Method for preventing and treating the cases of metastases after surgically removing intraocular neoplasms

FIELD: medicine.

SUBSTANCE: method involves intravenously administering 0.1-1% aqueous solution of khlorin, selected from group containing photolon, radachlorine or photoditazine at a dose of 0.2-0.5 mg/kg or 0.2-1% aqueous solution of porphyrin like photogem at a dose of 0.2-1 mg/kg. Laser irradiation of blood is carried out 5-15 min later after beginning photosensitizer injection into cubital vein of one arm via laser light guide set in advance in the cubital vein of the other arm during 10-40 min at wavelength of 661-666 nm and power of 20-50 mW one session per day during 3-10 days with the aqueous solution of khlorin used as the photosensitizer, or laser irradiation of blood with wavelength equal to 630-633 nm during 10-45 min with power of 20-50 mW one session per day with the aqueous solution of porphyrin used as the photosensitizer. Repeated intravenous administration of photosensitizer is carried out 1-3 months later combined with repeated laser irradiation of blood.

EFFECT: reduced risk of tumor cells dissemination and metastasis development.

2 cl

 

The invention relates to medicine, namely to ophthalmology, to methods for the prevention and treatment of metastases after surgical removal of intraocular tumors, and can also be used after radiation, chemotherapy and photodynamic therapy of intraocular and orbital tumors.

There is a method of surgical removal of intraocular tumors, including performing a vitrectomy, retinotomy with subsequent exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection with its subsequent replacement by silicone oil (see Jose Garsia-Arumi, MD, Laura Sararols, MD, Vincent Martinez, MD, Borja Cjrcjstegui, MD, "Vitreoretinal Surgery and endoresection in high posterior choroidal melanomas, RETINA, 21:445-452, No. 5, 2001).

However, the known method when its use does not preclude the dissemination of tumor cells and subsequent metastasis.

The basis of the invention is to provide a method for the prevention and treatment of metastases after surgical removal of intraocular tumors, allowing for its use to reduce the risk of dissemination of tumor cells and reduce the risk of subsequent metastasis.

The problem is solved in that a method for prevention and treatment of meta the cans after surgical removal of intraocular tumors, including performing a vitrectomy, retinotomy with subsequent exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection with its subsequent replacement by silicone oil, the distinguishing feature of which is the fact that after removal of tumors intravenous drip in one of the cubital vein enters as a photosensitizer 0.1 to 1%aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg, or 0.2-1%aqueous solution of porphyrin, for example, is injected at a dose of 0.2-1 mg/kg, then after 5-15 minutes after the start of injection of the photosensitizer in the cubital vein of one arm passes through pre-installed in the cubital Vienna, on the other hand, the laser fiber laser blood irradiation with a wavelength of 661-666 nm for 10-40 minutes at power irradiation 20-50 mW one session a day for 3-10 days when used as a photosensitizer, an aqueous solution of chlorine, or laser blood irradiation with a wavelength of 630-633 nm within 10-45 minutes at a power of 20 to 50 mW one session per day when used as a photosensitizer, an aqueous solution of porphyrin. In addition after 1-3 months of repeated intravenous administration of photosensibility the ora with repeated intravenous laser irradiation of blood.

In the clinical practice of using the proposed method for the prevention and treatment of metastases after surgical removal of intraocular tumors, it was found that using all the selected parameters of the proposed method obtained the following technical result: significantly reduced the risk of dissemination of tumor cells and reduced the risk of subsequent metastasis.

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

Example 1. Patient D., 58 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with suspected tumors of the choroid right eye.

When the survey was diagnosed with melanoma of the choroid OD. Localization of lesions in the posterior pole of the eye. The size of the tumor by ultrasound B-scan: 10 to 12 mm, the size of prominence to 5 mm During PHAGE was detected characteristic "spotted" fluorescence in tumors.

Previously spent clarifying the true boundaries of the tumor by the method of transillumination.

