Ocular hemodynamics in patients with posterior uveitis entities

Background: In spite of recent advances in ophthalmology, the diagnosis and treatment of uveitis is still a challenge. Purpose: To assess ocular hemodynamics in patients with primary and recurrent posterior uveitis (focal and disseminated chorioretinitis) using ophthalmic rheography. Material and Methods: One hundred and eighteen patients (mean age ± standard deviation, 37.2 ± 1.5 years) with posterior uveitis were included in the study. The median duration of recurrent posterior uveitis was 2920 days (range, 1080 to 5110 days). The etiology of chorioretinitis was not established in all patients of the study. The age-matched control group was composed of 16 healthy volunteers (32 eyes). Patients and controls underwent ophthalmic rheography (ORG) with Reocom, the computerized rheography apparatus (Kharkiv, Ukraine). ORG included measurements of ocular pulse blood filling (expressed as RQ, ‰ rheographic coefficient) and vascular tone (expressed as alpha/T percentage index), and volumetric pulse blood filling rate (expressed as Ohm/s). Results: In primary focal and disseminated chorioretinitis, inflammation was characterized by increased ocular circulation, which was manifested by (a) 20% increased ocular pulse blood filling (both for unilateral and bilateral inflammation); (b) 1.4-times and twice, respectively, increased volumetric pulse blood filling rate and (c) 12.5% and 33.3%, respectively, increased vascular tone in large-caliber vessels and small-caliber vessels. Ocular hemodynamics was increased in patients with unilateral recurrent focal, bilateral recurrent focal and bilateral recurrent disseminated chorioretinitis in the period of recurrence; particularly, ocular pulse blood filling was 17% increased, and volumetric pulse blood filling rate, 1.6 times increased. In addition, vascular tone in large-caliber vessels was increased. The period of remission in patients with focal chorioretinitis was characterized by normal ocular pulse blood filling, whereas in those with recurrent disseminated chorioretinitis, by 20% decreased ocular pulse blood filling compared to the norm. Volumetric pulse blood filling rate in the period or remission was 1.4-1.5-times increased in patients with focal chorioretinitis, but not in those with disseminated chorioretinitis. Conclusion: Ocular pulse blood filling, volumetric pulse blood filling rate, and vascular tone in large-caliber and small-caliber vessels were increased in patients with primary posterior uveitis and those with recurrent posterior uveitis in the period of recurrence, both for unilateral and bilateral inflammation. In patients with recurrent posterior uveitis, the period of remission was characterized by a wide range of changes, from normal values to mild deficits, in ocular pulse blood filling, as well as increased vascular tone in vessels, which requires adequate anti-ischemic treatment in the period between recurrences

Use of Vasavital® in patients with diabetic retinopathy

Background: Diabetic retinopathy (DR) is a major cause of visual impairment or blindness among working-age adults worldwide. For years, researchers around the world have been trying to develop new effective pharmaceutical methods of treatment for preclinical and early DR. Purpose: To examine the effect of a one-month course of Vasavital on the function of the visual system and ocular hemodynamics (using ophthalmic rheography) in patients with non-proliferative and proliferative diabetic retinopathy (NPDR and PPDR, respectively). Material and Methods: Forty-seven type 2 diabetes patients with DR and moderate glycemic control were divided into those with NPDR (group 1 of 15 patients; 30 eyes) and those with PPDR (group 2 of 17 patients; 34 eyes). The control group was composed of 15 volunteers (30 eyes) of similar age having no systemic or eye disease. Patients received a one-month course of Vasavital-only therapy at a dose of one capsule twice a day as an outpatient treatment. They received visual acuity assessment, intraocular pressure measurement, ophthalmoscopy, biomicroscopy, perimetry, systemic blood pressure and pulse measurement, optical coherence tomography and fluorescein angiography, and ocular hemodynamics was assessed by ophthalmic rheography. Eleven patients (22 eyes) with NPDR and ten patients (20 eyes) with PPDR underwent electrophysiological studies of electrically evoked phosphene threshold (EEPT) and critical frequency of phosphene disappearance (CFPD), before and after a course of Vasavital treatment. Results: Patients reported that a one-month course of Vasavital was well-tolerated, with no new complaints. In addition, no side effects were observed. After treatment, the function of the photopic afferent system as assessed by light sensitivity at minutes 0 to 7 of adaptation improved by 33.3%-40% in patients with NPDR and by 27.2%-33.3% in patients with PPDR. In addition, there was a decrease in EEPT by 18% and 7.7%, respectively, and an increase in CFPD by 28.2% and 24.7%, respectively, for patients in groups 1 and 2. Moreover, ocular pulse blood filling improved by 27.7% in patients with NPDR and by 17.3% in patients with PPDR, and vascular tone in large-caliber vessels decreased by 8% in the former patients. Conclusion: A one-month Vasavital course administered to patients with DR had a positive effect on the visual system function and ocular circulation parameters, which provides grounds for the use of the Ginkgo biloba-based preparation as a monotherapy or as part of a combined treatment for initial functional changes in the visual system in DR

