Aim: to study clinical presentations of dry eye disease (DED) in intermediate uveitis (pars planitis) and develop a complex treatment algorithm including tear substitutes, reparative, and anti-inflammatory therapies combined with laser photocoagulation. Patients and Methods: the study enrolled 98 patients divided into the study group (n=78) and the comparison group (n=20). Study group patients received complex treatment, including tear substitutes, anti-inflammatory therapies, and laser photocoagulation. Comparison group patients received topical medications only. All patients underwent a complex examination including the OSDI questionnaire, visual acuity, IOP measurements, slit lamp examination, binocular dilated fundus examination with scleral indentation, and Schirmer’s test 1 at baseline, after baseline three and six months. Treatment efficacy was assessed based on the severity of intermediate uveitis presentations. Results: intermediate uveitis exacerbates DED. The more active chorioretinal inflammation near the ora serrata is, the more severe clinical, functional changes of the ocular surface are. Complex treatment significantly improved typical DED complaints by the OSDI score (by 34.8%), ocular surface by slit-lamp examination (lower occurrence of conjunctival fold overhang, by 51.8%), mild eyelid and conjunctival hyperemia, and conjunctival discharge. Six months after treatment, a 2-fold (vs. baseline) increase in total tear secretion and resorption of vitreous exudates and retinal edema were reported in the study group. Changes in all parameters in the study group were more significant than in the comparison group. Conclusion: complex treatment algorithm (tear substitutes, reparative, and anti-inflammatory therapies combined with laser photocoagulation) provides a more rapid and stable reduction in chorioretinal inflammation near the ora serrata. It significantly improves subjective and objective DED signs compared to conventional pharmacotherapy. Keywords: dry eye disease, intermediate uveitis, laser photocoagulation, ora serrata. For citation: Tatarnikova E.B., Krivosheina O.I. Complex treatment for dry eye disease in intermediate uveitis. Russian Journal of Clinical Ophthalmology. 2022;22(1):30–35 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-30-35.

Introduction. The development of inflammation and violations of the homeostasis of the tear film are of fundamental importance for the occurrence of dry eye disease (DED). In 28–57 % of cases, intermediate uveitis (IU) is accompanied by signs of irritation of the ocular surface and symptoms characteristic of DED. Purpose. Analysis of the effectiveness of complex treatment of DED and IU, including tear replacement and anti-inflammatory therapy in combination with laser retinal coagulation at the extreme periphery of the fundus. Material and methods. The results of treatment of 98 patients were analyzed: the main group – 78 patients – were prescribed complex treatment of DED, the comparison group – 20 patients – only local tear replacement and anti-inflammatory therapy. Evaluation of the effectiveness of the developed method of treatment of combined pathology was carried out after 3 and 6 months. based on the dynamics of OSDI indices, hyperemia of the bulbar conjunctiva, LIPCOF test and Norn test. Results. The use of complex treatment of DED in patients with IU contributes to a statistically significant (p < 0.05) decrease in signs of discomfort according to the results of OSDI to 34.8 %, a decrease in the bulbar conjunctiva hyperemia index to 51.4 %, a decrease in the LIPCOF test index to 22.2 %, an increase in tear film rupture time to 23.3 % with stable CP relief for 6 months observations. Conclusions. Thus, the results obtained clearly demonstrate the effectiveness of the use of complex treatment of DED in patients with IU. The developed method contributes not only to increasing the stability of the tear film, but also to reducing subjective feelings of discomfort and ensuring relief of inflammation at the extreme periphery, which allows us to recommend its wide application. Keywords: dry eye disease, intermediate uveitis, laser coagulation of the extreme periphery of the retina

Purpose. To evaluate the clinical and functional effectiveness of complex treatment of intermediate uveitis complicated by dry eye syndrome based on laser coagulation of chorioretinal structures near the toothed line using a diode laser. Material and methods. Clinical studies were performed among 98 patients who made up 2 observation groups: the main (78 people) and comparison (20 people). All patients were surveyed using the OSDI questionnaire, visometry, biomicroscopy, binocular ophthalmoscopy with sclerocompression, Schirmer I test, Norn test. Patients of the main group, along with conservative treatment, underwent laser coagulation of the extreme periphery of the retina, in the comparison group – conservative treatment. The follow-up period was 6 months. Results and discussion. The use of diode laser coagulation of chorioretinal structures near the toothed line in the complex treatment of intermediate uveitis occurring with dry eye syndrome reduces the number of complaints according to the OSDI questionnaire, positively affects the condition of the ocular surface, contributes to an increase in the parameters of the Schirmer I test and the Norn test, and in 100% of cases provides stable relief of inflammation of chorioretinal structures on the extreme periphery of the fundus. Conclusion. An integrated approach to the treatment of intermediate uveitis occurring with dry eye syndrome, using contactless diode laser coagulation of chorioretinal structures near the dentate line, allows achieving a significant reduction in signs of irritation of the ocular surface, up to their complete disappearance, providing rapid and stable relief of inflammation at the extreme periphery of the fundus in comparison with traditional pharmacotherapy. Keywords: dry eye syndrome, intermediate uveitis, peripheral laser coagulation of the retina.