Zborovska O. Experimental and clinical substantiation of the antimicrobial photodynamic therapy efficacy in patients with severe keratitis and endophthalmitis

Object: fungal keratitis and bacterial endophthalmitis. Aim: to justify in experiment and clinicaly usage of photodynamic therapy (PDT) in patients with severe keratitis and endophthalmitis by creating experimental models of fungal keratitis and bacterial endophthalmitis, developing of new ways of antimicrobial photodynamic therapy (APDT) with methylene blue (MB) and low-energy laser radiation (LELR) (wavelength 630-670 nm), and by studying influence of developed techniques for microorganisms and on inflammatory processes in eye tissues, to improve treatment efficacy of these diseases. Methods: microbiological, ophtalmological, histological, statistical. Equipment: spectrophotometer "Spekol-10", standard ophthalmological. Scientific evidence of fungistatic action on Candida albicans of the photosensitizer MB and LELR (wavelength 630-670 nm) were updated. First established bacteriostatic effect on Escherihia coli of the photosensitizer MB and dimethylsulfoxide with LELR (wavelength 630-670 nm). Scientific knowledge of bactericidal activity against Staphylococcus aureus of the MB and LELR (wavelength 630-670 nm) was updated. A model of moderate and severe fungal keratitis were created. A model of acute bacterial endophthalmitis with mixed etiology was developed. Firstly the positive effect of APDT on eye structures in the experiment of treatment of bacterial endophthalmitis was revealed. Experimentally confirmed the therapeutic efficacy of new treatment method - PDT with MB and LELR (on the model of fungal keratitis) and APDT with MB, and dimethylsulfoxide with and LELR (on the model of bacterial endophthalmitis with mixed etiology). The efficacy of the proposed new method for treatment of severe fungal keratitis and endophthalmitis was revealed. Endophthalmitis classification was updated by severity, based on a point (integrated quantitative) assessment of the set of clinical symptoms. Firstly identified prognostic factors leading to the enucleation in order of importance. Results have been implemented SI "Filatov Institute of Eye Diseases and Tissue Therapy NAMS of Ukraine", "Eye Microsurgery Center" Kiev, CS "Dnipropetrovsk Regional Ophthalmological Hospital", Zakarpatskiy RCH A.Novaka, CS "4th City Hospital" Krivoy Rog, "Vizus" Zaporozhye, CS "3rd Zaprozhskaya city hospital". Sphere of application - medicine, ophthalmology.