The thesis solves an urgent issue in ophthalmology improving the treatment of patients with bacterial keratitis by applying the hyperbaric oxygenation method and using an ozone-based liposomal solution in combination with a conventional treatment regimen.
The clinical study involved 98 patients (98 eyes) with bacterial keratitis (BK), of them males 55 (56,1%), females 43 (43,9%) ages range from 18 to 82 years old (average age 44.5 (15.9) years).
Patients with BK were randomly assigned to 3 clinical groups, depending on the treatment regimen used: Comparison group #1 (32 patients), patients who received complex treatment according to a generally accepted regimen BK, Comparison group #2 (33 patients), who received complex treatment according to the conventional regimen in combination with the use of HBO, and Main group (33 patients), who received complex treatment BK with the use of HBO and liposomal solutions based on ozone.
All patients with bacterial keratitis underwent a detailed collection of complaints, life and disease history; a comprehensive ophthalmological examination (visometry, autorefractive keratometry, pneumotonometry, biomicroscopy, ophthalmoscopy, eye photography, optical coherence tomography of the anterior segment of the eye, ultrasound examination (B-scan), corneal staining with fluorescein, Schirmer's test, Norn's test); microbiological examination and determination of sensitivity to antimicrobial agents; biochemical research in the tear fluid (study of the activity of oxidoreductases: glucose-6-phosphate dehydrogenase, lactate dehydrogenase, malate dehydrogenase, glutathione peroxidase, total protein and urea) and statistical processing of data obtained during hospitalization, on day 10 treatment and after 1 month.
We obtained and supplemented scientific data on the species composition of microflora, its sensitivity to antibiotics and ozone-based liposomal solution in patients with bacterial keratitis.
Scientific novelty:
Scientific information on the species composition of microflora, its sensitivity to antibiotics, and liposomal solutions based on ozone in patients with BK have been supplemented. Scientific information has been supplemented on the state of redox processes in BK treatment (activity of oxidoreductases: glucose-6-phosphate dehydrogenase, malate dehydrogenase, lactate dehydrogenase) and the antioxidant system (glutathione peroxidase), the content of total protein and urea in the tear fluid of patients.
The knowledge about the effect on the antioxidant system, protein and urea levels in the lacrimal fluid of patients with BK when used in HBO complex treatment in combination with an ozone-based liposomal solution (Main Group) was supplemented, in particular, a significant decrease in the level of enzyme activity in patients (LDH by 30.5% on day 10 and 58.9% (p < 0.001) after 1 month) was revealed; G6FDG by 39.6% after 10 days, and at the end of 1 month by 61.4% (p < 0.001); the MDH by 22.0% after 10 days, and after 1 month 49.4% (p < 0.001); increase in the level of GP by 46.1% after 10 days and by 80.5% after 1 month (p < 0.001).
For the first time, it was found that the use of HBO in the complex treatment of patients with bacterial keratitis in combination with an ozone-based liposomal solution significantly improves the clinical parameters of the disease: in the Main Group in patients, the period of infiltrate resorption decreased by 5,89±0,18 (95% Conf. 5,53-6,27) days (p<0.001), the onset of epithelization occurred earlier by 6,63±0,18 (95% Conf. 6,26-7,0) days, and the completion of epithelialization by 8,24±0,19 (95% Conf. 7,87-8,61) days (p<0.001), the average hospital stay decreased by 6,23±0,18 (95% Conf. 5,86-6,6)days (p<0.001), the visual acuity increased by 3.6 timesor 258% ( from 0.19(0,10) to 0.68(0,21)), p <0.001).
For the first time, the use of HBO in combination with an ozone-based liposomal solution in the complex treatment of patients with BK was substantiated and recommendations for their inclusion in complex therapy and educational processes were developed.
