[The use of flavonoid antioxidants in the complex treatment of patients with peripheral vitreo-chorioretinal dystrophies and dystrophic retinal detachment]. / Primenenie flavonoidnykh antioksidantov v kompleksnom lechenii bol'nykh s perifericheskimi vitreokhorioretinal'nymi distrofiiami i distroficheskoi otsloikoi setchatki.

Parameters of lipid peroxidation (LP) and antioxidant activity (AOA) of tear and blood plasma were examined in 22 healthy subjects (44 eyes) as well as in 33 patients with peripheral vitreochoreoretinal dystrophies (PVCRD--60 eyes), in 32 patients with non-operated dystrophic retinal detachment (DRD--34 eyes) and in 135 patients with operated retinal detachment, stable visual functions and with the postoperative period ranging from 4 months to 10 years (137 eyes). The results denoted a lower tear AOA (on the average by 35%) in patients with DRD and PVCRD, whereas, the blood plasma AOA or LP products' content remained unchanged. It is indicative of a local nature of metabolic impairments, specifically, of impairments in the system of antioxidant protection of the eye. Flavonoid antioxidants (dikvertin and ginkgo biloba) reduced the content of LP products, and induced the AOA in tear and blood plasma in patients with PVCRD and retinal detachment; they also improved the visual functions in patients with operated retinal detachment. Therefore, the flavonoid antioxidants can be recommended for adding to the complex treatment of PVCRD and DRD for the purpose of improving and stabilizing the visual functions and for neuroprotection.

[Surgical treatment of retinal detachment with multiple, giant and post-equatorial ruptures]. / Khirurgicheskoe lecheniie otsloiki setchatki s mnozhestvennymi, gigantskimi i postékvatorialnymi razryvami.

A method for surgical treatment of grave detachment of the retina with multiple, giant, and postequatorial ruptures has been developed. The method consists in combined extrascleral filling making use of bichannel silicon explants. A total of 78 patients (78 eyes) were operated on. For control the results of 30 interventions on 30 eyes (30 patients) with similar injuries have been analyzed; in this group traditional methods of combined filling with standard silicon explants were used. The patients were followed up for up to 7 years. In the main group adherence of the retina was observed in 71.8% of cases in remote periods and in 82% after repeated surgery (relapses of retinal detachment occurred in 15.4% of cases). In controls complete adherence was attained in 60% of cases and in 76.7% of those operated on repeatedly (relapses occurred in 23.3%). The developed models of bichannel silicon explants are simpler and more effective than the traditional methods.

[Modeling of vitreoretinal proliferation]. / Modelirovanie vitreoretinal'noi proliferatsii.

Complexes of endogenous immunopeptides produced by autologous peripheral blood lymphocytes were injected to the vitreous body of 17 chinchilla rabbits (34 eyes). The agents injected were autosupernatant. L fraction containing molecular substances with mol. weight of 40,000 to 60,000 D, and M fraction containing substances with mol. weight of 15,000 to 30,000 D. Clinical and morphologic studies demonstrated that injection of endogenous immunopeptides led to active lymphoid inflammatory infiltration associated with proliferation and formation of new vessels. In contrast to the M fraction, the exudative processes triggered by the L fraction were more definitely localized and associated with the appearance of fibroplastic cords (the proliferative component). The models created may be used for the development of methods for prevention and treatment of vitreoretinal proliferation.

[Clinico-immunological studies in dystrophic retinal detachment complicated by proliferative vitreoretinopathy]. / Kliniko-immunologicheskie issledovaniia pri distroficheskoi otsloike setchatki, oslozhnennoi proliferativnoi vitreoretinopatiei.

