Complex ophthalmic neurostimulation in the rehabilitation of patients with glaucomatous optic neuropathy

Abstract

Glaucomatous optic neuropathy differs significantly from other known ophthalmic neuropathies due to the gradual but steady progression, irreversible course, and resistance to treatment. Despite the fact that in recent decades, retinoprotective therapy and various physiotherapeutic factors have been widely used in the treatment of ophthalmic diseases and, in particular, this pathology [1–17], it has not been possible to reduce the incidence rate so far. In this regard, there is an urgent need for further development of comprehensive rehabilitation programs to prevent the progression of the disease. Material and research methods. The study included 78 patients (102 eyes): the main group included 58 eyes with stage 1 primary open-angle glaucoma (POAG1) of 42 patients aged 56±3.1 years (16 men, 26 women), who underwent a course of complex ophthalmic neurostimulation including transcranial magnetic stimulation with a magnetic field induction of 43 mT and a pulsating frequency of 100 Hz, endonasal electrophoresis with Semax, heliox inhalation of a heated mixture of He+O2 (21), and acupuncture. There were 10 procedures of each in a combined schedule. The comparison group included 36 patients (44 eyes) with POAG1 (14 men, 22 women) aged 53±3.2 years, who underwent a course of complex ophthalmic neurostimulation including transcranial magnetic stimulation with a magnetic field induction of 43 mT and a pulsating frequency of 100 Hz, and endonasal electrophoresis with Semax. The control group included 47 eyes of 38 patients aged 50±3.9 years (18 men, 23 women), who did not undergo physiotherapy. Results. The most pronounced results in POAG1 were obtained under the influence of an extended complex of ophthalmic neurostimulation including transcranial magnetic stimulation, endonasal electrophoresis with Semax, heliox therapy, and acupuncture, which was confirmed by a significant decrease in the number of relative scotomas, a decrease in electrical perceptual threshold, an increase in P50 amplitude in PERG, and an increase in the GCC layer that persisted up to 48 weeks in most cases. Somewhat less significant results were obtained in the comparison group, with the greatest therapeutic effect for most of the studied parameters observed in terms of up to 24 weeks, while in patients who received a vitamin therapy complex, there was noted only a positive trend, the duration of which was no more than 12 weeks, followed by deterioration. Conclusion: More pronounced therapeutic results obtained in the main group are explained by the formation of the trophostimulating effect of magneto-electrotherapy, the neuroprotective effect of the drug, as well as the pronounced neurotrophic effects of heliox therapy and acupuncture.