[Nitric oxide metabolites concentration in tear fluid and its prognostic value in development of early inflammatory reactions after consecutive intraocular surgery].

Dynamics of NOx concentration in tear fluid is studied before and different time after consecutive operations in various postoperative courses. Preoperative deviation of this parameters by 25-30% of control group was showed to be a risk factor of complicated postoperative course. It may be considered a prognostic criterion of early postoperative inflammatory reactions.

[Use of small-dose Cyclosporine HEXAL in the treatment of postoperative inflammation during intraocular surgical reinterventions].

The effectiveness of small doses of the selective immunosuppressive agent Cyclosporine HEXAL (2-2.5 mg/kg) was studied in 112 patients with early inflammatory reactions developing after various surgical reinterventions (cataract phacoemulsification with intraocular lens implantation after antiglaucoma surgery, repeated antiglaucoma, reconstructive operations, etc.). The drug was given as a short course for 5-10 days. As compared to the conventional treatment with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAID), Cyclosporine HEXAL exerted a rapider therapeutic effect, reducing the duration of exudate resolution and corneal edema and the length of hospital stay and improving functional outcomes. The drug was found to be well tolerated and induced adverse reactions in sporadic cases. Cyclosporine HEXAL may be recommended as the drug of choice in the treatment of the severest postoperative uveitis, particularly if there are contraindications to systemic and long-term use of corticosteroids and NSAID.

[Sympathetic ophthalmia. Clinical and morphological study in 6 cases after penetrating injury and subsequent repeated vitreoretinal operations].

The paper outlines the clinical and morphological picture of 6 sympathizing eyes enucleated in 1996 to 2003 after vitrectomy and other endovitreal interventions into early injured or operated eyes. Resurgery was attempted early after wounds or a primary operation on the average following 20 days. Sympathetic ophthalmia (SO) generally occurred in the posterior uveal tract as panuveitis or posterior uveitis and diagnosed in the late periods. Specific granulomatous inflammation in the uveal tract was observed in all eyes and the morphological feature of sympathizing eyes was the spread of an inflammatory process to the retina with the development of the latter's epithelioid-cell granulomas and adhesive chorioretinitis. The authors also discuss the possibility of additional antigenic stimulation accompanied by a progressive autoimmune process in the eye and by the generalization of a granulomatous inflammation, as well as the role of retinal minor lesions in this process as a source of additional autoantigens during repeated vitreoretinal operations. The latter, as the authors believe, are a risk factor of SO. In this connection, when repeated vutreoretinal interventions should be made in the presence of an uncompleted wound process in the eye and when they should be conducted under the conditions of active immunosuppressive therapy gain in great importance.

[Prognostic significance of local and systemic indicators of lipid peroxidation and antioxidant system in perforating wounds of the eyes and their time course during local antioxidant treatment]. / Prognosticheskaia znachimost' mestnykh i sistemnykh pokazatelei perekisnogo okisleniia lipidov i antioksidantnoi sistemy pri pronikaiushchikh raneniiakh glaz i ikh dinamika na fone mestnogo primeneniia antioksidantov.

Lipid peroxidation parameters malonic dialdehyde (MDA) and dienic conjugates (DC) and antioxidant defense (AOD) values superoxide dismutase (SOD), catalase, alpha-tocopherol were measured in the blood neutrophils and lacrimal fluid of 66 patients on days 1-2, 7-8, 14-15, and 21-22 after perforating wound of first, second, third, and fourth degree of severity according to P, 1. Lebekhov and in repeated injury, and the time course of these parameters during local treatment with therapeutic films with emoxipin and emoxipin + piridoxine was evaluated. A stable increase of MDA and DC levels in blood neutrophils, decrease of catalase, SOD, and alpha-tocopherol levels in blood neutrophils, and decrease of catalase enzymes and SOD activities in the lacrimal fluid of injured eye starting from days 7-8 are prognostically unfavorable signs. These data prompt the use of local and systemic treatment with antioxidants (emoxipin, tocopherol, etc.) in perforating wounds starting from the first days after the injury. Good clinical and antioxidant effect was observed after treatment with ocular therapeutic films with emoxipin and piridoxine.

[The characteristics of the clinical course of the wound process in the eye]. / Osobennosti klinicheskogo techeniia ranevogo protsessa v glazu.

Clinical course of wound process in the eye was studied in 279 patients with penetrating wounds of different severity. Modern microsurgical and drug treatment of penetrating wounds results in a favorable course in 2/3 (77.4%) of patients, while in the rest 22.6% the course of healing was complicated by intraocular infection (10.7%) and chronic noninfectious posttraumatic uveitis (11.7%). Risk factors of a complicated course were defined, among which of special importance are specific features of the injury and secondary immunodeficiency, clinically manifesting by chronic inflammatory diseases, predominantly of the ENT organs and bronchopulmonary system.

[Course of acute traumatic uveitis and rate of secondary immunological insufficiency detection at pre-laboratory level]. / Osobennosti techeniia ostrogo travmaticheskogo uveita i vyiavliaemost' vtorichnoi immunologicheskoi nedostatochnosti na dolaboratornom urovne.

