[Large foreign bodies inside the orbit and maxillary sinus (clinical observation)]. / Krupnye inorodnye tela glaznitsy i verkhnechelyustnoi pazukhi (klinicheskoe nablyudenie).

The great variety of orbital traumas can surprise and challenge specialists attempting to cure its consequences with the best possible outcome. This article presents a clinical case of a patient diagnosed with cicatricial deformity of the free edge and trichiasis of the upper eyelid in the lateral angle area, keratopathy, enophthalmos on the left side; posttraumatic defect of the inferior orbital wall; multiple foreign bodies in the orbit and maxillary sinus on the left side. Patient examination included conventional ophthalmological study methods, as well as multislice computed tomography with 3D-reconstruction. Surgical treatment required involvement of an ophthalmologist, an otorhinolaryngologist and a maxillofacial surgeon. The first stage of surgical treatment addressed the deformity of the lateral part of the upper eyelid margin including resection of its fragment, trichiasis surgery, and lateral canthoplasty. In the second stage, the multidisciplinary team of surgeons removed foreign bodies through combined subciliary and endonasal access with placement of a mandibular autograft onto the inferior orbital wall. Radiological examination should be done in all patients with trauma to the orbital area in order to detect latent injuries. When choosing a treatment strategy, specialists should be aware of trauma complicity and necessity to enlist a multidisciplinary medical team. Patients should be informed that sometimes the consequences of the trauma may not be treated completely.

[Morphological evaluation of orbital implants in postenucleation reconstruction (an experimental study)]. / Morfologicheskaya otsenka orbital'nykh implantatov v postenukleatsionnoi rekonstruktsii (eksperimental'noe issledovanie).

About 12 thousand surgeries for eyeball removal are performed every year in the Russian Federation. Formation of the supporting stump and implantation of the proper orbital implant is essential for successful cosmetic prosthesis. PURPOSE: Comparison of materials biocompatibility, design of different orbital implants and morphological condition of formed postenucleation stumps in an in vivo experiment. MATERIAL AND METHODS: In the course of the study 24 rabbits were operated, divided into three comparable groups. Enucleation with primary implantation of an orbital implant was performed in all subjects. The following implants were used: polymeric orbital implant - in the main (experimental) group, polytetrafluorethylene insertion implant - in the control group 1, and silicone endoprosthesis - in the control group 2. We assessed features of the implantation process, implant design, general condition of the operated animals, condition of the postenucleation stumps, passive motility of the stumps, and reaction of the surrounding tissues to the implants. RESULTS: Performed surgeries did not negatively affect the general condition of the rabbits, and there was no significant local tissue reaction to the implants. The structural and design features of the implants used in the main group were found to be more convenient for implantation, ensured stable fixation and position in the orbit. Postenucleation stump motility was comparable in all groups during the early postoperative period. This parameter decreased at later follow-up times mostly in the control group 2. When extracting the implants, it was revealed that in the main group it had secure fixation to the orbital tissues and stable position, did not cause abundant proliferation of connective tissue. Pathomorphological examination revealed that tissue reaction to the implants was less prominent and was reversed soon with fine connective tissue capsule formation in the main group and control group 2. In the control group 1 tissue reaction increased progressively, and capsule formation was delayed. CONCLUSION: Polymeric implant is the most suitable orbital implant for postenucleation orbital reconstruction.

[The experience of interdisciplinary interaction in elimination of midface deformation (clinical observation)]. / Opyt mezhdistsiplinarnogo vzaimodeistviya pri ustranenii deformatsii srednei zony litsa (klinicheskoe nablyudenie).

Fibrous dysplasia is a hamartoma appearing as a benign pathologic process in which normal bone tissue formation is replaced by overgrowth of fibrous connective tissue. The problem of diagnosis and treatment of patients with fibrous dysplasia remains unsolved in the absence of a uniform understanding of its etiology and pathogenesis. Treatment and rehabilitation of patients with midface fibrous dysplasia is a complicated medico-social problem, which requires interaction of specialists of different fields to resolve it. The disease presents a practical interest for doctors of more than 20 specialties, as it can lead to disability. The present article describes a clinical case of interdisciplinary interaction of specialists in the fields of maxillofacial surgery, ophthalmology, otorhinolaryngology, plastic surgery and radiology involved in complex treatment of a patient with midface fibrous dysplasia accompanied by eyeball dislocation, decreased vision, as well as progressive impairment of nasal breathing function. The performed treatment resulted in favorable functional and aesthetic outcomes including elimination of exophthalmos, vertical strabismus, lacrimation disorders, nasal breathing disorders, increase of visual acuity and improvement of external appearance.

