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Etiopathogenetical and curative aspects of the corneal ulcer


Author: Ceban Cornelia
Degree:doctor of medicine
Speciality: 14.00.08 - Ophthalmology
Year:2011
Scientific adviser: Eugeniu Bendelic
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Valentin Gudumac
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 23 February, 2011
Approved by NCAA on the 31 March, 2011

Abstract

Adobe PDF document – 0.37 Mb / in romanian

Keywords

corneal ulcer, comparative analysis, ozone, Bio-R, associated therapy, surgical treatment, amniotic membrane, single coverage, double coverage

Summary

The work contains 118 computer typed pages and includes: introduction, literature review, materials and methods, 3 chapters with the research results, discussion, conclusions, recommendations, bibliography which contains 266 literary sources, appendices.

Illustrative material: 31 tables and 35 figures. The results of the thesis were published in 8 scientific articles and 1 methodic recommendation. Field of Study: Ophthalmology.

Purpose and objectives of the study: to study the etiology, pathogenetic processes of the corneal ulcer and the efficacy of in its complex treatment using ozonized solution, the adaptogen remedy Bio-R and amniotic membrane in developing an optimal method of its application. To study the dynamics of clinical symptoms, systemic assessment of inflammation markers and cellular and humoral immune status, serum concentration of proinflammatory cytokines, indices of lipid peroxidation and to study their dynamics under the influence of the complex treatment including the preparation Bio-R, the ozone solution and their combination and under the influence of the surgical involvement by amniotic membrane coverage.

Research methodology. The study has an analytical, clinical and prospective nature. The study subjects were selected randomly, the recruitment of whom was based on both criteria of inclusion and exclusion. Collectioning of the data for the clinical research was of "case-control".

Novelty and originality of the study: Clinical data on the clinical efficacy of the preparation Bio-R and ozonized solution in the treatment of corneal ulcers were obtained. It was determined that supplementation of Bio-R or ozone solution to the complex treatment of corneal ulcers determines a quicker regression of the clinical symptoms of the disease, reduction in the levels of systemic indices of inflammation, normalization of POL-SAO indices, which manifested by a more benign clinical course of the disease and by a 2-fold reduction of complications of the illness after the therapy. For the first time in medical practice it was developed a new method of application of the amniotic membrane in various types of corneal ulcer - the coverage of the cornea with folded amniotic membrane, which allows a longer contact between the affected cornea and the amniotic membrane.

Theoretical significance: coverage with folded amniotic membrane (CFAM) may be used as a measure for preoperative corneal transplant if trophic changes of anterior segment of the eye by creating favorable conditions through inhibition of corneal neovascularisation and cropping of the inflammatory process. The developed clinical recommendations refer to the clinical usefulness of the CFAM using rehydrated amniotic membrane after preservation by lyophilization.

Applicative value. The usage in medical practice of covering of the cornea with folded amnion allows a more efficient and rapid rehabilitation of patients with various severe corneal pathology. Using CFAM causes significant reduction of hospitalization of patients.

Implementation of scientific results. Results of the study, particularly the method of assessment of severity of inflammation in ulcerative keratitis by determining the concentration of proinflammatory interleukins and markers of systemic inflammation, have been implemented in medical practice in Ophthalmology department of the Republican Clinical Hospital, Municipal Hospital „Sfânta Treime” and in the learning process of the department of Ophtalmology of the State University of Medicine and Pharmacy “Nicolae Testemitanu”.