The Results of the Usage of Electro Stimulation in Neuroprotective Therapy of the Glaucomatous Optic Neuropathy

Аннотация

Glaucoma is a chronic progressive optic neuropathy with characteristic morphologic changes in the head of optic nerve and progressive death of retinal ganglion fibers with narrowing of the visual field. Effective decrease of IOP is not able to serve as a guarantee of stabilization of glaucomatous process that continue to progress in part of patients. Thus, a search of a new direction of the drug therapy is needed because of the fact that hypotensive therapy is not completely effective. The most perspective of them is neuroprotection in combination with percutaneous electrostimulation that protect neurons of the retina and nerve fibers of optic nerve from different damage factors. Aim. To assess the effectiveness of percutaneous electrostimulation in complex neuroprotective treatment of the glaucomatous optic neuropathy Materials of the research. The study is based on the results of50 (90 eyes) patients that were examined with GON in condition with compensate IOP aged 18 to 55 years. Compensation of IOP was reached by medicinal, laser and surgical ways. All patients were divided into two homogeneous groups depending on the stage of primary open angle glaucoma and age of patients. In control group 25 (44) eyes took traditional therapy during 10 days in the scheme of which a preparation « Retinilamine» was included. In the study group 25 (46 eyes) patients along with traditional therapy took endonasal electrophoresis with preparation of «Tanakan» 1 time per day and percutaneous electrostimulation with a help of ESOM apparatus that based on the usage of a rectangular negative impulse with duration 1-10 ms, following with frequency 5-30 Hz and amplitude 10-1000 µA during the 10 days. A 4-6 series with 15-45 sec and interval among 30-60 sec were carried out on the each eyeball. Results. Clinical and functional assessment of the complex treatment of glaucomatous optic neuropathy with injection of preparation ―Tanakan‖ via endonasal electrophoresis in combination with percutaneous electrostimulation according to OCT and computer perimeter findings demonstrate reliable improvement of the average visual field and index of computer perimeter such as МD and PSD, as well as improvement indications of optical coherence tomography, especially RNFL compare to initial ones and prove effectiveness of the proposed therapy. 4198 http://annalsofrscb.ro Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203 Received 16 Fe bruary 2021; Accepted 08 March 2021. Conclusion According to our results, inclusion of endonasal electrophoresis with tanakan following with percutaneous electrostimulation in complex treatment of glaucomatous optic neuropathy has the effect of protecting from detrimental influence of IOP to retina, promotes prolongation of the main treatment and recovery of visual function of the eye. Given method associate with percutaneous electrostimulation has sufficient comfort, cost- effectiveness, fast and stable positive effect and can be used in both inpatient and outpatient condition KEYWORDS: GON, OCT, ERG, MD, PSD, Tanakan, endonasal electrophoresis, electrostimulation. Relevance A term of glaucoma unites a group of diseases with different ethology, but they comprises a set of general features in pathogenesis, clinics and methods of treatment. A distinctive symptoms of glaucoma are elevated intraocular pressure over the level of tolerance for head of optic nerve, development of glaucomatous optic neuropathy and appearance of the typical visual fields defects [A.P.Nesterov, 2005]. A considerable increase of the morbidity rate of glaucoma all over the world and leading role in forming irreversible blindness is made up medico-social importance in the given pathology [Н.А.Quigley at al., 2006; J.Goldberg, 2000]. The main therapeutic purpose in glaucoma is to protect visual functions and quality of patient’s life in condition with minimal side effects, acceptable therapy and the cost effectiveness of the drugs. Neurodystrophic nature of glaucomatous optic neuropathy determines a necessity of the usage of a new effective pharmacologic drugs with neuroprotective properties because of the fact that degenerative process in glaucoma that effects a nerve tissue extends to subcortical center, especially to lateral geniculate body [4,5,6]. A search of methods and preparations with prolong and stable effectiveness as well as an optimal tolerance and minimal amount of side effects are tend to be continued. A methods of treatment of glaucomatous optic neuropathy that enables a delivery of medical substance to the target organ presence a special interest [,1,2]. Neuroprotective therapy is directed to correction of metabolic disorder that occurs in the head of optic nerve during the glaucoma process and to improvement of local microcirculation and tissue trophic, normalization of rheological properties of blood and improvement of main and collateral blood circulation [7,8,9,]. One of the perspective direction