RESEARCH OF CONSERVATIVE EFFICIENCY TREATMENT OF PATIENTS WITH DESTRUCTIVE LESION (ULCER) OF THE CORNEA

• Main Authors: Rykov S. A., Shargorodska I. V., Lavryk N. S., Kornilov L. V L. V
• Format: Article
• Language: English
• Published: Ukrainian Medical Stomatological Academy 2019-04-01
• Series: Вісник проблем біології і медицини
• Subjects: destructive corneal lesions; metabolic therapy; Corneregel; Tealoz Duo; Restasis; Oftaquix; Ciloxan.
• Online Access: https://vpbm.com.ua/upload/2019-2-1/39-min.pdf
• ISSN: 2077-4214; 2523-4110

In recent years, an increase in metabolic lesions of the cornea of the cornea with destructive corneal lesions (DCL) has been observed on the background of conservative treatment using pathogenetically oriented drugs and drugs of symptomatic action. It is known that dystrophic processes in the cornea progress, causing profound tissue destruction, pain syndrome, significantly reducing function. Keratoplasty surgical interventions that are effectively used to treat this pathology are associated with problems with the use of donor material. This increases the significance of the use of metabolic therapy, aimed at optimizing antioxidant processes. However, effectiveness must be determined by evaluating clinical observations. Thus, when forming a list of medicines for conservative treatment of DCL, it is advisable to conduct a comparative study of the effectiveness of drugs for local application, namely: stimulators of reparative processes and metabolism, moisturizers, antibiotics. Objective. To study the effectiveness of local application of modern available drugs - stimulators of reparative processes and metabolism, broad-spectrum antibiotics in the treatment of destructive processes of the cornea. The object and methods of research. The study was conducted in parallel groups of patients with keratopathy (DCL). Evaluated the dynamics of objective clinical changes, which characterized the reparative processes in the cornea. The control was 10 eyes 7 patients with destructive corneal lesions (DCL) without the use of additional drugs for stimulation of reparation. To assess the eye condition, the Clinical Symptom Expression Index (CSEI) in eyeballs was used. The efficacy of treatment was defined as the percentage of cured patients (significant improvement) and the disappearance of destructive lesions (erosion) of the cornea. Thus, in patients with purulent DUR, broad-spectrum antibiotics of local use, namely: Oftaquix (Santen) and Ciloxan (Alcon), have a pronounced anti-inflammatory effect. Recovery time from 3 to 5 days in 56% and 38% of cases respectively, 44% of eyes in 5 days required further treatment due to the presence of destruction of the epithelial layer of the cornea. In assessing the effectiveness of the metabolic therapy options used in DUR to stimulate epithelization and healing of the cornea, it has been found that the use of corneoprotective Dexpanthenol (Corneregel Baush + Lomb) in combination with vitamin preparation resulted in improvement in 96% of eyes (control of 70%), with the appointment of 0.5% solution of Cyclosporin (Restasis), recovery is noted in 75% of cases in 30 days. Significant changes in reparation (epithelization) were not detected in 25% of severe DCL cases. Significant improvement in 75% of cases was noted with trehalose hyaluronic acid (Laboratoires Thea Tealoz Duo), but in 25% of cases no adequate repair was noted. Thus, broad-spectrum antibiotics, fluoroquinolones of local application, namely: Oftaquix (Santen) and Ciloxan (Alcon) have a clear anti-inflammatory action in patients with purulent DCL and well tolerated by patients. It has been noted that more than 44% of the 5 days of antibiotic therapy required further treatment due to the destruction of the epithelial layer of the cornea. Thus, with the conservative treatment of DCLs, the recommended use of drugs for 5-7 days followed by a determination of indications for surgical treatment.Conclusions 1. In patients with purulent DCL antibiotics of a wide range of local application, namely: Oftaquix (Santen) and Ciloxan (Alcon) have a clear anti-inflammatory action. Recovery time from 3 to 5 days in 56% and 38% of cases respectively, 44% of eyes in 5 days required further treatment due to the destruction of the epithelial layer of the cornea. 2. In patients with DCL, when assessing the effectiveness of metabolic therapy options for corneal reparation, it was determined that use of the corneoprotector Dexpanthenol (Corneregel Baush+Lomb) in combination with the vitamin preparation resulted in improvement in 96% of the eyes (control of 70%) (p < 0.05). 3. In the eyes with the DCL, a significant improvement in 75% of cases was noted with Trehalose Hyaluronic Acid (Laboratoires Thea Tealoz Duo) treating, but in 25% of cases, no adequate repair was noted. Improvement is associated with a positive effect on eye moisturizing. 4. In the group of patients with DCL receiving 0.5% solution of Cyclosporine (Restasis, Allergan), cure was noted in 75% of cases (8 eyes) for 30 days. Significant changes in reparation (epithelization) are not defined in 25% of severe cases of DCL. 5. Comparison of the time of reduction of the clinically significant score (CSEI) by 50% - Dexpanthenol with Taufon - 7 days - 5.1 points (P <0.05), Trehalose Hyaluronic acid - 14 days - 7.9 points (P <0.05), 0.5% Cyclosporine - 14 days - 5.7 points (P <0.05), gentamicin - 5 days - 6.6 points (P <0.05), Cyfloxane - 5 day - 5.9 points (P <0.05), Oftaquix - 5 days -3.7 points (P <0.05). 6. With the conservative treatment of DCL, the recommended use of drugs for 5-7 days with further determination of indications for surgical treatment.