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Marchenko NR, Kasparova EA, Budnikova EA, Makarova MA. [Anterior eye segment damage in coronavirus infection (COVID-19)]. Vestn Oftalmol 2021; 137:142-148. [PMID: 34965080 DOI: 10.17116/oftalma2021137061142] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Conjunctivitis may appear as the first symptom of the coronavirus infection (COVID-19). In isolated cases, the lesion of the conjunctiva evokes a systemic infectious process. Currently, the conjunctiva is not considered as an area of long-term reproduction of coronavirus, and its damage is caused by hyperproduction of pro-inflammatory cytokines (especially IL-6); development of iridocyclitis and keratoconjunctivitis is also possible. Most often, local corticosteroids are used to treat these processes, although their use requires caution due to the risk of activating secondary infection (herpetic bacterial, fungal), which often develops as a result of immunodeficiency caused both by COVID-19 and the massive corticosteroid and antibiotic therapy employed when the course of the disease is severe. The severe condition of patients, the lung ventilation, and the prone position all contribute to corneal erosions, exposure keratopathy, pseudomonas aeruginosa keratitis and angle-closure glaucoma attacks. The risk of transmission of coronavirus infection during keratoplasty is estimated as minimal.
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Affiliation(s)
| | | | | | - M A Makarova
- Research Institute of Eye Diseases, Moscow, Russia
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Neroev VV, Yani EV, Khoroshilova-Maslova IP, Golikova VA. The impact of corticosteroid therapy on the bacterial corneal ulcer healing process. RUSSIAN OPHTHALMOLOGICAL JOURNAL 2020. [DOI: 10.21516/2072-0076-2020-13-3-61-68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- V. V. Neroev
- Helmholtz National Medical Research Center of Eye Diseases
| | - E. V. Yani
- Helmholtz National Medical Research Center of Eye Diseases
| | | | - V. A. Golikova
- Helmholtz National Medical Research Center of Eye Diseases
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Kasparova EA, Fedorov AA, Yang B. [Clinical results of modified crosslinking in the treatment of purulent keratitis and corneal ulcers]. Vestn Oftalmol 2020; 136:64-73. [PMID: 32504479 DOI: 10.17116/oftalma202013603164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the efficiency of modified crosslinking (M-CXL) in the treatment of purulent keratitis (PK) and corneal ulcers, including ulcers of mixed etiology. MATERIAL AND METHODS M-CXL method involves simultaneous performance of CXL and frequent instillations of anti-infective agents (one drop every 5 minutes for 1 hour). The study included 39 patients (41 eyes) with purulent corneal ulcers (PCU) of various origin. The main group consisted of 26 patients (27 eyes) who were treated with M-CXL in combination with active conservative therapy. In the control group (13 patients, 14 eyes) only active conservative management was used. RESULTS Complete suppression of the purulent process in the main group was achieved in 21 (77.8%) eyes after 32.6±10.66 days, in the control group - in 9 (64.3%) eyes in 52.4±16.6 days. Complete suppression of purulent keratitis was achieved in 100% of cases with bacterial keratitis, 83% of cases with fungal keratitis and 70.5% of cases with mixed keratitis. When purulent infiltration occupied the entire depth of the stroma but was limited in area (less than 6 mm), the efficiency of M-CXL decreased to 66.6%. The clinical effect of M-CXL was absent or insufficient when PK extended to the Descemet's membrane with an area of more than 7 mm. CONCLUSION In 77.8% of cases, modified crosslinking has showed pronounced therapeutic effect - complete arrest of purulent corneal infiltration. Recovery time in the main group was 1.6 times shorter than in the control group (p<0.05). Resorption of the purulent infiltration occupying all layers of the stroma up to the Descemet's membrane with extensive areas was not achieved, however the corneal melting and keratitis progression were stopped, which allowed planned therapeutic penetrating keratoplasty with a graft of smaller diameter to be performed.
