Clinical And Functional Effectiveness Of Endonasal Electrophoresis In Combination With Electrostimulation In Complex Therapy Of Glaucomatous Optic Neuropathy

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Саидов T. ., Янгиева N., Хамидуллаев F., Назарова J., & Низомов O. (2021). Clinical And Functional Effectiveness Of Endonasal Electrophoresis In Combination With Electrostimulation In Complex Therapy Of Glaucomatous Optic Neuropathy. in Library, 21(1), 12–19. извлечено от https://inlibrary.uz/index.php/archive/article/view/13877
Темур Саидов, Самаркандский государственный медицинский институт

заведующий кафедрой офтальмологии ФПО

Нодира Янгиева, Ташкентский государственный стоматологический институт

к.м.н., доцент кафедры офтальмологии с курсом гинекологии

Фирдавс Хамидуллаев, Самаркандский государственный медицинский институт

Ассистент курса офтальмологии, факультет последипломного образования, Самаркандская офтальмологическая больница, Узбекистан

Жанна Назарова, Ташкентский институт последипломного медицинского образования

доцент кафедры неврологии

Охун Низомов, Самаркандский государственный медицинский институт

Магистр 1 курса кафедры офтальмологии

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Аннотация

The  aim  of  the  study  was  the  clinical  and  functional  assessment  of  the  complex  treatment  of glaucomatous optic neuropathy with the administration of the drug tanakan in the form of endonasal electrophoresis in combination with electrical stimulation according to IST and ultrasound Doppler mapping. We examined 43 (74 eyes) patients with GON aged from 58 to 76 years. The results of the study showed that this method effectively delays the development of optic nerve atrophy and, along with the improvement of visual functions, lengthens the positive effect of the main treatment, which was confirmed by a significant improvement in hemodynamic parameters according to the ultrasound Doppler study.

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The USA Journals Volume 03 Issue 03-2021

12

The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

Published:

March 17, 2021 |

Pages:

12-19

Doi:

https://doi.org/10.37547/TAJMSPR/Volume03Issue03-02




















































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ABSTRACT

The aim of the study was the clinical and functional assessment of the complex treatment of
glaucomatous optic neuropathy with the administration of the drug tanakan in the form of endonasal
electrophoresis in combination with electrical stimulation according to IST and ultrasound Doppler
mapping. We examined 43 (74 eyes) patients with GON aged from 58 to 76 years. The results of the
study showed that this method effectively delays the development of optic nerve atrophy and, along
with the improvement of visual functions, lengthens the positive effect of the main treatment, which
was confirmed by a significant improvement in hemodynamic parameters according to the ultrasound
Doppler study.

KEYWORDS

Glaucoma optic neuropathy, retinoprotection, endonasal electrophoresis, electrical stimulation.

Clinical And Functional Effectiveness Of Endonasal
Electrophoresis In Combination With Electrostimulation In
Complex Therapy Of Glaucomatous Optic Neuropathy

Temur Saidov

Head Of The Department Of Ophthalmology, Faculty Of Postgraduate Education Samarkand
State Medical Institute, Uzbekistan


Nodira Yangieva

PhD, Associate Professor Department Of Ophthalmology With The Course Of Gynecology,
Tashkent State Dental Institute, Uzbekistan

Firdavs Khamidullaev

Assistant Of The Course Of Ophthalmology, Faculty Of Postgraduate Education Samarkand State
Medical Institute, Samarkand Eye Care Hospital, Uzbekistan

Janna Nazarova

Associate Professor, Department Of Neurology Tashkent Institute Of Postgraduate Medical
Education, Uzbekistan

Okhun Nizomov

1st Year Master's Of The Department Of Ophthalmology Samarkand State Medical Institute,
Uzbekistan

Journal

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Copyright:

Original

content from this work
may be used under the
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The USA Journals Volume 03 Issue 03-2021

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INTRODUCTION

Glaucoma is one of the most severe eye
pathologies, ranking third in the world among
the causes leading to irreversible blindness [10,
11, 1] . According to domestic authors in
Uzbekistan, the increase in the incidence of
primary glaucoma among the population over
40 reaches 1.5-2.5%. Open-angle glaucoma
occurs in 20.1% of cases, angle-closure
glaucoma (ACG) in 29.9% of cases. In our
Republic, according to D.M. Tuychibaeva
(2004), the proportion of disability due to
primary glaucoma is 14.8%, causing the second
place in the structure of all primary visual
disability.

