Dynamics of cellular immunity indicators in the complex treatment of acute optic neuritis

An increase in the incidence of optic neuritis among the working-age population, as well as an unpromising prognosis for vision due to the development of optic nerve atrophy, determines the high social significance of this problem. The aim of the work is to analyze the effect of Imunofan at the parameters of cellular immunity and clinical symptoms of the disease in the complex treatment of optic neuritis associated with herpes virus infection. The study involved 37 people (37 eyes) with acute optic neuritis associated with herpes infection. The treatment regimen included the appointment of a dexamethasone solution according to a decreasing scheme, a 1% solution of the drug Emoxipin 0.5 mL and a 12.5% solution of the drug Dicynone 0.5 mL through an irrigation system implanted in the retrobulbar space, in combination with the neuroprotection drugs (Pikamilon and Semax) for 10 days. All patients were divided into 2 groups. The main group consisted of 20 patients who received Imunofan to the treatment regimen in addition. The comparison group included 17 patients who were treated only according to the method described above. The course of treatment lasted 10 days. The analysis of the data showed a more significant positive dynamics of cellular immunity parameters in those who received immunotherapy. Our studies showed the effectiveness of this drug in the complex treatment of optic neuritis associated with herpes infection, what is confirmed by the acceleration of inflammation relief, a more significant increase in visual functions of patients treated with Imunofan, and a lower percentage of optic nerve atrophy. In this group of patients, changes in the parameters of the cellular link of immunity occurred earlier and remained stable throughout the entire period of observation. According to our data, an intergroup assessment of the immunoregulatory index showed its faster increase in patients of the comparison group who received Imunofan, and reached normal values already 6 months after treatment. The clinical effectiveness of Imunofan in the complex therapy of optic neuritis associated with herpes infection was characterized by a reduction in the period of relief of signs of inflammation in the optic nerve by 2 times or more, by an increase in the maximum corrected visual acuity by 4.5 times, and by a decrease in the incidence of recurrence of optic neuritis by 2 times over a 12 months observation period

Assessment of Efficiency of Retrobulbar Infusion of Neurometabolic Preparations in Increase of Hemodynamic of Optic Nerve at Acute Ischemic Optic Neuropathy

Purpose. To study hemodynamic of optic nerve (ON) in process of complex pathogenetic direct treatment in patients with anteriorischemic optic neuropathy (AION). Patients and methods. 43 patients with acute phase AION were exanimated and treated. Besides the functional results (visual acuity, visual field), the diagnosis AION was based on indicators of ophthalmologic and angiographic researches of ON. Patients were divided into two groups. 23 patients were in the main group. They received neurometabolic medicinal preparations (MP) through a silicone retrobulbar catheter. The control group consisted of 20 patients who had the traditional method of medicines injection. Indexes of hemodynamic were estimated according to Doppler ultrasound of local blood flow at the short posterior ciliary arteries (SPCA). At the same time following indexes were estimated: Peak Systolic Velocity (PSV, cm/sec), End Diastolic Velocity (EDV, cm/sec), Average Blood Velocity (ABV, cm/sec), Index of peripheral vascular resistance (R1, M ± m). Results. After the end of hospitalization of patients with AION, more favorable shifts in indexes of hemodynamic in SPCA were reached in patients of main group of research that authentically exceeded the similar data obtained at patients in the control group. Improvement of blood flow of ON was followed by positive changes of thickness of the retinal nerve fiber layer and condition of disk ON. To the final stage of researches (12 months from beginning of treatment) according to degrees of functional disorders severity in the main group of patients prevailed I (14 patients, 60%), less often II degrees (9 patients, 40%) of optic nerve atrophy and absented patients with III degrees of defeat of ON. Among patients of control group II–III degree optic nerve atrophy (12 patients, 60%) met more often, less often I degrees (8 patients, 40%). Conclusion. The conducted research showed that at patients with AION receiving sub-Tenon's infusions of MP more significant favorable functional results were reached thanks to increase of indicators of blood flow in SPCA: PSV — on 24.5%, EDV — on 16.2%, ABV — on 32.2% that significantly exceeds similar data at patients in control group with traditional methods of MP injections

