EVALUATION OF THE EFFECTIVENESS OF ENZYMATIC TREATMENT IN POSTOPERATIVE COMPLICATIONS WITH PRIMARY CONGENITAL INFANTILE GLAUCOMA

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 234 EVALUATION OF THE EFFECTIVENESS OF ENZYMATIC TREATMENT IN POSTOPERATIVE COMPLICATIONS WITH PRIMARY CONGENITAL INFANTILE GLAUCOMA Yu.A. Khamroeva Tashkent State Medical University, Tashkent, Republic of Uzbekistan https://doi.org/10.5281/zenodo.17540044 Abstract. This article is devoted to the study of the effectiveness of enzymatic therapy in the treatment of complications associated with fibrinoid syndrome in the early postoperative period of primary congenital infantile glaucoma. The following methods and materials were used in this study: In the ophthalmology department of the multidisciplinary children’s clinic of Tashkent State Medical University, 16 patients (32 eyes) aged 3 to 10 years with a diagnosis of primary infantile glaucoma were treated. Among the patients, there were 10 boys (62.5%) and 6 girls (37.5%). All patients underwent surgical intervention. In the early postoperative period, complications such as fibrinoid syndrome developed in some patients. To treat this complication, an enzyme preparation with proteolytic activity (Chymotrypsin 10,000 IU diluted in 4.0 ml of 0.9% sodium chloride solution) was applied to the eyes according to a specific regimen. Patients who developed complications in the early postoperative period were divided into three groups depending on the type of complication: Group I: 8 patients (16 eyes) with exudative reaction. Group II: 3 patients (6 eyes) with pigment deposits on the anterior capsule of the lens. Group III: 5 patients (10 eyes) with hyphema of the anterior chamber. Keywords: primary congenital infantile glaucoma, lens, intraocular hemorrhage. Introduction. Since 1993, reports have appeared in the literature on the use of domestically produced urokinase and prourokinase in ophthalmology. These enzymes were used for the treatment of intraocular hemorrhages and fibrinoid syndrome after lensevitrectomy [1,2,3]. In 1996, E.V. Boyko and co-authors proposed the use of a recombinant prourokinase preparation for the same purpose [3]. The drug was applied not only in cases of hemophthalmos but also for other intraocular hemorrhages such as hyphema, intraretinal, preretinal, and subretinal hemorrhages. In 1999, this preparation received the name “Gemase.” Initially, Gemase was developed as a thrombolytic agent for the treatment of cardiovascular diseases. However, numerous studies conducted by domestic researchers revealed new potential applications of this preparation in ophthalmology. Today, Gemase is widely used in the treatment of acute circulatory disorders in the retinal vessels [4,5], intraocular hemorrhages and postoperative fibrinoid syndrome [6,7,8,22], intraocular traumatic hemorrhages [5,7], hemophthalmos in patients with diabetic retinopathy [8,9,18], as well as in the surgical management of submacular hemorrhages [10,11,21] and proliferative diabetic retinopathy [12,13,20]. The active substance of Gemase is the recombinant fibrinolytic proenzyme prourokinase, produced by genetically transformed Escherichia coli bacteria [5]. The mechanism of action of Gemase is as follows: under the influence of small doses of plasmin, prourokinase is converted into the active form of plasminogen activator—urokinase—which in turn catalyzes the conversion SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 235 of plasminogen into plasmin [6,6]. It is important to note that in a fibrin-free system, urokinase is the most active plasminogen activator [3,4]. Gemase is characterized by an almost complete absence of allergenic properties and a high degree of specificity. It has an increased affinity for fibrin and is resistant to plasminogen activator inhibitors [5]. Currently, Gemase is widely used in ophthalmology to improve the effectiveness of treatment for hemophthalmos of various origins, hyphema, fibrin exudation after cataract extraction and lensevitrectomy, thrombosis of the central retinal vein and its branches, prethrombotic conditions, for correcting local hemostasis in diabetic retinopathy and its hemorrhagic complications, as well as during antiglaucomatous surgeries to prevent adhesions and blockage of the filtration opening. The drug demonstrates high efficacy and almost complete absence of side effects [2,3,4,5]. Various methods of Gemase administration have been described in the literature: subconjunctival, into the anterior chamber of the eye, parabulbar at a dose of 5000 IU, intravitreal (500 IU), or by sub-Tenon implantation of a collagen infusion system. The highest concentration of the drug in the vitreous body is achieved with intravitreal administration [5,6,14,15]. Enzyme therapy has become firmly established in the arsenal of ophthalmologists [6,7,8,19]. Enzymebased medications are used to treat many diseases and are especially effective in the lysis of thrombi and fibrin [4–8]. At present, one of the main causes of visual impairment leading to disability remains the combination of glaucoma and cataract. According to various authors, this combination is observed in 17–76% of cases, and such variability is quite significant [12,13,14,15,16,17]. In 2000, Fedorov S.N., Malyugin B.E., and Jndoyan G.T. developed and introduced into clinical practice a new method for treating glaucoma in eyes with cataract — enzymatic trabeculocleaning during phacoemulsification. An important feature of this approach was the intraocular use of enzymes in the surgical treatment of glaucoma, where the introduction of hemazum at a dose of 