A method of treating inflammatory diseases of the cornea

 

(57) Abstract:

The invention relates to ophthalmology. The method consists in the fact that the treatment of inflammatory eye diseases is carried out by coating the affected area of the flap with the supply base, as flap use autochtonous capsule, drug therapy carried out by introducing into the thickness of the flap solution of gelatin and at the base of his solution of the antibiotic, and the introduction of a solution of gelatin is produced only once directly after coating, and antibiotic solution - 1 every 3 days for 10-12 days, after which the flap tenon's capsule are removed. The method allows to avoid the development of complications, shorten the treatment time.

The invention relates to medicine, in particular to ophthalmology, and can be used in the treatment of ulcerative lesions of the cornea.

Widely known methods of treatment of inflammatory diseases of the cornea using drugs, enter in the form of instalaci, ointments, subconjunctival and parabulbar injection, electro - and phonophoresis [1, 2, 3].

The method can ensure the supply of a medicinal product directly in the area of inflammatory focus and sufficient is that it requires frequent, repeated administration to create the necessary therapeutic dose. In this regard, the treatment is long and there is the possibility of allergic reactions that can lead to complications such as deepening ulcers, perforation until the death of his eyes.

However, prolonged use of antibiotics, for example, leads to the development of resistance microflora to antibiotics, as well as lower trophic tissues, their structural transformation [4, 5, 6].

There are other methods of treatment of inflammatory diseases of the cornea, including coverage of its isolated biological tissues - haloragaceae [6, 7], fresh amnion [8], epicardially coating dried blood plasma [9], crushed cornea [10, 11], collagen [12].

These methods protect the affected area of the cornea from external influences, and create conditions for its purification from the products of necrosis, acceleration of reparative processes in the cornea due to the influence of biological tissue coverage, sorption and membrane properties. This is somewhat reduced compared with the above methods) duration of treatment.

The main pursuit of the formation of immune responses. In addition, the methods do not eliminate the need for lengthy and frequent administration of drugs. However, the methods associated with difficulties billet biological coatings, storage and sterilization.

There is a method of treatment of inflammatory diseases of the cornea by covering the affected area flap of tissue in the cornea and sclera on the supply leg [13, 14].

The method leads to a plastic repair of a defect of the cornea, eliminates the possibility of immune reactions to biomatrica, does not require prior procurement of donor material.

However, the method is difficult to perform and requires prolonged treatment periods up to several weeks.

In addition, plastic closure of the defect affected cornea cause additional trauma to the eye, the formation of additional tissue defect with the ability to spread the infection of inflammatory focus of the cornea and the development of complications and even death eyes.

Closest to the present invention is a method of coating the affected area flap own conjunctiva on the supply leg [15].

This method is taken as a prototype.

SPO is part of the cornea, actively influence the restoration of its structure, to stimulate reparative processes, to ensure the plastic effect and to protect it from external influences.

However, the allocation of conjunctival flap with vascular pedicle associated with the creation of cosmetic defects and dysfunction of the eyes that will later require reconstructive surgery and will significantly increase the treatment time up to several months.

In addition, because the density of the tissue flap is impossible to control the dynamics of the inflammatory process in the cornea, resulting complications can be unnoticed.

Because of the abundant vascularization conjunctival flap of his newly formed vessels, which can grow into the underlying tissue of the cornea and to facilitate the formation of vascular leukoma, reducing the function of the eye and require subsequent additional surgical treatment that may increase treatment time up to several years.

However, the method requires frequent, repeated and painful injections of drugs to create the required therapeutic concentration.

The technical result of the present avici.

This result is achieved by the fact that in the known method of treatment of inflammatory diseases of the cornea of the eye by covering the affected area with a cloth with the supply base and subsequent drug therapy according to the invention as a flap with the supply base use autochtonous capsule of the eye, and drug therapy carried out by introducing into the thickness of the flap solution of gelatin and the basis of his solution of the antibiotic, and the introduction of a solution of gelatin is produced only once directly after coating, and solution of antibiotic - 1 every 3 days for 10-12 days, after which the flap tenon's capsule are removed.

Used as a flap to cover the affected area of the cornea autochtonous capsules provides more additional nutrition to the cornea (in comparison with conjunctival coating) due to the presence in it of the lymph spaces, accelerates the repair and plastic processes in the diseased cornea, protects it from external influences. All this, taken together, prevents the development of complications, significantly speeds up the healing time of corneal defect, which is confirmed by us with the clinical observation points in her blood vessels excludes the possibility of the formation of vascular leukoma, reducing the function of the eye and require subsequent additional surgical intervention.