At the preparatory stage after processing operating margins held anesthetic management. Spent vitrectomy and retinotomy with exposure of intraocular tumors. Then using vitrectomy intravitreal removed intraocular neoplasm, and after unfolding and crushing the retina performancesin connection, namely precontribution, spent restrictive endolaser coagulation section retinotomy. Performability was replaced with a silicone oil, and the operation is finished suturing the areas of sclerotome and conjunctiva.

Then an intravenous drip in the cubital vein of the right hand was introduced as a photosensitizer of 0.1%aqueous solution of chlorine, namely, Radachlorin in a dose of 0.5 mg/kg

Then 15 minutes after the start of injection of the photosensitizer in the cubital vein of the right hand held through pre-installed in the cubital Vienna left hand laser fiber laser blood irradiation with a wavelength of 666 nm for 40 minutes at a power of 20 mW irradiation one session a day for 10 days.

After 3 months, additional repeated intravenous administration as a photosensitizer Radachlorin and re-spent intravenous laser irradiation of blood for the same modes.

When the control ULTRASONIC study, after 6 months on the location of the mass was determined by dense scar up to 1 mm thick. Methods of radiography, computed tomography, nuclear magnetic resonance and ultrasound diagnosis of metastasis in the period from 1 year to 3 years is not detected.

Example 2. The patient is., 62 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with suspected tumors of the choroid of the left eye. When the survey was diagnosed with melanoma of the choroid. Localization of lesions in the posterior pole of the eye. The size of the tumor by ultrasound B-scan: 9 to 11 mm, the size of prominence to 5 mm During PHAGE was detected characteristic "spotted" fluorescence in tumors.

Previously spent clarifying the true boundaries of the tumor by the method of transillumination.

At the preparatory stage after processing operating margins held anesthetic management. Spent vitrectomy and retinotomy with exposure of intraocular tumors. Then using vitrectomy intravitreal removed intraocular tumor, and after unfolding and crushing the retina performancesin connection, namely preformulation, spent restrictive endolaser coagulation section retinotomy. Parfocality was replaced with a silicone oil, and the operation is finished suturing the areas of sclerotome and conjunctiva.

Then an intravenous drip in the cubital vein of the left arm was introduced as a photosensitizer 0.2% aqueous solution of porphyrin, namely injected at a dose of 0.2 mg/khaatam 5 minutes after the start of injection of the photosensitizer in the cubital vein of the left hand held through pre-installed in the cubital Vienna right hand laser fiber laser blood irradiation with length wavelength 630 nm for 10 minutes at a power of 50 mW irradiation one session per day for 3 days.

When the control ULTRASONIC study, after 6 months on the location of the mass was determined by dense scar up to 1 mm thick. Methods of radiography, computed tomography, nuclear magnetic resonance and ultrasound diagnosis of metastasis in the period from 1 year to 3 years is not detected.

1. Method for the prevention and treatment of metastases after surgical removal of intraocular tumors, including performing a vitrectomy, retinotomy with subsequent exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection with its subsequent replacement by silicone oil, characterized in that after removal of tumors intravenous drip in one of the cubital vein enters as a photosensitizer 0.1 to 1%aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg, or 0.2 to 1.0%aqueous solution of porphyrin, for example, is injected in the dose of 0.2-1 mg/kg, followed by 5-15 minutes after injection of the photosensitizer in the cubital vein of one arm carries through pre-installed in the cubital Vienna, on the other hand, the laser fiber laser irradiation of blood with donovani 661-666 nm for 10-40 min of exposure 20-50 mW one session a day for 3-10 days when used as a photosensitizer, an aqueous solution of chlorine, or laser blood irradiation with a wavelength of 630-633 nm within 10-45 minutes at a power of 20 to 50 mW one session per day when used as a photosensitizer, an aqueous solution of porphyrin.

2. The method according to claim 1, characterized in that it further after 1-3 months of repeated intravenous administration of a photosensitizer with repeated intravenous laser irradiation of blood.



 

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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.

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