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Place of publication: Bulletin of ophthalmology / vol. 140, No. 6, 2024

Resume
age macular degeneration (VMD) is a chronic multifactorial degenerative disease of the eyes, which is considered one of the main causes of irreversible blindness around the world. Despite numerous studies, there is no consensus regarding the predominant pathological mechanism leading to the death of photoreceptors. The IDMD is a disease based on molecular and cellular disorders, ultimately leading to the degeneration of photoreceptors. The review article presents the data of foreign and domestic researchers on the study of pathophysiological mechanisms for the development and progression of photoreceptor degeneration, scientific developments are given in relation to modern methods of therapeutic correction of identified disorders, and also presents promising areas of drug neuroretinoprotection, requiring confirmation in clinical studies.

Keywords: age -related macular degeneration, neuroprotection, retinoprotection, peptide bioregulators, antioxidants, ethylmethylhydroxypirine succinate.

Information about the authors:
Vlasova A.S. -https://orcid.org/0000-0002-6835-3393
Petrov S.A. -https://orcid.org/0000-0002-1566-2299
Renzyak E.V. -https://orcid.org/0007-0007-2258-2207
Author responsible for correspondence: Vlasova Anastasia Sergeevna-E-mail: okula-83@mail.ru
How to quote:
Vlasova A.S., Petrov S.A., Renzyak E.V. Neuroprotective therapy for age -related macular degeneration. Bulletin of ophthalmology. 2024; 140 (6): 152–158. https://doi.org/10.17116/oftalma2024140061152

Place of publication:
Bulletin of Ophthalmology, 2024, T.140, No. 4

Summary:
many key aspects of neurodegeneration of ganglion cells of the retina (GKS) with glaucoma are focused on mitochondrial dysfunction. Understanding the mechanisms and the relationships between structural and functional changes in mitochondria would be useful for development related to the mitochondria of the therapeutic strategy for the protection of GCS from glaucomone neurodegeneration. The purpose of the study. To find out the degree of severity of mitochondrial dysfunction in patients with primary open -angle glaucoma (POUG) and evaluate the possibility of stabilizing the glaucomic process by improving the functional activity of mitochondria, their energy -forming function against the background of therapy with Mexidol and Mexol Forte 250. Material and methods. The study was involved in 80 patients with a developed stage with compensated intraocular pressure and 20 healthy volunteers. The degree of severity of mitochondrial dysfunction was determined by the level of activity of mitochondrial enzymes: succinate dehydrogenase (SDH) and α-glycerophosphatedehydrogenase (α-GFDD)-in peripheral blood lymphocytes during cytochemical examination and cytomomorphodenxitis. Patients of the main group received consistent therapy with Mexidol with the following scheme: Mexoling a solution for intravenous and intramuscular administration of 50 mg/ml 300 mg per day intramuscularly 1 time per day for 14 days, followed by the purpose of Mexol Forte 250 1 tablet 3 times per 3 times aim Day for 56 days. Stabilization of glaucoma of optical neuropathy against the background of treatment was evaluated using a complex of perimetric, electrophysiological, structural-topographic methods in a period of 14, 56 and 90 days. Results. Against the background of consistent therapy, patients of the main group revealed a significant increase in the activity of mitochondrial enzymes compared with the initial level after 14 and 56 days with smooth regression by the end of the observation period (after 90 days), which was accompanied by an increase in the amount of mitochondria, an increase in their optical density in cytomorphodensitometry. Improving the enzymatic activity of mitochondrial enzymes in a period of 14 and 56 days was accompanied by a positive dynamics of structural-functional retinal indicators according to static perimetry, optical coherent tomography and a complex of electro-physiological studies. Conclusion. The data obtained can be used to optimize therapy for therapy by a decrease in mitochondrial dysfunction and stabilizing the glaucoma of optical neuroopticopathy. Keywords: primary open-angle glaucoma, mitochondrial dysfunction, succinate dehydrogenase, α-glycerophospatdehydrogenase, cytomomorphodenxometry, mexidol.

