Method for improving vision function in the cases of primary open angle glaucoma with normalized ophthalmic tonus

FIELD: medicine.

SUBSTANCE: method involves per os introducing lipoic acid concurrently with beta-carotene at a dose of 0.05 and 10 mg 3 times a day during 1 month, respectively.

EFFECT: enhanced effectiveness of treatment; improved antioxidation activity in eye tissues; improved vision function.

3 dwg, 1 tbl

 

The present invention relates to ophthalmology and is intended for treatment of primary open-angle glaucoma (POAG) with the aim of improving visual function. Glaucoma is one of the first places on blindness and disability, among other types of pathology. Primary disability from glaucoma in Russia according to Libman E.S., 1984-1989, around 12%.

Hydrodynamic and vascular theories of pathogenesis are theoretical basis by which to explain the emergence of the two most common clinical manifestations of glaucoma: elevated intraocular pressure (IOP) and glaucomatous optic neuropathy (GON).

However, in 80-ies of the last century, in domestic and foreign literature reports emerged about the possibility of damage in glaucoma tissue drainage system of the eye is contained in the aqueous moisture free radicals (SRS) and the products of lipid peroxidation (LPO) (Bunin YA, A.A. Filin, Erichev VP Deficiency of glutathione in open angle glaucoma and approaches to correct it. // Vestnik St.Petersburg University. ophthalmology.- 1992, No. 4-6, C-15; Bunin YA Pathogenetic factors of destructive process in trabecular tissues with primary open-angle glaucoma. // Vestnik St.Petersburg University. of ophthalmology. - 2000, No.5, pp.24-27.) Excess free radicals and LPO products in the media of the eye leads to RUTTING and reduce the visual functions (Nesterov A.P., - Glaucoma. M.: Medicine, 1995, s.)

With that said medication POAG should be comprehensive and include drugs anti-hypertensive action, neuroprotective agents, and antioxidants.

Antioxidants are compounds that prevent the formation of free radicals and reduce the level of lipid peroxidation (Vladimirov, Y.A. Free radicals and antioxidants. // Bulletin of the Russian Academy of medical Sciences. - 1998, No. 4, s.43-50.). In physiological conditions in the body there is a balance between Pro - and antioxidants. Imbalance caused by excess free radicals and peroxidation products, leads to destructive processes in the eye at the cellular level, the decline of visual functions and RUTTING (Zigangirov GG, Antonova O.-lipid Peroxidation in the pathogenesis of primary open-angle glaucoma. // Vestnik St.Petersburg University. of ophthalmology. - 2003, No. 4, p.54-55.).

The anti-oxidant system contains 2 types of substances, both nonenzymatic and enzymatic nature. The first type includes nutrients: vitamins a, C, E, K, bioflavonoid group R, coenzyme Q. the second catalase, glutathione peroxidase, restored glutathione and superoxide dismutase (SOD) (Kuryshev NI-Mechanisms of decline of visual functions in primary open-angle glaucoma and ways of their prevention. // The Diss. Prof. the honey. Sciences. - M., 2001, pp.93-102.).

Important rol the local antioxidant defense of eye tissues plays the Tripeptide glutathione, which restores the lipid peroxide, supports the activity of thiol enzymes containing sulfhydryl groups) and the level of vitamins C and E in the cells (Owl A.A. Effect of lipoic acid on the components of the glutathione system in the tear fluid of patients with primary open-angle glaucoma. // Vestnik St.Petersburg University. of ophthalmology. - 1993, No.5, pp.5-6.)

Literature data indicate a decline in the level of glutathione in the blood of moisture in the anterior chamber and tear fluid of patients with glaucoma (Birich T.V., Birich T.A., Marchenko LN. and others - lipid Peroxidation in the blood of patients with primary glaucoma. // Vestnik St.Petersburg University. of ophthalmology. in 1986, No. 1, s-15; Makashov, NV, Babenkov IV, teselkin CREATING the Antioxidant activity of the lacrimal fluid in patients with primary glaucoma. // Vestnik St.Petersburg University. of ophthalmology. - 1999, No. 5, p.3-4.)

It follows the advisability of appointing glaucoma patients antioxidants, which help to reduce the level of CF and peroxidation products, as well as to increase the concentration of glutathione in the tissues of the eye.

We selected the closest analogue relates to a method of improving visual function of the neuropeptide Semax POAG patients with normalized intraocular pressure (Kuryshev NI et al. "Semax" in the treatment of glaucomatous optic neuropathy in patients with normalized intraocular pressure. // Vestnik St.Petersburg University. of ophthalmology. - 2001, No. 4, pp.5-8.) The drug develo the tan team of scientists of the Institute of molecular genetics of RAS and Moscow state University under the guidance of academician I.P. Ashmarina. The method is quite effective, but has its disadvantages.

