[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.

[Scientific legacy of Professor A.A. Kasparov. Inductor of endogenous interferon Poludan in the treatment of ocular herpes and other corneal diseases]. / Nauchnoe nasledie professora A.A. Kasparova. Induktor endogennogo interferona Poludan v lechenii oftal'mogerpesa i drugikh zabolevanii rogovitsy.

This article presents a retrospective analysis of the research findings by professor A.A. Kasparov, who developed and implemented a novel approach to treating ocular herpes. The treatment system is fundamentally different from the conventional chemotherapeutic approach and revolves around non-specific immunotherapy using an endogenous interferon inducer - a biosynthetic complex of polyriboadenylic and polyribouridylic acids, known as Poludan. This approach also incorporates personalized cell therapy based on Poludan, along with herpes vaccine aimed at preventing recurrence. The regenerative and antiviral properties of this approach have proven successful in treating other corneal conditions such as adenovirus infections, early postoperative bullous keratopathy, as well as in stimulation of epithelialization after refractive surgeries (photorefractive keratectomy, phototherapeutic keratectomy).

[Application of visible longwave radiation for inactivation of microorganisms]. / Primenenie dlinnovolnovogo izlucheniya vidimogo spektra dlya inaktivatsii mikroorganizmov.

PURPOSE: To perform a comparative assessment of the bactericidal and fungicidal effects of various parts of the radiation spectrum (Ultraviolet A, red, green and blue). MATERIAL AND METHODS: The study included strains of the most clinically significant microorganisms, which are the most common causes of purulent keratitis - S. aureus, P. aeruginosa and fungi C. albicans. After populating the surface of Petri dishes uniformly with microorganisms of each culture, on four out of the five specimens the central zone of the surface with a diameter of 1 cm was irradiated with light of different spectrum - from ultraviolet to red, with a total radiation energy density of 5.4 J/cm2. One specimen remained as the control subject. After irradiation, scanning electron microscopy with lanthanides contrasting (SEMLC) was used to evaluate the total metabolic activity, the activity of the efflux systems and the morphological characteristics of the microorganisms. RESULTS: The damaging effect of visible spectrum light and UVA radiation on S. aureus, P. aeruginosa and C. albicans cultures was proved by SEMLC. Green spectrum emission with a wavelength of 500 nm had the highest antimicrobial activity. It was manifested by a decrease in the overall level of metabolic activity (from 40-63 c.u. to 26-37 c.u. (S. aureus (p<0.01), P. aeruginosa (p<0.01) and C. albicans (p<0.05)), as well as a 2-fold increase in the proportion of S. aureus cells with active efflux systems. CONCLUSION: SEMLC allows evaluation of parameters of the microorganisms` state: morphological (form and size) and functional (general metabolic activity, activation of efflux systems). Investigation of S. aureus, P. aeruginosa and C. albicans cultures using SEMLC demonstrated the antimicrobial activity of green spectrum radiation of 500 nm wavelength. This will serve as a basis for further research and development of a method of treating infectious keratitis using green light.

[Manifestations of herpes zoster ophthalmicus]. / Glaznye proyavleniya opoyasyvayushchego gerpesa.

The article reviews the main ocular features of Herpes Zoster Ophthalmicus (HZO) including Ramsay-Hunt and Tolosa-Hunt syndromes that involve III, IV and VI pairs of cranial nerves and I branch of the trigeminal nerve, and describes treatment methods of its active manifestations and postherpetic neuralgia, as well as herpes zoster vaccination practices.

[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.

[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.

[Corneal collagen cross-linking in the treatment of infectious keratitis and corneal ulcers]. / Krosslinking rogovichnogo kollagena v lechenii infektsionnykh keratitov i gnoinykh iazv rogovitsy.

In recent years, collagen cross-linking (CXL) of the cornea has acquired a new usage - in the treatment of infectious keratitis and corneal ulcers. This review was aimed at compiling the previously published data and assessing the effectiveness of the method.

[Diagnosis of Acanthamoeba keratitis]. / Diagnostika akantamebnogo keratita.

The Acanthamoeba keratitis is a relatively rare, but dangerous disease of the cornea. Its development is thought to be associated with contact lens wearing as well as corneal microwounds contaminated with soil or water. The disease has no evident distinctive clinical features and is, therefore, difficult to be distinguished from herpetic or fungal keratitis. Nevertheless, Acanthamoeba infection can be suspected judging from anamnestic data (i.e. contact lens use and corneal injury with subsequent contamination of the wound), inadequately strong pain syndrome, ring-shaped infiltration of the cornea and ineffectiveness of conventional therapy. Also helpful may be such measures as isolating the bacteria using the method of biocultures, morphological examination of corneal biopsy material (using light and luminescent microscopy), genetic testing, and in vivo confocal microscopy of the cornea. Other promising methods are also listed in this article. A widely accepted diagnostic technique is yet, however, missing.