Place of publication:
Bulletin of ophthalmology, No. 4, t.139, 2023

Summary:
in patients with glaucoma, one of the main initiating mechanisms launching the chain of events, is a violation of the universal mechanism for regulating vascular tone due to endothelial dysfunction (ED). The main manifestation of the ED is the imbalance of vasoconstrictor and vasodilating endothelial mediators, the vastness of which triggers the mechanisms of adaptation distress, leading to the progression of morphological destruction, dyslipidemia, atherogenesis acucleration, the development of hemodynamic and hydrodynamic disorders. The drug Mexidol has a wide range of pharmacological activity, acting on the main pathogenetic links of the primary open -angle glaucoma (s). The purpose of the study. To study the vasomic, antioxidant and antihyplance effects of the drug Mexidol in patients with soup. Material and methods. The study includes 78 patients with the initial stage (n = 43) and the developed stage (n = 35), whose average age was 67.8 ± 1.5 years; 47 patients of the main group in addition to local hypotensive treatment were received by Mexidol, 31 patients compiled a control group. In comparison groups, the degree of ED was determined by the results of a sample with reactive hyperemia, investigated the level of stable metabolite of nitrogen oxide (ny2– nitrite) and endothelina-1 in blood plasma. The general assessment of oxidative stress was carried out by highly effective liquid chromatography. Studies of the functional activity of the retina were carried out using an electroretinograph and static computer perimetry according to the standard method. Results. Against the background of the use of Mexidol, in patients of the main group, the oscillator potential index is significantly increased, the inter-pertory latency decreases, the positive dynamics of perimetric indices, the improvement of the vascular endothelium in the sample with reactive hyperemia, the concentration of the Blood Plazm of the Mediator ET-1, and the moderate growth of nitrite are observed (NO2–) and a decrease in the bioactive vasotonic activity coefficient, the level of glutathioneperoxidase increases (p <0.05 compared to the initial value), the content of the spallic dyilladehyde is reduced, the lipid metabolism in patients of the main group (reducing the level of general cholesterol, low density lipoproteins, and low -density cholesterol, triglycerides, reduction of the atherogenic index compared to the initial value). Conclusion. Mexol's drug proved itself as an effective endothelioprotector, a powerful antioxidant and anti -enylaxant, contributed to a decrease in the factors of atherogenesis azecleization in patients with soup. Key words: primary open -angle glaucoma, endothelial dysfunction, Mexidol.

Place of publication:
Bulletin of ophthalmology, 5, 2022

Summary:
the development of diagnostic technologies in medicine, in particular in ophthalmology, made it possible to study the human eye not only at the histological, but also at the cellular level. The role of the nervous system in the operation of the visual analyzer is associated not only with the provision of motor, protective and sensory functions, but above all, with the provision of the visual process itself. Neurodegenerative diseases occupy a special place among systemic pathologies. Currently, the development of this process is associated with neo -sleeping, the role of which is confirmed by glaucoma. For this reason, achieving the target level of intraocular pressure does not always guarantee the stabilization of the degenerative process. Due to this, neuroprotectors are recommended to be used in any patient with glaucoma, taking into account the characteristics of the pathogenesis of the disease. Due to its antioxidant and neuroprotective properties of ethylmethylhydroxypyridine, succinate (Mexidol) is widely used in ophthalmological practice, in particular in the treatment of patients with optical neuropathy and retinal diseases. The research results showed the effectiveness of Mexidol in relation to the slowdown of neurodegeneration and stabilization of visual functions in patients with primary open -angle glaucoma due to the anti -hyphyxant, antioxidant and membranebusing properties of the drug and its positive effect on the neuromatible balance and eye bloodstreams. Keywords: ophthalmology, eye, neuro -drunk, glaucoma, glaucoma optical neuropathy, neuroprotection for glaucoma, ethylmethylhydroxypyridine succinate, Mexidol, Mexidol Forte 250.

Place of publication:
Effective pharmacotherapy, 2022

Summary:
the article is devoted to the complex therapy of primary open -angle glaucoma, namely, the understanding of the principles of neuroprotection in the pathogenesis of the development of the glaucoma of optical neuropathy. Various biochemical reactions are described that are involved in the apoptosis of the layer of nerve fibers of the retina and the processes of neurodegeneration. In the Russian Federation, a reference (original) antioxidant with a multimodal mechanism of action of Mexidol (ethylmethylhydroxypyridine is actively used in the Russian Federation. Due to its unique complex molecule - the pyridine base and derivative of amber acid, Mexidol is characterized by high bioavailability and the ability to penetrate through the hematoencephalic barrier. The presence of succinate in the molecule also enhances the antioxidant effect, which fundamentally distinguishes the drug from other antioxidant analogues presented in the domestic pharmaceutical market. The mechanism of action of Mexidol is based on antioxidant, antihyplance and membrane effects. The use of Mexidol, which affects different links of oxidative stress, is justified in the complex treatment of primary open -angle glaucoma. It is no coincidence that the drug is included in the standards of medical care in patients with glaucoma. An analysis of a number of publications containing the results of studies of ethylmethylhydroxypyridine of succinate in the primary open-angle glaucoma of the I-III stages. A consistent scheme of therapy with Mexidol with proven effectiveness, slowing down the processes of neurodegeneration and stabilizing visual functions in patients with primary open -angle glaucoma, has been developed. Keywords: glaucoma, Mexidol, antioxidant, neuroprotection, oxidative stress.

