Surgical photodynamic method for treating the cases of endophthalmites

FIELD: medicine.

SUBSTANCE: method involves taking fibrinous exudates from the anterior chamber, pupil area, iris and from vitreous body cavity to carry out bacteriological analysis. Closed subtotal vitrectotmy is carried out with maximum exudates and inflammatory membranes being removed from the vitreous cavity. A photosensibilizer agent is introduced into the vitreous cavity and hold without being exposed to light action during 10-1t5 min. Photodynamic therapy with endolaser radiation treating the vitreous cavity is applied by applying intravitreous light guide with wavelength of 661-666 nm. The vitreous cavity tamponade with silicon oil is carried out and antibacterial preparations are introduced. The photosensibilizer agent is introduced into the anterior chamber and the anterior chamber is irradiated with coaxial halogen lamp light via corneal paracentesis with red light filter being used.

EFFECT: enhanced effectiveness of treatment; eliminated endophthalmitis symptom manifestations; retained anatomical correspondence of ophthalmic tunics; excluded early stage eye evisceration.

3 cl

 

The invention relates to medicine, namely to ophthalmology, surgical methods of photodynamic treatment of endophthalmitis.

Treatment of intraocular infection is a difficult task and is a major unsolved problem ophthalmology.

There is a method of surgical treatment of endophthalmitis, including anesthetic management, fence filmy fibrinous exudate from the anterior chamber, the area of the pupil and the surface of the iris and exudate from the vitreous cavity for bacteriological analysis, the closed Subtotal vitrectomy with maximum removal of exudate and inflammation of the membranes of the vitreal cavity, and an introduction to the vitreal cavity of antibacterial drugs (see Gusev Y.A. “Comprehensive surgical treatment of postoperative endophthalmitis”, the dissertation on competition of a scientific degree of candidate of medical Sciences, MNTK “eye microsurgery”, Moscow, 1994).

However, the known method when its use has the following disadvantages:

- does not allow to achieve the disappearance of the symptoms of endophthalmitis,

is not always possible to preserve anatomical compliance with internal membranes of eyes with normalization of intraocular pressure,

is not always possible to exclude in RA is it the postoperative period Eviscerate eyes.

The objective of the invention is the creation of a surgical method of photodynamic treatment of endophthalmitis.

The technical result is the disappearance of symptoms endophthalmitis, the preservation of the anatomical correspondence of the inner membranes of eyes with normalization of intraocular pressure, and exclusion in the early postoperative period of evisceration eye.

The technical result is achieved due to vitrectomy, allowing fully remove the products of inflammation of the vitreous cavity. Used photodynamic therapy photosensitizers has antibacterial and anti-inflammatory properties, stimulates phagocytosis and slows the process of cell proliferation, reducing swelling, restoring circulation and preventing neuropilins infiltration. Antimicrobial effect of photodynamic therapy is associated with an active selective accumulation of a photosensitizer and its possible impact on the vegetative forms of microorganisms. When laser irradiation of the sensitizer, the formation of singlet oxygen, which has a high oxidative capacity, resulting in realized damaging effects on the membrane of the microorganism. Photosensitizers well generate singlet oxygen, a relatively fast time is ro eliminated from the body (half-life up to 3 hours) and have low toxicity (weakly react with the cells of healthy tissues under the influence of radiation, that reduces the risk of photodermatol, FS-induced nephritis, hepatitis and so on).

The method is as follows. Perform anesthetic management, fence filmy fibrinous exudate from the anterior chamber, the area of the pupil and the surface of the iris and exudate from the vitreous cavity for bacteriological analysis, the closed Subtotal vitrectomy using endometrial lighting with maximum removal of exudate and inflammation of the membranes of the vitreal cavity, after the most complete removal of the modified vitreous intravitreal injected into the vitreal cavity of the photosensitizer in the amount of 1-5 ml and after soaking for 10-15 minutes without access of light exercise photodynamic therapy indolizinyl irradiation vitreal cavity using intravitreal optical fiber with wavelength 661-666 nm within 1-3 minutes for a total dose of irradiation 40-100 J/cm2and after irradiation vitreal cavity plugging silicone oil, through a corneal paracentesis into the anterior chamber and injected photosensitizer in the amount of 1-1,5 ml, and then using a red filter with a maximum transmission of light with wavelength 660-670 nm carried out the irradiation of the anterior chamber coaxial light is alogeno lamp microscope with a capacity of 100-200 watts for 1-3 minutes. At the same time as entered in the vitreal cavity of the photosensitizer used is 0.1-2% aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine. At the same time as entered in the anterior chamber of the photosensitizer used is 0.1-1% aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine.

In the clinical practice of applying the proposed method of surgical photodynamic treatment of endophthalmitis was found that the use of all the selected parameters of the proposed method has improved the effectiveness of the treatment of endophthalmitis.

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

Example 1. Patient C., 56 years. Endophthalmitis occurred after conducting extracapsular cataract extraction with IOL implantation. Performed the surgical operation photodynamic treatment of endophthalmitis. At the preparatory stage held anesthetic management first implementation of epibulbar anesthesia introduction of 1% tetracaine in the amount of 1 ml, then retro-bulbar anesthesia introduction 4% of procaine in the amount of 0.5 ml and akinesia of the circular muscles of the introduction of 2% procaine in the amount of 4.5 ml. of Rovelli fence filmy fibrinous exudate from the front camera, the area of the pupil and the surface of the iris and exudate from the vitreous cavity for bacteriological analysis. Then ran Subtotal vitrectomy using endometrial lighting with maximum removal of exudate and inflammation of the membranes of the vitreal cavity. After fully removing the modified vitreous intravitreal introduced into the vitreal cavity 2% aqueous solution of a photosensitizer chlorin number of Radachlorin in the amount of 1 ml, and after holding for 10 minutes without access of light made photodynamic therapy indolizinyl irradiation vitreal cavity using intravitreal optical fiber with a wavelength of 666 nm for 1 minute at a total dose of 40 j/cm2. Vitreal cavity was temporaroly silicone oil through a corneal paracentesis into the anterior chamber imposed a 1% aqueous solution of a photosensitizer chlorin number of Photolon in the amount of 1 ml and Then using a red filter with a maximum transmission of light with wavelength 660-670 nm spent the irradiation of the anterior chamber coaxial with the light of a halogen lamp of the microscope with a power of 200 W for 1 minute.

