Immunological Approach To The Treatment Of Glaucoma In Patients With Chronic Viral Hepatitis

Evaluation of changes in the visual organ of prostaglandin drugs used in the treatment of primary open-angle glaucoma (POAG) in viral hepatitis. Use of non-steroidal anti-inflammatory (NSAID) drugs to increase the effectiveness of prostaglandin analogs (PA) and reduce their side effects.

30 patients (60 eyes) with viral hepatitis and POAG, 17 of them are women, 13 are men, the average age is 54.2 years. 9 patients have hepatitis B, 8 have hepatitis C, 6 have B+C and 7 have B+D. Standard ophthalmological examinations, Schirmer's test, UBM and OCT-Angio examination were performed. The amount of inflammatory mediator - IgE is determined in patients and the results of laboratory and instrumental examination were used to evaluate the functional activity of the liver. 

PAs are drugs of choice in the treatment of POAG, they increase the uveoscleral outflow of intraocular fluid. This, in turn, normalizes intraocular pressure. In chronic viral hepatitis, the amount of inflammatory mediator - IgE differed according to the clinical course of the disease and the level of activity. The combination of two types of viral hepatitis, i.e. B+D or C+B in a mixed case, causes a further increase in IgE levels.

Under the influence of prostaglandin used in POAG, the inflammatory process increased, conjunctivitis in 55% of patients, cyclitis and episcleritis in 35%, uveitis in 30%, dry eye syndrome in 25%, cystoid macular edema in 20%, increased cataract in 15%, optic neuritis in 10%.  Antihypertensive drugs other than PA are recommended for POAG patients with high IgE level of 450 MU/ml, PA and NSAID together with IgE level of 160-450 MU/ml, and PA in cases of less than 160 MU/ml. In the OCT-Angio cystoid edema of various degrees in the macula, dystrophic changes in the pigment epithelium layer, choriopathy and chorioretinopathic changes were observed along with the edema in the optic nerve disc.  

Usually, in infectious diseases, NSAIDs are used to block inflammatory mediators. But these drugs have a very high toxic effect on liver cells. In order to increase the effectiveness of PA in patients and prevent side effects, NSAID drugs were used in the form of eye drops 2 times in the first half of the day, and PA was used at the end of the second half of the day. As a result, symptoms of conjunctivitis by 85 %, uveitis by 70%, cyclitis by 55%, episcleritis by 60%, and dry eye syndrome by 35% were reduced