[Recurrent herpetic erosion of the cornea: diagnosis, treatment and prevention of recurrences]

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

[Diagnosis and treatment of adenoviral keratoconjunctivitis]

PURPOSE

To improve the treatment of adenoviral lesions of the eye based on express diagnostics by the fluorescent antibody technique (FAT) and the use of modern drugs.

MATERIAL AND METHODS

The study included 184 patients (333 eyes) with various manifestations of adenoviral lesions of the ocular surface, who were divided into two groups: group 1 (149 patients, 196 eyes) - acute form, and group 2 (76 patients, 137 eyes) - long lasting form. Effectiveness of the proposed treatment was evaluated against separate group 3 (controls) consisting of 28 people (46 eyes) with completed acute adenovirus infection, who had previously received antibiotic and corticosteroid therapy in other clinics. Conjunctival scrapings of study patients were examined with FAT in our proposed modification. Study patients received local therapy with modern drugs (Okomistin, Aktipol).

RESULTS

FAT detected the adenovirus antigen in 169 cases in group 1 (86%) and in 99 cases in group 2 (72%). Treatment duration amounted to 12±6 days in group 1, 18±8 days in group 2, and 29±7 days in controls. In both study groups, the duration of treatment was significantly reduced in comparison with the controls (p<0.01). Stable clinical effect and complete restoration of visual acuity have been achieved in most cases. There were no allergic and side effects from the therapy.

CONCLUSION

Fluorescent antibody technique is a fast and effective way to diagnose adenovirus infection in ophthalmology. In terms of therapy, the use of an antiseptic, an antiviral drug and diluted corticosteroids is the most rational approach.

[Anterior eye segment damage in coronavirus infection (COVID-19)]

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.

[Confocal microscopy in the diagnosis of acanthamoeba keratitis]

Acanthamoeba keratitis (AK) is a dangerous disease of the cornea, its prevalence has increased significantly due to widespread usage of contact lenses. The similarity of the clinical manifestations of AK to other infectious keratitis (especially herpetic keratitis) requires introduction of a rapid diagnosis method into clinical practice.

PURPOSE

To evaluate the capabilities of corneal confocal microscopy (CCM) in the diagnosis of acanthamoeba keratitis.

MATERIAL AND METHODS

We examined 33 patients (35 eyes) with suspected acanthamoeba keratitis using light and laser confocal microscopy of the cornea (ConfoScan and HRT devices, respectively).

RESULTS

CCM was technically feasible in 23 of 35 cases (65.7%). Acanthamoeba cysts were detected in 16 cases (69.6%); trophozoites were visualized in 17.4% of cases; signs of keratoneuritis were detected in 12 eyes (52.2%); in 7 cases (30.4%), hyporeflective honeycomb-like cavities were observed in the stroma; deep stromal striae were observed in 9 cases (39.1%); activated keratocytes were detected in 11 patients (47.8%), and Langerhans cells were detected in 19 cases (82.6%).

CONCLUSIONS

The main diagnostic value of confocal microscopy is the detection of direct markers of AK - cysts and trophozoites of Acanthamoeba. Both light and laser CCM techniques are suitable for the diagnosis of AK, but the resolution of laser confocal microscopy is higher. The non-invasive nature of this method and the possibility of multiple subsequent examinations make it possible to verify the diagnosis of acanthamoeba keratitis and monitor the treatment.

[Manifestations of herpes zoster ophthalmicus]

The article reviews the main ocular features of Herpes Zoster Ophthalmicus (HZO) including Ramsay-Hunt and Tolosa-Hunt syndromes that involve III, IV and VI pairs of cranial nerves and I branch of the trigeminal nerve, and describes treatment methods of its active manifestations and postherpetic neuralgia, as well as herpes zoster vaccination practices.

