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Background: Dry eye disease (DED) is a disorder of the anterior segment of the eye which is common in patients with type 2 diabetes mellitus (T2DM). It has been reported that symptoms of DED were observed in 60-70% of patients with T2DM. Given that inflammation has a key role in the progression of both T2DM and DED, we believe it is reasonable to study the role of neutrophils in this process. Purpose: To assess the percentage expression of CD15, a neutrophil activation marker, in the peripheral blood of patients with both DED and T2DM. Material and Methods: Forty-six patients (92 eyes; mean age, 54.0 ± 8.0 years) with both DED and T2DM were included in this study. There were 19 (40%) women and 27 (60 %) men. Mean diabetes duration was 8.0 ± 6.6 years. All patients had well-compensated diabetes. In addition to a routine examination of the eye, Schirmer I test and tear film break-up time (TBUT) test, they had their corneal fluorescein staining (CFS) scored using the Oxford schema, severities of dry eye graded according to the DEWS II classification and Ocular Surface Disease Index (OSDI) obtained. An immunohistocytochemical study was employed to assess the expression of CD15, a neutrophil activation marker, in peripheral blood cells of patients. Results: The mean percentage expression of CD15, a neutrophil activation marker, in the peripheral blood, was 46.7% for 14 patients with T2DM plus DED and punctuate keratopathy, and 28.5% for 32 patients with T2DM plus DED and intact cornea (р=0.0001). There was a mild negative correlation between the expression of CD15 and the Schirmer score (r = -0.32; р = 0.032), and between the former and the TBUT score (r = -0.34; р = 0.019).

Purpose: To assess cytological conjunctival changes in patients with type 2 diabetes mellitus (T2DM)-associated dry eye disease in the presence of treatment with a combination of trehalose and sodium hyaluronate. Material and Methods: This study was conducted at the Pirogov Vinnytsia Regional Clinical Hospital, the clinical site of the National Pirogov Memorial Medical University, from April to December 2023. We used prospective data of 46 patients (92 eyes; mean age, 62.47 ± 6.24 years). Results: Most patients (67%) showed abnormal conjunctival impression cytology (CIC) changes (Nelson's grade 2 and 3) before treatment. Among these, grade 3 squamous metaplasia was twice as common as grade 2 squamous metaplasia; this demonstrated apparent CIC changes in the group of patients, and a substantial prevalence of squamous metaplasia in type 2 diabetics. After treatment with a combination of trehalose 3% plus sodium hyaluronate 0.15%, neutrophil infiltration was observed only in 5 (11%) patients (p = 0.0375), which may indicate an anti-inflammatory effect of the combination. Conclusion: We found a significant effect of a combination of trehalose 3% plus sodium hyaluronate 0.15% on the state of the ocular surface, with the resolution of inflammatory conjunctival infiltration, in patients with T2DM (p = 0.0375). Because stabilization or slowing of damage to epithelial cells is important for patients with T2DM and was observed in the presence of treatment with the combination eye drop, these patients require long-term treatment with the medication. [ABSTRACT FROM AUTHOR]

