Materials and methods. Under observation, there were 64 patients (106 eyes) aged 59 to 79 years; of which 39 are men and 25 are women. Depending on the stage of primary open-angle glaucoma (POAG), patients are divided into two groups that are comparable by age, gender and clinical condition – 34 patients (53 eyes) with 2 stages of POAG and 30 patients (53 eyes) with 3 stages of POAG. A prerequisite for inclusion in the study is the stabilization of IOP.
As direct neuroprotection drugs, citicoline and memantine were used.
To assess the course of the neurodegenerative process for the period from 2011 to 2019 The perimetric indices of MD and PSD, morphological characteristics according to optical coherence tomography – Vrim, GCC, GLV, FLV, as well as latency and amplitude of the early components of visual evoked potentials were analyzed.
Results. The highest efficiency of direct neuroprotection was found for stage 2 of POAG with monotherapy with citicoline, and for stage 3 of POAG with combination therapy with citicoline and memantine. At long-term follow-up, the results of neuroprotective monotherapy with memantine were practically the same as traditional treatment. The obtained results demonstrated a slowdown in the progression of glaucomatous optical neuropathy in all objective indicators by 2–2.5 times in patients who received combined neuroprotective therapy – citicoline and memantine, compared with patients who received conventional therapy.
Veselovska Z. F., Veselovska N. M., Zaporozhchenko I. B.
Kyiv Medical University, Eye Clinic of Kyiv City Hospital No 1, Kyiv, Ukraine
Abstract
The aim of research is to study the hypotensive, neuroprotective effects and side effects of Monoprost in comparison with the original preserved latanoprost (Xalatan).
Material and methods. The I group includes 20 patients (26 eyes), who obtained instillations of preserved latanoprost (one dose before night). The II group consists of 20 patients (26 eyes), who used eye drops of Monoprost (one dose before night).
The observation period was 12 weeks. The examination included visual acuity, perimetry, tonometry and optical coherence tomography of the retina and optic nerve.
Results. The examination revealed high hypotensive effect of Monoprost in comparison of the original preserved latanoprost (IOP reduction at the end of the study was 32% and 29%, respectively). Eye drops of Monoprost was characterized by a low level of local side effects, leading to a decrease IOP in patients with POAG by an average of 32% from the initial level. The achieved hypotensive effect and the absence of the toxic effect of preservatives provided the effect of indirect neuroprotection and was accompanied by positive dynamics of both visual acuity and perimetry and OCT data.
The drug is characterized by low level of side effects and may be recommended as a hypotensive drug in patients with primary open-angle glaucoma.
Kyiv City Clinical Ophthalmological Hospital “Eye Microsurgery Center”, Kyiv, Ukraine Medical Center “LASER Plus”, Lviv, Ukraine
Abstract
Background. The search for relapses risk and prognosis factors in the surgical treatment of diabetic maculopathy (DMP) in patients with type 2 diabetes mellitus (T2DM) is very important. In this regard, our attention was drawn to an important pathogenetic factor of DMP – tumor necrosis factor-alpha (TNFα).
Aim. To study the relationship of TNFα with DMP relapse after its surgical treatment using various options for vitreoretinal interventions in patients with T2DM.
Materials and methods. We observed 313 patients with T2DM (313 eyes) with DMP and initial (group 1; n = 40), moderate or severe non-proliferative diabetic retinopathy (NPDR; group 2; n = 92) and proliferative diabetic retinopathy (PDR; group 3; n = 181). Four types of surgical interventions were used in patients: 78 patients underwent three-port closed subtotal vitrectomy; 85 patients underwent peeling of the inner limiting membrane in addition to these methods; 81 patients additionally received panretinal laser coagulation; cataract phacoemulsification was additionally performed in 69 patients. Prior to surgery, TNFα blood levels were determined by enzyme-linked immunosorbent assay. The control group consisted of 95 people. For statistical data processing, the program Statistica 10 (StatSoft, Inc., USA) was used.
Results. Before surgery the blood TNFα level was increased according to the severity of retinopathy: in group 1, the TNFα level exceeded the control group level by 1.2 (p = 0.005), in groups 2 and 3 – by 2.0 and 3.4 respectively (p < 0.001). In groups 1 and 2, in cases of DMP relapse, the level of TNFα was significantly higher than in case of no relapse, which was especially characteristic of patients with initial NPDR and related to early relapses. There was no association of TNFα level with DMP relapses in patients with PDR (group 3) – cytokine level was significantly increased, although this was more true for patients with PDR (the median was 49.2 pg/ml in case of relapse and 57.4 pg/ml in case of its absence; p = 0.062). Also, there was a higher level of TNFα in patients with early and persistent relapses (p < 0.05).
Conclusion. The study revealed a relationship between the elevation of TNFα baseline blood level and the formation of early and persistent relapses after surgical treatment of DMP.
Keywords: diabetic maculopathy, type 2 diabetes mellitus, surgical treatment, TNFα.