[Treatment of neurotrophic keratopathy in combined lesions of the trigeminal and facial nerves]. / Lechenie neirotroficheskoi keratopatii pri sochetannom porazhenii troinichnogo i litsevogo nervov.

Ocular symptomatology in lesions of the facial nerve is associated with disturbed innervation of the circular muscle of the eye that leads to disruption of the protective function of the eyelids and the development of exposure symptoms, and is accompanied by a breach in corneal tear film integrity. The main clinical manifestation of the trigeminal nerve damage is the loss of sensory innervation of the cornea and disruption of the supply of neurotransmitters to its cells, manifesting as corneal hypo- or anesthesia. This triggers a cascade of pathological processes that lead to the development of neurotrophic keratopathy. In combined pathology of the facial and trigeminal nerves, a number of interrelated and mutually aggravating problems arise that require correction of lagophthalmos and functional restoration of the trigeminal nerve, since there is an interaction between the corneal epithelium and trigeminal neurons through trophic neuromodulators, which normally contribute to the proliferation of epithelial cells, their differentiation, migration and adhesion, and are essential for vital functions, metabolism and healing of surface lesions of the eye. Classical methods of treating neurotrophic keratopathy aim to protect the ocular surface, and are palliative or auxiliary, do not provide radical relief of the symptoms of neurotrophic keratopathy. Modern surgical technique of neurotization of the cornea allows restoring the structural growth of the nerve, which provides nerve trophism and corneal sensitivity, and is the only pathogenetically substantiated method of effective treatment of neurotrophic keratopathy. At the same time, direct neurotization has undeniable advantages over methods involving intercalary donor nerves, since neuropeptides from nerve fibers are immediately released into the recipient tissue and start reparative processes. Taking into account the accumulated positive experience of neurotization surgeries, scientific and clinical research should be continued in order to improve the most effective methods of corneal neurotization and promote their wider implementation into clinical practice.

[Computer technologies in diagnostics and treatment of worsening post-enucleation socket syndrome]. / Komp'iuternye tekhnologii v diagnostike i lechenii progressiruiushchego anoftal'micheskogo sindroma.

Enucleation with primary orbital implantation and the use of ocular prosthesis does not exclude the risk of post-enucleation socket syndrome (PESS). Correction of such conditions requires modern visualization methods and software for calculation, modelling and control of the surgery. PURPOSE: To demonstrate the capabilities of modern computer technologies in diagnostics and treatment of patients with worsening post-enucleation enophthalmos. MATERIAL AND METHODS: The retrospective study included 6 patients (4 male and 2 female) aged 29-68 years who exhibited signs of PESS in 2017-2018. To define the orbital condition, patients underwent multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI) followed by image analysis with computed exophthalmometry and step-by-step computed exophthalmometry. Results of these examinations helped construct 3D-models of patients' orbits, which were then used to calculate the parameters of the silicone implants. Patient-specific silicone implants were implanted into their orbits during surgery under general anesthesia. RESULTS: Implantation of the patient-specific silicone implant resulted in increase of the volume behind orbital prosthesis and correction of post-enucleation enophthalmos in all patients allowing them to use thinner, more mobile ocular prosthesis, and restore normal eyelid position. The patients also noted better appearance of the eye and personal comfort. CONCLUSION: Modern visualization methods along with computer analysis and modelling, as well as technologies to produce medical products enable creation of the best suitable patient-specific orbital implants. This allows achieving better clinical results and better quality of life for patients with monolateral anophthalmos.

[Experimental justification of the use of a polymeric implant in reconstructive and regenerative surgery of the sclera and tarsal plate]. / Éksperimental'noe obosnovanie ispol'zovaniia polimernogo implantata v rekonstruktivno-vosstanovitel'noi khirurgii sklery i tarzal'noi plastinki.

INTRODUCTION: Congenital and acquired diseases, as well as traumatic injuries of the sclera and tarsal plate can lead to serious complications up to the complete loss of visual functions and loss of the eye as an organ if not treated timely. Due to that, it becomes necessary to use biological and synthetic materials during reconstructive and regenerative surgeries to replace the defects and reinforce the carcass properties of the sclera and tarsal plate. PURPOSE: To compare experimental and morphological features of the response of the eye and surrounding tissues to implantation of the synthetic polymeric implant for reconstructive and regenerative surgery (PERRS) 'Reperen-6' and biological xenopericardium implant taken from cattle on the sclera in animal experiment. MATERIAL AND METHODS: The studies were conducted on 12 chinchilla rabbits. PERRS 'Reperen-6' was implanted on the surface of the sclera (into the subtenon space) of left eyes of 6 rabbits from the main group. Similar surgeries with biological xenopericardium implant taken from cattle were performed on the left eyes of 6 rabbits from the comparison group. The right eyes of each animal from both groups remained intact. After the surgery, we performed examination of the animals and acquisition of the material (the eyes and surrounding tissue) in 16, 34 and 68 days. Enucleated eyes were fixed in 10% buffered formalin solution with subsequent preparation of histologic specimen according to standard procedure. CONCLUSION: The experimental and morphological studies showed that the postoperative period went smoother in the main group of animals. Thanks to its structure, PERRS 'Reperen-6' fixed tightly to the sclera and surrounding structures forming a firm 'own tissue-implant' complex. The polymeric implant 'Reperen-6' can be recommended for reconstructive and regenerative surgeries to reinforce the connective tissue structures in pathological conditions of sclera and appendages of the eyes.

