[The place of ciclosporin A cationic emulsion 0.1% in the therapy of xerophthalmia]. / Mesto kationnoi emul'sii tsiklosporina A 0,1% v terapii kseroftal'mii.

Dry eye disease (DED) is pathogenetically based on inflammation of the ocular surface. A step-by-step approach to DED treatment involves early initiation of anti-inflammatory therapy, including instillation of cyclosporine A (CsA). However, recommendations for the use of topical CsA in clinical practice are limited. This article presents an expert consensus on practical recommendations for the management of patients with DED, including indications, time of initiation and duration of CsA therapy, comparison of CsA forms currently registered in the Russian Federation, as well as issues of patient education.

[New possibilities for reparative therapy of dry eye syndrome]. / Novye vozmozhnosti reparativnoi terapii sindroma «sukhogo glaza¼.

In recent years, among artificial tear preparations that have additional metabolic properties, in addition to moisturizing the ocular surface, there has been a drug Optinol Soft Recovery (LLC JADRAN). In addition to 0.15% sodium hyaluronate, it contains 2% dexpanthenol, which stimulates reparative regeneration of the corneal epithelium, in particular in patients with dry eye syndrome (DES). PURPOSE: This study evaluates the clinical efficacy of the drug Optinol Soft Recovery in the treatment of patients with DES accompanied by xerotic changes in the corneal epithelium. MATERIAL AND METHODS: The study included 82 patients (15 children and 65 adults) with moderate and severe DES accompanied by the following corneal pathology: filamentous keratitis (20 patients, 33 eyes), persistent corneal erosion (28 patients, 49 eyes) and punctate keratopathy (34 patients, 68 eyes). RESULTS: All patients receiving fourfold instillations of the studied drug were observed already during the first 7 days to have increased stability of the tear film and decreased severity of staining of the cornea and conjunctiva with vital dyes (0.1% sodium fluorescein and 3% lissamine green, respectively). Further, as the patients were transferred to an individual instillation regimen, a progressive decrease in the Ocular Surface Disease Index (OSDI), an increase in corneal sensitivity and tear meniscus index were also recorded. The differences in most parameters of the course of xerosis compared to the initial ones were statistically significant starting from day 10-20 of therapy, depending on the initial severity of corneal xerosis (p<0.05-0.001). CONCLUSION: Patients with moderate DES complicated by punctate keratopathy were the most susceptible to therapy with the drug Optinol Soft Recovery, while patients with filamentous keratitis secondary to a severe clinical form of DES were the least susceptible.

[Modern possibilities of pathogenetically oriented therapy for dry eye syndrome]. / Sovremennye vozmozhnosti patogeneticheski orientirovannoi terapii sindroma «sukhogo glaza¼.

In recent years, anti-inflammatory therapy has become a significant part of the complex approach to treatment of patients with dry eye syndrome (DES), with cyclosporine preparations becoming increasingly important in the structure of the therapy. Taking into account the immunosuppressive effect of cyclosporine A, which is realized through hindering the activation of T-lymphocytes in the tissues of the ocular surface, its topical application in DES has a pronounced pathogenetic focus. Numerous clinical studies have shown that instillations of cyclosporine into the conjunctival cavity contribute to an increase in total tear production, as well as recovery of the density of goblet cells in the conjunctiva of DES patients. The positive effect of cyclosporine A instillations has been convincingly demonstrated in the complex therapy of patients with vernal and atopic corneal conjunctivitis, Thygeson's superficial punctate keratitis, autoimmune keratitis, meibomian gland dysfunction, etc. However, one significant problem associated with cyclosporine A instillations is the irritating effect of the drug. That prompted the development of a drug that is safe and tolerable during instillations into the conjunctival cavity - preservative-free 0.1% cyclosporine A labelled Ikervis (Santen, Japan). The drug carrier is artificial tear Cationorm (Santen), which has an advantage of stabilizing the tear film and protecting the ocular surface from the irritating effect of cyclosporine. According to numerous clinical studies, Ikervis instillations can improve the effectiveness of complex therapy in patients with DES (especially secondary to Sjögren syndrome, Stevens-Johnson syndrome, graft-versus-host disease), with allergic diseases of the cornea and conjunctiva (spring, atopic corneal conjunctivitis), with corneal transplant disease, and other similar conditions. The high efficacy and safety of Ikervis constitute the reason to recommend it for wide clinical use.

