First Author: S.Mykhalchyk UKRAINE
Co Author(s): N. Zavgorodnyaya
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Diabetes mellitus is the first among systemic diseases that lead to loss of vision. The main cause of blindness in diabetes is diabetic retinopathy (DR). The incidence of (DR) depends on the type of diabetes and according to various authors in Ukraine detected in 30 - 90% of diabetic patients. In turn, low vision results in disability ANC more than 10% of cases and blindness recorded 25 times more frequently. There is evidence that in 60% of cases of blindness can be prevented as a result of DR. In connection with this study is still relevant mechanisms of DRP.
The study involved 102 patients. Men - 63, women - 39, at the age of 27 to 67 years (mean age - 49 years). the vast majority of patients had diabetes type II, most of the patients were persons with an average severity of diabetes (56.9%) and stage subcompensation
All patients received the necessary hypoglycaemic drugs. Ophthalmic examination included - visus, perimetry, tonometry, ophthalmoscopy, fluorescein angiography (FAG), biomicroscopy of bulbar conjunctiva. Ophthalmic examination included computer perimetry, phospho-test (a measure of the critical flicker frequency of extinction in phosphenes - CFFF threshold electrical sensitivity for phosphenes - PECHF), optical coherence tomography STRATUS OCT-3000 and imaging with calculation of ganglion cells in the retina tomograph for high resolution ZEISS Cirrus HD -OCT 4000 (3D image).
Improvement of visual functions associated with improvement in the fundus picture. According to the results of perimetry of the central zone of the retina, the number of cattle in the standard points decreased as a result of the combined treatment by 66.4%, compared with 9.7% in the control group. Before treatment in two groups of patients visual acuity was reduced to an average of (0,61 ± 0,03) units (units.) (P <0.05), CFFF reduced to 29,4 ± 1,2 Hz (p <0.05) and threshold electrical sensitivity phosphenes PECHF increased to 148 ± 0,7 mA (p <0.05). After treatment, it was found a significant increase in uncorrected visual acuity in 93% of patients by 0.25 units, corrected visual acuity, increased overall lability of the retina by an average of 8-16 Hz, the level of PECHF decreased to 87 mA (p <0.05), increased sensitivity of the retina an average of 16 dB, the relative decrease in the number cattle, all patients reported subjective general well-being. Course introduction antioxidants have the most significant impact on the performance of the system NO and nitrosating stress. Since the content of NOS decreased by 54.0%, to nitrites by 46.5%, 61.3% nitrotyrosine.
Research findings point to the desirability of placing on preparations containing short carotenoids in the complex therapy of patients with diabetes mellitus with diabetic retinopathy in order to maintain visual function. In diabetic retinopathy, under the influence of short carotenoids in treatment noted a significant reduction in microvascular complications, increased overall lability of the retina. Based on the identified reactive oxygen species-dependent mechanisms of diabetic retinopathy is justified and proved the feasibility of inclusion in complex therapy of short-carotenoids (lycopene, beta-carotene, aksaksantin) in order to correct the expression of angiogenesis molecular factors and improvement of visual functions. On the basis of clinical and biochemical results of the study of the drug, formulated recommendations for its inclusion in the complex therapy of patients with DM. It was found that appropriate for the laboratory diagnosis of diabetic retinopathy, and monitor the effectiveness of its treatment is to be determined in the blood of patients with diabetes markers of oxidative stress, iNOS, VEGF for the prediction of adverse development of the DRP.