Firstly, the selected treatment regimen bulky, economically costly, and implementation is expected only in the hospital ophthalmic profile.

Secondly, the author's proposed combination of Semax with antioxidants on the background of antiplatelet and calcium channel blockers, gave the overall effect of treatment GON, reinforced by Semax.

Thus, in the similar improvement of visual functions in patients with POAG with normalized intraocular pressure achieved as a result of the treatment, the direct effect of the peptide offset (or not present).

The task of the invention is to develop a method for the treatment of patients with POAG with normalized intraocular pressure, but deteriorating visual functions, the appointment of antioxidants.

The technical result of the proposed method is to improve the antioxidant activity in the tissues of the eye.

The technical result is achieved due to the simultaneous application of two antioxidants lipoic acid and beta-carotene in certain doses. Control is the level of glutathione (CH) in the tear fluid and data ophthalmic examination.

The proposed method of conservative treatment of primary open-GL is okomi as follows: lipoic acid simultaneously with beta-carotene in doses of 0.05 g and 10 mg, respectively, give orally 3 times a day for months.

The effectiveness of the proposed method is evaluated in the following studies. In the tear fluid was determined by the content of glutathione (non-protein SH-groups) according to the method of Sedlak and Lindsay (Analit. Biohem. - 1968, V 25, R-205). Was taken for analysis of 0.15-0.2 ml tears after stimulation - inhaling through the nose ammonia (10% ammonia solution).

Clinical examination included visiometry, static threshold perimetry program "glaucoma is an abbreviated screening for domestic automatic paragraphe "Peric", which was estimated dynamics of changes in the Central visual field (CPS) on two indicators: the deficit area (DP), i.e. the number of points where the object does not vary, and the lack of sensitivity (DF), i.e. the product of the number of cattle on their intensity (SCH - sensitivity to light). Kinetic perimetry with counting the peripheral boundaries of the field of view (RFP) 8 meridians were investigated on polusirovom perimeter of the "Carl-Zeiss, Jena. All studies were carried out before and after 1-2 months after completing the course of treatment.

Monotherapy lipoic acid and beta-carotene inferior in the efficiency of their simultaneous reception, which can be clearly seen from table 1.

Table 1.

The effect is of antioxidants on the parameters of the visual functions of patients with POAG (%).
DrugsN/NDP↓Midrange↓QH↓FP↑CH↑
Lipoic acid62/4233,969,542,04556
Beta carotene40/2433,661,541,23350
Lipoic acid + beta carotene37/2844,278,048,65370

N/N (numerator - the number of the examined eye; the denominator is the number of eyes with significant improvement in %).

In the diagrams (Fig.) the Central field of view presents the result of a decrease in the deficit area in patients with POAG who received beta-carotene, lipoic acid, and a combination of lipoic acid with beta-carotene (1, 2, and 3, respectively).

The example 1 is illustrated in figure 1.

Patient N., 65. Diagnosis: POAG OSIIInstage. High IOP OS reduced operational by up to 18 mm Hg, however, visual function continued to decline. The course antioxidant therapy only beta-carotene (10 mg 3 times a day for months). The number of cattle in CPS decreased from 42 to 26, i.e. the lack of space declined by 16%.

Example 2, is illustrated in figure 2.

Bstage. Normalization of intraocular pressure up to 21 mm Hg maximum hypotensive mode (4% taufon +2% trusopta +0,005% ksalatan). Despite this, visual function continued to decline. The course antioxidant therapy only lipoic acid (0.05 g 3 times a day for months). The number of cattle in CPS decreased from 44 to 26. The lack of space has decreased by 18%.

The example 3 is illustrated in figure 3. Patient P., aged 65. Diagnosis: POAG OSIIBthe stage is set a year ago. IOP OS on antihypertensive therapy was not more than 23 mm Hg, However, during the observation time in CPS OS dramatically increased the absolute number of animals. Within one month the patient received simultaneously lipoic acid 0.05 g and beta-carotene 10 mg 3 times a day. The number of cattle in CPS decreased from 45 to 5. The lack of space has decreased by 39%.

Thus, the proposed method of treatment allows to reliably ascertain the effectiveness of the simultaneous reception of lipoic acid and beta-carotene to improve visual function in patients with POAG. The method is distinguished by the simplicity and affordability.

Method for improving visual function in primary open-angle glaucoma with normalized intraocular pressure, characterized in that use lipoic acid simultaneously with beta-carotene in doses of 0.05 g is 10 mg, respectively orally 3 times a day for 1 month.



 

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