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Loading of the upper eyelid with palpebral implants made of noble metals is the modern standard of surgical treatment for paralytic lagophthalmos, and is aimed at increasing the mobility of the upper eyelid and normalizing involuntary blinking movements. This review presents the results of morphological studies, including immunohistochemical studies, reflecting the features of biointegration of palpebral implants in uncomplicated and complicated course of the postoperative period, and describes the modern understanding of the causes and immunopathological processes underlying the development of nonspecific inflammatory response, which is one of the most serious complications that often becomes an indication for implant removal.

Standard bacteriological examinations, which involve culturing microorganisms at 37 °C, are commonly used in clinical practice for diagnosing infectious diseases. However, the growth temperature of microorganisms on the ocular surface (OS) during infectious keratitis (IK) may not coincide with the laboratory standard, which is due to the characteristic features of heat exchange in the eye., Purpose: This exploratory study examines the distribution and properties of OS microorganisms isolated under different temperature cultivation conditions in patients with IK and healthy volunteers without ophthalmic pathology., Material and Methods: Fifteen participants were divided into two groups. Group 1 ( n =10) consisted of patients with signs of unilateral infectious keratitis, while group 2 ( n =5) served as the control group. A novel microbiological method was employed to isolate pure cultures of microorganisms. This method involved cultivating microorganisms at two temperature regimes (37 °C and 24 °C) and subsequently identifying them using biochemical, immunological, and physicochemical techniques, including mass spectrometry. Scanning electron microscopy (SEM) with lanthanide staining used as the reference method. The temperature status of the ocular surface was assessed using non-contact infrared thermography., Results: The study demonstrated the presence of psychrotolerant microorganisms on the ocular surface, which exhibited growth at a relatively low temperature of 24 °C. These psychrotolerant microorganisms were found to be isolated from the ocular surface displaying signs of temperature dysregulation. Among such microorganisms are Acinetobacter lwoffii, Achromobacter xylosoxidans, Bacillus licheniformis, Enterococcus faecalis, Klebsiella oxytoca, Klebsiella pneumoniae, Micrococcus luteus, Pseudomonas luteola, Streptococcus spp., Conclusion: When identifying the causative agent of infectious keratitis, it is crucial to consider the divergence of growth temperature of ocular surface microorganisms. The presence of psychrotolerant microorganisms on the ocular surface, which can effectively grow at room temperature, should be taken into account, especially in cases of temperature dysregulation.

This review compares data from scientific studies on the microbial community of the ocular surface (OS) in conditionally healthy individuals using cultural methods (including culture-dependent diagnostic tests), microscopic and molecular genetic methods, and assesses the influence of research methods and sample preparation on the results. Concordance and discordance of the sets of identified microorganisms were analyzed using overlapping and non-overlapping methods of studying the microbial community of a healthy OS. The article presents tables showing the names of microorganisms that were identified in different sources. Cross-verification in taxa of different ranks helped confirm the following most frequently found microorganisms on healthy OS: coccomorphic microorganisms of the genera Staphylococcus , Micrococcus , Kocuria , Streptococcus , Enterococcus ; gram-positive spore-forming bacilli of the genera Bacillus and Paenibacillus ; gram-positive non-spore-forming rod-shaped bacteria, including Corynebacterium , but excluding Propionibacterium and Microbacterium ; gram-negative non-spore-forming rod-shaped microorganisms of the genera Moraxella and Serratia . The study also assessed the effect of wearing soft contact lenses on the composition of the microbial community of the OS.

The main goal in the treatment of lagophthalmos is prevention of serious corneal complications. Based on the results of 2453 surgeries performed in patients with lagophthalmos, a detailed analysis of modern surgical techniques was carried out highlighting their advantages and disadvantages. The article describes in detail the most effective methods of static correction of lagophthalmos, their features and indications, and presents the results of using an original palpebral weight implant.

