Photodynamic surgical method for treating the cases of intraocular neoplasms

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, 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 implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, 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, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

 

The invention relates to medicine, namely to ophthalmology, surgical methods of photodynamic treatment of intraocular tumors predominantly thickness up to 3 mm

There is a method of photodynamic treatment of intraocular tumors, including intravenous administration of a photosensitizer and laser irradiation at the dose of 60 to 120 j/cm2(see Kim R.Y., Nor L.K., Foster B.S., E.S. Gragoudas, L.H. Young // Photodynamic therapy of pigmented choroidal melanomas of greater than 3-mm thickness.// Ophthalmology. 1996. Dec. 103(12): 2029-2036).

However, the known method when its use has the following disadvantages: low efficiency of destruction of tumor tissue, while using it is not possible to reach a complete stop of growth and regression of intraocular tumors.

The basis of the invention is to provide a method of surgical photodynamic treatment of intraocular tumors, allowing for its use to achieve the complete destruction of intraocular tumors and prevent its further growth.

The problem is solved in that a method of surgical photodynamic treatment of intraocular tumors, including intravenous administration of a photosensitizer and laser irradiation of intraocular tumors at the dose of 60 to 120 j/cm2, Otley is sustained fashion feature of which is that, that the Meridian of the projection of intraocular tumors between the sclera and tenon's membrane form the tunnel, then transscleral diaphanoscopy precise localization and dimensions of intraocular tumors, jaw transscleral under Ophthalmoscope control with the help of a special needle into the structure of intraocular tumors injected with 0.1-0.3 ml photosensitizing gel-based viscoelastic of hyaluronic acid selected from the group healon, viscoat or giacolone, this gel contains from 0.1 to 2 wt.% chlorine selected from the group Photolon, Radachlorin or photoditazine, then the previously formed tunnel in the area of the projection of intraocular tumors extrascleral placed under visual control using beam interference polymer elastic magnetic laser implant is equipped with a ring permanent magnet with axial magnetization of the permanent magnetic field with induction 3-4 MTL in the center of which is fixed short-focus diffuser lens laser emitter connected to a light guide in a soft elastic shell, and the implant placed its North magnetic pole to intraocular neoplasm with accurate extrascleral placement in the projection of intraocular tumors lens laser emitter of impl ntata, then the fiber implant is stitched to the sclera 5-6 mm from the limbus one hub seam, cover the implant conjunctiva, impose on her makeshift stitches, and the output optical fiber is fixed to the head by any known means, such as adhesive tape, then carry out a visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and upon reaching the maximum level of saturation of intraocular tumors, the drug passes through the laser fiber and the lens implant transscleral laser irradiation of intraocular tumors divergent laser radiation with a wavelength 661-666 nm within 60-180 seconds, and after treatment to remove the implant and suture on the conjunctiva. When this permanent magnet polymer elastic laser magnetic implant made of a material system samarium - cobalt, neodymium - iron - boron or samarium - iron - nitrogen. Thus an additional 2-3 days intravenous as a photosensitizer of 0.1-2% aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.8-1.1 mg/kg, carry out a visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and maximize the level of saturation of intraocular tumors photosensitizer is repeated laser irradiation of intraocular tumors for 30-90 seconds at the dose of 30-60 j/cm 2.

In the clinical practice of application of the method of surgical photodynamic treatment of intraocular tumors, it was found that using all the selected parameters of the proposed method obtained the following technical result: achieved full stop growth of intraocular tumors with subsequent regression, achieved by increasing the efficiency of destruction of tumor tissues with minimal trauma, surgery. Most of the operated patients noted the preservation of visual function.

To illustrate the proposed method on the drawing schematically shows its basic steps.

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

Example 1. Patient K., 68 years. Entered the Kaluga branch of IRTC “eye microsurgery” with a referring diagnosis of Central involutional retinal degeneration. The initial cataract OU.

The result is a comprehensive ophthalmic examination was diagnosed with melanoma of the choroid of the left eye. Ophthalmoscopically paramacular a few down from the fovea centralis was determined rounded, prominere in the vitreous hearth grey slate colour. According to the PHAGE fundus diagnosis was confirmation is N. Ultrasonic b-scanning enabled to specify the size of the tumor 6 to 8 mm; the value of prominence - 2 mm.

Performed extrascleral implantation elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In the Meridian of the projection of intraocular tumors between the sclera and tenon's membrane formed tunnel. Then transscleral diaphanoscopy said localization and dimensions of intraocular tumors. Metered transscleral under Ophthalmoscope control with the help of a special needle into the structure of intraocular tumors were injected 0.1 ml of photosensitizing gel based on visco-elastic hyaluronic acid, namely healon containing 2 wt.% chlorine, which is used photoditazine. Then in the previously formed tunnel in the area of the projection of intraocular tumors extrascleral placed under visual control using beam interference polymer elastic magnetic laser implant is equipped with a ring permanent magnet with axial magnetization of the permanent magnetic field with induction 3 MT in the center of which is fixed short-focus diffuser lens laser emitter connected to the lights of the house in soft elastic shell. When the implant is placed the magnetic North pole to intraocular neoplasm with accurate extrascleral placement in the projection of intraocular tumors lens laser emitter implant. When this permanent magnet polymer elastic laser magnetic implant was made from material systems samarium - cobalt. Then the fiber implant attached to the sclera 6 mm from the limbus one hub seam, covered the implant conjunctiva, filed her makeshift stitches, and the output optical fiber fixed to the head by adhesive tape. Carried out visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and upon reaching the maximum level of saturation of intraocular tumors photosensitizer conducted through the laser fiber and the lens implant transscleral laser irradiation of intraocular tumors divergent laser radiation with a wavelength of 661 nm for 180 seconds at the dose of 120 j/cm2.