The nature of changes in the hemodynamics of the eyes of patients with chronic anterior idiopathic uveitis complicated by optic neuritis with transition to atrophy

Комплексне лікування згідно зі стандартним протоколом одержали 18 пацієнтів з хронічним переднім ідіопатичним увеїтом, ускладненим невритом зорового нерва з переходом в атрофію. До і після лікування двічі проведено стандартне офтальмологічне обстеження і визначення об’ємного пульсового кровонаповнення, судинного тонусу очей, швидкості об’ємного кровотоку. Статистичний аналіз виконували в Statistica 12.0, використовували критерії Стьюдента і Вілкоксона. Після лікування зорові функції на хворому оці поліпшуються, не змінюючись до року. До лікування показники гемодинаміки збільшені (p<0,000) на хворих очах відносно здорових. Через 6 і 12 міс. після лікування достовірно знижені об’єм пульсового і швидкість об’ємного пульсового кровонаповнення, тонус великих і дрібних судин щодо вихідних даних.Aim. To determine the nature and direction of changes in the hemodynamics of the eyes of patients with chronic anterior idiopathic uveitis complicated by optic neuritis with transition to atrophy. Materials and methods. The study involved 18 people with chronic anterior idiopathic uveitis complicated by optic neuritis with transition to atrophy. Ophthalmological (ophthalmoscopy, biomicroscopy, intraocular pressure, perimetry, visual acuity with maximum correction) and electrophysiological (volumetric pulse blood filling, vascular tone of the eye, volumetric blood flow rate) studies were performed before and after treatment for a year. The treatment was carried out according to the protocol: at the first visit – non-steroidal anti-inflammatory drugs, antibiotics, immunosuppressant, corticosteroids and immunomodulatory; with subsequent metabolic and vitamin therapy, physiotherapy. Statistical analysis was performed using Statistic 12.0 software. The t-test of Student and Wilcoxon was used. Research results. As a result of treatment, the visual functions of patients improved: the number of people with higher visual acuity is increasing. In the period up to 6 months after treatment, the number of patients with low visual acuity (0.12–0.5) decreased from 94.4 to 50%; in 11 of 13 visual acuity increased to 0.3–0.5 (66.7% of all subjects). A year after the treatment, the visual acuity in the diseased eyes remained the same. The study of eye hemodynamics showed a significant (p<0.000) increase in all parameters in the diseased eye relative to the healthy one before treatment: volumetric pulse blood filling – by 64.8; the tone of large eye vessels – by 10.1, small – by 17.5; the rate of volumetric pulse blood filling – by 37.8%. Comparative analysis of the hemodynamic data of sick eyes at different periods after treatment revealed a significant decrease in volumetric pulse blood filling to 66.4 and 52.4%, the rate of volumetric pulse blood filling to 60.2 and 44.4%. A decrease in the tone of large vessels by 3.1 and 6.4%, and small – up to 94.6 and 92.7% at the time of up to six months and up to a year relative to the initial data (p<0.000 in all cases). Conclusions 1. As a result of treatment, the visual functions in the diseased eye improve without deteriorating until a year after treatment. 2. Before treatment, hemodynamic indices are increased (p<0.000) in the diseased eye relative to the healthy one. 3. Six and 12 months after treatment, the volumetric pulse blood filling, the rate of volumetric pulse blood filling, the tone of large and small vessels were significantly reduced relative to the initial data