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Affiliation(s)
| | - A A Fedorov
- Research Institute of Eye Diseases, Moscow, Russia
| | - Biao Yang
- Research Institute of Eye Diseases, Moscow, Russia
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Kasparova EA, Kasparov AA, Sobkova OI, Kasparova EA, Rozinova VN. [A method of treating purulent corneal ulcer in the eyes with neuroparalytical keratitis and lagophthalmos]. Vestn Oftalmol 2019; 135:220-225. [PMID: 31691664 DOI: 10.17116/oftalma2019135052220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To develop a method for treatment of advanced purulent corneal ulcers in eyes with neurotrophic keratitis that developed as a complication of intracranial pathological processes or brain surgeries. MATERIAL AND METHODS The study involved 13 patients (14 eyes) that underwent combined surgery - keratoplasty, autoconjunctival flap covering, partial tarsorrhaphy performed simultaneously. Before and after the surgery, patients received frequent instillations of antimicrobial agents and autologous serum. RESULTS The organ of vision was preserved in all patients, visual function - in 50% of cases, it improved in 35.7% of cases from 0.07±0.05 to 0.26±0.11. Lagophthalmos has decreased from 6.11±0.99 to 2.78±0.62 mm. CONCLUSION Patients with intracranial lesions and complicated by neurotrophic keratitis and lagophthalmos often develop advanced severe and progressive corneal purulent ulcers, which seldom respond to the most active conservative therapy. Simultaneous surgery that includes keratoplasty, auto conjunctival flap covering and partial superficial tarsorrhaphy is an effective treatment option that helps preserve visual function in such eyes.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Kasparov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O I Sobkova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - El A Kasparova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V N Rozinova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Kasparova EA, Fedorov AA, Sobkova OI. [Influence of frequent instillations of anti-infective solutions on eye tissues (an experimental study)]. Vestn Oftalmol 2019; 135:160-170. [PMID: 31691655 DOI: 10.17116/oftalma2019135052160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the toxic effects of frequent instillations of anti-infective solutions (antibiotic eye drops - 0.3 and 1.4% tobramycin, 0.5% levofloxacin and 0.5% moxifloxacin; antiseptic eye drops - 0.05% pyloxidine and 0.025% chlorhexidine; antifungal drug - 2 mg/ml fluconazole solution) on ocular tissues. MATERIAL AND METHODS The study was conducted on 21 Wistar rats (42 eyes) using method of semi-fine sections. RESULTS The majority of antibiotics and antifungal agents do not cause toxic reactions in rats` eyes when instilled with frequent regimen with the exception of 'fortified' 1.4% tobramycin and pyloxidine solutions, which caused a decrease in corneal endothelial cells density and formation of fibrovascular tissue in the anterior chamber. CONCLUSION Frequent instillations of antimicrobial drug solutions is a safe method for the treatment of purulent corneal ulcers and purulent keratitis. The exceptions were solutions of 'fortified' 1.4% tobramycin and piloxidine (vitabact).
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Affiliation(s)
- E A Kasparova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Fedorov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O I Sobkova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Kasparova EA, Sobkova OI, Kasparova EA, Kasparov AA. [Surgery treatment of purulent corneal ulcers associated with neuroparalytic keratitis]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018. [PMID: 29543218 DOI: 10.17116/neiro201882172-77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study objective was to develop a method for surgical treatment of advanced purulent corneal ulcer in the setting of neuroparalytic keratitis developed after acoustic neuroma removal and strokes. MATERIAL AND METHODS The study included 12 patients (13 eyes). All patients underwent single-step keratoplasty, conjunctival autografting, and partial permanent tarsorrhaphy. RESULTS The eye as an organ was spared in 100% of cases; vision was spared in 50% of cases and improved, from 0.09±0.05 to 0.21±0.13, in 29% of cases. Lagophthalmos was reduced from 5.86±1.35 to 3.01±0.75 mm. CONCLUSION Patients with intracranial lesions complicated by neuroparalytic keratitis often develop progressive purulent corneal ulcers. The simultaneous use of surgery, including keratoplasty, conjunctival autografting, and partial (external) tarsorrhaphy, is an effective treatment that can preserve the visual function of these eyes.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, str. Rossolimo, 11 A, Moscow, Russia,119021
| | - O I Sobkova
- Research Institute of Eye Diseases, str. Rossolimo, 11 A, Moscow, Russia,119021
| | - E A Kasparova
- Research Institute of Eye Diseases, str. Rossolimo, 11 A, Moscow, Russia,119021
| | - A A Kasparov
- Research Institute of Eye Diseases, str. Rossolimo, 11 A, Moscow, Russia,119021
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Kasparova EA, Sobkova OI, Kasparova EA, Fedorov AA, Kasparov AA. [Surgical treatment of purulent corneal ulcers in eyes with neurotrophic keratitis and paralytic lagophthalmos]. Vestn Oftalmol 2017; 133:32-37. [PMID: 29165410 DOI: 10.17116/oftalma2017133532-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to develop a surgical approach to the treatment of purulent corneal ulcer in eyes with neurotrophic keratitis with lagophthalmos after auditory neuroma removal or stroke. MATERIAL AND METHODS A total of 12 patients (13 eyes) have been managed. All received combined surgery that included simultaneous keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy. RESULTS Ocular integrity was preserved in all cases, and also vision - in half of them. In 29% of cases, visual acuity increased from 0.09±0.05 up tо 0.21±0.13. Lagophthalmos decreased from 5.86±1.35 mm down to 3.01±0.75 mm. CONCLUSION Patients with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos often develop progressive purulent ulcers of the cornea. One-step keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy is an effective treatment that can help preserve visual function in such eyes.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - O I Sobkova
