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Pathogenic course of general conservative treatment of patients with juvenile glaucoma occurring on the base of progressive myopia
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DOI: http://dx.doi.org/10.20534/ESR-17-3.4-31-33
Zakhidov Ulugbek Basitovich, CMS, applicant of Tashkent advanced medical studies institute, Eye diseases department E-mail: [email protected]
Pathogenic course of general conservative treatment of patients with juvenile glaucoma occurring on the base of progressive myopia
Abstract: we observed 44 patients, aged from 11 to 18 years, with progressive myopia, juvenile glaucoma, juvenile glaucoma on the base of progressive myopia. All patients were investigated by biochemical methods to the level of oxyproline in blood serum and on the base of this method there were prescribed the conservative treatment. Keywords: progressive myopia, juvenile glaucoma.
Introduction. One of the major pathogenetic links ofmyopia's progression is a weakening of the supporting properties of the sclera on the base of damage its metabolism and structure [7]. With the progression of myopia in the sclera there occur biochemical, bio-mechanical and structural changes in the anterior segment of the eyeball and then in the rear section of the zone. The collagen framework changes, the fibrils split and as a result of it there the collagen's disaggregation occurs, which leads to the weakening and stretching of the sclera. In the posterior part the eyeball takes elongated shape, there occurs a tendency to increase the intraocular pressure, which further leads to the progression of myopia [1; 3].
In recent years, we study the connection between myopia and glaucoma. In addition, currently myopia has been regarded as one of the risk factors of appearing glaucoma [3,4]. Epidemiological data indicate a high risk of glaucoma in patients mainly with high and middle degrees of myopia [5]. A common feature of the analyzed diseases (myopia and glaucoma) are expressed by trophic changes, celebrated not only in the posterior of the eyeball, but also by the presence of the imbalance of contenting microelements in the sclera [2].
The study of the fractional composition of collagen gives an indication of changes in the catabolic processes, namely the content of the free oxyproline and decreasing total collagen in the tissues. The major metabolite of characterizing the rate of collagen decay is oxyproline. Increasing its content in blood plasma indicates disorders of collagen maturation. Since the free oxyproline is not included in the new chains of collagen biosynthesis, its content in the blood reflects the rate of collagen's decay [6].
The aim of the research: set the effectiveness of the general pathogenetic conservative treatment in patients with juvenile glaucoma occurring on the base of progressive myopia
The materials and methods. This study presents the results of surveys of 44 patients, aged from 11 to 18 years (mean age 16,8 ± 2,4 years), there are 14 boys and 30 girls. Patients were divided into 3 groups. The1st group is of 16 patients with JG on the base PM, the 2nd group is of 17 patients with PM and the third group is of 11 patients with JG. Control data of biochemical results were 9 healthy subjects of different ages. Each patient is examined with the use of traditional ophthalmological methods (visometry, tonometry, tonography, static and kinetic perimetry, biomicroscopy, Gonioscopy using a three-mirror Goldmann gonioscopy). The daily tonometry of patients received every two hours, starting from 6-00 to 22-00 for a more detailed study of the IOP fluctuations. Also there were carried ultrasound echobiometry (Oftascan mini-B «Alcon»), computerized perimetry (Peritest-300, Russia) and also on the testimony the Doppler of brachiocephalic vessels and vessels of the eyeball. In the blood serum there were determined the total index of connective tissue metabolism of oxyproline. To determine the amount of oxyproline in the blood serum the work was divided into two stages. In the preparatory phase proteins of collagen of various fractions subjected to alkaline hydrolysis in sealed glass ampoules. Hydrolysis was carried out daily, 3, 5, 10 and 15 days of a complete hydrolysis time. Further, hydrolysates of proteins were evaporated in a ceramic dish at water bath. The dry residue was dissolved in a precise volume of water. The resulting solutions were
Section 5. Medical science
taken to determine the amount of oxyproline. The second stage used a method based on oxidation of Oxyproline by chloramine B and by condensation of products of oxidation with Ehrlich's reagent to produce a product colored red with further determination of the optical density on the photoelectric colorimeter concentration of PCC-2 with a wavelength of 590 nm. This is the most simple and fairly accurate method of determining the oxyproline by Bergman and Loxley, which modificates the method of Stegeman.
All studied patients received general conservative treatment to stimulate collagen formation, which was conducted with the use
of drugs such as aktovegin 200 mg pro injectionibus or solkoseril 2.0 ml № 10 in muscular with cofactors of collagen synthesis — the solution for injection 5% ascorbic acid C № 10, zinc-containing drug — komplivit by 1 tab. per 1 time a day for 4 weeks, Magne B6 per os by 1 tab. 3 times a day for two months and glycinum by 1 tab. 3 times a day under the tongue for 2 months.
The results and discussion.
We studied the level of oxyproline in the blood serum of patients which reflects the breakdown of proteins of the extracellular matrix, the results of which are shown in table 1.