Course of acute traumatic uveitis was evaluated in 146 patients with penetrating wounds of different severity in scores starting from the first days after the injury was inflicted and after operations performed in early terms after the injury. The inflammatory process normalized by weeks 2-3 in a favorable course, while in severe injuries and early reoperations and in wounds of the fourth degree of severity posttraumatic uveitis persisted during weeks 3-4, and 35.2% patients developed chronic posttraumatic uveitis. Clinical signs of immunological insufficiency, presenting mainly as the infectious syndrome (28%), were detected in 35.6% patients with penetrating injuries on the basis of case history analysis by means of a universal diagnostic chart and clinical findings. Penetrating wounds of the third and fourth degree of severity, reoperations during early terms after primary surgical treatment, chronic inflammatory diseases (mainly of the ENT and bronchopulmonary system, indicating secondary immunodeficiency, which necessitate prescription of immunocorrectors starting from the first days after the injury) are factors of risk of protracted or chronic course of posttraumatic uveitis.

[Sympathetic ophthalmia as an autoimmune disease]. / Simpaticheskaia oftal'miia kak autoimunnoe zabolevaniie.

Discusses published reports and one's own findings indicating that sympathetic ophthalmia can be regarded as an autoimmune disease.

[Clinical and immunomorphological parallels in posttraumatic uveitis]. / Kliniko-immunomorfologicheskie paralleli pri posttravmaticheskikh uveitakh.

Parallels between the clinical diagnosis, immunological parameters of the leukocyte migration inhibition test (LMIT) to eye tissue antigens (uveoretinal, lenticular, and retinal), and morphological picture are studied in patients with posttraumatic uveitis and consequences of grave penetrating injuries to the eye without uveitis symptoms. Cell sensitization to uveoretinal antigen is detected only in posttraumatic uveitis but not in consequences of injuries without uveitis. The authors come to a conclusion that only positive LMIT with uveoretinal or a combination of uveoretinal and lenticular antigens may be considered as an immunological validation of autoimmune posttraumatic uveitis. Further improvement of LMIT with purified fractions of uveoretinal antigens is needed.

[Clinical and immunological factors in predicting an early exudative reaction after extraction of senile cataracts with implantation of elastic IOL]. / Kliniko-immunologicheskie faktory prognozirovaniia rannei éksudativnoi reaktsii posle ékstraktsii senil'noi katarakty s implantatsiei intraokuliarnykh linz.

Clinical and immunological studies in 170 patients with senile cataracts carried out before and during the first 7 days after cataract extraction with implantation of intraocular lenses helped define the risk factors for development of an early exudative reaction: patients' age under 60 years, clinical signs of secondary immune deficiency presenting as infection syndrome, increased levels of nonspecific immunity factors with deterioration of the phagocytic component, T-lymphopenia, CD4/CD8 imbalance, and increased levels of interleukin-1 beta and tumor necrosis factor in the serum and lacrimal fluid.

[Sympathetic ophthalmia 21 years after penetrating eye injury]. / Simpaticheskaia oftal'miia cherez 21 god posle pronikaiushcheí travmy glaza.

Sympathetic ophthalmia developed 21 years after penetrating wound during a relapse of posttraumatic uveitis 10 days after enucleation of the injured eye and discontinuation of dexamethasone. The diagnosis was confirmed histologically. The authors believe that enucleation and discontinuation of steroids provoked the development of inflammation in the paired eye.

[Epidemiological characteristics and risk factors of sympathetic ophthalmia]. / Epidemiologicheskie osobennosti i faktory riska simpaticheskoi oftalmii.

Clinical factors of risk of sympathic ophthalmia (SO) determined by the type of injury, methods of surgical and drug treatment, and supported by published data were distinguished as a result of treating 158 patients with SO at the Helmholts Research Institute of Ophthalmic Diseases from 1965 to 1994. Special attention is paid to the possibility of SO development during steroid therapy of posttraumatic uveitis. In such cases SO develops in case of 1) sudden discontinuation of a course of steroids; 2) discontinuation of a short course of steroid therapy in the presence of persisting signs of posttraumatic uveitis; and 3) in surgery on the traumatized (operated on) eyes and low steroid doses.

[Clinical pre-laboratory diagnosis of immune deficiency in diseases of the vascular coating and retina]. / Klinicheskaia, dolaboratornaia diagnostika immunologicheskoi nedostatochnosti pri zabolevaniiakh sosudistoi obolochki i setchatki.

The authors analyze the results of prelaboratory diagnosis of immunologic insufficiency in 948 patients with various clinical forms of endogenic uveitis and retinovasculitis; the diagnosis was based on the totality of clinical signs and ther combinations, summed up in a universal diagnostic chart developed at the Institute of Immunology of the RSFSR Ministry of Health. Immunologic insufficiency was diagnosed in 67.5 percent of uveitis patients mainly in the presence of infectious or autoimmune syndromes developing, as is well known, in depression of T cellular immunity. This is practically valuable for the development of pathogenetic treatment of these grave patients, whose multiple-modality treatment should include immunostimulants and immunomodulators.