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Photodynamic therapy of fungal inflammatory eye diseases: from studies in vitro: to clinical practice

Session Details

Session Title: Uveitis

Session Date/Time: Saturday 19/09/2015 | 11:00-12:30

Paper Time: 12:20

Venue: Hermes

First Author: : O.Zborovska UKRAINE

Co Author(s): :    O. Dorokhova              

Abstract Details

PURPOSE:To increase the effectiveness of fungal inflammatory eye diseases treatment by using in complex therapy the photodynamic chemotherapy (PDT) with methylene blue (MB) and laser radiation.

Setting:

SI 'The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine';

Methods:

We compared effect of different MB concentrations (0.05%, 0.1%, 0.2%) on the growth of Candida albicans “in vitro” by optical density. We also established best laser exposure. We modeled fungal keratitis in 15 rabbits. All rabbits were divided into two groups. The control group received standard anti-inflammatory therapy, the main group received standard anti-inflammatory therapy and PDT. Patients with severe fungal keratitis (44 people, 44 eyes) received standard therapy, 22 of them in the complex treatment also recieved PDT with 0.1% methylene blue. In all patients corneal infiltrate area and erosion area exceeded 50%. There were no posterior segment lesions identified by ultrasonography. The observation period was 3 months. Outcome measures were reduction of infiltration area, absence of fungal contamination.

Results:

During in vitro experiment we determined the most effective parameters of PDT with MB. We determined MB concentration as 0.1% and laser exposure as 3 min. Rabbits: in the control group with moderate fungal keratitis duration of a disease was 14,25±1,0 days (outcome local stromal opacity with neovascularisation), and 21,1 ± 1,7 days with severe keratitis (outcome – intensive stromal opacity with active neovascularisation). In the main group with moderate fungal keratitis duration of a disease was 7,15 ± 0,75 days (outcome – dotted superficial opacity), and severe - 14,25 ± 1,0 days (outcome – local stromal opacity with inactive neovascularisation). On the 14th day from the begining of treatment patients with corneal infiltrate and erosion area less than 50% apperared in both groups. C. albicans didn’t identified in inflammatory focus in main group in a month. After 3 months: proportion of patients with infiltrate area less than 50% was 72.2% in main group, while in control group only 35,3%; proportion of patients with erosion area less than 50% was 89,6% in main group, while in control group only 53,1%.

Conclusions:

PDT with 0.1% MB is an effective treatment of fungal (C. albicans) keratitis. This is confirmed by experimental and clinical studies. PDT requires further studies in treatment of fungal inflammatory eye diseases.

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