In the recent past, the disease was considered
exclusively as a pathology of increased
intraocular pressure (IOP), but now it is quite
obvious that this is only one of many risk
factors, albeit a leading one. Numerous
scientific studies have shown that an effective
decrease in IOP cannot serve as a guarantee of
stabilization of the glaucoma process, which
continues to progress in some patients. The
main reason for the deterioration of visual
functions in patients with glaucoma, with
normalized and stable ophthalmotonus is
glaucomatous optic neuropathy (GON). This
has been confirmed in a number of large
multicenter studies devoted to the study of
glaucoma (Advanced Glaucoma Intervention
Study, Collaborative Normal Tension Glaucoma
Study,

Collaborative

Initial

Glaucoma

Treatment Study, early Manifest Glaucoma
Trail).

The absence of signs of stabilization of
neuropathy, against the background of
compensated ophthalmotonus, dictates the
need to search for new directions of drug
therapy aimed at improving the functional

state of the optic nerve and retina of the
glaucomatous eye [2,3].

The

most

promising

drugs

were

neuroprotectors from the cytomedin group -
cortexin and retinalamin. The neurotrophic
effect of retinalamin in patients with initial and
advanced stages of primary open-angle
glaucoma (POAG) is expressed in a significant
increase in the average thickness of retinal
nerve fibers. The results of a clinical study in
most patients demonstrated a positive
dynamics of peripheral vision according to the
indications of the threshold sensitivity of the
retina, a subjective increase in visual acuity, a
significant objective improvement in central
vision,

psychophysiological

and

electrophysiological

parameters

[5],

a

decrease in the number and depth of cattle in
areas characteristic of glaucoma [4], an
increase in the tolerance of the optic nerve to
increased stress. To correct microcirculation
disorders in the vessels of the optic nerve and
retina in glaucoma, attempts have been made
to use a complex drug treatment, including
vasodilators, anti-sclerotic drugs, agents that
improve microcirculation and tissue metabolic
processes [12]. The high efficiency of the herbal
preparation “Gingkobiloba” has been proven,
which affects metabolic processes in cells,
rheological properties of blood, vasomotor
reactions of blood vessels, and thus, increases
peripheral

and

retrobulbar

circulation,

improves visual fields in normotensive
glaucoma, traps free radicals, including nitric
oxide, and inhibits its production [6,13,14].
However, in tablet form, the drug has a delayed
cumulative effect, which is achieved only with
prolonged systematic use - from three to nine
months. In this connection, in recent years,
methods of drug administration using
physiotherapeutic procedures (endonasal,


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bath electrophoresis, phonophoresis, laser
electrophoresis),

which

enhance

the

penetration of drugs into the eye tissue, have
become

widespread.

Medicinal

electrophoresis

is

an

electropharmacotherapeutic method that
combines the effect of direct current on the
div and drugs administered with its help.

The method of endonasal electrophoresis was
chosen because it ensures the penetration of
the drug in the required amount through the
nasal mucosa. According to N.A. Borisova, R.M.
Khaziakhmetova, under the action of an
electric current, drugs with endonasal
administration penetrate the nasal mucosa,
moving perineurally and along the lymphatic
pathways, enter the tissues and fluids of the
eyeball. Thus, a pronounced and long-term
neurophysiological effect is provided due to
the creation of a kind of depot of the drug in
the structures of the eyeball [7, 15].

An important direction in the treatment of
GON was the development of electrical
stimulation of the peripheral part of the visual
analyzer,

in

particular,

transcutaneous

neuroelectrostimulation of the optic nerve,
carried out by the “ESOM” apparatus, the
principle of which is based on the phenomenon
of the appearance of electrical phosphene
when exposed to an electrical impulse [8].

Considering the above, it can be assumed that
one

of

the

important

points

of

neuroprotection is a decrease in the level of
cytotoxicity

in

the

intercellular

space

surrounding neurons, neutralization of toxic
substances or a decrease in sensitivity to them.
These requirements are met by peptide
bioregulators (Stavitskaya T.V. et al., 2004;
Khavinson V.Kh. et al., 2005). Since the
disturbance of ocular microcirculation is one of

the fundamental factors in the pathogenesis of
glaucomatous

optic

neuropathy,

the

correction of hemodynamic changes is most
effectively achieved with preparations based
on ginkobiloba extract. Given the delayed
cumulative effect, which is achieved with long-
term use of these drugs, methods of targeted
exposure such as subtenon administration and
endonasal electrophoresis solve this problem.
It should be noted that after cumulation of
these drugs in the posterior segment of the
eye, to increase their effectiveness and
improve neuronal impact not only between
cells, but also at different levels of the visual
system in the complex treatment of glaucoma
with severe optic neuropathy, it is rational to
use percutaneous electrical stimulation [9].
The method is based on a preliminary
diagnostic study of the electrical sensitivity
threshold and the critical fusion frequency of
phosphene scintillations (CFF).

PURPOSE OF THE STUDY

Clinical and functional assessment of the
effectiveness

of

complex

pharmaco-

physiotherapeutic treatment of patients with
glaucoma optic neuropathy.

