Volume 02 Issue 11-2022
36
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
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ABSTRACT
60 patients (90 eyes) with a burn of the eyes of I and II degree of severity of various etiologies were examined. In the
control group of patients, traditional treatment was carried out, for patients of the main group, in addition to the
above treatment, photodynamic therapy was carried out. The level of protein, malondialdehyde, and catalase activity
were determined in the lacrimal fluid. The use of photodynamic therapy in the complex treatment of patients with
eye burns activates catalase and reduces the high level of malondialdehyde, especially with II degree burns, reduces
the degree of endogenous intoxication and helps to accelerate the reparative processes of post-burn damage.
KEYWORDS
Acid burn, alkaline burn, chemical burn of the eye, malondialdehyde, catalase, anterior surface of the eye
INTRODUCTION
In diseases of the anterior segment of the eye, an
ophthalmologist has a large selection of treatment
methods. However, with the development of new
techniques and modern methods of treatment, in the
last decade, the study of laser therapy has become of
great importance.
Research Article
USE OF PHOTODYNAMIC THERAPY IN CHEMICAL BURNS OF DIFFERENT
ETIOLOGIES OF THE SURFACE OF THE EYE
Submission Date:
November 01, 2022,
Accepted Date:
November 08, 2022,
Published Date:
November 18, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue11-07
Oralov Behruz Abdukarimovich
PHD, Assistant Of The Department Of Ophthalmology, Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 02 Issue 11-2022
37
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
02
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SSUE
11
P
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:
36-41
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(2021:
5.
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(2022:
5.
893
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OCLC
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1121105677
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IF
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5.654
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In medical practice, in all branches of medicine, lasers
of the red and infrared radiation spectrum have mainly
found application.
Lasers with a wavelength in the range of 0.61-
0.69 μm
of the red spectrum are used to influence the mucous
membranes, nearby skin and tissues, since the
penetration depth reaches 2 cm [5].
The red spectrum can cause both antioxidant and
prooxidant effects in the form of the formation of
singlet oxygen. Significantly facilitates the non-invasive
use of the red spectrum, the high transparency of
biological tissues for it relative to other wavelengths of
the optical range. In human tissues, photoacceptors of
the red spectrum are molecules of deoxyribonucleic
acid, the maximum absorption of which occurs at a
wavelength of 0.620 nanometers (nm), cytochrome
oxidase - 0.600 nm, cytochrome - 0.632 nm, superoxide
dismutase - 0.630 nm and catalase at a wavelength of
0.628 nm [7].
To influence deep tissues and organs, laser radiation of
0.8-0.95 microns in the infrared range is universal. The
infrared spectrum penetrates into biological tissues to
a depth of 6-7 cm, the energy of its quantum is not
enough to influence biochemical processes, and its
initial effect is a thermal effect [9].
The clinical effects of the infrared spectrum are
manifested in improving blood microcirculation,
reducing the intensity of pain. The disadvantage of this
spectrum lies in the energy of its quanta, which is 1 eV.
When biochemical processes in biological tissues have
an energy of about 2 eV [4], near-infrared radiation is
absorbed mainly by nucleic acid molecules at a
wavelength of 0.820 nm, and most importantly, both
radiation spectra are also absorbed by oxygen [2,3,8].
All of the above factors in the form of DNA and
enzymes are the basis for the further proper
functioning of structures in various lesions. But a
considerable controversy arose around the red
spectrum of radiation in the application of certain
ophthalmopathologies. There have been numerous
studies devoted to this wavelength.
Purpose of the work. Improving the complex
treatment of eye burns using photodynamic therapy.
Research
methods.
On
the
basis
of
the
multidisciplinary clinic of the Tashkent Medical
Academy, together with the emergency ophthalmic
microsurgical department of the Clinical Emergency
Hospital, 60 patients (90 eyes) with eye burns of I and
II degrees of severity of various etiologies were
examined. I degree burns were detected in 57 eyes, II
degree burns - in 33 eyes.
Depending on the treatment, the patients were
divided into two groups. Depending on the severity of
the burn injury and clinical and functional
manifestations, the groups were homogeneous.
In the control group, 30 patients (45 eyes) underwent
traditional
treatment,
including
tetracycline
derivatives on an ointment basis (3 times a day),
instilled M-anticholinergics in the form of 1%
tropicamide (2 drops 2 times a day), 20% corneregel gel
( 1 drop 3 times a day), antihistamines 1 tablet 1 time a
day, vitamin B complex 2.0 ml IM. In addition to the
above treatment, 30 patients (45 eyes) of the main
group underwent photodynamic therapy (PDT) at a
dose of 300 mJ (630 nm), exposure for 3 minutes, for 7
days on domestic-made equipment - the Vostok laser
therapy device with a specially created ophthalmic
nozzle with a diameter of 3 cm, repeating the
horizontal anatomical section of the human eye. A 1%
aqueous solution of methylene blue was used as a
Volume 02 Issue 11-2022
38
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
02
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(2022:
5.
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Publisher:
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photosensitizer, which was instilled immediately
before laser irradiation, 1 drop into the conjunctival
cavity. In many cases, the process was two-sided,
therefore, in the future, when describing the results
obtained, data on the number of eyes will be given.
The duration of the disease averaged 8±2 days, the
average age of patients was 49±28 years.
In the course of treatment, safety measures were
taken into account, since the domestic device belongs
to class 1 in terms of the safety of laser radiation
according to the
“international sanitary standards and
rules for the operation of lasers” and in terms of
electrical safety class 2 with a degree of protection BF.
