Surgical removal and photodynamic method for treating subretinal neovascular membranes

FIELD: medicine.

SUBSTANCE: method involves building tunnel to posterior eyeball pole in inferoexterior and superexterior quadrants. The tunnel is used for implanting flexible polymer magnetolaser implant to the place, the subretinal neovascular membrane is localized. The implant has a permanent magnet shaped as a cut ring and is provided with drug delivery system and a short focus scattering lens of laser radiator connected to light guide. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 5-7 mTesla units intensity. It is arranged with its north pole turned towards sclera at the place of the subretinal neovascular membrane projection with extrascleral arrangement of laser radiator lens membrane being provided in the subretinal neovascular membrane projection area. The other implant end is sutured to sclera 5-6 mm far from the limb via holes made in advance. The implant is covered with conjunctiva and retention sutures are placed thereon. Light guide and drug supply system lead is attached to temple with any known method applied. Drugs are supplied via the implant drug supply system in retrobulbary way in any order. Triombrast is given in the amount of 0,4-0,6 ml and dexamethasone or dexone in the amount of 0,4-0,6 ml during 3-4 days every 12 h. 0.1-1% aqueous solution of khlorin is intravenously introduced at the third-fourth day after setting the implant as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, at a bolus dose of 0.8-1.1 mg/kg. Visual control of subretinal neovascular membrane cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the subretinal neovascular membrane with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at general dose of 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 subretinal neovascular membrane via laser light guide and implant lens, repeated laser irradiation of the subretinal neovascular membrane is carried out with radiation dose of 30-60 J/cm2.

EFFECT: accelerated subretinal edema and hemorrhages resorption; regression and obliteration of the subretinal neovascular membrane; prolonged vision function stabilization.

6 cl

 

The invention relates to medicine, namely to ophthalmology, surgical methods of photodynamic treatment of subretinal neovascular membranes.

There is a method of treatment of subretinal neovascular membranes, including intravenous administration of a photosensitizer and laser irradiation subretinal neovascular membrane (see Treatment of age-related macular degeneration with photodynamic therapy (TAP) study group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with. One-year results of 2 randomized clinical trials - TAP report 1// Arch. Ophthalmol. - 1999. - Vol.117. - P.1329-1345).

However, the known method when its use does not allow for photodynamic therapy in the presence of subretinal edema and hemorrhages and does not achieve complete regression of subretinal neovascular membranes, as well as the preservation and long-term stabilization of visual functions.

The basis of the invention is to provide a method of surgical photodynamic treatment of subretinal neovascular membranes, allowing for its use to achieve accelerated resorption of subretinal edema and hemorrhages, to obtain the regression and the obliteration subretinal neovascular membrane to ensure the conservation and long-term stabilization of visual functions in the long term.

The problem is solved in that the proposed methods for the surgical photodynamic treatment of subretinal neovascular membranes, includes intravenous administration of a photosensitizer and laser irradiation subretinal neovascular membrane, the distinguishing feature of which is that in the lower-outer or upper outer quadrants form the tunnel toward the posterior pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant fitted made in the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens laser emitter, which is connected to a light guide, while the permanent magnet of the implant is performed with axial magnetization of the permanent magnetic field with induction 5-7 MT and place its North magnetic pole to the sclera at the site of projection of the subretinal neovascular membrane with accurate extrascleral placement in the projection of subretinal neovascular membranes lens 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 and supply system drugs fiksirujut temple by any known method, for example, adhesive plaster, and then through the delivery system of drugs implant retrobulbarno served in any order drugs triombrast in the amount of 0.4-0.6 ml and dexamethasone or deksona in the amount of 0.4-0.6 ml for 3-4 days every 12 hours, then for 3-4 days after placing the implant 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, carry out a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level saturation subretinal neovascular membrane with a photosensitizer passes through the laser fiber and the lens implant transscleral laser irradiation subretinal neovascular membrane divergent laser radiation with a wavelength 661-666 nm within 60-180 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. P and an additional 2-3 days after the first laser irradiation is repeated intravenous administration of a photosensitizer in the same amounts, carry out a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer passes through the laser fiber and the lens implant re transscleral laser irradiation subretinal neovascular membranes for 30-90 seconds at a total dose 30 to 60 j/cm2.