Clinical and immunologic study of patients with detachment of the retina complicated by proliferative vitreoretinopathy (PVRP) revealed medium and high titers of S antibodies in the lacrimal and subretinal fluid of patients with stages A and B PVRP in 92 and 70%, respectively, and did not detect these antibodies in patients with stages C and D PVRP in 68 and 78.9%, respectively. A statistically reliable increase of IgG and IgA levels in the subretinal fluid was observed, as well as of IgA and SIgA in the lacrimal fluid of patients with dystrophic detachment of the retina. The levels of circulating immune complexes (CIC) in the blood serum were decreased, with CIC detected in the subretinal fluid of all the patients. The production of antibodies to S antigen ceased 3 months after the retina adhered to the eyeball. The results indicate the impact of immunological factors in the pathogenesis of dystrophic detachment of the retina.

[Role of immunological factors in peripheral vitreo-chorioretinal dystrophies and macular ruptures of the retina]. / Izuchenie roli immunologicheskikh faktorov pri perifericheskikh vitreokhorioretinal'nykh distrofiiakh i makuliarnykh razryvakh setchatki.

The authors analyze the results of clinical and immunological examinations of patients with peripheral vitreo-chorioretinal dystrophies (PVCRD) and macular ruptures of the retina. No antibodies to S-AG were detected in the lacrimal fluid in 87.5% of patients with PVCRD without retinal defects. In patients with PVCRD with retinal defects antibodies to S-AG were detected in 70% of cases. These antibodies were absent in the patients with macular ruptures of the retina. In none of the patients were these antibodies detected in the blood serum. The levels of circulating immune complexes were normal in the patients PVCRD and increased in those with macular ruptures of the retina. These data permit a hypothesis on the development of local autoimmune reactions in PVCRD patients in response to the appearance of AG of the injured tissues.

[Acute retinal necrosis syndrome: diagnosis and treatment strategy]. / Sindrom ostrogo nekroza setchatki: diagnostika, taktika lecheniia.

The authors describe the clinical picture, diagnostic criteria, and treatment strategy in patients with the syndrome of acute retinal necrosis, based on their own findings and published data. The syndrome of acute retinal necrosis is binocular, the difference in the time of involvement of the paired eye varying from 3 weeks to 18 months; the course of the disease is extremely severe. Starting as acute iridocyclitis, the disease rapidly progresses and leads to the development of vaso-occlusive necrotic retinitis, eventuating in retinal tissue degradation at the site of involvement, formation of ruptures and detachment of the retina. Detachment of the retina developing during its acute necrosis is associated with a drastic hypotension and rapid proliferative changes in the retina and vitreous body with the formation of numerous "dense" epiretinal membranes and funnel-shaped detachment of the retina. Active treatment strategy is recommended: emergency surgical intervention aimed at blocking of necrosis sites and ruptures of the retina. Such an approach helped attain adherence of the retina and stabilize the course of the disease. Prolonged conservative therapy of this syndrome is ineffective.

[Scleral compression in assessment of the stage of proliferative vitreoretinopathy and type of subretinal contents in retinal detachment]. / Sklerokompressiia v otsenke stadii proliferativnoi vitreoretinopatii i kharaktera subretinal'nogo soderzhimogo pri otsloike setchatki.

The authors analyse intraocular changes occurring in detachment of the retina using sclero-compression data. A total of 447 eyes of 417 patients with detachment of the retina complicated by proliferative vitreoretinopathy of various severity were examined. Four main types of compression chorioretinal relationships are distinguished permitting a preoperative differential diagnosis of stages of concomitant proliferative vitreoretinopathies and of the type of subretinal contents in detachment of the retina. The diagnosis of proliferative vitreoretinopathy in detachment of the retina is based on international classification, though it does not fully reflect all specific features of the disease. Basing on the data of analysis of compression chorioretinal relationships, the authors supplement the known classification as regards the interpretation of the minimal stage A which is considered more extensively and the moderate stage B of proliferative vitreoretinopathy. The described assessment of intraocular changes in detachment of the retina permits not only a correction of the routine assessment of stages of this condition, but is practically valuable. The authors suggest four basic approaches to the choice of the optimal surgical strategy, based on the disease characteristics, stage of proliferative vitreoretinopathy, and type of compression chorioretinal relationships.

