A method for preventing recurrence of erosion and ulceration of the cornea with bilateral eye burns

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and for the prevention of recurrence of erosion and ulceration of the cornea on the eye ended with the healing of burn wounds with bilateral burns after keratoplasty about ulceration of the cornea of one eye. To do this, in the eyes ended with healing directly after surgery on the other eye, within two weeks subconjuctival and parabulbarno impose anti-inflammatory and antiproteolytic drugs. The method allows to prevent relapse of erosion and ulceration of the cornea on neoperabelnom eye. 2 Il.

The invention relates to the field of medicine - ophthalmology, and is intended to prevent recurrence of erosion and ulceration of the cornea on the eye with savertime the healing of burn wounds with bilateral burns after keratoplasty about ulceration of the cornea of one eye.

Treatment of patients with bilateral burns eye injury remains an urgent problem in ocular trauma care. Often the process of destruction of damaged membranes of eyes and continues on the background using the most modern methods of Ksenia clinical picture, some time after the injury is replaced by the slow process of healing, the emergence of recurrent erosion of the cornea, the growing processes of destruction of corneal tissue and the risk of perforation of one of the two affected eye. This calls for urgent therapeutic keratoplasty for the purpose of eliminating the threat of corneal perforation. At the same time, we observed that after 2-3 weeks after keratoplasty about the threat of perforation of the cornea of one eye, the other eye with previously completed the healing of burn wounds relapses erosion and Yasmine of the cornea.

It is known that the result of trauma, one eye on the pair intact eye usually occurs friendly reaction, manifested in changes of electrophysiological, immunological, biochemical, and other indicators. For these parameters defined the limits of physiological norm, the excess of which indicates that an induced pathological process in the fellow eye (post-traumatic and postoperative sympathetic ophthalmia, bilaterial process in endogenous unilateral uveitis) and requires special medical treatment.

However, if the burn injury, especially bilateral, this problem remains unstudied in bilateral burn eye lesions in the literature we have not found.

After burns of the cornea is one of the main causes of destruction of the cornea is increased proteolytic (MP) and a decrease antiproteolytic (ATL) activity in the tissues of the affected eye (N. Chesnokov.B. "The role of proteolytic enzymes and their inhibitors in the pathology of the cornea", dissertation Prof. the honey. Sciences. Moscow, 1991).

As biochemical indicators of the inflammatory and reparative process in the cornea, we studied the activity of trypsin-like proteolytic enzymes and their inhibitors:1-antitrypsin and2-macroglobulin. Trypsin-like proteases play an important role in inflammatory and reparative processes, as carried out the destruction of damaged tissue elements, thus preparing the wound surface to repair and regulate the levels of mediators of inflammation, migration of cells involved in inflammation and the formation of their predecessors active forms of the enzymes, etc.

However, excessive protease activity can lead to the destruction of native tissues and strengthening of destructive processes. The most universal control mechanism of proteolysis is control by the end of the balance between aktivnosti proteolytic enzymes and their inhibitors. The study of the activity of trypsin-like proteases,1-antitrypsin and2-macroglobulin in the tear fluid of patients and experimental animals with burns of the cornea, keratitis, as well as in patients undergoing keratoplasty, has allowed to establish the existence of dependencies between the dynamics of these indicators and the nature of the clinical manifestations of the disease (N. Chesnokov. B., "the Role of proteolytic enzymes and their inhibitors in the pathology of the cornea", dissertation Prof. the honey. Sciences. Moscow, 1991). Analysis proteinase-inhibitory balance in the tear fluid provides objective information about the course of pathological process in the cornea and allows you to decide on the indications and correction method proteolysis.

There is a method of treatment of erosion and ulceration of the cornea, proposed by N. Chesnokova, B. , consists in the correction of proteolytic activity in the tissues of the eye by introducing subconjunctival and installations antiproteolytic drugs - Gordons, kontrikala, antisana.

However, this method involves the treatment of an already existing erosion and ulceration of the cornea.

Clinical observation of the phenomenon of relapse erosion and ulceration of the cornea on the eye is and the other eye in patients with bilateral severe burn injury eyes demanded an experimental study on rabbits.