In the clinical practice of application of the method of surgical photodynamic treatment of subretinal neovascular membranes, it was found that using all the selected parameters of the proposed method achieved accelerated resorption of subretinal edema and hemorrhages, resulting regression and obliteration subretinal neovascular membrane with preservation and long-term stabilization of visual functions in the long term.

To illustrate the proposed method figure illustrates its basic steps.

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

Example 1. Patient S., 62 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with the diagnosis of Central involutional chorioretinal dystrophy. Subretinal neous ulama membrane OS. Before surgery, the visual acuity OS - 0,05 n/K. Foveolar sensitivity 12 dB. The fundus of the eye: OS - in the macular area was determined rounded, prominere hearth. The presence of strong subretinal perifocal edema and hemorrhages indicated the presence of a hidden neovascularization. As a result fluorescein angiographic studies were identified juxtafoveal subretinal neovascular membrane with an intense fluorescence. However, to fully assess the extent and limits subretinal neovascular membrane was not possible due to the shielding effect of subretinal edema and hemorrhages.

Surgery for implantation of polymer elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In the lower-outer or upper outer quadrants formed a tunnel to the rear pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant fitted made in the form of a split ring permanent magnet, supply of drugs and short-focus scattering laser lens from which uchtala, connected with fiber. The permanent magnet of the implant was performed with axial magnetization of the permanent magnetic field with an induction of 5 MT and placed its North magnetic pole to the sclera at the site of projection of the subretinal neovascular membrane with accurate extrascleral placement in the projection of subretinal neovascular membranes lens laser emitter implant. The permanent magnet of the implant is made of a material system samarium - cobalt. The other end of the implant is attached to the sclera at 5 mm from the limbus two interrupted sutures through pre-made holes. The implant is covered by the conjunctiva, filed her makeshift stitches, and the output optical fiber and supply system of medicinal substances fixed to the head of the patient by adhesive tape. Through the delivery system of drugs implant retrobulbarno entered in any sequence triombrast in the amount of 0.4 ml and dexamethasone in an amount of 0.6 ml for 4 days every 12 hours. Then on the 4th day after placement of the implant intravenous bolus introduced as a photosensitizer 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 subretinal neovascular membranes using fluorescence diagnostics and upon reaching the Maxi the actual level of saturation of the subretinal neovascular membrane with a photosensitizer through the laser fiber and the lens implant spent transscleral laser irradiation subretinal neovascular membranes laser divergent radiation with a wavelength of 666 nm for 180 seconds with a total dose of 120 j/cm2. 2 days after the first laser irradiation was carried out by repeated intravenous administration as a photosensitizer 1% aqueous solution of chlorine, namely Radachlorin at a dose of 1.1 mg/kg, carried out a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer repeated laser irradiation subretinal neovascular membranes for 90 seconds with a total dose of 60 j/cm2. After the end of treatment removed the elastic polymer laser magnetic implant and put the seams on the conjunctiva.

During the control study three months after surgery, the visual acuity OS - 0.1 g/K. Foveolar sensitivity of 24 dB. In the fundus of the left eye in the macular region formed flat fibrovascular lesion; edema and subretinal hemorrhage is almost completely resorbed. According to the control fluorescein angiography revealed complete obliteration of the newly formed neovascular network. In the period up to 1.5 years of recurrence development of subretinal neovascular membrane is not from the echino.

Example 2. Patient R., 67 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with the diagnosis of Central involutional chorioretinal dystrophy. Subretinal neovascular membrane OD. Before surgery, the visual acuity OD - 0,08 n/K. Foveolar sensitivity of 13 dB. The fundus of the eye: OD - in the macular area was determined rounded prominere hearth. The presence of strong subretinal perifocal edema and hemorrhages indicated the presence of a hidden neovascularization. As a result fluorescein angiographic studies were identified juxtafoveal subretinal neovascular membrane with intense fluorescence.