Clinical experience of the use of Vasavital® in dry age-related macular degeneration and ischemic optic neuropathy

and brain is a component of the pathogenesis of ischemic optic neuropathy and age-related macular degeneration, and requires prompt and adequate treatment. Purpose: To examine the effect of a one-month course of Vasavital on the function of the visual system and regional hemodynamics in patients with dry age-related macular degeneration and those with ischemic optic neuropathy. Material and Methods: Thirty-two patients with dry age-related macular degeneration (AMD) (mean age, 66 ± 1.5 years) and 22 patients with chronic ischemic optic neuropathy (mean age, 57.0 ± 1.4 years) underwent examination and treatment at the Department of Uveitis and Laboratory for Functional Examination of the Visual System of the Filatov institute. They received a one-month course of Vasavital-only therapy at a dose of one capsule twice a day as an outpatient treatment. Patients reported their complaints and underwent routine eye examination, studies of regional hemodynamics in the eye and brain (by ophthalmic rheography and rheoencephalography with Reocom, the computerized rheography apparatus), and electrophysiological studies of electrically evoked phosphene threshold (EEPT) and critical frequency of phosphene disappearance (CFPD) at two time points: prior to and after a one-month course of Vasavital-only therapy. Results: A one-month course of Vasavital-only therapy resulted in 24% and 9.6%-25% increases in ocular pulse blood filling in patients with chronic ischemic optic neuropathy and patients with age-related macular degeneration with various baseline levels of visual acuity, respectively. In addition, vascular tone in large-and small-caliber ocular vessels decreased significantly, by 12-17%, in patients with chronic ischemic optic neuropathy, and by 10-20%, in patients with age-related macular degeneration, and vascular tone in large-caliber brain vessels (in the vertebral-basilar system) decreased by 21.6% in patients with ischemic optic neuropathy. A course of Vasavital-only therapy resulted in improved optic nerve function in patients with ischemic optic neuropathy, with a 20.5% improvement in electrically evoked phosphene threshold (EEPT), and 22-63% improvement in critical frequency of phosphene disappearance (CFPD); this indicated an improved function of the peripheral as well as central retina

Levels of pro-inflammatory (TNF-α and IL -6) and anti-inflammatory (IL -10 and IL- 4) interleukins in ocular herpes patients with frequent and infrequent recurrences

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

Efficacy of transscleral Nd:YAG laser cyclophotocoagulation and changes in blood circulation in the eye of patients with absolute glaucoma

Background. Absolute glaucoma is a disease which is caused by a range of different factors and which refers to a most severe ophthalmic pathology. Treatment of absolute glaucoma is often insufficient to manage pain and to decrease intraocular pressure. The purpose. To study changes in ocular hemodinamics and efficacy of transscleral (TS) Nd-YAG laser cyclophotocoagulation (CPC) in patients with absolute glaucoma. Material and Methods. We followed-up 30 patients (32 eyes) with absolute glaucoma; patients' age averaged 62.5 (SD, 2.09); 19 males (63%) and 11 females (37%). Baseline best corrected visual acuity (BCVA) averaged 0.011 (SD 0.018): BCVA=0.001-0.06 in 15 eyes (47%); BCVA=light perception (correct) in 5 eyes; BCVA=no light perception (incorrect) in 2 eyes; BCVA=0 in 12 eyes. A baseline IOP level averaged 38.2 (SD 5.05) mmHg ranging from 29.0 to 47.0 mmHg. A treatment course included three TS CPC sessions performed by Nd:YAG laser (λ=1.06 μm, I=0.8 J) every other day. TS CPC was performed concentrically in full circle (360°) in two rows, at 1.5-2.0 mm from the surgical limbus. A schedule of antihypertensive instillations was not changed. Additionally, a course of anti-inflammatory therapy was prescribed (indometacin, 0.1%, 4 times a day for a month). Results and Discussion. TS CPC of the ciliary body resulted in pain management in all patients (100%). The IOP level was significantly decreased compared to baseline: by 32%, immediately after TS CPC of the ciliary body and by 23% at 3 months after TS CPC, to 26 (SD 2.85) mmHg and 29.4 (SD 5.44) mmHg, respectively. Visual function remained the same after a treatment course. RQ blood circulation decreased after a treatment course at average by 34%, or to 2.3 (1.46) ‰ (р=0.00002). Vascular tone improved after TS CPC in 11%, 25.0 (SD 1.29)‰. The correlation analysis revealed a direct relationship between: the number of applications performed and a decrease of IOP (r=0.45), (р<0.05) as well as postoperative blood circulation (r=0.36), (р<0.05). There was also noted a significant correlation relationship (r=0.42), (р<0.05) between a decrease of an IOP level and a decrease of volume blood circulation of the eye after TS CPC of the ciliary body. Age and gender had no significant correlation relationship with IOP changes. TS CPC of the ciliary body did not achieve a desired effect in 8 patients (25%), which required a repeat course after three months. Conclusions. TS CPC of the ciliary body in patients with absolute glaucoma decreases IOP at average by 32% immediately after surgery and by 23% at 3 months after TS CPC. TS CPC of the ciliary body in patients with absolute glaucoma decreases volume blood circulation in the vascular pool of the ciliary body by 34% and reduces tonic properties of ciliary vessels by 11 %. TS CPC of the ciliary body is a successful organ-sparing treatment for patients with absolute glaucoma and has an apparent analgesic endpoint

