[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.

[Effects of reconstructive operations on the development of systemic autosensitization in patients with anophthalmos]. / Vliianie rekonstruktivnykh operatsii na razvitie sistemnoi autosensibilizatsii u patsientov s anoftal'mom.

The role of systemic autoimmune reactions to organ-specific antigens (DNA and collagen) was studied in patients with anophthalmia before and after interventions on the stump and conjunctival cavity making use of autotransplants and synthetic implants. A total of 220 analyses of the serum were performed in the main group and 50 in the control. Autosensitization was detected in 10 (18.2%) patients. The data were processed using Statistica software. A series of previous reconstructive operations is a factor promoting the development of systemic autosensitization to collagen. A trend to an increase in the levels of antibodies to DNA and collagen was observed in the presence of cicatricial changes in adjacent tissues, foreign bodies, cartilaginous implants, and fistulas causing a latent fibrous reaction. The type of intervention (use of implants or autotransplants) does not affect the level of antibodies to DNA and collagen.

[The validation of and approaches to the use of immunocorrective agents in contusive eye trauma]. / Obosnovanie i podkhody k primeneniiu immunokorrigiruiushchikh sredstv pri kontuzionnykh travmakh glaza.

Patients with contusions of the eye of different severity were examined. The concentrations of cytokines (interleukin 1 beta, alpha-interferon, tumor necrosis factor-alpha), levels of immunoglobulins and circulating immune complexes were measured and organ-specific immunity was studied. Severe and medium-severe contusions of the eyeball were associated with immune shifts at a local and systemic levels. Shifts regarded as adaptation compensatory immune response were detected in medium-severe contusions. Severe contusions involve immunity disorders which are characteristic of developing secondary immunodeficiency. Postcontusion hemorrhages are a clinical factor of risk of pathogenetically unfavorable autoimmune reactions. The efficiency of immunocorrective drugs is discussed.

[Clinical and immunomorphological parallels in posttraumatic uveitis]. / Kliniko-immunomorfologicheskie paralleli pri posttravmaticheskikh uveitakh.

Parallels between the clinical diagnosis, immunological parameters of the leukocyte migration inhibition test (LMIT) to eye tissue antigens (uveoretinal, lenticular, and retinal), and morphological picture are studied in patients with posttraumatic uveitis and consequences of grave penetrating injuries to the eye without uveitis symptoms. Cell sensitization to uveoretinal antigen is detected only in posttraumatic uveitis but not in consequences of injuries without uveitis. The authors come to a conclusion that only positive LMIT with uveoretinal or a combination of uveoretinal and lenticular antigens may be considered as an immunological validation of autoimmune posttraumatic uveitis. Further improvement of LMIT with purified fractions of uveoretinal antigens is needed.

[Prospects of immunotropic therapy of traumatic uveitis]. / O perspektivakh immunotropnogo lecheniia travmaticheskikh uveitov.

Traditional corticosteroid and antiinflammatory therapy should be supplemented with new immunocorrective drugs in patients with traumatic uveitis and ocular subatrophy. Immunotherapy is a pathogenetically justified and perspective trend in multiple-modality treatment of patients with injuries to the organ of vision. The authors validate the use of immunocorrectors utilized in general transplantology for preventing rejection crisis. Immunostimulants or immunosuppresants can be added to treatment protocols for patients with traumatic uveitis, depending on the changes in the patient's immune status. New immunotropic drugs affecting all components of immunity are needed.

[Clinical aspects of traumatic uveitis and causes of enucleation]. / Kliniko-immunologicheskie aspekty travmaticheskikh uveitov, prichiny énukleatsii.

The authors analyze 37 cases with grave traumatic uveitis eventuating in enucleation. Terms of enucleation after the injury, type of the injury, clinical picture of chronic uveitis, echographic and electrophysiological findings are presented. In ten patients signs of sensitization to ocular tissues were detected in various periods after the injury. Sensitization was detected by the leukocyte migration inhibition test (LMIT). The authors regard the results as a response to release of tissue antigens in the bloodflow because of impairment of the blood-eye barrier caused by the trauma. The authors claim that the results of LMIT in traumatic uveitis may be regarded as an additional, together with the clinical symptoms, criterion among indications to enucleation.

[Immunological reactions in pathogenesis of posttraumatic uveitis and eyeball subatrophy]. / Immunologicheskie reaktsii v patogeneze posttravmaticheskogo uveita i subatrofii glaznogo iabloka.

Clinical and morphological examinations of 30 eyes enucleated for relapses of traumatic uveitis and subatrophy caused by grave penetrating wounds involving a complete loss of visual function were carried out and 12 patients were tested for sensitization to tissue antigens by the leukocyte migration inhibition test. Morphological examination revealed cellular reaction in eye membranes, indicating an autoimmune process developing in response to release of the antigenic tissue substances of the eye into the bloodflow and reactive flow of immunocompetent cells towards ocular tissues because of injury to the blood-eye barrier. Detection of sensitization to tissue antigen in the patients confirms this viewpoint. The authors compare the revealed inflammatory process in the injured eye with the graft rejection reaction and find them similar.