Use autochtonous capsule also prevents the formation of a cosmetic defect, the selection of the flap is not traumatic to the eye and does not affect its function.

Because of the tenon capsule is translucent and elastic connective tissue, this allows you to observe the course of the inflammation in the affected cornea not only through the flap, but also by mechanical displacement.

Introduction in the base of the flap of a solution of the antibiotic provides a therapeutic effect for the treatment of inflammatory lesions of the cornea, and the multi-layer mesh structure of the flap tenon's capsule, you can create it thicker depot medication that can a long time to enter the lesion and to provide the desired therapeutic effect within 1 day.

Introduction to the flap tenon's capsule of gelatin solution allows you to reinforce plastic and reparative processes in the diseased cornea and to have a positive impact on the trophic tissue.

In addition, since gelatin has a high sorbtive hearth, but to saturation drugs (antibiotics), this allows to prolong their therapeutic activity up to 3 days.

It tested us in the experiment on animals ' eyes (rabbits) with the experimental ulcer of the cornea and confirmed by clinical observations in patients.

This introduction of the antibiotic, as we have shown, it is necessary for 10-12 days, because by this time there is a complete resorption of the solution of gelatin from tenon's capsule, and the complete healing of the ulcer of the cornea allows the flap to remove.

The method consists in the following.

A patient with an ulcer of the cornea produce arcuate incision of the conjunctiva of the eyeball in its outer division parallel to the limb. Through an incision in the conjunctiva surgical scissors make the selection of the flap tenon's capsule in the form of a tape with a width twice the size of the inflammatory focus of the cornea during from top to bottom straight muscle preserving two supply bases. Flap cover the affected area of the cornea and strengthen it in this position by suturing to episclera region of the limb. The conjunctival wound impose a continuous seam. In the melting of the grounds - 0.2 ml of the antibiotic. In subsequent introduction of the antibiotic in the base of the flap produces 1 every 3 days for 10-12 days. After treatment, the flap is removed.

The essence of the method is illustrated by example.

Example 1. Sick,, 51, history N 1473, entered the eye Department of the Republican hospital, Petrozavodsk, September 7, 1994 with the diagnosis of deep bacterial keratitis, corneal ulcer in the left eye. Within 2.5 months of unsuccessfully treated as outpatients and inpatients.

Right eye healthy.

When receiving the complaints of pain in left eye, tearing, decreased vision.

Clinical biomicroscopic - left eye - mixed injection of the eyeball, in panopticism area of the cornea is oval-shaped infiltrate a size of 4 mm, a depth of 2/3 of the thickness of the cornea in the center of which is the plague 2 x 2 mm, the moisture front camera is transparent, the front camera is of medium depth, uniform, iris calm, the fundus of the eye reflex weakened due to changes in the cornea. Visual acuity 0,04 not also corrected.

Given the ineffectiveness of traditional methods of treatment for 2.5 months, the patient has expressed trophies the AI, the patient is recommended to ensure the use of tenon's capsule. The operation made on 8 September 1994.

Patient after local epibulbar anesthesia 0.25% solution dikaina, retro-bulbar anesthesia and akinesia age 2% solution of novocaine under the control of the operating microscope has made arcuate incision of the conjunctiva of the eyeball in the upper-outer his Department in parallel limb 5-7 mm from it. Through an incision in the conjunctiva surgical scissors made a selection of the flap tenon's capsule in the form of a tape with a width of 11 mm, length 15 mm, preserving two supply its grounds. Flap closed the affected area of the cornea and strengthened in this position the overlay to episclera near the limbus of the two seams on each base of the flap. The conjunctival wound left continuous seam. In column tenorowego flap in the area of the projection of the ulcer was injected with 0.3 ml of a solution of gelatin, and in both the base of the flap at the limbus, 0.2 ml (20 units) of a solution of gentamicin.

The postoperative course was favorable. Daily produced biomicroscopic control eyes, evaluated the dynamics of the inflammatory lesion in the cornea, examining it through a translucent gel-like teanaway maintain Olney reported a decrease of pain in the eye, reducing photophobia, watery eyes.

After 3 days was observed a decrease of the reactive edema and infiltration of the cornea.

September 11 was again introduced into the base of the flap 20% solution of gentamicin. Observed a further decrease infiltration of the cornea.

September 14 was repeated introduction of a solution of gentamicin in the base of the flap in the same dose.

On the 7th day after treatment was observed cleansing ulcers from necrotic tissue and evidence of epithelialization.

17 and September 20, twice made the introduction of 0.2 ml (20 units) of a solution of gentamicin in the base of the flap tenon's capsule.

On the 10th day showed complete epithelialization of the ulcer.

