Corneal transplantation is a method of surgical treatment used to restore the optical and structural properties of the diseased cornea which is successfully performed for over 100 years. The immune rejection remains one of the most common causes of an unsatisfactory outcomes of penetrating keratoplasty. The cases of corneal allograft rejection range from 2.3% to 65% depending on the risk factors taking place in the recipient. The most well-known risk factors for corneal allograft rejection are neovascularization of the recipient’s cornea, active ocular inflammation, herpetic keratitis, ocular surface disease, young age, previous surgery of the anterior segment of the eye, neurotrophic keratopathy, big and eccentric graft, anterior synechia. Given the fact that the pathophysiology of corneal graft rejection is very complex and not fully understood the applied methods of treatment and prevention are often ineffective in “high risk” patients. New experimental targeted approaches including the use of antibodies and gene therapy are currently being developed but do not have a clear success in the clinic yet.Therefore for obtaining satisfactory outcomes of corneal transplantation in “high risk” patients all main known risk factors have to be taken into account with subsequent possible preoperative therapy to reduce their impact; careful monitoring of the patient in the postoperative period should be done to early detection of allograft rejection signs; optimal schemes and combinations of immunosuppressive drugs authorized for use in the clinic have to be developed.

 

Keratoconus is a progressive degenerative corneal disease. It causes a disruption in the structure and organization of the corneal collagen matrix and leads to its thinning and protrusion. In children keratoconus progresses faster and differs in more severe course, compared with adults. It is associated with the age structure of the child’s cornea. Until recently, the treatment of keratoconus included visual rehabilitation in the early stages and surgical treatment in advanced stages. Both methods didn’t have any effect on the disease’s pathogenesis. Cross-linking is a method inhibiting the progression of keratoconus, it allows to change the treatment approach fundamentally. Cross-linking is the only method directly acting on the pathogenesis of keratoconus, forming new molecular bonds between the collagen filaments, strengthening the corneal stroma and changing its biomechanical properties, which allows to slow the disease’s progression. Taking into account the peculiarities of keratoconus development in children, cross linking in children’s practice is even more perspective than in adults. Nevertheless, the novelty of the method, the lack of long-term studies about the effects for the child’s cornea and the variability of treatment protocols, are the main factors for the careful use this method in children. This work is a literature review describing the principles, advantages and limitations of the use of different types of cross-breeding in children with an analysis of the evidence base and consideration of possible options for the development of this method in children’s practice in the future.

There is no doubts that problem of keratoconus treatment is high relevant. The number of diagnosed ectasia, including iatrogenic ectasia, increased — in recent years. The amount of post-LASIK and ectasia after RK in late postoperative period multiplies significantly. It is associated not only with inception of new ways of treatment into practice, but also with the upgrade of diagnostic methods and equipment. A new method of local personalized crosslinking (LCXL) was integrated into clinical practice using Laplace’s equation, pachymetry and topography maps data, It exceeds usual Dresden protocol on several parameters. This article shows the reaction of patients’ eyes on the treatment and the effectiveness of technique is provided. Materials and methods: topographic indications were evaluated (Orbscan II (B+L)) of 28 patients (40 eyes) aged 18 — 44 with keratoconus stages I-IV (12 eyes — I stage; 16 eyes — II stage; 9 eyes — III stage; 3 eyes — IV stage classified by Abugova T.D.), as well as UCVA, BCVA for 12 months after surgery. Normal values were estimated by characteristics of 30 eyes without any refractive errors. Results: LCXL is an effective way of treatment of corneal ectasia; it’s more effective in early stages. This technique has a strong controlled refractive impact and allows to reduce inflammatory after procedure.

