[Intracorneal selective stromal transplantation]. / Vnutrirogovichnaya transplantatsiya stromy.

Deep anterior lamellar keratoplasty or penetrating keratoplasty are currently considered the optimal methods of surgical treatment of stromal dystrophies and corneal degeneration. Despite certain advantages and benefits of these methods, they also have significant limitations: involvement of superficial corneal layers in the surgery, need for suturing, development of post-keratoplasty astigmatism etc. PURPOSE: This study aimed to test and describe the new method of closed sutureless keratoplasty (intracorneal selective stromal transplantation), which was indicated in isolated dystrophic and degenerative pathology of the stroma. MATERIAL AND METHODS: Intracorneal selective stromal transplantation was performed in a 62-year-old patient with stromal degeneration and intact corneal layers between the altered stroma and the Descemet's membrane posteriorly, and the Bowman's layer anteriorly. The patient also had immature senile cataract. Corneal stroma was removed and replaced with a graft in the optical center of the lens, while the endothelium, the Descemet's membrane and the Bowman's layer remained intact. RESULTS: The proposed technique of intracorneal selective stromal transplantation makes it possible to replace only the pathologically altered stroma through closed surgical approach, without affecting the anterior and posterior surfaces of the cornea. Best-corrected visual acuity has increased in the patient from 0.01 to 0.6, while mean endothelial cell density has not changed in the course of 24-months follow-up. CONCLUSION: The proposed keratoplasty method can be used in patients with dystrophy or degeneration of the corneal stroma and preserved endothelial cells, intact Descemet's membrane and Bowman layer. Since the superficial corneal layers are not involved during the surgery, intracorneal selective stromal transplantation combined the advantages of both deep anterior lamellar keratoplasty and endothelial keratoplasty. The biologically favorable result in this first clinical case allows a preliminary conclusion on the technical possibility and functional effectiveness of the proposed method, but further long-term observation and more clinical cases are required.

[Descemet membrane endothelial keratoplasty after implantation of glaucoma drainage devices]. / Vozmozhnosti transplantatsii endoteliya s destsemetovoi membranoi posle implantatsii antiglaukomnogo drenazha.

Secondary decompensation of corneal endothelium, including transplanted, is a frequent long-term complication of glaucoma drainage surgery. According to literature data, after implantation of a glaucoma drainage device into the anterior chamber, the speed of endothelial cells density (ECD) loss increases significantly. PURPOSE: To study the possibility of performing modified Descemet membrane endothelial keratoplasty (DMEK) with maximum graft diameter, and to assess its short-term effectiveness in the treatment of bullous keratopathy (BK) in the presence of a glaucoma drainage device in the anterior chamber. MATERIAL AND METHODS: Modified surgery 3/4-DMEK was performed in 9 eyes of 7 patients with BK and Ahmed glaucoma drainage using graft of maximum diameter (11±1 mm). Average follow-up time was 15.3±2.5 months (12 to 18 months). RESULTS: No intraoperative or postoperative complications were observed. Mean ECD after 12 months amounted to 1664±346 cells/mm2, which corresponds to ECD reduction of 34±9.6% (24 to 49%) in comparison to preoperative values. Mean best corrected visual acuity 12 months after surgery increased from 0.04±0.03 (0.01 to 0.1) to 0.3±0.2 (0.04 to 0.7). The last follow-up examination revealed all corneas to have preserved transparency and stable pachymetry measurements (from 488 to 548 µm). CONCLUSION: Performing 3/4-DMEK with a mega graft for treatment of BK after drainage surgery is technically possible. Absence of Descemet membrane (DM) donor and preservation of DM recipient in the drainage tube plane eliminates its contact with the endothelium. Maximum graft diameter should in the long term help prolong the effectiveness of the surgery.

Effect of hrWnt7a on Human Retinal Pigment Epithelial Cells In Vitro.

Human recombinant protein Wnt7a (hrWnt7a) inhibits cell proliferative activity and triggers cell polarization. Although cell polarization process was maintained only over a short time, probably via microenvironmental stimuli, hrWnt7a is involved in the transformation of the retinal pigment epithelium. Analysis of Wnt signaling pathway and its regulation will help to understand the processes in retinal pigment epithelial cells under pathological conditions, which can be useful in developing new generation drugs.

