[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.

[Express-diagnosis of the diseases of the eye and its appendages by scanning electron microscopy with supravital staining]. / Skaniruyushchaya elektronnaya mikroskopiya s supravital'nym kontrastirovaniem v ekspress-diagnostike zabolevanii glaza i pridatochnogo apparata.

This review describes the history of development of a new line of chemical reagents that prompts to significantly reevaluate the application of scanning electron microscopy (SEM) in medical and biological studies, particularly in ophthalmology; considers the establishing of SEM as an analytical method; covers the problems in its application associated with the needs of clinical medicine and the complexities of biological sample preparation for electron microscopy. The article also presents in chronological order the technical solutions associated with creating a unique line of reagents for supravital staining. The multitude of technical solutions allows considering SEM as a method of express diagnostics. The review discusses examples of practical application of these methods for solving certain cases in clinical ophthalmology. The niche of SEM is considered among other methods of clinical diagnostics, as well as its future development involving the use of artificial intelligence.

[Anterior eye segment damage in coronavirus infection (COVID-19)]. / Porazhenie perednego segmenta glaza pri koronavirusnoi infektsii (COVID-19).

Conjunctivitis may appear as the first symptom of the coronavirus infection (COVID-19). In isolated cases, the lesion of the conjunctiva evokes a systemic infectious process. Currently, the conjunctiva is not considered as an area of long-term reproduction of coronavirus, and its damage is caused by hyperproduction of pro-inflammatory cytokines (especially IL-6); development of iridocyclitis and keratoconjunctivitis is also possible. Most often, local corticosteroids are used to treat these processes, although their use requires caution due to the risk of activating secondary infection (herpetic bacterial, fungal), which often develops as a result of immunodeficiency caused both by COVID-19 and the massive corticosteroid and antibiotic therapy employed when the course of the disease is severe. The severe condition of patients, the lung ventilation, and the prone position all contribute to corneal erosions, exposure keratopathy, pseudomonas aeruginosa keratitis and angle-closure glaucoma attacks. The risk of transmission of coronavirus infection during keratoplasty is estimated as minimal.

[Confocal microscopy in the diagnosis of acanthamoeba keratitis]. / Vozmozhnosti konfokal'noi mikroskopii v diagnostike akantamebnogo keratita.

Acanthamoeba keratitis (AK) is a dangerous disease of the cornea, its prevalence has increased significantly due to widespread usage of contact lenses. The similarity of the clinical manifestations of AK to other infectious keratitis (especially herpetic keratitis) requires introduction of a rapid diagnosis method into clinical practice. PURPOSE: To evaluate the capabilities of corneal confocal microscopy (CCM) in the diagnosis of acanthamoeba keratitis. MATERIAL AND METHODS: We examined 33 patients (35 eyes) with suspected acanthamoeba keratitis using light and laser confocal microscopy of the cornea (ConfoScan and HRT devices, respectively). RESULTS: CCM was technically feasible in 23 of 35 cases (65.7%). Acanthamoeba cysts were detected in 16 cases (69.6%); trophozoites were visualized in 17.4% of cases; signs of keratoneuritis were detected in 12 eyes (52.2%); in 7 cases (30.4%), hyporeflective honeycomb-like cavities were observed in the stroma; deep stromal striae were observed in 9 cases (39.1%); activated keratocytes were detected in 11 patients (47.8%), and Langerhans cells were detected in 19 cases (82.6%). CONCLUSIONS: The main diagnostic value of confocal microscopy is the detection of direct markers of AK - cysts and trophozoites of Acanthamoeba. Both light and laser CCM techniques are suitable for the diagnosis of AK, but the resolution of laser confocal microscopy is higher. The non-invasive nature of this method and the possibility of multiple subsequent examinations make it possible to verify the diagnosis of acanthamoeba keratitis and monitor the treatment.

[Mooren's ulcer]. / Yazva Murena.

The article reviews available data on Mooren's ulcer - a rare disease of, supposedly, autoimmune origin that manifests as peripheral ulceration of the cornea and poses a risk of its perforation. The variability of clinical presentation and course of the disease often leads to misdiagnosis and inadequate treatment. The present review focuses on specific signs characteristic of the disease and the most effective methods of its treatment.

