[Congenital glaucoma and thymomegaly: clinical and immunological characteristics].

A comprehensive examination of children with thymomegaly and congenital glaucoma revealed systemic and local humoral immunological disorders mainly as immunodeficiency, a family history of the disease, susceptibility to infections and allergic diseases, the presence of malformations, severe glaucoma, and a complicated postoperative period, which are suggestive of the defective state of the immune system, which should be kept in mind while making a surgical treatment and using an immunomodulator therapy, by exercising a great caution. Such children require observations by a pediatrician, an oculist, and an immunologist and consultations given by other specialists.

Cytomegalovirus antibodies in tear fluid of patients with retinitis.

The diagnosis of cytomegalovirus retinitis (CMV-R) is difficult and usually based on clinical criteria or invasive diagnostic procedures. The purpose of this study was to investigate a possible association between CMV-R and specific anti-CMV antibodies in tears. Paired tear and serum samples were obtained from 96 individuals, which included 20 children with congenital CMV infection and chorioretinitis, 56 adults with retinitis with clinical signs suggestive of viral infection, and 20 healthy control subjects, and were tested for CMV antibodies using ELISA. The prevalence of anti-CMV antibodies in tears was found to be 80% (16/20) in children, 35% (20/56) in adults, and 5% (1/20) in control subjects. Furthermore, high antibody levels were detected in 35% (7/20) of children and 10.7% (6/56) of adults with retinitis, and were not found in control subjects. There was a strong association between high tear levels of anti-CMV antibodies and active ocular infection. No correlations were found between tear and serum antibodies. ELISA sensitivity was 80% and specificity 95%. Further studies are needed to compare the tear and intraocular levels of CMV-specific antibodies in patients with retinitis to find out if CMV antibody testing in tear fluid could substitute for more invasive diagnostic procedures.

[Hyper-IGE reactions in uveitis and their immunomodulation with cytokine-containing agents].

Examination of 73 patients with primary, active uveitis of various etiology established a high frequency (78%) of IgE hyperconcentrations particularly among patients with viral uveitis (95%) and in the presence of systemic diseases (65.2%). The correlations between IgE and some values of T, humoral immunity, and cytokines support the multiple factors of the immunopathogenesis of uveitis. Combined treatment with local instillations of autocytokines and superlymph provided a high immunomodulating effect. The established IgE hyperproduction in uveitis may be a reflection of either rapidly progressive allergy or an allergic background and serve as a pathogenetic rationale for the use of antihistamines and immunotherapy with cytokine-containing agents.

[Systemic autoantibodies and their correction in patients with diabetic retinopathy in type 1 diabetes mellitus].

Examination of 91 patients with diabetic retinopathy in the presence of type I diabetes mellitus (DM-1) showed that 56% of the patients had a great variety of organ-specific and organ-nonspecific autoantibodies (AABs), including those to the microsomal and cytoplasmic fractions of endocrine glands, such as pancreas, thyroid, and pituitary. AABs were most common to the pituitary (23.2%), total myelin protein (18.7%), and denatured DNA (17.6%). There were correlations between AAB and the duration of DM-1 more than 20 years (78.3%; p < 0.05), between the total myelin protein AAB and encephalopathy (31.3%; p < 0.05), between the denatured DNA AAB and the increased retinal vascular permeability (29.3%; p < 0.05), which suggests their implication in vascular wall disintegration. No correlations could be found between AAB to the pituitary, pancreas, and thyroid and obvious pathology of the glands. Combined therapy with the immunomodulators thymactid and lycopide yielded a total beneficial effect (AAB disappearance, decreased titers, and no changes) in 88.3% of case while beneficial effect of insulin therapy was obtained in 53.9% of cases, which suggests that it is expedient to include of currently available immunomodulators into traditional insulin therapy.

[Immunologic autoagression in patients with diabetic retinopathy under type I diabetes mellitus].

Presence of IgG autoantibodies to broad spectrum of tissues' antigens in patients with diabetic retinopathy under type I diabetes mellitus was studied. Increased levels of antibodies to different antigens were observed in 56% of patients. Increased levels of antibodies to hypophysis, denaturated DNA, and myelin basic protein were detected most frequently. Correlation in presence of autoantibodies of different specificity with diabetes length as well as with frequency of respiratory infections was established. There was relation between level of antibodies to DNA and increased permeability of microvascular network of retina as well as between presence of autoantibodies to myelin basic protein and encephalopathy in patients with type I diabetes mellitus.

