Method for applying surgical removal and photodynamic prophylaxis of recurrent subretinal neovascular membranes

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

The invention relates to medicine, namely to ophthalmology, to methods of surgical removal and photodynamic prevention of recurrence of subretinal neovascular membranes.

A known method of surgical treatment of subretinal neovascular membranes, including vitrectomy, retinotomy and mechanical removal from under the retina, subretinal neovascular membranes (see Olsen TW, Capone A Jr, Sternberg P Jr, Grossniklaus HE, Martin DF, Aaberg TM Sr. Subfoveal choroidal neovascularization in punctate inner choroidopathy. Surgical management and pathologic findings. Ophthalmology. 1996 Dec; 103 (12):2061-9).

However, the known method does not provide the most complete removal of subretinal neovascular membranes, does not exclude the risk of recurrence of subretinal neovascular membranes and will not prevent the development of proliferative vitreoretinopathy, and a high risk of retinal detachment.

The basis of the invention is to provide a method of surgical removal and photodynamic prevention of recurrence of subretinal neovascular membranes, allowing to achieve the exception of recurrence of surgically remote subretinal neovascular membrane and the development of proliferative vitreoretinopathy, to achieve complete elimination of retinal detachment, as well as to preserve visual function.

The problem is solved in that the proposed pic is b surgical resection and photodynamic prevention of recurrence of subretinal neovascular membranes, including vitrectomy, retinotomy and mechanical removal from under the retina, subretinal neovascular membrane, the distinguishing feature of which is the fact that after removal of the subretinal neovascular membrane in its place through the site retinotomy using intravitreal cannula under the retina impose 0.1-0.3 ml pre-activated by laser irradiation photosensitizing gel-based viscoelastic hyaluronic acid, containing from 0.1 to 2 wt.% chlorine selected from the group Photolon, Radachlorin or photoditazine, with photosensitizing gel just before the introduction activated in vitro by laser irradiation with a wavelength of 661-666 nm within 3-10 minutes for a total dose of irradiation 100 to 600 j/cm²and injected immediately after activation, and then crushing the retinal vitreal cavity fill performancesin connection or air, which then replaces the silicone oil, and the surgery is completed by suturing the areas of sclerotome and conjunctiva. At the same time as viscoelastic based on hyaluronic acid is used, for example, healon, viscoat or gigathlon. At the same time as performancesthe connection to fill the vitreal cavity using, for example, performancecriteria, performability or perfo the polyester.

In the clinical practice of application of the method of surgical removal and photodynamic prevention of recurrence of subretinal neovascular membranes, it was found that using all the selected parameters of the proposed method was not observed recurrence of surgically remote subretinal neovascular membrane, excluding the development of proliferative vitreoretinopathy, a significant reduction in the risk of retinal detachment, and preserved visual function.

To illustrate the proposed method on the drawings shows a diagram of the implementation of its main stages. (Fig.1-5).

Implementation of the proposed method is illustrated by the following clinical examples.

Example 1. Patient M. 74 years. entered the Kaluga branch of IRTC “eye microsurgery” with a diagnosis of Central involutional dystrophy OU. Subretinal neovascular membrane OS. The initial cataract OU.

Visual acuity when applying for OS-0,2 n/K. In the fundus paramacular was determined rounded prominere subretinal lesion yellow-grey color with a strong exudation and minor perifocal the haemorrhage. The PHAGE - angiographic signs of subretinal neovascular membrane; localization - extrafoveally.

At the preparatory stage after treatment is otci operating margins held anesthetic management. Spent vitrectomy, retinotomy and mechanical removal from under the retina, subretinal neovascular membrane. Then after removal of the subretinal neovascular membrane in its place through the site retinotomy using intravitreal cannula under the retina entered 0.3 ml pre-activated by laser irradiation photosensitizing gel-based viscoelastic hyaluronic acid, namely kalona, when the content of 0.1 wt.% as chlorin - Radachlorin. This photosensitizing gel just before the introduction activated in vitro by laser irradiation with a wavelength of 666 nm within 10 minutes with a total dose of 600 j/cm²and introduced immediately after activation. For crushing retinal vitreal cavity filled performancesin connection, which used parfocality, which is then replaced with silicone oil. The operation was finished suturing the areas of sclerotome and conjunctiva.

During the control study after 3 months, visual acuity with correction in the left eye was 0,30 n/K. In the fundus paramacular on the location of the subretinal neovascular membrane is marked by the formation of flat scar, when this phenomena preretinal fibrosis and "folding" in the macular region were noted. In alenna the observation period up to 1 year recurrence of subretinal neovascular membranes observed not observed. In FACT, the complete obliteration subretinal neovascular network.

Example 2. Patient K., aged 52 received in the Kaluga branch of IRTC “eye microsurgery” with a diagnosis of Central chorioretinal dystrophy with exudative-hemorrhagic detachment of the neuroepithelium OD. Initial visual acuity OD-0.1 g/K. Foveolar sensitivity 17 dB. The fundus of the eye: OD - in the macular region rounded prominere hearth to 3PD dark red color due to the presence of subretinal hemorrhage with perifocal sediments yellow hard exudates. On the PHAGE identified active fluorescence on the edge fluorescentes hearth with a sharp increase in intensity, indicating the presence of a hidden form subretinal neovascular membrane.

Conservative treatment without effect.

At the preparatory stage after processing operating margins held anesthetic management. Spent vitrectomy, retinotomy and mechanical removal from under the retina, subretinal neovascular membranes. Then after removal of the subretinal neovascular membrane in its place through the site retinotomy using intravitreal cannula under the retina introduced 0.1 ml pre-activated by laser irradiation photosensitizing gel-based viscoelastic hyaluronic acid, namely viscoat, when the soda is to maintain it contained 2 wt.% as chlorin - photodithazine. This photosensitizing gel just before the introduction activated in vitro by laser irradiation with a wavelength of 661 nm for 3 minutes with a total dose of 100 j/cm²and introduced immediately after activation. For crushing retinal vitreal cavity filled with air, which is then replaced with silicone oil. The operation was finished suturing the areas of sclerotome and conjunctiva.

During the control study after 3 months, visual acuity OD-0,15 n/K. Foveolar sensitivity of 21 dB. In the fundus of the right eye observed the formation of flat chorioretinal scar in the absence of exudation and hemorrhage in the macular area. Within 1 year of observation recurrence of subretinal neovascular membrane is not marked.

1. A method of surgical removal of subretinal neovascular membranes, including vitrectomy, retinotomy and mechanical removal from under the retina, subretinal neovascular membrane, characterized in that after removal of the subretinal neovascular membrane in its place through the site retinotomy using intravitreal cannula under the retina impose 0.1-0.3 ml photosensitizing gel-based viscoelastic hyaluronic acid, containing from 0.1 to 2 wt.% chlorine selected from the group Photolon, Radachlorin or fot detain, this photosensitizing gel just before the introduction activated in vitro by laser irradiation with a wavelength of 661-666 nm with a total radiation dose of 100 to 600 j/cm and injected immediately after activation, and then crushing the retinal vitreal cavity fill performancesin connection or air, which then replaces the silicone oil, and the surgery is completed by suturing the areas of sclerotome and conjunctiva.

2. The method according to claim 1, characterized in that as viscoelastic based on hyaluronic acid is used, for example, healon, viscoat or gigathlon.

3. The method according to claims 1 and 2, characterized in that as performancesthe connection to fill the vitreal cavity using, for example, performancecriteria, performability or parfocality.