Alkaline burns of the cornea severe rabbit was modeled as follows: mugs from crisp cotton with a diameter of 7 mm, soaked in 10% NaOH was applied to the Central region of the cornea, 40 with the circles were removed and the eyes were washed with 20 ml of saline.

After 3-4 weeks the rabbits were formed deep corneal ulcer in one eye. In doubles the affected eye occurred or persistiruuschem erosion of small diameter or complete healing of the cornea with the formation of vascularized leukoma. In any case, we did not observe the formation of ulcers on both eyes.

4 weeks after injury in one eye with corneal ulceration or without spent Subtotal layer-by-layer keratoplasty.

Fence tear fluid in both eyes and blood was performed at the following stages of the experiment: before surgery, at 3, 7, 14 and 21 days after application of the burn, at 3, 7, 14 and 21 days after surgery.

Fence tears in rabbits was performed using circles of filter paper with a diameter of 5 mm, which is 5 min was placed in the lower arch konyunktivalny bag. Components tears suirable saline. The eluate was centrifuged to separate insoluble componentat trypsin-like proteases and their inhibitors:1-antitrypsin and2-macroglobulin.

To measure the proteolytic activity of enzymes (TPA) and their inhibitors (ATA) used enzymatic methods based on determining the amount of colored product formed during the enzymatic reaction with the corresponding specific substrate N-benzoyl-DL-arginyl-n-nitroanilide (BAPNA. (Biochemical research methods in the clinic//Ed. by A. A. Pokrovsky. - M., 1969. - S. 206-210. Chesnokov N. B. Role of proteolytic enzymes and their inhibitors in the pathology of the cornea. - M., 1991. - Diss. Prof. the honey. Sciences).

Biochemical studies showed that bilateral eye burns in the tear fluid of the eye with complete healing of burn wounds after surgery on the other eye regarding corneal ulceration, there is a gradual rise TPA (Fig.1) and the decline ATA (Fig.2) the 14th day after the surgery in tears.

Clinical observations in the experiment showed that after 14-21 days after layer-by-layer keratoplasty in one eye to the other eye with the completed healing process is recurrent erosion or ulceration of the cornea.

Analysis of the obtained results allowed to conclude that PR is the hospital after emergency surgery on the other eye in experiment and clinic with bilateral severe burns of the eyes is the rise of TPA in the tear fluid of a sweating eyes.

The results obtained allowed to apply the method in clinical practice.

The technical result of the invention is to eliminate the risk of recurrence of erosion and ulceration of the cornea on neoperabelnom eye with complete healing of burn wounds in bilateral burns, which occurs as a result of increased TPA and lowering ATA in the tissues of the eye after surgery on the other eye with corneal ulceration.

The result is achieved that after therapeutic keratoplasty about ulceration of the cornea in one eye with bilateral burn eye lesions begin and continue for 2 weeks local (subconjunctivally and parabulbar injection) anti-inflammatory and antiproteolytic treatment neopoznannogo eyes with complete healing process, thereby preventing the increase of TPA and lowering ATA and eliminate the threat of recurrence of erosion and ulceration of the cornea, and activation of inflammation and destruction of the cornea on the eye.

The method is as follows.

After emergency therapeutic keratoplasty in one eye with corneal ulceration with bilateral severe burns chap who vospalitelnoe (dexamethasone, diprospan, kenalog 0.5 ml) and antiproteolytic (gordox, contrical, antagony) treatment of other eye to complete the healing process of the cornea, thereby preventing the increase of TPA and lowering ATA and eliminate the threat of recurrence of erosion and ulceration of the cornea on the eye.

Specific examples of the complete method.

Rabbit 1.

On the 28th day after alkali burn both glah on one eye came complete epithelialization of burn wounds, and the other eye has formed a deep corneal ulcer. Transaction layer-by-layer keratoplasty eye with a corneal ulcer.

On the 3rd day after surgery decreased TPA in tears in both eyes, and 14 - day increase of TPA in both eyes.

Against the background of reduced TPA was well-noted characteristic of the inflammatory process rise ATA in a tear in the operated and neoperabelnom eye (its amplitude in the fellow eye was much smaller). At 14-21 day increase ATA was not observed. On neoperabelnom eye on the 14th day after the operation noted the recurrence of erosion and ulceration of the cornea. Thus, the increase of TPA in the tear paired with a deficit of protease inhibitors has led to the development and erosion of the macroglobulin, that shows the development of the immune response.

