[First experience of intrastromal ring segments insertion for correction of posttraumatic cicatricial corneal astigmatism].

The potential of MAGELLAN MAPPER corneal topographer in evaluation of corneal refraction in the early postoperative period after surgical debrigement of scleral and corneal penetrating wounds is shown. The accuracy of corneal topography is satisfactory and its results reproducible what makes the method suitable for evaluation of corneal refraction and follow-up in patients with penetrating wounds and scarring of sclera and cornea. The possibility of posttraumatic cicatricial astigmatism correction by insertion of Keraring intrastromal corneal ring segments (ICRS) using femtosecond surgical laser FEMTO LDV were studied. Results of cicatricial corneal astigmatism correction in early posttraumatic period are encouraging.

[Alterations in ocular biomechanical properties after non-automated endokeratoplasty].

The study was undertaken to determine the parameters of corneal hysteresis in healthy individuals and patients before and after non-automated endokeratoplasty. An Ocular Response Analyzer (Reichert Inc., USA) was used to study ocular biochemical properties. At the same time, the value of corneal hysteresis (mm Hg) and the central corneal thickness (microm) were evaluated. The study demonstrated lower corneal hysteresis in primary and secondary corneal dystrophy than that in normal eyes.

[Study of the efficacy of cyclosporine used in patients at high risk of keratograft rejection. Communication 1. Results of clinical monitoring].

The paper presents the results of a long-term (up to 2-year) clinical monitoring of 30 patients operated on for leukomas of various etiology, who were a high risk group and received the oral cyclosporine HEXAL postoperatively. Three types of the course of a postoperative period were identified. These included: an absolutely favorable course in 33.3% of cases (Group 1), a relatively favorable one in 30% (Group 2), and an absolutely unfavorable course in 36.7% (Group 3). The studies demonstrated that cyclosporine diminished the degree of an inflammatory reaction and promotes its rapid relief and better functional results in the late postoperative period. Transparent and semi-transparent engraftment could be achieved in 63.3% of cases. The causes of poor outcomes (in 36.7%) may be the inadequate doses of the cyclosporine and the time of its administration (unsteady-state blood cyclosporine concentrations (TO), the inadequate efficiency or initial inefficiency of immunosuppressive therapy.

[Study of the efficacy of cyclosporine used in patients at high risk of keratograft rejection. Communication 2. Immunological treatment monitoring].

The paper presents the results of a long-term (up to 2-year) clinical and immunological monitoring of 25 patients operated on for leukomas of various etiology, who were a high risk group. The objective of the study was to clarify the causes of the inefficiency of treatment with cyclosporine (Cs) and to develop specific indications for its usage. The autoimmune reactions against the cornea (a cellular response) were studied. The levels of cytokines (interferon (IFN)-gamma, IFN-alpha, interleukin (IL)-1beta, IL-2, IL-4, IL-8, and IL-10) and the markers of herpesvirus activation (IgM antibodies) were defined. Retrospectively, the patients were divided into groups according to the pattern of a postoperative period and to the type of immunograms: moderately reactive (n = 6 (24%)), hyperreactive (n = 6 (24%)), and areactive (n = 13 (52%)). The findings suggest that the inefficiency of treatment using the Cs dosage regimens may be due to the wide variability and specific features of immunological responsiveness in particularly critically ill patients. In the authors' opinion, areactive patients (most of them were the post-burnt) need the most careful approach. Overall, the findings suggest that it is necessary to strictly select a Cs dosage regimen on an individual basis and to correct it during clinical and immunological monitoring.

[Limbic transplantation in the surgical rehabilitation of patients with prior severe ocular burns].

The paper provides the results of limbic transplantations in 21 patients with varying postburn leukomas. Autolimbic (n = 6; 28.6%) and limbic (n = 15; 71.4%) transplantation was performed 34.27 +/- 13 months after injury. Limbic transplantation with removal of the fibrovascular pannus resulted in improved visual acuity in all cases with the relatively transparent corneal stroma (Group 1; n = 10). In some cases, limbic transplantation could circumvent the problems associated with corneal graft epithelization after further corneal transplantations in Group 2 patients (n = 8) with turbid corneal stroma. In Group 3, surgery was made to prevent corneal changes occurring when the bulbar conjunctiva was removed during plastic repair of mucosal fornices from the lip. Postoperative recurrent corneal conjunctivization and epithelial erosion were observed only in 4 patients. The findings are of value in defining the site and indications for limbic transplantations in the surgical rehabilitation of patients who have experienced severe eye burns.

[Deep layer posterior keratoplasty: preliminary data].

The paper presents preliminary results of deep layer keratoplasty first performed in Russian ophthalmology. It describes its surgical techniques. Deep layer posterior keratoplasty was made in 3 patients with epithelial-and-endothelial dystrophy of the cornea. The operation was simultaneously made with ultrasound cataract phacoemulsification and intraocular lens (IOL) implantation artificial in one case. In the early postoperative period, the fixed position of a transparent keratograft was achieved and the epithelial layer also recovered without signs of bullous keratopathy. The immediate results of posterior keratoplasty inspire optimism. Deep layer keratoplasty is technically more difficult than penetrating keratoplasty, more painstaking and more prolonged. At the same time it has no shortcomings typical of penetrating keratoplasty. The procedure of deep layer keratoplasty requires further long-term study, simplification of surgical techniques, detection of possible complications, and modes of their correction.

[Examination of the local antioxidative system of the eye in experimental corneal burn injury and the prospects for pharmacological correction of its parameters].

The present paper deals with the study of the efficiency of oral use of the antioxidative drug Immugen (a complex of alpha-tocopherol, oubichinone, selenium aspartate, methionine, and soyabean phospholipids) on a rabbit model of severe alkaline-induced corneal burn. The investigations have indicated that addition of Immugen to the rabbit feed exerts a significant positive effect on the parameters of the local antioxidative system of the eye and causes an increase in the activity of superoxide dismutase and catalase, and, on day 14, in antioxidative activity. The early experimental periods were marked by a slight rise in the frequency of deep corneal ulcerations. Moreover, the long-term clinical effect of use of Immugen appears as a significant increase in the area of the transparency-preserving affected cornea. The findings suggest that the antioxidants can show their optimal effect in the complex therapy for burn processes, including the use of proteinase inhibitors.

[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.