One of the most common scientific methods to study the chemical composition of bone matter is energy-dispersive X-ray spectroscopy (EDS). However, interpretation of the data obtained can be quite complicated and require a thorough understanding of bone structure. This is especially important when evaluating subtle changes of chemical composition, including the age-related ones. The aim of current study is to create a method of processing the obtained data that can be utilized in clinical medicine and use it to evaluate the age evolution of bone chemical composition. To achieve this goal, an elemental composition of 62 samples of cadaver compact bone, taken from the skull base (age: Me = 57.5; 21/91(min/max); Q1 = 39.5, Q3 = 73.75), was studied with EDS. We used the original method to estimate the amount of Mg 2+ cations. We detected and confirmed an increase of Mg 2+ cation formula amount in the bone apatite, which characterizes age-related resorption rate. Analysis of cation estimated ratio in a normative bone hydroxylapatite showed an increase of Mg 2+ amount (R = 0.43, p = 0.0005). Also, Ca weight fraction was shown to decrease with age (R = - 0.43, p = 0.0005), which in turn confirmed the age-dependent bone decalcification. In addition, electron probe microanalysis (EPMA) and X-ray diffraction analysis (XRD) were performed. EDS data confirmed the EPMA results (R = 0.76, p = 0.001). In conclusion, the proposed method can be used in forensic medicine and provide additional data to the known trends of decalcification and change of density and crystallinity of mineral bone matter., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Clinical manifestations of the new coronavirus infection can vary greatly and affect different organs and systems. Despite the lack of convincing data on the possible direct damage to the structures of the eyeball by the SARS-CoV-2 virus, indirect involvement of the organ of vision both in the acute period of the disease, during the period of convalescence, and as a part of the post-COVID syndrome is common in clinical practice. The condition of the ocular surface is not given much attention during the treatment of the main disease, especially in severe cases, which can lead to serious complications and visual acuity loss after recovery. Timely measures can prevent the loss of visual acuity. This article presents a description and discusses a rare case of multiple neuropathy of the cranial nerves associated with COVID-19, with bilateral involvement of the olfactory (I), trigeminal (V), facial (VII) and sublingual (XII) nerves, as well as the right optic nerve (II), which required staged rehabilitation.

Purpose: To determine the possibilities of impression cytology (IC) with subsequent visualization of the sample on a scanning electron microscope in assessment of normal microflora of the ocular surface., Materials and Methods: The article presents a visual characteristic of the microorganisms of the ocular surface (OS) captured during impression cytology (IC) in individuals without signs of inflammatory and degenerative eye diseases. The original method of staining the sample with heavy metal salts made it possible to identify the individual signs of the microorganisms in their subsequent visualization by scanning electron microscopy (SEM)., Results: The paper presents photomicrographs of the microorganisms most common for the OS obtained with the help of SEM, confirming and supplementing the data of non-visual methods of studying the ocular microflora. It was shown that the detection frequency of the microbial component of the OS by the visual method presented in this study is comparable with the detection frequency when using the microbial cultivation method (<80%). Coccoid and rod-shaped microorganisms were detected with relatively equal frequency, with the coccoid organisms mainly represented in association with epithelial cells. The morphological diversity of rod-shaped microorganisms is shown., Conclusion: The results of the study can be used as a visual reference for the normal microbiome of the eye.

Purpose: To identify the possible cause of an inflammatory reaction to a Russian-manufactured palpebral implant made of gold in the long term after surgery, and to determine the clinical and morphological changes in the tissues of the upper eyelid when the presence of the implant caused the inflammatory reaction., Material and Methods: The results of 150 operations with placement of a palpebral implant were analyzed. In 12 cases, a nonspecific inflammatory reaction was revealed within 2 to 4 weeks after the operation, in 7 cases it necessitated explantation, in 5 cases the local long-term use of an ointment with a corticosteroid made it possible to avoid extrusion and explantation. Chemical microanalysis of the palpebral implant and fragments of the removed capsule was performed using scanning electron microscopy (SEM), as well as immunohistochemical (IHC), macro- and microscopic examination of the fragments of connective tissue capsule was carried out after removal of the palpebral implant., Results: The obtained data confirm the chemical purity of the implant, the absence of abnormal accumulation of metals in the tissues of the eyelid. IHC, macro- and microscopic examination of the presented fragments of the connective tissue capsule revealed signs characteristic of an inflammatory reaction to a foreign body., Conclusion: Further research is needed to establish the factors and predictors for the development of inflammatory reactions to a foreign body and, in particular, to gold.