MATERIAL AND RESEARCH METHODS

The studies were carried out in the SamMI
clinic in cooperation with the Samarkand
regional specialized eye hospital and the
private clinic “Alfa-Med”. We observed 43 (74
eyes) patients with GON aged 58 to 76 years, of
which 23 (53.4%) were women, 20 (46.5%) were
men, with an established diagnosis of POAG
stage II or III POAG in conditions of IOP
compensation (21.3 ± 3.2). IOP compensation
was achieved by medication, laser and surgical
methods. All patients were divided into two


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homogeneous groups depending on the stage
of POAG and the patient’s age. The control
group consisted of 20 (34 eyes) patients with
stage II, of whom there were 15 (27 eyes) and
stage III - 5 (7 eyes), who received traditional
therapy for 10 days, which includes the
following drugs: Sol. Mildronati 10% -5.0 I / O,
Tab. Nootropili 800 mg x 3 times, Sol.
Pyridoxinihydrohloridi 5% -2.0 w / m, Sol.
Emoxypini 1% -0.5 parabulbar, Sol.Taufoni 4% -
5.0 l / t, as well as a single subtenon injection of
Retinylamine at a dose of 5 mg. In the main
group, 23 (40 eyes) patients, the distribution of
which by stages was 13 (25 eyes) with stage II
and 10 (15 eyes) with stage III, respectively,
along with traditional therapy and subtenon
administration of Retinylamine, received
endonasal electrophoresis with Tanakan 1 time
per

day

and

percutaneous

electrical

stimulation using the ESOM apparatus, based
on the use of a rectangular negative pulse with
a duration of 1-10 ms, following with a
frequency of 5-30 Hz and an amplitude of 10-
1000 μA for 10 days. For each eyeball, 4-6 series
of 15-45 s were performed with an interval
between series of 30-60 s. All patients before
and after treatment, as well as 3 months after
the course of therapy, underwent clinical
studies:

visometry,

ophthalmoscopy,

ophthalmobiomicroscopy,

Maklakov

tonometry, tonography, gonioscopy, studies
of the peripheral visual field (computer static
perimetry on the Humphrey apparatus using
the SAP-30-2 protocol, laser scanning confocal
retinotomography of the optic nerve head
using the HRT-2 apparatus (Heidelberg
engineering GmbH, Germany). The study of
intraocular blood flow by the method of
ultrasound color Doppler mapping was carried
out on a multifunctional ultrasound system
SonoscapeC 50, while the spectral velocity
parameters of hemodynamics were assessed:

maximum systolic velocity (Vmax), end
diastolic velocity (Vmin) and peripheral
resistance index (Ri).

RESULTS AND DISCUSSION

The average visual acuity of the patients of the
two groups before treatment was 0.06 ± 0.02.
In patients of the control group, visual acuity
improved by 0.09 ± 0.01 by month 3 of the
study, which was 1.5 times higher than the
initial values. In the main group, visual acuity
increased to 0.2 ± 0.04, which was 3.33 times
more than the initial value. It should be noted
that the IOP of patients in both groups
throughout the study was within 21.3 ± 3.2,
which did not exceed the permissible tolerant
IOP. The results of computer perimetry
showed a significant decrease in the integral
indicator of the average deviation of the level
of photosensitivity in the visual field from the
age norm (MD), as well as the magnitude and
degree of local changes (PSD), which varied
between - 10.48 ± 2.45dB and 12.67 ± 3.35dB
before therapy in both groups and decreased
to - 8.68 ± 2.15dB and 10.67 ± 3.32dB in the
control group and 5.53 ± 1.65dB and 8.67 ±
2.42dB in the main, respectively, which showed
an improvement within 1.2 times from the
initial in both integral indices and which was
confirmed in the reliability coefficients, where
the points below the 5% level became
significantly less, than points with a level of 1%
in the control group. While in the main group,
both indicators improved by 1.9 and 1.46 times,
respectively, which was confirmed by a
uniform decrease in both points of the
coefficient of reliability with the level of 5% and
1%, it should be noted that the PSD indicator
lost its informative value in patients with stage
III POAG, however, these indicators were of
low statistical significance. According to the
OST observation, a significant difference was


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revealed in the studied groups of patients,
depending on the stage of POAG. Thus, in
patients with stage II POAG, a moderate
decrease in the area and volume of the
neuroretinal girdle and a moderate deficit of

nerve fibers were observed, while in the group
of patients with stage III of the process, these
changes were significantly pronounced.
Parameters of laser confocal tomography of
the optic nerve head are shown in Table 1.

