EC Ophthalmology

Degradation of the corneal stroma is caused by an imbalance of a number of enzymes of the prooxidant and antioxidant systems. An imbalance in the enzymes of the prooxidant and antioxidant systems causes thinning of the stroma and the appearance of stromal scars.

The purpose of our study was to evaluate the neurotrophic regulation of metabolic processes in patients with early stage keratoconus and the possibility of correcting conservative treatment depending on the identified imbalance.

The study used the results of observation of patients with stages I - III of keratoconus (classification by M. Amsler (1961), J. Krumeich (1998). All patients with corneal and corneoscleral rigid gas permeable contact lenses of various models and manufacturers. Duration of observation from 2005 to 2019 year, along with the study of the ophthalmological status of the patients, before starting conservative treatment, cardiointervalography was performed to clarify the vegetative status.

In 97% of cases, autonomic dysfunction was determined in our patients, while in 85% of all those examined, a significant predominance of sympathicotonic neurotrophic regulatory processes was determined. Based on this, we have proposed an effect that allows, at the first stage, to enhance cholinergic neurotrophic regulatory influences and activating aerobic processes in the tissues of the eyeball. At the next stage of treatment for keratoconus, they provide membrane stabilizing (regulation of the synthesis of phospholipids and proteins, stabilization and normalization of the structure of cell membranes), antioxidant (inhibition of the formation of free radicals and lipid peroxidation of cell membranes), and antihypoxic effects.

Analysis of the results of long-term (more than a year) observation of patients with keratoconus receiving conservative treatment aimed at normalizing the neurotrophic effect on regenerative processes in the tissues of the eye showed the possibility of stabilizing the pathological process and revealed disease progression in only three patients from the group with stage II keratoconus, 4% of all patients). All other patients experienced long-term stabilization of the disease. Three patients who had progression of keratoconus from stage II to stage III underwent a corneal collagen cross-linking procedure.

 Keywords: Keratoconus; Monitoring; Autonomic Reactivity; Neurotrophic Regulation; Oxidative Stress; Conservative Treatment of Keratoconus

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