Electrochemical destruction and photodynamic surgical method for treating the cases of intraocular neoplasms

FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. 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, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. 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, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

 

The invention relates to medicine, namely to ophthalmology, surgical methods electrochemical degradation and photodynamic treatment of intraocular tumors.

Known surgical method of photodynamic treatment of intraocular tumors, including intravenous administration of a photosensitizer and laser irradiation of intraocular tumors (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 growth and development of recurrent intraocular neoplasms.

The basis of the invention is to provide a method of surgical electrochemical degradation and photodynamic treatment of intraocular tumors, allowing for its use to achieve the complete destruction of intraocular tumors and prevent the development of recurrent tumors, to reduce the risk of tumour cell dissemination and metastasis.

The problem is solved in that a method of surgical electrochemical degradation and photodynamic treatment of intraocular novobrdo the deposits, includes intravenous administration of a photosensitizer and laser irradiation of intraocular tumors, the distinguishing feature of which is that pre-transscleral diaphanoscopy precise localization and dimensions of intraocular neoplasms, then 2/3 of the thickness of the sclera above the intraocular neoplasm form a scleral pocket rectangular base from limb, formed through the bed is introduced into the structure of intraocular neoplasms multiple electrodes made of platinum group metal, then by changing the polarity of the electrodes, conduct electrochemical destruction of intraocular tumors with amperage 10-100 mA for 1-10 minutes and remove the electrodes, the superficial scleral flap returns to its place and fixed with interrupted sutures, and then intravenously injected 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 spend it transpupillary laser irradiation with a wavelength of 661-666 nm within 60-180 s at the General the Oze exposure 30-120 j/cm 2and the surgery is completed by suturing on the conjunctiva. As a platinum group metal electrodes using platinum, iridium or rhodium, the number of electrodes selected from 4 to 8. Thus an additional 2-3 days re-injected 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, 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 for 30-90 seconds at the dose of 30 to 45 j/cm2.

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 technical solutions have the following technical result: achieved full stop growth of intraocular tumors with subsequent regression, achieved by increasing the efficiency of destruction of tumor tissues and reduced the invasiveness of surgical intervention. Most operas the bathrooms patients noted the preservation of visual function.

To illustrate the proposed method on the drawings schematically shows his main stages (Fig.1-3).

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

Example 1. Patient A., 58 years. Entered the Kaluga branch of IRTC “eye microsurgery” with a referring diagnosis of melanoma of the choroid of the right eye. The initial age-related cataract in both eyes.

The tumor was localized temporal in the Equatorial region. According to the ultrasonic B-scanning: the size of the tumors was 9 to 10 mm when the value of prominence 3 mm.

Pre transscleral diaphanoscopy said localization and dimensions of intraocular tumors. At the preparatory stage after processing operating margins held anesthetic management. Then 2/3 of the thickness of the sclera above the intraocular neoplasm formed scleral pocket rectangular base from the limbus. Through the formed bed introduced into the structure of intraocular tumors 4 electrode made of platinum. Then, by changing the polarity of the electrodes, held electrochemical destruction of intraocular tumors with rated current of 10 mA for 10 minutes and removed the electrodes. The superficial scleral flap was returned to its place and zafiksirovat and interrupted sutures. Intravenous introduced as a photosensitizer 1% aqueous solution of chlorine, namely the solution of Radachlorin in a dose of 0.8 mg/kg was Carried out by visual inspection of the fluorescence of cells intraocular tumors using fluorescent diagnostics and upon reaching the maximum level of saturation of intraocular tumors photosensitizer spent his transpupillary laser irradiation with a wavelength of 661 nm for 60 s with a total dose of 30 j/cm2. The operation ended with the stitches on the conjunctiva. Then, optionally after 3 days again intravenously introduced as a photosensitizer 1% aqueous solution of chlorine, namely the solution of Radachlorin in 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 repeated laser irradiation of intraocular tumors within 90 seconds at the dose of 45 j/cm2.

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 research did not reveal pathological fluorescence in the nidus. In the late postoperative period in SRO and up to 1.5 years of recurrent tumors were noted.

