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Усов В.Я., Тарик Абоу Тарбоуш. Клинические наблюдения за развитием катаракты у больных с кератитом
09.08.2014, 16:49

Резюме
Усов В.Я. , Тарік Абоу Тарбоуш. Клінічні спостереження за розвитком катаракти у хворих з кератитом.
Застосування крапель емоксипіну підвищує стійкість кришталика до дії катарактогенного фактора , яким є наявність у хворих кератиту . У терміни спостереження до 18 місяців в групі хворих з кератитом і корковою катарактою, що застосовували емоксипін відзначається уповільнення прогресування початкової катаракти із зменшенням кількості пацієнтів з незрілою і зрілою катарактою в порівнянні з контролем на 39 % і збереженням високої гостроти зору ( 0,7-1 ,0 ) в 53,3 % випадків ( p<0,05 ).
Ключові слова: катаракта, кератит, лікування, емоксипін.

Резюме
Усов В.Я., Тарик Абоу Тарбоуш. Клинические наблюдения за развитием катаракты у больных с кератитом.
Применение капель эмоксипина повышает устойчивость хрусталика к действию катарактогенного фактора, каким является наличие у больных кератита. В сроки наблюдения до 18 месяцев в группе больных с кератитом и корковой катарактой, применявших эмоксипин отмечается замедление прогрессирования начальной катаракты с уменьшением количества пациентов с незрелой и зрелой катарактой по сравнению с контролем на 39% и сохранением высокой остроты зрения (0,7-1,0) в 53,3% случаев (p<0,05).
Ключевые слова: катаракта, кератит, лечение, эмоксипин.

Summary
Usov V.Y., Tarik Abou Tarboush. Clinical monitoring of the cataracts development in patients with keratitis.
Found that the use of emoxipine drops increases the resistance to the action of the lens cataractogenic factor, which is the presence of patients with keratitis. In terms of observation of 18 months in patients with keratitis and cortical cataract, who used emoxipine drops marked slowing the progression of early cataract patients with a decrease in the number of immature and mature cataracts compared with the control by 39% and maintaining high visual acuity (0,7-1, 0) in 53,3% of cases (p<0,05).
Key words: cataractа, keratitis, treatment, emoxipine.

Рецензент: д.мед.н., проф. А.М. Петруня

УДК 617.741-004.1 – 031.62

ГУ «Институт глазных болезней и тканевой терапии им. В.П. Филатова НАМН Украины» (Одесса)

SI « Filatov Institute of Eye Diseases and Tissue Therapy Ukraine NAMS"

ussov2002@rambler.ru

Introduction. According to WHO data up to 20 million people worldwide suffer from cataract which is a cause of blindness. It is important to note that about 70% of cataract disease cases have progressive nature and require surgery [1,2,3,4]. Among many factors contributing to cataract development a substantial interest exists in the study of inflammatory process influence in the cornea on the stability of the lens to cataractogenic factors activity Influence of toxic products caused by cornea inflammation process and cytolysis followed by lysis of cellular proteins, release of biologically active substances (biogenic amines, prostaglandins) and underoxidized products of metabolism lead to the development of endogenous intoxication, which in varying degrees, accompanies almost all periods of keratitis [2, 3].

The use of modern technology in cataract surgery has improved the quality of this widespread disease treatment. However, existing postoperative complications put this problem in one line with currentophthalmology surgery sections. Slowing down the process of cataract progress by using ophthalmology and therapeutic techniques is able to reduce the number of operations on average of 50%. Thereupon the improvement of drug therapy effectiveness prevention progression of cataract is of current concern [5,6,7].

Purpose. To evaluate the effectiveness of emoxipinum drops for prophylaxis of advance of cataract development for patients with keratitis.

Material and methods. 110 patients took part in the research. There were:33 patients with nuclear cataract, 66 with cortical, 11with posterior subcapsular. As for maturity: 46 incipient, 64 immature, 43 with visual acuity 0,3-0,7, 21 people with visual acuity of 0,3 - 0,1.

