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

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Саидов T., Янгиева N., Хамидуллаев F., & Низомов O. (2021). The Results of the Usage of Electro Stimulation in Neuroprotective Therapy of the Glaucomatous Optic Neuropathy. in Library, 21(1), 4198–4203. извлечено от https://inlibrary.uz/index.php/archive/article/view/13876
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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.

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203
Received 16 February 2021; Accepted 08 March 2021.

4198

http://annalsofrscb.ro

The Results of the Usage of Electro Stimulation in Neuroprotective

Therapy of the Glaucomatous Optic Neuropathy

Saidov T.T

1

., Yangieva N.R

2

., Khamidullaev F.F

3

., Nizomov O.A

4

.

1

Samarkand State Medical Institute, Uzbekistan

2

Tashkent State Dental Institute, Uzbekistan

3

Samarkand State Medical Institute, Uzbekistan

4

Samarkand State Medical Institute Uzbekistan

Email: temur.saidov.90@mail.ru

Annotation.

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.


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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203
Received 16 February 2021; Accepted 08 March 2021.

4199

http://annalsofrscb.ro

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 div
[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 in clinical medicine is the usage of a new groups of drugs -
biogenic peptides such as cortexin, retinylamine, as well as extract of Gingko Bilabo 761 (
tanakan), that possesses especially antioxidant, antiexititoxic, blocking calcium channel and
neurotropic influence. In complex neuroprotective treatment of glaucoma associate with
extract of Gingko Bilabo Egb 761 is recommended the usage of preparations such as
picamilon, emoxipin, histochrome. These days, considering delayed, cumulative effect of
extract of Gingko Bilabo Egb 761 that is achieved during prolonged systematic usage, it is
advisable to increase effectiveness because of targeted delivery with a help of endonasal
electrophoresis[5].
The works of the last years demonstrate positive prolonged effect of electrostimulation in
treatment of glaucomatous optic neuropathy. Improvement of visual function is based on both


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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203
Received 16 February 2021; Accepted 08 March 2021.

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restoration of the conductivity of visual functions and disinhibition of the early differentiated
visual cortex and restoration activated and regulated of it on the functioning the whole visual
system. Electrostimulation restores conductivity of the nerve fibers, improves blood supply of
affected nerves, has an antiparabiotic effect on the nerve fibers that contributes to the
normalization of the electro excitability of the damaged nerve[2,3]. Consequently, the
method based on combined effect of galvanic current and pharmaceutical substance on the
one hand and electrostimulation on the other hand presence a great interest in
neurodegenerative process of the posterior segment of the eye and is considered to be
indispensable chain to work out reasonable complex and more effective neuroprotection.

Aim

To assess the effectiveness of electrostimulation in complex neuroprotective treatment

of the glaucomatous optic neuropathy

MATERIALS AND METHODS

Materials

The study was carried out in clinic Sam MI in eye diseases department associate

with Samarkand regional specialized eye hospital and private clinic « Sphere» . 50 (90 eyes)
patients 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 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.

Methods of the examination

All patients were carried out: visometry, ophthalmoscopy,

biomicroscopy, computer perimeter, optical coherence tomography «Cirrus HD-OCT 4000»
before treatment, after 1 and 3 month. Topographical findings of the head of optic nerve (the
degree of pathological excavation) and the thickness of the nerve fiber layer ( in the four
quadrants and meridians) were assessed with OCT. The results of scanning were
demonstrated with parameters such as square of the optic nerve and neuro-retinal rim, the
volume of excavation, different correlation ( correlation of the excavation square to square of
optic nerve) and others. As other methods, in OCT is also carried out comparison results of a
determined patients with similar parameters in a healthy population with purpose of
monitoring in dynamic of glaucomatous optic neuropathy.
Analyzer of the Humphrеy visual field is considered to be ― gold standard‖ of the automated
computer perimeter all over the world. A number of criteria enabling to analyze dynamics of
the glaucomatous process was used to assess progression of the visual field defects. The
usage of the given findings are considered to be perspective for assessment of
neuroprotective therapy. Statistical processing of materials was carried out using software
Statistica for Windows.