Rabbit 2.

To 28-th day after alkali burn both eyes on one eye came complete epithelialization of burn wounds, and the other eye was formed, the ulcer of the cornea. Transaction layer-by-layer keratoplasty eye with a corneal ulcer.

TPA in a tear of the operated eye within 21 days after surgery remained unchanged, possibly due to the treatment with dexamethasone. However, in neoperabelnom eye has been a significant rise TPA at 3 and 14 days (the maximum among all animals). That shows the development of an active inflammatory process. ATA tears in both eyes were raised, and in the operated eye improvement lasted for 7 and 14 days. Activity2-macroglobulin also increased to 14 days in both eyes. For 21 days on the operated eye happened graft rejection, and neoperabelnom the eye of the newly formed erosion of the cornea, and the area was maximum among all animals.

Thus, the process of transplant rejection biochemically characterized, early and prolonged increase in ATA and higher level2-SLE operations. Since the increase of TPA in the tear neopoznannogo eyes on the 14th day is not accompanied by an increase in ATA, developing erosion of the cornea.

It should be noted that the tear of both eyes of the rabbit before the operation was discovered very high level2-macroglobulin in excess of this figure in other animals in 5-10 times. Perhaps this is indicative of the busy state of the immune system of the animal.

Rabbit 3.

On the 28th day after alkali burn both eyes on one eye came complete epithelialization of burn wounds, and the other eye has formed a deep corneal ulcer. Transaction layer-by-layer keratoplasty eye with a corneal ulcer.

After therapeutic keratoplasty in one eye started and continued for 2 weeks parabulbar injection Neopalimovsky eye Gordons and dexamethasone.

In the operated eye for 3 days there has been some increase in TPA with a further steady decline. In neoperabelnom eye increase TPA was not found.

The characteristic increase in ATA 3 and 14 days was found only in the operated eye. In the fellow eye ATA gradually increased to 14 days before the normal indicators of the 2, this animal use antiproteolytic drug Gordons and dexamethasone prevented the development of recurrence of erosion and ulceration of the cornea pair neopoznannogo eyes.

Clinical examples.

The patient P.

Severe chemical burns to both eyes. After 6 weeks after injury on the background of conservative treatment noted the development of ulceration of the cornea with a risk of perforation of the cornea in my right eye. Left eye formed vascularized a thorn with complete epithelialization of the cornea.

Produced therapeutic layer-by-layer keratoplasty in the right eye with corneal ulceration. After 12 days on the left neoperabelnom the affected eye noted the recurrent erosion of cornea ulceration.

Thus, keratoplasty in the right eye caused a relapse of erosion and ulceration of the cornea on the left neoperabelnom eye.

Patient K.

Severe chemical burns to both eyes.

4 weeks after injury noted the deep corneal ulceration with risk of perforation on the left eye. On the right eye by this time the cornea is completely covered with epithelium.

Produced therapeutic layer ceratopsia injection Gordons and dexamethasone, which continued for 2 weeks.

During the whole observation period (2 months) recurrent erosion of the cornea on the right neoperabelnom eye was revealed.

Thus, preventive treatment neopoznannogo eyes with complete healing of burn wounds (installation and parabulbar injection Gordons and dexamethasone after surgery the surgery on the other eye with corneal ulceration helped to avoid the development of recurrent erosion of the cornea on neoperabelnom eye.

The proposed method treated 10 patients with bilateral severe eye burns.

All patients were able to avoid exacerbation of burn disease and relapse of erosion and ulceration of the cornea fellow eyes after the surgery the surgery on the other eye.

The main advantage of the proposed method over other methods is the ability for two-sided burns to pursue an active prevention of recurrence of erosion and ulceration of the cornea on the eye with complete healing of burn wounds, the danger which occurs after curative surgery on the other eye with corneal ulceration.

A method for preventing relapse after keratoplasty about ulceration of the cornea of one eye, including subconjuctival and parabulbar introduction to eye with resulting anti-inflammatory and healing antiproteolytic drugs directly after keratoplasty for two weeks.

 

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