[Modern capabilities in diagnosis and treatment of neurotrophic keratopathy]. / Sovremennye vozmozhnosti diagnostiki i lecheniya neirotroficheskoi keratopatii.

In recent years, the problem of diagnosing and treating neurotrophic keratopathy (NK) has become relevant in view of its prevalence reaching 1.6-11.0 per 10000 people. While previously it was associated only with neuroparalytic keratitis, at present the violation of sensitive and trophic innervation of the cornea with the development of characteristic keratopathy is observed in many diseases and injuries of the organ of vision. Diagnosis of NK is based on anamnestic information and assessment of clinical and functional parameters: determination of the stability of the tear film, tear production and assessment of staining of the ocular surface with vital dyes. The main role in the diagnosis of NK belongs to corneal sensitivity determined with the Cochet-Bonnet esthesiometer. Treatment of NK is designed to restore or increase corneal sensitivity and involves tear replacement therapy, instillations of preparations derived from patient's own blood, anti-inflammatory, metabolic and antibacterial therapy. However, instillations of human erve growth factor (NGF) - the drug Cenegermin (registered in Europe in 2017 at a dose of 20 µg/ml under the name Oxervate), a recombinant form of human rhNGF from Escherichia coli bacteria - exhibit the highest pathogenetic orientation. Its «target¼ is the affected nerve fibers (specific receptors for their growth factor), which makes it possible to eliminate the violation of reparative processes in neural and epithelial cells. A high and long-term clinical efficacy of a course of six (with an interval of 2 hours) instillations of the drug for 8 weeks in the treatment of children and adults with NK has been established. Among the pathogenetically justified methods of surgical treatment, there is the so-called surgical neurotization of the cornea involving the contralateral supraorbital, supratrochlear, great auricular and other nerves, which has a long-term clinical effect.

[Relative effectiveness of methods of obturating the lacrimal duct in the treatment of patients with dry eye syndrome]. / Sravnitel'naia éffektivnost' metodov obturatsii slezootvodiashchikh putei v lechenii patsientov s sindromom sukhogo glaza.

Obturation of the lacrimal duct is a new method being developed in parallel to drug therapy for the treatment of patients with dry eye syndrome (DES). However, the abundance of methods of obturation and the lack of experience with them indicates the necessity of their comparative evaluation and development of a therapeutic algorithm. PURPOSE: To compare the effectiveness of various ways of obturating the lacrimal duct, to determine their choice and the sequence of their application in the treatment of patients with DES. MATERIAL AND METHODS: The study included 85 patients with DES: 23 - on the basis of disturbed tear production, with denervation and after extirpation of the lacrimal gland; 62 - due to the combination of disturbed tear production and increased tear film evaporation: with Sjogren syndrome, Graft-versus-host reaction, and scarring pemphigoid. All patients were examined using methods of functional evaluation of the ocular surface. RESULTS: The effect of artificial tear after 1 month of instillations was sufficient in 31 patients. The remaining 54 patients underwent lacrimal duct obturation: at first - temporary (with catgut thread), and after it proved effective (48 patients) - permanent: Punctal plugs® (FCI), conjunctiva coating, diathermocoagulation, and canals ligation (when previous methods were ineffective). The intervention was accompanied by a decrease in the severity of DES symptoms, increased stability of the tear film and high tear meniscus index values. However, none of the methods used was absolutely reliable: recanalization of the tear ducts was noted in 28.2% after their closure by Punctal plugs, in 25-60% after conjunctival coverage, and in 51.7% after diathermocoagulation. CONCLUSION: The least traumatic way of lacrimal duct obturation is the Punctal plugs. The most reliable, but also the most traumatic is canals ligation, which was effective in re-obturation. Covering lacrimal papillae with conjunctiva occupies an intermediate position in terms of traumatism and effectiveness. During the surgery, it is reasonable to consider blocking both canals, and not just obturating the lower one.