Surgery for implantation of polymer elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In the lower-outer or upper-outer quadrant sportively the tunnel toward the posterior pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant fitted made in the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens La is cluster emitter, connected with fiber. The permanent magnet of the implant was performed with axial magnetization of the permanent magnetic field with induction 7 MT and placed its North magnetic pole to the sclera at the site of projection of the subretinal neovascular membrane with accurate extrascleral placement in the projection of subretinal neovascular membranes lens laser emitter implant. The permanent magnet of the implant is made of a material system neodymium - iron - boron. The other end of the implant is attached to the sclera 6 mm from the limbus two interrupted sutures through pre-made holes. The implant is covered by the conjunctiva, filed her makeshift stitches, and the output optical fiber and supply system of medicinal substances fixed to the head of the patient by adhesive tape. Through the delivery system of drugs implant retrobulbarno entered in any sequence triombrast in the amount of 0.6 ml and deksona in the amount of 0.4 ml for 3 days every 12 hours. Then on the 3rd day after placement of the implant intravenous bolus introduced as a photosensitizer 0.1% 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 in the subretinal neovascular membrane and upon reaching the maximum level of saturation subretinal Neova the circular membrane with a photosensitizer conducted through the laser fiber and the lens implant spent transscleral laser irradiation subretinal neovascular membrane divergent laser radiation with length waves 661 nm for 60 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.

During the control study three months after surgery, the visual acuity OD - 0,2 n/K. Foveolar sensitivity of 23 dB. In the fundus of the right eye in the macular region formed flat fibrovascular lesion; edema and subretinal hemorrhage is almost completely resorbed. According to the control fluorescein angiography revealed complete obliteration of the newly formed neovascular network. In the period up to 1.5 years of recurrence development of subretinal neovascular membrane is not marked.

There is a method of treatment of subretinal neovascular membranes, including intravenous administration of a photosensitizer and laser irradiation subretinal neovascular membrane (see Treatment of age-related macular degeneration with photodynamic therapy (TAP) study group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with. One-year results of 2 randomized clinical trials - TAP report 1// Arch. Ophthalmol. - 1999. - Vol.117. - P.1329-1345).

However, the known method using does not allow for photodynamic therapy in the presence of subretinal edema and hemorrhages and not achieving the full regression of subretinal neovascular membrane, and from the wound and prolonged stabilization of visual functions.

The basis of the invention is to provide a method of surgical photodynamic treatment of subretinal neovascular membranes, allowing for its use to achieve accelerated resorption of subretinal edema and hemorrhages, to obtain the regression and the obliteration subretinal neovascular membrane to ensure the conservation and long-term stabilization of visual functions.

The problem is solved in that a method of surgical photodynamic treatment of subretinal neovascular membranes, including intravenous administration of a photosensitizer and laser irradiation subretinal neovascular membrane, the distinguishing feature of which is that in the lower-outer or upper outer quadrants form the tunnel toward the posterior pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant fitted made in the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens laser emitter, which is connected to a light guide, with a constant the magnet of the implant is performed with axial magnetization of the permanent magnetic poles induction 5-7 MT and place it on the magnetic North pole to the sclera at the site of projection of the subretinal neovascular membrane with accurate extrascleral placement in the projection of subretinal neovascular membrane 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 and delivery system of drugs is fixed to the head by any known means, such as adhesive tape, and then through the delivery system of drugs implant retrobulbarno served in any order drugs triombrast in the amount of 0.4-0.6 ml and dexamethasone or deksona in the amount of 0.4-0.6 ml for 2-3 days every 12 hours, then 3-4 day after placing an implant injected into the retro-bulbar space as a photosensitizer 0.1 to 1% aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine and intended for intravenous administration in the amount of 0.6-1.5 ml 4-7 times within 3 hours, then carry out a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer passes through the laser fiber and the lens implant transscleral laser irradiation subretinal neous Blarney membrane divergent laser radiation with a wavelength 661-666 nm within 60-180 seconds for a total dose irradiation 30-120 j/cm 2and 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 retro-bulbar injection of photosensitizer within 3 hours, carry out a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer is repeated laser irradiation subretinal neovascular membranes for 30-90 seconds at a total dose 30 to 60 j/cm2.

In the clinical practice of application of the method of surgical photodynamic treatment of subretinal neovascular membranes, it was found that using all the selected parameters of the proposed method achieved accelerated resorption of subretinal edema and hemorrhages received full regression and obliteration subretinal neovascular membrane with preservation and long-term stabilization of maturing the selected functions in the long term.

To illustrate the proposed method figure illustrates its basic steps.

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

Example 1. Patient P., 68 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with the diagnosis of Central chorioretinal dystrophy in both eyes in the stage of exudative retinal pigment epithelium with the presence of the alleged subretinal neovascular membrane in the right eye.

