[Functional rehabilitation of patients after endovitreal surgery of rhegmatogenous retinal detachment with complete retinal attachment]. / Otsenka rezul'tatov primeneniya novogo farmakoterapevticheskogo podkhoda v funktsional'noi reabilitatsii patsientov posle endovitreal'noi khirurgii regmatogennoi otsloiki setchatki s polozhitel'nym anatomicheskim rezul'tatom.

Rhegmatogenous retinal detachment (RRD) is one of the most severe eye diseases typically occurring in people of working age. The annual rates of primary vision disability in patients with RRD is 2-9%. PURPOSE: To increase the functional effectiveness of endovitreal surgery in patients with RRD by including Cytoflavin in the system of postoperative rehabilitation. MATERIAL AND METHODS: The study involved 68 patients with RRD aged 37 to 65 years. Patients underwent vitrectomy using the 25 Gauge technology with endolaser coagulation of rupture zones and silicone oil tamponade in the vitreous cavity. Three months after the surgery, silicone oil was removed from the vitreous cavity. Patients were divided into 2 groups: the main - 34 people who received Cytoflavin in addition to standard therapy, and the control - 34 people receiving only standard postoperative treatment. The time course of the treatment's functional effectiveness was analyzed using best corrected visual acuity (BCVA) and macular photosensitivity. Laser Doppler flowmetry (LDF) was used to register the microcirculation and microcirculation efficiency indices. Morphological signs of macular ischemia were registered by optical coherence tomography angiography (OCT-A). RESULTS: Patients of the main group showed higher level of restoration of macular function compared with the control group. The increase in functional activity of the macular area correlated with postoperative dynamics of restoration of central retinal thickness. Analysis of LDF and OCT-A indices showed that improvement of visual functions in patients treated with Cytoflavin is directly related to restoration of chorioretinal blood flow. CONCLUSION: The use of Cytoflavin in patients after endovitreal surgery of RRD led to improvement of BCVA by an average of 2.6 times and photosensitivity of the macula by 2 times. The visual functions of patients improved after using Cytoflavin due to its positive effect on chorioretinal microcirculation and the density of macular capillary plexuses.

[Herpesviral infection as an etiological factor of acute idiopathic optic neuritis]. / Gerpes-virusnaia infektsiia kak étiologicheskii faktor ostrogo idiopaticheskogo opticheskogo nevrita.

PURPOSE: To assess the etiological significance of herpesviral infection (HVI) in patients with acute idiopathic optic neuritis (ON) using clinical and laboratory monitoring. MATERIAL AND METHODS: Clinical and laboratory examinations were conducted for 10 years and were based on the results of etiological monitoring of 79 patients (85 eyes) with acute idiopathic ON in the period of 2005-2015. RESULTS: During a complex examination of 79 patients with acute idiopathic ON, various infectious pathogens were diagnosed in 75 people (94.9±2.1%). HVI was clearly dominant (69 patients - 87.3±2.4%). These patients were divided into 3 etiological groups. The first group - 34 people with herpesviral monoinfection; the second group - 15 people with mixed viral-viral infections; the third group - 20 people with mixed viral-bacterial infections. In the general population of patients with acute idiopathic ON associated with HVI, herpes simplex virus-1 is the most frequent (by more than 2.5 times), the infections of Epstein-Barr virus and cytomegalovirus were detected less often (p<0.05). Active current HVI in the general group of patients was diagnosed in 58 patients (84%). At the same time, reactivation of chronic infection (79.7%) was noted to be prevalent, while primary acute HVI was diagnosed rarely (4.3%). The remaining 11 patients (16%) had chronic persistent HVI. CONCLUSION: Clinical and laboratory monitoring of HVI in patients with acute idiopathic ON has shown the etiological role of herpesviruses in its development. Based on a complex of serological markers in enzyme-linked immunoassay reactions of blood serum, it was found that in patients with acute idiopathic ON the frequency of herpesviral infection is 87.3±2.4%. The proportion of active (etiologically significant) herpesviral infection is 84% of the total group. The results of the clinical and laboratory studies are of great practical importance for verification of the etiologic diagnosis and selection of adequate etiopathogenetic therapy in patients with acute idiopathic ON associated with HVI.

[Stress protection therapy in the prevention of macular morphological lesions in patients with diabetes mellitus at cataract microsurgery].

