OUR EXPERIENCE OF USING AUTOLOGICAL BLOOD SERUM IN COMPLEX TREATMENT OF BACTERIAL CORNEAL ULCERS IN PATIENTS WITH DIABETES MELLITUS DEPENDING ON THESEVERETY OF DIABETIC POLYNEUROPATHY

  • O. V. Zavoloka
  • P. A. Bezditko
  • M. A. Karliychuk
  • N. M. Bezega
Keywords: diabetes mellitus, bacterial corneal ulcers, diabetic polyneuropathy, autological blood serum, corneal reepithelialization.

Abstract

Summary. Diabetic keratopathy, which develops against the background of diabetic corneal neuropathyshould be taken into account when choosing tactics for the treatment of bacterial corneal ulcers in patients with diabetes mellitus.

The aim of the study was to determine the effectiveness of treatment of bacterial corneal ulcers with the help of additional local use of autological serum eye drops in patients with type 1 diabetes depending on the severity of diabetic polyneuropathy (DPN).

Materials and methods. The results of observation of 10 patients (10 eyes) with bacterial corneal ulcer and type 1 diabetes mellitus, in which delayed healing of corneal ulcer defect were noted and the absence of microorganisms ware confirmed by repeated bacteriological examinations of corneal smears and scrapings,were analyzed. In addition to standard therapy, all patients 2 weeks after the start of treatment were additionally prescribed eye drops with autologous serum. Patients were divided into 2 groups according to the stage of severity of DPN: the first group consisted of 5 patients with symptomatic stage, the second - 5 patients with a stage of severe complications. In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye on the device TOPCON 3D OCT-2000, non-contact examination of corneal sensitivity.

Results and discussion. It was found that the threshold of corneal sensitivity in patients with bacterial corneal ulcer at the stage of severe complications of DPN was higher than that in symptomatic DPN by an average of 16.6 % during the observation. The degree of pericorneal injection and infiltration of the cornea, as well as the size and depth of the ulcerative defect of the cornea at the stage of severe complications exceeded the corresponding indicators of patients with symptomatic DPN during the observation. Normalization of conjunctival color and reepithelialization of the cornea in all patients with severe complications occurred 3 days later than in patients with symptomatic DPN.

Conclusions. The course of bacterial keratitis in patients with diabetes mellitus depends on the severity of DPN: a pronounced violation of corneal innervation at the stage of severe complications of DPN, manifested by a decrease in its sensitivity, leads to prolongation of treatment, even with additional use of eye drops with autologous serum.

References

1. Vieira-Potter VJ, Karamichos D, Lee DJ. Ocular complications of diabetes and therapeutic approaches. Biomed ResInt. 2016; 2016:3801570. [PubMed: 27119078]
2. Schulze SD, Sekundo W, Kroll P. Autologous serum for the treatment of corneal epithelial abrasions in diabetic patients undergoing vitrectomy. American Journal of Ophthalmology.2006;142(2):207–211.
3. Geerling G, MacLennan S, Hartwig D. Autologous serum eye drops for ocular surface disorders. British Journal of Ophthalmology.2004;88(11):1467–1474.
4. International Guidelines on the Out patient management of Diabetic Peripheral Neuropathy. 1995;17 р.
5. Zavoloka OV, Bezditko PA, Lukhanin OO. Efektyvnist’ novoho prystroyu dlya bezkontaktnoyi diahnostyky chutlyvosti rohivky pry vyznachenni yiyi neyrotrofichnoho stanu u khvorykh na tsukrovyy diabet I typu ta bakterialʹnyy keratyt. Oftalʹmol. zhurn. 2019;6:29-33. In Ukrainian. http:// doi.org/10.31288/oftalmolzh201962933
6. Davidson EP, Coppey LJ, Kardon RH, Yorek MA. Differences and similarities in development of corneal nerve damage and peripheral neuropathy and in diet-induced obesity and type 2 diabetic rats. Invest Ophthalmol Vis Sci. 2014 Mar 3;55(3):1222-30. doi: 10.1167/iovs.13-13794.
Published
2020-03-12
How to Cite
Zavoloka, O. V., Bezditko, P. A., Karliychuk, M. A., & Bezega, N. M. (2020). OUR EXPERIENCE OF USING AUTOLOGICAL BLOOD SERUM IN COMPLEX TREATMENT OF BACTERIAL CORNEAL ULCERS IN PATIENTS WITH DIABETES MELLITUS DEPENDING ON THESEVERETY OF DIABETIC POLYNEUROPATHY. Kharkiv Surgical School, (3), 92-98. https://doi.org/10.37699/2308-7005.3.2020.18
Section
QUESTIONS OF OPHTHALMOLOGY