[Determination of cytokines in the blood serum and in the aqueous humor of the anterior camera during pseudoexfoliative syndrome and cataract.]

There have been studied changes of proinflammatory cytokines, IL-1ß and TNF-α, in anterior chamber aqueous humor and in blood serum before cataract surgery in 81 patients with cataract. Of these, 46 patients had verified diagnosis of pseudoexfoliative syndrome (PEÐ¥) of varying degree of manifestation of dystrophic changes and deposits of pseudoexfoliative material (main group). In 35 patients, PES (comparison group) has not been detected. 2-stage biomicroscopy (with a narrow pupil, after tonometry with mydriasis) and ultrasound biomicroscopy (UBM) have been conducted. According to the results of biomicroscopy and UBM structures of the eye, 3 stages of development of PEX have been identified: I - 11 (23,91%), II - 20 (43,48%), III - 15 (32,61%). Inflammatory complications after cataract surgery have been in 17,39% of eyes with PEÐ¥, of which PEX Stage II in 13,04% and PEÐ¥ Stage III in 4,35%. There have been no complications in the eyes with PEX Stage I and without PEX. In comparison with patients without PEX, significant differences in the indicators of IL-1ß and TNF-α both in the blood serum and in the aqueous humor of the anterior chamber of patients with PEX have been found. In particular, there have been confirmed significant differences of indicators depending on the stage of development of changes during PEX. At the same time, higher concentrations of IL-1ß and TNF-α during PEX, as well as somatic pathologies in patients with PES occurring 2 times more often, confirm the opinion that PEX should be considered as pathology of the organ of vision. Thus, decrease in the compensatory abilities of the body with age and a set of chronic age-related pathology form the pathogenetic mechanisms of PEX, including age-related changes in structures and surgery background in older patients, to a certain extent predetermining the nature and features of the postoperative period and possible complications.

[To the analysis of outcomes and severity of eye trauma in elderly patients].

PURPOSE: To study functional consequences of mechanical eye injury in older patients. MATERIAL AND METHODS: Clinical records of 601 patients aged from 50 (min) (current clinical material) to 92 (max) years, once admitted to the hospital with an eye injury during the last decade, were used in the study. The group included 438 (72.9%) men with an average age of 63.4 +/- 0.4 years and 163 (27.1%) women with an average age of 67.1 +/- 0.8 years. Functional parameters of each eye were analyzed by two rating scales: the first included five levels of visual impairment, the second - three, i.e. moderate hypovision (0.1-0.3), severe hypovision (0.09-0.05), and near or absolute blindness (0.04-0). Then, the joint performance of both eyes was analyzed (the best corrected visual acuity of the better or, in case of monocular vision, the only functional eye was taken into account). RESULTS: Comparison of visual functions of the two eyes at the discharge in regard to the potential risk of vision-related disability revealed that 33 patients (5.5 +/- 0.9%) with eye trauma had visual impairment that could be considered as a risk factor for group 1 disability, 26 patients (4.3 +/- 0.8%) were at risk for group 2 disability, and 58 patients (9.7 +/- 1.2%)--for group 3 disability. A total of 484 patients (80.5 +/- 1.6%) had satisfactory visual functions and were capable of handling daily living activities. CONCLUSIONS: Age-related vision changes can and should be considered as potential risk factors for eye injury. Given the high probability of preexisting age-related vision changes and, thus, a higher risk for complications, eye injuries in elderly patients can be undoubtedly attributed to heavy ones and are associated with the need for preventive measures.

[To the question of frequency of mechanical eye trauma in senile patients in Azerbaijan].