The main group of patients with keratitis and cortical cataract 34 (31%) together with traditional keratitis therapy had emoxipinum drops instillated. The control group consisted of 32 patients (29%) with cortical cataract who underwent only keratitis therapy. The main group of patients with keratitis and nuclear cataract 18 (16,4%) together with traditional keratitis therapy had emoxipinum drops instillated.

The control group consisted of 15 patients (13,6%) with nuclear cataract, who underwent only keratitis therapy. The main group of patients with posterior subcapsular cataract and keratitis 6 people (5,4%) together with traditional keratitis therapy had emoxipine drops instillated. The control group consisted of 5 patients (4,6%) with posterior subcapsular cataract who underwent only keratitis therapy.

The degree of pathological changes severity in the lens and the treatment effectiveness were assessed by visual acuity, lenticular opacity grade, expressed in 1 to 4 grades using ophthalmobiomicroscopy. Dynamic supervision of patients was performed in 3, 6, 12, 18 months. Statistical processing of the results was performed using Statistica 8.0 package.

Results. From the patients of main group who were admitted to hospital with keratitis and cortical cataract, incipient cataract was diagnosed in 15 (44,1%), immature cataract with visual acuity 0,3-0,7 was diagnosed in 13 patients (38,3%) and immature cataract with visual acuity 0,1-0,3 was in 6 patients (17,6%). Within 3 months supervision of patients with keratitis and cortical cataracts of main group the number of patients with incipient cataract decreased to 12 (35,3%) At the same time, the number of patients with immature cataract and visual acuity of 0,3-0,7 increased up to 14 (41,2 %) and with immature cataract and visual acuity 0,1-0,3 to 8 patients (23,5% ).

Within 6 months supervision the number of patients with incipient cataract also decreased to 9 (26,5%). At the same time, the number of patients with immature cataract and visual acuity of 0,3-0,7 increased to 15(44,1%) and with immature cataract and visual acuity 0,1-0,3 to 10 patients (29,4%). Within 12 months supervision the number of patients with keratitis and incipien  cataract remains the same 9 (26,5%).

At the same time, the number of patients with immature cataract and visual acuity of 0,3-0,7 decreased to 14 (41,2%) and with immature cataract and visual acuity 0,1-0,3 increased to 11 patients (32,3%). Within up to 18 months supervision the number of patients with keratitis and incipient cataract decreased to 8 (20,6%).

At the same time, the number of patients with immature cataract and visual acuity of 0,3-0,7 decreased to 12 (35,3%) and with immature cataract and visual acuity 0,1-0,3 increased to 12 patients (38,3%). At the same time, 2 patients (5,8%) showed mature cataract with <0,1 vision loss.

From the patients of main group who were admitted to hospital with keratitis and cortical cataract,incipient cataract was diagnosed in 14 (43,7%), immature cataract with visual acuity 0,3-0,7 was diagnosed in 11 patients (34,4%) and immature cataract with visual acuity 0,1-0,3 was in 7 patients (21,9%) (Table 1). Within 3 months supervision the incipient cataract had 10 (31,2%), immature cataract and visual acuity of 0,3-0,7 had 14 (43,8%) and immature cataract and visual acuity 0,1-0,3 had 8 patients (25%).

Within 6 months supervision the incipient cataract had 6 (18,7%), immature cataract and visual acuity of 0,3-0,7 had 12 patients (37,5%) and immature cataract and visual acuity 0,1-0,3 was also in 12 patients (37,5%).