Visual acuity at admission on the OD of 0.1 n/K. Foveal sensitivity - 12 dB. In the fundus of the right eye in the macular area was determined rounded prominere hearth yellow. On the fluorescent angiogram showed signs subfoveal CNM, with poorly defined borders.

Surgery for implantation of polymer elastic laser magnetic implant.

At the preparatory stage after processing processing operating margins held anesthetic management. In the lower-outer or upper-outer quadrant sportively the tunnel toward the posterior pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant equipped performed is the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens laser emitter, which is connected to a light guide. The permanent magnet of the implant was performed with axial magnetization of the permanent magnetic field with induction 7 MT and placed its North magnetic pole to the sclera at the site of projection of the subretinal neovascular membrane with accurate extrascleral placement in the projection of subretinal neovascular membranes lens laser emitter implant. The permanent magnet of the implant is made of a material system samarium - cobalt. The other end of the implant is attached to the sclera 6 mm from the limbus two interrupted sutures through pre-made holes. The implant is covered by the conjunctiva, filed her makeshift stitches, and the output optical fiber and supply system of medicinal substances fixed to the head of the patient by adhesive tape. Through the delivery system of drugs implant retrobulbarno entered in any sequence triombrast in the amount of 0.6 ml and deksona in the amount of 0.6 ml for 2 days every 12 hours. Then on the 3rd day after placement of the implant into the retro-bulbar space as a photosensitizer has introduced a 1% aqueous solution of chlorine, namely Radachlorin, intended for intravenous administration, in the amount of 0.6 ml 7 times during the 3 hours. Then made a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer through the laser fiber and the lens implant spent transscleral laser irradiation subretinal neovascular membrane divergent laser radiation with a wavelength of 661 nm for 60 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.

At the control examination after 3 months according to the PHAGE and ophthalmoscopy on the operated eye revealed complete obliteration SNM with resorption of subretinal macular edema. Visual acuity in the operated eye amounted to 0.2 n/K.

Example 2. Patient F., 67 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with the diagnosis of Central chorioretinal dystrophy in both eyes in the stage of exudative retinal pigment epithelium with the presence of the alleged subretinal neovascular membrane in the left eye.

Visual acuity when applying for OS - 0.1 g/K. Foveal sensitivity - 12 dB. In the fundus of the left eye in the macular area was determined ukrplastforma prominere hearth yellow. On the fluorescent angiogram showed signs subfoveal CNM, with poorly defined borders.

Surgery for implantation of polymer elastic laser magnetic implant.

At the preparatory stage after processing operating margins held anesthetic management. In ninananajna or upper outer quadrants formed a tunnel to the rear pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant fitted made in the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens laser emitter, which is connected to a light guide. The permanent magnet of the implant was performed with axial magnetization of the permanent magnetic field with an induction of 5 MT and placed its North magnetic pole to the sclera at the site of projection of the subretinal neovascular membrane with accurate extrascleral placement in the projection of subretinal neovascular membranes lens laser emitter implant. The permanent magnet of the implant

made of a material system samarium - iron - nitrogen. The other end of the implant is attached to the sclera 6 km MOT limb two interrupted sutures through pre-made holes. The implant is covered by the conjunctiva, filed her makeshift stitches, and the output optical fiber and supply system of medicinal substances fixed to the head of the patient by adhesive tape. Through the delivery system of drugs implant retrobulbarno entered in any sequence triombrast in the amount of 0.4 ml and dexamethasone in an amount of 0.4 ml for 3 days every 12 hours. Then 4 days after placement of the implant into the retro-bulbar space as a photosensitizer has introduced a 0.1% aqueous solution of chlorine, namely Photolon intended for intravenous, 1.5 ml of 4 times within 3 hours. Then made a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer through the laser fiber and the lens implant spent transscleral laser irradiation subretinal neovascular membrane divergent laser radiation with a wavelength of 666 nm for 180 seconds with a total dose of 120 j/cm2. 2 days after the first laser irradiation was carried out by re-retro-bulbar introduction as a photosensitizer 1% aqueous solution of chlorine, namely Radachlorin in dose is 1.1 mg/kg, carried out visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer repeated laser irradiation subretinal neovascular membranes for 90 seconds with a total dose of 60 j/cm2.