Patients with a family history of diabetes mellitus should undergo complex antistress protection of the macula for the prevention of its stress-induced lesions during cataract phacoemulsification with intraocular lens implantation. A differential algorithm of stress protection therapy has been developed in relation to the phase of surgical stress, the use of which is to enhance the tolerance of vegetovascular, hemodynamic, and metabolic systems to the aggressive components of surgical stress, thus reducing the incidence of transient subclinical and clinical macular edema.

[Clinical and morphometric macular changes in patients with diabetes mellitus after cataract phacoemulsification].

Optical coherent tomography (OCT) shows that in patients with diabetes mellitus (DM), a macular morphological response to cataract phacoemulsification (CPE) with intaocular lens (IOL) implantation proceeds as 3 types: 1) areactive without macular morphological changes; 2) hyperreactive with the development of reversible subclinical macular edema; and 3) aggressive with the transition of stress-induced retinal morphological lesions to clinically significant diabetic macular edema. Morphological differences in OCT parameters were established to have impact on the effect of visual rehabilitation. Following 3-4 months of CPE with IOL implantation in DM patients with the areactive type of a macular morphological response to surgical stress, the increase in visual acuity exceeded that observed in the hyperactive and aggressive types of a macular response by 12.8 and 57.7%, respectively. The findings suggest that medical preventive measures reducing the negative consequences of surgical stress should be implemented in DM patients at catarrhal surgery.

[Experimental study of the efficiency of use of sodium hypochlorite in the complex treatment of purulent keratitis].

The experiment has provided evidence for the safe use of 0.1% aqueous sodium hypochlorite for ocular tissues and for its therapeutic efficacy in purulent keratitis. The therapeutic effect is achieved by accelerating the lysis of neurotic tissues, by suppressing the pathogenic microflora, by alleviating an inflammatory reaction, by stimulating epithelization and reparative regeneration, by activating the phagocytic properties of neutrophilic leukocytes by 1.8-times, by increasing their functional reserves by 1.3 times as compared to the similar parameters observed in the use of conventional treatments.

[Administration of epithalamine in the treatment of unstable glaucoma of different types after normalization of intraocular pressure]. / Primenenie épitalamina dlia lecheniia razlichnykh tipov nestabilizirovannogo techeniia glaukomy posle normalizatsii vnutriglaznogo davleniia.

The treatment effect and clinical efficacy of epithalamine solution was studied on 28 patients (42 eyes) with unstable glaucoma and normalized intraocular pressure (IOP). Epithalamine belongs to the group of cytomedines and it has a modeling effect on the functional activity of the simpatico-adrenaline system, adrenal cortex and anti-oxidizing activity. The clinical study showed that the use of epithalamine solution resulted in normalization of the biochemical activity of the neuro-humoral triphism (adrenaline, norepinephrine, and hydrocortisone). It leads to an increased diameter of arterioles of the bulbar conjunctiva and of the optic disk as well as to a decreased degree of congestive angiopathy and of intravascular aggregation of erythrocytes.

[Study of the surface tear tension and evaluation of its importance for the retinal physiology and pathology in contact correction and in adaptation to soft contact lenses]. / Issledovanie poverkhnostnogo natiazheniia slezy i otsenka ego znacheniia dlia fiziologii i patologii rogovitsy pri kontaktnoi korrektsii, a takzhe ego roli v protsesse adaptatsii k miagkim kontaktnym linzam.

The surface lachrymal-fluid (LF) tension was investigated by teardrop dissection in 115 patients with myopia before they were prescribed soft contact lenses (SCL). Such tension was found to be of clinical importance for the development of SCL adaptation disorders. A longer adaptation period in patients with myopia was associated with a low surface LF tension. A high surface LF tension concurrent with the teardrop dissection mode of the destruction type was typical of the pathological nature of SCL adaptation (12.1% of patients). The obtained data are needed to detect timely the risk of dysadaptation disorders and corneal complications before SCL prescription for the purpose of undertaking the pathogenetically substantiated medication to prevent such complications.

[Study of the nervous-vascular reactivity of the bulbar conjunctiva in patients with primary open-angle glaucoma with normalized intraocular pressure]. / Izuchenie nervno-sosudistoi reaktivnosti bul'barnoi kon"iunktivy glaza u bol'nykh pervichnoi otkrytougol'noi glaukomoi s normalizovannym vnutriglaznym davleniem.

