The dissertation is devoted to the solution of the current task of modern
ophthalmology – optimization treatment of eye auxiliary apparatus injuries based on
the study of the peculiarities of the wound process and healing mechanisms by
studying their connection with the enzymatic system of traumatic wounds, as well as
the development of a new method of treatment of traumatic injuries.
Injuries of the eye and its auxiliary apparatus occupy leading positions in the
system of general traumatism. Traumatic damage to the organ of vision and their
consequences remain the main causes of blindness and disability. In modern
literature, there is a very large number of studies by various authors on eyeball
injuries. There is a much smaller number of works related to injuries of the accessory
eye apparatus (AEA) and orbit, however, damage to the AEA and orbit is a socially
significant problem, since such injuries reduce the quality of life of patients due to
functional and cosmetic defects of the face.
According to the literature over the last 60 years, 13% of all combat injuries are
related to damage to the eye and its supporting apparatus, which are the fourth cause
among all injuries received during military operations. In connection with the war in
Ukraine, the number of patients with AEA injuries, which are complicated by
purulent-inflammatory processes and cicatricial deformations, has increased
significantly. Purulent-inflammatory complications are one of the main problems in
the case of injuries to the auxiliary apparatus of the eye, which remains relevant for
clinical ophthalmic surgery today. The relevance of this problem is explained by the
frequent severe course of the pre- and postoperative period in patients with traumatic
damage to the auxiliary eye apparatus, which is accompanied by long-term local
12
infection, violation of general and local regulatory mechanisms, generalization of the
process and, as a result, delayed wound healing. This ultimately leads to
unsatisfactory functional and cosmetic treatment results.
AEA traumatic wound healing is a complex mechanism with multiple processes
that harmoniously combine for structural and functional restoration of injured tissue.
Wounds that are accompanied by long-term inflammation and slow healing are a
serious clinical complication, as such wounds end in defective re-epithelialization
and undesirable formation of a postoperative scar.
The process of wound healing occurs through the interaction of mediators that
are synthesized by neutrophils, monocytes, lymphocytes, platelets, fibroblasts,
histiocytes, epithelial cells, vascular endothelium and components of the extracellular
matrix (ECM). Intercellular and cell-matrix interaction in a wound form a complex
cascade of processes that are closely related to each other and include coagulation,
inflammatory reaction, synthesis and accumulation of ECM components,
neovascularization, contraction, ECM remodeling and re-epithelialization. In the
literature, there is a sufficient amount of information about the key role of enzymes
of the superfamily of matrix metalloproteinases (MMP, which includes
endopeptidases, which are zinc-dependent in the processes of migration and
proliferation of cells on the wound surface. However, the analysis of modern
scientific literature showed that metalloproteinases in the wound process of the
auxiliary eye apparatus in ophthalmology are covered in a fragmentary manner ,
since the main focus in the study of traumatic damage to the organ of vision is
directly on the eyeball, so this prompted us to study this topic.
Recently, there has been active research and the impact of biological films on
wound healing processes. However, the role of biofilms in the wound process of
traumatic injuries of the auxiliary apparatus of the eye has not yet been determined,
and methods for monitoring the condition of these structures have not been developed.
Thus, optimization of medical care for patients with traumatic damage to the
auxiliary apparatus of the eye is an important and urgent task of modern
ophthalmology.
13
The purpose of the study: optimization treatment of eye auxiliary apparatus
injuries based on the study of the peculiarities of the wound process and healing
mechanisms by studying their connection with the enzymatic system of traumatic
wounds, as well as the development of a new method of treatment of traumatic
injuries.