 

Purpose: to analyze the effectiveness of endolaser retina photocoagulation and subtotal vitrectomy in patients with proliferative diabetic retinopathy complicated by hemophthalmos using intraoperative fluorescein angiography. Patients and methods. Patients were divided into two groups. In the main group (24 patients, 29 eyes) we performed endolaser photocoagulation of the retina using intraoperative fluorescein angiography data after removal of the altered vitreous body. In control group (31 patients, 32 eyes) we performed endolaser photocoagulation after the altered vitreous body removal in the zones of suspected ischemia without data of fluorescein angiography. Conclusions about the effectiveness of therapy were based on improvement / decrease of visual acuity, intraocular pressure dynamics, electrophysiological studies data and the number of complications (recurrent hemophthalmos, increased intraocular pressure, macular edema and iatrogenic scotomas). Results. The study was conducted on 61 eyes of 55 patients (age 23–80 years, male/female ratio was 0,53). Visual acuity before the operative intervention was 0.001 (median). Visual acuity in the main group was 0.3 (vs 0.1 in the control group) in one month after surgery, 0.35 — after 3 months and 0.3 — after 6 months (vs 0.1 and 0.2 in the control group, respectively). The sensory threshold in the control group (100 μA) was significantly higher than in the main group (90 μA). The incidence of hemophthalmos was significantly lower in the main group compared with the control (6.9% in the main group vs 31.3% in the control group). The incidence of absolute scotomas in the laser photocoagulation zone was significantly higher in the main group (100.0% vs 6.3%), and the incidence of absolute scotomas outside the laser photocoagulation zone was significantly higher in the control group in comparison with the main group (100.0% vs 3.4%). Conclusion. Endolaser photocoagulation in the target non-perfused retinal areas according to intraoperative fluorescein angiography data effectively increases visual acuity at 1, 3 and 6 months after surgery and reduces the number of complications such as hemophthalmos, development of iatrogenic absolute scotomas outside the laser coagulation zone.

Objective. To study the effect of uncomplicated phacoemulsification through the corneal incision with implantation of the intraocular lens (IOL) for changes in the macular region of the retina. Methods: The study included 35 eyes of 35 patients who underwent uncomplicated phacoemulsification with IOL implantation. The average age of the patients was 67±2,3 years, among them were 19 women and 16 men. Exclusion criteria: retinal pathology (postthrombotic and diabetic retinopathy, wet form of age-related macular degeneration and other diseases of the retina), previous eye injuries, uveitis, intra-operative complications. Retinal thickness in the fovea, the macula, and macular volume were measured by optical coherence tomography on the first day, after 2 weeks, 1 and 3 months after surgery. Results. In the period between the first day and two weeks after surgery there were the statistically significant incensement in retinal thickness in the macula from 306,64±21,15 mkm to 321,46±27,83 mkm (p <0.05), in the fovea from 211,45±20,24 mkm to 218,69±17,84 mkm (p<0.05), macular volume from 8,08±0,35 cubic mm to 8,46±0,54 cubic mm were registered. By the end of the first month after surgery maximum retinal thickness was 327,23±27,16 mkm, thickness in the fovea 220,31±18,63 mkm, macular volume 8,61±0,55 cubic mm. After 3 months, the maximum thickness of the retina reached 325,11±26,13 mkm, in the fovea 220,31±18,63 mkm, macular volume 8,55±0,49 cubic mm. Conclusion. There was an incensement of macular volume and retinal thickness in the period between the first day and two weeks after uncomplicated cataract phacoemulsification with intraocular lens implantation. The growth of these indicators continued within the first month after surgery, three months after phacoemulsification there was a downward trend. This can be important in determining the duration of drug therapy in the postoperative period.

