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1RESULTS OF ASSESSING THE EFFECTIVENESS OF COMPLEX TREATMENT IN PATIENTS WITH STAGES 3-4 HYPERTENSIVE ANGIORETINOPATHY
JZhalalova D.Z. 2Shernazarov Farrukh
Samarkand State Medical University, associate professor at the Department of Ophthalmology 2Student of group 608 of the Samarkand State Medical University Faculty of Medicine https://doi.org/10.5281/zenodo.10391157
Abstract. The division into the studied subgroups is presented in Table 5.7. The duration of dynamic observation ofpatients in group 1 was 2 years. The first observation point was based on the data from the initial ophthalmological examination, as well as the results of assessing the level of endothelin-1 in the tear fluid of 15 patients in this group. A follow-up examination was carried out after 2 years, during which endothelin-1 levels in tear fluid were also re-examined in 15 patients in the group.
Keywords: the graphs show that in both groups there was a positive BCVA indicator both at distance and near.
Table 5.7
Studied subgroups of patients with stages 3-4 of HAR.
Group 1 Group 2 Group 3
(n =28, 32 eyes) (n = 16, 20 eyes) (n = 10, 10 eyes)
3-4 grades of GAR without signs of 4 tbsp GAR with signs
macular edema, optic disc edema or macular edema, optic disc edema
neovascularization or neovascularization
Standard drug therapy for Conservative therapy Conservative
hypertension with the choice of an + therapy
antihypertensive drug from the group Panretinal laser +
of ACE inhibitors or ARB II. coagulation Micropulse laser
C special scheme of conservative (using green laser) treatment
therapy for GAR: using
Sermion 30 mg 3 times a day for 2 yellow laser
months Detralex 1000 mg 2 times a 577 NM
day for 2 months.
FDP 5.0 IV drop for 5 days.
Nucleo and Gliatilin, 1 capsule 2 times
a day for 1 month.
Table 5.8 shows the dynamics of the main clinical and laboratory indicators. The table shows that in group 1, under the influence of therapy, significant positive dynamics were observed (p <0.05) in terms of CTX, general PD and CFA indicators. At the same time, the decrease in the thickness of the GC-IPL complex was much less pronounced and statistically insignificant. The results also showed that patients with conservative therapy also experienced a significant (p <0.05) decrease in the level of endothelin-1 in the tear fluid.
Table 5.8
Results of a comparative analysis of BCVA, OCT parameters and OCTA signs in group 1 over
time.
Indicators Before treatment After 2 years
MCOH, in the distance 0.68±0.12 0.74±0.11
PZT, |m 293.7±15.5 260.6±12.2*
CTC, |m 295.5±10.5 269.2±11.2*
GC-IPL, |m 77.8±3.8 76.1±3.5
Total P D 32.1±0.94 34.8±0.75*
CFA, mm 2 1.82±0.06 1.93±0.08*
Endothelin-1, fmol/ml 2.84±0.32 1.88±0.38*
*- significant in relation to the indicators before treatment atp <0.05;
The results of dynamic observation of the results of complex treatment using various types of laser exposure in groups 2 and 3 are shown in the graphs in Figure 5.6.
The graphs show that in both groups there was a positive BCVA indicator both at distance and near. Moreover, in both groups a significant ( p <0.05) increase in BCVA was recorded after 15 months of follow-up. There were no statistically significant differences between the final mean BCVA values in the study groups.
The duration of follow-up was 15 months. In both groups, after 2-3 sessions of laser treatment, patients continued treatment according to the appropriate scheme of conservative therapy (Table 5.7).
Since at stage 4 of HAR there was the development of macular edema or significant accumulation of subretinal fluid, the CTS indicator was assessed during dynamic observation. The research results showed that in both study groups there was a positive CV indicator.
At the same time, in both groups a significant ( p <0.05) decrease in the indicator was recorded, which indicates a decrease in edema or the volume of subretinal fluid after 15 months of observation.
There were no statistically significant differences between the final average CTS indices in the study groups. This indicates that both types of laser exposure, both PRLC and SMLV using a yellow laser, are an effective additional treatment method for stage 4 GAD.
Dynamic assessment of the CTC indicator showed that despite the fact that in both groups there was a significant ( p <0.05) decrease in choroidal thickness, in group 3 the final average indicator was closer to normal values and was significantly lower in comparison with the same indicator in the group 2.
An assessment of OCTA indicators characterizing the state of chorioretinal circulation showed that in the dynamics of the group there were no statistically significant changes in indicators in comparison with the initial indicators, despite some positive dynamics.
In group 3, a significant ( p <0.05) increase in the total perfusion density and choriocapillary blood flow zone was established.
This indicates that SMLV using a yellow laser as an addition to conservative therapy has a pronounced positive effect on chorioretinal circulation in stage 4 GAD.
This fact confirms the advantage of this type of laser treatment for HAR in the long term.
Dynamics of BCVA in the distance Dynamics of BCVA near ■ baseline ■ in 15 months
■ baseline ■ in 15 months
0,82 0,81
0,71 0,7 0,67
0,65
0,43 0,39
GROUP 2 rpynnA3 GROUP 2 GROUP 3
PZT, ^m CTC, ^m
■ baseline ■ in 15 months ■ baseline ■ in 15 months
366,7 363,8 311,4 312,2
272,3 270,1 285,6
267,7
GROUP 2 GROUP 3 GROUP 2 GROUP 3
General PD Choriocapillaris flow area ,
■ baseline ■ in 15 months
■ baseline ■ in 15 months
8
34,8 1,91
33,2
1,82
32,4 32,1 1,76 1,74
GROUP 2 GROUP 3 GROUP 2 GROUP 3
Figure 5.6. Dynamics of the main clinical and functional indicators in patients against the background of complex treatment in groups 2 and 3.
(*-significant in relation to the original indicator ( p <0.05); A-significant in relation to the same indicator in group 2 ( p <0.05)).
Conclusion
In conclusion, the results of assessing the effectiveness of complex treatment in patients with stages 3-4 hypertensive angioretinopathy demonstrate the potential benefits of a comprehensive therapeutic approach in managing this advanced stage of the condition. Complex treatment strategies typically involve a combination of medical interventions, lifestyle modifications, and close monitoring of blood pressure and retinal status. The findings indicate that such an approach can lead to positive outcomes, including stabilization or improvement of visual acuity, reduction in retinal edema, regression of retinal hemorrhages, and preservation of retinal function.
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