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - E A Kasparova
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Fedorov
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Kasparov
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Kasparova EA, Kasparov AA, Kasparova EA, Zaytsev AV. [Severe bilateral pseudomonas sclerokeratitis in comatose patient (clinical case)]. Vestn Oftalmol 2017; 133:68-73. [PMID: 28980569 DOI: 10.17116/oftalma2017133468-73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents a clinical case of severe bilateral pseudomonas sclerokeratitis in a patient with occlusion hydrocephalus and intracranial hypertension, who was in a coma and on a ventilator for 20 days. At first examination (7 days after the onset of purulent keratitis, during which the process had been rapidly progressing), the clinical picture included lagophthalmos, severe purulent corneal ulcer, bilateral purulent scleromalacia, perforated cornea in the left eye. On the same day, in order to maintain eye integrity, urgent reconstructive penetrating sclerokeratoplasty with subsequent sclerocorneal coating was performed in both eyes right in the intensive care unit. Parts of the melted iris and ciliary body pars plana that were left in place were abundantly washed with BSS and moxifloxacin solutions - 150 µg/ml. Postoperative care included forced instillations of antibiotics and antiseptics. Two years after the first surgery, 2 more full-thickness corneal transplantations were performed in the patient's right eye aiming at restoration of its optical system. Thus, immediate sclerokeratoplasty with anterior segment irrigation and intraocular administration of highly diluted antibiotics appeared to be the only chance to save the vision in one eye. The fellow eye, where perforation occurred as a result of severe purulent sclerokeratitis and purulent iridocyclitis, despite all measures taken, lost its sight. After three surgeries (penetrating sclerokeratoplasty and two re-PK), visual acuity in the only seeing (right) eye was 0.1, which can be considered a satisfactory result.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - A A Kasparov
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - E A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - A V Zaytsev
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russia, 119021
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Markova EY, Polunina EG, Pron'ko NA, Venediktova LV, Kurganova OV. [Ocular surface viral diseases in children]. Vestn Oftalmol 2016; 132:68-72. [PMID: 27600898 DOI: 10.17116/oftalma2016132468-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Over the past 15 years the number of children with inflammatory eye diseases has increased by five-six times. Data analysis of Moscow children's health clinics in 2014 showed that for 40,000 outpatients a viral infection was observed in 49,000 cases, whereas some children suffered from the viral infection twice or thrice. 344 children (0.7 percent) had the viral infection accompanied by keratoconjunctivitis. According to 2015 data, viral infection was observed in 37,957 children, including 325 outpatients (0.8 percent) with keratoconjunctivitis. AIM To analyze clinical features and treatment options of ocular surface viral diseases in children. MATERIAL AND METHODS We observed 140 children aged 2 to 13 years with ocular surface viral diseases. RESULTS Despite the presence of corneal disorders, in 95 percent of children changes were reversible - in 1.5 months corneal opacity was not observed. Yet five percent of children, despite the intensive treatment, had bacterial complications, causing decrease in visual acuity. CONCLUSION In case of viral infections, ophthalmologists, pediatricians and general practitioners should all be aware of ocular manifestations of these diseases. Even if adequate therapy for ocular surface viral disorders is appointed, in five percent of cases complications are possible, causing decline in visual function. Changes in vision can be a result of general disease manifestation, and only timely and proper treatment will help to relieve the symptoms of inflammation and prevent complications.The results of our observations revealed that the addition of Ophtalmoferon medication to the complex therapy of ocular surface diseases in children showed a high therapeutic efficacy and a good safety profile. This medication, in contrast to other antiviral agents, is available in the form of ready-to-use eye drops, significantly enhancing medication compliance in outpatients.
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Affiliation(s)
- E Yu Markova
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation, 117997; Moscow Children's Health Clinic #12, 1 Eletskaya St., Moscow, Russian Federation, 115583
| | - E G Polunina
- Institute of Postgraduate Education, Federal Medical Biological Agency, 91 Volokolamskoe Shosse, Moscow, Russian Federation, 125371
| | - N A Pron'ko
- Moscow Children's Health Clinic #12, 1 Eletskaya St., Moscow, Russian Federation, 115583
| | - L V Venediktova
- Moscow Children's Health Clinic #12, 1 Eletskaya St., Moscow, Russian Federation, 115583
| | - O V Kurganova
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation, 117997
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