In the early postoperative period there was a gradual disappearance of the symptoms of endophthalmitis, the reduction and disappearance is the exudation into the vitreous body and in the anterior chamber. Changes in the cornea was observed. Detachment of the retina with symptoms of hypotension was not observed. The intraocular pressure returned to normal.

Example 2. Patient T., 62. Endophthalmitis occurred after penetrating corneal wounds. Performed the surgical operation photodynamic treatment of endophthalmitis. At the preparatory stage held anesthetic management first implementation of epibulbar anesthesia introduction of 1% tetracaine in the amount of 1.5 ml, and then retro-bulbar anesthesia introduction 4% dikaina in the amount of 0.7 ml and akinesia of the circular muscles introduction 2% dikaina in the amount of 6.5 ml. Spent the fence filmy fibrinous exudate from the anterior chamber, the area of the pupil and the surface of the iris and exudate from the vitreous cavity for bacteriological analysis. Then ran Subtotal vitrectomy using endometrial lighting with maximum removal of exudate and inflammation of the membranes of the vitreal cavity. After fully removing the modified vitreous intravitreal introduced into the vitreal cavity of 0.1% aqueous solution of a photosensitizer chlorin series - photodithazine in an amount of 5 ml and after exposure for 15 minutes without access of light made photodynamic therapy indolizinyl irradiation wits is a pressing cavity using intravitreal optical fiber with a wavelength of 666 nm for 3 minutes with a total dose of 100 j/cm 2. Vitreal cavity was temporaroly silicone oil through a corneal paracentesis into the anterior chamber introduced a 0.1% aqueous solution of a photosensitizer chlorin number of Radachlorin in the amount of 1.5 ml Then using a red filter with a maximum transmission of light with wavelength 660-670 nm spent the irradiation of the anterior chamber coaxial with the light of a halogen lamp of the microscope 100 watts for 3 minutes.

In the early postoperative period there was a gradual disappearance of the symptoms of endophthalmitis, the reduction and disappearance of exudation into the vitreous body and in the anterior chamber. Changes in the cornea was observed. Detachment of the retina with symptoms of hypotension was not observed. The intraocular pressure returned to normal.

1. The surgical method of photodynamic treatment of endophthalmitis, including anesthetic management, fence filmy fibrinous exudate from the anterior chamber, the area of the pupil and the surface of the iris and exudate from the vitreous cavity for bacteriological analysis, the closed Subtotal vitrectomy with maximum removal of exudate and inflammation of the membranes of the vitreal cavity, and an introduction to the vitreal cavity of antibacterial preparations, characterized in that after the maximum removal is modified vitreous body intravitreal injected into the vitreal cavity of the photosensitizer in the amount of 1-5 ml, and after soaking for 10-15 minutes without access of light exercise photodynamic therapy indolizinyl irradiation vitreal cavity using intravitreal optical fiber with wavelength 661-666 nm within 1-3 min for a total dose of irradiation (40 to 100 j/cm2and after irradiation vitreal cavity plugging silicone oil, through a corneal paracentesis injected photosensitizer in front of the camera, then using a red filter with a maximum transmission of light with wavelength 660-670 nm carried out the irradiation of the anterior chamber coaxial with the light of a halogen lamp of the microscope with a capacity of 100-200 watts for 1-3 minutes

2. The method according to claim 1, characterized in that, as entered in the vitreal cavity of the photosensitizer used is 0.1-2%-aqueous solution of a photosensitizer chlorin number, selected from the group of Photolon, Radachlorin or photoditazine.

3. The method according to claim 1, characterized in that the insertion in the anterior chamber of the photosensitizer used is 0.1-1%-aqueous solution of a photosensitizer chlorin number, selected from the group of Photolon, Radachlorin or photoditazine.



 

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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.

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

2 cl

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

FIELD: medicine.

SUBSTANCE: method involves applying vitrectomy, retinotomy and mechanical removal of subretinal neovascular membranes from under the retina. 0.1-2% photosensibilizer agent solution of clorine row selected from a group containing photolon, radachlorine, or photoditazine at a dose of 0.8-1.1 mg/kg is intravenously introduced. Visual control of subretinal neovascular membrane cells fluorescence is carried out with photodynamic fluorescent diagnosis method being applied. Trans-scleral laser radiation with wavelength of 661-666 nm during 40-140 s with radiation dose being equal to 30-130 J/cm2. Irradiation is carried out via laser light guide having lens mounted in advance in tunnel formed in inferoexterior or superoexterior quadrant at the subretinal neovascular membrane localization place. The light guide is removed after having finished photodynamic therapy course. Surgical removal of the subretinal neovascular membrane is carried out in 2-3 weeks concurrently with subretinal edema and hemorrhages resorption taking place with following perfluororganic compound tamponade that is substituted with silicon oil in course of operation. The operation is finished with sutures placed over sclerectomy and conjunctiva areas.

EFFECT: enhanced effectiveness of treatment; avoided hemorrhages occurrence.

2 cl

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