After the end of treatment removed the elastic polymer laser magnetic implant and put the seams on the conjunctiva.

At the control examination after 3 months according to the PHAGE and ophthalmoscopy on the operated eye revealed complete obliteration SNM with resorption of subretinal macular edema. Visual acuity in the operated eye was - 0.25 n/K.

1. The surgical method of photodynamic treatment of subretinal neovascular membranes, including intravenous administration of a photosensitizer and laser irradiation subretinal neovascular membrane, characterized in that in the lower-outer or upper outer quadrants form the tunnel toward the posterior pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant equipped performed is the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens laser emitter, which is connected to a light guide, while the permanent magnet of the implant is performed with axial magnetization of the permanent magnetic field with induction 5-7 MT and place it on the magnetic North pole to the sclera with the provision of extrascleral placement in the projection of subretinal neovascular membranes lens 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 and delivery system of drugs is fixed to the temple, then through the delivery system drug substances implant retrobulbarno served in any order drugs triombrast in the amount of 0.4-0.6 ml and dexamethasone or deksona in the amount of 0.4-0.6 ml for 3-4 days every 12 h, then for 3-4 days after placing the implant 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, carry out a visual inspection of the fluorescence of cells in the subretinal neovascular membrane using fluoresc nteu diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane the drug passes through the laser fiber and the lens implant transscleral laser irradiation subretinal neovascular membrane 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 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, 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 subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer passes through the laser fiber and the lens implant re transscleral laser irradiation subretinal neovascular membrane with a total dose 30 to 60 j/cm2.

4. The surgical method of photodynamic treatment of subretinal neovascular membranes, including intravenous administration of a photosensitizer and laser irradiation subretinal neovascular the nuclear biological chemical (NBC membrane, characterized in that in the lower-outer or upper outer quadrants form the tunnel toward the posterior pole of the eyeball, through which under visual control using beam interference implanted to the localization of subretinal neovascular membrane polymer elastic magnetic laser implant fitted made in the form of a split ring permanent magnet, supply of drugs and short-focus scattering lens laser emitter, which is connected to a light guide, while the permanent magnet of the implant is performed with axial magnetization of the permanent magnetic field with induction 5-7 MT and place it on the magnetic North pole to the sclera with the provision of extrascleral placement in the projection of subretinal neovascular membrane 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 and delivery system of drugs is fixed to the temple, and then through the delivery system of drugs implant retrobulbarno served in any order drugs triombrast in the amount of 0.4-0.6 ml and dexamethasone or deksona inthe number of 0.4-0.6 ml for 2-3 days every 12 h, then for 3-4 days after placement of the implant is injected into the retro-bulbar space as a photosensitizer 0.1 to 1%aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine and intended for intravenous administration, in the amount of 0.6-1.5 ml 4-7 times within 3 hours, carry out a visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer passes through the laser fiber and the lens implant transscleral laser irradiation subretinal neovascular membrane 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 suture on the conjunctiva.

5. The method according to claim 4, 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.

6. The method according to claims 4 and 5, characterized in that it further 2-3 days after the first laser irradiation is repeated retro-bulbar injection of photosensitizer within 3 h 4-7 times, the OS is p visual inspection of the fluorescence of cells subretinal neovascular membranes using fluorescence diagnostics and upon reaching the maximum level of saturation of the subretinal neovascular membrane with a photosensitizer passes through the laser fiber and the lens implant re transscleral laser irradiation subretinal neovascular membrane with a total dose 30 to 60 j/cm2.



 

Same patents:

FIELD: medicine.