Background: Herpetic stromal keratitis (HSK) is an immunomodulatory disease that develops as a result of herpes simplex virus (HSV)1 or HSV2 reactivation. HSK is the most common form (20-50%) of recurrent herpetic keratitis (HK) that most commonly results in significantly reduced vision. It is well known that changes in biological compound levels in tear fluid can be indicative of the state of the ocular surface and determine whether ocular surface pathology is present, and, therefore, can be used as diagnostic markers of pathological changes in the ocular surface. Lactoferrin (LF) is one of these compounds and has been proven to have innate antibacterial, antifungal, antiviral, antiparasite, anti-inflammatory, immunomodulatory, antioxidative and other properties. Purpose: To determine tear Lf concentration in patients with recurrent acute HSK, its effect on functional characteristics of the ocular surface, and the therapeutic effect of Lacto eyedrops in the comprehensive treatment for this disorder. Material and Methods: The study was conducted at the site of Corneal Pathology Department and Immunology Laboratory of the Institute in January to December 2021. Seventeen patients (17 affected eyes and 17 fellow eyes) with recurrent acute HSK were included in the study. Mean patient age plus or minus standard deviation (SD) was 48.7 ± 16.0 years. The ophthalmological examination included biomicroscopy of the bulbar conjunctiva and cornea, fluorescein test, determination of corneal sensation and basal tear production (Schirmer's II test), and microbiological examination of the conjunctiva. Tear Lf concentration was determined by a human Lf enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Inc., Wuhan, China). The results were photometrically measured at 450 nm with an ELISA reader (Stat Fax 2100, Awareness Technology Inc, Palm City, FL). Lacto eyedrops were administered two times a day for 30 days. Tear Lf concentrations were determined at baseline and at day 30. Results: Mean tear LF concentration plus or minus SD in eyes of patients with recurrent HSK was 1.21 ± 0.52 g/l, with no significant difference between the affected eye and fellow eye. However, a subnormal tear LF concentration was more common in the affected eye than in the fellow eye (X² = 4.24, p = 0.04). After a 30-day anti-inflammatory treatment with Lacto eyedrops, mean tear LF concentration plus or minus SD increased by 47% to 1.78 ± 0.7 g/l in the affected eyes. A corneal sensation score of 1 to 9 was 12.4 times more common in HSK eyes than in fellow eyes (OR = 12.4; 95% CI, 2.0-76.8), which reflects neurosensory abnormalities in the affected eye. Corneal sensation loss, was, however, more common in HSK eyes with a low tear Lf concentration than in fellow eyes with a low tear Lf concentration. Median basal tear production (as assessed by Schirmer's II test) was as low as 7-8 mm in eyes with a low tear Lf concentration and as high as 13-16 mm in eyes with a high tear Lf concentration (p < 0.05). There was a direct correlation between the basal tear production and the tear Lf concentration (r=0.45; p < 0.05). Among study patients with recurrent HSK, 24.9% showed baseline microbiological evidence of potentially pathogenic or fungal organisms in the conjunctiva. A course of multicomponent anti-inflammatory treatment with Lacto eyedrops contributed to complete removal of these organisms. Conclusion: We determined mean tear Lf concentrations in affected and fellow eyes of patients with recurrent HSK, and established certain relationships between functional characteristics of the ocular surface and tear Lf concentrations in these eyes. A disinfecting effect of Lacto eyedrops against any microorganisms present in the conjunctival sac of patients with recurrent HSK was confirmed by the absence of culture growth on completion of the multicomponent anti-inflammatory treatment. [ABSTRACT FROM AUTHOR]

Background: Lactoferrin (LF) is a non-heme iron-binding glycoprotein of the transferrin family. It is a natural component of the tear film, has bacteriostatic, bactericidal, fungicidal, antiviral, and antioxidant properties, and thus plays an important role in the protection of the ocular surface from infections. A low tear LF concentration has been found in some ocular disorders, but there have been no reports on the determination of LF concentration in tears of patients with chronic conjunctivitis (CC). Purpose: To determine LF concentration in tears of patients with CC, and to assess the effect of LACTO eye drops in the multicomponent treatment for the disorder. Material and Methods: Eleven patients (17 eyes) with CC were included in the study. Patient age ranged from 27 to 68 years, and the duration of CC, from 3.5 to 7 months. The ophthalmological examination included biomicroscopy of the bulbar conjunctiva and cornea, fluorescein examination, determination of corneal sensation and basal tear production (Schirmer's II test), and microbiological examination of the conjunctiva. Corneal and conjunctival xerosis was assessed using the method of van Bijsterveld. Patients were administered a topical antiseptic four times daily, preservative-free hyaluronic acid artificial tears four times daily, and Lacto eye drops twice daily over a month. Concentration of LF in the tear samples was determined by a human LF enzyme-linked immunosorbent assay kit before treatment and at day 30 of treatment. Results: Seven patients (11 eyes) underwent an examination after the completion of a onemonth treatment with Lacto eye drops. Tear LF concentration (mean ± standard deviation (SD)) in patients with CC was 1.37 ± 0.4 mg/ml (95% confidence interval, 1.16-1.58). The examination found no microbial growth in all these 11 eyes, with 6/7 patients presenting no complaints after treatment. There was no statistically significant change in Schirmer II test values from baseline. Corneal sensation was found to be improved in 6/11 eyes. After a onemonth treatment with Lacto eye drops, tear LF concentration (a) decreased from a relatively high (mean ± SD, 1.65 ± 0.45 mg/ml) value at baseline to 1.05 ± 0.33 mg/ml (? = 0.04) in four eyes (eyes nos. 1-4), (b) increased from 1.52 ± 0.21 to 2.03 ± 0.41 gm/ml in other four eyes (eyes nos. 6-8, 11), and (c) increased from a low value (0.85 ± 0.17 mg/ml) to 1.18 ± 0.27 (? = 0.07) in eyes nos. 5, 9, and 11. Conclusion: Lacto eye drops were found to have an immune modulating effect, with any low tear LF at baseline increased in an amount required for normalization of the conjunctival microbiota after treatment. In addition, our microbiological study after onemonth administration of Lacto eye drops as a component of therapy for CC demonstrated that the medication provided a sanitizing effect, with no conjunctival microbiota growth but subjective improvement in complaints in all patients. [ABSTRACT FROM AUTHOR]