[THE ROLE OF BIOLOGICAL MEMBRANES IN DIFFERENTIAL DIAGNOSTICS OF SALMONELLA AND ACUTE ALCOHOL GASTROENTERITIS].

We evaluated the influence of Salmonella infection and alcohol on biological membranes from the content of serum phospholipid fraction known to be a component ofenterocyte membranes. Any change of membrane phospholipid content leads to a change of their blood level. The study included 50 patients with acute alcohol gastroenteritis, 50 ones with salmonella gastroenteritis, and 50 healthy subjects. Both salmonellosis and alcohol caused differently directed changes in biological membranes. The mechanism of diarrhea in patients with salmonella and acute alcohol gastroenteritis is different. Diarrhea associated with alcohol gastroenteritis is due to enhanced viscosity of biomembranes that decreases in salmonella gastroenteritis. It suggests different approaches to the treatment of these conditions. The membrane destruction coefficient below 2 is an additional proof of alcoholic etiology of gastroenteritis whereas its value above 3 confirms the involvement of salmonellosis in pathogenesis of gastroenteritis.

[PCR study of the human herpes virus type 6 and other viruses of the herpes group in eye diseases].

To study the role of the HHV-6 type in the development of eye diseases PCR tests of blood (152), cornea biopsies (61), and intraocular fluids (11) for HHV-6 and other viruses of the herpes group (HSV type 1 and 2, CMV, EBV) were conducted. It was found that the HHV-6, along with other representatives of the Herpesviridae, can be detected in patients with different clinical forms of ophthalmopathology (174 patients were surveyed). Viral DNA was detected in blood, cornea, and in the anterior chamber fluid. The obtained data allow that the HHV-6 to be suggested as a possible cause of the ophthalmic herpes along with the other viruses of this group. It makes finding the virus DNA an essential step towards setting the etiologic diagnosis of the ophthalmological patients.

[The mode of differential diagnostic of and acute alcoholic gastroenteritis].

The study was carried out to develop mode of differential diagnostic of salmonella and acute alcoholic gastroenteritis on the basis of phospholipid specter of blood serum. The indicators of phospholipid fractions of blood serum were analyzed in 50 healthy persons, 50 patients with acute alcoholic gastroenteritis and 50 patients with salmonella gastroenteritis were analyzed. The relative content of following fractions of whole phospholipids were analyzed--total lysophospholipids, sphyngomiyelin, phosphatidcholine, phosphatidyletanolamin. The phospholipid spectrum of blood serum can be applied in differential diagnostic of salmonella gastroenteritis and acute alcoholic gastroenteritis. The disorders of metabolism of lipids under given pathological conditions have a multidirectional character. The salmonella gastroenteritis is characterized by decreasing of relative content of total lysophospholipids and increasing of phosphatidcholine as compared with standard conditions. The acute alcoholic gastroenteritis is characterized by increasing of relative content of total lysophospholipids and phosphatidcholine and decreasing of level of phosphatidcholine. The content of total Iysophospholipids in blood serum is lower on 35% or 30.0 mg% permits diagnosing acute alcoholic gastroenteritis. The content of phosphaltidcholine in blood serum higher than 40% or 50 mg% permits diagnosing salmonella gastroenteritis.

[An experience of dried cornea transplantation].

Sometimes an urgent lamellar keratoplasty remains the only treatment option for corneal defect closure. When fresh donor tissue is absent as it is regular in recent years dried cornea transplantation becomes reasonable. In recent years in ocular trauma department 320 transplantations of dried on silicagel cornea were performed. Analysis of results allows to conclude that use of dried cornea is a promising surgical procedure to preserve the globe and in some cases to prepare the eye with severe trauma for subsequent optic surgery.

[Rehabilitation of patients with burn injury to the eye].

