Surgical method for forming primary movable supporting stump and applying photodynamic therapy after eye enucleation on account of tumor

FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-1% aqueous solution of photosensibilizer agent of porphyrin or hematoporphyrin series belonging to Photohem or Photophryne group at a dose of 2.5-5.0 mg/kg. After accomplishing enucleation, scanning laser radiation of muscle funnel cavity is carried out. Muscle funnel cavity tamponade is done with two implant components. The implant is manufactured from carbon felt impregnated with photosensibilizing gel based on hyaluronic acid viscoelastic from chealon, viscoate or hyatulon group. The gel has 0.1-1 % by mass of photosensibilizer of porphyrin or hematoporphyrin series belonging to Photohem or Photophryne group. The first implant component is placed at the beginning. Scanning laser radiation of muscle funnel cavity with the first implant component being arranged in it, is carried out during 2-4 min after 15-30 min long exposure away from light action. The second implant component is placed. Scanning laser radiation of muscle funnel cavity after 15-30 min long exposure away from light action is carried out in the same mode. Direct muscles are sutured. Soft tissues are sutured layer-by-layer. The postoperative space is drained. Laser light guide is introduced into cubital vein immediately after enucleation. Intravenous laser radiation treatment of blood is carried out during 10-45 min with total power of 20-50 mW.

EFFECT: enhanced effectiveness of treatment; excluded soft tissue deformity in orbital region; reduced implant rejection and carcinoma cells dissemination risk.

 

The invention relates to medicine, namely to ophthalmology, to methods of surgical formation of the primary movable abutment stump and photodynamic therapy after eye enucleation about the tumor.

Known method of enucleation of the eye about the tumor, including the removal of the eye, the direct binding of the muscles between themselves and the installation of artificial eye (see “Oftalmologia”, edited by corresponding member of the Russian Academy of medical Sciences A.F. Brovkin, M.: Medicine, 2002, s-293).

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

- the inability to form the stump in early (before 5 years) time, which leads to deformation of the soft tissues of the orbital region and significant cosmetic defects,

- requires the use of x-ray irradiation cavity of the orbit after enucleation, which leads to radiation damage to the surrounding tissue and, consequently, difficult in subsequent delayed surgical formation of a movable abutment stump,

- creates a high risk of rejection of the implant, which in turn places high demands on the used implant

- the application of the proposed method makes it impossible for socio-psychological rehabilitation of the patient in time earlier than 5 years after enucleation.

The task of the invention is to create the tion of a surgical method of formation of the primary movable abutment stump and photodynamic therapy after eye enucleation about the tumor.

The technical result is the possibility of initial surgical form the stump immediately after enucleation of the eyeball, with the exception of the deformation of soft tissues of the orbital region and reducing the risk of rejection of the implant, reducing the risk of metastasis and dissemination of tumor cells.

The technical result is achieved by using the proposed method of photodynamic therapy. In the process of its implementation are the photosensitizers of the porphyrin and hematoporphyrin number that actively accumulate in cells with high mitotic activity (tumor cells) and become chemically active form under the influence of laser radiation with wavelengths of from through the process svetoindutsirovannoi chemotherapy in the pathological lesions of orbital tissues with minimal damage to normal tissues. Using the proposed method, the implant impregnated photosensitizing gel helps to enhance this effect. Intravenous laser irradiation of blood with the same wavelength can reduce the risk of dissemination and metastasis of tumor cells. Also important is the fact that cosmetic prosthesis and, therefore, socio-psychological rehabilitation of patients is carried out immediately after removal the Oia eyeball about the tumor. The photosensitizers of the porphyrin and hematoporphyrin of some interest to those that allow for repeated intravenous administration of a photosensitizer to carry out intravenous laser irradiation of blood during the operation to increase the efficiency of photodynamic therapy.