Background: The prevalence of keratitis and corneal ulcers among rheumatoid arthritis (RA) patients with corneal disease is not known for certain, and the features of their clinical manifestations have been not sufficiently studied. Purpose: To retrospectively assess the prevalence and clinical manifestations of keratitis and corneal ulcers in RA patients with corneal disease based on the medical records of patients that were hospitalized at Corneal Pathology Department of the Filatov Institute from January, 2014, through August, 2019. Material and Methods: We have retrospectively examined the medical records of 6627 patients that were hospitalized at Corneal Pathology Department of the institute in the above period of time. Results: Of the 6627 patients that were hospitalized, 82 (or 1.2%) were RA patients with keratitis and/or corneal ulcers. Of these 82 patients aged 37 to 79 years, 23 (28%) were men and 59 (72%) were women. Bilateral corneal lesions were found in 71 (86.6%), and unilateral corneal lesions, in 11 (13.4%) of the 82 study patients, with 153 eyes totally included in the study. Punctate or filamentary keratitis was found in 90 (58.8%) eyes. Severe corneal lesions (ulcers or keratoscleromalacia) were found in 63 (41.2%) eyes. Of the 82 RA patients with corneal lesions of the current study, 39 (47.6%) did not receive basic therapy for RA, and exhibited the most severe corneal lesions. Conclusion: Patients with RA need to be systematically seen by an ophthalmologist and a rheumatologist. The absence of treatment with basic therapy for RA can cause ocular complications. A patient with RA needs to be treated for any corneal lesion at a tertiary care center where a required surgical procedure can be timely performed. The success of treatment for corneal lesions in a RA patient requires a set of treatment measures, and adequate basic therapy for RA is a necessary component of this set. [ABSTRACT FROM AUTHOR]

Background: Amniotic membrane (AM) is widely used in ophthalmic surgery. There are three major techniques for amniotic membrane transplantation (AMT): 'onlay' ('patch') technique, 'inlay' ('multilayer transplantation') and 'sandwitch' technique (a combination of the two techniques mentioned before), but there is no universal technique for placing the amnion on the ocular surface for AMT. In conventional multilayer AMT, the membrane is fixed layer by layer with numerous interrupted sutures, which contributes to a severe corneal inflammatory response and the formation of intense corneal opacity. Purpose: To improve the multilayer amniotic membrane transplantation technique. Material and Methods: The method proposed by us consists in forming a two layer or three layer amniotic graft and anchoring it to the surrounding cornea by a row of interrupted 10-0 sutures. Twenty eight patients with corneal ulcers of different causes underwent amniotic membrane transplantation. There were 17 men (60.7%) and 11 women (39.3%). Mean patient age (standard deviation) was 51.3 (0.81) years. Corneal ulcers were categorized based on the etiology as herpetic (7/28, 25%), neurotrophic (10/28, 35.7%), bacterial (3/28, 10.7%), fungous (2/28, 7.2%), autoimmune (3/28, 10.7%) and those caused by rosacea (3/28, 10.7%). Results: After AMT by the proposed technique, there was a reduction in corneal stromal edema at discharge (χ² = 29.7; p = 0.0005). In addition, corneal stromal infiltration resorbed at 1 month after surgery compared to at discharge (χ² = 9.16; p = 0.0025). AMT by the proposed technique facilitated the formation of mild focal corneal opacity in 26 patients (92.8%). Conclusion: Our improved AMT technique reduces the number of sutures on the cornea, enables filling the corneal stromal defect and contributes to decreased inflammatory response and early epithelialization of the corneal surface. [ABSTRACT FROM AUTHOR]

