Combined method for removing intraocular neoplasm

FIELD: medicine.

SUBSTANCE: method involves carrying out vitrectomy, retinotomy, exposing the intraocular neoplasm, surgically removing the intraocular neoplasm, smoothing retina with perfluororganic compound and substituting the perfluororganic compound with silicon oil. After having removed the perfluororganic compound, 10% ozonized Perfluoran emulsion having ozone concentration of 2-4 mg/l is intravenously introduced. Photosensibilizer agent is introduced into cubital vein of the same arm during 5-10 min. Intravenous laser radiation treatment of blood in 5-15 min after beginning photosensibilizer agent injection with wavelength corresponding to maximum light absorption value characteristic of the photosensibilizer agent within 10-45 min under radiation power required for activating photochemical process. Smoothing retina with perfluororganic compound being completed, separating endoscopic laser coagulation of retinotomy region is carried out with diode laser. 1-3 months later, ozonized Perfluoran emulsion, photosensibilizer agent and intravenous laser radiation treatment are repeatedly applied.

EFFECT: enhanced effectiveness of treatment; reduced risk of tumor cell dissemination.

 

The invention relates to medicine, namely to ophthalmology, and can be used for removal of intraocular tumors, and also to prevent metastasis.

There is a method of destruction of intraocular tumors transpupillary photodynamic therapy (Barbazetto IA, Lee TC, Rollins IS, Chang S, Abramson DH. Treatment of choroidal melanoma using photodynamic therapy. Am J Ophthalmol. - 2003. - Vol. 135. No. 6. - P. 898-899), including intravenous administration of a photosensitizer. However, the application of this method in half of the cases you cannot stop the growth of intraocular tumors.

Closest to the claimed method is surgical removal of intraocular tumors (JOSE GARCIA-ARUMI, MD, LAURA SARAROLS, MD, VINCENTE MARTINEZ, MD, BORJA CORCOSTEGUl, MD. VITREORETINAL SURGERY AND ENDORESECTION IN HIGH POSTERIOR CHOROIDAL MELANOMAS. - RETINA. - 2001. - Vol. 21. No. 5. - P. 445-452), including vitrectomy, retinotomy, exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection (PFOS), replacement of PFOS in silicone oil (SEE).

The disadvantage of this method is that it does not impede the dissemination of tumor cells and subsequent metastasis.

The objective of the invention is to provide an efficient method for the combined removal of intraocular tumors.

Technical the definition result is to reduce the risk of dissemination of tumor cells and subsequent metastasis, the efficiency impact of the photosensitizer on migratory in the bloodstream and pathological lesion tumor cells.

The technical result is achieved in that in the method of the combined removal of intraocular tumors, including vitrectomy, retinotomy, exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection (PFOS), replacement of PFOS in silicone oil (CM), according to the invention after surgical removal of intraocular tumors for destruction of tumor cells remaining in the hearth and not amenable to surgical removal, as well as tumor cells, migrated through the blood stream provoked by surgical removal, additionally spend drip intravenous administration of 40 ml of 10% ozonated emulsion “Perftoran” with ozone concentration of 2-4 mg/l, then in the cubital vein of the same hand intravenously over 5-10 minutes injected photosensitizer (PS) in a concentration and dose allowed for intravenous injection, such as 0.1-1% aqueous solution FS chlorophyll-type selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg or 0.2-1% aqueous solution FS hematoporphyrin number, for example Photohem dose of 0.2-1 mg/kg Over 5-15 mine is after the beginning of the introduction of the FS in the cubital vein of one hand through established before the introduction of the aqueous solution of FS in the cubital the vein of the other hand, the laser light guide conduct intravenous laser irradiation of blood (ILIB) length the wave corresponding to the maximum absorption of the photosensitizer, light radiation, for example with a wavelength of 661-666 nm when using as FS aqueous solutions of chlorophyll-type or wavelength 630-633 nm when using as FS aqueous solutions hematoporphyrin series. Intravenous laser irradiation is carried out within 10-45 minutes at a power of irradiation required to activate the photochemical process, for example when the power 20-50 mW when using as FS as aqueous solutions of chlorin and hematoporphyrin series. All stages abdominal surgery following the removal of intraocular tumors, conducted in parallel with the intravenous injection of ozonized emulsion “Perftoran”, by the intravenous injection of a photosensitizer and intravenous laser irradiation of blood. Abdominal surgery, intravenous injection of ozonized emulsion “Perftoran”, intravenous FS and vlok be completed independently of each other.

The ozone concentration of 2-4 mg/l is non-toxic, allowed for intravenous (Ozone therapy in ophthalmology. A manual for physicians / Borsenik S.A., frost SI, Smyslova AV - M., 2000).

Intravenous FS for 5-10 minutes due to the amount of time needed to accumulate the Federal Assembly of the organization in olewig cells.

Time 5-15 minutes from the start of intravenous FS to vlok sufficient for accumulation of FS in tissue cells with high mitotic activity.

The choice of the length vlok 10-45 minutes and the laser power 20-50 mW depends on the size of intraocular tumors and depth of its germination in the sclera, which causes the risk of dissemination and migration of tumor cells.

The technical result is achieved due to the fact that:

1. Application of ozonized emulsion “Perftoran” allows you to enhance the effect induced photochemical reactions during ILIB with the wavelength corresponding to maximum absorption of the photosensitizer, light radiation, by increasing the number of active forms of oxygen (ozone + “Perftoran”), the cytotoxic effect of ozone on cells with high mitotic activity and enhance penetration of the Federal Assembly of the cell (patent RF 2160615).