The method is as follows. Before enucleation of the eye intravenously in one of the cubital vein injected with 0.1-1%aqueous solution of porphyrin photosensitizer and hematoporphyrin selected from the group Photohem or Photofrin, at a dose of 2.5-5.0 mg/kg are eye enucleation. After enucleation performed with a scanning laser irradiation cavity muscle funnel using a probe with a wavelength of 630-633 nm for 2-4 minutes at a total dose of 200-300 j/cm2. This is followed by a gradual plugging cavity muscle funnel two parts of the implant, made of carbon felt and impregnated photosensitizing gel-based viscoelastic of hyaluronic acid selected from the group healon, viscoat or hatulan containing 0.1-1 wt.% porphyrin photosensitizer and hematoporphyrin number selected from the group Photohem or Photofrin. After exposure for 15-30 minutes without access of light is performed using a laser probe phased scanning laser is the second irradiation cavity muscle funnel placed in her first part of the implant with the wavelength 630-633 nm for 2-4 minutes at a total dose of 150-200 j/cm 2and then scanning the laser irradiation is repeated in the same mode after laying the second impregnated photosensitizer part of the implant. Then sew straight muscle sutured in layers of soft tissue and provide drainage of postoperative space. Thus immediately after enucleation performed through mounted in the cubital Vienna hand laser fiber laser blood irradiation with a wavelength of 630-633 nm within 10-45 minutes at a total power of radiation 20-50 mW.

Among the essential features characterizing the surgical method of formation of the primary movable abutment stump and photodynamic therapy after eye enucleation about the tumor, distinctive are:

introduction before enucleation of the eye intravenously in one of the cubital vein of 0.1-1%aqueous solution of porphyrin photosensitizer and hematoporphyrin selected from the group Photohem or Photofrin, at a dose of 2.5-5.0 mg/kg,

- conducting after enucleation scanning laser irradiation using a probe cavity muscle funnel with wavelength 630-633 nm for 2-4 minutes at a total dose of 200-300 j/cm2,

- carrying out gradual plugging cavity muscle funnel two parts of the implant, made of carbon felt and impregnated photosensibility the m gel-based viscoelastic hyaluronic acid, selected from the group healon, viscoat or hatulan containing 0.1-1 wt.% porphyrin photosensitizer and hematoporphyrin number selected from the group Photohem or Photofrin,

- conducting after exposure for 15-30 minutes without access of light using a laser probe phased scanning laser irradiation cavity muscle funnel placed in her first part of the implant with the wavelength 630-633 nm for 2-4 minutes at a total dose of 150-200 j/cm2and then repeating the scanning of the laser irradiation in the same mode after laying the second impregnated photosensitizer part of the implant,

- immediately after enucleation through mounted in the cubital Vienna hand laser fiber laser irradiation of blood with wavelength 630-633 nm within 10-45 minutes at a total power of radiation 20-50 mW.

Experimental studies of the proposed surgical method of formation of the primary movable abutment stump and photodynamic therapy after eye enucleation about tumors in a clinical setting showed high efficiency of the proposed method.

Implementation of the proposed method of formation of the primary movable abutment stump and photodynamic therapy is illustrated by the following clinical examples.

Example 1. Patient I.,52, entered the Kaluga branch of IRTC “eye microsurgery” diagnosis: “Melanoblastoma choroid right eye”. Conducted enucleation of the right eye with the formation of the movable anchor stump and photodynamic therapy.

Under endotracheal anesthesia before enucleation intravenously in one of the cubital veins introduced a 0.1%aqueous solution of porphyrin photosensitizer and hematoporphyrin series - injected at a dose of 5.0 mg/kg Spent the enucleation of the right eye by a standard method. After enucleation was performed by laser scanning probe, laser irradiation of the cavity of the orbit with a wavelength of 630 nm for 2 minutes with a total dose of 200 j/cm2. Thus immediately after enucleation conducted through mounted in the cubital Vienna laser fiber laser blood irradiation with a wavelength of 633 nm for 45 minutes with a total capacity of 50 mW irradiation. Then temporaroly the cavity of the orbit the first of two parts of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - viscoat with the content of 1 wt.% porphyrin photosensitizer and hematoporphyrin series - injected. Then, after exposure for 30 minutes without access of light, held scanning laser irradiation of the cavity of the orbit with its first composition of the Oh part of the implant with a wavelength of 633 nm for 4 minutes with a total dose of 200 j/cm 2. Then the cavity of the orbit was temporaroly the second part of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - giacolone with the content of 1 wt.% porphyrin photosensitizer and hematoporphyrin series - injected, and after exposure for 30 minutes without access of light held laser scanning irradiation for 2 minutes with a total dose of 200 j/cm2and with a wavelength of 633 nm. The operation was finished by sewing the direct muscle layer suturing soft tissue, suturing on the conjunctiva and postoperative drainage space. In the cavity of the prosthesis is installed eyes and sew the eyelids to each other.