[Clinical forms of ocular dirofilariasis]. / Klinicheskie formy glaznogo dirofiliarioza.

The prevalence of dirofilariasis in Russian Federation has been increasing in recent years. Diagnosis of ocular dirofilariasis is difficult due to polymorphism of its clinical manifestations. Systematized data on this disease in literature is virtually absent. The study included 142 cases of ocular dirofilariasis registered in Russian Federation and the former Soviet Union, which were described in the literature of 1915-2016 years. An analysis of the registered cases of dirofilariasis allowed the following classification points to be defined: localization-based - subcutaneous soft tissue, subconjunctival, orbital, scleral, intraocular; in terms of clinical forms - capsular (with perifocal inflammation, asymptomatic disease course, with fixed or unfixed capsule) and acapsular/migrating (with or without infiltration of surrounding tissues). The most difficult to diagnose are the capsular forms. In such cases, ultrasonography is used to reach final diagnosis. The developed working classification of ocular dirofilariasis enables to refine the approaches to diagnosing this pathology, which will undoubtedly improve the quality of medical care.

[Ophthalmic manifestations of facial nerve palsy]. / Oftal'mologicheskie proiavleniia paralicha litsevogo nerva.

Facial nerve palsy is a common pathology that develops due to various diseases, traumas and medical interventions. The most common peripheral type of facial paralysis leads to acute unilateral involvement of facial muscles along with the development of paralytic lagophthalmos. The absence of adequate and timely medical treatment in patients with paralytic lagophthalmos can lead to severe corneal complications such as cornea perforation causing loss of eye and consequently restricted professional ability, work capacity and significant decrease of patient's life quality. Patients with paralytic lagophthalmos require timely, complex, planned treatment involving various correction methods aimed at protection of the cornea, as well as anatomical and functional recovery of the eyelids. Chemodenervation of the upper eyelid muscles is a pathogenetically substantiated method that can help restore the protective function of the upper eyelid and prevent corneal complications; it can be recommended for early stages of the disease.

[Exophthalmometry with computed tomography]. / Metod ékzoftal'mometrii s ispol'zovaniem komp'iuternoi tomografii.

Bone abnormalities of orbit seen in patients with trauma or radiolesion are accompanied by enophthalmos or exophthalmos. Conventional measurements of eyeball protrusion with Hertel's exophthalmometer or with computed tomography do not provide accurate and reliable data, especially in patients with asymmetry of lateral orbital rims. PURPOSE: To develop a method of computed exophthalmometry that provides accurate and reliable measurements in patients with various orbital conditions. MATERIAL AND METHODS: Medical records and computerized axial tomography scans of 25 patients' orbits without false enophthalmos or exophthalmos were analyzed posthoc. First group included 13 patients with trauma or radiolesion of the orbit at the different stages of plastic-reconstructive treatment. Second group consisted of 12 patients with lacrimal duct obstruction and without any orbital bone abnormalities. Eyeball protrusion was measured from a line joining styloid processes of temporal bones according to the developed method. RESULTS: Comparison of the results of three independent measurements showed that in group 1 mean value varied from 0.40 mm to 10.13 mm and in group 2 - from 0.10 mm to 0.87 mm. Standard deviation (0.00-0.29 mm) and standard error in mean (0.00-0.17 mm) was the same in both groups. CONCLUSION: The newly developed method of exophthalmometry with the use of computed tomography provides accurate and reliable data in patients with various orbital conditions including asymmetry of lateral orbital rims. Eyeball protrusion with asymmetry not exceeding 0.9 mm does not lead to functional and esthetical abnormalities and may be considered normal. The developed method is easy to setup and use, it can be applied in medical practice for diagnostics, surgery planning and evaluation of postoperative results in patients with various orbital conditions.

