and complete resolution of corneal opacities (92.8%). In addition, we revealed a correlation between local cytokine status changes and clinical results. CONCLUSION: The proposed therapeutic regimen enabled complete suppression of residual interferon-α antiviral activity, an increase in interleukin-4 that regulates local humoral immunity, and a decrease (down to a complete suppression) in anti-inflammatory interleukin-2, which is responsible for activation of cell-mediated immunity, thus, resulting in resolution of the immune-mediated inflammation in the cornea.