Background: Infectious corneal ulcers and infectious keratitis are a major global cause of visual impairment and blindness. Although there are numerous antimicrobial agents available, novel methods should be designed to allow for fast and comprehensive microbicidal and microbistatic response on their target with minimum toxic effect to the body in order to preserve vision in patients with severe corneal infections. Purpose: To assess in vitro the antimicrobial effect of photosensitizer-mediated 365-nm ultraviolet (UV) irradiation in combination with 630-670 nm low-energy laser irradiation on the suspensions of Candida albicans and Fusarium spp. Material and Methods: The Mueller-Hinton medium was used to conduct a routine disc diffusion susceptibility test and assess the antimicrobial activity of the preparations. Methods for exerting effect on test strains of Candida albicans and Fusarium spp isolated from the conjunctival sac: The method of low-energy laser irradiation (clinically, photodynamic therapy or PDT) was as follows. A sterile disc was placed, along with test strains of microorganisms, on the surface of the medium. Methylene blue 0.1% was instilled on the surface of the sterile disc until the disc was completely covered. Thereafter, the disc was irradiated with 630-670-nm low-energy laser for three minutes. The method of UV irradiation (clinically, collagen cross-linking or CXL) was as follows. The sterile disc was placed, along with test strains of microorganisms, on the surface of the medium. Riboflavin 0.1% was instilled on the surface of the sterile disc until the disc was completely covered. Thereafter, the disc was irradiated with 365-nm UV light delivered by the UVX 2000 for 10 minutes. Results: Growth inhibition zone analysis found that Candida albicans was susceptible to PDT as well as to CXL. The diameter of the growth inhibition zone after treatment with PDT plus CXL plus fluconazole was significantly, 6.3 mm, larger than for the control disc with fluconazole. Fusarium spp was found to be susceptible to PDT plus CXL as well as to PDT plus CXL plus itraconazole, with the diameter of the growth inhibition zone being significantly, 4.2 mm and 7.8 mm, respectively, larger than for the control disc with itraconazole. Conclusion: In the in vitro experiment, the combination treatment (365-nm UV light using riboflavin 0.1% as a photosensitizer and 630-670-nm low-energy laser irradiation using methylene blue 0.1% as a photosensitizer) we proposed had a demonstrated antimicrobial effect on Candida albicans and Fusarium spp, showing fungal growth inhibition. This experimental study showed that the approach is promising and warrants further research in ophthalmology. [ABSTRACT FROM AUTHOR]

Background: Pathologic changes in the ocular surface in diabetes mellitus (DM) may result from various causes such as metabolic abnormalities (hyperglycemia and dyslipidemia, leading to changes in tear composition), perilimbal vascular microangiopathy (leading to impaired blood supply to the cornea), lacrimal gland lesions, and various abnormalities in innervation. Purpose: To determine the cytological features of the bulbar conjunctival epithelium in patients with T2DM. Material and Methods: We analyzed clinical and impressive cytology data of 34 patients (18 (52.9%) men and 16 (47.1%) women; age, 50 to 79 years) having clinical signs of dry eye disease (DED). Patients were divided into two equal groups of 17 patients each, group 1 (diabetes duration of less than 5 years) and group 2 (diabetes duration of more than 5 years). They underwent Schirmer 1 test, tear break-up time (TBUT) test, and impression cytology of the bulbar conjunctiva. The cytologic changes of the bulbar conjunctiva were graded according to Nelson's grading system. Results: Comparison of clinical and cytolological characteristics of study patients suggests that, severity, duration and course pattern of diabetes mellitus affect the development of compensatory and adaptive mechanisms in the bulbar conjunctival epithelium, these mechanisms being reflected by the formation of the surface epithelium of increased density due to squamous metaplasia and keratinization. Conclusion: Our impression cytology study of the bulbar conjunctival epithelium found that most patients (94.1%) with T2DM had squamous metaplasia grade (Nelson) of 2 or 3, and 80% of those with squamous metaplasia grade (Nelson) of 3 had T2DM duration of more than 5 years. In addition, squamous metaplasia of grade 3 was fourfold more common among patients with T2DM duration of more than 5 years than among those with T2DM duration of less than 5 years. [ABSTRACT FROM AUTHOR]