However 2 (6,3%) of patients had a development of mature cataract with<0,1vision loss. Within 12 months supervision the number of patients with incipient cataract decreased to 3 (9,4%).The number of patients with immature cataract and visual acuity of 0,3-0,7 had remained the same 12 patients (37,5%) and with immature cataract and visual acuity 0,1-0,3 increased to 14 patients (43,7 %). 3 patients (9,4%) had a development of mature cataract with <0,1 vision loss. Within 18 months supervision the number of patients with incipient cataract decreased to 2 (6,3%). The number of patients with immature cataract and visual acuity of 0,3-0,7 also decreased to 9 patients (28,1%). The number of patients with immature cataract and visual acuity 0,1-0,3 remained the same 14 patients (43,7%). At the same time the development of mature cataract with <0,1 sight loss had 7 patients (21,9%) (Table 1).

From the patients of main group who were admitted to hospital with keratitis and nuclear cataract,incipient cataract was diagnosed in 8 (44,4 %), immature cataract with visual acuity 0,3-0,7 was diagnosed in7 patients (38,9 %) and immature cataract with visual acuity 0,1-0,3 was in 2 patients (16,7%). Within 3months supervision the number of patients with keratitis and incipient cataract remained at the same level 8 (44,4%). At the same time the number of patients with immature cataract and visual acuity 0,3-0,7 decreased to 6 patients (33,4%) and immature cataract with visual acuity 0,1-0,3 increased to 4 patients (22,2%). Within 6 months supervision the number of patients with keratitis and incipient cataract remained at the same level and made 8 (44,4%). At the same time the number of patients with immature cataract and visual acuity 0,3-0,7 decreased to 5 patients (27,8%) and immature cataract with visual acuity 0,1-0,3 increased to 5 patients (27,8%). Within 12 months supervision the number of patients with keratitis and incipient cataract decreased to 5 (27,8%). At the same time the number of patients with immature cataract and visual acuity 0,3-0,7 increased to 7 patients (38,9%) and immature cataract with visual acuity 0,1-0,3 remained at the same level and made 5 patients (27,8%). 1 patient (5,5%) had a development of mature cataract with <0,1 vision loss. Within 18 months supervision the number of patients with keratitis and incipient cataract decreased to 4 (22,2%). At the same time the number of patients with immature cataract and visual acuity 0,3-0,7 increased to patient (44,4%) and immature cataract with visual acuity 0,1-0,3 decreased to 4 patients (22,2%). At the same time 2 patients (11,2%) had a development of mature cataract with <0,1 vision loss.

Among the main group patients with keratitis and nuclear cataraсt, incipient cataract was diagnosed in 5 (33,3%), immature cataract with visual acuity 0,3-0,7 was diagnosed in 6 patients (40%) and immature cataract with visual acuity 0,1-0,3 was in 4 patients (26,7 %). Within 3 months supervision the incipient cataract had 5 patients (33,3%), immature cataract and visual acuity of 0,3-0,7 had 5 patients (33,3%) and immature cataract and visual acuity 0,1-0,3 had 5 patients (33,3%). Within 6 months supervision incipient cataract was diagnosed in 3 patients (20%), immature cataract with visual acuity 0,3-0,7 was diagnosed in 7 patients (46,7%) and immature cataract with visual acuity 0,1-0,3 was in 5 patients (33,3%). Within 12 months supervision the number of patients with incipient cataract decreased to 2 (13,3%). The number of patients with immature cataract and visual acuity 0,3-0,7 decreased to 4 (26,7%) and immature cataract with visual acuity 0,1-0,3 increased to 8 patients (53,3%). 1 patient (6,7%) had a development of mature cataract with <0,1 vision loss. Within 18 months supervision the number of patients with incipient cataract decreased to 1 (6,7%). The number of patients with immature cataract and visual acuity 0,3-0,7 decreased to 5 (33,3%). The number of patients with immature cataract with visual acuity 0,1-0,3 decreased to 6 (60%). At the same time the development of mature cataract with <0,1 sight loss had 3 patients (20%) (Table 2).

From the main group patients who were admitted to hospital with keratitis and back capsular cataract, incipient cataract was diagnosed in 2 (33,3%). Immature cataract and visual acuity 0,3-0,7 had 3 patients (50%) and immature cataract with visual acuity 0,1-0,3 had 1 patient (16,7%).