[The surgical treatment of retinal detachment by temporary balloon buckling: the late results, reasons for inefficacy and indications]. / Khirurgicheskoe lechenie otsloiki setchatki metodom vremennogo ballonnogo plombirovaniia: otdalennye rezul'taty, prichiny neéffektivnosti, pokazaniia.

Retinal detachments were for the first time treated using inflatable balloons in 1979 by Lincoff et al. A characteristic feature of this method is simplicity and low traumatism. Up to the present time it was used in the treatment of retinal detachments with single breaks or groups of breaks altogether not surpassing equatorially one o'clock on the fundus. We suggest several new modifications of balloons and a method permitting widening of indications for application of this technique (double and sectorial balloon buckling, combination of this technique with drainage of subretinal fluid, prevention of balloon buckling dislocation). The efficacy of balloon buckling procedures in patients with retinal detachments and various stages of proliferative vitreoretinopathy was assessed. Extrascleral balloon buckling was carried out in 159 eyes of 156 patients, including those with somatic diseases and senile ones, with detachments of the retina. The results were followed up for 5 years. Early reattachment of the retina was attained in 134 eyes (84.3%). In remote period redetachments occurred in 20 eyes, complete attachment was attained in 71.7% of cases (114 eyes).

[Peripheral vitreochorioretinal dystrophies in myopia patients]. / Perifericheskie vitreokhorioretinal'nye distrofii u bol'nykh s miopiei.

The problem of retinal detachment prevention is closely connected with a competent diagnosis of peripheral vitreochorioretinal dystrophies (PVCRD). The present research was aimed at analysis of PVCRD incidence in myopia of various degree and of the incidence of pathologic shifts requiring prophylactic laser coagulation or cryopexy. A total of 1022 patients (2044 eyes) with myopia of various degrees aged 5 to 58 were examined. Sclerocompression method was used in ophthalmoscopy in all the cases. PVCRD were diagnosed in 73.2% of patients. The detection rate of this condition was directly proportional to myopia degree; 52.6% in weak myopia, 70.7% in medium-grave myopia, 86.4% in high myopia. The detected patients with PVCRD were in need of preventive treatment whatever myopia degree: 38.7% of those with weak myopia, 46.9% of those with medium-grave myopia, and 46.5% of those with high myopia, 42.4% of patients with myopia on an average. Detachment of the retina was diagnosed in 4% of patients with myopia, in 0.5% surgical treatment of this condition was needed, and in 3.5% it was subclinical, this permitting a prophylactic laser coagulation.

[The dynamic indices of local blood circulation in the surgical treatment of retinal detachment]. / Dinamika pokazatelei mestnogo krovoobrashcheniia pri khirurgicheskom lechenii otsloiki setchatki.

The hemodynamics of both eyes was examined before and after surgery in patients with detachment of the retina. The depression of uveal blood stream was transitory in extrascleral ballooning, in contrast to that in cerclage and filling, when the hemodynamic characteristics of both eyes are significantly reduced.

[Peripheral segments of the fundus oculi in highly myopic patients after scleroplasty]. / Sostoianie perifericheskikh otdelov glaznogo dna u bol'nykh s vysokoi miopiei posle skleroplastiki.

Prolonged (3 to 9 years) follow-up of 219 patients with high rapidly progressing myopia, treated with scleroplasty, has demonstrated an inhibiting effect of this surgery on the development and progress of peripheral vitreochorioretinal dystrophies: a negative time course on the fundus oculi periphery of the operated on eye was observed in 21.5 percent of patients and that of the intact eye in 35.1 percent of patients. Scleroplasty, carried out at the age of 9-11 and 15-17, was found the most effective from the viewpoint of preventing the peripheral vitreochorioretinal dystrophies. Reduced incidence of such dystrophies on the operated on eyes may be explained by the favorable effect of surgery, i.e. scleral distension arrest or delay, improved hemodynamics and trophics of ocular tissues. The results helped define the indications to scleroplasty with due regard for the patient's age and fundus oculi status.

