THERAPY OF FIBRINOUS PLASTIC ANTERIOR UVEITIS

Aim. To analyze the efficacy of modified pupillary massage technique using cycloplegic agent Appamide Plus in the treatment of anterior uveitis. Patients and methods. 45 patients (25 men and 20 women) aged 21‑69 with endogenous uveitis (51 eyes) were enrolled in the study. Etiology of uveitis was identified in 57.7 % of cases: herpes simplex virus (22.2 %); systemic disorders — rheumatoid arthritis, Reiter syndrome, Bechterew’s disease, psoriasis (17.7 %); local infection — purulent periodontitis or sinusitis (11 %). Patients were divided into two groups. Group I received basic therapy in combination with traditional pupillary massage. Group II received basic therapy in combination with modified pupillary massage using Appamide Plus (muscarinic receptor antagonist and alpha adrenergic agonist) and plasma exchange with cell mass ozonation. Results. Inflammation of the uveal tract was prevented in all patients. In group I (traditional pupil massage), posterior synechiae persisted in 26 % of cases. In group II (pupil massage using Appamide Plus), anterior chamber humor was transparent, posterior synechiae were broken, normal pupillary response was re-established. Additionally, inflammatory exudate in the anterior chamber and endothelial precipitates resolved by 3.3 days earlier than in group I (р < 0.05). Visual outcomes were also better in Appamide Plus group. T cell-mediated immunity study revealed initial CD3+ cell and T cell subpopulation deficiency. Relative and absolute references of T cells and their subpopulations tended to decrease even when uveitis signs reduced. Conclusions. T cell-mediated immunity depression is probably due to pharmacotherapy. Appamide Plus eye drops are highly effective for therapeutic mydriasis and pupillary massage in the course of anterior uveitis treatment to prevent synechiae formation in enlarged or small pupil.

1. Katargina L. A., Khvatova A. V. [Endogenous uveitis in children]. Endogennye uveity u detey i podrostkov. Moscow, Medicina, 2000. (in Russ.).

2. McClellan K. A., Coster D. J. Uveitis: a strategy for diagnosis. Aust. N. Z. J. Ophtalmol. 1987; 15 (3): 227.

3. Pen’kov M. A., Shpak N. I., Avrushchenko N. M. [Endogenous uveitis]. Endogennye uveity. Kiev.: Zdorov’ya, 1979. (in Russ.).

4. Chesnokova N. B., Neroev V. V., Beznos O. V., Beyshenova G. A., Nikol’skaya I. I., Kost O. A., Binevskiy P. V., Shekhter A. B. [Oxidative stress in uveitis and its correction with antioxidant enzyme, superoxide dismutase (experimental study)]. Okislitel’nyy stress pri uveite i ego korrektsiya antioksidantnym fermentom superoksiddismutazoy (eksperimental’noe issledovanie). [Annals of Ophthalmology]. Vestnik oftal’mologii. 2014; 5: 30-34. (in Russ.).

5. Belousova N. Yu. [Modern approaches to the therapy of uveal ocular hypertension]. Sovremennye vozmozhnosti konservativnoy terapii uveal’noy oftal’mogipertenzii. [Annals of Ophthalmology]. Vestnik oftal’mologii. 2014; 5: 74-77. (in Russ.).

6. Kushnir V. N., Dumbrevyanu L. G., Groppa L. G. [Clinical therapeutic characteristics of secondary glaucoma in uveitis associated with reactive arthritis and ankylosing spondylitis]. Kliniko-terapevticheskie osobennosti vtorichnoy glaukomy u patsientov s uveitami, assotsiirovannymi s reaktivnym artritom i ankiloziruyushchim spondiloartritom. [Clinical Ophthalmology]. Klinicheskaya oftal’mologiya. 2012; 3: 95‑97. (in Russ.).

7. Onishchenko A. L., Kolbasko A. V., Tchernyshev A. D. Neopterin value in etiological diagnostics of endogenous uveitis. [Annals of Ophthalmology]. Vestnik oftal’mologii. 2011; 2: 25-29. (in Russ.).

8. Onishchenko A. L., Kolbasko A. V., Tatarnikova G. N., Grebenchuk O. S. [Retinal detachment in AIDS patients with cytomegalovirus uveitis]. Otsloyka setchatki u VICh-infitsirovannykh bol’nykh s tsitomegalovirusnym uveitom. [Annals of Ophthalmology]. Vestnik oftal’mologii. 2014; 3: 42‑44. (in Russ.).

9. Borzenok S. A, Moroz Z. I., Zmyzgova A. V. [Ozone therapy in ophthalmology: Guidelines for doctors]. Ozonoterapiya v oftal’mologii: Posobie dlya vrachey. Moscow, GU MNTK «Mikrokhirurgiya glaza», 2000. (in Russ.).

10. Grechanyy M. P., Chentsova O. B., Kil’dyushevskiy A. V. [Etiology, pathogenesis, and perspectives of ocular autoimmune disorder treatment]. Etiologiya, patogenez i perspektivy lecheniya autoimmunnykh zabolevaniy glaz. [Annals of Ophthalmology]. Vestnik oftal’mologii. 2002; 5: 47‑52. (in Russ.).

11. Grechanyy M. P., Chentsova O. B., Kil’dyushevskiy A. V. [External hemocorrection in the treatment of ocular autoimmune disorders in children]. Ekstrakorporal’naya gemokorrektsiya pri lechenii autoimmunnykh zabolevaniy glaz u detey. [Clinical Ophthalmology]. Klinicheskaya oftal’mologiya. 2003; 4: 170-173. (in Russ.).