Method for preventing metastases after having surgically removed intraocular neoplasms

FIELD: medical engineering.

SUBSTANCE: method involves exposing an intraocular neoplasm after vitrectomy and retinotomy, smoothening retina with perfluororganic compound later substituted with silicon oil. After having removed the neoplasm, intravenous 10% Perfluorane emulsion transfusion is carried out at a rate of 60 drops per 1 min in the amount of 80-100 ml. Next to it, photosensitizer is intravenously drop-by-drop introduced into cubital vein of the same arm. Laser irradiation of blood is carried out with power of 20-50 mW through laser light guide set in advance into cubital vein of the other arm in 5-15 min after starting introducing Perfluorane. When applying 0.1-1% water solution of Khlorine as photosensitizer at a dose of 0.2-0.5 mg/kg, irradiation is carried out at wavelength of 630-633 nm during 10-45 min. The treatment is administered twice with 5 days long pause.

EFFECT: enhanced effectiveness of treatment; reduced risk of tumor cells dissemination and metastases formation.

3 cl

 

The invention relates to medicine, namely to ophthalmology, to a method of preventing metastases after surgical removal of intraocular tumors, and can also be used after radiation, chemotherapy and photodynamic therapy of intraocular and orbital tumors.

There is a method of surgical removal of intraocular tumors, including performing a vitrectomy, retinotomy with subsequent exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection with its subsequent replacement by silicone oil (see Jose Garsia-Arumi, MD, Laura Sararols, MD, Vincent Martinez, MD, Borja Cjrcjstegui, MD, "Vitreoretinal Surgery and endoresection in high posterior choroidal melanomas, RETINA, 21:445-452, No. 5, 2001).

However, the known method when its use does not preclude the dissemination of tumor cells and subsequent metastasis.

The basis of the invention is to provide a method of preventing metastases after surgical removal of intraocular tumors, allowing for its use to reduce the risk of dissemination of tumor cells and reduce the risk of subsequent metastasis.

The problem is solved in that a method of preventing metastases after surgery at the Alenia intraocular neoplasms, including performing a vitrectomy, retinotomy with subsequent exposure of intraocular tumors, surgical removal of intraocular tumors, smoothing retina performancesin connection with its subsequent replacement by silicone oil, the distinguishing feature of which is the fact that after removal of tumors spend intravenous transfusion of 10% emulsion “Perftoran” with a rate of 60 drops per minute in the amount of 80-100 ml twice with an interval of 5 days, with pre-40 minutes prior to injection of the emulsion “Perftoran” perform intramuscular pretreatment solution Relanium at a dose of 0.15 mg/kg and solution hydrocortisone at a dose of 1.6 mg/kg and perform two biological samples 20 drops simultaneously 7-10 minutes, then in the cubital vein of the same hand intravenously injected as a photosensitizer 0.1 to 1% aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine, at a dose of 0.2-0.5 mg/kg, or 0.2-1% aqueous solution of porphyrin, for example, is injected at a dose of 0.2-1 mg/kg, followed by 5-15 minutes after the start of injection of the photosensitizer in the cubital vein of one arm passes through pre-installed in the cubital Vienna, on the other hand, the laser fiber laser blood irradiation with a wavelength of nm 661-666 within 10-40 minutes when power is plucene 20-50 mW two sessions with an interval of 5 days when used as a photosensitizer, an aqueous solution of chlorine, or laser blood irradiation with a wavelength of 630-633 nm within 10-45 minutes at a power of 20 to 50 mW two sessions with an interval of 5 days when used as a photosensitizer, an aqueous solution of porphyrin. In addition after 1-3 months of repeated intravenous transfusion emulsion “Perftoran”, repeated intravenous administration of a photosensitizer with repeated intravenous laser irradiation of blood.

In the clinical practice of using the proposed method for preventing metastasis after surgical removal of intraocular tumors, it was found that using all the selected parameters of the proposed method obtained the following technical result: significantly reduced the risk of dissemination of tumor cells and reduced the risk of subsequent metastasis. At the same time it was found that the use of emulsions of perftoran would facilitate the diffusion of gases blood on the section of the capillary - tissue cell, thereby making it possible to saturate the tissues with oxygen, which resulted in increased efficiency of photodynamic therapy.

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

Example 1. Patient A., 56 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with suspicion nooob is adowanie choroid right eye. When the survey was diagnosed with melanoma of the choroid. Localization of lesions in the posterior pole of the eye. The size of the tumor by ultrasound B-scan: 10 to 11 mm, the size of prominence to 4-year-mm. During PHAGE was detected characteristic "spotted" fluorescence in tumors.

Previously spent clarifying the true boundaries of the tumor by the method of transillumination.

At the preparatory stage after processing operating margins held anesthetic management. Spent vitrectomy and retinotomy with exposure of intraocular tumors. Then using vitrectomy intravitreal removed intraocular tumor, and after unfolding and crushing the retina performancesin connection, namely preformulation, spent restrictive endolaser coagulation section retinotomy. Parfocality was replaced with a silicone oil, and the operation is finished suturing the areas of sclerotome and conjunctiva.