[Extra-scleral balloon catheterization. Report 3. New ways of its use--prevention of hypotonia and intraocular hemorrhages in vitreo- retinal surgery]. / Ekstraskleral'noe ballonirovanie. Soobshchenie 3. Novye puti primeneniia--profilaktika gipotonii i vnutriglaznykh krovoizliianii v vitreoretinal'noi khirurgii.

Hypotonia and ex vacuo hemorrhages are the most grave complications of vitreoretinal surgery; the known methods of their prevention are altogether inadequate. The authors have developed extra-scleral ballooning (ESB) methods that improve the efficacy of surgery and reduce the rate and severity of complications in subretinal fluid draining during surgery for detachment of the retina and in arresting intraocular hemorrhages during closed vitrectomy. ESB application helped elevate intraocular pressure in the patients with drastic hypotonia, permitting a reliable and easy-to-perform monitoring of intraocular pressure over the course of surgery. This was conducive to complete evacuation of subretinal fluid, thus preventing the development of hypotonia and its complications, as well as to a rapid arrest of intraocular hemorrhage due to rapid elevation of intraocular pressure up to the values essential for the bleeding vessel collapse. Surgical methods are described and their results analyzed in 65 cases. The developed ESB methods for the prevention of hypotonia and intraocular hemorrhages in vitreoretinal surgery are effective, low traumatic, and may be recommended as alternative ones.

[Extrascleral ballooning. 2. New approaches: double and sector ballooning]. / Ekstraskleral'noe ballonirovanie. Soobshchenie 2. Novye puti primeneniia--dvoinoe i sektoral'noe ballonirovanie.

Treatment of retinal detachment with the use of distended balloons (extrascleral ballooning) holds good promise due to ease of operation and low traumatism. Unfortunately it may be used only in cases with fresh not high detachments of the retina with solitary or multiple ruptures up to 1-2 optic disk diameters in length. That is why the authors suggest two new modifications of the method: double and sector ballooning, widening the indications for the employment of the method. Double ballooning is recommended for cases with retinal detachments with 2 ruptures up to 2 disc diameters in length, located at a distance of 2-3 disc diameters from each other within one quadrant or in different quadrants of the fundus oculi. Sector ballooning is recommended for cases with retinal detachments with ruptures or breaks off 3-6 disc diameters in length. The results of 24 surgeries are analyzed. Double ballooning is effective in 77 percent of cases, sector ballooning in 82 percent. The presence of proliferative vitreoretinopathy, stages C3-D, is a contraindication against the use of this technique.

[State of peripheral sections of the fundus oculi in progressive high myopia]. / Sostoianie perifericheskikh otdelov glaznogo dna pri vysokoi progressiruiushchei blizorukosti.

The incidence and structure of peripheral vitreochorioretinal dystrophies (PVCRD) were analyzed in 219 patients with high rapidly progressing myopia, aged 7 to 48, with different forms and degrees of the condition. A 'cross section' of the condition incidence has shown the peak of dystrophy accumulation at the age of 12-14. PVCRD forms recorded in the youngest age are peripheral retinoschisis (37.4%), retinal dystrophy (14.8%), and retinal ruptures (7.8%); these forms are detectable in the majority of patients by the age of 17-20. On the whole PVCRD develop earlier and are more frequent in females than in male patients, though retinal dystrophy and ruptures were recorded in men 1.4 times more frequently than in women. Bearing in mind the relationship between PVCRD and myopia development time and growth, the authors recommend prophylactic interventions at the age of 9-11.

[Modification of an inflatable balloon catheter for the treatment of retinal detachment]. / Modifikatsiia razduvaemogo ballona-katetera dlia lecheniia otsloiki setchatki.

The technique of extrascleral ballooning used in surgery for detachment of the retina is widely used in clinical practice. H. Lincoff and I. Kreissig's balloon catheter, widely used abroad since 1979, is described, and reasons why it cannot be used in this country are stated. The authors suggest their own modification of distensible balloon catheter for temporary scleral impression; the technique of making the device and of surgery is described in detail.