Background: Herpes simplex virus ocular infection is the major cause of corneal blindness in developed countries. The methods used for the treatment of recurrent herpes infections give only temporary remission, and the results of studies on prevention and prediction of the course of the disease are contradictory, which makes management of these infections not only medically, but also socially important. The mechanism of recurrence of herpetic stromal keratitis (HSK) infection has not been clearly understood, since the disease involves complex pathophysiological mechanisms and immune factors (including cytokines) are complexly interrelated in the pathogenesis. Purpose: To assess serum levels of proinflammatory cytokines (TNF-α and IL-6) and antiinflammatory cytokines (IL-10 and IL-4) in ocular HSK patients with frequent and infrequent recurrences during remission and recurrence. Material and Methods: Thirty-three in-patients (15 patients and 18 patients experiencing less than and more than one recurrence annually, respectively) treated for recurrent HSK at the Department of Corneal Disorders of the Filatov Institute were included in the study. Serum IL-4, IL-6, IL-10 and TNF-α levels were determined using enzyme-linked immunosorbent assay (ELISA) kits from Vektor-Best (Novosibirsk, Russia) according to the manufacturer's instruction. Photometric measurements were performed on an ELISA plate reader (Stat Fax 2100, Awareness Technologies Inc, Palm City, FL). Reference normal values were taken from the manufacturer's instructions. Results: We found that the mean serum TNF-α level in patients with infrequent recurrences and in those with frequent recurrences during remission was 2.6 times and 4 times, respectively, higher, and during recurrence, 5.6 times higher, compared to normal values, which is likely to indicate a subclinical inflammatory process. Both in patients with infrequent recurrences and in those with frequent recurrences of keratitis, the mean serum TNF-α level was 50% higher during recurrence than during remission. The mean serum IL-6 level during remission was comparable to, and during recurrence was 3 times higher than the norm, with no significant difference between patients with infrequent and frequent recurrences. Serum IL-4 levels in patients with infrequent and frequent recurrences were 8.5 times and 22.5 times, respectively, higher than reference values. During recurrence, the mean serum IL-4 level in patients with frequent recurrences was 39% higher than in those with infrequent recurrences. No significant difference was observed in serum IL-10 level between remission and recurrence for patients with infrequent recurrences, with a mean value being 24% higher than reference values. The mean serum IL-10 level (for recurrence and remission) in patients with frequent recurrences was 74% higher than for patients with infrequent recurrences (p = 0.01), and two times higher than reference values. Conclusion: HSK in patients with frequent recurrences was characterized by the pattern of regulation of cytokine expression, with decreased expression of TNF-α and increased expression of pro-inflammatory (IL-6) and anti-inflammatory (IL-10 and IL-4) interleukins, which might reflect a mechanism of autoimmune response in such a course of herpetic keratitis. [ABSTRACT FROM AUTHOR]

Background: In spite of intensive antiviral and anti-inflammatory therapy, recovery is not always achieved in patients with stromal herpes keratitis (HK). Inflammatory host response and a complex immune defense system play a major role among the numerous factors involved in herpes simplex virus (HSV) reactivation from latency. Inter-Cellular Adhesion Molecule (ICAM-1) is best known for its role in mediating leukocyte adhesion to endothelial cells and guiding leukocytes across the vascular wall. This factor is considered as an inflammatoty biomarker. Given that signs of inflammation in recurrent stromal keratitis are not always clinically manifest, additional diagnostics is required for wellfounded anti-inflammatory treatment decisions. Purpose: To assess the expression of ICAM-1 on blood lymphocytes in patients with primary stromal HK and patients experiencing one or more annual recurrences of stromal HK at different periods of disease. Material and Methods: Fifty-six patients (age, 20 to 60 years) who had been consulted and treated for stromal HK at the Department of Corneal Disorders and 27 systemically and ophthalmologically healthy controls (age, 20 to 64 years) were involved in the study. Of the 56 patients, 10 had primary HK with disease duration = 6 months, and 46 had recurrent HK with disease duration = 20 years. Individuals experiencing more than one recurrence annually were defined as those with frequent recurrences. Absolute and relative ICAM-1 expression on lymphocytes was examined. Immunohistochemical staining with monoclonal antibodies for ICAM-1 (CD-54) was performed. Results: The median and interquartile range of the absolute expression level of ICAM, and the mean (standard deviation) of the relative ICAM-1 expression on peripheral blood lymphocytes in controls were 113.3 cells/µL, 87-168 cells/µL, and 8.5 (2.0)%, respectively. Total patients with HSV keratitis exhibited significantly (4.0 times; p = 0.0001) higher absolute counts of peripheral blood lymphocytes expressing ICAM-1 (median, 450 cells/µL; interquartile range, 326-552 cells/µL) compared to controls. In patients in remission with recurrent stromal HK, the relative ICAM-1 expression did not depend on the frequency of recurrence and was 23.4 (4.0)%, which was 2.8 times higher than in controls (p = 0.000). Patients with active keratitis experiencing one recurrence annually had practically the same relative ICAM-1 expression as those experiencing more than one recurrence annually, with a mean value of 26.8 (4.6)%. This was 3.3 times higher than in controls (p = 0.000) and 15.8% higher than in patients in remission with recurrent HK (23.4 (4.1)%; p = 0.001). The relative ICAM-1 expression in patients with primary keratitis was 16% higher than in patients on remission, and there was no significant difference in this parameter between patients with primary keratitis and patients with active recurrent HK. Conclusion: The absolute and relative ICAM-1 expression on peripheral blood lymphocytes in patients with HSV keratitis was 4.0 times and 3.1 times, respectively, higher than in controls. The relative expression of ICAM on lymphocytes in patients with active recurrent disease and in patients with primary keratitis was 16% higher than in patients on remission. [ABSTRACT FROM AUTHOR]