CLINICAL EFFECTIVENESS OF NEUROTRANSMITTERS PATIENTS WITH PRIMARY GLAUCOMA VEGF INHIBITOR IN PATIENTS WITH CHOROIDAL NEOVASCULARIZATION CAUSED BY DEGENERATIVE MYOPIA

Purpose. Morphological and functional evaluation of results of intravitreal injections of ranibizumab in treatment of choroidal neovascularization (CNV) caused by degenerative myopia (DM). patients and methods. The study included 32 patients (32 eyes) aged from 29 to 55 years with the CNV, developed due to the DM. They received 0.5 mg (0.05 ml) ranibizumab according to the standard. Indications for repeat intravitreal injections of ranibizumab were retention of the CNV activity or its recurrence. In addition to the standard ophthalmologic examination all patients were examined with fluorescein angiography (FAG) with photodetection of fundus picture and optical coherence tomography (OCT) of the retina (sizing subretinal neovascular membrane (SNM), evaluation of retinal foveal thickness (FCS). The study was conducted before the introduction of ranibizumab, monthly during the first 6 months after surgery, and then, in the absence of symptoms of CNV activity, every 2-3 months. The total follow-up was 12 months. results. the transition the CNV in inactive form according to FAG was observed in 25 people (78.1%) was observed after 1 month (single injection of ranibizumab). The angiographic signs of CNV activity remained after the first injection in 7 patients (21/9%). They received second intravitreal injection of ranibizumab. After 3 months from the beginning of observation according to FAG and OCT data relapse of activity of myopic CNV occurred in 5 patients (15.6%) after a single injection, and in 2 patients (6.3%) — after a double injection of ranibizumab. After 6 months according to FAG disappearance of pathological leakage of the dye was diagnosed in 87.5% of patients (28 eyes). After 12 months follow-up all 32 patients had remission of the pathological process with no evidence of CNV activity with formation of local subretinal fibrosis with choriocapillaries atrophy. Conclusions. It took from 1 to 3 (average 1.58) injections of ranibizumab to transfer the active phase of the CNV in inactive. Complete inhibition of the growth and activity of myopic CNV was accompanied by positive morphological and functional results, which led to a significant improvement in visual acuity in 2 times at the observation period of 12 months

Modern possibilities increasing efficiency of medical rehabilitation in patients with acute ischemic optic neuropathy

Purpose. To study an efficiency in the system of pathogenetic treatment of patients with anterior ischemic optic neuropathy (AION).Material and methods. The research included 43 patients with an acute AION phase. The average age of patients was 52.3±4.5 years. All patients were divided into two groups. The study group consisted of 23 patients. The system of treatment included retrobulbar implantation of a silicone catheter to the posterior pole of the eye with infusion of medicinal preparations (MP): Cerepro (dose 0.5 ml), then with interval of 1 hour, 0.5 ml of 5% Mexidol solution for injections and then 5 mg of Cortexin. After a two-hour break, retrobulbar MP infusions were repeated. The control group consisted of 20 patients who underwent the traditional method of injections of Cerepro, Mexidol and Cortexin. At the same time the patients of both groups of study within 10 days received daily a course of magnetic stimulation using the AMO-ATOS device with the OGOLOVE attachment («Trima», Russia).Results. After the end of treatment in a hospital, in the main group of patients there were noted: increase of visual acuity, expansion of visual field limits, electrophysiological indices authentically exceeded the similar data obtained in patients of the control group. According to degrees of functional disorders severity after one year of the treatment the degree I prevailed in the main group of patients, less often the degree II of optic nerve atrophy (ONA) (9 individuals, 40%). According to degrees of functional disorders severity one year after the treatment in the main group of patients the degree I prevailed, and less often the degree II of optic nerve atrophy (ONA) (9 individuals, 40%). Among the patients of the control group the ONA degrees II-III were met more often.Conclusions. The therapeutic effect of system of treatment, including sub-Tenon’s retrobulbar infusion of MP for neuroprotection, of patients with AION was manifested in: increase of visual acuity by 1.5 times, expansions of the total of the visual field limits on the average by 69.5±4.9 degrees, decrease of number of absolute and relative scotomas by 1.6 times, increase of amplitude by 1.35 times and decrease of latency of visual evoked potential by 1.2 times, in comparison with traditional methods of implantation of MP. More significant favorable functional results in AION patients of the main group were achieved thanks to an increase of blood flow indices in short posterior ciliary arteries

