Резюме

Максименко О.Н. Эффективность глутаргина в комплексной терапии больных сухой формой возрастной макулярной дегенерации.

Включение глутаргина в комплексную терапию 48 больных сухой формой ВМД способствует улучшению зрительных функций, нормализации электрофизиологических показателей органа зрения. Полученные данные являются основанием для разработки методов лечения пациентов с сухой формой ВМД.

Ключевые слова: возрастная макулярная дегенерация, сухая форма, глутаргин

Резюме

Максименко О.М. Ефективність глутаргіну в комплексній терапії хворих на суху форму вікової макулярної дегенерації.

Включення глутаргіну в комплексну терапію 48 хворих на суху форму ВМД сприяє поліпшенню зорових функцій, нормалізації електрофізіологічних показників органа зору. Отримані данні є підставою для розробки методів лікування пацієнтів з сухою формою ВМД.

Ключові слова: вікова макулярна дегенерація, суха форма, глутаргін.

Summary

Maxymenko O.N. Glutargin efficiency in complex therapy patients with dry form of age-related macular degeneration.

Glutargin inclusion in the complex therapy of 48 patients with the dry form of AMD helps improve visual function, normalization of electrophysiological parameters of the vision. The obtained data are the basis for the development of methods of treating patients with a dry form of AMD.

Key words: age-related macular degeneration, the dry form, Glutargin.

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

UDK 612.017.1:617.735:621.039.353.5

Glutargin EFFICIENCY IN COMPLEX THERAPY dry form of age-related macular DEGENERATION

Maksymenko O.N.

Dnepropetrovsk Medical Institute of Traditional and Alternative Medicine

According to the World Health Organization , in the structure of low vision age-related macular degeneration (AMD ) is the second largest. Typically, the process is always reversible, both eyes are affected in 60% of cases [2]. Ubiquitous this pathology is 300 people per 100,000 population. Currently, about 25-30 million people worldwide suffer from AMD. At the age of 40 years develop 25-40 % of the population of people over 60 years , this pathology is detected in 58% [6].

Age-related macular degeneration is a progressive disease, manifested by chronic degenerative process in the pigment epithelium , Bruch's membrane and retinal macular choriocapillyar layer [6,7]. To date, the pathogenesis of age- related macular degeneration is completely not fully understood. There are suggestions that some of the basic mechanisms of AMD are disorders of microcirculation eyes, immune and biochemical disorders [ 3,4,5,8 ] .

Despite the numerous schemes proposed treatment dry form of AMD, most of them there is a progressive course of the disease with decreased visual function [4,5]. Therefore, the development of rational new treatments of AMD requires further improvement.

In this regard, our attention was attracted drug antioxidant and antitoxic action Glutargin. In chemical composition before the drug constitutes a salt of L-arginine and glutamic acid. Glutargin has clearly your antitoxic action, improves energy metabolism of cells, correct acid-base status due to the normalization of blood alkali reserve. Medicine has antioxidant and membrane stabilizing action through the way decreases the products of lipid peroxidation , as well as stabilize the hepatocyte membrane by reducing the activity of cytolytic enzymes [2,3].

The aim of study was to evaluate the clinical efficacy Glutargin in complex treatment of the dry form of AMD.

Material and methods

We observed 98 patients (196 eyes) dry form of AMD in both eyes. The age of patients ranged from 55 to 78 years .

Ophthalmic examination included: definition of visual and visual fields, refraction, accommodation, color vision, held tonometry, ophthalmoscopy in forward and backward views, biomicroscopy.

Electrophysiological indicators of the vision were examined using the diagnostic module stimulator ophthalmic KNSO2 -91 " phosphene " (Odessa ), the determined sensitivity threshold retinal phosphenes ( PECHF ) , critical flicker fusion frequency ( CFFF ) , critical flicker frequency of extinction by phosphenes ( KCHIMF ) . Photo registration carried pictures of the fundus using a fundus camera TRC-NV7SF (Topcon, Japan ) to exclude patients with the wet form of carried OST (Stratus OCT) and fluorescein angiography .