Background: Ultraviolet (UV-X) corneal collagen cross-linking (CXL) involves photopolymerization of corneal collagen and in recent decades has been commonly employed for the treatment of stage 2 to 3 keratoconus. The high-intensity illumination of the UV-X™ 2000 Crosslinking System (Avedro, Inc., Waltham, Massachusetts) provides accelerated CXL (A-CXL), reducing treatment time threefold (to 10 minutes) compared with conventional CXL protocol. Purpose: To assess 24-month outcomes of A-CXL for stage 2 to 3 progressive keratoconus. Material and Methods: One hundred and nineteen patients (167 eyes) who underwent ACXL for keratoconus were included in this study. At 24 months, ocular changes were assessed in 40 eyes. A-CXL was carried out using the UV-X™ 2000 Crosslinking System at an irradiation intensity of 9 mW/cm². Results: Mean astigmatism decreased by 1.15 D to 3.02 ± 1.73 (SD) D (for n=40 eyes) and mean corneal refractive power as assessed by Kmax decreased by 3.4 D to 54.4 ± 6.62 (SD) D (median value, 54.3 D; n=40 eyes) at 24 months compared to baseline values. Mean thinnest local corneal thickness increased by 3.0 µm (mean value, 462.7± 34.3 (SD) µm; median value, 455.5 µm; n=40 eyes; ? = 0.009), mean uncorrected visual acuity increased by 0.2, and mean best-corrected visual acuity increased by 0.25 at 24 months compared to baseline values. Of the 40 eyes examined at 24 months, BCVA improved in 34 eyes (85%). Conclusion: A-CXL for stage 2 to 3 progressive keratoconus resulted in a steady state of the pathological process, decrease in astigmatism by 1.15 D, decrease in corneal refractive power as assessed by Kmax by 3.4 D, and an increase in thinnest local corneal thickness by 3.0 µm for the total study cohort, and improvement in BCVA in 85% of eyes at 24 months. [ABSTRACT FROM AUTHOR]

