Efficacy of complex treatment of glaucoma optical neuropathy by Cortexin

The comparative analysis of efficacy of intranasal and intramuscular application of cortexin in combination with transcranial magnetotherapy in patients with primary open-angle glaucoma was conducted. 102 patients (182 eyes) took part in research with primary open-angle glaucoma of I, II, III stages. The most considerable improvement of visual functions resulted from intramuscular and endonasal introductions of cortexin in combination with transcranial magnetotherapy; and longer stabilization of functional indicators was marked in this grou

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ПРИМЕНЕНИЯ РАЗЛИЧНЫХ МЕТОДИК ФИЗИОТЕРАПЕВТИЧЕСКОГО ВОЗДЕЙСТВИЯ В ЛЕЧЕНИИ БОЛЬНЫХ ПЕРВИЧНОЙ ОТКРЫТОУГОЛЬНОЙ ГЛАУКОМОЙ

Background: Therapeutic action of physical therapy aims at the recovery of conductibility of optic tracts, improvement of microcirculation and hemodynamics, stimulation of regulatory brain structures and improvement of psycho-neurological status of patients. Aim: To assess efficacy of transcranial magnetic therapy, contemporary transcranial magnetic therapy/electrostimulation and magnetic sympathocorrection in the treatment of primary open-angle glaucoma. Materials and methods: 397 patients (634 eyes), aged 58–76 years, with verified diagnosis of stage I, II or III primary open-angle glaucoma, received transcranial magnetic therapy (group 1, 182 eyes), contemporary transcranial magnetic  herapy/electrostimulation (group 2, 258 eyes) and magnetic sympathocorrection (group 3, 194 eyes). All patients underwent routine ophthalmological examination, visual evoked potential recording and assessment of ocular circulation. Results: In patients with initial stage of glaucoma, most prominent changes of electrophysiological parameters was demonstrated in the group 2: visual evoked potential amplitude increased from 8.4 ± 0.4 to 11.3 ± 0.2 mcV, latency decreased from 77.6 ± 1.3 to 70.4 ± 2.1 ms. Maximal improvement of ocular circulation (decrease of resistance index of posterior short ciliary arteries from 0.69 ± 0.02 to 0.51 ± 0.03) was registered in the group 3. In patients with evolved glaucoma (stage II), significant increase of P100 amplitude of visual evoked potentials (from 7.5 ± 0.2 to 9.8 ± 0.3 mcV) was found in the group 2; latency period decreased from 84.6 ± 1.5 to 74.8 ± 2.1 ms. In stage II glaucoma patients, prominent increase of systolic blood velocity was demonstrated in groups 3 and 2: from 11.26 ± 0.8 to 13.64 ± 0.63 cm/s and from 10.5 ± 0.2 to 13.9 ± 0.7 cm/s, respectively. Resistance index decreased from 0.76 ± 0.05 to 0.52 ± 0.02 and from 0.75 ± 0.02 to 0.65 ± 0.02 in groups 3 and 2, respectively. In advanced glaucoma (stage III), most prominent increase of P100 amplitude of visual evoked potentials was demonstrated in group 2: amplitude of visual evoked potentials increased from 6.5 ± 0.2 to 8.1 ± 0.2 mcV, latency decreased from 87.5 ± 2.3 to 80.1 ± 2.1 ms. Maximal improvement of ocular circulation (increase of systolic blood velocity from 9.2 ± 0.72 to 11.2 ± 0.6 cm/s) and decrease of resistance index (from 0.84 ± 0.04 to 0.66 ± 0.03) was found in patients with stage III glaucoma in the group 3. Conclusion: Use of different methods of magnetic therapy especially in combination with electrostimulation activates ocular hemodynamics and stimulates bioelectric activity of visual cortex and may prevent visual functions impairment in glaucoma.Актуальность. Лечебное действие физических факторов при первичной открытоугольной глаукоме направлено на восстановление проводимости зрительных нервных волокон, улучшение микроциркуляции, коррекцию гемодинамики, стимуляцию регуляторных мозговых структур и нормализацию психоневрологического статуса пациента. Цель – оценить эффективность применения методик транскраниальной магнитотерапии, одномоментной транскраниальной магнитотерапии и электростимуляции, магнитной симпатокоррекции в лечении больных первичной открытоугольной глаукомой. Материал и методы. Под наблюдением находились 397 больных (634 глаза) в возрасте от 58 до 76 лет с установленным диагнозом первичной открытоугольной глаукомы I, II или III стадии, которые получали транскраниальную магнитотерапию (группа 1, 182 глаза), одномоментную транскраниальную магнитотерапию и электростимуляцию (группа 2, 258 глаз) или магнитотерапию в проекции шейных симпатических ганглиев (группа 3, 194 глаза). Всем пациентам до и после лечения проводили стандартные офтальмологические исследования, регистрацию зрительных вызванных потенциалов и исследование внутриглазного кровотока. Результаты. У больных с начальной стадией глаукомы наиболее выраженное изменение электрофизиологических показателей наблюдалось в группе 2: амплитуда зрительных вызванных потенциалов возросла с 8,4 ± 0,4 до 11,3 ± 0,2 мкВ, латентность снизилась с 77,6 ± 1,3 до 70,4 ± 2,1 мс. Наиболее выраженное улучшение внутриглазного кровотока (снижение индекса резистентности задних коротких цилиарных артерий с 0,69 ± 0,02 до 0,51 ± 0,03) регистрировали в группе 3. В группе 2 у пациентов с развитой глаукомой увеличение амплитуды P100 зрительных вызванных потенциалов было значимым (с 7,5 ± 0,2 до 9,8 ± 0,3 мкВ), латентный период сократился с 84,6 ± 1,5 до 74,8 ± 2,1 мс. Выраженное повышение систолической скорости кровотока отмечалось у больных со II стадией глаукомы в группах 3 и 2: с 11,26 ± 0,8 до 13,64 ± 0,63 см/с и с 10,5 ± 0,2 до 13,9 ± 0,7 см/с соответственно. Индекс резистентности снизился с 0,76 ± 0,05 до 0,52 ± 0,02 и с 0,75 ± 0,02 до 0,65 ± 0,02 у больных с развитой глаукомой в группах 3 и 2 соответственно. У больных с далеко зашедшей глаукомой увеличение амплитуды P100 зрительных вызванных потенциалов было наиболее выражено в группе 2: амплитуда зрительных вызванных потенциалов увеличилась с 6,5 ± 0,2 до 8,1 ± 0,2 мкВ, латентность снизилась с 87,5 ± 2,3 до 80,1 ± 2,1 мс. Наиболее выраженные улучшение внутриглазного кровотока (с 9,2 ± 0,72 до 11,2 ± 0,6 см/с) и снижение индекса резистентности (с 0,84 ± 0,04 до 0,66 ± 0,03) наблюдались у больных глаукомой III стадии в группе 3. Заключение. Вследствие активизации гемодинамики в сосудистом бассейне глаза и биоэлектрической активности зрительной коры применение различных видов магнитного воздействия, особенно в сочетании с электростимуляцией, в составе курса нейропротекторного лечения позволяет предотвратить распад зрительных функций у больных глаукомой

