[Clinical and immunological factors of the onset and development of age-related macular degeneration].

UNLABELLED: The purpose of the study is to determine the role of certain clinical and immunological factors of the onset and development of age-related macular degeneration (AMD). MATERIALS AND METHODS: Retrospective analysis of patients records; determination of IFNalpha IFNgamma, IL-1beta, and TNFalpha cytokines levels as well as extracellular peroxidase activity (EPA) in blood serum and tear; measuring frequency of occurrence of intraocular infectious antigens with predominantly intracellular localization, such as Herpesviridae spp. (Herpes simplex, Cytomegalovirus, Epstein-Barr virus) and Chlamydiaceae spp. (Chlamydia pneumoniae, Chlamydia trachomatis) in lens matter and aqueous humor by means of polymerase chain reaction (PCR). The new evidence strongly suggests a relationship between AMD development and hypertension (p < 0.001; r = +0.30, P < 95%) as well as between AMD progression and hypertension accompanied by chronic inflammation with predominantly intracellular localization of the infectious agent (p < 0.05 for the predisciform stage, p < 0.001 for the disciform and cicatrical stages; r = +0.30, P < 95%). "Dry" AMD is characterized by hypertension-associated systemic and then local increase of EPA. In "wet" AMD it is the interferon response that is impaired: IFNalpha and IFNgamma are systemically decreased, while local level of IFNalpha is increased. Intraocular Herpes simplex infection is pathogenically significant for AMD development (18.8% in the study group vs 0% in the control group). CONCLUSION: AMD progression is associated with hypertension accompanied by chronic inflammation with predominantly intracellular localization of the infectious agent as well as impairment of the interferon response (systemic decrease of IFNalpha and IFNgamma with local increase of IFNalpha). Moreover, the presence of intraocular Herpes simplex infection leads to activation of the first line antiviral immunity (IFNgalpha) with decompensation of the local interferon response (IFNgamma).

[Intrascleral-intracapsular flexible intraocular lens in children with lens dislocation].

The results of surgical treatment were studied in 12 children with lens dislocation (20 eyes) were studied. According to the procedure of intraocular lens (IOL) fixation, the patients were divided into 2 groups: 1) transscleral suture fixation in 2 sectors [7 children (11 eyes)] and 2) intrascleral fixation in one sector and intracapsular fixation in another sector [5 children (9 eyes)]. IOLs made from polymethyl methacrylate were applied in Group 1. Flexible IOLs with rigid haptic elements were used in Group 2. The postoperative follow-ups lasted 4 months to 2 years. In Group 1, IOL dislocation developed in 2 cases. In Group 2, secondary cataract developed in 1 case. The findings prove that the optimum procedure for intraocular correction of aphakia in children with lens dislocation is the developed technique that ensures a reduction in the frequency of complications and a stable position of IOL, resulting in the inclusion of more indications for its use in young children.

[Primary artificial lens implantation in young children with the primary hyperplastic vitreous body].

The paper gives the results of surgical treatment in 30 children (30 eyes) aged 2 months to 5 years who had primary persistent hyperplastic vitreous body. A study group (with intraocular lens (IOL) implantation) comprised 12 children (12 eyes). At surgery, the age of 8 babies was 4 to 12 months and that of 4 children was 13 to 36 months). Postoperative follow-ups lasted 6 to 40 months. Flexible lenses were implanted. A control group consisted of 18 children (18 eyes) operated on at the age of 2 months to 5 years (without IOL implantation). Despite severe retinal and optic nerve changes that are the ground to avoid surgical treatment, the authors' findings provide evidence that early primary IOL implantation in children with the primary persistent hyperplastic vitreous body yields satisfactory functional results.

[Intraocular infection with herpesviruses and antiviral immunity in patients with age-related macular degeneration].

Polymerase chain reaction revealed Herpesviridae (Herpes simplex, Cytomegalovirus) in the lens substance in 46 patients operated on for age-related cataract. Thirty-two patients of them had age-related macular degeneration. Herpes simplex was found in 6 (18.8%) of the patients with age-related macular degeneration. At the same time there were signs of lacrimal fluid antiviral immunity imbalance with decreased IFN-gamma and TNF-alpha and increased IFN-alpha. The authors consider it advisable to perform antivirus treatment in patients with the above abnormality, preventing the active forms of herpetic infection.