[Treatment of Acanthamoeba keratitis]

In recent years, Acanthamoeba keratitis (AK) has became a clinically significant problem because of the broad use of contact lenses that are the major risk factor of the disease. The treatment presents considerable difficulties due to similarity of clinical manifestations of AK to other keratites (bacterial, herpetic, and fungal). This often leads to late diagnosis and formation of drug-resistant cysts. There is currently no specific drug universally suitable for monotherapy of AK. Instead, 2 agents (usually chlorhexidine and poligexametilen biguanide) are used that, if combined, are effective against both trophozoites and cysts. If necessary (severe keratitis, insufficient treatment effect), diamidines (propamidine and its analogs), antifungals (fluconazole, itrakonazol), certain antibiotics (Neomycinum), and iodine-containing medications (povidone-iodine) can be prescribed. The use of corticosteroids is considered unjustified because of the risk of rapid progression (due to disturbance of local immunity and also provocation of excystation of the amoebas). The penetrative keratoplasty may be required, especially if a descemetocele or corneal perforation occurs, however, its results are generally worse than those in other keratites because of a higher risk of complications (iridocyclitis, secondary glaucoma, AK recurrence in the graft). In some cases, good results are achieved with minimally invasive surgeries, such as mechanical epithelial debridement, conjunctivoplasty and cryopreserved amniotic membrane transplantation, excimer laser phototherapeutic keratectomy, and cross-linking. In the future, gene therapy and specific chemotherapy of AK may well be developed.

[. Oсumethyl in the treatment of allergic diseases of eyelids and conjunctiva]

Treatment of allergic diseases of eyelids and conjunctiva (conjunctivites and blepharoconjunctivites) often presents difficulties due to peculiarities of their pathogenesis - allergic and vascular reactions, disorder of lacrimal production, meibomian gland dysfunction, and possible bacterial contamination. It has been suggested to use Ocumethyl, which contains zinc sulfate (binding, drying, anti-inflammatory, and antiseptic effect), diphenhydamine hydrochloride (an Н1-antihistamine that decreases capillary permeability and helps resolve conjunctival and eyelid edema), naphazoline hydrochloride (a sympathomimetic notable for its strong, rapid, and long-lasting vasoconstrictive effect), and methylene blue (antiseptic effect, disintoxication, and antioxidant activity). A total of 80 patients with chronic allergic conjunctivitis, blepharoconjuntivitis, or giant papillary conjunctivitis associated with contact lens wearing were treated with Ocumethyl instillations (3 times daily for 15-30 days). A clinically significant effect was obtained in 77-91% of patients depending on the disease entity.

[Diagnosis of Acanthamoeba keratitis]

The Acanthamoeba keratitis is a relatively rare, but dangerous disease of the cornea. Its development is thought to be associated with contact lens wearing as well as corneal microwounds contaminated with soil or water. The disease has no evident distinctive clinical features and is, therefore, difficult to be distinguished from herpetic or fungal keratitis. Nevertheless, Acanthamoeba infection can be suspected judging from anamnestic data (i.e. contact lens use and corneal injury with subsequent contamination of the wound), inadequately strong pain syndrome, ring-shaped infiltration of the cornea and ineffectiveness of conventional therapy. Also helpful may be such measures as isolating the bacteria using the method of biocultures, morphological examination of corneal biopsy material (using light and luminescent microscopy), genetic testing, and in vivo confocal microscopy of the cornea. Other promising methods are also listed in this article. A widely accepted diagnostic technique is yet, however, missing.

[Combination of microdiathermocoagulation and local express autocytokine therapy in treatment of superficial infectious corneal ulcers]

Current surgical non-keratoplastic options of superficial infectious corneal ulcers treatment are presented. Literature data is analysed and proposed methods are assessed.

[Recurrent herpetic corneal erosion: diagnosis and treatment]

Recurrent corneal erosion (CE) is a common anterior eye disease, which usually occurs after injury, substantially limits a patient's ability to work, and is intractable. The authors single out an individual form of CE herpetic CE (HCE) on the basis of immunofluorescence assay of a conjunctival scrape, which shows the high concentration of herpes simplex virus antigen in 53% of CE cases. Confocal microscopy revealed epithelocyte polymorphism and basement membrane defects. The treatment of patients with HCE involved 2 steps: 1) relief of acute signs of the disease via drug therapy, rapid local autocyte cinotherapy (RLACCT), or phototherapeutic keratectomy (PTK) and 2) prevention of recurrences. For this the authors developed a method based on the systemic use of a new composition of the intradermal herpes vaccine Vitaherpavac in combination with the subcutaneous interferon inducer Poludan. RLACCT was found to be the most effective medical treatment for CE and PTK was the most effective surgical one. Vaccination with the concurrent subcutaneous injection of Poludan is an effective method in preventing recurrent HCE. During a follow-up of 2 years or more, 81% of the patients achieved clinical resolution; there was a decrease in recurrence rates and severity in 15.1% and no effect in 3.8%.

