DOI: https://doi.org/10.22141/2309-8147.5.1.2017.172577

OCULAR INFLAMMATORY DISEASE: MODERN DIAGNOSTICS AND TREATMENT

S. A. Rykov, I. V. Shargorodska, D. D. Gurska, A.A. Liemiemieva, N. S. Nikolayshuk, L. I. Vaduk, О. А. Belyaeva

Abstract


Summary. This study presents the analysis of modern diagnostic capabilities and treatment of ocular infl ammatory disease (OID). A total of 80 eyes (40 patients) with ”dry eye” syndrome (SDE), and allergic conjunctivitis were examined.
Depending on the scheme of tear substitute pathogenetically substantiated therapy, patients were divided into 3 groups. All patients underwent a comprehensive eye examination in dynamics, as well as analysis of the osmolarity of the tear fl uid, questioning the assessment of complaints, using 4-point scale and diagnostic tests (Schirmer’s test, Norn test, and fl uorescent LIPKOF test). The corneal and conjunctiva epithelium condition was evaluated by impression cytology (the standard method) using a millipore fi lter. To study the humoral immunity local content of immunoglobulins in tear was investigated.
The study results confi rm the dominant position of lipid layer of the tear fi lm damage in the pathogenesis of the syndrome of “dry eye” (SDE). The evaluation of the effectiveness of tear substitute remedies (EYE-t® Ectoin 0.5% and EYE-t® Ectoin 2.0% eye drops). It was revealed that: EYE-t® Ectoin 0.5% and EYE-t® Ectoin 2.0% reduced tear fi lm, increasing the hydration of the surface, stabilized the lipid layer of the tear fi lm and reduced the osmolarity of the tear fl uid. The drug EYE-t® Ectoin 2.0% improves cellular and humoral local immune system, stabilizes cell membranes and reduces the degree of infl ammation, stimulates reparative processes of the cornea and conjunctiva.
A direct strong correlation between Norn test, fl uorescein test and the eyes of patients of the fi rst, second and third groups (r=0,85, r=0,89, r=0,88, respectively, p<0.05) was revealed. LIPKOF test results showed: in the eyes of the fi rst, second and third groups before therapy there were 3.58; 3.91 and 3.81 points, and after 2 months of treatment – 1.8; 0.85 and 1.1 points, respectively (p<0.05). There was a high correlation between the level of osmolarity of the tear fl uid and the level of IOP in the eyes of all patients (r=0,89, p<0,05). The most signifi cant decrease in the osmolarity of the tear fl uid, correlated with IOP levels was observed in the third group of the eyes (ΔOsm = (–)13,7 mosm / L, r=0,88, p<0,05). In the eyes of the fi rst and the second groups a signifi cant decrease in the osmolarity of the tear fl uid in the course of the therapy was also noted, but to a lesser extent (ΔOsm = (–)11.4 and (–)12,2 mosm/L, respectively, p<0.05), which also correlated with the level of intraocular pressure (r=0,86, r=0,87; p<0.05). In the study of the local humoral immune the following was identifi ed: after the treatment the concentration of IgA and IgM in tear increased and averaged 3.7±0.29 g/l and 3.2±0.25 g/L, respectively (p<0.05). The concentration of lysozyme in tears on average increased to 3,9±0,22 g/l (p<0.05), the circulatory immune complex (CIC) in tears decreased to 2,31±0,03 g/l, respectively (p<0.01). Analyzing the results of fi ngerprint epithelium tarsal and bulbar conjunctiva in the third group of eyes before and after treatment the following was identifi ed: before treatment signs of severe squamous metaplasia (keratinization) of epithelial cells was shown, diffuse atrophy of the epithelial layer of cells with the expansion of intercellular spaces, the presence of infl ammatory cells, partial hyperplasia of goblet cells, the presence of eosinophils and mucus threads in the preparation. The number of epithelial cells per 100 cells was on average 98.3%; leukocytes was on average 1,7±0,2%, isolated eosinophils observed. After the treatment changes in cellular reactions of local immunity were revealed. Treatment contributed to the preservation of leukocyte infi ltration of the conjunctiva. The number of white blood cells in the epithelium prints of tarsal and bulbar conjunctiva increased (7,9±0,3%), and eosinophils decreased (p<0.001). Throughout the entire period of observation visual function remained stable in all patients.
Mandatory assessment of the state of the epithelium of the conjunctiva and cornea, the osmolarity of the tear fl uid factor in the treatment of patients with ocular infl ammatory disease (OID) is further needed.


Keywords


ocular infl ammatory disease, “dry eye” syndrome, osmolarity, impression cytology

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