A method for the treatment of postinflammatory bullous keratopathy

 

(57) Abstract:

The invention relates to medicine, in particular to ophthalmology, and can be used for the treatment of postinflammatory bullous keratopathy. Carry out the introduction of a medicinal composition in lymphatic region of the orbit on the side of the affected eye through the pterygopalatine blockades. The mixture includes lidocaine 20-40 mg, dexason 4-8 mg, taufon 40-80 mg, dalargin 1-2 mg, lydasum 16-32 units act., distilled water 3-6 ml. Spend 3-6 blockades at intervals through the day. The method improves the efficiency of the treatment and reduces the treatment time. 1 C.p. f-crystals.

The invention relates to medicine, namely to ophthalmology, and is intended for the treatment of postinflammatory keratopathy.

Bullous keratopathy (Bq) - polietiologic disease, associated with damage to the endothelial monolayer that covers the posterior surface of the cornea and having a low regenerative capacity. BC, along with herpetic keratitis, is currently the most frequent provider debilitating corneal leukomas. A radical method of treatment is penetrating keratoplasty.

There is a method of treatment of erosions of the cornea after excimer laser is of modulator poludana as subconjuctival injection and instillation in into the conjunctival cavity of the eye (the Patent of the Russian Federation 2122386, class a 61 F 9/00, publ. 27.11.98).

The method allows to reduce the treatment time erosion of the cornea after PRK, i.e., to affect the epithelium, rather than on the endothelium.

The most closest to the claimed method of the prototype is a method for the treatment of postinflammatory Bq by incorporating into the anterior chamber of the mixture autoplasma and immunomodulator poludana and also under a conjunctiva of the eye - freshly prepared mixture of autologous blood and poludana (RF Patent 2165747, class a 61 F 9/00, publ. 27.04.2001). The method is as follows. From a vein of the patient take autochrome, followed by mixing it with a solution poludana. Then taken the blood is centrifuged and collect the syringe with the top layer of the formed plasma. In terms of operating, under control of the operating microscope, after pre-corneal paracentesis and lavage of the anterior chamber of the patient in a balanced saline solution in it enter autoplaza. Excess autoplasma enter paralambano. Re-cell injections are conducted at intervals of 3-6 days, their number ranges from 1 to 4.

The disadvantages of the method are the duration and complexity, because it is operationally who="ptx2">

An object of the invention is to increase the effectiveness of treatment, and a shorter postoperative rehabilitation in inflammatory bullous keratopathy.

The goal of the project is achieved by the fact that to create a depot of drugs in the area of the "target organ" hold lymphotropic infostealers treatment of the regional lymph collector on the side of the affected eye by performing the pterygopalatine blockades using therapeutic mixture. therapeutic effect achieved by the formulations of therapeutic mixture comprising: lidocaine 20-40 mg, dexason 4-8 mg, taufon 40-80 mg, dalargin 1-2 mg, hyaluronidase - 16-32 units, water - 3-6 ml, and the topography of its introduction. This mixture contains a complex of pharmacological agents, which has strong anti-inflammatory and infostealers action.

Methods of making the pterygopalatine blockade is as follows. The patient is in the supine position, head turned to the side. Directly below the zygomatic arch, in the middle of the distance between the tragus of the ear and the edge of the orbit produce vcol. Then change the angle of the needle 30 degrees, the needle advancing past the pterygoid processes is fundamental to the movement of the needle. Pulling the piston itself and ensure that no blood type a therapeutic mixture, which leads to blocking of the second branch of the trigeminal nerve and pterygopalatine site and the creation of depot medications.

Determining the distinctive features of the proposed method in comparison with the prototype are:

- drug mixture is injected into the lymphatic region of the orbit on the side of the affected eye through the pterygopalatine blockages that allows you to create a depot of drugs that provides fast relief of inflammation and stimulation of reparative processes;

- as a therapeutic mixture used experimentally chosen, the optimal combination of the mixture of drugs taken in the following proportions: lidocaine 20-40 mg, dexason 4-8 mg, taufon 40-80 mg, dalargin 1-2 mg, lydasum 16-32 units act., water 3-6 ml, which improves the effectiveness of treatment, to increase the intensity and speed of reparative processes in the cornea.

The inventive method allows to stimulate lymph circulation, improve lymphatic drainage, to restore the circulation in the region of the orbit, to restore the normal conditions of hydrodynamics of the eye, which is manifested in the reduction of vospolenie the response to inflammatory bullous keratopathy (corneal syndrome, the disappearance pericorneal injection, bullous changes of corneal edema corneal tissue and increase its transparency, resorption of precipitates and exudate, normalization of intraocular pressure, visual acuity improvement) was achieved in all cases in the shortest possible time from 6 to 9 days.

The effect is explained in more rapid and effective relief of the inflammatory period in the initial stages, the positive effect of dalargin and taufona on reparative process by stimulating the proliferation and subsequent differentiation of cellular elements. This is due to protective effect of dalargin, stimulating collagen synthesis through activation of macrophages, and increased macrophage fibroblast contacts.

The invention is illustrated by the following examples of specific performance.

Example 1. Patient B., 59 years old, was operated on for open-angle glaucoma of the right eye. Performed non penetrating deep sclerectomy. On the second day post-operative period was complicated by phenomena inflammatory bullous keratopathy: decreased vision, appeared photophobia, lacrimation and pain in operirovanne swollen in the form of bubbles in the Central zone. Slice the cornea is thickened in 1,5 times in comparison with the norm, uneven because of the folds descemets membrane. Stroma and endothelium of the cornea is edematous, the imposition on it of precipitates. The moisture front camera opalestiruet. Intraocular pressure (+) 1. Visual acuity equal to 0.5. On the first day received conventional therapy: antibiotics, steroidal and non-steroidal anti-inflammatory drugs, antihistamines, Actovegin without positive dynamics.

On the second day in lymphatic region of the orbit is made pterygopalatine blockade by the claimed method, using a mixture of drugs, including lidocaine, 20 mg, dexason 4 mg, taufon 40 mg, dalargin - 1 mg, hyaluronidase - 16 units act., distilled water - 3 Jr. Only made 3 blockade at intervals through the day. On the sixth day phenomena inflammatory bullous keratopathy was stopped. Visual acuity = 1,0.

Example 2.

Patient B, 59 years old, was operated on for open-angle glaucoma of the left eye. Performed non penetrating deep sclerectomy. On the second day post-operative period was complicated by pronounced symptoms of inflammatory bullous keratopathy. Intraocular pressure (+) 1.

the filling up pterygopalatine blockades by the claimed method. Just completed 6 blocks with an interval of one day using a therapeutic mixture of the following composition: lidocaine 40 mg, dexason 8 mg, taufon 80 mg, dalargin - 2 mg, lydasum - 32%, water 6 ml.

On the ninth day phenomena postinflammatory bullous keratopathy fully cropped.

Thus, the use of lymphotropic lampotiloissa therapy using a therapeutic mixture of medicines, including a range of mediators of immunity and anti-inflammatory drugs with pronounced reparative action, provides the ability to effectively and quickly treat inflammatory bullous keratopathy.

1. A method for the treatment of postinflammatory bullous keratopathy, including the introduction of a drug, wherein the drug delivery is carried out in lymphatic region of the orbit on the side of the affected eye by performing the pterygopalatine blockades, and quality of medicines use therapeutic mixture containing lidocaine 20-40 mg, dexason 4-8 mg, taufon 40-80 mg, dalargin 1-2 mg, hyaluronidase 16-32 units act., distilled water 3-6 ml

2. The method according to p. 1, characterized in that exercise 3-6 blockades at intervals through the day.

 

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