Rykov S. O.1, Mogilevskyy S. Yu.1, Petrenko O. V.1, Shargorodska I. V.1, Tretyak V. V.2
1P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine 2National Military Medical Clinical Centre “Main Military Clinical Hospital”, Kyiv, Ukraine
Abstract. Glaucoma is a serious medical and social problem, which significantly decreases the quality of patients’ life, decreases working capacity, affects the personality and psycho-emotional status of patients with glaucoma. Psychological maladjustment leads to inadequate reaction to treatment. In connection with this the investigation of peculiarities of psychological status and its correction in patients with glaucoma is an important and actual purpose.
The purpose. The aim of our work was the investigation of peculiarities of psychoemotional status in patients with glaucoma.
Materials and methods. There were 146 patients with primary open-angle glaucoma of I–IV stages included in the study without severe non-compensated accompanying pathology. Standard ophthalmological investigation was carried out in all patients. Psychological status was evaluated with the help of brief multivariable questionnaire for investigation of personality and also method of “Type of attitude to disease”, directed towards diagnostics of attitude of patient to disease. Package Statistica 8.0 was used for statistical analysis of acquired data.
Results. It was established the connection between the progression of disease and certain mental disorder in patients with primary open-angle glaucoma. Psychological maladjustment with severe form of anxiety and depression was revealed in 77.4 % of patients. The mood of anxiety concerning their disease and excessive concentration on symptoms and self state of health were noted in 61.6 % of patients.
Conclusions. Investigation of psychological status in patients with glaucoma is expedient for carrying out of optimal treatment of primary open-angle glaucoma with the usage of methods of psychological correction. More profound and particular studying of this problem will allow to decrease the level of social disadaptation and increase the quality of life of those patients.
Keywords: primary open-angle glaucoma, the psychological status of glaucoma patients, psychological maladjustment.
REFERENCES
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GI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine
Abstract. Glaucoma is a major cause of irreversible vision loss. Modern clinical research methods such as scanning laser polarimetry and optical coherence tomography (OCT), the structural changes recorded on different functional levels of the retina and optic nerve. According to the literature, the structural changes in progressive glaucomatous optic neuropathy ahead the clinical functional manifestations of the disease. In case of OCT of eyes with glaucoma is also recommended to scan the macula with the Quick protocol (Fast Macular Thickness Map). It makes possible to reveal additional information about the disease process.
Neurophysiological methods (electroretinography) allow to study the processes at various levels of morphological and functional retina, to specify the location and nature of pathological changes in the above structures, to control the dynamics of changes in the structure of the primary lesions in various stages of glaucomatous process.
Objective. The aim of the study is to examine the state of the peripheral and central vision and carry out their comparative characteristics of patients with primary open-angle glaucoma (POAG) in the context of the bioelectric activity of the retina corresponding levels.
Materials and methods. On the basis of GI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine” we have carried out complex clinical and neurophysiological study of 144 patients (274 eyes). Among those were diagnosed 114 people (214 eyes) with the average age of 58.41 + 3.96 years at different stages of POAG (the main group). For diagnosis of a pathological condition it was used a neurophysiological research method – electroretinography, which was carried out on the unit “RETI scan” (Multifocal ERG/VEP, Roland Consult, Germany).
Survey results. For the first time when using neurophysiological research method (electroretinography) in patients with POAG it was found the reduction of bioelectrical activity of neurons in the outer and inner layers of the macular area. In a retinogram zone (Rod-Respons, dark phase), in patients with primary and advanced stages of POAG we noted reducing of the amplitude of waves b at 79.35 %, p < 0.05 and 78.88 %, p < 0.05 respectively compared with the control group. According to these data we can confirm that in patients with POAG growth of lesions of peripheral vision occurs by reducing the bioelectric activity of neurons in the inner layer of the retina.
According to our data of rhythmic retinogram (according to the 30 Hz Flicker) we have seen reduction in the amplitude of the peak N1–P1 in patients with primary, advanced and developed stages of POAG at 70.33 %, p < 0.05 and 72.71 %, p < 0.05 and 79.56 %, p < 0.05, respectively, compared with the control group. According to data of 30 Hz Flicker we can find significant lesions of the cone cells in outer layers of the retina macular area at all stages of POAG starting with the primary.
The most pronounced process we observed in the photoreceptor cells of the outer layers of the retina is the unit of cone in the macular area. When comparing the outer and inner layers of the macular and peripheral portions of the retina we observed significantly defeat at all stages of POAG of inner layer of the retina and the peripheral device of cone photoreceptor of outer layer of the retina in the macular area. Especially it should be emphasized that the power of destruction in these areas at appropriate stages of POAG is almost the same as simultaneous processes that occur at the above levels and areas of the retina.
Keywords: peripheral vision, the macula, the retina, electroretinography, primary open-angle glaucoma.
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1GI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine 2Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
Abstract
Introduction. In today’s world the problem of the syndrome of dry eye is quite relevant and meaningful in ophthalmology.
Purpose. The aim is to study the influence of Lipoflavon redox enzymes in the tear fluid of patients with keratitis and dry eye syndrome.
Methods. Clinical and biochemical studies have been conducted on 84 patients with dry eye syndrome and keratitis. Patients were divided into 4 groups: group 1 – patients with dry eye syndrome (30 patients), group 2 – patients with herpetic keratitis (17 patients), group 3 – patients with herpetic keratitis and dry eye syndrome (23 patients), group 4 – patients with herpetic keratitis and dry eye syndrome, which use of Lipoflavon (14 patients). In the tear fluid of patients was measured activity of lactate dehydrogenase and malate dehydrogenase.
Results. Overall analysis of the data suggests that the development of keratitis, patients with dry eye syndrome leads to sharper pathochemical changes in the tear fluid, expressed in significantly higher decrease in the activity of lactate dehydrogenase and malate dehydrogenase as compared with patients with keratitis, which did not have dry eye syndrome. Lipoflavon has a beneficial effect – it reduces the degree of impairment of biochemical parameters in the tear fluid of patients with keratitis in the presence of dry eye syndrome.
Conclusions. Patients with dry eye syndrome revealed a clear damage to cellular and subcellular structures of the corneal epithelium, as evidenced by a decrease in activity of the cytosolic enzyme (lactate dehydrogenase) – by 50.7 % and mitochondrial (malate dehydrogenase) – by 41.8 % in the tear fluid of patients. The activity of lactate dehydrogenase and malate dehydrogenase in the tear fluid in the development of keratitis, patients with dry eye syndrome was significantly decreased as compared to the patients who developed keratitis without dry eye syndrome. It was established that Lipoflavon appreciably reduces the negative membranotropic impact of dry eye syndrome in the corneal epithelium, which is clearly expressed when keratitis in patients with dry eye syndrome.
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