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The aspects of the pathogenesis and treatment of the primary glaucoma


Author: Borovic Djina
Degree:doctor of medicine
Speciality: 14.00.08 - Ophthalmology
Year:2008
Scientific adviser: Eugen Bendelic
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Vladimir Horneţ-Eremeev
dr. în medicină, conf. univ.,
Institution:

Status

The thesis was presented on the 1 October, 2008
Approved by NCAA on the 23 October, 2008

Abstract

Adobe PDF document0.37 Mb / in romanian

Keywords

primary open-angle glaucoma, kalikrein-kinin system, renin-angiotensin system, angiotensin conversion enzyme activity, the kalikrein activity, the prekalikrein activity, the dopplerography of the ophthalmic artery

Summary

The study is based on the analysis of the investigations results of the biochemical systems as the renin-angiotensin and the kalikrein-kinin systems in the plasma, tear and aqueous humour and the examination of the regional sanguine circulation through the performance of the dopplerography of the ophthalmic artery in the patients with primary open-angle glaucoma (POAG). It was performed a comparison of the biochemical investigations results in the patients with primary open-angle glaucoma tonometric uncompensated, before the operation and tonometric compensated, after the operation with the results of the control groups. It was established in primary open-angle glaucoma tonometric uncompensated, an increased level of the angiotensin conversion enzyme (ACE) activity and of the kalikrein and a decrease of the ratio of the activity of the prekalikrein/kalikrein in the tear and in the aqueous humour, in concordance with the stage of the evolution of the glaucoma, with a decrease of the prekalikrein activity in tear in each group of the patients. At IOP compensation by surgery, in the tear of the patients with GPUD took place a decrease of the ACE activity, and also a decrease of the kalikrein activity, without attaining the control groups values, and an increase of the prekalikrein activity and of the ratio of the activity of the prekalikrein/kalikrein, the sum activity remaining practical constant. The dopplerographical data revealed IOP compensation in the period after the operation, is associated with the amelioration of the hemodynamical indexes of the ophthalmic artery, in the patients with POAG that supported an antiglaucomatosly intervention of the fistulisant type. Are proposed new diagnostical tests for the primary open-angle glaucoma and of the evaluation of the degree of the glaucomatous disease by the determination in the tear and in the aqueous humour of the ACE activity, prekalikrein and kalikrein activity and the ratio of the activity of the prekalikrein/kalikrein. Determination of the functional deterioration in POAG tonometric uncompensated and compensated, with the evaluation of the dynamic evolution of the glaucomatous disease, may be appreciated through the determination of the hemodynamical indexes of the ophthalmic artery, using the Doppler technique.

The combination of the reduction of the intraocular pressure procedures with the neuroprotective therapies, that involve the modification in the sanguine and tissular (including the inhibitors of the ACE), renin-angiotensin and kalikrein-kinin systems, might become the standard conduct in the treatment of the open-angle glaucoma.