The way to prevent postoperative complications after implantation of artificial lens

 

(57) Abstract:

The invention relates to ophthalmology and is intended for the prevention of postoperative complications after implantation of the artificial lens. Patient before and after surgery impose additional mielopid within 3-5 days in a dose of 0.04-0.06 mg/kg not more than 5 injections. The method allows to achieve the prevention of postoperative complications after implantation of the artificial lens.

The present invention relates to medicine, namely to ophthalmology, and can be used in the treatment of patients with cataract, need surgical treatment.

The achievements of modern ophthalmic surgery has led to the extension of indications for intraocular correction afakii (Fedorov, S. N., Egorova, E. C. 1992, Savinykh Century. And. 1990). However, the postoperative period in 14-30,2% of cases complicated by prolonged inflammatory reaction (Rossa et al, 1994, Bobrov N. F. 1996, Fedorov S. N. 1992). Postoperative inflammatory response, inadequate surgical intervention volume, lengthens the postoperative period, increases length of stay of patients in hospital, affects the functional outcome of the operation.

Chirolracolo injury flows by type of response to stress, involving the reaction of all systems providing homeostasis.

In recent studies, showing that severe inflammatory reaction in response to minimal surgical trauma develops in violation of immunology, humoral, hemodynamic status, and body in General. The leading role in the development of inadequate inflammatory process belongs immune factors (Sadowska T. C. 1993, Veselovskaya H. F. 1989, Likhvantseva Century, 1992, Egorova, E. C. 1994). It is established that the failure of adaptive mechanisms, depression of the immune system is an unfavorable postoperative.

Thus, the development of new treatments based on immunokorrigiruyuschy impact, aimed at prevention and reduction of early inflammatory response in patients with intraocular aphakia correction, is an actual problem of modern ophthalmology.

The known method of prevention of postoperative complications after implantation of the artificial lens.

Sadowska T. C. "Clinical and immunological studies in patients with implantation of intraocular lenses in cataract various origins. Abstract. dis. Kida. the honey. Sciences. -Voronoi in the postoperative period in patients with artiphakia.

Immunological screening of patients with complicated postoperative period showed a significant decrease in cellular immunity T - lymphocytes, T-helpers, T-suppressors, the presence of sensitization to antigens of Uvea and lens detected in the reaction RTML and an antigen of rosethorne.

Studies of clinical and immunological status of patients with cataract extraction with IOL implantation has established the relationship between the state of immunoreactivity of the body of the patient and postoperative period, and allowed pathogenetically to justify the immune correcting means - nucleinate sodium in the treatment of patients with artiphakia. Immunological indication for nucleinate sodium was the decrease in the content of T-lymphocytes and their subpopulations with helper and suppressor function.

Nukleinat sodium used in complex therapy and was appointed in the early postoperative period along with the use of traditional medicines. The drug is used orally in the dose of 0.5 g 3 times a day for 7 days.

The application nukleinat receiving nukleinat sodium, at discharge from hospital was 0.1-0.2 higher than that in the group of patients who were treated according to the standard scheme. Length of stay of patients in hospital was reduced by 2-3 days. The positive dynamics of immunological status was reflected in the increased number of T-lymphocytes, teophelinresistent and definintely T cells with helper and suppressor activity, sensitization to antigens of the lens and the choroid were not found.

The results obtained have allowed the author to recommend the use of nucleinate sodium in pre - and postoperative period in patients with immunosuppression for prevention of exudative reaction in the postoperative period after implantation of intraocular lenses.

However, used in the work routine methods 1 level immunodiagnostics, which aims to identify only the quantitative fluctuations of T - and b-lymphocytes and detection of sensitized cells in the peripheral blood of patients. Not opened key points immunopathological reactions underlying the development of complications in the postoperative period.

In this regard, the author was employed by factors of immunity, the proliferation of b - and T-lymphocytes.

The drug is used orally in the dose of 0.5 g 3 times a day for 7 days. Positive therapeutic effect was observed not earlier than the 5th day from the start of treatment, which does not allow to consider the use of nucleinate sodium as a fast tool in the treatment and prevention of exudative complications in patients with intraocular lens implantation.

There is also known a method of preventing the inflammatory response of the eye after cataract extraction with implantation of an artificial lens.

Veselovska H. F., "Prediction and prevention of the development of the inflammatory response of the eye after cataract extraction with implantation of an artificial lens

Abstract.dis.. Dr. med. Sciences, Odessa, 1989 - 30 s

The author proposes a scheme of pre-operative preparation of patients at risk. The scheme involves the application of askorutin, Ca gluconate, indomethacin and dexamethasone injection and instillation in the prevention of severe uveitis with exudative component in patients with artiphakia in the postoperative period.