Purpose: To evaluate the role of tarsorrhaphy and its effectiveness in the treatment of patients with thyroid eye disease (TED)., Material and Methods: The study identified the patients who required tarsorrhaphy for corneal lesions associated with TED among the total number of 457 patients who underwent tarsorrhaphy at the Research Institute of Eye Diseases over the past 20 years., Results: Overall, 477 tarsorrhaphy surgeries (457 patients) were performed, including temporary and permanent, partial and complete. The corneal involvement in TED was the indication for tarsorrhaphy in 81 patients (101 tarsorrhaphies). TED patients were divided depending on the date of operation, and it was found that 61 tarsorrhaphies were performed in the period from 2000 to 2009, and 40 similar interventions were performed in the period from 2010 to 2019., Conclusion: The reduction in the number of tarsorrhaphy surgeries in patients with TED in the last decade due to improvement of techniques for bony decompression of the orbit and increase in the number of these operations allowed significant reduction of the degree of proptosis and, as a consequence, the exposure surface area of the eye. However, despite all the successes achieved in orbital surgery, tarsorrhaphy still remains an affordable technique that can always be used in case of corneal lesions in thyroid eye disease.

Floppy eyelid syndrome is rarely diagnosed nowadays. Most patients remain without the correct diagnosis for a long time, which means they do not receive adequate treatment. This syndrome is known to be accompanied by many concomitant clinical manifestations complicating the diagnostic search. It should be included in the diagnostic search algorithm in patients with chronic conjunctivitis, abnormal eyelid position, point keratopathy. This review presents the modern understanding of characteristic clinical features, associated conditions, as well as information about the pathogenesis of this syndrome.

Combined lesions of the facial and trigeminal cranial nerves are typical after neurosurgical treatment. Violation of the innervation of orbicularis muscle leads to inability to completely close the eyelids, while denervation of the cornea is often manifested as a long-term ongoing and recurring neurotrophic keratitis. The restoration of corneal innervation is a pathogenetically targeted treatment for this pathology. For this purpose, neurotrophic keratitis could be reversed via the method of corneal neurotization using contralateral n. ophthalmicus . The presented clinical case demonstrates the results of the first operation of neurotization of the cornea in a patient with combined lesions of the facial and trigeminal nerves.

Palpebral eyelid weight implants are currently considered as the gold standard method for lagophthalmos correction. Manufactured from different precious metals, they have both benefits and drawbacks. The article presents the results of an experimental morphological study of biointegration of different eyelid weight implants used for correction of paralytic lagophthalmos., Purpose: To investigate biointegration properties of implants made of gold, platinum and platinum-gold alloy., Material and Methods: The study enrolled 4 Chinchilla rabbits (8 eyelids). Palpebral implants manufactured of gold, platinum and platinum-gold alloy were placed into the eyelids of the experimental animals. The morphological examination was performed 1 and 6 months after the implantation using paraffin sections., Results: Light microscopy revealed that the implant beds were surrounded by pronounced fibrovascular capsule of uneven thickness over the whole follow-up. The capsule formed after the placement of an implant made of gold and platinum alloy was more loose. However, the emerging connective tissue bridges of the capsule contributed to its immobilization in the tissues and lower risk of extrusion. No signs of an inflammatory and/or allergic reaction were observed in any of the cases., Conclusion: The obtained results show that implants made of a 90/10% platinum-gold alloy and 999.9 fine platinum have similar biointegration in terms of morphological features during 6 months of the follow-up period.

Modern public healthcare practices are constantly being improved by the medical community, which involves approval and implementation of professional standards such as including public health activities in the responsibilities of medical specialists. To understand how well such skills can be mastered by the specialists, we have conducted a comparative analysis of ophthalmologist qualifications found in the most often used guidelines and textbooks. With logical, analytical and hypothetical analysis, books and guides published before 2018 were found to have insufficient coverage of the public health responsibilities. Improvement of the public healthcare in terms of professional standards is an important course of development for the medical field. The continued work on Russian Federal State Educational Standard (Higher Education) for Ophthalmology - index number 31.08.59 - should include actualization of educational materials with modern public health notions, development of a universal learning evaluation database for specialist accreditation, as well as evaluation tools for the obtainment and confirmation of their qualification. The professional standards for ophthalmologists should fully account for the job responsibilities they acquire. Training of ophthalmologists in the public healthcare should utilize the following textbooks published in 2018: 'Organization of medical aid in the Russian Federation' under the editorship of V.A. Reshetnikova, 'Healthcare and public health' under the editorship of G.N. Tsarik, and 'Public health and healthcare' by V.A. Medic.

