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First Author: A.Zilfyan ARMENIA
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To reveal cortisol in aqueous humour of the eye as their high level in case of complicated cataracts on the background of primary open angle and pseudoexfoliative glaucoma increase the intraocular pressure. The local factors relatively persistent elevation of intraocular pressure, primary dystrophic and atrophic changes, including age-related shifts in the cornea, ciliary body and the trabecular meshwork, which cause the infringement of hydrodynamic and hydrostatic properties of the aqueous humour, are considered. The currently available data of scientific publications and results of our own investigations devoted to the role of in situ produced biologically active substances hormonal origin in mechanisms of a stable increase of the intraocular pressure in case of anterior open-angle glaucoma will be analyzed in this work. The available publications are not numerous; furthermore, they are of a rather statement-of-the-fact character [Burch J. et al., 2005; Pleyer U. et al., 2005; Schwartz B. et al., 2005; Vessey K. et al., 2005]. Molecular mechanisms underlying the biological action of glucocorticosteroids in eye membranes were also studied. Specifically, in the experiment, under conditions of cornea transplantation the influence of glucocorticosteroids (SEGRA) was studied to the labeled synthesis of anti- and pro-inflammatory cytokines.
Artashes Zilfyan MD Scientific-Research Center, Yerevan State Medical University, Yerevan, Armenia Shengavit Medical Center, Yerevan, Armenia Under our observation there were 360 patients with the senile and complicated cataracts operated at Shengavit Medical Center within a period of 2008-2012 .
All patents were divided into three groups. The first group included patients with senile cataract 120 eyes. The second group was made up of patients with the complicated cataract on the background of existing anterior open-angle glaucoma 120 eyes. The third group involved patients with complicated cataract on the background of existing pseudoexfoliative glaucoma 120 eyes. All patients underwent microcoaxial phacoemulsification ? Microincision Cataract Surgery (MICS) through 2.2 mm incision with implantation of posterior chamber intraocular lens. Intra-chamber administration of antibiotics was not applied in these groups. The procedure of extracting aqueous humour was used intra-operatively by insulin syringe through the limb; 0.1 ml aqueous humour was extracted. We observed the patients in the early post-operative period. In all the three study groups by 120 samples of aqueous humour and blood serum were allocated for test. The content of cortisol in aqueous humour was determined with the use of appropriate kits (DRG-International Inc., USA). The immune enzyme assay was performed on the automatic spectrophotometer Stat-Fax 3200 (USA) in the absorbance wavelength range 420-450 nm. The obtained results were exposed to statistical analysis using Students criteria and application of SPSS-13 programme (one Sample T-Test and Paired Sample T-Test).
As obvious from Table 1, in patients of study group II the level of cortisol in aqueous humour markedly increased (as compared to hormone levels determined in aqueous humour of patients with the senile cataract control group). Cortisol content in blood serum and aqueous humour of patients with the senile and complicated cataracts Study groups of patients Studied indices Aqueous humour Blood serum I 12.90ḟ0.64 56.90ḟ4.15 II 23.38ḟ1.46 ?<0.0005 64.84ḟ7.28 0.1<0.25 III 30.4ḟ1.56 ?<0.0005 50.70ḟ6.91 0.1<0.25 Note: p indices of complicated cataracts as related to indices of senile cataracts. Thus, the level of cortisol in aqueous humour of patients with cataract on the background of primary open-angle glaucoma was 1.8 times higher compared to norm. The highest indices of cortisol were observed in aqueous humour of patients of the study group III. In particular, cortisol levels in aqueous humour of patients with the senile cataract on the background of primary open-angle glaucoma and pseudoexfoliative glaucoma increased 2.3 times. The results of immune enzyme assays performed on aqueous humour were compared with cortisol levels in blood serum of the same group of patients.
The high level of a cortisol found by us in aqueous humour can serve one of possible causes of infringement of the ionic balance. This assumption appears very reasonable, as it is known that high concentrations of cortisol in separate membranes of an eye lead to ionic imbalance in connection with enhanced inflow of ions of sodium in aqueous humour that results in an increase of intraocular pressure. In impairment of drainage network functions a definite role is also devoted to in situ produced cortisol and processes resulting in disorders of ionic balance between the membranes and liquid media of an eye (first of all: between the cells of the ciliary body, cornea, trabecular meshwork and the aqueous humour). In the mechanism of impaired ionic balance that at the primary open-angle glaucoma is characterized by excessive accumulation of sodium ions in aqueous humour a certain part belongs also to cortisol produced in eye membranes. In cases of pseudoexfoliative glaucoma deposition of pseudoexfoliative matter in the anterior segment of an eye might cause blocking of the drainage system