Modern approaches to surgical glaucoma treatment is based on the safe and effective methods. In recent years, great attention is paid to the techniques of stimulating uveoscleral path outtake aqueous humor from the eye. Uveoscleral space in the extended outflow pathways is dominant and constitutes about 72%. Sclera is a field of the greatest interest, as the end stages of the outflow of aqueous humor via the uveoscleral path. The aim of the study was to investigate the influence of excimer laser sclerectomy on the drainage function of the eye and development of a mathematical model based on the permeability of the sclera of the amount of laser ablation at a defined area of laser exposure and the level of IOP. Studies were conducted on 12 human cadaver eyes isolated person. The domestic excimer laser “MicroScan Vizum” with a wavelength of 193нм (0,193 µm) was used for the thinning of sclera. In the experiment used a special computer program provided ablation of scleral tissue, the scleral bed forming a rectangular shape with a size 7,0x5,0 mm. the Depth of influence started from 100 microns to 600 microns in increments of 50 µn. The exposure was carried out at a constant perfusion pressure of 25 mm Hg After each impact was measured of the coefficient ease the outflow. A correlation was established between the factor and effective features, i.e., between the excimer laser deep sclerectomy (µm) and ratio of lightness outflow (mm3/min/mm Hg.St). Thinning of the sclera leads to an improvement of its permeability and increasing the coefficient ease the outflow. A mathematical model, allowing to achieve the desired ratio of lightness outflow experiment by excimer laser sclerectomy was developed. The mathematical model has the form of the regression equation.The sclera is a promising object for further developments in the surgical treatment of glaucoma. Laser ablation of the sclera leads to an improvement of outflow via the uveoscleral path and reduce intraocular pressure.

Purpose: To evaluate the results of intraocular correction of presbyopia by monovision in patients with cataract and primary corneal astigmatism and conduct a comparative analysis of these outcomes with the results of binocular multifocal IOLs implantation. Patients and methods. There were 21 patients with bilateral cataract surgery performed using toric monofocal intraocular lenses (monovision group) in the study. The indications for the operation were: 1) primary corneal astigmatism ≥ 1.0D in patients with cataract, 2) inability to conduct excimer laser correction. Reduction of spectacle dependence by monovision was discussed during preoperative conversation. The age of patients range from 32 to 65 years. Target refraction: Emetronopia on the dominant eye (DG) and myopia at 1.0–2.0 D in the non-dominant eye (NDG). Evaluation included measurement of uncorrected visual acuity, refraction, stereopsis, contrast sensitivity and patient satisfaction. The results were compared with the outcomes of binocular multifocal Iols implantation in 22 patients (44 eyes). Results. The spherical component decreased from 3.39±2.63D to 0.34±0.24D, cylinder decreased from 3.05±1.47D to 0.44±0,35D (P <0.01) in the monovision group three months after surgery . The deviation from target refraction was 0.30±0.35D. The mean difference between postoperative refraction on the two eyes was 1.92±0.57D. Postoperative corrected visual acuity significantly exceeded preoperative parameters. In 18 patients (88%) the stereoscopic visual acuity did not exceed 60 seconds and corresponded to the age norm, in 3 patients (12%) it was at the level of 80–100 arc seconds. In patients with multifocal IOLs, the stereovision values were identical (Ferrer-Blasco T. et al, 2008). Conclusion. The monovision is an effective method of reducing dependence on additional correction in patients with cataract and corneal astigmatism. Refractive outcomes, binocular visual acuity, predictability and stability are comparable with the results after multifocal IOLs implantation.

 

The exact diagnosis of the fundus pathology requires the most modern equipment use. This is mandatory for the selection of the most complete therapy and monitoring of ongoing treatment. At present, the method of scanning laser ophthalmoscopy is widely spread. However, for the earliest detection of the smallest pathological changes, data of the normal ocular fundus state using a scanning laser ophthalmoscope is necessary. Thus, the purpose of our research becomes relevant. Purpose: to give a characteristic of the fundus in patients without concomitant pathology with using various modes of a scanning laser ophthalmoscope. Patients and methods. 116 people (232 eyes) at the age from 17 to 71 years (mean age 32.5±12 years) were examined. The patients were divided into two groups. Group I: 81 patients (162 eyes) with different ophthalmopathology. Group II: 35 people (70 eyes) — practically healthy and did not have an anamnesis of consulting an ophthalmologist. Diagnosis of the patients’ fundus was performed using a scanning laser ophthalmoscopy with retro-mode imaging and autofluorescence registration. Results. After the conducted research features and regularities of the reflectivity distribution of laser beams from the fundus structures are revealed. Also a characteristic of various anatomical formations and zones of the fundus in the normal conditions is given when examined by a scanning laser ophthalmoscope. An algorithm for examining patients and analyzing the images was developed. Conclusion. The use of scanning laser ophthalmoscopy made possible to take a fresh look at the algorithms of diagnosing patients with fundus pathology. Understanding the normal conditions ofundus allowed an earlier detection of the smallest pathological changes in the retina.

