A method of treating inflammatory conditions of the iris and ciliary body, accompanied fibrinous exudation

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and is intended for the treatment of inflammatory diseases of the iris and ciliary body, accompanied fibrinous exudation. Perform laser irradiation on the area of projection of the iris with a wavelength of 0,488 μm, the radiation power of 1 mW, exposure 2-8 min before laser exposure subkonyunktivalno administered ascorbic acid and heparin, and the lack fibrinolizinom effect subkonyunktivalno enter urokinase dose 30000 ME. The method allows you to quickly and fully to arrest the inflammatory process in the area of the iris and ciliary body. 2 C.p. f-crystals.

The invention relates to medicine, namely to ophthalmology, and relates to methods of treating inflammatory conditions of the iris and ciliary body, accompanied fibrinous exudation.

There are various methods of treatment of inflammatory conditions of the iris and ciliary body. In particular, a number of methods associated with the use of pharmacological agents with anti-inflammatory or antimicrobial effect.

Also known lasern the red range 0,644 μm (helium-neon) (Chentsova O. B. and other "low-intensity helium-neon laser radiation in complex treatment of lesions of the cornea." Vestnik of ophthalmology, 1991, 6, S. 23-26)

The exposure was carried out with the help of therapeutic helium-neon laser with a wavelength of 0,644 μm for the treatment of diseases of the anterior segment of the eye: iridotsiklity, traumatic erosion of the cornea, the epithelial-endothelial dystrophy of the cornea, keratitis various etiologies.

As the laser light source used for laser helium-neon therapeutic setting LTM-01. To achieve therapeutic effect rasfokusirovka the laser beam is directed onto the cornea. The session duration was 5-15 min, capacity of 2 mW, a beam diameter of 5-10 mm, the continuous, the rate of 12-15 sessions.

The application of the described laser irradiation leads to the activation of metabolic processes in the ciliary body, restoring the functions of endothelial cells, reparation, which helps to restore the functions of the ciliary body and cornea in the postoperative period, as well as in other cases. This method is adopted for the nearest equivalent. The described method helps to restore the functions of the ciliary body, allows to improve the social barrier. The disadvantage of this method is anti-poor and lack fibrinoidnogo actions radiation of helium-neon laser, which is extremely necessary for edema effects fibrinous plastic iridocyclitis in the postoperative period.

The technical result of the proposed method is rapid and complete relief of the inflammatory process in the area of the iris and ciliary body. The technical result is achieved due to fibrinoidnogo effect provided by the combination of laser therapeutic exposure with a wavelength of 0,488 microns, reducing the pH of the moisture front camera, braking fibrinopeptide, activation of fibrinolysis. The method involves the use of therapeutic monochrome blue emitter light with a wavelength of 0,488 μm. The output power of the radiation head is equal to 1 mW beam diameter was 10 mm allows to reach in tissues maximally effective doses 2.5 j/cm2where there has been improvement of microcirculation in the vessels of the iris, reducing venous stasis, reducing the rate of aggregation of red blood cells, improving cell respiration due to the formation of singlet oxygen, growing from infrared to ultraviolet. At a power of 1 mW enegia photon blue spectrum is 220 kJ/mol, and the energy of electrostatic links fibrin molecules 200 kJ/mol, resulting in a unique fibrinolytic action monochrome emitter of this region of the spectrum compared to the other analogues. The most effective exposure time was recognized for 6-8 minutes, as at this time have a maximum structural alteration liquid media cell membranes.

In all cases, the sessions of laser irradiation was combined with subconjunctival injections of ascorbic acid and heparin. The ends of the fibrinogen molecules have a strong negative charge; this is due to the presence of a large number of residues aspartate and glutamate And in-field circuit and the field circuit C. in Addition, In the scope chain contains unusually negatively charged residue tyrosine O-sulfate. Negatively charged ends of the fibrinogen molecules not only contribute to the solubility of the latter in water, they push the ends of other molecules of fibrinogen, which prevents aggregation of the latter.

It seems advisable to use mild acids (ascorbic K-TA) in the form subconjunctival injection in m is s is to reduce the solubility of the molecules and to facilitate their aggregation, what prevents enzymatic hydrolysis (thrombin) fibrinogen into fibrin.