After completing the course of treatment, the implant can be removed and put seams on the conjunctiva.

When the control ULTRASONIC study, after 6 months on the location of the mass was determined by dense scar up to 1 mm thick. Control PHAGE study showed no pathological fluorescen the AI in the nidus. In the late postoperative period up to 1.5 years of recurrent tumors were noted.

Example 2. Patient Hours, 59 years old. Entered the Kaluga branch of IRTC “eye microsurgery” with a referring diagnosis of melanoma of the choroid of the left eye. The initial age-related cataract in both eyes.

The tumor was localized temporal in the Equatorial region. Detailed assessment ophthalmoscopy and PHAGE were difficult because of the state of the optical media. According to the ultrasonic B-scanning: the size of the tumors was 9 to 10 mm when the value of prominence 3 mm.

Refinement of the localization of the boundaries of the tumor was performed intraoperatively by using diaphanoscopy.

With the consent of the patient had surgery on extrascleral implantation elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In the Meridian of the projection of intraocular tumors between the sclera and tenon's membrane formed tunnel. Then transscleral diaphanoscopy said localization and dimensions of intraocular tumors. Metered transscleral under Ophthalmoscope control with the help of a special needle into the structure of intraocular tumors were injected with 0.3 ml photosensibility the respective gel-based visco-elastic hyaluronic acid, namely giacalone containing 0.1 wt.% chlorine, which is used by Radachlorin. Then in the previously formed tunnel in the area of the projection of intraocular tumors extrascleral placed under visual control using beam interference polymer elastic magnetic laser implant is equipped with a ring permanent magnet with axial magnetization of the permanent magnetic field with induction 4 MT in the center of which is fixed short-focus diffuser lens laser emitter connected to a light guide in a soft elastic shell. When the implant is placed the magnetic North pole to intraocular neoplasm with accurate extrascleral placement in the projection of intraocular tumors lens laser emitter implant. When this permanent magnet polymer elastic laser magnetic implant made of a material system samarium - iron - nitrogen. Then the fiber implant attached to the sclera at 5 mm from the limbus one hub seam, covered the implant conjunctiva, filed her makeshift stitches, and the output optical fiber fixed to the head by adhesive tape. Carried out visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and maximize the level of saturation of intraocular tumors photosensitizer conducted through the laser fiber and the lens implant transscleral laser irradiation of intraocular tumors divergent laser irradiation with a wavelength of 666 nm for 60 seconds at the dose of 60 j/cm2. Then an extra 2 days intravenous introduced as a photosensitizer 1% aqueous solution of chlorine, namely Radachlorin, at a dose of 0.8 mg/kg, carried out a visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and upon reaching the maximum level of saturation of intraocular tumors photosensitizer conducted through the laser fiber and the lens implant transscleral repeated laser irradiation of intraocular tumors within 90 seconds at the dose of 60 j/cm2.

After completing the course of treatment, the implant can be removed and put seams on the conjunctiva.

When the control ULTRASONIC study, after 6 months on the location of the tumors was determined flat seams up to 1 mm thick. Later in the follow-up period of 1.5 years signs of recurrence was not found.

1. The surgical method of photodynamic treatment of intraocular tumors, including intravenous administration of a photosensitizer and laser irradiation of intraocular tumors at the dose of 60 to 120 j/cm, characterized in that the Meridian of the projection of intraocular tumors between the sclera and tenon's membrane form the tunnel, tra is skleraina diaphanoscopy precise localization and dimensions of intraocular tumors, metered transscleral under Ophthalmoscope control structure of intraocular tumors injected with 0.1-0.3 ml photosensitizing gel-based viscoelastic of hyaluronic acid selected from the group healon, viscoat or giacolone, this gel contains from 0.1 to 2 wt.% chlorine selected from the group Photolon, Radachlorin or photoditazine, then the previously formed the tunnel in the area of the projection of intraocular tumors extrascleral placed under visual control using beam interference polymer elastic magnetic laser implant is equipped with a ring permanent magnet with axial magnetization of the permanent magnetic field with induction 3-4 MTL in the center of which is fixed short-focus diffuser lens laser emitter connected to a light guide in a soft elastic shell, and the implant placed its North magnetic pole to intraocular neoplasm with providing extrascleral placement in the projection of intraocular tumors lens laser emitter implant, the fiber implant is stitched to the sclera 5-6 mm from the limbus one hub seam, cover the implant conjunctiva, impose on her makeshift stitches, and the output optical fiber is fixed to the temple, perform a visual inspection of the fluorescence of the cells winatrip the EIT tumors using fluorescent diagnostics and upon reaching the maximum level of saturation of intraocular tumors, the drug passes through the laser fiber and the lens implant transscleral laser irradiation of intraocular tumors divergent laser radiation with a wavelength 661-666 nm, and after treatment to remove the implant and suture 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, neodymium - iron - boron or samarium - iron - nitrogen.

3. The method according to claims 1 and 2, characterized in that it further 2-3 days intravenous as 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, carry out a visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and upon reaching the maximum level of saturation of intraocular tumors photosensitizer is repeated laser irradiation of intraocular tumors at the dose of 30 to 45 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.

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

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.

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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.

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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.

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