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Analysis of 37 corneal disks removed in perforating keratoplasty for stages II-IV keratocone and of 15 corneal disks (control) from subjects dead from mechanical injuries at the age of 17-35 years was carried out. The expression of CD95 receptors on keratocyte membranes was evaluated by indirect immunofluorescent label using rabbit antibodies. Keratocyte apoptosis was evaluated by indirect immunofluorescent labeling of nuclear DNA nucleotides. Estimation of the volumic share of keratocytes expressing CD95 on cell membrane showed it to be almost 8-fold higher and apoptosis index almost 5-fold higher in the keratocone corneal disks than in the control. The results indicate the presence of a Fas-mediated mechanism of keratocyte apoptosis and its manifold predominance in the cornea in keratocone. These results are clinically significant for the choice of pathogenetic therapy of patients with keratocone.

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Biochemical parameters of the tears, reflecting oxidative processes in the eyes, were analyzed in 79 patients (146 eyes) aged 19-42 years with progressive and acute keratocone and with long remission of the disease. The data indicate disorders in oxidative processes with predominance of aerobic oxidation over anaerobic in the anterior segment of the eye. Evaluation of lipid peroxidation and antioxidant enzymes showed predominance of prooxidant processes over oxidant. These disorders are related in keratocone and differ in progressive, acute condition, and remission. The greatest changes in the lacrimal oxidative processes are observed during the disease progress and even more so in acute disease. The detected changes in the lacrimal biochemistry in patients with keratocone can be regarded as an important mechanism underlying the dystrophic processes in the cornea.

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Local immunity is analyzed in 81 patients (146 eyes) aged 16-49 years with three clinical patterns of keratocone. During long remission, IgG level was the maximum. In progressive disease, sIgA and transferrin levels were increased. The most pronounced shifts were detected in the patients with acute keratocone: increased concentrations of IgM, C3 and C4 complement components, alpha 1-antitrypsin, orosomucoid, lysozyme activity, and immune complexes. These data prompt the development of pathogenetically based approaches to the treatment of patients with various clinical immunological types of keratocone.

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Analysis of the prevalence of keratocone in the Urals showed it to be 1:500,000 population. Young capable men suffer from this condition 3 times more often than women, urban residents more often than rural ones (5 times more often). The prevalence of keratocone in the Urals is the maximal in the ecologically unfavorable Chelyabinsk district: 1:250,000.

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Local immunity was studied in 81 patients (146 eyes) aged 11-49 with keratoconus at different stages of the disease running different course. The concentrations of IgG, IgM, secretory IgA, lysozyme, immune complexes, C3 component of the complement, transferrin, and alpha 1-antitrypsin are increased in tears of patients with keratoconus, reflecting the activation of local immunity in this condition.

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Histotyping of HLA I antigens in 100 patients with keratoconus. Europeoids of the Chelyabinsk district, and of 701 controls (donors listed in the regional register) showed an increased incidence of HLA A28, B12, and B15, a decreased incidence of HLA B8, B13, and complete absence of HLA A11. Estimation of HLA haplotypes in keratoconus showed an increased incidence of haplotypes A1-B5 (relative risk RR = 5.9), A2-B15 (RR = 3.34), A2-B27 (RR = 2.12), and A9-B21 (RR = 4.13) and decreased incidence of A1-B8 (RR = 0.31). The incidence of incomplete phenotypes was 27%. The most incident of incomplete phenotypes was A3-B35. Reliably linked HLA haplotypes A3-B7, A2-B27, A9-B21, and A9-B35 were typical of men with keratoconus, whereas A2-B21 haplotype was characteristic of the female patients.

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The effect of rigid contact lenses on the course of keratocone during different stages is studied. A total of 121 patients (234 eyes) aged 11 to 49 years were examined. Early onset of keratocone is associated with its more rapid progress; the evolution of the disease from the initial to terminal stage takes 7 years with lenses and 4 without them; the progress of keratocone from one stage to another with contact correction takes more than 2 years versus less than 1.5 years without correction. Rigid contact lenses inhibit the progress of keratocone only at the initial stage of the disease.

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Psychological testing of 63 normal subjects and 84 patients with keratocone was carried out separately for men and women aged 18-64 years using 11 scores of a brief multifactorial questionnaire for personality examination (BMQP). Comparison of averaged profiles of examined men and women with keratocone showed features of sensitive and psychasthenic personalities. According to BMQP scores, the population of men with keratocone is characterized by increased levels of psychasthenia and schizophrenia, whereas women develop depression, psychasthenia, and schizophrenia.

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Analysis of deviations in the distribution of HLA antigens and haplotypes characteristic of each of the three patterns of keratocone revealed a genetic predisposition to the development of a certain pattern of the illness. HLA-B27 antigen in the phenotype and increased incidence of haplotypes A2-B27 and A3-B35 were typical of patients with the progressive course of keratocone. In patients with a favorable course of the illness the incidence of HLA-A2 and B15 was the highest. Patients with a history of acute keratocone were characterized by an increased incidence of HLA-A1, A19, B7, and complete absence of HLA-A2. Our findings will help predict the course of keratocone and its relapses presenting as acute keratocone and plan the treatment strategy with due consideration for the immunogenetic features.

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Three clinical patterns of keratoconus were distinguished in the course of a long (up to 15 years) follow-up of 162 patients with different stages of the disease: chronic progressive stage, long (more than 5.5 years) remission, and acute stage. Keratoconus progresses for up to 5 years in 82.1% of cases. In 11.4% the disease remains at one stage, more often at the initial one, and a long remission ensues. Acute keratoconus develops in 6.8% of cases, not only in terminal and far advanced, but even at the well-developed stage, this proves the desirability of early keratoplasty in the progressive course of the disease.

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The paper presents results after examination of 1260 adults (2547 eyes), aged from 18 to 55 years, for the period from 1982 to 1988. The examination was carried out in order to reveal the incidence of refractive, anisometropic amblyopia without strabismus in persons using glasses (a control group) and contact lenses as well as to determine a degree of spheric, astigmatic refraction in development of amblyopia on the background of contact lenses. It was found that amblyopia on the background of contact correction, as compared with glass correction, develops rarer making up 22.03% of them low degree of amblyopia is recorded in 51,16%, moderate--in 35,65% high--in 13,19% to the total number of amblyopic eyes examined. Direct relationship between the number of amblyopic eyes and degree of astigmatism and anisometropia is revealed. Detection of amblyopia in adults without strabismus with subsequent contact correction and treatment is considered to be necessary for medical and labour rehabilitation of such patients.

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