A method of treating diabetic retinopathy

 

(57) Abstract:

The invention relates to medicine, in particular to ophthalmology, and can be used for the treatment of patients with diabetic retinopathy. To do this, in the cavity of the orbit set of the catheter, through which the lymphatic region of the orbit injected drugs. First enter infostealer, mainly lidocaine and hyaluronidase. Then enter a therapeutic mixture containing 10-30 mg Glutoxim, 30-90 thousand cells/ml autolymphocyte and 6-8 ml of saline. Introduction medicinal mixture is performed two to three times with an interval of 48-72 hours Received autolymphocyte can also be activated by incubation for 40-60 min with 10-20 mg Glutoxim when 24-26oC. the Method provides an improvement of visual functions by accelerating metabolic and reparative processes, and increase the immunological reactivity of the organism. 3 C.p. f-crystals.

The invention relates to medicine, namely to ophthalmology and efferent therapy, and is intended for the treatment of patients suffering from diabetic retinopathy before ophthalmic surgery (refractive keratoplasty, antiglaucoma operations cataract extraction).

Dia is rangiatea, one of the characteristic manifestations of the OTHERS and wearing a generalized character. Among the various reasons for the development of OTHERS are immunological, metabolic, hormonal, gipotonicescie, genetic and other factors, leading sequentially or simultaneously damage the walls of the capillaries of the retina and vascular permeability.

After carrying out eye operations such patients often develop complications, and therefore the development of new treatments for this group of patients remains relevant.

There is a method of treatment of diabetic retinopathy by parabulbar and injecting the supernatant autoplasma, while the introduction of ATP in the amount of 0.3-0.4 mg/ml and thrombin at 0.1 to 0.3 IU/ml (RF Patent 2161020, class a 61 F 9/00, publ. 27.12.2000).

The method can effectively treat hemorrhage in the internal environment and membranes of the eyes, but has no effect on pathogenic mechanisms, ETC.

There is a method of surgical treatment of patients with retinal detachment in the macular region (method vitrectomy through the flat part of the ciliary body) with the simultaneous introduction of autochromatic in the region of the t enhance the regeneration of this area (Clin. Exp. Ophthalmol., 1998, v. 236, RV 151-153).

However, this method is not effective for the treatment and prevention of postoperative complications in diabetic retinopathy.

The most closest to the claimed method - prototype - is a way of pre - and postoperative treatment of patients with cataracts, including the introduction of enhanced patient autolymphocyte blood in the form of instillation before and after surgery within 7 days 1 ml daily (RF Patent 2085158, class a 61 F 9/00, publ. 27.07.97).

The method allows to improve visual function and accelerate the reparative processes in tissues of the eye after surgery, but it is not effective for patients with diabetic retinopathy.

An object of the invention is to increase the effectiveness of treatment and reduce the frequency of postoperative complications in patients with diabetic retinopathy.

The goal of the project is achieved by the proposed method lies in the following.

Under aseptic conditions, after local infiltration anesthesia, produce a puncture through the pterygopalatine fossa and nienaganny crack the cavity of the orbit needle with a diameter of 1 mm and a length of 80 mm After puncturing, alternating with the second region of the orbit through a fixed catheter introducing a therapeutic mixture, containing 10-30 mg Glutoxim, 30-90 thousand cells/ml autolymphocyte and 6-8 ml of saline. Introduction medicinal mixture is performed two to three times with an interval of 48-72 hours To improve lymphocirculation, before the introduction of the drug mixture is injected through the catheter 1 ml of 2% lidocaine and 32 units of the act. lidz. Autolymphocyte obtained by lymphocytapheresis separator blood cells AS-TEC 204 firms "Fresenius". The resulting autolymphocyte at a concentration of 30 to 90 thousand cells/ml incubated for 40-60 min with 10-30 mg Glutoxim at a temperature of 24-26oC. Treatment is mainly carried out prior to the upcoming operation.

The method allows to increase the effectiveness of the treatment, to avoid postoperative complications, to achieve significant improvement of visual functions: visual acuity, total fields of view, data electrophysiology.

Drug Glutoxim is representative of a new class of medicines tipatina having a modulating effect on intracellular processes thiol metabolism, plays an important role in the regulation of genetic and metabolic processes in cells and tissues.

Autolymphocyte contain immunopeptides providing neurotransmitter interactions in the immune is to, stimulate the proliferation and accelerate the healing process in injured tissues.

The technical result is achieved due to the directed delivery to the lymphatic region of the posterior pole of the eye immunomodulator of Glutoxim using as vectors of activated autolymphocyte in experimentally chosen, optimal concentration, mode of administration and the topography of the introduction. Activation of lymphocytes is carried out by cytapheresis followed by incubation with Glutoxim, which leads to saturation of the drug autolymphocyte due to the formation of pores in cell membranes and sorption on them transported drug. When injected into the lymphatic region of the orbit of Glutoxim with autolymphocyte significantly changing its pharmakinetic expressed in selective accumulation of Glutoxim in inflammation and long-term maintenance of high therapeutic concentrations of the latter.