The proposed scheme is based on the author's concept of the pathogenesis of severe uveitis after extraction cataractae state of metabolic processes in the eye, creating in patients with cataract unfavorable background predisposition to the development of the expressed clinical signs of postoperative uveitis.

The dependence of postoperative uveitis from the temperature coefficient of the cornea, the concentration of protein in eliminate eyes and the number of leukocytes in regional blood flow of the eyeball.

The influence of the immune system (decreased T - and b-lymphocytes) on the severity of postoperative sore eyes.

The indication for preoperative preparation was increasing temperature coefficient (TC), the concentration of protein and prostaglandin in eliminate of the moisture front camera, index increase besttransport with antigens of the lens and declining cellular immunity (T and b - lymphocytes).

The proposed scheme pre-operative preparation of patients at risk, which involves the application within 7 - 21 days askorutin, Ca gluconate, indometacin pills and dexamethasone injection and instillation. For all its efficiency of the proposed scheme has several disadvantages - firstly, the duration of use up to 21 days in lateline, as it can worsen the condition of the coronary blood flow. Indomethacin belongs to the nonsteroidal anti-inflammatory drugs, which have a number of side effects that can not be ignored when treating elderly patients. First and foremost is ulcerative lesions of the gastrointestinal tract, kidney function, inhibit chemotaxis and aggregation of neutrophils, cellular activation of leukocytes, but at the same time enhance the proliferative ability of T-lymphocytes. Dexamethasone injection and instillation slows down the regeneration of tissues after surgery, increases the risk of viral, bacterial, and fungal infection.

The closest in nature pathogenetic orientation is the way Likhvantseva Century, "Clinical and immunological factors in patients with cataract with IOL implantation." Abstract. dis. Kida. the honey. Sciences. M., 1992, 20 S.

In the work proposed for the prevention and treatment of exudative reaction in patients with artiphakia pre - and postoperative immunotherapy.

The scheme provides for the introduction of gemodeza, native plasma, aminocaproic acid, ascorbic acid.

The basis for the development of this method was discovered by the author of the>the immune status of patients with cataracts, with a predominance stimulate local and systemic autoimmunity. Immunological examination of patients was carried out in dynamics before and after surgery and included:

- determination of the level of auto-antibodies to DNA (native and denatured) in the serum;

the sizes and concentrations of CIC (circulating immune complexes) in the serum and tear fluid

the sizing of the CEC;

- study the functional activity of the alternative pathway of complement in serum and tear.

The indication for the use of preoperative preparation with the inclusion in the scheme gemodeza, native plasma, aminocaproic and ascorbic acid and as an intravenous or intramuscular injection was identification before surgery increased levels of DNA auto-antibodies in serum, or the simultaneous detection in serum and tear fluid circulating immune complexes (CIC) average molecular masses in high concentrations.

Detection described above immunopathological changes is the indication for preoperative and postoperative immune.

Before the ith disintegration and elimination of the CEC from the body: native plasma, gemodez, and drugs modulating the activity of the alternative pathway of complement: E-aminocaproic, ascorbic acid.

Despite the effectiveness of the method has several disadvantages. The offered drugs are administered intravenously and often have a high allergenicity, and there are known cases of anaphylactic shock with the introduction of native plasma ascorbic acid. Gemodez has a toxic effect on the endothelium of the renal glomeruli, and in the presence of a chronic process in the kidneys, the introduction of this drug may worsen the General condition.

Thus, further investigation of the links immunopathological reactions in patients with artiphakia to better identify risk factors for exudative reactions in the postoperative period and ultimately the development of pathogenetic, fast and secure methods of prevention and treatment of this condition remains a topical problem in ophthalmology.

Goal - improving the efficiency of treatment of patients with cataract and improved outcomes of operations with implantation of artificial lens through prevention and treatment of inflammatory reactions niodnogo immune status of patients with cataract during artiphakia.

2. The definition of clinical and immunological criteria, the risk of inflammatory reactions in the postoperative period.

3. The study of immunopathological changes in the postoperative period.

4. Substantiation of rational treatment and prevention of inappropriate inflammatory reactions in patients with artiphakia.

The essence.

Patient before and after surgery impose additional mielopid within 3-5 days.

The nature of the proposal.

The method is as follows.

In patients with cataract assessment of immune status, including:

1) delaboratory diagnosis by a secondary immunological map, developed at the Institute of immunology;

2) laboratory evaluation of the immune status using immunological methods I and level II: determination of peripheral blood T-(BG3) and b-lymphocytes (SD), subpopulations of T-lymphocytes (T-helpers/inductors CD4 and T - suppressor/killer CD8) expression of E-receptor on the membrane NG (early Ep-POH and later E-POH);

cytochemical indices NG: cationic protein (KB), myeloperoxidase (MP), neutral polysaccharides (NG), indicators of fictiune secondary immunological failure patient is assigned mielopid.

