Sakovych V. N.1, Volok S. I.2, Malik L. P.2, Isaev A. A.1
1Dnipropetrovsk Medical Academy of Ministry Health of Ukraine, Dnipro, Ukraine 2Dnipropetrovsk Regional Clinical Ophthalmology Hospital, Dnipro, Ukraine
Summary. The article is devoted to the issue of pathogenesis and treatment of eyes with bacterial keratitis, depending on pathogenetic features and type of pathogens. The results of the works presented in the literature indicate an increasing number of bacterial keratitis with resistance to the therapy. Also, the appearance in recent years of strains of bacteria that are resistant to many antibiotics used in medical practice has significantly worsened the positive dynamics for the standard treatment regimens used. And the problem of evolutionary changes in the structure of pathogens and their biological properties dictates the need for clinical and microbiological monitoring, which can provide an adequate range of therapeutic and preventive measures.
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Clinica Oculistica, University of Genoa, Genova, Italy
Summary. Brinzolamide is a white powder commercially formulated as a 1 % ophthalmic. Suspension to reduce intraocular pressure (IOP). Pharmacologically, brinzolamide is a highly specific, non-competitive, reversible, and effective inhibitor of carbonic anhydrase II (CA-II), able to suppress formation of aqueous humor in the eye and thus to decrease IOP. Several clinical trials have evaluated its safety and the most commonly ocular adverse events are blurred vision (3–8 %), ocular discomfort (1.8–5.9 %), and eye pain (0.7–4 %). Brinzolamide has been introduced to treat ocular hypertension and primary open-angle glaucoma. In some clinical studies it has been estimated that brinzolamide reduced IOP by was about 18 %. Brinzolamide can be added to beta-blockers and prostaglandins. In the latter combination, because prostaglandin derivatives improve the uveoscleral outflow but also increase the activity of CA in ciliary epithelium with a secondary increase in aqueous humor secretion, and slightly reduce the efficacy of prostaglandin analogues, theoretically topical CA inhibitors (CAI) decrease IOP by inhibiting CA-II, thus improving prostaglandin efficacy as well as lowering IOP. Brinzolamide could have a secondary possible effect on ocular flow too. Some clinical studies showed a mild improvement of ocular blood flow. Theoretically, CAI could give rise to metabolic acidosis, with secondary vasodilatation and improvement of blood flow. Systemic acidosis can occur in the setting of oral CAI therapy, and local acidosis within ocular tissues is theoretically possible with topical CAI therapy, with the potential for a local increase in ocular blood flow. In conclusion, topical CAI treatment has efficacy in IOP-lowering ranging from 15 % to 20 %. From published data, brinzolamide can be used as first-line medication, even if other medications have a higher efficacy, with few side effects and it is a good adjunctive treatment. In some type of glaucoma patients with a vascular dysregulation, topical CAI could have a double effect: reducing IOP and improving ocular blood flow.
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Hovhannesyan A. H., Minasyan A. H., Seiranyan V. M., Hakobyan V. Ye.
Department of Ophthalmology, National Institute Health of MH RA Ophthalmology service of Erebouni Medical Center; Diagnostic center “Optomedˮ Canada − Armenia, Yerevan, Armenia
Summary. The eye drops containing 1 % N-acetylcarnosine (Clarastill™, Bruschettini, Genoa, Italy) have been tested in patients with diabetic retinopathy in randomized blind placebo-controlled clinical trial.
The results of the trial have shown that N-acetylcarnosine in the content of the eye drops during 6 months of using statistically significantly (versus placebo) decreases the severity of diabetic retinopathy on ETDRS scale and prevents the further development of the disease (p < 0.001).
The early prescription of long term application of Clarastill™ eye drops is recommended for prevention of diabetic retinopathy in patients with diabetes mellitus.
Taking into account the antioxidant, cytoprotective, eutrophic, moisturizing, lubricating properties of N-acetylcarnosine, the use of Clarastill™ eye drops is justified before and after laser coagulation of the retina; the use of the drops is also indispensable in advanced diabetic retinopathy for prevention of total blindness.
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