[Efficiency of treatment of uveitis with the drug superlymph].

Comparative analysis of the results of combination treatment using superlymph and the conventional therapy in 17 and 52 patients, respectively, demonstrated that the combination therapy showed a marked clinical and immunological effect. The use of superlymph in local therapy, unlike the conventional etiopathogenetic treatment, resulted in an earlier decrease and arrest of an inflammatory reaction, in recovery of visual functions (for 2-4 day). Superlymph was found to be well tolerated and to cause no subjective discomfort or complications. Its immunomodulating effect was to normalize the count of T-theophylline-sensitive lymphocytes and, accordingly, the immunoregulation index, the serum concentrations of serum IgG, IgA, particularly IgE, and the phagocytic function of neutrophils. Superlymph exerted a pronounced effect on the systemic and local cytokine status, by decreasing the hypersecretion of cytokines, the regulators of inflammation. The clinical and immunological effects and good tolerability of superlymph permit it to recommend for its wide use in therapy of inflammatory eye diseases.

[Disorders in the immune regulation and hemostasis as factors triggering the proliferative retinopathy in diabetes mellitus]. / Narusheniia immunoi reguliatsii i gemostaza kak faktory razvitiia proliferativnoi retinopatii i otsloiki setchatki pri sakharnom diabete.

A comprehensive clinical- immunological- and-hemostasiological study of the lachrymal fluid and blood of 105 patients with diabetic retinopathy (DR) showed that an "extreme" activity of the local antibody-dependent response to collagens, DNA, cytokine, TNF-alpha, increased levels of the circulating immune complexes (CIC) and of antibodies to DNA in the blood serum as well as local immune insufficiency and deficiency of free antibodies to collagens and TNF-alpha in the lachrymal fluid and serum during the onset of proliferative forms and traction retinal detachment are the key manifestations of the immune pathology in a progressing DR. Signs of hypercoagulation, free heparin deficiency, a reduced activity of fibrinolysis and insufficiency of the anti-thrombin system were detected with the development of the chronic syndrome of disseminated intravascular blood coagulation. Trends of the immunohemostatic correction of the activity of the local and systemic autoimmune responses and of hemostasis were substantiated during the generally accepted therapy of diabetes mellitus and of systemic micro- and-macroangiopathy.

[Complications of trabeculectomy in congenital glaucoma in children]. / Oslozhneniia trabekuléktomii pri vrozhdennoi glaukome u detei.

Presently, trabeculectomy is being widely used for congenital glaucoma in children. The authors established, after examining 92 children, that the efficacy of surgical treatment was on the average affirmed in 98.7% of cases during the early observation period, and in 89.8% of cases during the late observation period (1-5 years). Complications occurred in 12% of eyes during the early and late postoperative periods. The complications observed during the early postoperative period were not the cause for relapses of elevated intraocular pressure. Excessive cicatrization in the surgical intervention zone was the most prevalent cause for the instability of the achieved treatment results in the late period.

[Immunopathogenetic, clinical features and treatment of external exudative Coats' retinitis]. / Immunopatogeneticheskie, klinicheskie osobennosti i lechenie naruzhnogo éksudativnogo retinita Koutsa.

The findings of comprehensive clinical and immunopathogenetic examinations of 42 patients with external exudative Coats' retinitis showed the significance of infection in the etiopathogenesis of disease and helped identify the etiology, mainly infectious, in 47.6% patients, which correlated with case histories indicating foci of chronic infection and type I immunological insufficiency. Toxoplasma infection was the predominant etiological factor (38 cases). The predominant clinical symptoms were solid exudation, vascular changes, hemorrhages, vitreous involvement, and exudative detachment of the retina. Changes in the immune status were as follows: shifts in T- and B-immunity, impaired complex formation, in some cases selected deficit of IgA. Association of Coats' retinitis with erythrocytic phenotype B(III) was detected in 44% patients (p < 0.02); carriers of this blood group are at a high risk (RR 11.16) of the disease. The treatment was carried out with consideration for etiology, immunopathogenesis, and clinical picture and was supplemented by argon laser coagulation, if indicated.