 

This article deals with the PCR diagnostic results of the vitreous and retina biopsy material in patients suffering from panuveitis with retinal detachment. Rhegmatogenous retinal detachment with partial hemophthalmia was diagnosed as a result of primary diagnosis. The pair eyes were intact. Ultrasound B-scan, electrophysiological studies, ocular fundus photoregistration and standard ophthalmological examination was conducted for all patients. As a special method of investigation, PCR diagnostics of a biopsy material from a primary vitrectomy was used as a special method. In ten patients with panoveitis, acute retinal necrosis and retinal detachment, vitrectomy with endolaser coagulation of the retina and a silicone tamponade was performed. Vitrectomy with endolaser retinal photocoagulation and silicone oil tamponade was performed in ten cases of panuveitis with acute retinal necrosis and retinal detachment; postoperatively systemic antiviral therapy was administered for 6–12 weeks. In the postoperative period, all patients underwent a course of systemic antiviral therapy with valaciclovir 500 mg twice a day for 6-12 weeks. In the absence of effect, valganciclovir 900 mg twice daily for 21 days was additionally used. As a result of PCR-diagnostics mixed infection (in the biopsy of the retina — viral DNA, in the biopsy of the vitreous body — DNA of the mycobacterium tuberculosis) was detected in 2 patients with the most severe retinal necrosis and panoveitis with funnel-shaped retinal detachment, Viral DNA was found in the retina biopsy specimen in one patient, and in the vitreous biopsy specimen DNA of the pathogen was not detected. Early primary vitrectomy promotes the most functional results: best corrected visual acuity after removal of the silicone oil reached 0,3–0,6 in the Golovin-Sivtsev table. The obtained data had shown, PCR is the most informative method for determining the etiology of the process is PCR diagnostics of the retina biopsy that with panoveitis with acute retinal necrosis. A potential cause of this nosological form is a mixed infection, namely, the combination of the viral nature of the disease with tuberculosis, although it is not always possible to identify all etiological agents.

 

The purpose: to evaluate the informativity of optical coherence tomography in patients with aggressive posterior retinopathy of prematurity. Patients and methods. spectral optical coherence tomography using portable device iVue-100 with a removable camera (Optovue, USA) was held in 32 children (64 eyes) with aggressive posterior retinopathy of prematurity with a gestational period 26–31 week. Results. Children with aggressive posterior retinopathy of prematurity at the stage of early clinical manifestations, in addition to the indication that the immaturity of the retina, according to the spectral optical coherence tomography revealed only a few areas of epiretinal proliferation, which are not visualized with a digital retinoscopy and binocular indirect ophthalmoscopy. When the process is more pronounced in children with retinopathy of prematurity aggressive rear stage manifestation already determined multiple zones epiretinal proliferation as a "mushroom" and "flake" conglomerates with rear zone hyaloid membrane had an uneven seal. Coarser structural disorders of the retina and the vitreoretinal interface have been identified in patients with advancedstage aggressive posterior retinopathy of prematurity. We determined the shaft extraretinal proliferation as a "comb", as well as portions of epiretinal proliferation on the border of vascularized and avascular retina, which tended to merge, and the formation of massive hyperreflection complexes, lifted back hyaloid membrane, which was not only uneven sealed, but in some places is stratified. Conclusion. Despite the complexity of the procedure and the complexity of its implementation, the data obtained are particularly valuable and informative because they allow to complement the clinical picture and objectify it. It helps to choose the optimal tactics and improvement of a differentiated approach to the treatment of aggressive posterior retinopathy of prematurity.

