The effectiveness of complex treatment of endothelial dysfunction in patients with primary open angle glaucoma

Abstract

Currently, endothelial vascular dysfunction, leading to ischemia of the optic disc and compression of the optic nerve axons, is considered to be one of the main mechanisms underlying the development of primary open-angle glaucoma (POAG). Purpose: to assess the severity of endothelial dysfunction (ED) in patients with different stages of POAG receiving complex therapy. Material and methods. 94 POAG patients were divided into three groups depending on the type of treatment. Group 1 (29 patients, control) received traditional therapy: 1 % emoxypine parabular injections, 5 % pyridoxine hydrochloride and 5 % ascorbic acid intramuscularly, and piracetam tablets. Group 2 (34 patients) additionally received combined therapy: Clexan 4000 iu, 0.5 mg lymphotropically and Omega-3 capsules. Group 3 (31 patients) received, in addition to traditional therapy, Clexan 4000 iu, 0.5 mg lymphotropically, intravenous injections of 10 ml Cytoflavin dissolved in 200 ml of 5 % glucose solution (later to be replaced by tablets), and 1 capsule of Omega-3 three times a day for one month. Before and after the course of treatment, levels of endothelin-1, VEGF and Willebrand factor in blood serum were measured by immunoenzymatic assays using Human test systems (Germany). Results. Traditional treatment of the patients’ cohort provides an insignificant reduction of endothelin-1 but does not affect endothelial dysfunction. Complex therapy with the addition of Clexan and Omega-3 helped reduce the amount of endothelin-1 and the Willebrand factor. The most pronounced changes were observed when cytoflavin was added: from 42.9 ± 3.4 ng/ml to 34.9 ± 2.9 ng/ml and from 50.8 ± 4.7 ng/ml to 32.1 ± 2.4 ng/ml, respectively (p < 0.05). Conclusion. An increased level of endothelin-1 and Willebrand factor, as well as a low VEGF level in POAG patients indicate the role of these pathogenetic factors in the formation of endothelial dysfunction. The correction of ED marker levels in patients with different POAG stages using the proposed compound therapy confirm its effectiveness.

Keywords

• primary open-angle glaucoma
• endothelin-1
• endothelial markers
• complex therapy