[Antibodies to types II and IV collagens, tumor necrosis factor-alpha and circulating immune complexes in lacrimal fluid and serum of patients with diabetic retinopathy and different stages]. / Antitela k kollagenu II i IV tipov, faktor nekroza opukholi al'fa i tsirkuliruiushchie immunnye kompleksy v sleze i syvorotke krovi u bol'nykh s razlichnymi stadiiami diabeticheskoi angioretinopatii.

Clinical and immunological examinations are carried out in patients with preclinical, nonproliferative, preproliferative, and proliferative diabetic retinopathy (DR). On the whole, DR is characterized by a notable increase in antibody-dependent immune response, associated with appearance of antibodies to collagen of the II and IV types in the lacrimal fluid and serum, with the "local" reactions predominating. The level of reactions of cellular autoimmune response (tumor necrosis factor-alpha) and cell-to-cell reactions in the lacrimal fluid and serum is low. Increased level of circulating immune complexes in the serum and almost complete absence of free antibodies to collagen in the blood may be indicative of formation of pathogenic immune complexes precipitating on vascular walls and in other tissues. Various forms of immune response were revealed, conducive to a favorable or unfavorable course of DR.

[Diagnosis, immunopathogenesis, clinical picture and treatment of uveitis in nephropathies]. / Diagnostika, immunopatogenez, klinika i lechenie uveitov pri nefropatiiakh.

Complex clinical and immunological studies in 39 patients with uveitis and a history of nephropathies disclosed a relationship between renal diseases and vascular tract of the eyes. Specific features in the clinical symptomatology and immunological disorders were detected. Anterior and generalized forms, bilateral involvement, Tyndall's symptom, combined vitreolenticular changes, often with the exudative hemorrhagic component, predominated in the clinical picture of uveitis in patients with nephropathies. Uveitis ran a protracted course resistant to therapy, with frequent relapses. The disease occurred mainly in women. Predominant disorders in immunopathogenesis were disorders in the complex formation system. Uveitis in patients with nephropathies should be treated with due consideration for the etiology of nephropathy, clinical course of uveitis, and immunological disorders. Diseases of the vascular tract associated with nephropathy are rare in the etiological structure of uveitis and retinovasculitis (3.24%).

[Heparin inhalations combined with intravenous laser exposure of blood in patients with diabetic retinopathy]. / Ispol'zovanie ingaliatsii geparina v sochetanii s vnutrivennym lazernym oblucheniiem krovi u bol'nykh s diabeticheskoi retinopatiei.

Heparin inhalations combined with intravenous laser exposure of the blood are effective in patients with nonproliferative, preproliferative, and proliferative diabetic retinopathy. Clinical effect consisted in decrease of edema in the macular area, partial resolution of hemorrhages, a tendency to decrease in the caliber of veins, improvement of visual acuity, and extension of visual field. Immunological studies revealed immunomodulating effect of heparin inhalations and intravenous laser exposure of the blood, manifesting by decreased levels of pathological circulating immune complexes and increased concentrations of immunoglobulins, mainly IgG and IgM. Diabetic hemophthalmia is to be treated by subtenon implantation of a collagen system with injection of a prourokinase thrombolytic in combination with preoperative preparation including heparin inhalations, intravenous laser exposure of the blood, and parabulbar administration of 0.5 ml 1% emoxipin for 5 days in order to normalize immune hemostatic and redox processes and create conditions for effective action of the thrombolytic.

[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.

[Clinical-immunological disorders in uveitis in patients with Behçet's syndrome]. / Kliniko-immunologicheskie narusheniia pri uveitakh u bol'nykh s sindromom Bekhcheta.