The article presents the results of the trauma of the eyes for a period of 10 years (2000-2009) in 601 hospitalized patients of 50 (min)-92 years (max) years old. By the age criteria, the eye injury most often occurred in senile patients (50.9%), the proportion of senile patients over time decreases due to the increase of middle-aged patients. By decades of age groups, there is a slight excess of the frequency injury index at the age of 51 to 60 compared with age from 61 to 70. As potential risk factors for injury the age-related changes in quality of vision cannot be excluded. Men were 438 (72.9%), women 163 (27.1%) with an average age of males 63.4 +/- 0.4 years, females--67.1 +/- 0.8. Timely provision of expert care, as a visual criterion, reflected the time factor of patients' addressing to the hospital. The analysis of the causes of eye injuries confirmed their diversity. The traumas received by the patients while falling (14.5 +/- 1.4) including--frequent due to the aggravation factor of the patient that determines both the injury and delayed treatment are noteworthy. According to addressing to the hospital, primary emergency aid was rendered on the first day only to 15.3 +/- 1.5% patients, within 1 to 3 days 34.9 +/- 1.9% were hospitalized, 4-7 days--10.5 +/- 1.2%, 8-14 days--7.5 +/- 1.1%. The problem of eye injury in senile patients remains topical, given the frequency of eye injuries in senile patients, given the high probability of somatic aggravation of the patients as a potential risk factor for injury, delayed treatment, which makes the problem of eye trauma in senile patients the one that demands increased and due attention.

[Scanning electronic microscopy of lens after mechanical eye injury].

The results of scanning electronic microscopy (SEM) of 12 lenses after mechanical eye injury with rupture of Zinn ligament fibers in elderly patients. SEM results are compared to those of lenses after senile cataract cryoextraction including pseudoexfoliation syndrome (PES). Characteristic features of lens capsule changes after mechanical eye injury are revealed including PES as a pathologic lens aging.

Hageman factor and kallikrein in pathogenesis of senile cataracts and the pseudoexfoliation syndrome.

It is thought that dystrophic changes in the human aging anterior eye are due to lipid peroxidation in both the cortical and nuclear structures of the lens under the conditions of ischemia. These changes are often accompanied by only lens opacification (senile cataract-SC) or by formation of amorphous or fibrillar deposits in anterior eye, disturbances of eye hydrodynamics and lens opacification (pseudoexfoliation syndrome-PES). Our results suggest that the main reason of dystrophic changes in the tissues of the aging anterior eye is the disturbance of the haemato-ophthalmic barrier and that the plasma kallikrein-kinin system takes part in this disturbance. Penetration of plasma proteins, such as C-reactive protein, complement components, immunoglobulins and coagulation factors, from plasma into the aqueous humor is responsible for damaging epithelial structures of anterior eye and formation of pseudoexfoliative material. Using ELISA, the C-reactive protein, IgG and IgM antigens have been shown to localize on the surface of the opaque lenses. Presence of these complement binding proteins in the superficial lens structures as well as the high C3a concentration in the aqueous humor substantiates the pathogenic role of complement activation in the lenticular epithelium upon cataract and PES formation.

[Pseudoexfoliative syndrome. Possible role of C-reactive protein and autoantibodies in the pathogenesis of the disease]. / Psevdoéksfoliativnyi sindrom. Vozmozhnoe uchastie C-reaktivnogo belka i autoantitel v patogeneze zabolevaniia.

Participation of acute inflammatory proteins (C-reactive protein, alpha-I-inhibitor of proteinases, C1q component of complement, IgG and IgM) in pathogenesis of pseudoexfoliative syndrome (PES) and, particularly of senile cataract was studied. In the course of the syndrome development blood vessel permeability was increased in the anterior chamber of the eye. Content of proteins in aqueous humor was increased 10-fold and even more as compared with normal state. High amount of proteins, main fractions of which were located at zones of 68,000, 37,000 and 20,500 D, were detected after polyacrylamide gel electrophoresis in presence of sodium dodecylsulfate. The zone of a protein with molecular mass of 20,500 D was found in presence of a reducing agent; in absence of the latter the zone was only slightly visible. The enzyme-labelled assay, used for detection of antigens in lens capsule, enabled to find such antigens as C-reactive proteins, IgG, IgM and less distinctly C1q component of complement.