Photodynamic surgical method for treating the cases of choroid hemangioma

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

 

The invention relates to medicine, namely to ophthalmology, surgical methods of photodynamic treatment of choroidal hemangiomas.

There is a method of photodynamic treatment of choroidal hemangiomas, including intravenous administration of a photosensitizer followed transpupillary laser irradiation of choroidal hemangiomas (see dreperla S.A., Choroidal I treated with photodynamic therapy using verteporfin//Arch/Ophthalmol. 2001, Nov. 119 (11), 1606-10).

However, when using the known method is not always possible to achieve complete regression of the tumor and preserve visual function. In addition, the progression of choroidal hemangiomas accompanied by the development of serous retinal detachment, subretinal fluid significantly reduces the effectiveness transpupillary photodynamic therapy.

The basis of the invention is to provide a method of surgical photodynamic treatment of choroidal hemangiomas, allowing for its use to achieve a complete stop of growth and regression of the tumor with preservation and improvement of visual functions.

The problem is solved in that a method of surgical photodynamic treatment of choroidal hemangiomas, including intravenous administration of a photosensitizer followed transpupillary laser irradiation is the group of choroidal hemangiomas, the distinctive feature of which is that in the Meridian of the projection choroidal hemangioma on the sclera, some distance from the limb 3-4 mm, in the area of the projection area choroidal hemangioma perform incision of the conjunctiva and tenon's membrane size 3-4 mm, is formed between the sclera and tenon's membrane tunnel after transscleral diaphanoscopy Refine the localization and size of choroidal hemangioma, under visual control using beam interference extrascleral implanted to the localization of choroidal hemangioma polymer elastic magnetic laser implant fitted made in the form of a ring permanent magnet in the center of which is fixed short-focus diffuser lens laser emitter connected to a light guide in soft elastic shell, while the permanent magnet of the implant is performed with axial magnetization of the permanent magnetic field with induction 2-3 MTL and place it North magnetic pole to the choroidal hemangioma with providing extrascleral placement in the projection of her lenses laser emitter implant, then the other end of the implant is stitched to the sclera 5-6 mm from the limbus two interrupted sutures through pre-made holes, cover the implant conjunctiva, impose on her makeshift stitches, and you are the od of the optical fiber is fixed to the head by any known method, for example, with adhesive tape, then intravenous bolus enters as a photosensitizer 0.1 to 1% aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine at a dose of 0.8-1.1 mg/kg, then carry out a visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation choroidal hemangioma photosensitizer passes through the laser fiber and the lens implant transscleral laser irradiation of choroidal hemangioma divergent laser radiation with a wavelength 661-666 nm within 60-100 seconds for a total dose of irradiation 30-120 j/cm2and after the end of treatment to remove the polymer elastic magnetic laser implant and suture on the conjunctiva. When this permanent magnet polymer elastic laser magnetic implant made of a material system samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron. Thus an additional 2-3 days after the first laser irradiation is repeated intravenous administration of a photosensitizer in the same quantities, carry out a visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation of the choroid is hemangioma the photosensitizer is carried out through the laser fiber and the lens implant re transscleral laser irradiation subretinal neovascular membranes for 30-90 seconds for a total dose irradiation 30-60 j/cm2.

In the clinical practice of application of the method of surgical photodynamic treatment of choroidal hemangiomas found that using all the selected parameters of the proposed method obtained the following technical result: the complete regression of choroidal hemangiomas in the conservation and improvement of visual functions in separate period.

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

Example 1. Patient R., 68 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with a diagnosis of “wet” form of senile macular degeneration in his right eye. According to the results of a comprehensive ophthalmic examination including ophthalmoscopy and ULTRASOUND B-scan and fluorescent angiography, was diagnosed with hemangioma of the choroid of the right eye. Initial visual acuity OD-0.30 OS is 0.60. Hemangioma is peripapillary in the lower nasal side of the optic nerve disc. The thickness of the hemangioma - 2 mm in base diameter 6 mm

Surgery for implantation of polymer elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In the Meridian of the projection choroidal hemangioma on the sclera, some distance from lim is 3 mm, in the area of the projection area choroidal hemangioma performed incision of the conjunctiva and tenon's membrane with a size of 4 mm Formed between the sclera and tenon's membrane tunnel after transscleral diaphanoscopy Refine the localization and size of choroidal hemangioma, under visual control using beam interference extrascleral implanted to the localization of choroidal hemangioma polymer elastic laser magnetic implant. The implant is equipped with a made in the form of a ring of permanent magnet material system samarium-cobalt with axial magnetization of the permanent magnetic field with induction 3 MT. In the center of the permanent magnet of the implant is fixed short-focus diffuser lens laser emitter connected to a light guide in a soft elastic shell. The permanent magnet of the implant placed its North magnetic pole to the choroidal hemangioma with accurate extrascleral placement in the projection of her lenses laser emitter implant.

The other end of the implant is attached to the sclera at 5 mm from the limbus two interrupted sutures through pre-made holes, covered the implant conjunctiva and put on her makeshift stitches. The output of the fiber was fixed to the head by adhesive tape. Then intravenous bolus back and as a photosensitizer 0.1% aqueous solution of chlorine, namely Radachlorin at a dose of 1.1 mg/kg Then carried out a visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation choroidal hemangioma photosensitizer conducted through the laser fiber and the lens implant transscleral laser irradiation of choroidal hemangioma divergent laser radiation with a wavelength of 666 nm for 60 seconds with a total dose of 30 j/cm2. Then advanced through 3 days after the first laser irradiation was repeated intravenous administration of a photosensitizer in the same quantities. Carried out visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation choroidal hemangioma photosensitizer conducted through the laser fiber and the lens implant repeated laser irradiation subretinal neovascular membrane for 30 seconds with a total dose of 30 j/cm2. After the end of treatment removed the elastic polymer laser magnetic implant and put the seams on the conjunctiva.