Among the control group patients with keratitis and back capsular cataract, incipient cataract had 2patients (40%), immature cataract and visual acuity 0,3-0,7 had 3 patients (60%) and there were no patients with immature cataract with visual acuity 0,1-0,3. Within 3 months supervision of the main group patients with keratitis and back capsular cataract, the number of patients with incipient cataract remained the same 2patients (33,3%). At the same time the number of patients with immature cataract and visual acuity 0,3-0,7remained the same – 3 patients (50%) and immature cataract with visual acuity 0,1-0,3 – to 1 patient (16,7%).

Within six month observation the number of patients with keratitis and incipient cataract did not change and consists of 2 people (33,3%), though the number of patients with immature cataract and acuity of vision 0,3-0,7 decreased to 2 patients(33,3%),but the number of patients with immature cataract and acuity of vision 0,1-0,3-increased to two people (33,3%). In the period of 12 month observation the number of patients with keratitis and beginning cataract reduced to one (16,7%) and the number of patients with immature cataract and acuity of vision 0,3-0,7 increased to 3 (50%), the patients with immature cataract and acuity of vision 0,1-0,3 remained at the same level, which is 2 patients (33,3%). In 18-month observation period the number of sick with keratitis and incipient cataract remains at the same level-1 (16,7%), though the number of patients with immature cataract and acuity of vision 0,3-0,7 decreased to 2(33,3%), but the number of patients with mature cataract and acuity of vision 0,1-0,3 increased to 3 patients (50%), the development of mature cataract followed by decreasing vision was not observed<0,1 (Table 3).

Among patients with keratitis and backcapsular cataract of the control group observed within 3 month period 2 patients (40%) suffered of incipient cataract, immature cataract with the acuity of vision 0,3-0,7 was diagnosed at 3 patients (60%). Within 6 month observation incipient cataract was diagnosed at 2 patients (40%), immature cataract with acuity vision 0,3-0,7 was diagnosed also at 2 patients (40%) and 1 patient (20%)with acuity vision 0,1-0,3 had immature cataract. Within 12 month observation period the number of patients with beginning cataract decreased to 1 patient (20%). The number of patients with immature cataract and acuity of vision 0,3-0,7 also decreased to 1 (20%) and the number of patients with immature cataract and acuity of vision 0,1-0,3 increased to 3 (60%). Within 18 month observation period the number of patients with incipient cataract was 1 (20%). The number of patients with keratitis and immature cataract with acuity of vision 0,3-0,7 was also 1 (20%). The number of patients with immature cataract and acuity of vision 0,1-0,3 was 3 (60%). In this case the development of mature cataract with decreasing acuity of vision <0,1 was not observed.

Within the period of 18 month observation in the main group of patients with keratitis and cortical cataract the number of patients with incipient cataract with high acuity of vision(0,7-1,0) decreased  from 15 to 8 which is 53,3%. The number of patients with immature cataract (acuity of vision 0,3-0,7)decreased as well,2 of them(5,8%) developed mature cataract with decreasing vision reduced to light perception. After 18 month observation period In the control group of patients with keratitis and cortical cataract the  number of patients with beginning cataract keeping high acuity of vision (0,7-1,0) dramatically decreased from 14 to 2,which is 14,3%,39 % more than in the main group,though the number of patients with immature cataract (acuity of vision 0,1-0,3) increased and 7 patients (21,9%) developed mature cataract with decreasing vision to light perception.