Table 1. — The content of oxyproline (mmol/l) in blood serum (M±m)
Groups Numder of patients Content of oxyproline (mmol/l) Р
Juvenile glaucoma on the base of progressive myopia 16 30,68±0,96 <0,001
Progressive myopia 17 26,03±1,05 <0,05
Juvenile glaucoma 11 24,98±0,17 <0,01
Control group 9 18,61±0,68
Studies have shown a significant increase in the level of oxyproline in patients with PM 1.4 times and 1.34 times with JG and with combined pathology (JG on the base PM) is of 1.65 times relatively to healthy individuals.
Analysis ofoxyproline level, depending on the stage ofglaucoma and myopia showed the presence of a certain relationship. Thus, patients with PM, we observed differences depending on the degree of myopia in a significant increase of 1.4 (up to 26.03 ± 1.05 mmol/l) and 1.48 times (up to 27.02 ± 1.10 mmol/l), respectively, for medium and high degrees ofmyopia relativelyt to the values ofhealthy individuals.
In patients with combined pathology (JG on the base PM), as the progressing of disease, we observed an increase the levels of oxyproline in blood serum. If the level of oxyproline at the developed stage ofJG significantly increased in 1.54 times, accounting for 28,65 ± 0,67 mmol/l, then at the far-advanced stage — in 1.89 times, accounting for 35,14 ± 1,10 mmol/l.
In patients with combined pathology (JG on the base PM) at the developed stage, raising the level of the oxyproline was 1.46 and 1.57 times, and in far-advanced stage — 1.75 and 1.87 times, respec-tivelyto the middle and high myopia. As can be seen from the data, the presence of the accelerated catabolism of collagen at the PM leads to increase connective tissue of dysplasia, as it was setting the stage for the rapid progression of the juvenile glaucoma.
Researched results are consistent with the clinical data of patients in groups. Thus, during the initial examination of patients with
JG and installed combined JG on the base PM, the typical complaints were visual discomfort (27%) and fatigue, especially when working near (45%) and the deterioration of twilight vision (61%). In the group with combined pathology (JG on the base PM) there was reported a more rapid progression of myopia (82%) in patients relatively with PM.
On the basis of researches of the level of oxyproline pointing to lack of collagen in the ECM system, in general conservative treatment of patients with combined pathology (JG on the base PM) were included the drugs of replacement therapy and drugs, which stimulate collagen formation along with local antihypertensive drugs. This treatment was carried out to all researched patients. We have not noted the above-mentioned side effects of medicines which would lead to stop the treatment.
Analysis of achieved results of the level of oxyproline in the blood serum in patients after treatment showed that the therapy helped to a significant decrease in the level of oxyproline in patients with combined pathology (JG on the base PM) and PM. Moreover, a significant reduction of oxyproline levels in patients with developed stages of glaucoma and far- advanced stage is statistically significant when compared with the results of researched patients with the comparison group regardless of the degree of myopia. Consequently, there achived conditions for the suspension and reduction of collagen decay in ECM system (Table 2).
Table 2. - Data of the oxyproline level (mmol/l) in combined pathology (JG on the base PM) and PM before and after treatment.
Stages of glaucoma Degrees of myopia
Middle High
Before treatment (mmol/l) After treatment (mmol/l) Before treatment (mmol/l) After treatment (mmol/l)
Developed 27,23 ± 1,13 24,42 ± 1,08 29,19 ± 1,28 25,02 ± 1,23
Far-advanced 32,57 ± 0,77 25,49 ± 0,79 36,68 ± 1,15 27,63 ± 1,16
Progressive myopia 25,03 ± 1,05 23,91 ± 0,86 27,02 ± 1,10 25,01 ± 1,10
Control group 18,61±0,68 mmol/l
So a decrease of oxyproline in blood serum of patients with combined pathology (JG on the base PM) was observed more at the developed (on average, 4,17 ± 0,05) and far-advanced (on average, 9,05 ± 0,09) stages of glaucoma with high degree of myopia comparing the data of combined with the developed (an average of 2,18 ± 0,03) and far-advanced (an average of 7,08 ± 0,04) stages of glaucoma. Relatively these changes have been identified in patients of comparison group with PM downward at middle (an average of
1,12 ± 0,02) and high degree of myopia (an average of 2,01 ± 0,04) relatively on the data before treatment (p < 0.05). In the control group of healthy individuals observed changes regarding the reduction were not statistically significant.
Conclusion
In our opinion, the accelerated disintegration of the extracellular matrix components, especially collagen, the severity of which depended combined on the stage ofJG and on the degree
Morphological and functional features of thyroid gland of posterity under in utero and early postnatal exposure to pesticides
of myopia, is one of the pathogenetic mechanisms of the myopia progression.