Place of publication:
Bulletin of ophthalmology, 6, 2015

Summary:
the goal is to develop an algorithm for neuroprotective treatment during the dispensary observation of railway workers with primary open -angle glaucoma (s) based on an assessment of the effectiveness of the phased use of intravenous and tablet forms of the drug Mexidol. Material and methods. The study included patients - workers of various professions of the Russian Railways company with stages I - III with a compensated level of intraocular pressure (IOD). Mexidol was prescribed 250 mg intravenously drip for 5 days in a daily hospital mode, then an outpatient basis 125 mg 3 times a day for 3 months. In the first, second and third visits, patients conducted a comprehensive ophthalmological examination using high -tech control methods. Results. Analyzed data from 58 patients (96 eyes). A reliable improvement of perimetry indicators, optical coherent tomography was received only to the third visit, at the end of the course of treatment with a tablet form of Mexidol. In patients with the I - II stage of the disease, the greatest effect of neuroprotective therapy was noted. Conclusion. The results obtained during the study allow us to recommend the appointment of patients with soup both combined therapy with Mexidol - injection and tablet forms, and long (3 months) isolated use of the tablet form of the drug. Neuroprotective therapy with Mexidol is most effective in the early stages of the disease.

The goal is to develop an algorithm for neuroprotective treatment during the dispensary observation of railway workers with primary open -angle glaucoma (s) based on the evaluation of the effectiveness of the phased use of intravenous and tablet forms of the drug Mexidol.

Material and methods. The study included patients - workers of various professions of the Russian Railways company with stages I - III with a compensated level of intraocular pressure (IOD). Mexidol was prescribed 250 mg intravenously drip for 5 days in a daily hospital mode, then an outpatient basis 125 mg 3 times a day for 3 months. In the first, second and third visits, patients conducted a comprehensive ophthalmological examination using high -tech control methods.

Results. Analyzed data from 58 patients (96 eyes). A reliable improvement of perimetry indicators, optical coherent tomography was received only to the third visit, at the end of the course of treatment with a tablet form of Mexidol. In patients with the I - II stage of the disease, the greatest effect of neuroprotective therapy was noted.

Conclusion. The results obtained during the study allow us to recommend the appointment of patients with soup both combined therapy with Mexidol - injection and tablet forms, and long (3 months) isolated use of the tablet form of the drug. Neuroprotective therapy with Mexidol is most effective in the early stages of the disease.

Key words: glaucoma, neuroprotective therapy, Mexidol, dispensary observation.

Bolmet Publications:
Labor Hygiene and Medical Ecology. No. 2 (47), 2015

Summary:
the article analyzes the results of an open comparative study of the effectiveness and safety of the drug Mexidol in a dosage form for injection as part of therapy in patients with open -angle glaucoma of various stages. During the clinical study, the good tolerance of the drug Mexidol in the dosage form is confirmed by the injection solution when prescribing it to patients with various stages of open -angle glaucoma in doses of 100-300 mg/day. intramuscularly within 14–21 days. It was proposed to include Mexidol, a multifaceted effect, in the composition of the complex therapy of patients of various stages, which has a multifaceted effect. The identified unwanted phenomena related to the prescription of this therapy are not serious, and the probability of their appearance is taken into account in the instructions for the medical use of the studied drugs. Thanks to membrane, nootropic, anti -hypoxic and antioxidant effects, Mexidol is recommended to be used in the complex therapy of optical neuropathy in the early and later stages of the disease.

Place of publication:
Russian Glack School, Glaucoma Conference Theory and Practice. No. 8, 2013, p. 33-37.

Summary:
Purpose of the study. To study the effectiveness of the drug Mexidol in the complex treatment of primary open -angle glaucoma. Materials and methods. The study included patients from 55 to 75 years with a diagnosis of signs I-III Art. on both eyes, with a normalized level of IOA (not more than 21 mm Hg according to Goldman); not having a serious ophthalmic and general somatic pathology that affects the course and results of the study; Benzodiazepine anxiolytics, anticonvulsant and anti -parquinsole drugs that do not use as concomitant therapy, as well as the last 3 months that do not participate in another clinical study.

Place of publication:
Bulletin of ophthalmology, No. 2, 2013

Summary:
The purpose of this study is to study the effectiveness and safety of the use of Mexidol as part of combined treatment of primary open -angle glaucoma (s). The study was involved in 94 patients (185) aged 18 to 75 years with the I -III staging, which were divided into 3 groups: 50 patients were prescribed combined treatment of 100 mg of Mexidol and 150 mg of picmilon, 22 patients took 300 mg of Mexidol and 150 MG picmilon, 22 patients received only 150 mg of picclon. Patients took drugs once a day for 14 or 21 days. The examination included standard ophthalmological, as well as perimetry, electroretinography, the study of the arterial blood flow of the retina and the optic disk. After taking combination therapy, an improvement in visual acuity, perimetry, electrophysiological parameters and increasing the velocity of arterial blood flow in the retina were recorded. Thus, combined therapy allows you to improve the treatment of patients with soup.