Numerous studies have demonstrated the efficacy of anti-VEGF medications for exudative (wet) age-related macular degeneration (AMD). Significant IOP elevation is one of the side effects of anti-VEGF intravitreal injection., Purpose: To study the changes in the parameters of anterior segment of the eyeball against acute IOP elevation after repeated intravitreal injections (IVI) of anti-VEGF medication., Material and Methods: The study was conducted on a random sample of 45 patients (45 eyes) diagnosed with exudative (wet) form of AMD. All patients received two 0.05 ml intravitreal injections of ranibizumab with one-month interval. Measurements of IOP were performed with rebound tonometer Icare-Pro (ICare, Finland) before intravitreal injection, then one minute, 30 minutes and 3 hours after. The parameters of the ocular anterior segment, namely thickness and optical density of the cornea, volume and angle of the anterior chamber were evaluated by Scheimpflug imaging (Pentacam HR, Oculus, Germany) before IVI, and 15 minutes after., Results: Statistically significant (p<0.05) elevation of IOP to 40 mm Hg (confidence interval 32-48 mm Hg) was recorded one minute after injecting 0.05 mL of ranibizumab solution into the vitreous cavity with IOP having the tendency for gradual normalization. When measured 15 minutes after IVI, the following parameters of the ocular anterior segment structures had reliably changed in the setting of elevated IOP: corneal thickness had increased to 27 µm (confidence interval 14-38 µm), corneal optical density - to 16.7 (confidence interval 10.4-19.5). No significant changes of either volume or angle of anterior chamber were revealed. Comparative analysis showed no significant changes of parameters after the 1 st and the 2 nd IVI., Conclusion: The revealed changes were transient in nature and did not require any corrections since all parameters returned to baseline after each injection.

The article reviews the particularities of development and pathogenesis of secondary dry eye syndrome (DES) after refractive surgeries including a complex of problems related to changes in tear film content, damage of eye surface and neurotrophic epitheliopathy. Additionally, modern algorithms of treatment and prevention of secondary DES in patients after refractive surgeries are described. Despite the transient nature of the changes, excimer-laser surgery can lead to lasting deficiencies of eye surface in some patients. Therefore, intensive and early treatment of secondary DES during the early follow-up period after refractive surgery may significantly reduce risks of tear dysfunction and neurotrophic epitheliopathy development in the long term.

Unlabelled: Upper eyelid weigh gold implant is the widely accepted standard for the treatment of paralytic lagophthalmos (PL)., Aim: To evaluate late outcomes of PL correction with chain gold implants., Material and Methods: Chain gold implants were inserted in the upper eyelids of 70 patients with lagophthalmos due to chronic facial paralysis. A comprehensive ophthalmic examination was performed prior to surgery and then at months 1, 3, 6, 12, 24, and 36., Results: The results obtained prove the method highly effective. None of the patients developed any severe complications. Cases of implant removal were few. Some of the studied biometric parameters decreased significantly after surgery, while the upper eyelid excursion increased. The implant had no effect on the inner surface of the cornea and its peripheral thickness., Conclusion: Efficacy of the proposed eyelid implant has been convincingly demonstrated; late complications have been analyzed.

Unlabelled: The article presents the results of an experimental morphological study of biointegration of different eyelid weight implants used for paralytic lagophthalmos correction., Aim: To investigate biointegration features of gold monolithic and chain implants., Material and Methods: The study enrolled 11 Chinchilla rabbits (22 eyelids). Light and scanning electron microscopy was performed 2 weeks, 1, 2, 3 and 6 months after the implantation., Results: Over the whole follow-up period chain implants capsules remained more integrated with surrounding connective tissue than those of monolithic implants., Conclusion: The obtained results prove better immobilization of a gold chain implant preventing it from dislocation in the late postoperative period.