ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2019-3-317-328ophthalmology-1009Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHФрактальная фототерапия в нейропротекции глаукомыFractal Phototherapy in Neuroprotection of GlaucomaЗуеваМ. В.ZuevaM. V.

Зуева Марина Владимировна - профессор, доктор биологических наук, начальник отдела клинической физио‑ логии зрения им. С.В. Кравкова

Zueva Marina V. - Professor, Dr. Biol. Sci., the Head of the Department of Clinical Physiology of Vision named after S.V. Kravkov

visionlab@yandex.ruКовалевскаяМ. А.KovalevskayaM. A.

Ковалевская Мария Александровна - профессор, доктор медицинских наук, заведующая кафедрой офтальмологии

Kovalevskaya Marya A. - MD, professor, the Head of the Ophthalmology Department

ДонкареваО. В.DonkarevaO. V.

Донкарева Ольга Валериевна - кандидат медицинских наук, доцент кафедры офтальмологии

Donkareva Olga V. - PhD, docent, Department of Oftalmology

КаранкевичА. И.KarankevichA. I.

Каранкевич Александр Иванович - кандидат технических наук, доцент

Karankevich Alexandr Ivanovich - Assoc. Prof., Cand. Tech. Sci.

ЦапенкоИ. В.TsapenkoI. V.

Цапенко Ирина Владимировна - кандидат биологических наук, старший научный сотрудник отдела клинической физиологии зрения им. С.В. Кравкова

Tsapenko Irina V. - Cand. Biol. Sci., senior researcher of the Clinical Physiology of Vision Department named after S.V. Kravkov

ТарановА. А.TaranovA. A.

Таранов Александр Александрович - программист

Taranov Alexsandr A. - programmer

АнтонянВ. Б.AntonyanV. B.

Антонян Вероника Брониславовна - заочный аспирант кафедры глазных болезней

Antonyan Veronika B. - post-graduate

ФГБУ «Московский НИИ глазных болезней им. Гельмгольца»РоссияMoscow Helmholtz Research Institute of Eye DiseasesRussian FederationВоронежский государственный медицинский университет им. Н.Н. БурденкоРоссияVoronezh State Medical University named after N.N. BurdenkoRussian FederationМосковский государственный технический университет им. Н.Э. БауманаРоссияBauman Moscow State Technical UniversityRussian Federation201902102019163317328Copyright © Зуева М.В., Ковалевская М.А., Донкарева О.В., Каранкевич А.И., Цапенко И.В., Таранов А.А., Антонян В.Б., 20192019Зуева М.В., Ковалевская М.А., Донкарева О.В., Каранкевич А.И., Цапенко И.В., Таранов А.А., Антонян В.Б.Zueva M.V., Kovalevskaya M.A., Donkareva O.V., Karankevich A.I., Tsapenko I.V., Taranov A.A., Antonyan V.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1009

Целью работы явилось изучение влияния низкоинтенсивной фрактальной светостимуляции на чувствительность в поле зрения пациентов с подозрением на глаукому (ПГ) и с первичной открытоугольной глаукомой (ПОУГ). Пациенты и методы. В исследовании приняли участие 146 человек, включая 98 пациентов основной группы — 1 и 49 человек контрольной группы «плацебо» терапии — 2. Выполняли стандартную автоматическую периметрию (SITA-Standard, Humphrey, CarlZeissMeditec, 24-2), оценивали динамику периметрических индексов MD и PSD до и после курса из десяти 10-минутных сеансов фрактальной фототерапии или после 10-дневного курса релаксации, состоящего в просмотре дважды в день специального тренирующего видео. Максимальная яркость мельканий на роговице при фототерапии составляла 10–12 люкс, фрактальная размерность оптического сигнала D = 1,4. Результаты. Двухнедельный курс низкоинтенсивной стимуляции фрактальными оптическими сигналами достоверно улучшал показатели MD, отражающие средний дефект в поле зрения, у всех пациентов с ПГ и ПОУГ. Просмотры видеороликов с программой релаксации не оказывали статистически значимого влияния на индексы MD и PSD. Выраженный эффект фрактальной стимуляции для глаз с ПОУГ III (уменьшение MD в среднем на 4,39 дБ) говорит о том, что даже на развитых стадиях глаукомы в общей популяции ганглиозных клеток сетчатки имеется значительный процент клеток, которые еще находятся на пластической стадии обратимых функциональных изменений и способны позитивно реагировать на терапию. Результаты говорят о целесообразности проведения нейропротекторной терапии больным с любой стадией глаукомы, включая развитую стадию. Заключение. В данном исследовании мы впервые использовали технологию фрактальной оптической стимуляции для терапии глаукомы. Получены первые свидетельства нейропротекторного эффекта фрактальной фототерапии при ПОУГ разных стадий. Фрактальная стимуляция может рассматриваться как новый нефармакологический, а физиотерапевтический подход к нейропротекторной терапии, чей потенциал и механизмы требуют дальнейшего изучения.

Purpose: to study the effect of low-intensity fractal light stimulation on the sensitivity in the visual field in patients with suspected glaucoma (SG) and primary open-angle glaucoma (POAG). Material and Methods. The study involved 146 people, including 98 patients of the main group (No. 1) and 49 people from the control group “placebo”-therapy (No. 2). Standard automatic perimetry was performed (SITA-Standard, Humphrey, CarlZeissMeditec, 24-2). The dynamics of the perimetry indices MD and PSD were evaluated before and after the course of a ten 10-minute session of fractal phototherapy or after a 10-day course of relaxation consisting in watching a particular training video twice a day. The maximum brightness of the flashes on the cornea during phototherapy was 10–12 lux, the fractal dimension of the optical signal was D = 1.4. Results. A two-week course of low-intensity stimulation with fractal optical signals reliably improved the MD reflected the common defect in the visual field, in all patients with SG and POAG. The expositions to videos with a relaxation program did not have a statistically significant effect on MD and PSD indices. The pronounced effect of fractal stimulation revealed in eyes with POAG III (a reduction of MD on average by 4.39 dB) suggests that even in advanced stages of glaucoma in the general population of retinal ganglion cells there is a significant percentage of cells that are still at the plastic stage of reversible functional changes and can respond positively to therapy. The results substantiate the feasibility of application neuroprotective therapy to patients with any stage of glaucoma, including the advanced stage. Conclusion. In this study, we first used the technology of fractal optical stimulation for the treatment of glaucoma. The first evidence of the neuroprotective effect of fractal phototherapy for POAG at different stages has been obtained. Fractal stimulation can be considered as a new non-pharmacological (physiotherapeutic) approach to neuroprotective therapy, whose potential and mechanisms need to be studied in future studies.

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The authors declare that there are no conflicts of interest present.