Most antithrombine activity characteristic of antithrombin III, which has a negligible endogenous activity and is strongly activated by heparin, which causes coenzyme a change of anti-thrombin III, leading to the ability to communicate with all the serine proteases, including trypsin. The daily dose is 750 UNITS.

In the absence of clinically significant fibrinoidnogo effect on the second day combination therapy all patients were additionally introduced a proteolytic enzyme urokinase dose me 0.5 ml of physiological solution, which activates plasminogen, splitting it in two places, turning it into plasmin. Urokinase was administered in the form of subconjunctival injections.

Thus:

1. Blue laser is the physical destruction of the fibrin clot at an early stage of its formation.

2. Reducing the pH of the moisture front camera (ascorbic acid) affects the solubility of fibrinogen, reduces access to thrombin.

3. Heparin provides violating the formation of fibrin monomers from Phi is brinolysis the plasminogen-plasmin (i.e., enzymatic hydrolysis of already formed fibrin conglomerate.)

The method is as follows. The patient after local anesthesia with 2% lidocaine solution make two subconjunctival injections of 750 IU of heparin 0.5 saline in the lower conjunctival fornix and 0.5 ml of 5% solution of ascorbic acid in the upper conjunctival fornix. Then carry out a focusing monochromatic beam on the cornea or iris. Laser treatment is carried out in the following mode: 1 mW, a beam diameter of 10 mm is Only performed from 3 to 10 sessions depending on the course of the inflammatory process. In the absence of a positive clinical dynamics together with heparin and ascorbic acid additionally used urokinase dose ME 0.5 saline as subconjunctival injections.

Example 1

Patient N. 63 years old, was on the surgical treatment with a diagnosis of OD-open-IIB glaucoma, OS-open-IIA glaucoma, OU-primary age-related cataract. On the second day after sinustrabeculectomia on OD in front of the camera expressed fibrinous exudation.

During the survey:

Vis OD=0.03 s/n IOP(P0)=21 MND

Vis OS=0,4 Sph+0,75=0,9 IOP(P0)=17 MND

the e, pathological discharges no, the cornea is slightly swollen, diffuse swelling of the epithelium, the endothelium multiple irregular precipitates, anterior chamber average depth of the moisture front camera opalestiruet (+++), threads of fibrin and inflammatory kletochnie elements in the moisture, iris swollen, figure stueven, basal coloboma 12 hours, iris and lens poorly differentiated for fibrinous exudate, more deep superficial environment is not ophthalmoscopically.

The patient underwent a course of treatment blue laser 1 mW 5 sessions over 8 min with a focus on iris combined with subconjunctival injection of 750 IU of heparin and ascorbic acid, and 0.5 ml of 5% solution.

1 day after start of treatment:

Vis OD=0,05 n/a IOP 18 MND

OD-local swelling of the epithelium, stromal edema of the cornea, the endothelium unformed precipiate, moisture front camera opalestiruet(++), fibrinogen membrane in the area of the pupil.

3 days after the start of treatment:

Vis OD=0,09 n/a IOP 18 MND

OD-light swelling stormy of the cornea, anterior chamber, the average depth on the endothelium aging precipitates, opalescence(+), swollen iris, the pupil gentle fibrinogen membrane reflex glienna injection, water filtration bleb, the seams are clean, Pat. detachable no, smooth transparent cornea, the endothelium of isolated irregular pigment precipitates, anterior chamber of the mean depth, moisture transparent, iris calm, basal coloboma at 12 hours, the pupil of 5 mm (the honey. mydriasis), on the anterior lens capsule remains fibrinogens membrane in the form of single tender cords. The reflex of the eye fundus pink.

Thus, during the whole course of the patient showed marked anti-inflammatory effect, starting from the first day to complete resorption of fibrinous exudate by the end of treatment.

Example 2

Patient P. 45 years old, was hospitalized with a diagnosis of OD-fibrinous plastic iridocyclitis.

During the survey:

Vis od=0,07 n/a IOP(P0)=18 MND

Vis OS=1,0 IOP(P0)=15 MND

Status oculorum: OD-mixed conjunctival injection, corneal slightly swollen, swelling of the epithelium, the endothelium multiple irregular and sporadic sebaceous precipitates, anterior chamber average depth of the moisture front camera opalestiruet (+++), threads of fibrin and inflammatory cellular elements in the moisture, iris swollen, figure stueven, planar beeliada environment is not ophthalmoscopically.

