ENDOTHELIUM PROTECTIVE TIVOREL EFFICACY IN PATIENTS WITH DIABETIC RETINOPATHY

Abstract

Diabetic angio-retinopathy included to specific diabetic eye disorders, which is found in patients with type 1 diabetes mellitus in the range of 20–80 %, and in type II diabetes – in 30–90 % of cases, and despite of some advances in the treatment of diabetes mellitus the incidence of diabetic retinopathy (DR) development remains a stable value and often ends with complete blindness. In this connection, testing of drugs with a broad therapeutic spectrum that can simultaneously influence to various pathogenetic links of diabetic angio-retinopathy is relevant.

The aim of the study – to improve the efficiency of treatment in patients with diabetic retinopathy by the use of ACE inhibitors of moexipril with metabolic- and endothelial modifying drug tivorel, depending on the characteristics of the clinical course of the disease.

Material and Methods. 74 patients (148 eyes) were examined and treated for diabetes with different stages of DR. In 21 (28.4 %) patients the vascular stage of DR was diagnosed, in 20 (27.0 %) – exudative, in 15 (20.0 %) – hemorrhagic and in 18 (24.3 %) – proliferative retinopathy. By the method of treatment, the patients were divided into 4 groups: the control group consisted of 15 patients, DR in which they were treated according to the generally accepted method; the second group included 25 patients with different stages of DR, which additionally included Tivorel 100 ml intravenously daily for 10 days; the third group (18 patients with DR) received monotherapy with moexipril (15 mg/day); fourth (16 patients) – received a course of combined treatment with Tivorel and moexipril, followed by supportive treatment of moexipril in the dose of 7.5–15 mg / day for 6 months. In all patients, general clinical and specific ophthalmologic studies were performed in baseline, after 3 weeks and 6 months after the start of treatment.

Results. The presence of vascular changes on the bottom of the eye led to the decrease in visual acuity to a level that is within certain limits, characterised for each stage of DR. Thus, in the majority of cases (67.7 %), the visual acuity was detected in the vascular stage, in the exudative stage, such visual acuity was 38.6 % and in the rest of the patients it was within the range of 0.3–0.8. In patients with hemorrhagic and proliferative stages of DR, visual acuity was normal only in 21 % and in 12 % – respectively, while in the rest it decreased to (0.44±0.11). Perception in diabetic retinopathy is affected by one of the first and first of all was a violation of the perception of green color. Disturbance in contrast sensitivity was noted in 100 % of patients by more than 3.5 %. In the retinophotographic study of the bottom in patients with diabetes with diabetic retinopathy, an essential dependence of the microhemocirculation of the retina of the eye was found from the age, duration of the disease and the stage of DR. That was interpreted as a syndrome of capillary-trophic insufficiency with violation of metabolic and trophic processes and functional capacity of the eye.

Traditional complex therapy has proven to be the most effective in treating of initial stages of DR, where its efficacy reaches 67–71 %. Conversely, recommended therapy revealed insufficient angioprotective, hemodynamic and antioxidant effects in older patients, with long-term progression of the disease with the development of hemorrhagic and proliferative DR. Combined therapy with the inclusion of moexipril and tivorel was the most effective, clinical remission and restoration of visual acuity was achieved in 100 % of patients in the vascular stage, 62.5 % in exudative, 56 % in hemorrhagic and 22 % in proliferative retinopathy. At the next long-term (more than 6 months) supportive treatment of moexipril in 69 % of patients with diabetes mellitus, complicated by retinopathy, improvement of microhemocirculation of the retina and normalization of endothelial function of the vessels occurs.

Based on the above facts and comparing the results of the survey with the clinical efficacy of the four therapeutic programs, it can be concluded that the therapeutic efficacy of the proposed therapeutic programs was significantly higher in comparison with the complex of commonly used therapy in all selected subgroups of patients with different clinical stages of DR (P<0.05). It should also be noted that a significantly smaller number of patients with a lack (insufficiency) of the effect of the proposed treatment programs. The obtained results allow us to recommend the more widely used metabolic modifying nitric oxide donators (L-arginine) and ACE inhibitors in the complex therapy of patients with diabetic retinopathy.