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Резюме Рецензент: д.мед.н., проф. А.М. Петруня УДК 617.736-007.17-085.849.19-036.8 1 Национальная медицинская академия последипломного образования им. П.Л. Шупика (Киев) Shupyk National Medical Academy of Postgraduate Education 2Киевская городская клиническая больница № 9 Kyiv City Clinical Hospital № 9
nataliya_dz@ukr.net
According to the data of global statistics, age-related macular degeneration (AMD) is the principal cause for irreversible loss of vision in the second half of life for citizens of developed countries along with diabetic retinopathy and central retinal vein occlusion (CRVO) [20].Severity of such disorder is caused by irreversibility ofdystrophic process, its central localization, bilateral affection observed in 70% of patients after 5-8 years on average. Physiologic aging of certain systems and structures of organism, as well as complex combined disorder typical for elderly and senium age of diseased, lead to necessity of application of large quantity of medications simultaneous effect of which does not always lead to favorable result, hence the search for new pathogenetically targeted methods of local treatment of visual organs of AMD patients with physical factors is absolutely reasonable. We directed our attention towards the physical factor light as an effective pathogenetically targeted method of local treatment for AMD patients. Impact of green and red light to an eye induces through central nervous system (subcortical predominantly) relevant vegetative shifts, ionic composition of eye tissues and acetylcholine balance in them depend on [3]. Various authors confirm the hypothesis that green light is sympathicotropic, and red light is vagotropic [4,7,19]. Within our work, we take up the ideas of L.A. Linnyk. Research of L.A. Linnyk with his co-authors indicated that in cases of dystrophic diseases of macular area low-power laser radiation (LPLR) shows stimulating effect on retina. Immediately after the LPLR treatment of retina intensification of DNA synthesis in nucleuses of ganglion and neuroepithelial cells is observed. Such condition remains for rather long period of time and is followed by considerable growth of resistive power of cells to impact of damaging factors. Electron microscopy researchestablished the fact of intensification ofbiosyntheticprocesses, in nerve cells of retina close to the area of direct application [11,12]. One of the mechanisms of curative effect of laser stimulation in case of central chorioretinal dystrophy is connected to intensification of phagocytic activity of retinal pigment epithelium and probably to direct impact of LPLR on decay products of neuroreceptors [16]. Infrared laser radiation penetrates the tissue deeper than radiation of visible range,consequently it has more intensive impact on such structures as choroid [5]. Results of research of cell elements membrane structures exposed to small doses of radiation by helium-neon laser indicated stability augmentation of lysosomemembranes ofpigment epithelium and retina, what could be one of the elements of the mechanism for DNA level increase in retina after LPLR application [10]. Effectiveness of LPLR for retinal deceases is proved by many authors [1,6,14]. Effectiveness of phototherapy is proved for pathological myopia [8], partial optic nerve atrophy [9], amblyopia [3]. They use chromatic impulse photic stimulation for diagnosticsby the method of critical flicker fusion frequency (CFFF), as well as for treatment of retina and optic nerve disorder [15]. The obtained results indicate improvement of functional indicators of central retina and optic nerve after course of stimulation with flickering light. Authors suggest a thought that impulse monochromatic light with appropriately selected stimulation frequency as curative factor plays role of certain stimuli which triggers various processes of activity regeneration of neuronal mechanisms of visual perception. OBJECT: To study vision acuity dynamics of dry AMD patients after two courses of low-light LED-based therapy. MATERIAL AND METHODS. We were watching 165 patients with dry form of AMD. The main group consisted of 90 patients (152 eyes) who underwent two courses of low-light LED therapy with a 6-months interval. The procedure of transpupillary radiation of macule by monochromatic light of green, red and infrared spectrums with energy 2 x 10-6 J was performed with use oflight emitting diodes. The treatment course consisted of 10 sessions 5 minutes each during 5 days (2 sessions a day). The control group consisted of 75 patients (136 eyes) who underwent two courses of conservative therapy within an inpatient hospital during 10 days with a 6-months interval. The conservative therapy course included: emoxipineparabulbar injection of 0.5 ml no. 5, mildronateparabulbar injection of 0.5 ml no. 5, mildronatei.m. 4.0 no. 5, thiotriazolinumi.m. 2.0 no. 10, neurobioni.m. 3.0 no. 6, ascorbic acid i.m. 1.0 no. 10, actovegini.m. 2.0 no. 10. All the patients went through standard ophthalmological examination. Visometry was measured with ETDRS tables (number of signs). ETDRS (Early TreatmentDiabeticStudy) is the test that was elaborated in order to eliminate errors in tests based on Snellen and Sloan charts, as well as for statisticallyvalid examination of visionacuity.Distinctions distinguishing ETDRS tables: equal quantity of optotypes in lines (5 letters for 1 line), same interval between lines (lines are separated with 0.1 log interval), same interval between letters according to logarithmic scale, certain lines are balanced in regard to complicacy of letters, all the letters are of square shape. Vision acuity of the patients in the main group was examined before the first treatment course, after sessions on the 3rd day, after sessions on the 5th day, after 1, 3 and 6 months after the first course, before the second treatment course, after sessions on the 3rd day, after sessions on the 5th day, after 1, 3 and 6 months after the second treatment course. Vision acuity of the patients in the control group was examined before the first treatment course, on the 5th day, on the 10th day, after 1, 3, 6 months after the first course, before the second treatment course, on the 5th day, on the 10th day, after 1, 3, 6 months after the second treatment course.Statistical data processing was executed by the application statistical analysis package Statistica 10.Were used: method of graphical analysis, generalizing characteristics of division, variation indexes, hypothesis testingmethod, Student’s t-criterion. RESULTS.Data on vision acuity of the patients in the main group before and after the first and second courses of low-light LED-based therapy is presented in the tables 1, 2, 3, 4. Table 1 Vision acuity indicators of the patients from the main group before and after the first treatment course (n=152)
Remark: data in the table calculated forp ≤ 0,05.
Table 2 Vision acuity indicators of the patients from the control group before and after the first treatment course (n=136)
Remark: data in the table calculated for p ≤ 0,05.
Table3 Vision acuity indicators of the patients from the main group before and after the second treatment course (n=152)
Remark: data in the table calculated for p ≤ 0,05. Table 4 Vision acuity indicators of the patients from the control group before and after the second treatment course (n=136)
Remark: data in the table calculated for p ≤ 0,05.
During the 1-year period of observation average level of vision acuity in the main group increased by 1.82, in the control group decreased by 3.72. By applying Student’s t-criterion, it was established that the gap is not accidental (p<0.05), so we can affirm that implementation of the new low-light LED-based therapy methodology provides the average level of vision acuity which is higher comparing to the conservative treatment course. All the conclusions made with 0.95 probability. Taking into consideration effectiveness of LPLR in AMD treatment proved by various authors, as well as absence of perceptible difference betweentherapeutic effects ofcoherent and incoherent lightthat is experimentallyconfirmed [13,18],for the purpose of cheapening of affordability, simplicity of the procedure execution, which does not require relevant personnel training, there are grounds for focused study of possibility of application of impulse monochromatic light radiated by light emitting diodes. CONCLUSIONS.
Литература
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