Rania A Abdullah1, M.S, Eman A Awad2, MD, Tarek A Mohsen2, MD, Tharwat H. Mokbel2, MD
1Ophthalmolgy hospital, Mansoura, Egypt 2Ophthalmology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Abstract. Fungal keratitis is a sight threatening condition which is widespread in tropical and subtropical countries. This study aimed to evaluate the efficacy of a combination of topical and intracameral injections of amphotericin B in the treatment of severe fungal keratitis. Patients and methods. This prospective, comparative study included 40 patients of culture proved fungal keratitis recruited from outpatient clinic of Mansoura ophthalmic center, faculty of medicine Mansoura University, Egypt, in the period from January 2017 to December 2018. Pregnant and lactating women, Children < 12 years of age, One-eyed patients, Patients with concurrent sclera involvement and Patients with impending perforations, elevated intraocular pressure were excluded from the study. The patients were randomly divided into 2 groups: Group A: underwent only topical amphotericin B. Group B: underwent combined topical & intracameral injection of antimicrobials. Patients were followed up at 1 day, 1 week, weekly till the end of the first month after injection then every 2 weeks for another month after then monthly till the 6th month. Results. Both groups were sex and age matched. Trauma was the most common risk factor recorded. Aspergillus was the commonest causative agent (85%) in group A, the size of corneal ulcer improved from 32.44 ± 19.37 to 29.71 ± 17.16 at 1st week to 18.81 ± 10.04 in the 1st month, in group B the ulcer size decreased from 30.24 ± 16.09 to 21.81 ± 11.04 (p<0.001) in the 1st week the ulcer achieved complete healing within 3 months. In group A the hypopyon level was 2.46 ± 1.23 mm which was fixed at the same value at 2nd day then decreased to 1.36 ± 0.43 ml at 1st month then to 0.90 ± 0.31 mm and 0.37 ± 0.17 mm at 2nd and 3rd months. In group B, the base line of hypopyon level was 3.22 ± 2.09 mm decreased to 1.45 ± 0.62 mm (at 1st week) decreased from 1.02 ± 0.61 mm at 2nd weeks to 0.33 ± 0.19 mm at 6th weeks. In group A, the reported complications were staphyloma (2 cases), thinning (6 cases), hyphema (2 cases) and Atrophia Bulbi (1 case). In group B the complications showed mild variations in distribution as follows; staphyloma (1 case), thinning (3 cases), hyphema (3 cases) and Atrophia Bulbi (1 case). The mean duration for the complete healing in group A, was 48.82 ± 5.31 days while the mean duration in group B, that was 29.59 ± 3.24 days (p< 0.001). Conclusions. Intracameral Amphotericin B injection is safe and effective technique in treatment of fungal keratitis.
1Zaporizhia Medical Academy of Post-graduate Education of the Ministry of Health of Ukraine, Zaporizhzhia, Ukraine 2“Zaporizhzhia Regional Clinical Hospital” of the Zaporizhzhia Regional Council, Zaporizhzhia, Ukraine
Abstract. Heat shock proteins (HSP) are important components of the defense mechanism that increases the survival of body cells in adverse conditions due to antiapoptotic and cytoprotective effects. Since their discovery, numerous studies and experimental models have proved the role of HSPs as a key link in the processes of both repair and coagulation of proteins, as well as in the protection of cells from oxidative stress. The potential for pharmacological induction of HSPs in the human body makes them an attractive therapeutic target for many neurodegenerative diseases. This review examines the role of HSPs, especially fraction 70, in the mechanisms of neuroprotection of retinal ganglion cells in primary open-angle glaucoma being one of the common neurodegenerative diseases that can lead to complete loss of visual functions. A number of studies have shown the protective effect of HSP70 on retinal ganglion cells in animals with artificially induced glaucoma. But in the course of experiments on animal models, it was also proved that direct immunization with HSP through intravitreal injections induced pressure-independent degeneration of retinal ganglion cells. This indicates the need for indirect stimulation of HSP70 in order to activate their neuroprotective properties. To date, there are insufficient data on the circulation of HSP70 in the body of a person with glaucoma. These data indicate the prospects for further study of the role of HSP70 in glaucoma degeneration and elucidation of the ways of their mediated induction.
Pavlova L. S.1, Gazizova I. R.2, Alekseev V. N.3, Alekseev Yu. A.3
1AlKadi Medical Group, Dorrat Alkadi Polyclinic, 7036 AlAziza AlDjadidah 3418, Tabuk, 47911, Saudi Arabia 2Federal State Budgetary Institution of Science “Institute of the Human Brain named after N. P. Bekhterevoy”, Saint Petersburg, Russia 3North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
Abstract This review of modern literature presents the issue of early diagnosis of primary open-angle glaucoma (POAG) which is one of the most important problems in ophthalmology. According to the World Health Organization (WHO), the number of glaucoma patients all over the world ranges from 60.5 to 105 million people, and in the next 10 years it will increase by another 10 million. The subtle onset of the disease usually leads to late diagnosis, since visual field defects are often first detectable by visual field testing when 25–35% of retinal ganglion cells have already been lost. In modern studies, it has been established that the cell death in POAG is accompanied by oxidative stress. It is considered a key factor indicating the pathological process of a fairly large number of chronic diseases of the whole body, including complicated eye pathologies and inflammatory processes. The resulting free radicals oxidize lipids and phospholipids which leads to their peroxidation and triggers damage to cell membranes. The lipid peroxidation is one of obligatory processes occurring in neurodegenerative conditions including POAG. Modern technologies analyzing lipid peroxidation may accelerate the diagnosis, to identify glaucoma biomarkers at an earlier stage, and as a result to maintain quality of vision more efficiently. These studies were carried out in different countries and using different methods such as serological proteomic analysis, chromatography and mass spectrometry, and new technological approaches such as MultiOmics. The study of the protein profile, lipase activity, nitric oxide concentration, activity of carbonic anhydrase enzyme, malondialdehyde (MDA) and other compounds are also very informative. Various fluids were taken as a basis for the study: tears, aqueous humor of the anterior chamber, blood and its components. Together these technologies enable to evaluate the oxidative process in different ways. Earlier diagnosis of glaucoma is very important as it will enable to maintain the quality of vision for a longer time and reduce the rate of the disease progression.