Evalutation of efficiency of dynamic laser magnetic stimulation of eye drainage system of patients with open angle glaucomatosis

The purpose of the study is to develop a comprehensive treatment aimed at improving uveoscleral outflow in the application of dynamic laser magnetic stimulation of the drainage system of the eye and evaluation of its effectiveness in treating patients with primary open-angle glaucoma (POAG). Material. 106 patients diagnosed POAG I, II, III stages were examined. Group 1 consisted of 62 patients treated with medical therapy and dynamic laser magnetic stimulation of the drainage system of the eye using the "AMO-ATOS-ICL", produced by JSC "TRIMA", Saratov. Group 2 consisted of 64 patients who received only medical therapy. Comprehensive survey including standard eye examination, static perimetry, visual evoked potentials study, the study of intraocular blood flow was conducted to all patients. Analysis of the results of the complex therapeutic effects showed that as the result of treatment 73% of patients had a decrease of intraocular pressure and the ease factor outflow increase. 52% of patients had a decrease in the number and area of relative. 63% of patients had activation of intraocular blood flow. These indices remained stable for three months. Conclusion. The treatment with the technique of dynamic laser magnetic stimulation of the drainage system of the eye of patients with primary open-angle glaucoma leads to lower intraocular pressure, and to the improvement of dopple-rographic and perimetric indications

The effectiveness of The Atlas of Ophthalmic Instruments (an application for smartphones) in optimization of the educational process of students, residents, and ophthalmologists

Objective: to determine the effectiveness of the Atlas of Ophthalmic Instruments for Smartphones (the application for smartphones) in optimization of the educational process of students, residents, and ophthalmologists. Material and methods. On the Android platform there had been created and placed in the Google Play an application "Ophthalmic Instruments" with illustrations and description of ophthalmic surgical instruments. Next, a survey had been conducted of users of the application (1005 respondents). To this was applied a specially designed questionnaire in English. Results. According to the survey, the average score among students (652 users) is 4.9; among residents (281) 4.7 and doctors (72) and 4.6. Conclusion. Obtained data allow to conclude that the use of interactive mobile applications positively influences the optimization of the educational process and can be considered as a new and effective form of tutorials.</p