30-40 min before the operation the patient enter mielopid.

The drug is used in the form of intramuscular injections is used to 0.3-0.6% solution. For the preparation of 0,3-0,6%-aqueous solution of 1 or 2 bottles of the drug containing 3 mg of active substance, dissolved in 1.0 ml of sterile isotonic sodium chloride. The drug is used in the form of a single injection daily dose of 0.04-0.06 mg/kg of body weight over the next 2-4 days.

After injection of mielopid postoperative period has a smooth flow, not observed any complications or amplification of the inflammatory response.

The immunological indexes indicate the increase in the number of T-lymphocytes (LED3), the normalization of b-lymphocytes, increased to normal values of T-helper cells (CD4) and T-suppressor (CD8), normalization Ep-POH and lower Tu-RON, increase the absorptive and digestive functions NG.

Examples of implementation.

B-e-Reva 61,, East.bol. N 154, was admitted to the hospital with a diagnosis of Mature cataract of the right eye.

History of chronic bronchitis, allergic to penicillin.

Admission: ONE - eye relaxed. The cornea is spherical, transparent, shiny, smooth. The front camera of uniform, medium is no light on. In the lumen of the pupil cloudy lens. The fundus of the eye reflex is not received. IOP = 22 mm RT.article Visual acuity of the right eye = light sensation with the correct projection. Visual acuity of the left eye = 0.7 s Corr. sphere - 1,0 D = 1,0. The left eye is calm. In the lens seal seams, single subcapsular vacuoles. Otherwise, without features.

The patient performed extracapsular cataract extraction with implantation of an intraocular lens from PMPA with fixation in the capsular bag (model Alekseev). The surgery went without any technical difficulties. Assigned to anti-inflammatory treatment. Given the presence of clinical signs of WINES (chronic bronchitis, allergic reaction to penicillin), the patient was classified as immunological skomprometirovana persons In the tests before surgery disorders have been observed in the T-system of immunity and system NG: LED3=58%, CD4=33%, CD8+18%, SD =18%, pE-POH=40%, PE-RON=49%. Contents KB=2.6 services units, MP= 2.0 services.ed., NP=1.7 services.ed., %F=55%, FC=2,1, %N=48%.

Given the presence of clinical signs of WINES and a decline in cellular immunity, inhibition of phagocytic link to treatment added mielopid 3 mg intramuscularly daily N 5. The first injection was done for 40 min before the operation.

The patient was discharged from the hospital on the 8th day. During the whole observation period (3 months) eyes remained calm. Visual acuity was 0.9 without correction. Signs of uveitis were observed.

B-Neu-kin Century,, 63,, East.bol. N394, was admitted to the hospital with a diagnosis of Mature cataract of the right eye.

A history of cholecystectomy, atherosclerosis.

When one eye is calm. The cornea is spherical, transparent, shiny, smooth. Front camera uniform average depth of moisture clean. Iris calm, somatropina, the pupil is centrally located, responds to light In the lumen of the pupil cloudy lens. Reflex eye Nam is not received. IOP = 23 mm RT.article Acuity of light perception with the correct projection. Visual acuity of the left g the I moderately expressed.

Patients received extracapsular cataract extraction with implantation of intraocular lens fixation in the capsular bag (model Alekseev). The surgery went without complications. Assigned to anti-inflammatory treatment.

In the immunological before surgery disorders have been observed in T - and NG-systems. SRS = 66%, CD4 = 40%, CD8 = 24%, SD = 19%, d-RON = 38%, PE-RON = 40%, KB = 1.3 services. units, MP = 1.5 services. units, NP = 1.6 services. units, %f =67%, FC= 5,0, %N = 30,2%.

Given the decline in cellular immunity, inhibition of phagocytosis, treatment added mielopid 3 mg intramuscularly daily N3.

The first injection with the protective order did 40 min before the operation.

On the 7th day after the operation, the eye almost calm, a slight injection of vessels in the area of conjunctival scar. The transparent cornea, anterior chamber, the average depth, humidity, net, Tyndale-0, iris calm, artiphakia the posterior capsule is transparent. With fundus reflex rose. Visual acuity of 0.6-corrected IOP =21 mm RT.article.

In immunograms LED3 = 70%, CD4 = 42%, CD8 = 29%, SD = 23%, d-RON 40%, PE-RON - 41 %, KB = 1.5 sm. units, MP = 1,34 srvc.ed., NP = 1.9 services. units, %f = 71%, FC = 4,2, %N = 72%

The patient was discharged on the 8th day from the hospital. During the whole period was nabljudalaos.

The way to prevent postoperative complications after implantation of artificial lens, including the use of medication, wherein the patient before and after surgery impose additional mielopid within 3 to 5 days at a dose of 0.04 - 0.06 mg/kg not more than 5 injections.

 

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FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

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