Clinical evaluation of adrenoreception was carried out in 96 patients with various clinical patterns of primary open-angle glaucoma with normalized intraocular pressure by changes in vascular reactivity in the bulbar conjunctiva capillaries in response to epinephrine and norepinephrine. Neuro-vascular reactions of the bulbar conjunctiva in response to norepinephrine and epinephrine were different in patients with different patterns of primary open-angle glaucoma with normalized intraocular pressure. A significant correlation between the rate of progress of optic disk glaucomatous atrophy and the parameters of ocular adrenoreceptor structures of the eye was detected.

[Differentiated approaches to the treatment of nonstabilized primary open-angle glaucoma with normalized intraocular pressure considering its pathogenic features]. / Differentsirovannye podkhody k lecheniiu nestabilizirovannoi pervichnoi otkrytougol'noi glaukomy s normalizovannym vnutriglaznym davleniem s uchetom ee patogeneticheskikh osobennostei.

Clinical efficiency of dedystrophic treatments for nonstabilized primary open-angle glaucoma (POAG) in the presence of normalized intraocular pressure is compared in 168 patients (246 eyes). In one group of patients ischemic angiopathy and hyperreactivity of optic vessel adrenoreceptors associated with hypokinetic central hemodynamics and constitutional metabolic status of the organism was corrected by cinnarisin and riboxin. Patients with predominating congestive angiopathy symptoms, hyper- or eukinetic circulation and "slow" acetylation were treated by pantothenic acid, endotelon, and hyperbaric oxygenation. In both groups epithalamine, eiconol, and magnetic laser therapy were used, if indicated. This helped stabilize the process in 91% patients with initial POAG, in 87.5% with well-developed condition vs. 66.1% and 38.2% patients treated by traditional therapy (period of observation 3 years).

[Central and regional hemodynamics of eye in different course of primary open-angle glaucoma with normalized intraocular pressure and their relationship with circulation types, sympathoadrenal activity and hydrocortisone level]. / Osobennosti tsentral'noi i regional'noi gemodinamiki glaza pri razlichnom techenii pervichnoi otkrytougol'noi glaukomy s normalizovannym vnutriglaznym davleniem i ikh vzaimosviaz' s tipami krovoobrashcheniia, simpatiko-adrenalovoi aktivnost'iu i urovnem kortizola.

The relationship of systemic and local hemodynamics with neurohumoral factors has been evaluated in 104 patients with primary open-angle glaucoma with normalized intraocular pressure. Changes in the functional activity of the sympathoadrenal activity and hydrocortisone levels were in high correlation with the initial type of systemic hemodynamics: the hormonal activity of the sympathoadrenal system predominated in patients with eukinetic and hyperkinetic circulation with normal levels of hydrocortisone, while in patients with hypokinetic circulation the mediator (norepinephrine) component of the sympathoadrenal system combined with a high plasma level of hydrocortisone predominated. A principal characteristic of unstable primary open-angle glaucoma, discriminating it from the stable condition in all types of circulation, is the presence of deep autonomic disorders in the neurohumoral mechanisms of autoregulation of ocular blood flow, because of excessive accumulation of norepinephrine, epinephrine, and hydrocortisone in the lacrimal fluid at the expense of their decreased utilization by the receptor systems of ocular tissues and blood vessels.

[The effect of neurohumoral factors of the sympathoadrenal system on the results of cataract extraction with intraocular lens implantation in diabetic patients]. / Vliianie neirogumoral'nykh faktorov simpatoadrenalovoi sistemy na rezul'taty ékstraktsii katarakty s implantatsiei intraokuliarnykh linz u bol'nykh sakharnym diabetom.

Effect of the sympathoadrenal system (SAS) on the results of cataract extraction with IOL implantation was studied by analyzing the stress index in 64 patients with diabetes mellitus and 20 reference patients. SAS reaction to surgical stress was abnormal in 34 (53.1%) diabetics. The level of SAS activity, postoperative complications, and kinetics of regenerative repair processes in the cornea were related. In 15 (23.%) diabetics with a low stress index the postoperative period was characterized by frequent inflammations, longer repair of normal corneal homeostasis, and coarse cicatrization. In 19 (29.7%) diabetics with a high stress index after cataract extraction normalization of the corneal homeostatic parameters was delayed and macular edema developed 4.8 times more often.

[Clinical and pathogenetic features of neurotrophic corneal disorders in diabetes]. / Kliniko-patogeneticheskie osobennosti nervno-troficheskikh narushenii rogovitsy u bol'nykh sakharnym diabetom.