To solve the problems, all patients were divided into two groups randomized to each other by age and sex. Study group comprised 48 patients (96 eyes) , which along with the traditional treatment of AMD Glutargin further appointed as a 4% solution of 15-20 ml 2 times a day intravenously 5-10 consecutive days , followed by 0.25 g 3 times per day orally for 20-25 days. Comparison group comprised the remaining 50 patients ( 100 eyes ) who received only conventional therapy clinic in the dry form of AMD : angiograms , retinoprotektors, vitamin and tissue preparations , vasodilators , antioxidants, immunomodulators, vitamin complex okuvait complit .

Statistical data processing was carried out using computer technology.

As a control group for the development of standard indicators examined almost 70 somatically healthy individuals of the same age and sex living in the same ecoregion .

Results and discussion

When ophthalmoscopic study, all patients experienced a weakening foveal reflex, one small yellowish-white striped and pigmented foci that mottled appearance of this area, as merging process one source . In 18 (18.4%) individuals in both eyes macular region ¬ you are more pigmented with a single point of blood. When biomicroophthalmoscopy with increased 40-50 times in 59 (60.2 %) patients were found ¬ governmental bilateral small round yellowish Druze Proposition near microvessels, the width of the optical slice chat and transparency were not violated.

Before treatment, all patients showed significant violations of functional and electrophysiological performance of the vision. There was a reduction of visual acuity on average 0.03 to 0.6 units (P <0,01 in relation to the norm) , field of view to 489+ 0.2 degrees (P <0,01), extension blind spot area of to 200+​​0.2 mm2 (P <0,01). In electrophysiological terms, an increase in the average level PECHF to 143 + 0,2 mA (P <0,01), indicator KCHIMF to 38.1+ 0.02 Hz (P <0,01) and CFFF to 35,6+ 0.02 Hz (P <0,01). In the study group and the comparison group differences in the studied indicators were not significant ( Table 1).

Table 1

Functional and electrophysiological indicators of the vision of AMD patients before treatment (M + m)

Note . Here and in the table . 2 P - significance of differences between parameters in the study group and the comparison group

The main group influenced Glutargin in treatment was a significant improvement of functional parameters of the vision. At the same time, ophthalmoscopy and study using fundus camera fundus significant visual changes were observed. Thus , visual acuity in this group increased to an average of 0,79 + 0,02 units (P <0,01 compared with the previous value ) to the expanded field of vision 534 + 0,4 degrees (P <0,01); blind spot area decreased to 120 + 0,2 mm2 (P <0,01). There was a significant reduction PECHF to 68,1 + 0,3 mA (P <0,01), increase in the KCHIMF to 44,8 + 0,03 Hz (P <0,01) and CFFF to 41,7 + 0 02 Hz (P <0,01) ( Table 2).

Table 2

Glutargin influence on functional and electrophysiological

performance of the vision of patients with AMD (M + m)

Under Mapping Functional and electrophysiological indicators of the vision of patients changed insignificantly, while visual acuity increased to 0,67 + 0,03 units (P <0,01 compared with the rate of the main group ) , the field of view to 515 + 0 3 ° (P <0,01), the blind spot area has decreased to 160 ± 0,5 mm2 (P <0,01). At the same time there was a moderate decline in PECHF ¬ to an average of 91.9 ± 0.2 mA (P <0,01), KCHIMF rate increase to 41,1 + 0,05 Hz (P <0,01) and CFFF to 38 , 9 +0.03 Hz (P <0,01) ( Table 2).

Consequently, under the influence of Glutargin patients group showed restoration of disturbed functional and electrophysiological parameters of the vision , which was not observed under the influence of traditional therapy . At the same time, the morphological picture of the fundus did not change.

Clinical supervision for 1 year after treatment in the study group showed a stabilization of the pathological process in both eyes in 43 ( 89.6 %) patients, in comparison group - 33 patients ( 66.0% ) persons, which was 1.4 times less.

Thus, use of the drug Glutargin in the treatment of patients dry form of AMD pathogenesis is appropriate and justified.

findings

1. Glutargin inclusion in the complex therapy of patients dry form of AMD helps improve visual function, normalization of electrophysiological parameters of the vision.

2 . The obtained data are the basis for the development of methods of treating patients with a dry form of AMD and implementation in a wide Glutargin ophthalmic practice.