12 days after surgery established the absence of inflammatory responses eyes, full recovery of the epithelium of the cornea, and then made the destruction of tenorowego flap with scissors.

At discharge on September 22, 1994 - the eyes of calm, in the cornea in the area of ulcerative lesions has a translucent haze with stromal thinning and complete epithelialization. Vascularization of the cornea is not marked. Visual acuity of 0.2 not also corrected.

On examination, the patient after 1 year, in September 1995 the group of epithelium, no signs of vascularization.

In this way were treated 21 patients with keratitis of various etiologies. Of them with bacterial corneal ulcers - 7, herpetic ulcers - 10, keratitis mixed etiology - 4.

None of the 21 patients there were no complications requiring additional conservative or surgical treatment, and the development of which would be possible by using treatment method conducted on the prototype, and other conventional methods. It was noted a reduction of treatment time up to 2-3 weeks.

The proposed method is compared with the known has a number of advantages:

1. Prevents the development of complications such as the formation of vascular leukoma (in comparison with the prototype and analogues), due casinoplaytech actions autochtonous capsules and gelatin, as well as due to the effect of the coating on the trophic eyes and create a permanent therapeutic concentrations of the drug,

2. Allows you to reduce the treatment time up to 2-3 weeks, while the prototype treatment can take several months and even several years.

3. Reduces the number of injections of the antibiotic due to formirovanie treatments include daily its introduction.

4. Provides a painless injection of the antibiotic in Ternovoy capsule, which is important when treating children.

5. The method is technically more simple and easy to perform in any ophthalmic hospital, retraumatized and does not affect the function and cosmetics eye.

The method developed at the Department of pediatric ophthalmology at the St. Petersburg Medical Academy for postgraduate education and was clinically tested in 21 patients in the eye microsurgery Department of children's hospital No. 19 of them. K. A. St Petersburg and at the eye Department of the Republican hospital, Petrozavodsk with a positive effect.

References

1. Arkhangelsk Century. N. Eye diseases.- M: Medicine, 1963, 132 S.

2. Ceracchi L. E. physical therapy in ophthalmology. -Kiev: Health, 1979, 143 S.

3. Gandolas And Y. A. Ocular dosage forms in formation. - M.: Medicine, 1988, 254 S.

4. Cashiers I. A. Side effects of drugs. - M.: Medicine, 1971.

5. Puchkovska N. A. Treatment of superficial layer-by-layer keratoplasty and testimony to it. In the book: 6th national conference of ophthalmologists. -Kaunas: 1974, S. 93 and 94.

6. Puchkovska N. A. Tectonic keretapi. In kN. : So Dokl. 7th national conference of ophthalmologists of the ESSR. Tartu: 1987, S. 122.

7. Ivanov, C. F. Allosterically patients with inflammatory destructive disease of the cornea. In the book: So Dokl. 6-th Congress of ophthalmologists of Russia - M.: 1994, S. 299.

8. Batmanov Y. S. and other fresh amnion in the treatment of corneal diseases. Vestn. ophtalmol., - 1990, T. 106, 5, S. 17-19.

9. Pear O. C., Cherednichenko L. P. the Role of freeze-dried plasma in the process of healing of superficial lesions of the cornea. In the book: So Dokl. 7th national conference of ophthalmologists of the ESSR. Tartu: 1987, S. 83-85.

10. Talipova L. R., Talipov, R. A. a New method for the treatment of lesions of the cornea. In the book: So Dokl. 6-th all-Union Congress of ophthalmologists. -M.: 1985, T. 6, S. 35 and 36.

11. Michuk F. Y. New drugs and diagnostic tools for ophthalmic practice. Vestn. oftalmol. - 1988, 6, S. 5-9.

12. Zaporowski S. C. Collagen materials with injuries, inflammatory and degenerative diseases of the eye. Abstract. Diss. -SPb.: 1992, 3, 5 C.

13. Usdin M. I. Methodology autoclavability defect of the cornea when corroding ulcer of Moray. In the book: So Dokl. 4-th all-Union conference of the inventors of mologie.- Chisinau; 1981, 155 S.

15. Krasnov, M. M., Belyaev Century C. the Guide eye surgery.- M.: Medicine, 1988, 623 S.

A method of treating inflammatory diseases of the eye by covering the affected area with a cloth with the supply base and subsequent drug therapy, characterized in that as the flap is used autochtonous capsule, drug therapy carried out by introducing into the thickness of the flap solution of gelatin and at the base of his solution of the antibiotic, and the introduction of a solution of gelatin is produced only once directly after coating, and solution of antibiotic - 1 every 3 days for 10-12 days, after which the flap tenon's capsule are removed.

 

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