[Features of stress reactivity of the organism and clinical patterns of ocular burn].

Clinical patterns of ocular burn in patients with different types and variants of stress reactivity were studied. It is shown that patients with the maladaptive type of stress reactivity at any stage of the disease are at higher risk of complications. Rapid exhaustion of the sympathoadrenal system or a hyperactive stress response seen in cases of the labile and hyperergic individual adrenergic immune reactivity of the organism (IAIRO) can be considered as manifestations of a regulation disorder. The absence of complications along with mild changes in immune reactivity is characteristic of the normoergic variant of IAIRO.

[Clinical and immunological features of stress reactivity in the dynamics of ocular burn].

A series of clinical and immunological studies revealed peculiarities of stress reactivity in the course of ocular burn. According to adrenergic receptor expression level in active T-lymphocytes and its trend in the dynamics of ocular burn 2 types and 7 variants of individual adrenergic immune reactivity were identified and a physiologically adequate variant of stress reactivity was determined.

[Features of the stress-induced immunoreactivity of the organism in dynamics of the clinical current of the burn disease of eyes].

The individual adrenergical immunological reactivity of the organism (IA IRO) was investigated in 142 patients with eye burn of various degree. 2 types of IA IRO have been allocated by level and orientation of T-adrenoreception dynamics changes.

[Fluorescence angiography of the anterior eye segment in the evaluation of impaired microcirculation within the diagnosis of severity of eye burns]. / Rol' fliuorestsentnoi angiografii perednego otdela glaza v otsenke narushenii mikrotsirkuliatsii pri diagnostike stepeni tiazhesti ozhogov glaz.

We used fluorescence angiography to study the vascular microcirculation in the anterior eye segment of 14 patients with severe eye bums. The severity of eye burns is not only related with an impaired blood circulation in the conjunctiva, it also depends on a microcirculation status of episcleral vessels. Different degrees of permeability of fluorescein through the conjunctival or episcleral vessels make it possible to specify circulation disorders in both cases. Whether the impaired microcirculation in the anterior eye segment is transient or not can be established through a second fluorescence angiography made during days 7-8 from the burn trauma. The severity of eye burn depends directly on the sizes of ischemic regions of the sclera.

[The parameters of the body immune reactivity in applying the therapeutic keratoplasty for the treatment of ocular burn lesions of extra severity]. / Pokazateli immunologicheskoi reaktivnosti organizma pri primenenii lechebnoi keratoplastiki v lechenii ozhogovoi bolezni glaz osobo tiazheloi stepeni.

One hundred and two (128 eyes) patients with stage 4 ocular burns underwent examinations. One-stage therapeutic keratoplasty was used in 67 (67.7%) patients. Retransplantation was made in 35 (34.3%) of patients due to graft rejection. According to the study, the more severe the clinical course of burn lesions is (cases that necessitated transplantation in the present research), the more pronounced changes are observed in the body immune reactivity of victims. In particular, the below peculiarities were observed: a progressing reduction of the contents of lymphocytes' and of B-lymphocytes; and a diminishing phagocytic activity of neutrophils in the peripheral blood registered at the terminal treatment stage in the patients after retransplantation versus the 1st-group patients with a more favorable clinical course. The compensatory increase of T-lymphocytes, T-helpers and of IgA, IgG was found to be less pronounced in group 2. A notably more intense sensitization response of the body to corneal antigens was established in the patients after retransplantation, which was a basis for using this index as a prognostication test in respect to the graft rejection crisis.

[Necrolytic properties of alkaline protease in the treatment of severe eye burns]. / Nekroliticheskie svoistva shchelochnoi proteazy v lechenii ozhogov glaz tiazhelykh stepenei.

