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 0.1-2% aqueous solution of photosensibilizer agent of chlorine series. 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. The gel has 0.1-1 % by mass of photosensibilizer of chlorine series. The first implant component is placed at the beginning. Scanning laser radiation of muscle funnel cavity with the first implant component being arranged therein, 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. Muscles are sutured. Soft tissues are sutured layer-by-layer. The postoperative space is drained. Sutures are placed on conjunctiva. Eye prosthesis is set and eyelids are sutured to each other. Photosensibilizer agent of chlorine series is repeatedly introduced into cubital vein of one of the arms. 5-15 min later, intravenous laser radiation treatment of blood is carried out via laser light guide introduced into cubital vein of one of the other arm, 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 metastasis and 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. Brovkina, Moscow, “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 objective of the invention is one is by creating 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 uses the chlorin photosensitizers 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 tumour cell dissemination and metastasis. Also important is the fact that cosmetic prosthesis and, therefore, socio-psychological rehabilitation of patients is carried out immediately after removal of the eyeball according to claim what water tumors.

The method is as follows. Before enucleation of the eye intravenously in one of the cubital vein injected with 0.1-2%-aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg Spend enucleation. After enucleation performed with a scanning laser irradiation using a probe cavity muscle funnel with wavelength 661-666 nm for 2-3 minutes for a total dose of irradiation 80-150 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 0.1-2 wt.% photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine. After exposure for 15-30 minutes without access of light is performed using a laser probe phased scanning laser irradiation cavity muscle funnel placed in her first part of the implant with the wavelength 661-666 nm within 2-4 minutes for a total dose of irradiation 40-50 j/cm2and then scanning the laser irradiation is repeated in the same mode after laying the second impregnated photosensitizer h the particular implant. Then sew the muscles sutured in layers of soft fabric, stitched on the conjunctiva and provide drainage of postoperative space. In the cavity of installing a prosthetic eye and sew the eyelids together. From the second day after the operation is repeated intravenous infusion of 0.1-2%-aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine in the cubital vein of one arm at a dose of 0.2-0.5 mg/kg over 5-15 minutes is carried out through the set in the cubital Vienna, on the other hand, the laser fiber laser blood irradiation with a wavelength of 661-666 nm within 10-45 minutes at a total power of radiation 20-50 mW once a day for 3-4 days.

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 0.1-2%-aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg,

- conducting after enucleation scanning laser irradiation using a probe cavity muscle funnel with wavelength 661-666 nm for 2-3 mine is for a total dose of irradiation 80-150 j/cm 2,

- carrying out 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 0.1-2 wt.% photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine,

- 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 661-666 nm within 2-4 minutes for a total dose of irradiation 40-50 j/cm2and then repeating the scanning of the laser irradiation in the same mode after laying the second impregnated photosensitizer part of the implant,

- conduct from the second day after the operation repeated intravenous injection of 0.1-2%-aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine in the cubital vein of one arm at a dose of 0.2-0.5 mg/kg and conduction through 5-15 minutes later installed in the cubital Vienna, on the other hand, the laser fiber laser irradiation of blood with wavelength 661-666 nm within 10-45 minutes when the total power is STI exposure 20-50 mW once a day for 3-4 days.

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 B., 48 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” diagnosis: “Melanoblastoma choroid right eyeball”. Conducted enucleation of the right eye with the formation of the movable anchor stump and photodynamic therapy.

Under endotracheal anesthesia and before enucleation of the eye intravenously in one of the cubital veins introduced a 0.1%aqueous solution of a photosensitizer chlorin series - Radachlorin in a dose of 0.5 mg/kg Spent the enucleation of the right eye by a standard method. After removal of the eyeball laser probe was carried out by scanning the laser irradiation of the cavity of the orbit with a wavelength of 661 nm for 2 minutes with a total dose of 80 j/cm2. Then temporaroly the cavity of the orbit the first of two parts of the implant impregnated photosensitizing gel-based wescoal the stick hyaluronic acid viscoat with a content of 2 wt.% photosensitizer chlorin number of Radachlorin. Further, after exposure for 30 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 661 nm for 2 minutes with a total dose of 50 j/cm2. Then the cavity of the orbit was temporaroly the second part of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - giacolone containing 0.1 wt.% photosensitizer chlorin number of Photolon, and after exposure for 15 minutes without access of light held laser scanning irradiation for 4 minutes with a total dose of 40 j/cm2and with a wavelength of 666 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 together. From the second day after the operation began holding daily intravenous administration of 0.1%aqueous solution of a photosensitizer - Radachlorin in the cubital vein of one arm at a dose of 0.5 mg/kg and after 15 minutes spent through mounted in the cubital Vienna, on the other hand, the laser fiber laser blood irradiation with a wavelength of 666 nm within 10 mi the ut with a total output of 20 mW irradiation once a day for 3 days.