Based on the analysis of the results of treatment in patients with severe and particularly severe burn injuries to the eye, the authors developed principles in the rehabilitation of such patients. The rehabilitation period was divided into 4 stages: 1) treatment of burn injury (removal of necrotic tissues; revascularization of the outer membrane of the eyeball; prevention of cicatricial deformity of the eyelids); 2) treatment of burn disease complications (blood blepharorrhaphy, soft contact lenses, maximum antihypertensive therapy, treatment of cataract and glaucoma); 3) reconstruction of the eyelids, conjunctival vaults, eyeball surface (transplantation of autologous skin flaps, oral mucosa, fixation of leukoma with the automucosa, autocartilage); 4) functional rehabilitation (limbic transplantation, keratoplasty, keratic replacement with a Fedorov-Zuyev prosthesis). The use of the scheme in clinical practice can achieve a considerable reduction in the time of rehabilitation and the rate of functional and anatomic death of the injured eye and improve the functional outcomes of treatment in patients with severe and especially severe burn injury to the eye.

[Surgical treatment policy for concomitant burn injury to the eye in patients admitted to burn units].

The investigation was undertaken to study the causes of ocular complications in patients with extensive body surface burns. Ninety-five patients with concomitant eye burn injury and its consequences, of them 50 victims who had been first admitted to the unit after long-term treatment in burn centers and 45 patients observed jointly with the combustiologists of the Moscow City Burn Center were followed up. The frequency and pattern of destructive complications and, a result, eye burns were ascertained to be associated with the possibility of delivering a specialized ophthalmic care, its period, and nature.

[Experimental rationale for local use of angiotensin-converting enzyme inhibitors for the treatment of ocular tissue ischemia on a model of postburn conjunctival ischemia].

The authors have evaluated the local renin-angiotensin system on a model of experimental postburn conjunctival ischemia from the tear activity of angiotensin-converting enzyme (ACE) and studied whether impaired microcirculation might be restored by locally applying the ACE inhibitor captopril. It has been found that in conjunctival ischemia, there is a considerable increase in the activity of ACE, the key enzyme of the renin-angiotensin system, the activity of which largely determines the microcirculation in eye tissues. Instillations of the ACE inhibitor to rabbits within 2 weeks after alkaline burn of the eye result in a reduction in ACE activity and an earlier recovery of microcirculation in the area of conjunctival ischemia. Instillations of the ACE inhibitor captopril in ocular burn facilitate the maintenance of the tear antioxidant potential at the high level, which also suggests that the ACE inhibitor has a positive effect on the course of reparative processes after ocular burn injury. The findings suggest that it is promising to locally use ACE inhibitors for the treatment of ischemic processes in the eye.

[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.

[Limbic transplantation in the surgical rehabilitation of patients with prior severe ocular burns].

The paper provides the results of limbic transplantations in 21 patients with varying postburn leukomas. Autolimbic (n = 6; 28.6%) and limbic (n = 15; 71.4%) transplantation was performed 34.27 +/- 13 months after injury. Limbic transplantation with removal of the fibrovascular pannus resulted in improved visual acuity in all cases with the relatively transparent corneal stroma (Group 1; n = 10). In some cases, limbic transplantation could circumvent the problems associated with corneal graft epithelization after further corneal transplantations in Group 2 patients (n = 8) with turbid corneal stroma. In Group 3, surgery was made to prevent corneal changes occurring when the bulbar conjunctiva was removed during plastic repair of mucosal fornices from the lip. Postoperative recurrent corneal conjunctivization and epithelial erosion were observed only in 4 patients. The findings are of value in defining the site and indications for limbic transplantations in the surgical rehabilitation of patients who have experienced severe eye burns.

[Deep layer posterior keratoplasty: preliminary data].

The paper presents preliminary results of deep layer keratoplasty first performed in Russian ophthalmology. It describes its surgical techniques. Deep layer posterior keratoplasty was made in 3 patients with epithelial-and-endothelial dystrophy of the cornea. The operation was simultaneously made with ultrasound cataract phacoemulsification and intraocular lens (IOL) implantation artificial in one case. In the early postoperative period, the fixed position of a transparent keratograft was achieved and the epithelial layer also recovered without signs of bullous keratopathy. The immediate results of posterior keratoplasty inspire optimism. Deep layer keratoplasty is technically more difficult than penetrating keratoplasty, more painstaking and more prolonged. At the same time it has no shortcomings typical of penetrating keratoplasty. The procedure of deep layer keratoplasty requires further long-term study, simplification of surgical techniques, detection of possible complications, and modes of their correction.