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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203
Received 16 February 2021; Accepted 08 March 2021.

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RESULTS AND DISCUSSIONS

The results of statistical analysis demonstrated overall decrease of the symptoms
accompanied with glaucomatous optic neuropathy after usage of percutaneous
electrostimulation in combination with endonal electrophoresis. Thus a stabilization of visual
function was reached ( visual acuity, visual field, a subjective perception of dryness and
burning in the eyes had a tendency to decrease, according to findings of accomodametry,
visual fatigue was decreased) (table 1-3)

Table №1

Dynamics of the visual acuity indications in patients with glaucomatous optic neuropathy of
the both groups in a variety periods of the observation (М±m)

Observation

of

groups

Period of observation

Before treatment

After treatment

After 3 month

Control group

0,06 ± 0,02

0,07 ± 0,01

0,09 ± 0,01*

Study group

0,07 ± 0,01

0,09 ± 0,01

0,2± 0,04*

Note: *p<0,05 — compare to initial indications

Table № 2

Dynamics of the borders of the average visual fields in patients with glaucomatous optic
neuropathy of the both groups in a variety periods of the observation (М±m)

Observation

of

groups

Period of observation

Before treatment

After treatment

After 3 month

Control group

265◦ ± 25◦.

285◦ ± 35◦.

310±20

Study group

268◦ ± 28◦.

0,09 ± 0,01

385 ± 20*

Note: *p<0,05 — compare to initial indications

Table № 3

Observation of groups

Period of observation

Before treatment

After treatment

After 3 month

Control
group

МD

10,48± 2,45dB

9,43± 2,35dB

8,68± 2,15dB

PSD

12,67± 3,35dB

11,57± 3,12dB

10,67± 3,32dB

Study group

МD

10,12± 2,15dB

8,23± 2,55dB

5,53± 1,65dB*

PSD

11,97± 3,11dB

9,54± 3,10dB

8,67± 2,42dB*

Note: *p<0,05 — compare to initial indications


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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203
Received 16 February 2021; Accepted 08 March 2021.

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As could be glanced from the table chart, The average visual acuity of patients in two groups
before treatment was 0,06 ± 0,02. In the control group of patients on the third months of
research visual acuity improved to 0,09 ± 0,01, that was 1,5 times higher than the initial
number. In the main group figures for visual acuity increased to 0,2± 0,04 that was 3,33 times
higher than the initial number. The average visual field of patients before treatment in two
groups was 265◦ ± 25◦. In control group on the 3 months visual fields increased up to
310±20 that was 1,16 times higher than initial number, in the main group this index was 1,43
times higher than initial number and made up almost 385 ± 20◦ (p<0.05). Results of
computer perimeter on the apparatus Humphrey by the method SAP according to 30-2
program demonstrate a considerable decrease of the integral index of the mean deviation of
the level of light sensitivity in visual field out of age norm (MD). In addition to quantity and
degree of the local changes (PSD) that vary within – 10,48± 2,45dB и 12,67± 3,35dB before
therapy in both groups and decreased to - 8,68± 2,15dB и 10,67± 3,32dB in control group
and 5,53± 1,65dB и 8,67± 2,42dB in main one respectively that showed improvement
within 1,2 times from initial indicator in both integral indexes that was confirmed in reliable
coefficients where points below 5% became reliablely lower than points with level of 1% in
control group. While in the main group both indexes improves on 1,9 and 1,46 times
respectively that was confirmed by steady decrease of the both points of reliability coefficient
with level 5% and 1%. It should be noted that index PSD was tend to lose its informativeness
at patients with III stage of the primary open angle glaucoma, however this indicators had
low statistic importance. Ratio of the dynamics Ex/D and the square of neuroretinal rim
(NRR mm

2

) according to the findings of OCT in the main group before treatment was

0,55±0,06 and 0,74±0,07(p <0.05), after treatment given indicators were within 0,48±0,04
and 0,84±0,04 (p <0.05) respectively, indicator of the average thickness of peripapillary layer
of retinal nerve fiber ( RNFL µm) in the main group before treatment was 82,97±4,4 after
treatment this index was equal to 97,5±3,8.