Background: According to Tear Film and Ocular Surface Society's Dry Eye Workshop II, the precorneal tear film plays a crucial role in moisturizing the corneal surface and allowing for an optically smooth corneal surface. In addition, as a result of imbalanced secretion of the muco-aqueous phase of the tear film, the mucin layer traps shed epithelial cells, inflammatory cells, and debris to form a mucous clot within the lower conjunctival fornix. Increased mucus viscosity prevents moving mucus away via the punctum, which contributes to the development of severe dry eye syndrome (DES). Our clinical experience argues that tear replacement therapy alone can be not enough in the treatment of severe DES. N-acetylcysteine (NAC), a collagenase inhibitor, has been widely employed clinically as a mucolytic agent. Foreign literature is scant on the use of NAC as an anti-inflammatory, mucolytic, detoxicant and anti-oxidative agent in the treatment of DES. Purpose: To assess the efficacy of topical 5% N-acetylcysteine as a part of multicomponent treatment for severe DES associated with increased mucus production. Material and Methods: We reviewed records of 15 patients examined and treated for severe DES. At baseline, there was biomicroscopic evidence of mucous discharge in the lower conjunctival fornix, corneal epitheliopathy in the form of punctate fluorescein staining, and desquamated epithelium, which was consistent with severe DES. Results: At admission, mean Schirmer's test value and tear break-up time (TBUT) were 3.4 mm (range, 2 to 6 mm) and 4.2 s (range, 2 to 8 s), respectively, and conjunctival impression cytology revealed focal epithelial degeneration. Topical 5% NAC was administered 4 times daily for 3 months as a part of multicomponent therapy for severe DES. After 3 months of topical 5% NAC, 86.6% of patients noted good tolerance to the drug and improvement of subjective symptoms, and there was biomicroscopic evidence of a reduced amount of mucus in the lower conjunctival fornix and decreased epithelial desquamation. Mean Schirmer's test and TBUT values increased to 5.0 ± 1.7 mm (mean ± SD) and 6.4 ± 1.7 s, respectively. Conjunctival impression cytology showed the presence of mucoid substance; diffused, differentiated epithelial cells without signs of degeneration; and an adequate superficial conjunctival epithelial cell layer. Conclusion: Topical 5% N-acetylcysteine 4 times daily as a part of multicomponent treatment showed a substantial mucolytic effect for severe DES with apparent thick mucus discharge in the lower conjunctival fornix and resulted in the development of an adequate superficial conjunctival epithelial cell layer. Findings of this study allow us to recommend topical 5% N-acetylcysteine for severe DES patients with increased viscous mucous discharge in the lower conjunctival fornix. [ABSTRACT FROM AUTHOR]

Background: Post-crosslinking (CXL) biomicroscopic changes in patients with keratoconus can be detected by confocal microscopy. Few studies reported on morphological changes in the cornea after CXL. Purpose: To detect structural corneal changes by confocal microscopy after accelerated CXL for keratoconus. Material and Methods: This study included 119 patients (167 eyes) who underwent accelerated CXL for keratoconus and were followed up for 12 months. Accelerated CXL was carried out using the UV-X? 2000 Crosslinking System at an irradiation intensity of 9 mW/cm?. Confocal biomicroscopy was performed using the Confoscan 4 unit (NIDEK Co., Ltd., Aichi, Japan). Results: Accelerated CXL (carried out in 10 minutes) for stage 2 to 3 progressive keratoconus is safe and allows stabilizing the pathological process, based on the 12-month follow-up results. At 3 months after accelerated CXL, active regeneration of keratocytes was seen in the superficial and deep stroma, with resolution of fibrotic foci. Confocal microscopy found that recovery of normal corneal architectonics started at 6 months and keratocyte repopulation was complete at 12 months after CXL. [ABSTRACT FROM AUTHOR]

Background. It is known that a decreased level of thyroid hormones (TH) in the body causes hypothyroidism and is accompanied by metabolic, functional and structural changes in different organs and tissues, including an eye and tear glands, in particular. However, these changes in the conjunctiva, cornea, and tear fluid have not been studied. It has been shown in experiment that the decreased TH level can lead to the development of dry eye syndrome. The thyroid hormones induce the changes in the tear fluid and have an effect on the epithelium of ocular surface tissues although the mechanisms of this effect are understudied. The changes in the ocular surface tissues in the presence of hypothyroidism are also unclear. Purpose. To study experimentally the state of lipid peroxidation processes in the cornea, conjunctiva, and tear fluid on a model of hypothyroidism in rats. Material and Methods. Male white Wistar rats were used in the experiment. Forty-two animals were randomly divided into 3 groups: group 1, fourteen rats serving as control; group 2, fourteen rats with early hypothyroidism; group 3, fourteen rats with pronounced hypothyroidism. Hypothyroidism was induced by antithyroid tiamazole which the rats in the study groups received with drinking water (500 mg/l) for four and ten weeks to simulate early and pronounced hypothyroidism, respectively. We evaluated spectrophotometrically the content of malondialdehyde and diene conjugates in the tissues studied [5]. Results. In experimental hypothyroidism, the lipid peroxidation (LPO) processes are activated in the ocular tissues, which is evidenced by the increased content of malondialdehyde and diene conjugates in the conjunctiva by 85.6% and 55.6%, respectively, and in the cornea by 51.3% and 25.4%, respectively, especially in pronounced hypothyroidism. The highest rates of malondialdehyde were noted in pronounced hypothyroidism. The sharpest increase of malondialdehyde was in the tear fluid: by 70.2% and 101.3% in early and pronounced hypothyroidism, respectively. Conclusions. The increased content of malondialdehyde in the cornea, conjunctiva, and, especially, tear fluid, gives evidence of the activated LPO processes and depends on the stage of experimental hypothyroidism. The data obtained make it possible to consider a level of malondialdehyde in the tear as a biochemical indicator of damage to ocular surface tissues in hypothyroidism. [ABSTRACT FROM AUTHOR]