[Immunomorphological study of time course of repair of corneal deep burn defects after stromal equivalent transplantation].

Early defects due to the afflux of monocytic phagocytes into the inflammatory focus, rapid resorption of detritis and normalisation of correlation between contents of matrix proteinases and their inhibitors, stimulation of stromal cornea keratinocytes migration and their proliferation characterize repair of postburn defects in transplantation of the stromal equivalent. Repair against the background of stromal equivalent transplantation is of a histotypical character: collagen gel organizes and serves the basis for migration of the cornea fibroblasts and temporary matrix for growing new epithelium, while restored basal membrane is a derivative of cornea epithelium.

[Repair of corneal defects using tissue engineering].

We propose to treat deep corneal burns by grafting a living stromal equivalent, since keratocyte death and stromal destruction are the main factors of ulceration and destruction of the eye. A technique was developed for isolation and grafting a living stromal equivalent. Twenty one patients with deep corneal defects were treated. A stable therapeutic effect was observed in 95% of cases. The advantage of the developed method is partial recovery of affected corneal transparency.

[Examination of the local antioxidative system of the eye in experimental corneal burn injury and the prospects for pharmacological correction of its parameters].

The present paper deals with the study of the efficiency of oral use of the antioxidative drug Immugen (a complex of alpha-tocopherol, oubichinone, selenium aspartate, methionine, and soyabean phospholipids) on a rabbit model of severe alkaline-induced corneal burn. The investigations have indicated that addition of Immugen to the rabbit feed exerts a significant positive effect on the parameters of the local antioxidative system of the eye and causes an increase in the activity of superoxide dismutase and catalase, and, on day 14, in antioxidative activity. The early experimental periods were marked by a slight rise in the frequency of deep corneal ulcerations. Moreover, the long-term clinical effect of use of Immugen appears as a significant increase in the area of the transparency-preserving affected cornea. The findings suggest that the antioxidants can show their optimal effect in the complex therapy for burn processes, including the use of proteinase inhibitors.

[An efficiency study of transplantation of allogenic fibroblasts cultivated in collagen gel for the treatment of corneal burn defects in experiment]. / Izuchenie éffektivnosti transplantatsii kul'tivirovannykh allogennykh fibroblastov v kollagenovom gele pri lechenii ozhogovykh defektov rogovitsy v éksperimente.

The paper contains the results of using a mew method applicable to regulation of corneal regeneration, i.e. transplantation of allogenic fibroblasts cultivated in collagen gel within an experimental model of acute alkali corneal burns in rabbits. Two experimental stages, involving 120 animals, were undertaken. The above method was used, at stage 1, on day 2 after trauma and, at stage 2, it was applied in two weeks after ocular burns with profound corneal defects were inflicted. The clinical, morphological and immune-histochemical examinations were used to show a high efficiency of the method in healing the corneal burn wounds; the mechanism of the therapeutic action of the transplant components exerted on regeneration of the affected cornea was investigated; finally, good outlooks for using the discussed method in clinical practice were proven.

[Keratoplasty in the surgical treatment of eye burns and their complications]. / O keratoplastike v khirurgicheskom lechenii ozhogovoi travmy glaz i ee oslozhnenii.

The report contains the analysis results of 53 keratoplasty procedures in the treatment of patients with severe and extra severe burns of eyes (185 cases within 6 years). On the basis of the obtained results, the authors conclude that the active surgical approach, when used soon after trauma (necrectomy, autotenoplasty, bloody blepharorrhaphy), cut significantly the rate of indications for emergency keratoplasty (to 9% only in cases involving the presence of a deep defect caused by the thermal affection or the presence of burn-agent particles in the corneal stroma); an extra severe burn is the absolute indication for lamellar keratoplasty; indications for transplantation of the cornea, 1 week after trauma and more, arise, when there is ulceration (especially, perforation), due to a prolonged and ineffective therapy and due to an inadequate surgical tactics. The authors suggest the criteria for a substantiated and more effective use of transplantation of the cornea in the treatment of eye burns.