[Antiangiogenic therapy in high-risk keratoplasty]. / Antiangiogennaya terapiya pri keratoplastike vysokogo riska.

PURPOSE: To analyze the effectiveness and safety of VEGF inhibitor used to improve keratoconus transplant survival in patients with corneal neovascularization as stand-alone and in combination with laser coagulation of ingrowing vessels before keratoplasty. MATERIAL AND METHODS: The study included 56 patients (56 eyes) with corneal opacifications of various etiology complicated by corneal neovascularization (CNV). The patients were divided into three groups. The 1st group included 27 patients with diffuse CNV who were undergoing an antiangiogenic therapy using anti-VEGF drug, the 2nd group - 14 patients with stem cell CNV who underwent laser coagulation of major corneal vessels combined with subconjunctival administration of drug before keratoplasty; the control group consisted of 15 patients with mixed type CNV who were undergoing conventional treatment without antiangiogenic therapy. RESULTS: During the follow-up (24.5±4.84 months, 4 to 25 months), transplant rejection reaction was recorded in 7 (23%) patients of the 1st group, 5 (35%) patients of the 2nd group and 9 (60%) patients of the control group. CONCLUSION: Subconjunctival administration of Aflibercept as a stand-alone measure and in combination with laser coagulation of ingrowing vessels may increase the chances of transparent transplant acceptance in high-risk keratoplasty.

[Clinical results of modified crosslinking in the treatment of purulent keratitis and corneal ulcers]. / Klinicheskie rezul'taty modifitsirovannogo krosslinikinga v lechenii gnoinykh keratitov i yazv rogovitsy.

PURPOSE: To evaluate the efficiency of modified crosslinking (M-CXL) in the treatment of purulent keratitis (PK) and corneal ulcers, including ulcers of mixed etiology. MATERIAL AND METHODS: M-CXL method involves simultaneous performance of CXL and frequent instillations of anti-infective agents (one drop every 5 minutes for 1 hour). The study included 39 patients (41 eyes) with purulent corneal ulcers (PCU) of various origin. The main group consisted of 26 patients (27 eyes) who were treated with M-CXL in combination with active conservative therapy. In the control group (13 patients, 14 eyes) only active conservative management was used. RESULTS: Complete suppression of the purulent process in the main group was achieved in 21 (77.8%) eyes after 32.6±10.66 days, in the control group - in 9 (64.3%) eyes in 52.4±16.6 days. Complete suppression of purulent keratitis was achieved in 100% of cases with bacterial keratitis, 83% of cases with fungal keratitis and 70.5% of cases with mixed keratitis. When purulent infiltration occupied the entire depth of the stroma but was limited in area (less than 6 mm), the efficiency of M-CXL decreased to 66.6%. The clinical effect of M-CXL was absent or insufficient when PK extended to the Descemet's membrane with an area of more than 7 mm. CONCLUSION: In 77.8% of cases, modified crosslinking has showed pronounced therapeutic effect - complete arrest of purulent corneal infiltration. Recovery time in the main group was 1.6 times shorter than in the control group (p<0.05). Resorption of the purulent infiltration occupying all layers of the stroma up to the Descemet's membrane with extensive areas was not achieved, however the corneal melting and keratitis progression were stopped, which allowed planned therapeutic penetrating keratoplasty with a graft of smaller diameter to be performed.

[Influence of frequent instillations of anti-infective solutions on eye tissues (an experimental study)]. / Vliianie forsirovannykh instilliatsii rastvorov protivoinfektsionnykh sredstv na tkani glaza (éksperimental'noe issledovanie).

PURPOSE: To investigate the toxic effects of frequent instillations of anti-infective solutions (antibiotic eye drops - 0.3 and 1.4% tobramycin, 0.5% levofloxacin and 0.5% moxifloxacin; antiseptic eye drops - 0.05% pyloxidine and 0.025% chlorhexidine; antifungal drug - 2 mg/ml fluconazole solution) on ocular tissues. MATERIAL AND METHODS: The study was conducted on 21 Wistar rats (42 eyes) using method of semi-fine sections. RESULTS: The majority of antibiotics and antifungal agents do not cause toxic reactions in rats` eyes when instilled with frequent regimen with the exception of 'fortified' 1.4% tobramycin and pyloxidine solutions, which caused a decrease in corneal endothelial cells density and formation of fibrovascular tissue in the anterior chamber. CONCLUSION: Frequent instillations of antimicrobial drug solutions is a safe method for the treatment of purulent corneal ulcers and purulent keratitis. The exceptions were solutions of 'fortified' 1.4% tobramycin and piloxidine (vitabact).