The corneal neurotrophic status was evaluated in 110 patients (220 eyes) with diabetes mellitus and in 20 normal controls (40 eyes). Corneal abnormalities (gerontoxon, limb vascularization, punctate keratopathy, endothelial dystrophy, relapsing erosion, corneal ulcers) were detected in 73.6% diabetics. Corneal changes depended on the type, duration, and compensation of diabetes mellitus. Based on the diagnostic markers (threshold sensitivity of the cornea, microcirculatory status, bulbar conjunctiva status, level of lacrimal production, cellular composition of the limb smears impressions, lacrimal levels of catecholamines, hydroperoxides, and lipids), three types of diabetic neuropathy of the cornea were distinguished: vegetative, sensory, and vegetosensory. Corneal changes were associated with signs of diabetic neuropathy in 55.6% cases and with autonomic nervous disorders of the cardiovascular system in 46.9% cases, which evidences a generalized involvement. The detected neurotrophic features of the cornea should be borne in mind when choosing pathogenetic therapy for diabetics with corneal complications and preparing the patients to ocular surgery.

[Clinical efficacy of eiconol in patients with diabetic retinopathy]. / Klinicheskaia éffektivnost' primeneniia éíkonola u bol'nykh diabeticheskoí retinopatieí.

Eiconol, a nutrient additive from sea fish oil, was used in the treatment of 48 patients with diabetic retinopathy. Eiconol normalized lipid metabolism parameters, which were increased, in 79.2% patients: total cholesterol decreased by 19.1%, triglycerides by 27.8%, beta-lipoproteins by 12% vs. the initial level; 74.6% patients developed favorable shifts in the status of the hemoretinal barrier and ocular microcirculation mainly at the expense of improving blood rheology. This resulted in a decrease of the recovery coefficient in photostress test by 23 +/- 1.3%. The therapeutic effect of eiconol was particularly evident during the preclinical and initial stages of manifest diabetic retinopathy and decreased as the diseases augmented in severity. Eiconol monotherapy may be recommended for correction of lipid metabolism and of functional disorders of permeability at the level of vascular and tissue membranes, and for improving the blood rheology during the preclinical stage of diabetic retinopathy. In proliferative diabetic retinopathy it is advisable to add eiconol to a complex of pathogenetic therapy.

[Structural and functional disorders of transcapillary metabolism if retina in patients with diabetic retinopathy]. / Strukturno-funktsionalnye osobennosti narushenii transkapilliarnogo obmena setchatki u bolnykh diabeticheskoi retinopatiei.

Transcapillary metabolism of the retina and effects of triglycerides on the transcapillary function of the retina in diabetes mellitus were examined in 79 patients (mean age 45.4 +/- 3 years) with various stages of diabetic retinopathy (DR) by fluorometry of the vitreous body. The filtration in the blood-retina direction was 1.2-1.3 times higher than in the control as early as during the functional and preclinical stages of DR, and the coefficient of fluorescein withdrawal from the vitreous body was 4.5 to 6.2% decreased. As DR progressed, the permeability of the blood-retinal barrier in the blood-retina direction increased and the discharge from the retina to the blood was decelerated, which was confirmed by a progressive prolongation of diffusion of 0.1 ml of 1% fluorescein solution injected subconjunctivally: from 1.3 +/- 0.2 and 1.4 +/- 0.5 h in the functional and preclinical stages, respectively, to 2.7 +/- 0.3 h in the proliferative stage of DR versus 1.05 +/- 0.01 h in the control. The level of serum triglycerides and coefficients of fluorescein entry in and withdrawal from the vitreous body, time of papule diffusion, and vascular changes in the microcirculatory vessels reliably correlated.

[The pathogenetic treatment of age-related macular dystrophies]. / Patogeneticheskoe lechenie vozrastnykh makulodistrofii.

The paper analyses results after medicamentous treatment of 181 patients with senile macular dystrophies, using methods of pharmacologic correction of sympathetic-adrenal (phosphaden, pyridoxine, ethymisole, ascorbic acid), callicreine-kinin (andecaline, paramidine, cinnarisine) activities and methods of traditional therapy consisting of vasodilative, antisclerotic preparations, vitamins and biostimulants. The comparative analysis has shown that the above preparations normalize KA metabolism and processes of kininogenesis. Stabilization of the dystrophic process is achieved in 82.6% of cases as compared with 71.4% of patients treated by traditional methods; the duration of the therapeutic effect after one course of treatment increases by 3-4 months; the incidence of appearance of transudative-hemorrhagic changes in the central segments of the eye fundus in the presence of atrophic dystrophies of the retina decreases by three times.