CONCLUSION

According to our results, inclusion of endonasal electrophoresis with tanakan following with
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
electrostimulation has sufficient comfort, cost-effectiveness, fast and stable positive effect
and can be used in both inpatient and outpatient condition

REFERENCE:

[1]

Bakhritdinova F.A., Agzamov S.S., Karimov U.R. Early results of neuroprotective
treatment of primary open angle glaucoma. III Common national Russian
ophthalmologic forum. Collection of works of scientific and practical conference with
international participation dedicated to 110- year anniversary of Helmholtz Moscow
Research Institute of Eye Diseases. – 2010. – vol.1

[2]

Bakutin I.V., Bakutin V.V., Kirichuk V.F. and others. Clinical and experimental
research of the influence of dynamic electroneurostimulation on the eye hydrodynamics


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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 3, 2021, Pages. 4198 - 4203
Received 16 February 2021; Accepted 08 March 2021.

4203

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// Materials of the 14-th international scientific school regarding optics, laser physics
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[3]

Bakutin I.V., Bakutin V.V., Kirichuk V.F. and others. Influence of dynamic
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XVIII Russian national congress: collection of materials. – M., 2010. – C 40

[4]

Kurisheva N.I. Neuroprotection and neurodegeneration: perspective in treatment of
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[5]

Robert,N. Glaucoma neuroprotection: What is it? Why is it needed? // Can. J.
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[6]

Tayebati S.K., Di Tullio M.A., Tomassoni D., Amenta F. Neuroprotective effect of
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[7]

Chung H.S., Harris A., Evans D.W., Kagemann L., Garzozi H.J., Martin B. Vascular
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[8]

Mozaffarieh M, Grieshaber M.C., Flammer J. Oxygen and blood flow: players in the
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Yucel YH, Zhang Q, Weinreb RN, Kaufman PL, Gupta N. Atrophy of relay neurons in
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42(13).-p. 3216–3222









Библиографические ссылки

Bakhritdinova F.A., Agzamov S.S., Karimov U.R. Early results of neuroprotective treatment of primary open angle glaucoma. Ill Common national Russian ophthalmologic forum. Collection of works of scientific and practical conference with international participation dedicated to 110- year anniversary of Helmholtz Moscow Research Institute of Eye Diseases. - 2010. - vol. 1

Bakutin I.V., Bakutin V.V., Kirichuk V.F. and others. Clinical and experimental research of the influence of dynamic electroneurostimulation on the eye hydrodynamics // Materials of the 14-th international scientific school regarding optics, laser physics and bio phonetics. - Saratov: Noviy veter, 2010. - page 63-67

Bakutin I.V., Bakutin V.V., Kirichuk V.F. and others. Influence of dynamic electrostimulation on the function of the human ciliary body. // Human and pharmacy. XVIII Russian national congress: collection of materials. - M„ 2010. - C 40

Kurisheva N.I. Neuroprotection and neurodegeneration: perspective in treatment of glaucoma. M. - 2014. VoL3. - page 16-17.

Robert,N. Glaucoma ncuroprotcction: What is it? Why is it needed? // Can. J. Ophthalmol.- 2007,- v. 42

Tayebati S.K., Di Tullio M.A., Tomassoni D., Amenta F. Neuroprotective effect of treatment with galantamine and choline alphoscerate on brain microanatomy in spontaneously hypertensive rats.-2009.-v.283.- № 1 -2.-p. 187-194

Chung H.S., Harris A., Evans D.W., Kagemann L., Garzozi H.J., Martin B. Vascular aspects in the pathophysiology of glaucomatous optic neuropathy// Surv-Ophthalmol.-1999,-т.43.- c.43-50.

Mozaffarieh M, Grieshaber M.C., Flammer J. Oxygen and blood flow: players in the pathogenesis of glaucoma// Mol. Vis.-2008.-v. 14.-p. 224-233.

Yucel YH, Zhang Q, Weinreb RN, Kaufman PL, Gupta N. Atrophy of relay neurons in magno- and parvocellular layers in the lateral geniculate nucleus in experimental glaucoma// Invest. Ophthalmol. Vis. Sci.-2001.-v. 42(13).-p. 3216-3222

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