Evaluating the effectiveness of surgical detoxification treatment of inflammatory and vascular eye diseases

Purpose: to study the advantages and the efficiency of improvement of the surgical detoxification in patients with inflammatory and vascular eye diseases.Patients and Methods. Examination included visometry with maximum correction, optical coherence tomography (OCT), ophthalmoscopy, fluorescein angiography (FAG), B-scan.Results. The study was performed in 53 eyes of 53 patients (age from 45 to 60 years). There were 21 men, 32 women. 19 observed patients (19 eyes) had a partial or subtotal hemophthalmus. 34 patients (34 eyes) were observed for chronic recurrent uveitis. A significant decrease of blood in the vitreous was showed after treatment in 19 patients with hemophthalmus according to B-scan. Complete resorption of hemophthalmus and improvement in visual acuity (average: 0.71±0.15) was noted in 76,6%. In 14 from 34 people with chronic recurrent uveitis macular edema occurred. 3 months after surgical treatment retinal thickness in macular area decreased to an average of 256.3±9.2 mm. At the same time, there was an increase in visual acuity to an average of 0.65±0.05. Among 15 patients (15 eyes) with inflammatory exudation in the vitreous body against recurrent chronic uveitis there was a complete relief of symptoms of inflammation in 7‑10 days after surgical treatment in 78.4% of patients. In the remaining 26.6% the inflammatory exudates resorption in the vitreous occurred by 12‑15 day after the operation.Conclusion. The proposed method of ophthalmodetoxification is a promising method of treatment of chronic recurrent uveitis and vascular eye diseases. Terms of recovery of patients with inflammatory and vascular eye diseases were reduced by 30% and visual acuity achieved at discharge exceeded 3.2 times the original level

Structural and Functional Criteria of Neuroprotection Effectiveness after Anti-VEGF Therapy in Patients with Neovascular Age-Related Macular Degeneration

Purpose. Estimate of clinical efficacy of combined use of aflibercept and meldonium at tachyphylaxis of neovascular age-related macular degeneration (nAMD) to ranibizumab. Patients and methods. Comparative analysis of treatment results of nAMD in 25 eyes (25 patients) aged from 52 to 79 years was carried out. Main criterion for the patients inclusion was presence of nAMD resistant to intravitreal injections (IVI) of VEGF inhibitor ranibizumab with visual acuity values of not less than 0.1. Patients with different ophthalmologic pathology, accompanied by development of macular edema, with glaucoma and after any eye operations, performed during study period, were excluded from study. Before using aflibercept, all patients were treated with ranibizumab for 1.5–2 years (from 5 to 7 injections). The lack of persistent positive result was cause for change of course treatment of this patients on aflibercept (3 monthly injections) for enhance anti-vasoproliferative effect. The patients were divided into two groups — main and comparison, comparable by sex, age, visual acuity and type of choroidal neovascularization. In the main group, 3 aflibercept IVI were supplemented parabulbar injections of 0.5 ml of meldonium (with concentration of 500 mg / 5 ml) daily for 10 days. Patients of the comparison group did not receive meldonium. Results. The supplement of meldonium in the main group, relative to the comparison group, led to increase in 1.5 times of best corrected visual acuity, in 1.2 times of b-wave amplitude of the electroretinogram, preservation of the neuro- and pigment epithelium of retina, complete regression of neovascularization. Conclusion. Findings results evidence about clinically advisable to use meldonium in course treatment in patients with nAMD, resistant to ranibizumab, with aflibercept IVI for increase visual functions and stabilize the degenerative changes in neurosensory retina, pigment epithelium and choriocapillary layer