[Clinical forms of corneal abnormalities in atopic keratoconjunctivitis].

Atopic keratoconjunctivitis (AKC) is presently considered as an individual nosological entity of ocular allergosis, which is associated with the systemic disease - atopic dermatitis. The clinical features of corneal lesions were studied in 40 patients with AKC. Those associated with the systemic pattern of an atopic process as a severe form of ocular allergosis were revealed. A classification of the clinical forms of corneal lesions in AKC as limbitis, epithelial microerosions, epithelial keratopathy, superficial keratitis in mild forms of the disease, is presented. The severe forms of AKC were characterized by corneal manifestations: extensive keratopathy, stromal keratitis with neovascularization without ulceration, corneal infiltrates and ulcers of bacterial and herpetic etiology.

[The antiallergic eye drops "polynadyme": development, experimental and clinical studies].

The antiallergic eye drops "Polynadyme", proposed by the Helmgolz Moscow Research Institute of Eye Diseases, have been prepared by the "Sintez" PJSC (Kurgan). The drops exert a combination of antihistaminic and vasoconstrictive effects and, for better tolerability, contain a low-toxic preserving complex. The drops are polymer-based, which ensures a long action and an artificial tear effect. Preclinical rabbit trials have shown the safety of the "Polynadyme" eye drops, their specific activity in preventing an allergic reaction, and their antiallergic effect on a model of allergic conjunctivitis. Comparative clinical trials covering 150 patients have yielded excellent and good results in 93% of cases. In acute allergic reactions, hyperemia, itch, and burning diminished just 5 minutes after administration. The "Polynadyme" eye drops are effective in treating pollinous conjunctivitis, spring (vernal) keratoconjunctivitis, allergic reactions when wearing contact lenses, the dry eye syndrome, drug-induced and toxicoallergic conjunctivitis, and other ocular allergic reactions.

[Clinical forms of acanthamoeba keratitis as viewed from the standpoint of biomicroscopy and confocal microscopy]. / Klinicheskie formy akantamebnogo keratita v svete biomikroskopii i konfokal'noi mikroskopii.

Clinical cases of 60 patients with acanthamebic keratitis examined by biomicroscopy and of 22 patients largely examined by confocal microscopy are generalized. Acanthamebic keratitis is a slowly progressing infectious lesion of the cornea, which is caused by acanthamebas freely residing in soil and water. Contaminated contact lenses are the key risk factor. The main clinical features of acanthamebic keratitis are defined; they are presence of risk factors; a unilateral lesion in young, healthy and immune-competent persons; a typical clinical pattern of surface keratitis mainly of the ring shape; corneal neuritis without corneal neovascularization but with a severe pain in the eye; and a slow chronic clinical course, i.e. lasting for several weeks and months. Confocal microscopy is the most effective and fast diagnostic tool because it ensures the detection of acanthamebic cysts and trophozoids in all strata of the corneal stroma. The authors isolate, within the clinical course of acanthamebic keratitis, 5 stages; they are surface epithelial keratitis; surface epithelial punctate keratitis; stromal ring-shaped keratitis; ulcerous keratitis; and keratoscleritis.

[Levofloxacin (Tavanic) in the treatment of corneal ulcers]. / Levofloksatsin (Tavanik) v lechenii iazvennykh porazhenii rogovitsy.

The main clinical forms of cornea ulcers were systematized and high efficacy of levofloxacin in the treatment of bacterial ulcer of the cornea was shown. In the treatment of several bacterial affections of the eye the systemic use of levofloxacin should be combined with local antibiotic therapy. Combination of levofloxacin with ophthalmic drops of lomefloxacin (okacin) or ofloxacin (floxal) proved to be efficient.

[Diagnosis and importance of the opportunistic herpes-virus infection in etiology and pathogenesis of different eye diseases]. / Gerpesvirusnaia infektsiia v étiopatogeneze razlichnykh zabolevanii glaz.

A total of 439 patients (adults--184, children--255) with herpetic keratitis as well as with uveitis and choriorenitis of different geneses and localizations were examined. An aggravation of HSV-infection was determined by detecting, in the blood), anti-bodies to the unstructured early viral antigens by using the immune enzyme analysis (IEA). The efficiency of the test was demonstrated during the examination of patients with different ophthalmic pathologies. An active infection was detected in 16-39% of patients with various ocular diseases of non-herpetic etiology. The pathogenetic value of reactivated HSV infection is diverse: it can function as an etiological or trigger factor and it can aggravate the main disease through causing, postoperatively, complications.