One month after surgery was noted complete resorption of subretinal edema with visual acuity improvement to 0.4 on the operated glasperlen surgical photodynamic treatment led to complete regression of choroidal hemangioma with the development of atrophic chorioretinal scars after 3 months. 3 months after surgery, the visual acuity OD 0.5 in.

The duration of follow-up after treatment 12 months, recurrence of the disease was not found.

Example 2. Patient C., 66 years. When entering the Kaluga branch of IRTC “eye microsurgery” was diagnosed with a hemangioma of the choroid of the left eye. Initial visual acuity OS-0.2 and OD of 0.6. Hemangioma is paramacular down from f.centralis. The thickness of the hemangioma - 1.8 mm in base diameter 5-6 mm

Surgery for implantation of polymer elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In the Meridian of the projection choroidal hemangioma on the sclera, some distance from the limbus 4 mm, in the area of the projection area choroidal hemangioma performed incision of the conjunctiva and tenon's shell size 3 mm Formed between the sclera and tenon's membrane tunnel after transscleral diaphanoscopy Refine the localization and size of choroidal hemangioma, under visual control using beam interference extrascleral implanted to the localization of choroidal hemangioma polymer elastic laser magnetic implant. The implant is equipped with a made in the form of a ring of permanent magnet material system samarium-iron-AZ is t with axial magnetization of the permanent magnetic field with induction 2 MT. In the center of the permanent magnet of the implant is fixed short-focus diffuser lens laser emitter connected to a light guide in a soft elastic shell. The permanent magnet of the implant placed its North magnetic pole to the choroidal hemangioma with accurate extrascleral placement in the projection of her lenses laser emitter implant. The other end of the implant is attached to the sclera 6 mm from the limbus two interrupted sutures through pre-made holes, covered the implant conjunctiva and put on her makeshift stitches. The output of the fiber was fixed to the head by adhesive tape. Then intravenous bolus introduced as a photosensitizer 1,1% aqueous solution of chlorine, namely photodithazine at a dose of 0.8 mg/kg Then carried out a visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation choroidal hemangioma photosensitizer conducted through the laser fiber and the lens implant transscleral laser irradiation of choroidal hemangioma divergent laser radiation with a wavelength of 661 nm for 100 seconds with a total dose of 120 j/cm2. After the end of treatment removed the elastic polymer laser magnetic implant and put swina the conjunctiva.

At 1 month after surgery was noted complete resorption of subretinal edema with visual acuity improvement to 0.30 on the operated eye. Surgery photodynamic treatment led to complete regression of choroidal hemangioma with the development of atrophic chorioretinal scars after 1 year. The duration of follow-up after treatment for 18 months, recurrence of the disease was not found.

1. The surgical method of photodynamic treatment of choroidal hemangiomas, including intravenous administration of a photosensitizer followed by laser irradiation of choroidal hemangiomas, characterized in that the Meridian of the projection choroidal hemangioma on the sclera, some distance from the limb 3-4 mm, in the area of the projection area choroidal hemangioma perform incision of the conjunctiva and tenon's membrane size 3-4 mm, is formed between the sclera and tenon's membrane tunnel after transscleral diaphanoscopy Refine the localization and size of choroidal hemangioma, under visual control using beam interference extrascleral implanted to the localization of choroidal hemangioma polymer elastic magnetic laser implant fitted made in the form of a ring permanent magnet in the center of which is fixed short-focus diffuser lens delivers the aqueous emitter, combined with the fiber in soft elastic shell, while the permanent magnet of the implant is performed with axial magnetization of the permanent magnetic field with induction 2-3 MTL, and place it on the magnetic North pole to the choroidal hemangioma with providing extrascleral placement in the projection of her lenses laser emitter implant, then the other end of the implant is stitched to the sclera 5-6 mm from the limbus two interrupted sutures through pre-made holes, cover the implant conjunctiva, impose on her makeshift stitches, and the output optical fiber is fixed to the temple, then intravenous bolus enters as a photosensitizer 0.1 to 1%aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine at a dose of 0.8-1.1 mg/kg, then carry out a visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation choroidal hemangioma photosensitizer passes through the laser fiber and the lens implant transscleral laser irradiation of choroidal hemangioma divergent laser radiation with a wavelength 661-666 nm at a total dose of irradiation 30-120 j/cm2and after the end of treatment to remove the polymer elastic magnetic laser implant and ladywood seams on the conjunctiva.

2. The method according to claim 1, characterized in that the permanent magnet polymer elastic laser magnetic implant made of a material system samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron.

3. The method according to claims 1 and 2, characterized in that it further 2-3 days after the first laser irradiation is repeated intravenous administration of a photosensitizer in the same quantities, carry out a visual inspection of the fluorescence of cells choroidal hemangioma using fluorescent diagnostics and upon reaching the maximum level of saturation choroidal hemangioma photosensitizer is repeated laser irradiation of choroidal hemangioma with a total dose 30 to 60 j/cm2.

4. The method according to claims 1 to 3, characterized in that the fixation of the output fiber to the temple carried out by means of adhesive tape.



 

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FIELD: medicine.

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EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

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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.

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