The results of comprehensive clinicoimmunologic examinations of 38 uveitis patients with Behçet's disease indicate that uveitis in the presence of Behçet's disease should be referred to multifactorial diseases to whose pathogenesis immunopathologic reactions in various combinations and genetic predisposition contribute much. Generalization of the process in the eye predominated in the clinical picture with involvement of the anterior and posterior segments, retinal vessels, this being combined with general somatic symptoms (aphthae on the buccal mucosa, genitals, arthritides, urethritis/cystitis symptoms, positive 'pricking' test). Study of the immunity status revealed depressed lymphocyte proliferative response to mitogen in 58.8% of patients, hyperimmunoglobulinemia of the A and M classes in 63.3%, impaired complex formation (increased levels of circulating immune complexes in 78.3% and cryoglobulin presence in 57.1%), and various combinations of these immunologic signs. The results indicated patients' infection with herpes virus, streptococcus, toxoplasma. An associative connection of Behçet's disease with A (II) red cell phenotype in 54.8% of patients (p < 0.05) suggests a relationship between genetic factors and the conditions of a specific geographic region. A variety of immunologic changes necessitated the use of corticosteroids, hemoperfusion, cytostatics, and immunity stimulants in the treatment of uveitis in Behçet's disease patients.

[The immunological factors characterizing neurochorioretinitis]. / Immunologicheskie faktory v kharakteristike neirokhorioretinitov.

Comprehensive clinical and immunologic studies carried out in 38 patients with neurochorioretinitis have demonstrated the contribution of infection to the etiology and pathogenesis of this condition and helped identify the nature, mostly infectious, of the condition in 55.3% of patients. Toxoplasma infection, revealed in 39.5% of cases, is one of the major etiologic factors of neurochorioretinitis. Tuberculous etiology of the condition is more rare (7.9% of cases). The autoimmune systemic component was detected in 7.9% of the examinees. Immunopathologic shifts, presenting as hyperimmunoglobulinemia, were fairly frequent (71.9% of patients), excessive concentrations of circulating immune complexes were detected in 78.6% and cryoglobulins were found in 42.9% of the examinees, this permitting the authors to regard neurochorioretinitis as a form of immunocomplex conditions of the eye, most possibly, of an infectious origin. Blood group A (II) was found to be a risk factor for neurochorioretinitis patients; according to the literature data, this is explained by a reduction of the interferonogenic activity. Etiotropic anti-inflammatory drugs, including corticosteroids, and interferon preparations for the risk group patients appear to be advisable for the therapy of neurochorioretinitis.

[Immunologic disorders in patients with idiopathic subretinal neovascular membrane]. / Immunologicheskie narusheniia u bol'nykh idiopaticheskoi subretinal'noi neovaskuliarnoi membranoi.

The authors analyze the results of comprehensive clinical and immunologic examinations of 52 patients with this condition (SNVM) in its active and inactive phases, angiographically confirmed, aged 19 to 46; 32 of these were women (61.5%), 20 (38.4%) men. A complex of immunologic methods was employed to reveal the etiology of the condition and the immune status of SNMV patients. The origin of the condition was identified in 44.2% of patients; it was toxoplasmic in 19.2, autoimmune in 15.4, tuberculous in 7.7, and mixed toxoplasmic and tuberculous in 1.9% of cases. T lymphocyte functional activity was inhibited in 37.5% of patients with the exudative hemorrhagic phase of SNMV and in 16.7% of those in the cicatrization phase. Changes in the humoral immunity presenting as gammapathies were detected in 34% of patients, those manifesting by hyperconcentrations of circulating immune complexes in 66.7%, and of cryoglobulins in 37.8% of patients. Krypton laser coagulation was employed in multiple-modality treatment of patients with SNMV. The remissions persisted for 3-5 years.

[Immunologic disorders in young patients with retinal vein thrombosis]. / Immunologicheskie narusheniia pri trombozakh ven setchatki v molodom vozraste.

Immunologic shifts in 53 patients with retinal vein thrombosis, aged 20 to 41, were under study. Present-day immunologic methods were employed to investigate the status of the humoral and cellular immunity and define the infection rate. The results were assessed functionally and immunologically. The authors have revealed the contribution of infection to the development of retinal vein thrombosis in young patients, analyzed for the first time the immunity status of such patients, detected the signs of humoral immunodeficiency are senting as gammapathies and impaired complex formation, showed the relationship between thromboses and genetic predisposition and the role of the erythrocytic phenotype in the development of a cyst-like edema; this permitted them develop recommendations on the disease source and outcome prediction and on the choice of drugs.