Clinical, pathogenetic and prognostic value of diabetic retinopathy’s progression after phacoemulsification in patients with the essential hypertension

Purpose: to study the clinical and laboratory changes after phacoemulsification of the cataract in patients with diabetic retinopathy and essential hypertension as the comorbidity.
Patients and methods: 130 patients were divided into 3 groups. Visometry, tonometry, refractometers, perimetry, biomicroscopy and direct ophthalmoscopy, optical coherence tomography, autofluorescence, ultrasound biomicroscopy were conducted. The samples of tear fluid and serum were collected. The clinical and laboratory parameters of homeostasis (endothelial factors, cytokines (IL-6, TGF-β, VEGF, PEDF)), adhesion molecules (sICAM, sVCAM) have been evaluated.

Results: Stability of pro-and angiogenic balance has been defined after the phacoemulsification in patients with diabetic retinopathy without essential hypertension. Opposite changes proangiogenic potential has been observed in the group of patients with diabetic retinopathy and hypertension after phacoemulsification. Insignificant changes of immunobiochemical indicators were identified in patients, receiving Angiotensin-converting enzyme (ACE) inhibitors in postoperative period. It allows to predict a favorable course of disease. The changes in the balance of the evaluated parameters inpatients, receiving other medicines, were characterized with the increase of proangiogenic and endothelial dysfunction. It was a predictor of vascular changes. All identified laboratory patterns were confirmed by the parallel dynamic prospective ophthalmic studies that demonstrated a higher incidence of vascular disorders after phacoemulsification in patients with diabetic retinopathy and hypertension who were not taking ACE inhibitors. Accordingly, in patients treated with ACE inhibitors for the normalization of vascular hypertension, clinically stable course of disease has been noted.

Conclusion: The assessment of changes in vascular factors after phacoemulsification and the impact of antihypertensive drugs on the balance of laboratory parameters in patients with diabetic retinopathy and hypertensive disease allowed to establish a beneficial effect of ACE inhibitors on the stability of the angiogenic potential. It can be assumed that the basis of the picture described pharmacological properties of ACE inhibitors is a positive influence on the stabilization of the angiogenic potential and reduce endothelial dysfunction.

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