The treatment was carried out in accordance with the
Law of the Republic of Uzbekistan “On the protection
of
the health of citizens” and according to the ethical
principles of the Helsinki Declaration (2013).
As a rule, PDT was carried out on the periphery of the
pathological focus with the obligatory capture of
healthy tissues, remotely at a distance of 1-3 cm from
the surface, moving the defocused beam, that is,
scanning it over the irradiated surface. The laser
therapy procedure was carried out between 9 and 12
hours on the recommendation of a number of authors.
Treatment was carried out for 7-10 days depending on
the severity of the lesion. The procedures were carried
out in the morning 1 time per day, daily or every other
day. The total number was 5 sessions. After the
procedure, patients were allowed to rest for 30
minutes.
The degree of burn damage to the cornea and limbus
was controlled biomicroscopically (classification by
V.A. Puchkovskaya 2002), while the ocular surface was
stained with 1% sodium fluorescein solution, assessing
the uniformity and depth of burn damage according to
the recommendations of the National Eye Institute
(NEI/Industry Workshop on Clinical Trials in dry eyes)
[1].
The levels of protein, malondialdehyde (MDA), and
catalase activity were determined in the lacrimal fluid
(LF). From the affected eye of patients, SF was taken
with a cannula from the lacrimal lake, stimulated (0.15
ml) by inhalation of vapors of 10% ammonia, following
the required rules according to the method of N.A.
Terekhina before and after treatment. The resulting
tear fluid was placed in a centrifuge tube and
centrifuged at 1500 rpm for 5 minutes [9].
The Statistica 10.0 program was used for static data
processing.
Research results. When studying the effect of
traditional therapy and PDT in groups of patients, the
data of SG were compared. Our data indicate a
decrease
in
the
production
of
acute-phase
inflammatory proteins and the effectiveness of
ongoing therapeutic measures, especially during PDT
(Table 1.)
Table 1
MDA content and catalase activity in lacrimal fluid of patients with eye burns during treatment (M±m)
Volume 02 Issue 11-2022
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(ISSN
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VOLUME
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P
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(2021:
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(2022:
5.
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IF
–
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MDA content (nmol/ml)
Catalase activity (µmolH2O2/min mg protein)
Groups
Control group
Main group
Control group
Main group
I degree burns
Before treatment
2,61±0,05***
2,63±0,08***
0,14±0,005*
0,144±0,006*
After treatment
2,05±0,06*^^^
1,85±0,06^^^
0,16±0,006^
0,21±0,011^^^
II degree burns
Before treatment
4,70±0,14***
4,74±0,17***
0,085±0,01***
0,087±0,004***
After treatment
2,65±0,05***^^^
2,09±0,065*^^^
0,166±0,01
0,21±0,012^^^
Note:
* - differences relative to the data of the healthy group are significant (* -
p<0.05, *** - p<0.001), ^ - differences relative to the data of the group after
treatment are significant (^^^ - p<0.05)
Conducted basic therapy for burns of II degrees and I
leads to adequate activation of catalase in the SF by 1.13
and 1.89 times, and their approximation to the values
of practically healthy individuals. This led to a decrease
in the level of MDA in the SF by 1.24 and 1.64 times
relative to the values before treatment. Despite such
positive changes, the intensification of lipid
peroxidation persisted, since the values of the MDA
level were still statistically significantly higher than the
values of practically healthy individuals by 1.14 and 1.55
times, respectively, in groups of patients with burns of
II degrees, and I which indicates preservation of
destructive processes in the eye. PDT in patients with
eye burns led to a more pronounced activation of
catalase: an increase of 1.41 and 1.19 times in patients
with I degree burns, 2.32 and 1.22 times in the
treatment of II degree burns, respectively, the initial
parameters and relative to the values of patients
receiving basic treatment. In both groups, the activity
of the enzyme even slightly exceeded that of
practically healthy individuals. Such activation of
catalase in the SF contributed to a more pronounced
neutralization of peroxide radicals, which was
manifested by a decrease in the level of MDA after PDT
by 1.39 and 2.21 times, respectively, in groups of
patients with burns of I and II degrees, respectively, of
the initial parameters. It should be said that these
values were 1.09 and 1.30 times lower than those of the
groups of patients who received basic treatment,
respectively, for the above pathologies. It should be
said that if the level of MDA in the SF approached the
values of practically healthy individuals in patients with
first degree burns, then in the group of patients with
second degree burns it remained 1.16 times higher than
the norm.
CONCLUSIONS
Chemical burns of the eye, regardless of etiology, are
serious injuries that affect the patient's quality of life.
Volume 02 Issue 11-2022
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Such serious cases require urgent medical assistance.
Due to untimely and unqualified help, the patient often
becomes
disabled.
Effective
treatment
or
management of the disease makes it possible to
prevent negative complications and consequences and
to develop comprehensive measures. The most
important point is that washing the eye surface is
important in case of chemical eye burns. Many foreign
authors believe that washing is the best early measure
to prevent the corrosion process from spreading to the
eye
and
the
subsequent
development
of
complications, to eliminate inflammatory proteins. It
was recommend in all official standards worldwide
(ANSI
standards
in
Germany
and
Berufsgenossenschaften recommendations) for first
aid for eye burns.
In the lacrimal fluid of patients with eye burns, the level
of malondialdehyde increases, against the background
of a decrease in catalase activity and an imbalance in
the lipid peroxidation/antioxidant blood protection
system, especially in patients with II degree burns. The
use of photodynamic therapy in the complex
treatment of patients with eye burns activates catalase
and reduces the high level of malondialdehyde,
especially with II degree burns, reduces the degree of
endogenous intoxication and accelerates the
reparative processes of post-burn lesions.
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