[Outcomes of secondary implantation of posterior-chamber intraocular lenses in children with capsular and scleral sutural fixation].

The functional results and postoperative complications of secondary implantation of posterior-chamber artificial lenses (AL) in 122 children (165 eyes) aged 2 to 7 years. The specific feature of this operation in children is the high frequency of postoperative complications: 48 and 60% after capsular fixation and scleral sutural fixation, respectively. In most cases, they appear as a second-grade inflammatory reaction in the early postoperative period and as slowly progressive iridocyclitis in the late postoperative period. Secondary implantation of posterior-camber ALs with capsular fixation is an effective and safe technique for correcting aphakia in children, by yielding good functional results. Postoperative complications are treatable and fail to lower visual acuity. Secondary implantation of ALs with scleral fixation in children is associated with a relatively high risk of intractable complications that decrease visual results and it should be performed in single cases if there are strict indications.

[Results of primary IOL implantation after extraction of congenital cataract in two-year babies]. / Rezul'taty pervichnoi implantatsii intraokuliarnykh linz posle udaleniia vrozhdennoi katarakty u detei pervykh dvukh let zhizni.

The results of aspiration of congenital cataract and those of IOL implantation were analyzed for 15 children (17 eyes) aged 2 years or less. The specificity of the postoperative clinical course after implantation of different IOL types and of changes of refraction as well as peculiarities of the growth of the aphakic eye in unilateral cataract versus its match were analyzed. Exudative reaction, stages I-II, is the main problem encountered in the early postoperative period irrespective of a type of the implanted IOL. Implantation of rigid IOLs is associated with a higher risk of development of secondary cataract in the late postoperative period. The postoperative changes of refraction do not depend on an IOL type. The artiphakic eye becomes myopic as the anatomic-optic parameters of the growing eye change. There are no reliable differences between the growth indices in the anterior-posterior axis of the artiphakic and growing eyes.

[Results of surgical treatment for cataract with implantation of intraocular lenses in children with insulin-dependent diabetes mellitus].

Primary implantation of intraocular lenses (IOLs) was made in 9 children (16 eyes) after removal of cataract; secondary implantation was performed in 2 children (4 eyes) 3 and 4 years after diabetic cataract aspiration. After surgery, 4, 4, and 3 children were followed up 1, 2, and 3 years, respectively. Thirteen cases of secondary cataract were observed after primary implantation (16 eyes); secondary cataract was recorded in 100% of cases after implantation of polymethyl methaacrylate IOLs and hydrophilic "Centrflex" lenses and only in 57.1% after implantation of hydrophobic "Acrysof" lenses. The visual acuity was 0.48 +/- 0.14 after removal of secondary cataract and 0.88 +/- 0.11 after laser discission. Laser invention did not lead to the progression or occurrence of diabetic retinopathy (DR) in the late periods of a follow-up. Cataract removal with IOL implantation in children with insulin-dependent diabetes (IDD) yields high functional results. The postoperative follow-up did not demonstrate a significant increase in the severity and incidence of DR, which seems to be associated both with a good postoperative IDD compensation and preventive treatment. The use of the hydrophobic flexible lenses is more optimal to prevent the development of secondary cataract.

[Changing electrophysiological parameters in the eye in children with insulin-dependent diabetes mellitus]. / Izmeneniia élektrofiziologicheskikh pokazatelei organa zreniia u detei, bol'nykh insulinozavisimym sakharnym diabetom.

Fifty-eight (58) children with insulin-dependent diabetes mellitus (IDDM) were examined and shared between 6 groups: Group 1--primarily diagnosed diabetes mellitus (DM); Group 2--DM with an up to 5-year history; Group 3--DM with a an up to 10-year history; Group 4--children with non-proliferative diabetic retinopathy; Group 5--children with diabetic cataract. Forty-five healthy children were in the control group. According to the pattern registration of visual induced potentials (RVIP), a reliable prolongation of latency P100 was detected in children of Groups 1 and 4. The results of the general electroretinography (ERG) showed a reliably decreased amplitude of the basic wave b- in Groups 1-4 and an increased amplitude of wave a- in Groups 4 and 5. According to photopic ERG, a reliably decreased amplitude of wave a- was detected in Groups 1-5 and a decreased amplitude of wave b- was registered in all groups except for Group 2. Scotopic ERG showed, in Group 5, an increased amplitude of wave a- (p < 0.05) at the normal values of wave b-, and, in Groups 1-4,--a significantly inhibited amplitude of wave b-. Finally, rhythmic ERG showed a reliably inhibited amplitude in all groups.