Example 2. Patient K., 69 years. Entered the Kaluga branch of IRTC “eye microsurgery” diagnosed with melanoma of the choroid of the right eye. The tumor was localized in midperiphery in ninananajna quadrant of the fundus. Ophthalmoscopically was determined rounded, prominere in the vitreous hearth grey slate colour. According to the PHAGE fundus diagnosis was confirmed. Ultrasonic b-scanning enabled to specify the size of the tumor 7 to 8 mm; the value of prominence - 2.5 mm

Pre transscleral diaphanoscopy said localization and dimensions of intraocular tumors. At the preparatory stage after processing operating margins held anesthetic management. Then 2/3 of the thickness of the sclera above the intraocular neoplasm formed scleral pocket rectangular base from the limbus. Through the formed bed introduced into the structure of intraocular tumors 8 electrode made of iridium. Then, by changing the polarity of the electrodes, held electrochemical destruction of intraocular tumors with rated current 100 mA for 1 minute and removed the electrodes. The superficial scleral flap was returned to its place and recorded interrupted sutures. Intravenous introduced as a photosensitizer 0.1% aqueous the solution of chlorin, namely, the solution of Photolon at a dose of 1.1 mg/kg has 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 spent his transpupillary laser irradiation with a wavelength of 666 nm for 180 s at a total dose of 120 j/cm2. The operation ended with the stitches 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 research did not reveal pathological fluorescence in the nidus. In the late postoperative period up to 1.5 years of recurrent tumors were noted.

1. The surgical method of photodynamic treatment of intraocular tumors, including intravenous administration of a photosensitizer and laser irradiation of intraocular tumors, characterized in that before the operation transscleral diaphanoscopy precise localization and dimensions of intraocular neoplasms, then 2/3 of the thickness of the sclera above the intraocular neoplasm form a scleral pocket rectangular base from limb, formed through the bed is introduced into the structure of intraocular nooope the Finance several electrodes, made of a metal of the platinum group, then changing the polarity of the electrodes conduct the electrochemical degradation of intraocular tumors with rated current of 10 mA for 10 min or with rated current 100 mA for 1 min and remove the electrodes, the superficial scleral flap returns to its place and fixed with interrupted sutures, and then intravenously injected as a photosensitizer 0.1 to 1%aqueous solution of chlorine selected from the group Photolon, happy-chlorin 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 the saturation level of intraocular tumors photosensitizer spend it transpupillary laser irradiation with a wavelength of 661-666 nm at a total dose of irradiation 30-120 j/cm2and the surgery is completed by suturing on the conjunctiva.

2. The method according to claim 1, characterized in that as a platinum group metal electrodes using platinum, iridium or rhodium, the number of electrodes selected from 4 to 8.

3. The method according to claims 1 and 2, characterized in that it further 2-3 days re-injected as a photosensitizer 0.1 to 1%aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine in a dose of 0.8 to 1.1 is g/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.



 

Same patents:

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

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.

3 cl, 5 dwg

The invention relates to medicine, namely to Hepatology

The invention relates to medicine, namely to the field of physiotherapy and can be used for treatment of nervous system diseases of the spine
The invention relates to medicine, and is intended for the treatment of pain syndromes in patients with pathology of the peripheral nervous system

The invention relates to ophthalmology, and can be used to treat the false myopia

The invention relates to medicine, namely to physiotherapy, and can be used in the treatment of periodontitis
The invention relates to medicine, namely to traumatology and orthopedics, and can be used to diagnose areas of articular cartilage affected degenerative-dystrophic process
The invention relates to medicine, namely to orthopedics
The invention relates to medicine, namely to physiotherapy, and is intended for the rehabilitation of patients in the treatment of fractures of the pelvis

Galvanic comb // 2240840
The invention relates to medicine, namely to prevention devices, and is intended to affect the scalp, stimulation and hair growth

The invention relates to veterinary therapy, namely the treatment of cats in posleoperazionny period

The invention relates to animal husbandry

Dental capsule // 2229860
The invention relates to medicine, specifically to dentistry, and can be used for the treatment of periodontal diseases and diseases of the mucous membranes of the oral cavity, in particular stomatitis
The invention relates to medicine and is intended for diagnostics of muscular
The invention relates to medicine and is intended to perform electrotherapy

The invention relates to medical and biological engineering and can be used to influence human processes, as well as for treatment of various diseases in non-traditional ways
The invention relates to medicine, in particular, neurology, and can be used to treat Parkinson's disease, atherosclerotic encephalopathy with intellectual disabilities and memory, functional pain syndromes face and mouth

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

Up!