Both eyes of 62 rabbits (124 eyes) were experimentally studied. Necrolytic properties of alkaline protease were examined on a model of an isolated alkaline retinal burn by 10% NaOH with a 10 sec exposure; the protease optimal concentration and an optimal exposure were determined. It was established that a necrolytic effect correlating with that of lecozyme can be achieved when a protease solution with an activity of 25-27 PE is used. An increased activity of protease in the solution results not only in hydrolysis of the turbid corneal part, but it also melts the perifocal area entailing a danger of perforation. Alkaline protease can be used as an ointment to ensure the necrolytic effect, however, its dosage in such medication form must be above 30-35 PE. The administration of a preliminary enzymatic necrectomy produced a positive effect on the postoperative cause and the results of keratoplasty as compared with surgical necrectomy, which can be explained by a better quality necrectomy involving the use of alkaline protease.

[Applications of lecozyme with necrolytic purpose for subsequent keratoplasty in the treatment of eye burns: an experimental study]. / Pimenenie lekozima s nekroliticheskoi tsel'iu dlia posleduiushchei keratoplstiki v lechenii ozhogov glaz tiazheloi stepeni (éksperimental'nye issledovaniia).

Necrolytic properties of lecozyme diluted with urea were studied on a model of isolated alkaline burn of the cornea with 10% NaOH applied for 10 sec. Experimental studies were carried out on both eyes of 62 rabbits (124 eyes). Lecozyme applications in a dose of 17.5 FIP dissolved in urea in concentrations of 3.5 to 40% brought about a complete necrolytic effect in all cases. The results of keratoplasty depended on the concentration of urea. High concentrations (10-40%) caused severe complications in the eye (endophthalmitis). Application of 5-10% urea solutions caused no complications, but the graft healing was opaque in all cases. Satisfactory results were attained with 3.5 and 4% urea. Postoperative course and outcomes of keratoplasty after pretreatment with lecozyme were better than in the control animals subjected to surgical necrectomy. We explain better results of surgical treatment of induced burns by a higher quality of necrectomy, which can be attained by the enzyme. No melting or perforation of the cornea due to the enzyme was observed in any case. Good results of experiments necessitate further experimental and clinical studies.

[Phonophoresis of the proteolytic enzymes lekozim or kollalizin in the combined therapy of eye burns]. / Fonoforez proteoliticheskikh fermentov lekozima ili kollalizina v kompleksnoi terapii ozhogov glaz.

A two-stage phonophoresis of proteolytic enzymes of lecozim or collalysine was used in a complex treatment of severe eye burns. The main group of patients consisted of 20 patients (23 eyes) treated by lecozim phonophoresis and 6 patients (6 eyes)--by collalysine phonophoresis. The control group consisted of 23 patients (25 eyes) treated by a complex treatment without phonophoresis of proteolytic enzymes. The comparative analysis of the course of a burn disease in both groups has shown positive influence of enzyme therapy on its dynamics and outcome. In the main group, the arrest of inflammatory signs accomplished earlier (by the 27th-29th day) as compared with the control group (by the 32nd-38th day) as well as epithelialization of corneal defects (by the 27th-30th day and by the 34th-42nd day, respectively); earlier vascularization of the cornea stimulated improvement of the burn process. Of a characteristic feature of the treatment was resolution of corneal opacification that began already after the first stage and continued within the second stage of the treatment. This allowed to achieve higher functional results. In the main group, visual acuity rose in 88.5%, and in the control--in 48% of patients.

[The use of lekozim phonophoresis for the treatment of eye burns]. / Primenenie fonoforeza levkozima dlia lecheniia ozhogov glaz.

Experimental investigations concerning the influence of lecozyme phonophoresis on the development of a burn process in the eye have shown that lecozyme phonophoresis has a positive action on the development of a burn process, speeds up the stoppage of inflammatory signs, epithelialization and vascularization of the cornea, stimulates the formation of its less intensive opacifications. The most favourable term to use lecozyme phonophoresis is the second day after the moment of a burn trauma. To achieve a positive effect, 5 procedures are enough, while a longer course or treatment or later terms for its usage (7, 14, 21 days after burn) impairs the development of the burn process. The usage of lecozyme phonophoresis in two stages (5 sessions within the first day and 10 sessions after epithelialization of the cornea) allows to achieve the best results--stoppage of inflammatory signs, reduction of vascularization and opacifications of the cornea.