Method for diabetic retinopathy with exudative-hemorrhagic maculopathy accompanied by hypocoagulation and hemorrhagic syndrome

FIELD: medicine, ophthalmology.

SUBSTANCE: one should introduce 1.0% serotonin adipinate solution intravenously due to infusion once daily for 10-12 d. The method enables to increase visual functions due to decreased tissue hypoxia and normalization of retinal microcirculation, resorption of hemorrhages, reverse development of retinal edema, normalization of functional thrombocytic activity and hemostatic values.

EFFECT: higher efficiency for therapy.

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The present invention relates to ophthalmology and is intended for therapeutic treatment of diabetic retinopathy. Currently, diabetic retinopathy (DR) is the leading place among the causes of blindness and low vision (1). Stable symptoms clinical course OTHERS are hemorrhages in the internal environment and membranes of the eyes, accompanied by retinal edema, formation of hard exudates and decline in visual functions. Recurrent intraocular hemorrhage difficult to treat, toxic effect on the retina and significantly affect the outcome of the disease, the status of visual function and frequency of disability.

Currently, the goal of treatment and prevention of retinal hemorrhages in patients with PD remains an unsolved problem of ophthalmology.

In treating OTHERS with exudative-hemorrhagic maculopathy, as a rule, use local (parabulbar) application of hemostatic, resorptive and anti-fibrinolytic drugs (aminocaproic acid, dicine, collalysin, Gamesa). Despite widespread use of the above products, you cannot obtain long-term and stable high therapeutic effect.

Our attention to the problem of the pathogenesis and treatment of OTHERS attracted serotonin is one of the evolutionary oldest price is Central neurotransmitters, governing as a behavioral system, and participating in the regulation of tone and rhythmic oscillations of blood vessels, providing normal tissue metabolism and homeostasis (3). It is known that serotonin and its receptors are present in all structures of the eye and the visual analyzer (4).

In domestic and foreign literature we did not find publications on the effects of serotonin on the state of retinal haemorrhage, visual function, the functional activity of platelets and blood coagulation in patients with PD. Given the above, the task was to prove that a hemorrhagic condition in the fundus has a private character system disorders of hemostasis, and develop a method of therapeutic treatment of OTHERS, accompanied by hypocoagulation and hemorrhagic syndrome, parenteral introduction of a 1.0% solution of serotonin adipinate.

The technical result of the invention is to improve visual acuity in patients with PD by reducing retinal edema resorption of hemorrhages, normalization of functional activity of platelets and hemostasis.

The technical result is achieved by parenteral injection of 1.0% solution of serotonin adipinate, providing normal blood flow in the microvasculature and reinforcing fibre OLIS.

The premise of the proposed invention was clinico-laboratory study was performed in 10 healthy volunteers and 40 patients (80 eyes) with OTHERS. All patients ophthalmoscopically was determined exudative-hemorrhagic maculopathy with recurrent nature.

All volunteers and patients was performed aggregometry platelets in the domestic concentration colorimeter - ck-2. As Agrigento used physiological concentrations of thrombin (2). In addition, the domestic coagulogram - n explored some hemostatic parameters: a) the beginning of coagulation, oksywie on the time required for the formation of the first insoluble threads of fibrin; (b) the total clotting time indicates the time spent on the formation of a blood clot; the density of blood clot, describing in General, the usefulness retractile phase of coagulation.

All patients were randomly divided into two groups: the first group (28 patients) received previously provided by traditional drug therapy; the Second group consisted of 12 patients, of which 1.0 ml of 1.0% of serotonin adipinate, dissolved in 200.0 ml of 0.9% sodium chloride solution, was administered intravenous infusion with a speed of 40 drops in one minute once a day for 10-12 days.

Results of examination and treatment of the Sabbath.

The ratio of platelet aggregation in the group of volunteers was 38,0±2.4 mm; in the first group of patients to 12.0±0.9 mm; the second group of patients 08,0±0,07 mm In the study of hemostasis obtained the following results in the group of volunteers: a) the beginning of coagulation=3,2±0,07 min; b) the total clotting time=6,9±0,09 min; C) the density of the blood clot=0,3±0,002 see 2) B1 and 2 groups of patients, ETC results hemostasis was practically on one level, differing from each other in tenths: a) the beginning of coagulation=10,1±0,4 min; b) the total clotting time=13,2±0,02 min; C) the density of the blood clot=1,6±0,01 see Thus in patients with PD with exudative-hemorrhagic maculopathy indicators of coagulogram and platelet aggregation indicate pronounced gipokoagulyatsii and hypogravity. Given that the blood for the study were taken from the cubital vein, the results obtained prove that the disorder of hemostasis and platelet aggregation in patients with OTHER systemic nature. This determined the route of administration of serotonin adipinate patients of the second group.