Then spent intravenous transfusion introduction into the cubital vein of the right hand of a 10% emulsion “Perftoran” with a rate of 60 drops per minute in the amount of 80 ml twice with an interval of 5 days. When this pre-40 minutes prior to injection of the emulsion “Perftoran” fulfilled the intramuscular premedication of rest the rum Relanium at a dose of 0.15 mg/kg and solution hydrocortisone at a dose of 1.6 mg/kg and spent two biological samples 20 drops simultaneously in 7 minutes.

Then in the cubital vein of the same right hand intravenously as a photosensitizer 0.2% aqueous solution of porphyrin, namely injected at a dose of 0.2 mg/kg Then 5 minutes after the start of injection of the photosensitizer in the cubital vein of the right hand held through pre-installed in the cubital Vienna left hand laser fiber laser blood irradiation with a wavelength of 633 nm for 10 minutes at a power of 50 mW irradiation two sessions with an interval of 5 days.

When the control ULTRASOUND after 6 months on the location of the mass was determined by dense scar up to 1 mm thick. Methods of radiography, computed tomography, nuclear magnetic resonance and ultrasound diagnosis of metastasis in the period from 1 year to 3 years is not detected.

Example 2. Patient F., 60 years old, was admitted to the Kaluga branch of IRTC “eye microsurgery” with suspected tumors of the choroid of the left eye.

When the survey was diagnosed with melanoma of the choroid. Localization of lesions in the posterior pole of the eye. The size of the tumor by ultrasound B-scan: 11 mm to 12 mm, the size of prominence to 5 mm During PHAGE was detected characteristic "spotted" fluorescence in tumors.

Previously spent clarifying the true Gras is CI tumor by the method of transillumination.

At the preparatory stage after processing operating margins held anesthetic management. Spent vitrectomy and retinotomy with exposure of intraocular tumors. Then using vitrectomy intravitreal removed intraocular tumor, and after unfolding and crushing the retina performancesin connection, namely precontribution, spent restrictive endolaser coagulation section retinotomy. Performability was replaced with a silicone oil, and the operation is finished suturing the areas of sclerotome and conjunctiva.

Then spent intravenous transfusion introduction into the cubital vein of the left arm of a 10% emulsion “Perftoran” with a rate of 60 drops per minute in the amount of 100 ml twice with an interval of 5 days. When this pre-40 minutes prior to injection of the emulsion “Perftoran” performed intramuscular pretreatment solution Relanium at a dose of 0.15 mg/kg and solution hydrocortisone at a dose of 1.6 mg/kg and held twice a biological sample, 10 drops simultaneously in 10 minutes.

Then an intravenous drip in the cubital vein of the same left hand was introduced as a photosensitizer 0.1% aqueous solution of chlorine, namely Radachlorin in a dose of 0.5 mg/kg Then 15 minutes after the start of injection of the photosensitizer in the cubital vein l the new hand held through pre-installed in the cubital Vienna right hand laser fiber laser blood irradiation with a wavelength of 661 nm for 40 minutes at a power of 20 mW irradiation two sessions with an interval of 5 days.

After 3 months, additional repeated intravenous transfusion emulsion “Perftoran”, repeated intravenous administration as a photosensitizer Radachlorin and re-spent intravenous laser irradiation of blood for the same modes.

When the control ULTRASOUND after 6 months on the location of the mass was determined by dense scar up to 1 mm thick. Methods of radiography, computed tomography, nuclear magnetic resonance and ultrasound diagnosis of metastasis in the period from 1 year to 3 years is not detected.

1. A method of preventing metastases after surgical removal of intraocular tumors, including performing a vitrectomy, retinotomy with subsequent exposure of intraocular tumors, smoothing retina performancesin connection with its subsequent replacement by silicone oil, characterized in that after removal of tumors, conduct intravenous transfusion of 10% emulsion “Perftoran” with a rate of 60 drops per minute in the amount of 80-100 ml with subsequent introduction of the intravenous drip in the cubital vein of the same hand of the photosensitizer, in 5-15 minutes after injection of the photosensitizer, through pre-installed in the cubital Vienna, on the other hand, the laser light guide perform laser irradiation cu is VI when power 20-50 mW, when used as fotosensibilizatora 0.1 to 1% aqueous solution of chlorine dose of 0.2-0.5 mg/kg irradiation is carried out with a wavelength of 661-666 nm within 10-40 minutes, and when used as a photosensitizer of 0.2-1% aqueous solution of porphyrin dose of 0.2-1 mg/kg irradiation is carried out with a wavelength of 630-633 nm within 10-45 minutes, the session is performed twice with an interval of 5 days.

2. The method according to claim 1, characterized in that the aqueous solution of chlorine selected from the group Photolon, Radachlorin or photoditazine, and as a solution of porphyrin enter Photohem.

3. The method according to claim 1, characterized in that it further after 1-3 months re-spend intravenous transfusion emulsion “Perftoran”, intravenous administration of a photosensitizer and laser irradiation of blood.



 

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