STUDY OF THE EFFECT OF NEUROPROTECTIVE THERAPY ON THE FUNCTIONAL STATE OF EYES IN PATIENTS WITH LOW-PRESSURE GLAUCOMA

Sanin V. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Introduction. A review of the literature of recent years shows that the incidence of glaucoma in the population over the age of 40 is 1-2.5% and has no tendency to decrease. This pathology significantly disrupts visual function, which can affect the quality of life and work productivity of the global population. Recently, ideas about the mechanisms of glaucoma development have fundamentally changed. The gradual accumulation of data from the world literature indicates that an imbalance of oxidative stress can play a significant and important role in the damage of retinal ganglion cells. The aim of our research was to study the effect of the use of neuroprotective therapy on the functional state of the eye in patients with low-pressure glaucoma. Material and methods. 64 patients (128 eyes) were examined through a comprehensive ophthalmological examination. The main group consisted of 46 patients (92 eyes) with low-pressure glaucoma of the I (48 eyes – 52.17%) and II (44 eyes – 47.83%) stages of the disease. The comparison group included 18 patients (36 eyes) with hypermetropia up to 1.0 diopter without glaucoma. During the initial screening, patients of both groups underwent an initial standard comprehensive ophthalmological examination. The period of observation of patients was two years. Patients of the Іst subgroup of the main group underwent courses of complex neuroprotective therapy – local topical drugs that included N-acetylcarnosine. General therapy included: NMDA receptor antagonist, antioxidants and antihypoxants, amino acids. The results. Analysis of the results shows a general increase in markers of oxidative stress and a decrease in markers of antioxidant stress in the blood serum of patients with low-pressure glaucoma. Their changes were correlated with the stage of the glaucomatous process (r=0.81; p<0.05). In addition, in patients with low-pressure glaucoma, there was a significant decrease in the levels of vitamins C, A, E and transferrin, which correlated with the stage of glaucomatous damage (r=0.77; p<0.05). The analysis of the obtained results demonstrated positive dynamics and improvement of clinical and functional indicators in patients of the 1st subgroup of the main group after a course of neuroprotective therapy, which indicated a significant improvement in the functional activity of photoreceptors. An improvement in electrophysiological parameters was noted: a decrease in peak latency by 12.8-18.5% after 6 months of therapy and by 22.8-24.4% and by 19.9-22.8% after 12 and 24 months, respectively (p<0 .05), which indicated an improvement in the conductivity of nerve fibers. An increase in the amplitude of theelectroretinogram peaks by 17.1-18.2% after 6 months of therapy and by 25.0-27.3% and 23.7-25.0% after 12 and 24 months, respectively (p<0.05 ). At the same time, the results of the study showed that in patients who did not receive courses of systemic general and topical neuroprotection (II subgroup of the main group), there was a gradual linear deterioration of clinical and functional indicators and progression of visual fields. It should also be noted that the use of neuroprotective therapy for 4 months in patients with low-pressure glaucoma, which included general therapy and local instillation therapy with a drug containing N-acetylcarnosine, led to a probable improvement in visual field parameters. Thus, the expansion of the visual fields, the reduction of the number of scotomas, and the improvement of the MD index were determined (by 20.3% after 6 months, by 25.8% after 12 months and by 22.4% after 24 months, respectively (p<0.05)). During the 2 years of observation, there was a decrease in the PSD index (by 19.1-28.8% (p<0.05)), an improvement in the visual field index by 8.7- 18.5%, and a decrease in the rate of visual field progression from 2.4 %/year to 1.9%/year, by 20.8%, respectively (p<0.05). Conclusions. Our study demonstrated the positive effect of local N-acetylcarnosine and general citicoline on clinical and functional indicators in patients with low-pressure glaucoma of the I and II stages of the disease, which was accompanied by the improvement of electrophysiological indicators, the expansion of visual fields, the reduction of the number of scotomas, the improvement of the MD index, the decrease PSD indicator, visual field index improvement and visual field progression rate reduction. The possibility of expanding the volume of medical care and potentiating the effectiveness of other methods: physiotherapeutic, drug treatment, etc., by prescribing various schemes of neuroprotective therapy has been established.

: low-pressure glaucoma,neuroprotection,N-acetylcarnosine,citicoline,markers of oxidative and antioxidant stress.

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«Bulletin of problems biology and medicine» Issue 4 (167), 2022 year, 210-222 pages, index UDK 612.842.6+617.7-073.178+577.352.38+612.018.2+577.175.522+576.311. 347

10.29254/2077-4214-2022-4-167-210-222