In fact, in the period to 18 month observation in the group of patients suffering from keratitis and cortical cataract treated with Emoxipinum it was noticed that progressing of incipient cataract was slowing down and,the number of patients with immature and mature cataracts decreased compared to control to 39% and kept high acuity of vision (0,7-1,0) in 53,3%of the cases(p<0,05). In 18 month observation period the number of patients with incipient cataract and high acuity of vision (0,7-1,0) decreased from 8 to 4 (which is 50%) in the main group of patients sick with keratitis and nuclear cataract. At the same time the number of patients with immature cataract (acuity of vision 0,3-0,7) decreased 2 (11,1%) patients developed mature cataract with decreasing vision to light perception. In the control group of sick with keratitis and nuclear cataract that were observed up to 18 months the number of patients with incipient cataract keeping high acuity of vision (0,7-1,0) significantly decreased from 5 to 1 patient which is 20%, that is 30% less compared to the main group, but the number of patients with immature cataract (acuity of vision 0,1-0,3) increased, 3 patients (16,6%) developed mature cataract with the decrease of vision to light perception.

Thus,in the period of observation to 18 months in the group of sick with keratitis and nuclear cataract that were treated with Emoxipinum there is a tendency to slowing down of incipient cataract progress, the number of patients with immature and mature cataract decreases as well compared to control to 30%and keeping high acuity of vision(0,7-1,0) in 50% of the cases.

In the terms of observation to 18 months in the main group of sick with keratitis and backcapsular cataract the number of patients with incipient cataract and high acuity of vision (0,7-1,0) decreased from 2 to 1 patients which is 50%. Besides the number of patients with immature cataract (acuity of vision 0,3-0,7) decreased. In the control group of sick with keratitis and backcapsular cataract the number of patients with incipient cataract and high acuity of vision (0,7-1,0) decreased as well from 2 to 1 patients which is 50%, but the number of patients with immature cataract (acuity of vision 0,1-0,3) increased.

To conclude with in the terms to 18 month observation in the group of patients with keratitis and backcapsular cataract who have used Emoxipinum compared to control there was no difference in the number of patients who did not show a progress of beginning cataract keeping high acuity of sight (0,7-1,0).

Conclusions

1.The usage of Emoxipinum drops increases the resistance of lens to the action of cataractogenic factor which is promoted by the illness of keratitis.

2.In terms of observation to 18 months in the group of patients sick with keratitis and cortical cataract that used Emoxipinum there is a slowing down of progressing incipient cataract ,the decrease of patients with immature and mature cataract to 39% compared to control and keeping high acuity of vision (0,7-1,0) in 53,3% of the cases (p<0,05).

Литература

  1. Веселовская З.Ф. Катаракта / З.Ф. Веселовская, Н.Ф. Боброва, В.В. Вит. - Киев: Книга плюс, 2002. – 208 с.
  2. Леус Н.Ф. Изучение активности антиоксидантных ферментов во влаге передней камеры и хрусталике в эксперименте и клинике при увеальной катаракте / Н.Ф. Леус, В.В. Савко // Труды Крымского гос. мед. университета им. С.И. Георгиевского – Симферополь, 2008. – Т. 144, ч. 2. – С. 87-88.
  3. Мальцев Э.В. Эпидемиология катаракт / Э.В. Мальцев, Н.А. Багиров // Офтальмол. журн. – 2001. - № 6. – С. 45-49.
  4. Полунин Г.С. Классификация катаракт и возможность их терапевтического лечения / Г.С. Полунин, Е.Г. Полунина, Н.Л. Шеремет // Рефракционная хирургия и офтальмология. – 2003. – Т. 3, № 2. – С. 37-42.
  5. Truscott R.J. Age-related nuclear cataract-oxidation is the key / R.J. Truscott // Exp. Eye Res. – 2005. – Vol. 80 (5). – P. 709-725.
  6. Hockwin O. Lens and cataract, research of the 20th century: a review of results, errors and misunderstandings / O. Hockwin, M. Kojima, U. Muller-Breitenkamp // Dev. Ophthalmol. - 2002. - № 35. - P. 1-11.
  7. Schichi H. Cataract formation and prevention / H. Schichi // Expert Opion. Invest. Drugs. – 2004. – Vol. 13 (6). – P. 691-701.
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