New Algorithm for Conservative Treatment of Patients with Keratoconus

The purpose of our study was to substantiate and evaluate the effectiveness of the conservative method of treating keratoconus in the early stages of the development of the disease. Patients and methods. The study of the effectiveness of the proposed method for the conservative treatment of keratoconus was performed on clinical material obtained by monitoring 39 patients (75 eyes) with a diagnosis of keratoconus stage I–III for at least 10 years. Every 4–6 months, all patients underwent an ophthalmological examination — visometry, autorefractometry, keratometry, keratotopography, pachymetry, biomicroscopy. Along with the study of the ophthalmic status of the patients, cardiointervalography was performed before starting conservative treatment. The assessment of vegetative homeostasis was performed using the Mustang-Diagnost device of the Technika company (Russia). Results. All patients observed by us were matched with corneal or corneoscleral gas-permeable contact lenses of various models and manufacturers. According to cardiointervalography, in 97 % of our patients vegetative dysfunction was determined, while in 85 % and all examined, a significant predominance of sympatheticotonic neurotrophic regulatory processes was determined. At the first stage of the conservative treatment of keratoconus pharmacological agents were selected. They potentiate cholinergic neurotrophic regulatory effects and activate aerobic processes in the tissues of the eyeball. The next step was the potentiation of sympathicotonic (ergotropic) neurotrophic regulatory processes. Treatment was carried out during the entire observation period, alternating complexes of preparations for 60 days. An increase in diopter strength along the steep meridian was noted in patients with keratoconus of all stages. In the group of patients with stage I keratoconus in 4 eyes out of 16, in patients with stage II disease in 7 eyes out of 35, in stage III patients in 7 eyes out of 24. Opposite, a study of the KISA % index in all observed patients showed a decrease in the coefficient values. Conclusions. The combination of therapeutic factors into tonic (trophotropic, anabolic) and phase (ergotropic, catabolic) regulatory blocks, taking into account their mutual neurodynamic synergism and in accordance with the phase nature of biorhythmogenesis of reparative processes, makes it possible to prevent the progression of keratoconus. The use of the treatment complex developed by us, which includes therapeutic treatment and correction with rigid gas-permeable contact lenses, corrects metabolic disorders and stabilizes collagen synthesis, which makes it possible to lay off the surgical treatment of patients with keratoconus

New Opportunities for Complex Therapy in Patients with Dry Eye Syndrome of Various Etiologies

The purpose: to evaluate the effectiveness of the Delfanto® in the complex therapy of patients with dry eye syndrome of various etiologies and severity of the clinical course.Patients and methods. 114 patients (228 eyes) with dry eye syndrome of various etiologies were examined: 72 patients with chronic meibomian blepharitis and dysfunction of the meibomian glands (xerosis due to increased evaporation of the tear film), 33 women with perimenopause (a mixed form of xerosis with a predominant decrease in the production of components of the tear film) and 9 persons with Syegren syndrome (xerosis due to a pronounced decrease in tear production). All patients received individually selected tear replacement therapy over the past weeks and the drug was not replaced throughout the study. At the same time, patients with mild and moderate clinical course of SSG for 30 days received Delfanto® at a dosage of 60 mg, and with severe course — 120 mg per day.Results. All patients on the background of complex therapy showed a significant decrease in the severity of subjective manifestations of the dry eye syndrome, an increase in the of the tear film stability and indicators of tear production. At the same time, the dynamics of changes in these parameters of the course of the xerotic process increased as the therapy continued, reaching a maximum by the 30th day. The maximum effect of Delfanto® in the complex therapy of patients with dry eye syndrome was observed in patients with chronic meibomian blepharitis. Moreover, patients with a mild clinical course of cornealconjunctival xerosis were the most susceptible to the therapy.Conclusion. The effectiveness of the complex therapy for patients with dry eye syndrome can be significantly increased by prescribing Delfanto® in a daily dose of 60 mg for mild and moderate xerosis and 120 mg — for severe disease. Delfante® can be recommended for widespread clinical use in complex treatment of patients with various clinical and pathogenetic forms of dry eye syndrome