The patient underwent a course of treatment blue laser 1 mW of 8 sessions over 8 min with a focus on iris combined with subconjunctival injection of 750 IU of heparin and ascorbic acid, and 0.5 ml of 5% solution.

1 day after start of treatment:

Vis OD=0,08 n/a IOP 18 MND

OD-swelling of the corneal stroma decreased, on the endothelium unformed precipiate, moisture front camera opalestiruet(++), threads of fibrin in the anterior chamber.

3 days after the start of treatment:

Vis OD=0.2/n IOP 17 MND

OD-light swelling stormy of the cornea, anterior chamber, the average depth on the endothelium aging precipitates, opalescence(+), swollen iris, the pupil stored synechia, reflex ocular fundus faintly pink.

8 days after the start of treatment:

Vis OD=0,9 n/a IOP 14 MND

OD-light mixed injection, a smooth transparent cornea, the endothelium of isolated irregular pigment precipitates, anterior chamber of the mean depth, moisture transparent, iris calm, pupil of 6 mm(the honey. mydriasis), on the anterior lens capsule remains fibrinogens membrane and pigment in the form of single tender cords. The reflex of the eye fundus pink.

Example 3

Patient With. . Olesen spondylitis.

During the survey:

Vis OD=0,05 n/a IOP(P0)=21 MND

Vis OS=0.8 n/a IOP(P0)=16 MND

Status oculorum: OD-mixed conjunctival injection, corneal slightly swollen, swelling of the epithelium, the endothelium multiple irregular precipitates, anterior chamber average depth of the moisture front camera opalestiruet (+++), threads of fibrin and inflammatory kletochnie elements in the moisture, iris swollen, figure stueven, planar synechia from 10 a.m. to 3 p.m. and from 5 to 7 hours, iris and lens poorly differentiated for fibrinous exudate, more deep superficial environment is not ophthalmoscopically.

The patient underwent a course of treatment blue laser power of 1 mW of 8 sessions over 8 min with a focus on iris combined with subconjunctival injection of 750 IU of heparin and ascorbic acid, and 0.5 ml of 5% solution.

1 day after start of treatment:

Vis OD=0,05 n/a IOP 20 MND

OD-swelling of the corneal stroma decreased, on the endothelium unformed precipiate, moisture front camera opalestiruet(++), threads of fibrin in the anterior chamber.

3 days after the start of treatment:

Vis OD=0,06 n/a IOP 17 MND

OD-light swelling stormy of the cornea, anterior chamber of the average depth at VNA formed fibrinogen membrane in the plane of the pupil, the reflex of the eye fundus faintly pink.

Due to weak positive dynamics together with heparin and ascorbic acid solved primenenii urokinase dose ME 0.5 physiological solution in the form of subconjunctival injections.

8 days after the start of treatment:

Vis OD=0,8 n/a IOP 15 MND

OD-light mixed injection, a smooth transparent cornea, the endothelium of isolated irregular pigment precipitates, anterior chamber of the mean depth, moisture transparent, iris calm, pupil of 6 mm (the honey. mydriasis), on the anterior lens capsule remains fibrinogens membrane and pigment in the form of single tender cords. The reflex of the eye fundus pink.

The proposed method is applied in 150 patients with inflammatory diseases of the iris and ciliary body, accompanied by a fibrinous exudation, while positive results were obtained in 132 patients was not found dynamics in 18 patients. Complications were observed.

Thus, a method of treating inflammatory conditions of the iris and ciliary body, accompanied by a fibrinous exudation, allows in many cases to achieve rapid relief of inflammation in the anterior eye is fibrinozno exudation, including laser therapy on the area of projection of the iris, characterized in that before laser exposure subkonyunktivalno administered ascorbic acid and heparin, and laser therapy is performed with the wavelength 0,488 microns.

2. The method according to p. 1, characterized in that the laser is carried out with the radiation power of 1 mW, exposure 2-8 minutes

3. The method according to p. 1, characterized in that when there is insufficient fibrinolizinom effect subkonyunktivalno enter urokinase dose 30000 ME.

 

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