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 left eye and the right prosthesis is 1.1 mm

Example 2. Patient S., 43, enrolled in 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 anesthesia and before enucleation of the eye intravenously in one of the cubital veins introduced a 2%aqueous solution of a photosensitizer chlorin number of Photolon dose of 0.2 mg/kg Spent the enucleation of the left eye by a standard method. After enucleation of the laser probe was carried out by scanning the laser irradiation of the cavity of the orbit with a wavelength of 666 nm for 3 minutes with a total dose of 150 j/cm2. Then temporaroly the cavity of the orbit the first of two parts of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - kalona containing 0.1 wt.% photosensitizer chlorin series - photodithazine. Then, after e is pozicii for 15 minutes without access of light, spent scanning laser irradiation of the cavity of the orbit placed in her first part of the implant with a wavelength of 661 nm for 2 minutes with a total dose of 50 j/cm2. Then the cavity of the orbit was temporaroly the second part of the implant impregnated photosensitizing gel-based viscoelastic hyaluronic acid - giacolone containing 0.1 wt.% photosensitizer chlorin number of Photolon, and after exposure for 30 minutes without access of light held laser scanning irradiation for 4 minutes with a total dose of 40 j/cm2and with a wavelength of 666 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 together. From the second day after the operation began holding daily intravenous injection of a 2%aqueous solution of a photosensitizer - Radachlorin in the cubital vein of one arm at a dose of 0.2 mg/kg and after 5 minutes spent through mounted in the cubital Vienna, on the other hand, the laser fiber laser blood irradiation with a wavelength of 661 nm for 45 minutes with a total capacity of 50 mW irradiation once a day for 4 days.

Early post-operative period was uneventful. In otdalin the m postoperative period metastasis and recurrence of the tumor is not detected, signs of exposure and rejection of the implant were observed. If acsitlali 1.5 years difference in vistani between the right eye and ocular prosthesis on the left 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 0.1-2% aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg, and after enucleation perform scanning laser irradiation using a probe cavity muscle funnel with wavelength 661-666 nm for 2-3 min for a total dose of irradiation 80-150 J./cm2spend the 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 0.1-2 wt.% photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine, first carry out the laying of the first part of the implant, and last the exposure within 15-30 min without access of light conducting scanning laser irradiation cavity muscle funnel placed in her first part of the implant with the wavelength 661-666 nm within 2-4 min for a total dose of exposure 40-50 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, then from the second day after the operation is repeated intravenous infusion of 0.1-2% aqueous solution of a photosensitizer chlorin number selected from the group Photolon, Radachlorin or photoditazine in the cubital vein of one arm at a dose of 0.2-0.5 mg/kg over 5-15 min spend through mounted in the cubital Vienna, on the other hand, the laser fiber laser blood irradiation with a wavelength of 661-666 nm within 10-45 minutes at a total power of radiation 20-50 mW once a day for 3-4 days.



 

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6 cl

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: method involves intravenously administering 0.1-1% aqueous solution of khlorin, selected from group containing photolon, radachlorine or photoditazine at a dose of 0.2-0.5 mg/kg or 0.2-1% aqueous solution of porphyrin like photogem at a dose of 0.2-1 mg/kg. Laser irradiation of blood is carried out 5-15 min later after beginning photosensitizer injection into cubital vein of one arm via laser light guide set in advance in the cubital vein of the other arm during 10-40 min at wavelength of 661-666 nm and power of 20-50 mW one session per day during 3-10 days with the aqueous solution of khlorin used as the photosensitizer, or laser irradiation of blood with wavelength equal to 630-633 nm during 10-45 min with power of 20-50 mW one session per day with the aqueous solution of porphyrin used as the photosensitizer. Repeated intravenous administration of photosensitizer is carried out 1-3 months later combined with repeated laser irradiation of blood.

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 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.

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