Objective: Comparative morphological characteristic and evaluation of cytokine profile of idiopathic epiretinal membrane (ERM), complicated lamellar macular hole. Materials and Methods: Immunohistochemical study of 15 ERM removed during vitrectomy included the definition of responses to antigens fibronectin, laminin, glial fibrillary acidic protein. All membrane samples were divided into two groups: I group consisted of 8 ERM, which wasn’t clinically combined with retina defects, the II group included 7 ERM complicated lamellar macular hole. Results: ERM in group I were a collagen-membrane with a thickness from 2,1±0,7 to 4,4±1,4 µm, infiltrated radial glial cells, isolated fibroblastic cells. For membranes was characterized by a positive reaction to GFAP and largely negative reaction (62.7%) on fibronectin, laminin. ERM in group II were more thick, which was in the range from 6,03±1,6 to 7.56±1,02 µm, high cell density: radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. Immunohistochemistry complicated ERM had a positive immunophenotyping antigens against adhesion protein fibronectin, laminin, of GFAP along with a pronounced fibroblastic and macrophage infiltration. Conclusion: ERM complicated lamellar macular hole, characterized by an increased thickness, marked infiltration of radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. The positive response comparable ERM complicated lamellar macular hole on fibronectin, laminin and GFAP could mean cytokines involved into development and progression of neurodegenerative process. The accumulation of collagen fibers and myofibroblasts may help to strengthen the contractions and reduce the elastic properties of ERM, with the subsequent development of the tangential tractions and retinal tear.Objective: Comparative morphological characteristic and evaluation of cytokine profile of idiopathic epiretinal membrane (ERM), complicated lamellar macular hole. Materials and Methods: Immunohistochemical study of 15 ERM removed during vitrectomy included the definition of responses to antigens fibronectin, laminin, glial fibrillary acidic protein. All membrane samples were divided into two groups: I group consisted of 8 ERM, which wasn’t clinically combined with retina defects, the II group included 7 ERM complicated lamellar macular hole. Results: ERM in group I were a collagen-membrane with a thickness from 2,1±0,7 to 4,4±1,4 µm, infiltrated radial glial cells, isolated fibroblastic cells. For membranes was characterized by a positive reaction to GFAP and largely negative reaction (62.7%) on fibronectin, laminin. ERM in group II were more thick, which was in the range from 6,03±1,6 to 7.56±1,02 µm, high cell density: radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. Immunohistochemistry complicated ERM had a positive immunophenotyping antigens against adhesion protein fibronectin, laminin, of GFAP along with a pronounced fibroblastic and macrophage infiltration. Conclusion: ERM complicated lamellar macular hole, characterized by an increased thickness, marked infiltration of radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. The positive response comparable ERM complicated lamellar macular hole on fibronectin, laminin and GFAP could mean cytokines involved into development and progression of neurodegenerative process. The accumulation of collagen fibers and myofibroblasts may help to strengthen the contractions and reduce the elastic properties of ERM, with the subsequent development of the tangential tractions and retinal tear.

Objective: to evaluate the effect of NSAIDs eye drops with different preservatives on the viability of epithelial cells of human eyes in vitro. Materials and methods. The object of the study was four of the drug Broxinac®, Acular LS®, Diclo-F ®, Indocollyre®. As test-systems were used permanent cell lines of transformed conjunctival (Chang Conjunctiva, Clone 1-5c-4) and corneal (HCEC). The cytotoxicity of NSAID drops were assessed by the morphology and functional cells activity by the methods of phase contrast microscopy (PCM), MTT test and cell analysis in real time using the xCELLigence system. Results. It was found with MTT-test that cell lines HCEC are more sensitive to the cytotoxic action of the studied drugs than cell lines of Chang Conjunctiva, Clone 1-5C-4. The metabolic activity of conjunctiva cells in the presence of drugs, Acular LS® and Broxinac® was three times lower than in control; in the presence of drugs Indocollyre® and Diclo-F® — 20 times lower vs. the control. The metabolic activity of the cornea cells e in the presence of drugs, Acular LS® and Broxinac® was four times lower than in control; in the presence of drugs Indocollyre® and Diclo-F® viable cells were not identified. Drugs Indocollyre® and Diclo-F® has had a very high toxic effect on both cell types. The results of cell analysis xCELLIgence for both types of cells are consistent with the results of MTT test and in vivo observation of cells. Conclusion. Based on these data, there is the following gradation of NSAID eye drop’s cytotoxic potential: (reduce toxicity): Indocollyre® = Diclo-F® > Acular LS® = Broxinac®.