[Treatment of Acanthamoeba keratitis]. / Lechenie akantamebnogo keratita.

In recent years, Acanthamoeba keratitis (AK) has became a clinically significant problem because of the broad use of contact lenses that are the major risk factor of the disease. The treatment presents considerable difficulties due to similarity of clinical manifestations of AK to other keratites (bacterial, herpetic, and fungal). This often leads to late diagnosis and formation of drug-resistant cysts. There is currently no specific drug universally suitable for monotherapy of AK. Instead, 2 agents (usually chlorhexidine and poligexametilen biguanide) are used that, if combined, are effective against both trophozoites and cysts. If necessary (severe keratitis, insufficient treatment effect), diamidines (propamidine and its analogs), antifungals (fluconazole, itrakonazol), certain antibiotics (Neomycinum), and iodine-containing medications (povidone-iodine) can be prescribed. The use of corticosteroids is considered unjustified because of the risk of rapid progression (due to disturbance of local immunity and also provocation of excystation of the amoebas). The penetrative keratoplasty may be required, especially if a descemetocele or corneal perforation occurs, however, its results are generally worse than those in other keratites because of a higher risk of complications (iridocyclitis, secondary glaucoma, AK recurrence in the graft). In some cases, good results are achieved with minimally invasive surgeries, such as mechanical epithelial debridement, conjunctivoplasty and cryopreserved amniotic membrane transplantation, excimer laser phototherapeutic keratectomy, and cross-linking. In the future, gene therapy and specific chemotherapy of AK may well be developed.

[Modern treatments for purulent corneal ulcers]. / Sovremennye metody lecheniia gnoinykh iazv rogovitsy.

This review covers the most widely used modern treatment methods, minimally invasive and surgical, for therapy-resistant purulent corneal ulcers.

[Ocular toxicity of intracamerally injected antibacterial and antifungal drugs (experimental and morphological study)].

OBJECTIVE: To study anterior eye segment toxicity of variously diluted brand name and generic antibiotic and antifungal drugs, including domestically produced generics (Moxifloxacin, asketin cefuroxime, amikacin, gentamicin, Diflucan, and amphotericin B), experimentally injected into the anterior chamber. MATERIAL AND METHODS: A total of 13 Chinchilla rabbits were included in the experiment. Group 1 (6 rabbits) received sterile intracameral injections of 0.2 ml antibiotics and antifungals in concentrations suitable for intravenous administration (Moxifloxacin 1.6 mg/ml, Diflucan 2 mg/ml, and the following generics: asketin cefuroxime 125 mg/ml, amikacin 50 mg/ml, gentamicin 40 mg/ml, amphotericin B 50 mg/m). BSS was injected into the fellow eye for control. Group 2 (7 rabbits) also received sterile intracameral injections of 0.2 ml antibiotics and antifungals, which were the same as for group 1 but highly diluted (Moxifloxacin 150 µg/ml and 500 µg/ml, Diflucan 10 µg/ml, asketin cefuroxime 1 mg/ml, gentamicin 200 µg/ml, amikacin 400 µg/ml, amphotericin B 10 µg/ml). RESULTS: There were no toxic effects in group 1 after BSS and Moxifloxacin 1.6 mg/ml injections into the anterior chamber. However, high concentrations of other antibiotic and antifungal drugs were associated with changes in the corneal endothelium of various severity (from cytoplasmic swelling of the endothelial cells to their complete desquamation), as well as fibrin exudation in the posterior chamber. In group 2 neither of injected drugs caused toxic, allergic, or inflammatory reactions according to histopathological examination. CONCLUSION: The experiment proved safety of the intracameral route of administration for highly diluted medications from the list and also demonstrated the absence of toxic reaction after intracameral injection of Moxifloxacin 1.6 mg/ml.

[Review of approaches to cell therapy in ophthalmology].

The review covers global trends in cell therapy research and clinical trials aimed at the treatment of ophthalmic diseases. Some definitions are provided and mechanisms of action of cell products studied to date are listed.

[Purulent corneal ulcers: etiology, pathogenesis, classification].

Advanced purulent corneal ulcer, as well as abscess, is a serious vision-threatening condition notable for its fulminant course and possible loss of the eye due to endophthalmitis. Its leading causes, pathogenesis, and classifications are described and analyzed in this paper.

[Purulent corneal ulcers: clinical presentation, diagnosis, and conservative treatment]. / Gnoinye iazvy rogovitsy: klinika, diagnostika, konservativnoe lechenie.

This is a detailed review of purulent corneal ulcer signs and symptoms, problems in diagnosis, and conservative treatment options.

[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.

[Combination of microdiathermocoagulation and local express autocytokine therapy in treatment of superficial infectious corneal ulcers].

Current surgical non-keratoplastic options of superficial infectious corneal ulcers treatment are presented. Literature data is analysed and proposed methods are assessed.

[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.