[Viral lesions of the eye in human immunodeficiency virus infection]

HIV infection destroying cellular immunity system creates prerequisites for herpesvirus involvement of the anterior and posterior segments of the eye. A total of 370 HIV-infected patients were examined. Ocular diseases were detected in 53 (14.35%). The most prevalent conditions were retinal angiopathy (most often with cotton-like foci--in 7.3% and cytomegalovirus (CMV) retinitis in 4.1%). Cotton-like foci in the presence of CMV activation (evidenced by high level of CMV DNA in peripheral blood) are a sign of probable CMV infection manifesting by retinitis or involvement of other organs. Intravenous gancyclovir in a dose of 7.5 mg/kg twice a day and its combination with interferon inductor poludan are effective methods for therapy of CMV infection, preventing blindness or poor vision. Moreover, combination of chemotherapy with interferon inductors cured involvement of the anterior segment of the eye--herpetic keratitis and iridocyclitis, which sometimes develop in the presence of HIV infection.

[Express diagnosis of eye adenovirus infection by fluorescent antibody method]

Adenoviruses often cause epidemic keratoconjunctivitis. The infection is highly contagious, often leads to corneal opacities, and is therefore to be timely diagnosed and properly treated. The authors propose a method for rapid diagnosis of adenovirus infection based on examination of a scraping off the conjunctiva by indirect immunofluorescence with polyvalent fluorescent rabbit serum and offer recommendations on the use of this method. Using this technique, adenovirus antigen was detected in 14 (61%) out of 23 patients with acute follicular conjunctivitis and in 19 (95%) out of 20 patients with keratoconjunctivitis. Despite clinical cure after antiviral therapy, the antigen persisted for 1 month in 22-30% patients and in some patients for 3 months (as a rule, it was in patients treated too late or ineffectively or after corticosteroids). That is why maintenance antivirus therapy is recommended for 2-3 months after clinical cure.

[The diagnosis and clinical characteristics of cytomegalovirus infection in HIV-infected subjects]

Out of 180 HIV carriers active cytomegalovirus (CMV) infection was found in 30 patients, in 16 cases the infection manifested clinically. Most of the latter were patients with HIV infection IIIb or IIIc stage against persistent lowering of CD4-lymphocyte count under 100/mm3. Active CMV infection may be determined most significantly by the following criteria: high or moderate concentrations of CMV DNA in the blood, low concentrations of blood CMV DNA in the presence of long-term (at least 3 months) persistence of anti-CMV IgM and isolation of urinary CMV. CMV infection manifested usually as a generalized disease with typical signs of retinitis, myelitis, erosive-ulcerative colitis. Most patients had thrombocytopenia, functionally defective platelets. CNS involvement predicts poor prognosis in CMV-infected HIV carriers.

[On the role of the posterior hyaloid membrane in the pathogenesis of and surgery for proliferative diabetic retinopathy]

A total of 278 patients subjected to transciliary vitrectomy for proliferative diabetic retinopathy (PDR) were followed up. Thirty preparations of epiretinal membranes removed in surgery were examined under an optic microscope. Vessels newly forming in PDR were found to grow mainly along the external surface of the posterior hyaloid membrane; they ceased their growth after its removal. The posterior hyaloid membrane is the anatomical object of surgical intervention of PDR. The proliferative form of diabetic retinopathy is never seen in the presence of a naturally occurring or vitrectomy-induced complete posterior hyaloid detachment, that is why if the posterior hyaloid membrane is well detached from the retina in the course of operation, panretinal laser coagulation in the postoperative period is not recommended.