2. Injected FS, due to its selective properties (Woodburn KW, Engelman CJ, Blumenkranz MS. Photodynamic therapy for choroidal neovascularization: a review // Retina. 2002 Aug; 22(4):391-405), accumulates in cells with high mitotic activity in the pathological focus, and migrating through the blood stream, is activated under the action of intravenous laser irradiation of blood corresponding length in the us, which leads to the process svetoindutsirovannoi chemotherapy that destroys these cells and preventing, thus, their dissemination and subsequent metastasis.

The method is as follows. After processing the surgical field and conduct of regional anesthesia by a standard method performed vitrectomy and retinotomy with exposure of intraocular tumors. Then, using vitrectomy intravitreal remove intraocular tumors after removal of conduct intravenous drip injection of ozonized emulsion “Perftoran”, then in the cubital vein of the same hand intravenously over 5-10 minutes enter FS, and after 5-15 minutes after the start of introduction of the FS in the cubital vein of one hand through established before the introduction of the aqueous solution of FS in the cubital vein of the other hand, the laser light guide conduct intravenous laser irradiation of blood within 10-45 minutes at a power of 20 to 50 mW. In parallel with the intravenous injection of ozonized emulsion “Perftoran” intravenous administration of a photosensitizer and intravenous laser irradiation of blood perform the following steps abdominal surgery: straighten and press retina PFOS, such as piptochaetium or performability, then the diode laser conduct restrictive is holosericeus section retinotomy, PFOS replace CM; the surgery is completed by suturing the areas of sclerotome and conjunctiva. Abdominal surgery, intravenous injection of ozonized emulsion “Perftoran”, intravenous FS and vlok be completed independently of each other.

Prevention of metastasis in 1-3 month re-spend intravenous injection of ozonized emulsion “Perftoran”, intravenous FS and vlok.

The invention is illustrated by the following examples.

Example 1.

Patient Century, 60 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with suspected tumors of the choroid of the right eye. When the survey was diagnosed with melanoma, choroidea. Localization of lesions in the posterior pole of the eye. The size of the tumor by ultrasound B-scan: 9 to 10 mm, the size of prominence - up to 6 mm When performing fluorescein angiography (FAG) was revealed “spotted” fluorescence in tumors. Previously spent clarifying the true boundaries of the tumor by the method of transillumination.

The patient is treated under the proposed method. Conducted drip intravenous administration of 40 ml of 10% ozonated emulsion “Perftoran” with ozone concentration of 2 mg/l as PS used a 0.2% aqueous rest the p is injected at a dose of 0.2 mg/kg, was administered intravenously over 5 minutes. Laser blood irradiation was performed 5 minutes after the beginning of the introduction of the FS with a wavelength of 633 nm for 10 minutes at a power of 50 mW irradiation.

When the control ultrasonic B-scan after 6 months on the location of the mass was determined by dense scar up to 1 mm thick.

The patient was followed for 3 years. For the entire period of observation according to x-ray, computed tomography, nuclear magnetic resonance and ultrasound diagnosis of metastasis was not found.

Example 2.

Patient P., 62, entered the Kaluga branch of IRTC “eye microsurgery” with suspected tumors of the choroid of the right eye. When the survey was diagnosed with melanoma, choroidea. Localization of lesions in the posterior pole of the eye. The size of the tumor by ultrasound B-scan: 11 to 12 mm, the size of prominence ~ to 7 mm During PHAGE was detected characteristic “spotted” fluorescence in tumors. Previously spent clarifying the true boundaries of the tumor by the method of transillumination.

The patient is treated under the proposed method. Conducted drip intravenous administration of 40 ml of 10% ozonated emulsion “Perftoran” with ozone concentration of 4 mg/l as FS was used ,1% aqueous solution of Radachlorin in a dose of 0.5 mg/kg, was administered intravenously over 10 minutes. Laser blood irradiation was performed 15 minutes after the beginning of the introduction of the FS with a wavelength of 661 nm for 45 minutes at a power of 20 mW irradiation.

When the control ultrasonic B-scan after 6 months on the location of the mass was determined by dense scar up to 1 mm thick.

The patient was followed for 3 years. For the entire period of observation according to x-ray, computed tomography, nuclear magnetic resonance and ultrasound diagnosis of metastasis was not found.

Thus, the invention provides an effective method of combined surgical removal of intraocular tumors, providing a significant reduction in the risk of dissemination of tumor cells and subsequent metastasis.

The way the combined removal of intraocular education, including vitrectomy, retinotomy, exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection (PFOS), replacement of PFOS in silicone oil (CM), characterized in that after surgical removal of intraocular tumors for destruction of tumor cells remaining in the hearth and not amenable to surgical removal, and SDA is olewig cells, the migrated through the blood stream provoked by surgical removal, additionally carry out intravenous 10% ozonated emulsion “Perftoran” with ozone concentration of 2-4 mg/l, then in the cubital vein of the same hand intravenously over 5-10 minutes of entering the photosensitizer (PS) in a concentration and dose allowed for intravenous injection; then after 5-15 min after the beginning of the introduction of the Federal Assembly of conduct intravenous laser irradiation of blood (ILIB) with a wavelength corresponding to the maximum absorption of the photosensitizer light radiation within 10-45 min of exposure required to activate the photochemical process, all stages abdominal surgery following the removal of intraocular tumors, conducted in parallel with the intravenous injection of ozonized emulsion “Perftoran”, by the intravenous injection of a photosensitizer and intravenous laser irradiation of blood, and after retinal unfolding of PFOS spend the restrictive endolasercoagulation section retinotomy diode laser, with abdominal surgery, intravenous injection of ozonized emulsion “Perftoran”, intravenous FS and vlok completed independently from each other, with 1-3 month re-perform intravenous oz is nizovannoj emulsion “Perftoran”, intravenous FS and vlok.



 

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EFFECT: enhanced effectiveness of treatment; accelerated retinal edema resorption.

5 cl, 3 dwg

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