The defining difference of the proposed method from the prototype are:

- conduct directed transport of drug compound in lymphatic region of the orbit in the region of the pterygopalatine fossa through the fixed catheter that allows you to create a depot of drug compound, which sposored the introduction of the drug mixture is performed with the introduction through the catheter of lymphostimulation, mostly lidocaine and enzyme lidz, which enables to improve lymphosarcomas in the region of the orbit;

- as a medicinal mixture, a mixture containing: Glutoxim of 10-30 mg, autolymphocyte - 30-90 thousand cells/ml, saline - 6-8 ml, which can improve treatment efficiency and reduce postoperative complications in patients with diabetic retinopathy due to the broader spectrum of anti-inflammatory, reparative and metabolic actions proposed mix compared to the prototype;

- before the introduction autolymphocyte activated by incubation with Glutoxim for 40-60 minutes at a temperature of 24-26oWith that allows you to stimulate the functional activity of immunocompetent cells and boost immune response.

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

Example 1.

Patient S., 78 years old, was admitted NF of IRTC "MG" with a diagnosis of Mature cataract of the right eye, artiphakia left eye. Nonproliferative diabetic retinopathy in the left eye. VIS od=proectio lutic certa (pr.the lut.cer). Concomitant diagnosis: diabetes mellitus type II, moderate severity, injury, ischemic heart disease, CH2, FK. Hypertension 2-3 steo preoperative patient approach.

Under aseptic conditions, after local infiltration anesthesia, produced puncture through the pterygopalatine fossa and nienaganny crack the cavity of the orbit needle with a diameter of 1 mm and a length of 80 mm, after puncturing through the needle into the cavity of the orbit has established the catheter was fixed to the skin with adhesive tape. Later in the lymphatic region of the orbit through a fixed catheter was introduced 1 ml of 2% lidocaine and 32 units of the act. lidz. Then introduced a therapeutic mixture containing 10 mg of Glutoxim, 30 thousand cells/ml autolymphocyte and 6 ml of saline. Introduction medicinal mixture was carried out three times with an interval of 48 hours

Surgery extracapsular cataract extraction right eye with simultaneous implantation of an intraocular lens without features. The postoperative course was unremarkable, and the patient was discharged on the seventh day outpatient aftercare. VIS od= 0,2, when ophthalmoscopy was observed resorption of multiple retinal hemorrhages. When the control and monitoring 6 months after surgery VIS od=0,65, at the same time there has been an increase field of vision, with both eyes: od 57%, a os by 17%. According to EPE - marked improvement in the function of the optic nerve (papillomacular beam) for scheuplein: immature age-related cataract od, the initial cataract os. VIS od=0,05, VIS os=0,5. Concomitant diagnosis: diabetes mellitus type II, moderate severity, subcompensated, angiopathy, ischemic heart disease, CH2, FC, 2 hypertension severity.

Under aseptic conditions, after local infiltration anesthesia, produced puncture through the pterygopalatine fossa and nienaganny crack the cavity of the orbit needle with a diameter of 1 mm and a length of 80 mm, after puncturing through the needle into the cavity of the orbit has established the catheter was fixed to the skin with adhesive tape. Later in the lymphatic region of the orbit through a fixed catheter was introduced 1 ml of 2% lidocaine and 32 units of the act. lidz. Then introduced a therapeutic mixture containing 30 mg of Glutoxim, 90 thousand cells/ml autolymphocyte and 8 ml of saline. Introduction medicinal mixture was carried out twice with an interval of 72 hours

Surgery extracapsular cataract extraction right eye with simultaneous implantation of an intraocular lens without features. The postoperative course was unremarkable, and the patient was discharged on the sixth day of outpatient aftercare. VIS od=0,6. When the control and monitoring 6 months after surgery VIS od=l,0, and improvement and the pair is not operated eye VIS os=0,65 (uluchsheniya function of the optic nerve (axial beams by increasing lability), as well as improving papillomacular beam due to the increasing rate of ccsm.

The advantages of the proposed technical solution, in comparison with the prototype, are increasing the effectiveness of treatment and reduce the frequency of postoperative complications due to:

- selection of the exact number of autolymphocyte - cells, which occupies a Central place in the body's immune system that provide protection, immunoregulatory and trophic function;

- target effects of the immunomodulator on autolymphocyte in vitro conditions;

- summing up autolymphocyte treated with immunomodulator through the catheter directly into the lymphatic region of the eyes;

- experimentally established the optimal mode of administration of medicinal mixture.

1. A method of treating diabetic retinopathy, including the introduction of medicinal mixtures containing autolymphocyte, characterized in that the introduction is carried out in lymphatic region of the orbit of the affected eye in the region of the pterygopalatine fossa through the fixed catheter, and as a medicinal mixture, a mixture containing 10-30 mg Glutoxim, 30-90 thousand cells/ml autolymphocyte and 6-8 ml of saline; wage region through the catheter enter infostealer.

2. The method according to p. 1, characterized in that before the introduction autolymphocyte incubated for 40-60 min with 10-20 mg Glutoxim at 24-26C.

3. The method according to p. 1, characterized in that as lymphostimulation use lidocaine and the enzyme hyaluronidase.

4. The method according to p. 3, characterized in that the injected 1 ml of 2% lidocaine and 32 units of activity lidz.

 

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