Herpes simplex keratitis (HSK) is a severe ophthalmic pathology which comprises 20-50% of inflammatory diseases in the cornea. Since keratitis is characterized by a long-term duration, severity, and a tendency to recurrence, studies on ophthalmic herpes and searches for new treatments are of great relevance. Our clinical case demonstrated successful combined treatment of a recurrent stromal herpetic corneal lesion with ulceration. Both treatments, conservative (complex etiotropic, anti-viral, anti-inflammatory, and nutrition-improving) and surgical (an onlay technique), were successful. At 12 months after surgery, the patients had no pain syndrome; the corneal surface was epithelialized. No recurrence of herpetic keratitis was observed. Thus, a combination of etiotropic pathogenic treatment and AM transplantation appears to be effective for severe long-lasting recurrent herpetic keratitis with the presence of defects on the corneal surface. [ABSTRACT FROM AUTHOR]

Introduction. Patients with refractory glaucoma complicated by bullous keratopathy often suffer from insupportable pain and uncomfortable sensations in the eye, and visual acuity loss, which worsens the patients' quality of life. Purpose. To study the efficacy of a complex treatment of patients with refractory glaucoma complicated by bullous keratopathy through transscleral cyclophotocoagulation (TS CPC) (λ=1.06 µm) followed by laser stimulation for corneal regeneration (λ=0.63 µm) and in combination with a preservative-free tear substitute bio-protector, containing 3% trehalose and 0.15% sodium hyaluronate. Material and Methods. 23 patients (23 eyes) with refractory glaucoma complicated by bullous keratopathy were treated. TS CPC was performed using neodymium laser (λ=1.06 µm; 3 sessions). On completion of a TS CPC course, each patient underwent a course of helium-neon laser stimulation of the cornea (λ=0.63 µm, t=300 sec, 10 sessions) and a 3-month course of a bio-protective tear substitute, containing 3% trehalose and 0.15% sodium hyaluronate (1 drop thrice a day). Each patient underwent visual acuity assessment, IOP measurement, Ocular Surface Disease Index (OSDI) evaluation before treatment, after a course of TCCSC, and after a three-month follow-up. Results. The TS CPC course resulted in pain management in all patients. The posttreatment IOP level decreased to 26.0 mmHg, by 30%, as compared to pre-treatment IOP level and remained stable at 3 months. Visual acuity improved in 10 of 23 patients (43%). Dry eye severity decreased by 34% (OSDI=59.4 scores). Conclusions. The patients with refractory glaucoma complicated by bullous keratopathy had a significantly decreased IOP level (by 30% in 65% of the patients) after a TS CPC course. The following laser stimulation of the cornea in combination with a course of preservative-free tear substitute, containing 3% trehalose and 0.15% sodium hyaluronate, decreased the severity of dry eye disease and corneal syndrome by 34% and significantly improved the patients' quality of life. [ABSTRACT FROM AUTHOR]

TGFBI gene mutations cause corneal stromal dystrophies of autosomal dominant inheritance. The most frequent complication of stromal dystrophies is recurrent corneal erosion with varying degree of accompanying inflammation. IL-1beta, IL-6 and IL-8 are main cytokines involved in corneal erosion healing. This study aimed to investigate the association between IL1B gene -511C/T, IL6 gene -174G/C and IL8 gene -781C/T polymorphisms and risk of recurrent erosion development in patients with hereditary corneal stromal dystrophies. A trend to decrease of IL1B gene -511TT genotype frequency in group with erosion (3.7%) comparing to control (6.7%) was observed. IL6 gene -174C allele carriers frequency in control group (65.9%) was significantly (P < 0.05) lower comparing to patients with erosion (80.5%). Frequency of IL8 -781TT genotype was significantly (P < 0.05) lower in the group with erosion (10.7%) comparing to patients without erosion (30.8%) and control (25%). IL6 gene -174C allele may be considered as genetic marker of corneal erosion risk in patients with hereditary stromal corneal dystrophies, whereas IL8 -781TT genotype is associated with negative recurrent erosion prognosis in such patients.