Efficiency analysis of laser magnetic stimulation of an eye drainage system in the treatment of patients with different stages of primary open angle glaucoma based on developments of functional indicators and biochemistry factors

The purpose of study is to develop efficiency analysis of laser magnetic stimulation of an eye drainage system in the treatment of patients with primary open angle glaucoma (POAG). Material and Methods. The study included 197 patients with established diagnosis of POAG. The first group included 104 patients treated with drug treatment and laser magnetic stimulation of the drainage system of the eye using the «AMO-ATOS-ICL». The second group included 93 patients who received only drug therapy. Patient underwent visometry, oftalmobiomicroscopy, threshold perimetry electrophysiological study, the study of intraocular blood flow, level of VEGF and MCP-1. Results. A comparative analysis showed that the use of laser magnetic stimulation eye's drainage system in the treatment of patients with different stages of POAG to an activation of intraocular blood flow, but it was more significant in patients of the main group who were diagnosed with I and II stages of POAG. The decrease in intraocular blood flow resulted in ischemia while the level of VEGF increased. Conclusion. Analysis of clinical, electrophysiological and hemodynamic parameters in treatment of patients with POAG before and after laser magnetic stimulation improved of the state of the visual system in comparison with those in control group.</p

Clinical-and-functional basing of the tactics of complex pharmacophysiothera-py of patients with primary glaucoma simplex

The research goal was to estimate the effectiveness of complex pharmacophysiotherapy of patients with initial glaucoma simplex on the basis of analysis of morphology, visual cortex electrobiological activity and regional blood flow level. 80 patients (149 eyes) aged 60-75 were examined. All of them had an initial glaucoma simplex of II or III stage and normalized intraocular pressure. Depending on the stage of glaucoma there were two groups of patients and each group contained two sub-groups. patients of sub-group A were treated by percutaneous electrostimulation with feedback based on visual evoked biopotentials; and patients of sub-group В were treated by traditional electrostimulation. All patients got complex eye examination before and after the therapeutic course, and in 3 months after it. Method of selection of optimal electrostimulation parameters was worked out for the appropriate retina ganglionary cell effect. Individually selected electrostimulation in combination with nootropics contributes to eye hemodynamics improvement. Addition of magnetotherapy to the complex therapy of patients with eye hemodynamics leads to improvement of functional results. the increase of functional results of complex therapy with magnetotherapy that affects cervical sympathetic ganglia has been determined in patients with eye hemodynamic

Clinical and immunological parallels in the diagnosis of primary open-angle glaucoma.

The purpose of study is an assessment of the informative value of various diagnostic parameters in monitoring and prognosis of the state of the visual organ in patients with primary open-angle glaucoma. Material and methods. 216 patients (216 eyes) were examined. 126 patients (126 eyes) with the diagnosis of primary open-angle glaucoma I, II or III stage were included in the main group (I), and 90 patients (90 eyes) without ophthalmologic pathology were included in the control group (II). All patients underwent complex examination. Laser confocal scanning tomography for the analysis of the optic disc morphology was performed using a Heidelberg Retina Tomograph II from Heidelberg Engineering (Germany). Evaluation of the field of view was carried out using the computer static perimeter Oculus twinfield-2 (Germany). Electrophysiological studies (apparatus Roland Consult, Germany) included: the study of visual cortical potentials on the outbreak, the pattern-electroretinogram, photopic negative response. Neurotrophic brain factor, ciliary neurotrophic growth factor and protein NF-200, S-100 protein, monocyte chemoattractant, vascular endothelial growth factor were determined in the serum. Results. An increase in the concentration of the S-100 protein with progression of POAG testifies to the existence of parallels between apoptosis of retinal ganglion cells and systemic neurodegenera-tion affecting the central nervous system as a whole. The importance of electrophysiological research methods, which give information about the third neuron of the visual pathway, has been confirmed. Pattern-electroretinogram, photopic negative response most reflect abnormalities in the work of ganglion cells of the retina, including before the appearance of structural changes in the optic disc and the retina. Conclusion. The interrelation of dynamics of functional, morphological and immunological criteria of progression of POAG is revealed, which allows to predict the further course of the pathological process. Since the study involved patients with IOP target values, it is important not only to maintain IOP on target values, but also to carry out neuroprotection.</p