After the course of application of serotonin produced the following results: 1) platelet aggregation in all patients reached normal values and were within the range of 20.0-50,0 mm, 2) indicators of coagulogram significantly decreased and almost reached norms: the) beginning of coagulation=6,0± 0,09 min; b) the total clotting time=9,3±0,4 min; C) the density of the blood clot=0,4±0,009 see In 10 out of 12 patients, ETC with exudative-hemorrhagic maculopathy treated with serotonin, there has been a substantial resorption of hemorrhages, reducing retinal edema (this is probably connected not only with the normalizing action of serotonin in the blood vessels of the microvasculature, but with a pronounced its fibrinolytic effect), and visual acuity improvement was in the range of 0.2-0.4.

In the group of patients treated with the above-mentioned conventional therapy of 28 patients, a single patient has not occurred normalization of hemostasis and platelet aggregation. However ophthalmoscopically in 4 out of 28 patients had experienced a marked resorption of hemorrhages and improving visual acuity 0.1-0.2.

Clinical example. Patient GGE, 72 years. Diagnosis: preproliferative diabetic retinopathy with severe exudative-hemorrhagic maculopathy in both eyes. Recurrent hemorrhage in the macular region of the right eye. Diabetes mellitus type 2. Hypertension 2 tbsp.

Objective: the acuity of the right eye=0.2 incorrigible. The fundus of the eye-the optic disc pale pink with clear contours, the vascular bundle in the course is not changed; the veins are twisted, enlarged, many of microaneurysms in Central the region of the fundus extensive hemorrhage, around the eye to the bottom of many rounded hemorrhages of various sizes and age. Visual acuity of the left eye=0,6 incorrigible. The fundus of the eye-the optic disc is pale pink with clear margins, veins are enlarged, twisted, on average the periphery of the many small round hemorrhages at different stages. Clinical and laboratory data before the treatment: the ratio of platelet aggregation=08,0 mm; indicators of coagulogram - beginning of the collapse=14,5 min; total clotting time=18,0 min; density blood clot 1,3 see

TREATMENT. The patient on the background antidiabetic drugs received infusion of 10 mg (1.0 ml of 1% solution of serotonin adipinate) in 200.0 ml of 0.9% solution of sodium chloride at a speed of 40 drops per minute, once per day, five times a week, just for the course of treatment performed 12 infusions.

The RESULTS of TREATMENT, visual acuity of the right eye improved to 0.4 and 0.6, incorrigible, visual acuity of the left eye improved to 0.8. In the fundus of the right eye hemorrhage almost entirely resorbables in the fundus of the left eye remained isolated hemorrhage. In addition, normalized hemostasis: the beginning of a collapse=5,3 min; total clotting time=6.8 min; the density of blood clot=0.6 cm; the ratio of platelet aggregation=45,0 mm Thus, therapeutic effect of the treatment is manifested in significant improvement of visual acuity in both eyes, resorption of hemorrhages and retinal edema, normalization of hemostasis.

Thus, the obtained results show that therapeutic efficacy of serotonin in patients with diabetic retinopathy with severe exudative-hemorrhagic maculopathy was manifested in the following: 1) significant improvement of visual acuity; 2) resorption of hemorrhages in the fundus and reverse the development of retinal edema; 3) normalization of functional activity of platelets and indicators coagulogram. Obviously, the positive therapeutic effect of serotonin is mainly associated with normalization of microcirculation in the retina, as well as a strong fibrinolytic activity and direct participation in the mechanisms of hemostasis. Elimination of the pathological lesions in the retina (hemorrhages, edema of the macula, the normalization of blood flow in the microvasculature) restores the normal physiological activity of serotoninergicheskoi system of the retina and all of the visual analyzer.

Follow-up period (11 months), during which the continued therapeutic effect, shows the high efficiency of the proposed method for the treatment of patients with diabetic retinopathy with severe exudative-hemorrhagic maculopathy.

LITERATURE

1. Lysenko V.S.” Hemo magicheski syndrome in vascular diseases of the retina (patogenez, treatment, prevention). Abstract.... MD, Moscow, 2003, 46 S.

2. Lysenko V.S., Fly A.I. “Diagnostics thrombocytopathy in the latent period for vascular diseases of the eye” - recommendations - Moscow, 1988, 17 S.

3. Simonenkov A.P., Fedorov E, “Serotonin and its receptors in the Genesis of stress and adaptation”. Vestn. Grew up with. Acad. The honey. Sciences, 2002, No. 8, p.9-13.

4. Harries L.C., Awe S.D., C. Opere,A. et al. "3H-serotonin release from bovine iris-ciliry body: pharmacology of prejunction serotonin 5-HT7 autoreceptors" Exp. Eye Res. 2001, 73(1): 59-67.

A method of treating diabetic retinopathy with exudative-hemorrhagic maculopathy, accompanied by hypocoagulation and hemorrhagic syndrome, characterized by the fact that 1 time per day parenteral administered 1.0 ml of 1.0%aqueous solution of serotonin adipinate.



 

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