Офтальмохирургия (Dec 2015)
Clinically pathogenetic and prognostic value of factors of diabetic retinopathy progression associated with essential hypertension after phacoemulsification
Abstract
Purpose. To study clinical features of ophthalmic and laboratory changes after cataract phacoemulsification in patients with diabetic retinopathy associated with hypertension.Material and methods. It was selected 130 patients with the diagnosis of complicated cataract, non-proliferative diabetic retinopathy and they were divided into 3 groups: the group I – patients with non-proliferative diabetic retinopathy without hypertensive disease, the group II – patients with non-proliferative diabetic retinopathy and hypertension, who took angiotensin-converting enzyme (ACE) inhibitors, the group III – patients who took other antihypertensive drugs (a1-adrenoblockers and agonists I1-imidazoline receptors). The study included clinical and functional examinations: visometry, tonometry, refractometery, perimetry, bio-microscopy and direct ophthalmoscopy, optical coherence tomography, autofluorescence, UBM. Samples of lacrimal fluid and blood serum were collected. Clinical and laboratory parameters of homeostasis: endothelial factors, cytokines (IL-6, TGF-β, VEGF, PEDF), adhesion molecules: sICAM, sVCAM. All patients underwent micro-invasive cataract phacoemulsification with implantation of Acrysof Natural IOL (Alcon).Results. Based on the obtained results the stability of proand anti-angiogenic balance after phacoemulsification was determined in patients with diabetic retinopathy without hypertension. Opposite changes of proangiogenic potential were noted in the group of patients with diabetic retinopathy and hypertension after phacoemulsification. The group of patients with diabetic retinopathy and hypertension, who took angiotensin-converting enzyme inhibitors in the postoperative period showed an insignificant change of immune-bio-chemical indices early stabilized on the 3rd day, which allowed us to predict a favorable course of diabetic retinopathy. It is possible to ascertain a growth of pro-angiogenic potential and endothelial dysfunction by the nature of the changes in the balance of the studied parameters and to predict an aggravation of vascular changes in the group of patients with diabetic retinopathy and hypertensive disease, who received othergroups of drugs. All laboratory identified patterns were confirmed in the parallel dynamic ophthalmic studies which demonstrated a higher incidence of vascular disorders after phacoemulsification in patients with diabetic retinopathy and hypertension who were not treated with ACE inhibitors. Accordingly, a stable course of the disease clinically was observed in the group of patients treated with ACE inhibitors to normalize vascular hypertension. Conclusion. The performed evaluation of vascular changes factors after phacoemulsification and the effect of antihypertensive drugs on the balance of laboratory parameters in patients with diabetic retinopathy and hypertensive disease allowed to determine a beneficial effect of ACE inhibitors on the stability of the angiogenic potential. It can be assumed that a basis of the described picture is in pharmacological properties of ACE inhibitors which have a positive effect on the stabilization of the angiogenic potential and reduce endothelial dysfunction.