In Vitro Modeling of Co-Transplantation of Multipotent Stromal Mesenchymal Cells from Orbital Fat Pad and Lipoaspirate of Human Subcutaneous Adipose Tissue in Organ Culture in Collagen Gel.

The interplay of multipotent stromal cells derived from the orbital fat pads and cells of the lipoaspirate from the subcutaneous adipose tissue was studied using in vitro co-transplantation model in an organ culture in a collagen gel. Microscopy findings and intensity of apoptosis and cell proliferation in cultures of lipoaspirate with and without multipotent stromal cells showed that the cells maintained their viability, proliferation capacity, and cytokine secretion activity. Higher proliferatitive activity of cells in cocultures promotes renewal of fat transplant cells and can help to maintain its stable volume in delayed terms after transplantation.

Comparison of Morphology of Adipose Body of the Orbit and Subcutaneous Fat in Humans.

We compared histological structure of the orbital and subcutaneous adipose tissue. Quantitative morphometry showed that the mean diameter of adipocytes and their volume density in the orbital adipose tissue were significantly lower than in the subcutaneous fat, while volume density of vessels and elements of the connective tissue in the orbital adipose tissue was higher. Previously known and revealed here differences in the structure of orbital and subcutaneous adipose tissue do not answer the question, whether subcutaneous adipose tissue can be used for replacement of the orbital tissue deficit.

[Staged complex treatment of paralytic lagophthalmos (case report)]. / Kompleksnoe poetapnoe lechenie paraliticheskogo lagoftal'ma (klinicheskii sluchai).

Paralytic lagophthalmos, resulting from facial nerve palsy, is a difficult medical and social issue that requires cooperation of different specialists. Complications that arise in paralytic lagophthalmos may cause significant vision loss and even eye loss. Various techniques of paralytic lagophthalmos correction are used to protect the cornea and restore eyelid anatomy and functions. These comprise palliative (conservative), surgical, and alternative treatments (such as botulinum toxin type A therapy). Surgical treatment of paralytic lagophthalmos patients often has to be staged and complex. This article presents a clinical case of a female patient with paralytic lagophthalmos complicated by corneal perforation. Her staged complex treatment included lower eyelid surgery, chemodenervation of the upper eyelid levator and optical reconstructive surgery. The following positive results were achieved: the protective function of the eyelids was restored, residual visual functions - preserved, the risk of eye loss - eliminated, and the asymmetry between the two halves of the face - corrected.

[Orbital Adipose Tissue: Just a Fat Pad or Terra Incognita in Ophthalmology].

Our understanding of the role of adipose tissue has been completely changed during the past decades. The knowledge of its contribution to endocrine and immune pathways opened the new insights on the pathogenesis and therapy of many diseases and new perspectives for the regenerative medicine. The further researches should be provided to study anatomy and functions of local fat depots in more details. Of the most interest is the orbital adipose tissue due to its origin from the neural crest. This review represents the current data about anatomy, structure, cell composition and biochemistry of orbital fat. The main attention is put to such cell types as adipocytes and adipose derived mesenchymal stem cells. The foreign authors' findings on such characteristics of stem cells from orbital adipose tissue as CD markers and differential capacity are reviewed. The found evidences of interaction between orbital adipose tissue, eyeball and associated structures allow us to hypothesize that this fat depot may contribute to various ocular pathology. In this paper, we outlined the possible directions for further investigation and clinical application of orbital fat and cells its composing in ophthalmology, reconstructive and plastic surgery and regenerative medicine.

[Technology of new methods for adaptation of skin flaps, by using compression plates during reparative operations in the eyelid area and its adjacent tissues].

Oligocarbonate methacrylate-based hexahedral compression plates (CPs) are proposed for adjustment of wound edges and skin grafts during reconstructive operations in the eyelid area and its adjacent tissues. A hundred and twenty-eight reparative operations in the eyelid and its adjacent tissues, by employing various plastic repairs, were analyzed to make a clinical evaluation of the efficiency of the soft tissue adjustment technique, by applying CPs. The CPs proposed for the adjustment of wound edges and skin grafts to the adjacent tissues were used in 70% of cases. There is evidence for the reliable fixation of wound edges and skin grafts to the adjacent structures by means of CPs without negative effects of mimic and chewing muscles. In the presence of complex orbital and periorbital relief, microanatomic structures, and tissue deficiency, CPs provide a valid connection of the edges of skin wounds throughout healing and permanent microdraining of the postoperative space, reduce the number of complications, and ensure an uncomplicated course of reparative processes, by forming a fine delicate scar in 98.89% of cases. The proposed way of adjusting wound edges and skin grafts to the adjacent tissues improves the cosmetic and functional results of reconstructive operations in the orbital and periorbital areas.