Melatonin is a hormone of the epiphysis and a regulator of circadian rhythms of living organisms, which affects a number of important physiological processes. Melatonin synthesis has also been found in other organs, in particular in various structural systems of the eyeball. A number of studies demonstrate that melatonin plays an important role in a variety of biochemical and physiological processes that ensure functioning of visual analyzer. This review provides information on the synthesis of melatonin, its secretion and metabolism, considers key information about melatonin receptors (MT1, MT2 and MT3), their localization in various eye’s structures, and their affinity to melatonin. Over the last years, researchers’ attention has been drawn to the therapeutic properties of melatonin, relevant for treatment of age-related diseases. The aggressive effects of solar radiation and environmental toxicants expose the organ of vision to oxidative attacks. A large amount of evidence has been accumulated of the participation of oxidative stress in the development of many eye diseases, resulting in an imbalance between the generation of reactive oxygen species and the expression of antioxidant enzymes. Melatonin, which has antioxidant and anti-inflammatory properties and regulates mitochondrial functions, can be a powerful tool to counter age-related changes. Globally, the number of people of all ages with visual impairment is estimated at 285 million. Cataract and age-related macular degeneration (AMD) are the leading causes of vision loss around the world. AMD and cataracts often coexist in patients, so there is a concern that age-related cataract surgery increases the risk of morbidity and progression of AMD. The pathogenesis of both cataracts and AMD is still unclear, although a number of theories have been put forward, including oxidative stress, age-related changes, inflammatory processes, etc. Analysis of modern domestic and foreign literature shows good perspectives of using melatonin as preventive and therapeutic agent in the treatment of ophthalmic diseases of various origins.
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Современные аспекты этиопатогенетического лечения офтальмодемодекоза (обзор литературы) Оренбургский филиал ФГАУ «МНТК "Микрохирургия глаза" имени академика С.Н. Федорова» Министерства здравоохранения Российской Федерации ул. Салмышская, 17, Оренбург, 460047, Российская Федерация РЕЗЮМЕДемодекоз является одним из самых распространенных дерматозов. Среди всех воспалительных заболеваний век блефариты демодекозной этиологии занимают от 39 до 88%. Заболевание распространено повсеместно, паразитоносительство обнаружено у 89% больных, несмотря на то что у большинства носителей отсутствуют какие-либо проявления данной патологии. Способствует развитию демодекоза воздействие предрасполагающих факторов: хронические заболевания желудочно-кишечного тракта и печени, эндокринная патология, неправильное питание, вредные привычки и т.д. По данным ряда авторов, клещ рода Demodex является условно-патогенным микроорганизмом -сапрофитом, проявляя свою патогенную активность при определенных условиях. По данным российских исследований, инфицированность демодексом составляет до 92%, но далеко не всегда это проявляется демодекозом, что зависит не только от количества особей, но и от состояния местных защитных сил. В последние годы участились случаи обнаружения клеща у человека. Возможно, этому способствуют экологические условия, связанные с загрязнением окружающей среды, в том числе и воздуха, а также рост хронических заболеваний, особенно заболеваний ЖКТ и сахарным диабетом. Причиной, как правило, является неправильный образ жизни и питания. Несмотря на многообразие препаратов специфического и симптоматического действия, лечение демодекоза глаз оказывается малоэффективным. Этому способствуют длительность терапии, несоблюдение режима лечения и гигиенических норм, применение симптоматических препаратов, не оказывающих акарицидного действия, отсутствие адекватного лечения хронических заболеваний, а также необходимость комплексного лечения: демодекоза глаз -у офтальмолога, кожи лица -у дерматолога. Недостаточность знаний об этиопатогенезе и малая эффективность методов терапии демодекоза способствуют его хроническому рецидивирующему течению с углублением тяжести клинических проявлений, что является существенным психотравмирующим фактором для больных. Это приводит к развитию психастенических состояний и неврозов и указывает на медико-социальное значение проблемы этого дерматоза.Ключевые слова: демодекоз, блефарит, блефароконъюнктивит, клещ демодекс, demodex folliculorum Для цитирования: Чупров А.Д., Мальгина Е.К. Современные аспекты этиопатогенетического лечения офтальмодемодекоза (обзор литературы). Офтальмология. 2018;15(2S):281-285. https://doi.
Transepithelial photorefractive keratectomy (TransPRK) with excimer laser “Microscan Visum” (1100 Hz) is a one-stage surgery which does not require changing the sequence of stages for epithelium removal and ablation of cornea stromal part. The “know-how” of Russian excimer laser manufacturers allows to significantly reduce corneal tissue overheating during TransPRK surgery. A new approach to TransPRK surgery consists in simultaneous use of Platoscan program, age nomogram and size of epithelium initial thickness.Purpose: to assess functional outcomes and changes in the corneal epithelium thickness after TransPRK surgery in patients with myopia in the period from 1 month to 1 year.Material and methods. Sixty-six eyes of 33 patients were included in the trial. Average patients’ age was 25.6 ± 6.8 (mean 17–40); 18 men and 15 women. The average spherical component was –2.57 ± 1.54 diopters (from –0.75 to –5.75). The average cylindrical component before surgery was –0.79 ± 0.71 diopters (from 0.00 to –3.5); 45 eyes with mild myopia, 21 eyes with moderate myopia. Epithelium thickness was measured with RTVue-xR Avanti device (Optovue, USA). Calculations were made using Platoscan program and age nomogram (OOO “Opto-systems”, Russia). Assessment of functional outcomes was made using generally accepted standards in refractive surgery.Results. TransPRK has shown its high efficacy, safety, predictability and accuracy in patients with myopia correction. Analysis of OCT findings of the anterior segment using epithelial maps showed that there is no complete restoration of epithelium thickness both in cornea center and in cornea periphery in 7-mm zone by the end of the first month after TransPRK surgery. In one month after TransPRK, epithelium thickness restored by 86.64 % in the center and by 87.99 % in 7-mm zone. Complete restoration of epithelium thickness in the center and in periphery was reached in 6 months. Corneal epithelium thickness in the surgical field increased by 7.9 % both in the center and in periphery in 12 months after the surgery. The ratio of epithelium initial thickness in the center and in periphery to the total cornea thickness before and after the surgery was 10–12 % for the entire study period.
G The purpose of the study was to investigate the compliance of ophthalmologists and glaucoma patients using questionnaires for patients. Materials and methods: Questionnaires were applied to 72 glaucoma patients. The age range was between 47 and 76 years. All the patients were asked to answer anonymously a number of questions about their disease and treatment. Results and discussion: Problems of interaction and mutual understanding of ophthalmologists and glaucoma patients were revealed. On the one hand, ophthalmologists do not clearly and precisely explain to patients the importance of monitoring and treatment for glaucoma being a chronic disease. On the other hand, patients demonstrate carelessness regarding their health. Conclusion: Our goal was to help glaucoma patients to completely realize their problems, to incline them for treatment and to persuade them that they can cope with their problems only by cooperation of ophthalmologists and patients.G Key words: primary open-angle glaucoma; compliance of ophthalmologists and patients; questionnaires. УДК 617.7
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