Place of publication:
experimental and clinical pharmacology, volume 75, No. 7, 2012, p. 20-26

Summary:
a prospective randomized simple “blind” controlled study of the influence of domestic derivatives of 3-oxypyrididine and ambercal acid (Emoxypin, Reimberin, Mexidol) on the effectiveness of the complex treatment of patients with primary open-angle glaucoma (Lugus) was carried out. It was established that the two-week intravenous administration of 3-oxypyridine derivatives (Emoxypin and Mexidol) has a retinoprotective effect after 14 days from the beginning of treatment with 3 months delayed by 3 months changes in blood flow velocity in the central artery of the retina (CAS). The rectinoprotective effect of Emoxypin (a single dose of 150 mg) was manifested by a decrease in the horizontal dimensions of a blind spot after 2 weeks, followed by a decrease in the ultimate diastolic velocity of the blood flow in the CAS, 3 months after the end of infusion therapy. The use of Mexidol (a single dose of 300 mg) after 14 days from the start of treatment caused an expansion of the total field of view when using a test object with an area of ​​16 mm2 with a concomitant decrease in the threshold of the optic sensitivity of the optic nerve and a decrease in the severity of the Lugus-Associated hypotimia. 3 months after the end of the introduction of Mexidol, all speed indicators of blood flow to the CAS increased. Reimberin (a single dose of a 400 ml of a 1.5% solution of reamberin, representing a combination of polyelectric mixture of sodium meglumin of succinate) did not have a retinoprotective effect, but caused prospective changes in the lipid spectrum of blood and an increase in the ultimate diastolic velocity of blood flow to the CAS. Mexidol, at the same time, which is a derivative of 3-oxypyridine and amber acid, exceeds the isolated derivatives of 3-oxypyrididine (emoxypin) and amber acid (reamberin) in terms of the severity of the retinoprotective effect, a positive effect on the condition of the optic nerve and the mood of patients of the soup.

Place of publication:
Bulletin of ophthalmology, No. 4, 2012

Summary:
a prospective placebo-controlled simple blind randomized study of the influence of Mexidol (2-ETIL-6-methyl-3-hydroxypyrididine of the succinate) on the dynamics of the optic nerve and high-speed blood flow and orbit arteries in comparison with changes in indicators of the networks of luminosity of the networks of luminosity of the networks of luminous sensitivity , visual acuity and size of the visual fields with a course intravenous introduction of Mexidol against the background of standard therapy of primary open -angle glaucoma. It was established that the intravenous administration of Mexidol in a single dose of 300 mg after 14 days from the onset of treatment causes a decrease in the threshold of electrical sensitivity of the optic nerve and the concomitant expansion of the total field of view when using a test object with an area of ​​16 mm ² . These effects of Mexidol were not accompanied by changes in blood flow in the arteries of the eyeball and orbit, were transient and leveled 3 months after the end of therapy. The delayed vasotropic effect of Mexidol was manifested by an increase in blood flow velocity in the central artery of the retina 90 days after the completion of infusion therapy.

Place of publication:
Clinical ophthalmology volume 12, No. 3, 2011

Summary:
the incidence of primary open-angle glaucoma (s) to this day is one of the most important medical and social problems. Glaucoma is one of the leading causes of blindness in developed countries, therefore, issues of improving the diagnosis and treatment of this disease are extremely relevant. The etiopathogenesis of glaucomas is complicated and, despite numerous studies, has not been fully studied. There is every reason to believe that it has a multifactor character. Glacker optical neuropathy (Gon) is due to the action of various factors leading to the apoptosis of the ganglion cells of the retina: with pressure of the optic nerve axons in the openings of the ethmoid plate due to increased intraocular pressure (IPD), impaired blood supply to the optic head, the formation of an excess of free radicals, in the way of ischemia and increased peroxidation of lipids (floor). With ischemia in the nervous tissue, protein synthesis is inhibition and the activation of anaerobic glycolysis, then the work of K-NA pumps and depolarization of cell membranes occurs. In response to this, a glutamate is released, which activates neurons through NMDA receptors, leading to an excessive amount of calcium ions into the cage. Excessively high concentration CA2+ in cells triggers the activation of complex nuclease cascades, protease and lipase. They directly affect intracellular proteins and lipids, as a result of which active free radicals are formed, as well as an excessive amount of nitrogen oxide (No), which can contribute to the development of the race. Various active forms of oxygen are formed, which have a cytotoxic effect on the retina, visual nerve, lead to destructive changes in the drainage system. In fact, mechanical and vascular factors realize their effects through metabolic processes.