Nedzvetska O. V.1, Javtushenko L. A.2, Chumak S. O.3, Kuzmina de Gutarra O. V.2, Turchina S. I.3, Vorontsova N. M.1
1Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine 2Girshman City Clinical Hospital No 14, Kharkiv, Ukraine 3Institute for Children and Adolescents Health Care at the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
Abstract Progression of diabetic retinopathy is associated with a large number of risk factors, and hyperlipidemia is one of the most common. The work is focused on peculiarities of the progression of juvenile diabetic retinopathy (JDR), depending on the presence of concomitant distyroidism in patients with juvenile diabetes mellitus (JDM), the state of lipid metabolism and melatonin production. The aim. To determine the features of the JDR progression depending on the type of concomitant dysthyroidism, the state of lipid metabolism and production of the hormone melatonin. Materials and methods. The examination of three groups of patients was carried out: group 1 (152 patients) included patients in whom JDM proceeded without thyropathy; group 2 (99 patients) included patients with JDM in combination with autoimmune thyroiditis (AIT); group 3 (111 patients) included patients in whom JDM was accompanied by an increased level of thyroid-stimulating hormone (TSH). Results. It was found that the frequency of proliferative diabetic retinopathy (PDR) in the group with JCD and elevated TSH (21.6%) was 2.7 times higher than the frequency of PDR in the group with JDM and AIT (8.1%) and 3.7 times exceeded the frequency of PDD in JDM without distyroidism (5.9%). The greatest violations of all links of lipid metabolism were found in patients with JDM with an increased level of TSH, which contributes to a more pronounced progression of JDR than in patients without thyropathy or concomitant AIT. The average daily excretion of the hormone melatonin (M) among the studied groups was the lowest in patients with PDD with JCD in combination with increased TSH (38.4 ± 2.7 nmol/day) compared with patients with PDD with JCD without thyropathy (48.3 ± 3.8 nmol/day; p <0.01) and with AIT (42.5 ± 5.6 nmol/day; p <0.01), and compared with the control indicator (52.7 ± 5.8 nmol/day; p <0.001). Conclusions. Based on the results obtained it can be concluded that the combination of type 1 JDM with elevated TSH is accompanied by significant disorders of lipid metabolism and melatonin production and this is a risk factor for accelerated progression of JDR.
The Filatov Institute of Eye Diseases and Tissue Therapy of National Academy of Medical Sciences of Ukraine, Odesa, Ukraine
Abstract Post-vitrectomy vitreous hemorrhage in patients with proliferative diabetic retinopathy (PDR) occurs in up to 75% of cases, and this highlights the need to search for new treatment options. The aim. To analyze the results of anti-VEGF therapy in the treatment of post-vitrectomy vitreous hemorrhage in patients with PDR. Materials and methods. Seventy-eight patients (78 eyes) were examined. Twenty patients (20 eyes) of the control group underwent outpatient fluid gas exchange (OFGE) with a 20% gas-air mixture of perfluoropropane for the treatment of post-vitrectomy vitreous hemorrhage. The first main group included 28 patients in whom OFGE with the same mixture was supplemented by the injection of Lucentis at a dose of 0.5 mg into the vitreous cavity. The second main group included 30 patients who achieved Eylea at a dose of 2 mg in addition to the OFGE. Results. Within 2 months, no significant difference between groups in achieving vitreous transparency or in vitreous hemorrhage recurrence rate was found. After 6 months, the frequency of vitreous hemorrhage recurrence in the control group was significantly higher (χ2 = 4.27; p = 0.039) than that in the Lucentis group (9 eyes [45%] vs. 3 eyes [10.7%]). When using Eylea in the same period, the recurrence rate was 6.7% (2 eyes) which is significantly lower than 45% (9 eyes) in the control group (χ2 = 4.59; p = 0.032). Conclusions. The effectiveness of treatment of post-vitrectomy vitreous hemorrhage by OFGE with 20% gas-air mixture of perfluoropropane within 6 months of observation is 85.5%. The use of Lucentis increases the effectiveness to 92.8% with a recurrence rate of 10.7%, and the use of Eylea to 96.6% with a recurrence rate of 6.7%. There are no significant differences between the use of Lucentis and Eylea.
Donetsk National Medical University, Liman, Ukraine
Abstract AbstractCommon mechanisms of pathogenesis of diabetic retinopathy (DR) with type 2 diabetes mellitus (DM2) and glaucoma optic neuropathy (GON) with primary open-angle glaucoma (POAG) involve the possibility of their mutual clinical burden. The aim. To explore the features of the combination of DR in DM2 and POAG in terms of progression of the stages of the pathological process. Material and methods. 546 patients were examined (546 eyes): 301 patients (301 eyes) had DM2 and POAG; 164 patients (164 eyes) had DM2 and DR, but did not have POAG; 81 patients (81 eyes) had POAG, but did not have DM2. The DR stage was established according to the American Academy of Ophthalmology classification (2002); POAG stage was determined according to the classification of perimetric changes. Some patients were diagnosed with normal tension glaucoma (NTG; 72 eyes). The DR and GON progression indices in patients with POAG were calculated on the basis of the stage and the duration of the diseases and the patients’ age. The software used for statistical research: MedStat і MedCalc v.15.1 (MedCalc Software bvba). Results. The DR progression (by the ratio of the DR stage to the duration of the DM2) at various combinations with POAG had no significant differences. It increased only when NTG was combined with DM2. GON progression was higher when POAG was combined with DM2. In case of DM2 combined with POAG, the progression of GON was as follows. In the case of its primary development, it was higher in NTG, and when it was connected to DM2 – in POAG. The disease index (the ratio of the primary disease rate to age) was the highest when DM2 was combined with POAG, which made the progression of GON 1.2 times faster (p=0.001). The duration of comorbidity in the POAG + DM2 group was 3-4 years more than in DM2 + POAG and NTG + DM2 groups (p<0.001). No gender differences in the DR and GON progression were found. Conclusions. The studied characteristic of the combination of DR with DM2 and POAG revealed complex and ambiguous mechanism of their possible interaction, which dictates the need for further investigation of the mechanisms of their comorbidity.