[The role of infection foci in the onset and sustenance of inflammatory diseases of the eye]. / Rol' fokal'nykh ochagov infektsii v vozniknovenii i podderzhanii vospalitel'nykh zabolevanii glaz.

Numerous clinical observations indicate the importance of the role of 'focal sepsis' in the development and facilitation of inflammation in the anterior eye segment. The article describes possible routes of infection spread from various local foci to the eye. Studying the connection between local infection foci and inflammatory eye diseases will give ophthalmologists more opportunities for effective treatment and prevention of disease recurrences.

[The linkage of oral infection foci and inflammatory diseases of the eye]. / Vzaimosviaz' fokal'nykh odontogennykh ochagov infektsii i vospalitel'nykh zabolevanii glaza.

The paper presents a review of numerous clinical observations that indicate an important role of 'focal sepsis' in the development and persistence of the anterior eye segment inflammation. Possible routes of infection spread from local dental infectious foci to the eye are discussed.

[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.

[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.

[Proliferative potential of human corneal endothelium].

Despite of common opinion that mitotic processes in adult human corneal endothelium are absent the accumulated data show potential of these cells for proliferation. Mechanisms inhibiting endothelial corneal cells mitosis are illustrated. The data on possible ways of proliferation activation and cell division in vitro and in vivo is provided. A brief review of cell technologies applied in contemporary ophthalmology is given including method of personalized cell therapy, a way of effective medical impact on damaged corneal endothelium in early postoperative bullous keratopathy.

[Treatment option for intralamellar corneo-scleral abscesses in the zone of tunnel incision after phacoemulsification].

The article provides data on clinical diagnosis (4 patients, 4 eyes) and early surgical treatment of corneal intralamellar abscesses (ICA) in the zone of corneo-scleral tunnel incision after phacoemulsification (PE). ICA developed via corneo-scleral incision was a relatively reliable biomicroscopic sign of the beginning chronic endophthalmitis. Despite of massive nonsurgical treatment (antibiotics, glucocorticoids, non-steroid anti-inflammatory agents etc.) inflammation was not arrested completely, it recurred within 2,5-6 months after PE. Reconstructive conjunctivo-sclerokeratoplasty resulted in arrest of inflammation and visual function recovery in 3 patients. In one patient this procedure was not possible to perform because of total loss of visual functions due to chronic endophthalmitis.

[Nontransplantational options of corneal ulcers treatment].

Current surgical nonkeratoplastic options of superficial corneal ulcers treatment are reviewed. Literature data is analyzed and the main treatment methods are assessed.

[Vital confocal microscopy in evaluation of efficacy of personalized cell therapy in management of early postoperative bullous keratopathy].

The results of vital confocal microscopy (VCM) of 5 patients with early postoperative bullous keratopathy after cataract phakoemulsification (PE) treated with author's technique of personalized cell therapy (PCT, intracameral injection of activated patient's leukocytes in autologous serum) are presented. In 3 of all presented cases endothelial loss after PE was more than 50%. Before PCT using of VCM was not possible due to corneal edema. After 2-3 PCT sessions corneal clarity recovery was observed and signs of regenerative processes in cornea were captured by VCM: activation of keratocytes (hyperreflective nuclei) and endothelial cells (multinucleated cells), descemet membrane folds smoothening, normalization of epithelium. Results of VCM correlate with biomicroscopic signs of corneal edema resolution, corneal clarity recovery, improvement of visual acuity after PCT.

[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.

[The value of anterior stromal puncture in the treatment of bullous keratopathy].

Results of anterior stromal puncture (ASP) in treatment of painful bullous keratopathy (PBK) are presented and its mechanism of action is hypothesized. ASP is an effective, simple, safe and low-cost procedure for symptomatic relief in patients with PBK.