[The state-of-the art and prospects for the pharmacological therapy of infectious and allergic eye diseases]. / Sostoianie i perspektivy farmakoterapii infektsionnykh i allergicheskikh zabolevanii glaz.

The inflammatory, infectious and allergic diseases of the eye still remain an acute problem in practical ophthalmology due to their high prevalence, relapsing clinical course, a growing frequency rate of mycotic and acanthoamebic keratitis and a growing number of resistant causative agents of bacterial keratitis. 55.3% of corneal pathologies are related with the herpes simplex virus, 37.3%--with secondary bacterial infection, 33.2%--with primary bacterial infection, 6.7%--with mycotic infection and 5.6%--with acathoamebic infection. Algorithms of pharmacological therapy are suggested for a majority of inflammatory lesions of the eye, i.e. for herpetic keratitis, ulcerous keratitis caused by blue pus bacillus, gonococcus, staphylococcus, fungi, acanthomebas, as well as for adenoviral and Chlamidia conjunctivitis and allergy of the eye. The author points out that the treatment must be complex, including specific therapy--antiviral one (zovirax ointment, interferon locally, and zovirax or valtrex perorally), antibacterial one (okacin, tobrex, vitabact, fucithamic locally, quinine antibiotics perorally, aminoglycosides or cephalosporins subconjunctivally or intramuscularly) and antimycotic one (locally and perorally). Another part of the complex therapy is equally important--pathogenetic one (carnosine, taufon, vitacic, corneregel ointment), antiallergic one (spersallerg, allergophtal, alomide, lecrolin), antinflammatory one (naclof, maxidex, cyclolip) tears replacing one (natural tears, ophthagel) and immunomodeling one (affinoleicin, lycopid, tactivin).

[New modification of autoconjunctival plastic surgery in urgent corneal surgery]. / Novaia modifikatsiia autokon''iunktival'noi plastiki i neotlozhnoi khirurgii rogovitsy.

A new modification of plastic repair of deep defects of the cornea was performed: autoconjunctival plasty of the cornea with a flap on a pedicle with its rigid fixation in the corneal bed. The operation was carried out in 30 patients with infectious, trophic, and autoimmune involvement of the cornea, 24 of these with perforation of the cornea. The patients were observed for 1 year after the operation. The conjunctival-corneal complex formed in 24 cases, dislocation of the flap without its necrosis occurred in 2 cases, and necrosis of the flap in 4 cases. This modification of conjunctival plasty of the cornea can serve as the operation of choice in urgent ophthalmic surgery in cases when transplantation material is unavailable.

[Therapeutic algorithms in infectious ulcers of cornea]. / Terapevticheskie algoritmy pri infektsionnykh iazvakh rogovitsy.

Based on the experience gained at Department of Infections and Allergic Diseases of the Eyes and recent publications, the author proposes protocols of drug therapy of the major infectious ulcerative diseases of the cornea: herpetic ulcer, ulcer caused by Pseudomonas aeruginosa, gonococci, staphylococci, fungi, and acanthamedian keratitis. The authors emphasizes that the treatment of ulcers of the cornea should be complex, including specific therapy (corresponding to the identified agent or the agent most probable as judged from the clinical picture) and pathogenetic therapy (metabolic, antiallergic, antiinflammatory, immunomodulating, hypotensive). If corneal ulcer is rapidly recognized and forced therapy started, good results can be attained even in such a fulminant infection as those caused by Pseudomonas aeruginosa or gonococci. On the other hand, therapy of keratomycosis and acanthamebian keratitis remains a problem.

[New aspects in drug therapy of ocular allergies]. / Sovremennye aspekty farmakoterapii glaznykh allergozov.