Conservative general therapy of patients with juvenile glaucoma occurring on the base of progressive myopia, regardless of the stage of development of glaucomatous process, requires
the inclusion of pathogenetically directed treatment, the purpose of which is to slow and/or stabilization of the intensity of the destruction of collagen ECM system, prescribing substitution therapy and stimulating collagen formation on the base of antihypertensive therapy.
References:
1. Akopyan A. I. The interaction of biomechanical parameters of the eye and their role in the development of glaucoma, myopia, and combined pathology (preliminary report)//Modern methods of diagnosis and treatment of diseases of the cornea and sclera: Scient. Conf.: Coll. Scien. Art. - M., - 2007. - P. 243-250.
2. Dolzhich R. R. Pathogenic mechanisms to reduce the visual functions in complicated myopia and combined it with glaucoma, the development of a differentiated system of rehabilitation and dispensary observation: Avtoref.dis. .. .Dr. med. sciences. - Samara, -2006., - 46 p.
3. Khojabekyan N. V., Tarutta E. P., Kruzhkova G., Manukyan I. V. Clinical studies of biomechanical properties of sclera in patients with anisometropic myopia//Russian national ophthalmology forum. Collection of scientific works - Moscow. - 2008. - P. 593-596.
4. Konovalova O. S. Multifactor model of juvenile glaucoma on the base of progressive myopia//Actual problems of ophthalmology. Proceedings of the conference. Tyumen. - 2010. - P. 67-70.
5. Svetlov O. Features of interaction of the sclera, accommodative and drainage eyes with glaucoma and myopia pathology//Sciences: -Moscow. - 2009. - 2 p.
6. Severin E. S. Biochemistry. Textbook for high schools. - M.: Geotar Med, - 2008. - 776 p.
7. Seleznev A. V., Nasu H. Dynamics myopic disease in patients with connective tissue dysplasia syndrome//Ophthalmosurgery. - Moscow. - 2012. - No. 4, - P. 73-76.
DOI: http://dx.doi.org/10.20534/ESR-17-3.4-33-34
Zokirova Nargiza Bakhodirovna, Senior Researcher of Tashkent Medical Academy E-mail: [email protected]
Morphological and functional features of thyroid gland of posterity under in utero and early postnatal exposure to pesticides
Abstract: The effect of prenatal and early postnatal exposure to pesticides of new generation (cyhalothrin and fipronil) on the postnatal dynamics of the formation of pituitary-thyroid system of offspring has been studied. It was found that the impact of pesticides through the mother's body slows down the rate of formation of thyroid follicles offspring. Violation of the pituitary-thyroid system is manifested in the form of hypothyroidism. All this leads to a thorough monitoring of thyroid function in pregnant women and newborns at increased risk of environmental pollution by pesticides.
Keywords: pesticides, thyroid gland, pituitary-thyroid system, postnatal ontogenesis.
Introduction. Many chemicals that are widely used in households, agriculture and industry have a negative effect on the endocrine system. They are now united under the name of "endocrine-disrupting substances, EDs or endocrine disruptors, ED" [5; 6]. This term together those chemicals that in humans and animals change the processes of synthesis, secretion, transport, metabolism of natural hormones and thus lead to a breach of the hormonal homeostasis [5]. That action has a number of pesticides, including the latest generation, household chemicals, some drugs [3; 4; 5]. The high sensitivity of the thyroid to the EDs has caused the need for a separate group of chemical substances (thyroid-disrupting chemicals), which predominantly inhibit the processes of synthesis, transport and receptor function of thyroid hormones [7; 9]. To date, can be considered a proven role of EDs in the pathogenesis of several diseases, such as obesity, atherosclerosis, hypertension and coronary disease, some of reproductive dysfunction and other related metabolic disorders and hormonal homeostasis [5; 6; 9]. Analysis of the literature shows that the majority of studies on the mechanisms and effects of EDs on the endocrine system, unfortunately, animals and adults carried out on mature individuals [3; 4]. There are only a
few reports that such ED substances have a more pronounced pathogenic effect in childhood and adolescence, disrupting the growth and formation of the body in the postnatal period [8]. However, many questions of adverse effects of environmental chemicals on the developing human body and animals remain unsolved.
The purpose of research is identifying the structural and functional features of postnatal growth and the formation of the thyroid gland in the offspring in terms of pesticide exposure via the mother's body.
Materials and methods. Experiments were performed on nul-liparous, white adult female rats, which were divided into 3 groups of 30 animals each. Two groups of animals for 30 days daily per os obtained respectively pesticides cyhalothrin or fipronil. The third group receiving only the same volume of sterile saline served as a control. The following day, the females were coupled with healthy males for fertilization. Exposure of pesticides was continued incessantly during pregnancy and until the end of the lactation period. Pregnancy was monitored for the presence of sperm in vaginal smears. Offspring obtained from the experimental and control females were examined in dynamics on days 3,7,14, 21 and 30 after