[Immunological status and its changes in children during surgery on anterior eye segment]. / Immunologicheskii status i ego izmeneniia u detei pri provedenii operatsii na perednem otrezke glaznogo iabloka.

Nonspecific and specific immunity values were studied in 70 children before and in various periods after 74 operations on the anterior segment of the eyeball. In children with persistent autosensitization to ocular tissue autoantigens (alpha-crystalline and S-antigen) postoperative uveitis presented as an immunocomplex disease with signs of exhaustion of the functional potential of the phagocytosis and complement systems. In children without autosensitization uveitis was associated with immunity activation. Phagocytosis system and cooperation of lymphocyte subpopulations, including normal killers (CD16+), play an important role in prevention of sensitization to ocular tissue autoantigens. Therefore, complex immunological examinations of children before surgery and regular check-ups after it will help differentiate immunodeficiency from compensatory immunosuppression preventing autoimmune disease, which is important in prescription of immunostimulating therapy.

Some Parameters of Immune Status in Children before and after Cataract Extraction with Intraocular Lens Implantation.

An immunological study was performed in 71 children aged 6-15 years old. Twenty seven of these 71 patients have undergone surgery for congenital cataract, 23 - for traumatic cataract aspiration-irrigation with a posterior chamber intraocular lens implantation and 21 - for secondary intraocular lens implantation. The number of peripheral blood active T lymphocytes, CD4(+), CD8(+), HLA DR(+) lymphocytes and antibody response to lens (alpha-crystalline) and retina (S-antigen) proteins were determined. Tissue specific antibodies were revealed in cases of both increased and decreased T-cellular immunity parameters. Sensibilization to S-antigen at the background of HLA DR(+) lymphocytes increase and a decrease in other parameters of immunity that may be regarded as the autoimmune status was the most unfavorable prognostic sign. In these cases even after atraumatic surgery the risk of postoperative inflammation was rather high with development of chronicity.

[Results of the surgical treatment in syndrome of primary persistent hyperplastic vitreous body]. / Rezul'taty khirurgicheskogo lecheniia pri sindrome persistiruiushchego giperplasticheskogo pervichnogo steklovidnogo tela u detei.

Nineteen children with this syndrome aged 4 months to 15 years were treated. In case of a functioning hyaloid artery, the authors used an original surgical method. Visual functions were improved in 76.9% cases. In 23.1% cases vision acuity remained unchanged because of profound degenerative changes in the retina. Clinical results demonstrate the necessity of early surgery in children with the syndrome in question, because opening of the central retinal zone prevents the development of deprivation amblyopia.

[The results of a study of corneal thickness following the extraction of congenital cataract in nursing infants]. / Rezul'taty issledovaniia tolshchiny rogoviny posle ékstraktsii vrozhdennoi katarakty u grudnykh detei.

Measurements of the thickness of the cornea in the early postoperative period in babies have shown a low traumaticity of surgical interventions for congenital cataract extraction with the use of present-day technology. The conditions for the selection of soft contact lenses are created mainly in a week after surgery.

[Effect of early surgery in treating congenital cataracts on the growth of the eyeball in nursing children]. / Vliianie rannikh khirurgicheskikh vmeshatel'stv po povodu vrozhdennoi katarakty na rost glaznogo iabloka u grudnykh detei.

Echobiometry of 24 eyes operated on for congenital cataracts has been carried out. The infants' ages varied from 4 to 6 months. 23 children (43 eyes) have made up the peference group. The measurements have been carried out in 6-7, 10-12, and 24-26 months after surgery. The results evidence no relationship between early cataract extraction and the growth of the anteroposterion axis of the eye in infants.