Analysis of the Study of the Expression of Apoptosis Markers (CD95) and Intercellular Adhesion Markers (CD54) in Healthy Individuals and Patients Who Underwent COVID-19 When Using the Drug Mercureid

SARS-CoV-2, the pathogen, which is responsible for coronavirus disease 2019 (COVID-19), has caused unprecedented morbidity and mortality worldwide. Scientific and clinical evidence testifies about long-term COVID-19 effects that can affect many organ systems. Cellular damage, overproduction of proinflammatory cytokines and procoagulant abnormalities caused by SARS-CoV-2 infection may lead to these consequences. After suffering from COVID-19, a negative PCR test is only the beginning of a difficult path to full recovery. 61 % of patients will continue to have the signs of post-covid syndrome with the risk of developing serious COVID-19 health complications for a long time. Post-COVID syndrome is an underestimated large-scale problem that can lead to the collapse of the healthcare system in the nearest future. The treatment and prevention of post-covid syndrome require integrated rather than organ or disease specific approaches and there is an urgent need to conduct a special research to establish the risk factors. For this purpose, we studied the expression of markers of apoptosis (CD95) and intercellular adhesion (CD54) in healthy individuals and patients who underwent COVID-19, as well as the efficacy of the drug Mercureid for the treatment of post-covid syndrome. The expression level of the apoptosis marker CD95 in patients who underwent COVID-19 is 1.7-2.5 times higher than the norm and the intercellular adhesion marker CD54 is 2.9-4.4 times higher. This fact indicates a persistent high level of dysfunctional immune response in the short term after recovery. The severity of the expression of the intercellular adhesion molecule (ICAM-1, CD54) shows the involvement of the endothelium of the vascular wall in the inflammatory process as one of the mechanisms of the pathogenesis of post-covid syndrome. The use of Mercureid made it possible to reduce the overexpression of CD95 in 73.4 % of patients that led to the restoration of the number of CD4+/CD8+ T-cells, which are crucial in the restoration of functionally active antiviral and antitumor immunity of patients. Also, the use of Mercureid led to a normalization of ICAM-1 (CD54) levels in 75.8 % of patients. The pharmacological properties of the new targeted immunotherapy drug Mercureid provide new therapeutic opportunities for the physician to influence a number of therapeutic targets, such as CD95, ICAM-1 (CD54), to reduce the risk of post-COVID complications

ICAM-1 expression on blood lymphocytes in patients with stromal herpes keratitis at different periods of disease

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

Sensitivity of peripheral blood lymphocytes to adrenaline and acetylcholine in patients with primary and recurrent posterior uveitis

Background: Posterior uveitis is a polyetiologic group of diseases with polymorphic clinical manifestations and a prolonged, chronic and recurrent course. In addition, it is commonly bilateral and often causes complications, loss of working capacity and early visual disability in young adults. It is an important task of current clinical ophthalmology to find biomarkers indicating the severity of inflammation and the likelihood of developing a recurrence of the initial process. Purpose: To determine the sensitivity of peripheral blood lymphocytes to adrenaline and acetylcholine in patients with primary and recurrent uveitis at different phases of the disease. Material and Methods: One hundred patients with idiopathic posterior uveitis were examined at different phases of the disease. The control group was composed of 16 healthy individuals of a similar age. The specific sensitivity of lymphocytes to neuromediators, adrenaline and acetylcholine (expression of T cell adrenergic and acetylcholine receptors) was assessed using our complex methodology (in conjunction with a parallel sampling method) for assessing the individual’s sensitivity to medicaments (biological regulators) which has been developed at Immunology laboratory, Filatov Institute of Eye Disease and Tissue Therapy. The method involves obtaining lymphocytes from an individual, culturing lymphocytes with examined drugs immunohistochemically, and use of a peroxidase anti-peroxidase method with monoclonal T-cell antibodies. Results: Absolute and relative adrenoreceptor and acetylcholine receptor expression levels in patients with posterior uveitis were 1.8-2.0 times and 1.6-2.4 times, respectively, higher in patients with posterior uveitis compared to controls. Absolute adrenoreceptor and acetylcholine receptor expression values were 12.6% and 31.7%, respectively, higher in the recurrent process during active inflammation compared to the period of remission. However, in patients with posterior uveitis, adrenoreceptor and acetylcholine receptor expression values in the period of remission were still higher than normal values. The odds of an increased relative adrenoreceptor expression and the odds of an increased relative acetylcholine receptor expression on peripheral blood lymphocytes were 67.5-fold higher and 23.6-fold higher, respectively, among patients with posterior uveitis compared to controls. The correlation of adrenoreceptor expression and acetylcholine receptor expression with absolute counts of T cells and T helpers was stronger than the correlation with B cells, which reflects to a larger extent the association with the cellular immunity and to a lesser extent the association with the humoral immunity. There was a moderate correlation of adrenoreceptor expression and acetylcholine receptor expression with cell subsets of markers of early lymphocyte activation CD5, autoimmune aggression CD25, intercellular adhesion CD54 and apoptosis CD95 (Fas/APO-1). Conclusion: The adrenoreceptor expression and acetylcholine receptor expression on peripheral blood lymphocytes may be used as a non-specific biomarker of an activated inflammatory process in posterior uveitis