500 IU into the anterior chamber was combined with the hydromechanical component of trabecular cleaning. The outcome of this new surgical procedure was an improvement in visual acuity and a stable normalization of intraocular pressure and aqueous humor outflow parameters [5,6]. Thus, the use of enzymatic therapy for complications involving fibrinoid syndrome in the early postoperative period remains relevant. Objective of the study: to evaluate the effectiveness of enzymatic therapy for complications with fibrinoid syndrome in the early postoperative period in primary congenital infantile glaucoma. Materials and methods. Under our observation at the ophthalmology department of the multidisciplinary children's clinic of Tashkent State Medical University, 16 patients (32 eyes) were treated, including 10 boys (62.5%) and 6 girls (37.5%) aged 3 to 10 years with primary infantile glaucoma. All patients underwent surgical treatment. In the early postoperative period, complications such as fibrinoid syndrome were treated using an enzymatic (proteolytic) preparation administered in the form of instillations according to the following scheme: chymotrypsin 10,000 IU diluted in 4.0 ml of 0.9% sodium chloride solution. The children with early postoperative complications associated with fibrinoid syndrome were distributed as follows:  Group I: patients with early postoperative exudative reaction — 8 patients (16 eyes);  Group II: patients with pigment deposits on the anterior capsule of the lens — 3 patients (6 eyes); SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 236  Group III: patients with anterior chamber hyphema — 5 patients (10 eyes). To assess the content of cells and protein in the aqueous humor, the table for determining the degree of protein content in aqueous humor (Hogan M.J. et al., 1959; SUN Working Group, 2005) (Table 1) and the grading system for protein concentration in the anterior chamber fluid by L.A. Katsnelson and V.E. Tankovsky (2003) (Table 2) were used. Table 1. Content of Cells and Protein in the Aqueous Humor Step Description 0 Not exist 1+ Weak 2+ Moderate (the iris and lens are clearly visible) 3+ Pronounced (the iris and lens are seen through a haze) 4+ Significant or intense (fibrin or plastic exudate present) Table 2. Degree of Protein Content in the Aqueous Humor of the Anterior Chamber Step Description 0 (noy exist) Aqueous humor is transparent 1 (weak) Protein present in the anterior chamber, but the structure of the iris and lens is clearly visible 2 (pronuonced) A significant amount of protein in the anterior chamber; the iris and lens are seen through a haze, but their structure remains distinguishable 3 (maximum) A large amount of protein and fibrin; the structure of the iris and lens is not distinguishable All patients in the study groups received the enzymatic proteolytic drug Chymotrypsin as part of their comprehensive treatment, following the official usage instructions. Before surgical and conservative treatment, all patients underwent a standard ophthalmologic examination, which included visometry, biomicroscopy, gonioscopy, ophthalmoscopy, refractometry, tonography, and tonometry (10.0 g according to Maklakov). For data analysis, the results of the ophthalmologic examinations were processed using statistical analysis methods with the help of Microsoft Excel and SPSS software. Differences between the mean values (M ± σ) were considered statistically significant at P ≤ 0.05. Results and Discussion. During the examination, it was established that in patients of Group I—those with exudative reaction (8 patients, 16 eyes)—a moderate reaction (the iris and lens clearly visible) appeared on the second day after surgery. In Group II (3 patients, 6 eyes), with pigment deposits on the anterior capsule of the lens, pigment cells from the iris were found in the anterior chamber on the third postoperative day. In Group III (5 patients, 10 eyes), with blood elements (hyphema) in the anterior chamber, changes were observed 4 hours after surgery. To eliminate fibrinoid syndrome, the enzymatic proteolytic drug Chymotrypsin was added to the comprehensive treatment regimen. On the third day, the degree of fibrinoid syndrome was evaluated across the groups, and the results are presented in Table 3. Table 3. Evaluation of Fibrinoid Syndrome After Comprehensive Treatment Type of content On the 1st day after surgery On the 3rd day after surgery On the 5th day after surgery SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 237 Exudation (protein) Moderate (the iris and lens are clearly visible) – 6 patients (12 eyes) Mild – 2 patients (4 eyes) Absent Pigment (iris) Pigment elements in the anterior chamber; the iris and lens are seen through a haze, but their structure remains distinguishable – 2 patients (4 eyes) Pigment elements in the anterior chamber, but the structure of the iris and lens is clearly visible – 1 patient (2 eyes) Aqueous humor is transparent Hyphema (blood element) A large amount of blood elements (hyphema); the structure of the iris and lens is not distinguishable – 3 patients (6 eyes) A significant amount of blood elements (hyphema) in the anterior chamber; the iris and lens are seen through a haze, but their structure remains distinguishable – 1 patient (2 eyes Blood elements (hyphema) in the anterior chamber, but the structure of the iris and lens is clearly visible – 1 patient (2 eyes) Based on the results by groups, exudation (protein) and pigment (iris) after surgery were completely eliminated (100%) in 20 eyes of 10 patients, and by 75% in 2 eyes of 1 patient. 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