SUBSTANCE: method involves intravitreously introducing two electrodes into intraocular neoplasm after carrying out vitrectomy and retinotomy to expose the intraocular neoplasm. The electrodes are manufactured from platinum group metal. Electrochemical destruction is carried out with current intensity of 100 mA during 1-10 min or 10 mA during 10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% 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 fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous laser radiation is carried out in parallel light beam of wavelength equal to 661-666 nm is applied at a dose of 30-120 J/cm2.The transformed retina and tumor destruction products are intravitreally removed. Boundary-making endolasercoagulation of retinotomy area is carried out after having smoothed and compressed retina with perfluororganic compound. The operation is finished with placing sutures on sclerotomy and conjunctiva. Platinum, iridium or rhodium are used as the platinum group metals. Another embodiment of the invention involves adjusting position and size of the intraocular neoplasm in trans-scleral diaphanoscopic way. Rectangular scleral pocket is built above the intraocular neoplasm to 2/3 of sclera thickness with its base turned away from limb. Several electrodes are introduced into intraocular neoplasm structure via the built bed. The electrodes are manufactured from platinum group metal. Electrochemical destruction is carried out with the same current intensity in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. Superficial scleral flat is returned to its place and fixed with interrupted sutures. 0.1-1% 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 after having carried out vitrectomy and retinotomy. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous laser radiation is carried out in parallel light beam of wavelength equal to 661-666 nm is applied at a dose of 30-120 J/cm2. The transformed retina and tumor destruction products are intravitreally removed using vitreotome. Boundary-making endolasercoagulation of retinotomy area is carried out after having smoothed and compressed retina with perfluororganic compound. The operation is finished with placing sutures on sclerotomy and conjunctiva. Platinum, iridium or rhodium are used as the platinum group metals. The number of electrodes is equal to 4-8.

EFFECT: reduced risk of metastasizing.

4 cl, 13 dwg

FIELD: medicine.

SUBSTANCE: the present innovation deals with treating vascular cutaneous neoplasms, such as nevus flammeus and gemangiomas. Light-thermal impact at energy ranged 39-47 J/sq. cm should be performed in two stages, and between them, 2-3 wk after the onset of vascular resistance at the first stage one should perform beta-therapy daily for 2-3 d at single dosage being 20 g. Then, 3 wk later it is necessary to conduct the second stage of light-thermal impact by starting at energy value being 42 J/sq. cm, not less. The method enables to shorten therapy terms due to applying combined method to affect vascular cutaneous neoplasms.

EFFECT: higher therapeutic and cosmetic effect.

1 ex

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

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

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

The invention relates to medicine, and is intended to impact on the human body

The invention relates to medicine, and is intended for the treatment of acute oophoritis
The invention relates to medicine, magnitolazeroterapii
The invention relates to medicine, namely to physical therapy and urology

The invention relates to medicine, and is intended for direct endolymphatic laser therapy on Shulyak-Shuliak
The invention relates to medicine and can be used to treat long-term unhealed erosion and ulceration of the cornea

The invention relates to medicine, and is intended for the treatment of purulent wounds in the experiment

FIELD: medicine.

SUBSTANCE: method involves intravitreously introducing two electrodes into intraocular neoplasm after carrying out vitrectomy and retinotomy to expose the intraocular neoplasm. The electrodes are manufactured from platinum group metal. Electrochemical destruction is carried out with current intensity of 100 mA during 1-10 min or 10 mA during 10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% 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 fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous laser radiation is carried out in parallel light beam of wavelength equal to 661-666 nm is applied at a dose of 30-120 J/cm2.The transformed retina and tumor destruction products are intravitreally removed. Boundary-making endolasercoagulation of retinotomy area is carried out after having smoothed and compressed retina with perfluororganic compound. The operation is finished with placing sutures on sclerotomy and conjunctiva. Platinum, iridium or rhodium are used as the platinum group metals. Another embodiment of the invention involves adjusting position and size of the intraocular neoplasm in trans-scleral diaphanoscopic way. Rectangular scleral pocket is built above the intraocular neoplasm to 2/3 of sclera thickness with its base turned away from limb. Several electrodes are introduced into intraocular neoplasm structure via the built bed. The electrodes are manufactured from platinum group metal. Electrochemical destruction is carried out with the same current intensity in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. Superficial scleral flat is returned to its place and fixed with interrupted sutures. 0.1-1% 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 after having carried out vitrectomy and retinotomy. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous laser radiation is carried out in parallel light beam of wavelength equal to 661-666 nm is applied at a dose of 30-120 J/cm2. The transformed retina and tumor destruction products are intravitreally removed using vitreotome. Boundary-making endolasercoagulation of retinotomy area is carried out after having smoothed and compressed retina with perfluororganic compound. The operation is finished with placing sutures on sclerotomy and conjunctiva. Platinum, iridium or rhodium are used as the platinum group metals. The number of electrodes is equal to 4-8.

EFFECT: reduced risk of metastasizing.

4 cl, 13 dwg

Up!