[Prevention and treatment of degenerative changes in ocular surface epithelium in patients with dry eye syndrome]. / Profilaktika i lechenie degenerativnykh izmenenii épiteliia glaznoi poverkhnosti pri sindrome 'sukhogo glaza'.

In current understanding of the pathogenesis of xerotic changes of the ocular surface in patients with dry eye syndrome (DES), great importance is given to hyperosmolarity of the tear film, inflammatory process and oxidative stress. By now, no convincing data has been obtained on whether the oxidative stress is primary in relation to the inflammatory process in the ocular surface tissues, or if it is a complication. Furthermore, in the complex treatment of patients with DES, antioxidant therapy has so far received little attention. This problem can be solved with the 'artificial tears' preparation containing cyanocobalamin (vitamin B12), which antioxidant, anti-inflammatory and clinical effectiveness has been convincingly proved in a number of experimental and clinical studies of recent years. Improving the methods of vital diagnostics of xerosis of the ocular surface also enables detection of subclinical changes in epithelium of the cornea and conjunctiva, thus allowing timely prescription of metabolic therapy. One of the promising directions of such treatment is the use of 5% dexpanthenol, which stimulates the processes of reparative regeneration and possesses an anti-inflammatory effect.

[Ophthalmoferon efficacy in the treatment of children with chronic blepharoconjunctivitis]. / Éffektivnost' preparata 'Oftal'moferon' v lechenii khronicheskogo blefarokon''iunktivita u detei.

AIM: To study possibilities of using the medication Ophthalmoferon in the treatment of children with chronic allergic and Demodex blepharoconjunctivitis. MATERIAL AND METHODS: We examined 40 children (80 eyes) aged 3 to 17 years with chronic allergic (group I) and Demodex (group II) blepharoconjunctivitis. Each group was divided into two subgroups ('A' and 'B') respectively based on the treatment regimen used. Subgroup 'A' patients received Ophtalmoferon instillations (four times per day for four weeks) in addition to the standard therapy, whereas subgroup 'B' patients got only basic treatment of blepharoconjunctivitis. The latter included eyelids' ciliary edge massage, eyelids' free edge hygienic treatment, artificial tears instillations and oral intake of the medications, like enterosorbents, probiotics, enzymes and anti-allergic remedies. We evaluated the dynamics of subjective and objective blepharoconjunctivitis signs at 1,2,4 and 6 follow-up weeks. The dynamics of eosinophils content in cytograms as well as the dynamics of acarograms were also assessed. RESULTS: From the first treatment week in all patients, regardless of the treatment regimen used, we noted a statistically significant positive change in all subjective and the majority of objective blepharoconjunctivitis clinical manifestations, such as eyelids' edge and conjunctiva hyperemia and eyelid swelling. In patients with allergic and Demodex blepharoconjunctivitis, who received the medication Ophtalmoferon, a significantly more positive result was observed after the first treatment week, by comparing with the control group (p<0,01). The significant difference in the parameters of both comparison subgroups persisted for two weeks. There was a significant difference in the acarogram values, when Ophtalmoferon was used. A further decrease in the cellular infiltration of the conjunctiva by eosinophils was revealed in patients, who additionally used Ophthalmoferon, but without significant differences in parameters. There were no adverse effects in all cases, when the given medication was used. CONCLUSION: Our study results allow us to recommend the medication Ophtalmoferon for a wide clinical use in children with chronic allergic and Demodex blepharoconjunctivitis.