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CNAA / Theses / 2005 / June /

The diagnosis and treatment of ocular pathology in diabetic children


Author: Corina Magdei
Degree:doctor of medicine
Speciality: 14.00.08 - Ophthalmology
Year:2005
Scientific adviser: Valeriu Cuşnir
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Zinaida Anestiadi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:

Status

The thesis was presented on the 26 June, 2005
Approved by NCAA on the 22 September, 2005

Abstract

Adobe PDF document0.43 Mb / in romanian

Thesis

CZU 617,7-02:616,379-008,64-053,2.6-07-089

Adobe PDF document 2.69 Mb / in romanian
128 pages


Summary

The diabetic retinopathy is the most important cause of blindness. In the world, every year (yearly) – about 40000 diabetic patients lose the visual acuity. The problems bound with diagnosis, prophylaxis, treatment and reabilitation of children with diabetic retinopathy dictates the necessity to perfect the schemes directed on the adaptation and improvement of the quality of life in these patients.

In the Republic of Moldova, there is a lack of studies on the frequency of the diabetic retinopathy among children and teen-agers.

In the present study were analyzed the results of the diagnosis and treatment of 153 diabetic children.

The obtained results demonstrated that in Republic of Moldova, diabetic retinopathy among children represent 16,9%, with nonproliferative diabetic retinopathy in 35,4% cases, with preproliferative in 1,1% cases and proliferative diabetic retinopathy ]n 3,1 cases.

Our investigations confirmed a high visual acuity in children with diabetic retinopathy. The research of the contrast sensitivity showed the presence of preclinical changes in the area of high frequencies, with the evidence of a specific diabetic curve.

The examination of microcirculation in the bulbar conjunctive of diabetic children and teen-agers established that the intensity of conjunctival changes increases with the progression of the retinopathy and correlates directly with the duration of the diabet. The main risk factors for the development in progression of the diabetic retinopathy in children and adolescents are: the age of diabet, the decompens of diabet; the onset of diabet in the prepubertal diabetic duration and in the female sex.

We found a high level of Herpes infection markers HSV ½;-83,8%, CMV-93,3%, and EBV 97,1% in diabetic children and teen-agers that reflects indirectly the level of immunosupression in this patients and the replications of these virus could be an unfavorable factor for the development of retinal proliferation.

In diabetic children were praised the signs of autoimmunae process manifested by a wave increase of the level of anti-inflammatory cytokines and cellular immunity disorders regarding T-lymphocytes (CD4; CD8) a double increase of CD-8 beside normal level of CD-4.

The use of medical scheme nr. 1 a combination of the medicine Bilobil and Solution of Emoxypinae 1% and scheme nr. 2 a combination of Tocopherol aceatat and the Solution of Taufon 4% allow to improve the contrast sensibility in the area of high frequencies and the state of the microcirculation in the bulbar conjunctive.

Surgical treatment of the cataract was performed in 16 eyes. In the 16 eyes was performed a laser capsulorexis with the aspiration of cristallin mases. In all operated patients during two years of follow-up the visual acuity was good (81,3%).

The retinal laser photocoagulation in the presence of preproliferative retinopathy and proliferative process of the retinal allowed to stabilize the pathological disorders in 71,4% of cases.