Early post-operative period was uneventful. In the late postoperative period of recurrence and metastasis of the tumor is not found, signs of exposure and rejection of the implant were observed. If acsitlali 1.5 years difference in vistani between the right eye and a prosthetic left eye is 1.1 mm

Example 2. Patient F., 47 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” diagnosis: “Melanoblastoma choroid left eyeball”. Conducted enucleation of the left eye with the formation of the movable anchor stump and photodynamic therapy.

Under endotracheal drug is om and before enucleation of the eye intravenously in one of the cubital veins introduced a 1%aqueous solution of porphyrin photosensitizer and hematoporphyrin series - of Photofrin dose of 2.5 mg/kg of Spent removing the left eye by a standard method. After enucleation was performed by laser scanning probe, laser irradiation of the cavity of the orbit with a wavelength of 633 nm for 4 minutes with a total dose of 300 j/cm2. When it immediately after enucleation conducted through mounted in the cubital Vienna hand laser fiber laser blood irradiation with a wavelength of 630 nm within 10 minutes with a total output of 20 mW irradiation. Then temporaroly the cavity of the orbit the first of two parts of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - viscoat containing 0.1 wt.% porphyrin photosensitizer and hematoporphyrin number of Photofrin. Then, after exposure for 15 minutes without access of light, held scanning laser irradiation of the cavity of the orbit placed in her first part of the implant with a wavelength of 630 nm for 2 minutes with a total dose of 150 j/cm2. Then the cavity of the orbit was temporaroly the second part of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - giacolone with the content of 1 wt.% porphyrin photosensitizer and hematoporphyrin number of Photofrin, and after exposure for 30 minutes without access to the ETA held laser scanning irradiation for 2 minutes with a total dose of 200 j/cm 2and with a wavelength of 633 nm. The operation was finished by sewing the direct muscle layer suturing soft tissue, suturing on the conjunctiva and postoperative drainage space. In the cavity of the prosthesis is installed eyes and sew the eyelids to each other.

Early post-operative period was uneventful. In the late postoperative period of recurrence and metastasis of the tumor is not found, signs of exposure and rejection of the implant were observed. If acsitlali 1.5 years difference in vistani between the right eye and a prosthetic left eye is 1.2 mm

A method of surgical formation of the primary movable abutment stump after eye enucleation about the tumor, including the removal of the eye, the direct binding of the muscles between themselves and the installation of the ocular prosthesis, characterized in that before enucleation of the eye intravenously in one of the cubital vein injected with 0.1-1% aqueous solution of porphyrin photosensitizer and hematoporphyrin number selected from the group Photohem or Photofrin, at a dose of 2.5-5.0 mg/kg, and after enucleation perform scanning laser irradiation using a probe cavity muscle funnel with wavelength 630-633 nm within 2-4 min for a total dose of irradiation 200-300 j/cm, spend the plugging cavity muscle funnel two accounted for the different parts of the implant, made of carbon felt and impregnated photosensitizing gel-based viscoelastic of hyaluronic acid selected from the group healon, viscoat or hatulan containing 0.1-1 wt.% porphyrin photosensitizer and hematoporphyrin number selected from the group Photohem or Photofrin, first carry out the laying of the first part of the implant, and after exposure for 15-30 minutes without access of light conducting scanning laser irradiation cavity muscle funnel placed in her first part of the implant with the wavelength 630-633 nm for 2-4 min at a total dose of 150-200 j/cm2, then stack the second part of the implant and after exposure for 15-30 minutes without access of light conducting scanning laser irradiation cavity muscle funnel in the same mode, while immediately after enucleation performed through mounted in the cubital Vienna laser fiber laser blood irradiation with a wavelength of 630-633 nm within 10-45 minutes at a total power of radiation 20-50 mW.



 

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EFFECT: reduced risk of metastasizing.

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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 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.

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