Ophthalmic allergoses belong to highly prevalent ocular diseases. According to the records of the first center of allergic diseases of the eye set up in 1971 at Helmholtz Institute of Ocular Diseases in Moscow, the most prevalent clinical forms are seasonal pollenosis conjunctivitis, drug allergies, spring keratoconjunctivitis, large-papillary conjunctivitis, chronic allergic conjunctivitis, allergy associated with the "dry eye" syndrome, atopic keratoconjunctivitis, and ocular involvement in systemic immune diseases. Therapy of ocular allergies is based on the three main principles: removal of the allergen responsible for disease, immunotherapy, and symptomatic drug therapy. The main agents used in local antiallergic therapy are antihistaminic drugs (antasoline and acelastin), drugs inhibiting mast cell degranulation (chromoglycates and lodoxamide), and accessory drugs: corticosteroids (dexamethasone and deosonide), nonsteroid antiinflammatory agents (diclofenak), immunosuppressants (cyclosporin), and vasoconstrictors (tetrisoline). Antiallergic drugs can be used as monotherapy or in combinations, as they differ by the mechanism of action. Antiallergic drugs are used with good results in combined therapy of infectious conjunctivitis and keratitis.

[Prevalence and clinical significance of active cytomegalovirus infection in patients with inflammatory ophthalmopathy]. / Rasprostranennost' i klinicheskoe znachenie aktivnoi tsitomegalovirusnoi infektsii u bol'nykh s oftal'mopatologiei vospalitel'nogo kharaktera.

A total of 374 patients with different inflammatory diseases of the eyes were examined (227 children and 147 adults). For detecting active cytomegalovirus (CMV) infection, sera were tested for antibodies to nonstructural intact CMV proteins. Antibodies were detected in 26 of 147 adults (17.7%) and 15 of 227 children (6.6%). Difference in the frequency of detection of active CMV infection in adults and children is statistically significant (p < 0.01). Three groups of patients with active CMV were distinguished: children with congenital diseases, immunocompromised patients, and the most numerous group of patients with isolated ocular diseases without manifest signs of immunodepression. In this latter group active CMV was detected in patients with different clinical diagnoses, including ophthalmic herpes. Russian commercial enzyme immunoassay kit CMV-Control proved to be a highly sensitive, simple, and cheap test for the diagnosis of exacerbations of chronic CMV infection.

[Locferon: new eyedrops for treatment eye adenoviral diseases]. / Novye glaznye kapli "Lokferon" v lechenii adenovirusnykh zabolevanii glaz.

Locferon, interferon eyedrops, was used in the treatment of adenovirus diseases of the eyes in 68 patients. The results demonstrated the advantages of locferon over interferon. The drug was highly effective and duration of treatment decreased; it was well tolerated and caused no side effects or toxic allergic reactions.

[Lomefloxacin in treatment of infectious eye diseases]. / Lomefloksatsin v lechenii infektsionnykh zabolevanii glaz.

The data on the use of the difluoroquinolone lomefloxacin in the treatment of ocular infections such as bacterial conjunctivitis and keratitis, ulcer of the cornea, uveitis, gonococcal and chlamydial conjunctivitis are presented.

[Alomide eyedrops in the treatment of allergic conjunctivitis and keratoconjunctivitis]. / Primenenie glaznykh kapel' "Alomid" v lechenii allergicheskikh kon''iunktivitov i keratokon''iunktivitov.

New drug lodoxamine (alomide) opens new vistas in the treatment of allergic diseases of the eyes highly prevalent both in adults and children. This drug prevents release of mast cell mediators and delays eosinophil migration to conjunctival and corneal tissue, thus exerting a spectrum of antiallergic effects. Clinical studies carried out in 170 patients demonstrated a high efficacy of alomide in the treatment of subacute and chronic pollenosis conjunctivitis, spring keratoconjunctivitis, multiple and toxic allergic keratitis, and other allergic conjunctivities. Alomide can be used as a preventive drug in patients with allergies under high-risk conditions and in patients wearing contact lenses. It is effective in combined therapy of keratitis and keratouveitis. Alomide eye drops are well tolerated.

[Eye ointments eubetal and colbiocin in the treatment of chlamydial conjunctivitis]. / Glaznye mazi "Eubetal" i "Kolbiotsin" v lechenii khlamidiinykh kon"iunktivitov.

The above ointments were used for local treatment of chlamydial conjunctivitis in 325 patients. The results demonstrated their high efficacy, good tolerance, advantages over tetracycline ointment, and absence to toxic allergic reactions.