Analysis Study of Visual and Physiological Functions, Expression of Various CD Markers of the Immune System, Clinical Course and Treatment of Complications in Patients with COVID-19 When Using Drug Mercureid

The coming era of COVID-19 introduces critical challenges for researchers - what will happen to the patients who have suffered from long COVID-19? What diseases threaten them? What happens to the patients’ immunity after the action of antigen SARS-CoV-2? To what extent do the changes caused by it contribute to or, on the contrary, prevent from the development of long-term protective immunity? And how effective will COVID-19 vaccine be in these patients? We tried to answer some of these questions in our research. The study was conducted in 49 patients with ophthalmic pathologies who had previously undergone COVID-19. On the one hand, ocular pathologies are important because they allow in a non-traumatic way to obtain lifetime visualization of the state of blood vessels and capillaries, as well as to assess the effect of the virus on the central nervous system. On the other hand, immunological studies made it possible to draw a conclusion about the state of antiviral immunity, immune status and its correlation with the severity of inflammatory processes in the eye structure, the central nervous system including the vascular endothelium. The novelty of the study is that we have established a causal relationship between SARS-CoV- 2 infecting, formed dysfunction of immune parameters that caused the manifestation of chronic inflammatory diseases. As a result, light adaptation was impaired by 2.3 times, due to the damage to blood circulation owing to the neurotoxic effect of SARS-CoV-2 and hypoxemia. The corrective effect of drug Mercureid was fixed in 73.4 % of patients. The most dramatic cases were observed in the group of patients with damage to the retinal vascular system: the phenomenon of re-thrombosis of both the central retinal vein and its branches, as well as circulatory disorders in the optic nerve trunk - ischemic optic neuropathy with a sharp deterioration in vision. In these patients, the combination of vascular drugs and drug Mercureid allowed stabilizing the patients’ state, achieve remission and in some cases reach high visual functions in 50.0% of cases. Mercureid made venotonic and angioprotective effect. It reduced vein elasticity and capillary permeability. Also it improved venous outflow and microcirculation that allowed in some cases to restore lymphatic drainage. According to the results of the immune study, the targeted effect of the new drug Mercureid, aimed at modulating the activity of several critical target proteins, such as CD3, CD4, CD8, CD25, CD38, CD54, CD95 was revealed. The therapeutic efficacy of Mercureid was 75.1%. The second research finding is that in patients with manifestation of chronic inflammatory diseases who have previously been infected with SARS-CoV-2, the production of specific protective antibodies is likely to be impaired (as these patients often have pathologically low levels of CD4, CD8, CD25 and overexpression of CD38, ICAM-1, CD95 that causes apoptosis of immune cells, lymphopenia and also forms the phenotype of exhausted T-cells with activation of the expression of inhibitory receptors) and vaccination may be ineffective for them, due to the presence of a compromised immune system. Accordingly, the provision of corrective multitarget immunotherapy aimed at several target proteins, which are critical for the formation of long-term effective post-viral immunity to SARS-CoV-2, is an extremely important therapeutic need. This immunotherapy can be carried out both before and after vaccination in order to achieve the maximum protective effect from the vaccine. But the definite answer to this research question will require another type of study design, which we plan to conduct in the future