Practical application of a nutraceutical in age-related macular degeneration

Kamenskykh T.G., Kolbenev I.O., Veselova E.V., Batischeva Yu.S. Saratov State Medical University named after V.I. Razumovsky Age-related macular degeneration (AMD) occupies one of the leading places among diseases leading to visual impairment and blindness. Aim: to evaluate the results of the use of Retinorm in patients with a «dry» form of AMD based on optical coherence tomography (OCT) and multifocal electroretinography (MF-ERG) data. Patients and Methods: 40 patients (66 eyes) with a «dry» form of AMD (drusen) participated in the study. Group 1 — 20 patients (34 eyes) who received Retinorm 1 capsule 3 per day during meals, group 2 — 20 patients (32 eyes) who received standard conservative therapy for 16 weeks. The standard examination included static perimetry, OCT, OCT-angiography, MF-ERG. Results and Discussion: A statistically significant change in the total perfusion density in the foveal area was observed in patients with small hard drusen in the Retinorm group. The thickness of the retina in patients of group 1 was 258±31 μm before treatment and did not change significantly during the treatment. In group 2, the thickness of the retina in the foveal region was 245±46 μm before the study and 312±28 μm in 6 months. Normalization of the configuration of a three-dimensional image of MF-ERG was observed in 75% of patients in group 1, while in group 2, the electrophysiological parmeters worsened in 60% of patients. Within 6 months, no significant change in visual acuity was detected in both groups, but in group 2 there was a tendency to its decrease. The improvement of well-being and a decrease of complaints was noted in group 1, and in group 2 there were no changes. Conclusions: Retinorm, as a balanced source of substances necessary for the retina, can be recommended for the use in the complex therapy of patients with a «dry» form of AMD. Key words: age-related macular degeneration, drusen, optical coherence tomography, angiography, Retinorm. For citation: Kamenskykh T.G., Kolbenev I.O., Veselova E.V., Batischeva Yu.S. Practical application of a nutraceutical in age-related macular degeneration. RMJ “Clinical ophthalmology”. 2018;2: 107–112.<br

Cutting edge eye care at the Clinic of Eye Diseases of the Saratov State Medical University

The purpose of study is to analyze the results of providing patients with the high-tech medical care at the Clinic of Eye Diseases of the SSMU. Material and methods. Analysis of laws and regulations of the Ministry of Health of the Russian Federation, statistical data, accounting documents of the Clinic of Eye Diseases of the SSMU and a number of other medical institutions that provide patients with the high-tech medical care. A retrospective analysis of original medical records, outpatient medical records, medical charts was carried out. The methods of research that are used in this work include socio-hygienic, retrospective, system analysis, statistical. Results. The implementation of the National Project "Health" by the Clinic of eye diseases of the SSMU is made available through the providing residents of the Saratov region and other 29 regions of the Russian Federation with the high-tech ophthalmic care for. According to the statistical data 3,284 patients were provided with the high-tech medical care in 2014, 2015, 2016. Refractive, vitreoretinal, reconstructive-plastic and optico-reconstructive surgeries, optical through keratoplasty, cross-linking, glaucoma surgery are carried out at the Clinic. The largest number of patients provided with high-tech medical care in 2014-2016 had vitreoretinal surgeries. Conclusion. There is a significant increase in the functional results of patients' treatment, increasing accessibility and quality of high technologies in ophthalmology. Successful providing patients with the high-tech medical care was facilitated by the creation of a special commission of identifying the patients required the high-tech medical care, concerted efforts of the physicians and nurses, state-of-the-art diagnostic and therapeutic equipment.</p

Occurrence and features of uveitis in patients with rheumatic diseases: current peculiarities of clinical examination and patient management.

The objectives of the study are to establish the occurrence of uveitis in patients with rheumatic diseases, to assess the features of the uveitis in rheumatic disease in children and adults, and to analyze the effectiveness of theirtreatment. Materials and Methods. The study included 670 people with RH (stage I) and 35 patients who had uveitis and / or rheumatic fever who agreed to undergo additional ophthalmologic bleeding (stage II), including a standard ophthalmological examination including visiometry, biomicroscopy of the anterior segment, ophthalmoscopy of the posterior segment of the eye, refractometry, optical coherence tomography in angiomode(tomograph-angiograph CIRRUS HD-OCT MODEL 5000 (Carl Zeiss, Germany), dopplerography of the vessels of the eye. Results. The prevalence of uveitis in rheumatic diseases was established in 21%, which is higher than that in the general population. Uveitis in rheumatic diseases is recurrent and well-treated condition with frequent and complete improvement of visual acuity, and angiographycal features of uveitis, p &lt;0,05 for all parameters. Conclusions. The high incidence of uveitis and relapsing their course in rheumatic diseases lead to necessity of an ophthalmologist's examination every 6 months. It is desirable to perform a comprehensive angiographic examination of uvea for the timely detection of erased and subclinical forms of uveitis.</p