Purpose: clinical monitoring of functional parameters in patients with early stage of age-related macular degeneration (AMD) receiving the dietary supplement Retinorm. Patients and methods: clinical monitoring was conducted during 5 months in 40 patients aged 42–75 years with AMD-manifestations in the form of dry drusen and pigment epithelium defects typed as «geographic atrophy». The main group (20 subjects, 35 eyes) received dietary supplement Retinorm (1 capsule 3 times daily for two months with a month break and repeated admission rate, similar to the first). Patients also received instillations of Visomitin® with3 time daily by such mode: using of instillations 2 months, 1 month break, after that — continuation of instillations during 2 months. The control group (20 subjects, 34 eyes) received only Visomitin® instillations 3 times daily by the same scheme as group I. Checking of visual acuity with maximal correction, static computer perimetry, the optical coherent tomography of retina central area, definition of critical flicker frequency (CFF), retinal electrical sensitivity and optic nerve electrical lability were used as the examination methods. Results: Indicated therapy in the main group improved the monitored functional parameters. Increase of uncorrected visual acuity and the best corrected visual acuity, decrease of relative and absolute scotomas amount in central area of the visual field, increasing of CFF (p<0,05) and tendency to increasing of electrical lability (p<0,5) and lowering the threshold electrical sensitivity (p<0,2) were obtained. The changes of the pointed parameters in the control group were irrelevant and unreliable. Conclusions: The findings suggest a positive effect of Retinorm for the neurosensory cells of retina and for metabolism of the crystalline lens, which contributes to the stabilization of the pathological process in AMD and initial senile cataract. Supplement Retinorm can be recommended for widespread use in patients with early stage-AMD especially in the possible association with initial senile cataract.

Research objective: comparative assessment of efficiency of use of Emoxypin® by an endonasal electrophoresis and parabulbar injections at a chorioretinal dystrophy. Methods: 71 patients (average age of 55±3 years) suffering from a chorioretinal dystrophy of various genesis were in the study. The ophthalmologic examination included: evaluation of visual acuity, a field of vision, a visual fatigue, a condition of bulbar microcirculation (the general conjunctiva index). Besides, electrophysiological examination was conducted, including critical frequency of merge of flickers and electric sensitivity of an eye. The patients were divided into 2 groups. The main group (28 patients) received Emoxypin® with endonasal electrophoresis and group B (43 patients) received Emoxypin® by parabulbar injections. Results: Results of the statistical analysis in both groups showed visual acuity increasment, expansion of borders of a field of vision, depression of visual fatigability, indicators of electrophysiological examination and bulbar microcirculation improved. Conclusion: The comparative assessment of efficiency of use of Emoxypin® by an endonasal electrophoresis and parabulbar injections at a chorioretinal dystrophic various a genesis showed appreciable medical effect in the course of restoration of visual functions which in some cases (18%) even better effect observed at parabulbar injections.

Purpose: To describe the clinical case of advanced purulent corneal ulcer successfully treated with modified cross-linking (M-CXL). Key points: A developed purulent corneal ulcer augmenting from the center to the limb with stromal lysis in the zone of keratotomy incisions gradually progressed despite active conservative treatment during 1 month. After 2 sessions of modified PACK-CXL performed with simultaneous frequent instillations of preservant-free moxifloxacin eye drops, the purulent process and corneal lysis was successfully stopped. It allowed to perform optical penetrating keratoplasty in the non-inflamed eye and use smaller graft diameter. Conclusion: M-CRL demonstrated an excellent therapeutic effect — rapid resorption of active purulent infiltration and suppression of purulent corneal melting. This allowed to avoid emergency keratoplasty and to conduct it as a planned operation. M-CXL can become a promising method of treating purulent corneal ulcers in the absence of the effect of drug therapy, and also be used as a preparation for keratoplasty surgery to reduce the severity of inflammation and the risk of infection recurrence in the postoperative period.