Table 1

Average indices of laser confocal tomography in patients with GON

Параметры

томографии ДЗН

II stage POAG

28 (52 eyes) patients

III stage POAG

15 (22 eyes) patients

Neuroretinal girdle

area (mm2)

1,271±0,065*

0,972±0,062*

Neuroretinal girdle

volume (mm3)

0,245±0,054

0,113±0,083*

Thickness of the layer

of nerve fibers of the contour

line (mm)

0,135±0,090*

0,095±0,023*

* differences between groups of patients are significant, p <0.05

With ultrasound Doppler mapping of the CRA,
the initial level Vmax and Vmin, as well as the
index of resistance in both groups, were
determined, 10 days after the treatment in the
control group, these indicators increased by
1.32 and 1.14 times from the initial, and the
index of resistance tended to to a slight
increase and was equal to 0.74 ± 0.02. In the
main group of the study, the maximum

systolic and minimum diastolic blood flow
velocity on day 10 of observation significantly
increased by 1.72 and 1.23 times from the initial
values, and the resistance index reached 0.73 ±
0.02 (p≤ 0.05). The study of ocular
microcirculation in the CRA by the 3rd month in
patients of both groups showed a slight
decrease in all parameters, which had a low
statistical significance. Indicators of ultrasound
Doppler mapping of CRA are given in Table 2.


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Table 2

Dynamics of indicators of ultrasound Doppler mapping in patients with GON during

treatment

Terms of observation

CRA

Vmax (cm /

c)

Vmin(сm/с)

RI

Control group

Before treatment

11,92±2,03

4,13±1,12

0,65±0,02

After

treatment

After

10 days

15,73±1,67

4,72±1,51

0,74±0,02

3

months

14,15±1,53

4,31±1,32

0,71±0,02

Main group

Before treatment

12,14±2,12*

4,41±1,32

0,64±0,03

After

treatment

After

10 days

20,82±1,74

*

5,45±1,53

0,73±0,02

3

months

18,14±1,25

*

4,91±1,41

0,73±0,02

Note: * - significant in relation to this group before treatment (P≤0.05)

- reliable in relation to the data of the control group (P≤0.05)

Thus, a gradual increase in the deficit of blood
supply, corresponding to the progression of
the glaucomatous process, was revealed.
During the entire observation syndrome, the
patients of the main group showed a
significant improvement in hemodynamic
parameters, which correlated with visual acuity
and computer perimetry data.

CONCLUSION

The introduction of endonasal electrophoresis
with the Tanakan drug, followed by
transcutaneous electrical stimulation in the
complex treatment of GON, delays the
development of optic nerve atrophy and, along
with improving visual functions, lengthens the
positive effect of the main treatment, which
was confirmed in a significant improvement in
hemodynamic parameters according to the


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ultrasound Doppler study. The proposed
method of complex treatment will improve the
effectiveness of treatment of patients with
compensated open-angle glaucoma improve
the prognosis for vision and the quality of
rehabilitation measures.

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Библиографические ссылки

Libman E.S., Kaleeva E.V. The state and dynamics of disability due to visual impairment in Russia, Congress of ophthalmologists of Russia, 9th: abstracts. Report Moscow:, 2010.

Flammer D. Glaucoma // Glaucoma. World Wide Printing, 2003, — P-345

Kurysheva N.I. Glaucoma optic neuropathy, - Moscow: MED press-inform, 2006. - P.136.

Alekseev V.N., Kozlova N.V. The use of Retinalamin in patients with primary openangle glaucoma // Glaucoma. 2013. №1, P. 49-52.

Neroev V.V., Erichev V.P., Lovpache D.N. Peptides in neuroprotective therapy of patients with primary open-angle glaucoma with normal ophthalmotonus // Retinalamin. Neuroprotection in ophthalmology.2012. №6. P.37.

Basinsky S.P., Basinsky A.S. The effectiveness of complex therapy of patients with primary unstabilized openangle glaucoma with “normalized” ophthalmotonus // Clinical Ophthalmology. - 2015. - Tashkent: 6, №2. - P.62-64

Zakharov V.V., Yakhno N.N. The use of Tanakan in violation of cerebral and peripheral circulation // Russ. Medic, jurnal. - 2011. - Tashkent:.9 - P.6-8.

The effectiveness of percutaneous electrical stimulation in the treatment of patients with primary open-angle glaucoma I T.G. Kamenskikh, E.V. Veselova, Yu.A. Dubina Ц Modern technologies of the XXI century: Sat. scientific tr. - Saratov, 2009. - P. 53-54.

The effectiveness of percutaneous electrical stimulation in the treatment of patients with primary open-angle glaucoma I T.G. Kamenskikh, E.V. Veselova, Yu.A. Dubina // Russian National Forum. Sat. scientific tr. - Moscow:, 2008. - P. 487-489

Choplin N.T., Lundy D. C. Atlas of glaucoma, second edition. 2007.

Doshi V., Ying L.M., Azen S.P., Varma R. Sociodemographic, family history, and lifestyle risk factors for open-angle glaucoma and ocular hypertension. Ophthalmology, 2008; 11 s(i):639—647

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