Photodynamic therapy method for treating intraocular neoplasms

FIELD: medicine.

SUBSTANCE: method involves applying transpupillary irradiation of intraocular neoplasm with low intensity laser radiation of wavelength equal to 633 nm at a dose of 2.5 J or wavelength of 890 nm at a dose of 1.2 J. Then, chlorine row photosensitizer is intravenously introduced at a dose of 0.8-1.1 mg/kg. Spectral fluorescence diagnostic of photosensitizer accumulation is carried out 15-20 min later in the neoplasm. Intraocular neoplasm fluorescence being observed compared to the surrounding tissue, the neoplasm is transpupillary irradiated using laser radiation of wavelength corresponding to maximum light emission absorption on photosensitizer part and power density equal to 100-120 J/cm2. Then, tunnel is formed in subtenon space and neoplasm thermotherapy is trans-sclerally done.

EFFECT: enhanced effectiveness of treatment; dosed treatment course applied; completely stopped tumor growth.

2 cl

 

The invention relates to medicine, namely to ophthalmology, and can be used for the treatment of intraocular tumors of the small and medium size (classification J. Sields, 1983).

There is a method of photodynamic therapy of intraocular tumors (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 and transpupillary laser irradiation of tumors. However, the application of this method in half of the cases you cannot stop the growth of intraocular tumors. Photodynamic therapy in this way is ineffective and reoptimization area of irradiation power and time of radiation, requires multiple repeat sessions.

The technical result is to increase the efficiency of photodynamic therapy in the treatment of intraocular tumors, dosed conduct treatment sessions, full stop tumor growth. The technical result is achieved due to the fact that:

1. Transpupillary exposure of intraocular neoplasms of low-intensity laser radiation to intravenous FS improves blood circulation in the irradiated area, which leads to more intensive accumulation of PS in tumor tissue.

2. Used fotosensibilizatora (FS) chlorophyll-type have a high degree of purity, low toxicity, the ability to accumulate in tumor cells and even in small doses to exhibit a high photochemical activity during laser irradiation.

3. Conducting spectral-fluorescent diagnostics allows you to determine whether there was a sufficient and necessary to provide a therapeutic effect, the accumulation of the photosensitizer in the tumor tissue compared with the surrounding.

4. Following after intravenous FS and spectral-fluorescent diagnosis transpupillary exposure of intraocular tumors by laser radiation with the given parameters (photodynamic therapy (PDT)) causes stasis of blood and photoinduced thrombosis of blood vessels that feed the tumor and cause the death of tumor cells to a depth of about 3 mm.

5. Laser irradiation during PDT fields in a circle from the periphery to the centre with neighbouring fields on 5% of the area provides uniform irradiation of tumors on the entire surface, and eliminates the dissemination and migration of tumor cells.

6. Transscleral holding thermotherapy intraocular tumors after PDT allows you to achieve the destruction of tissue throughout the volume of the tumor.

7. The used dose ranges FS and parameters of laser radiation are necessary and sufficient for the NCD is estline svetoindutsirovannoi photochemical reactions with therapeutic effect, necessary to achieve the technical result.

The claimed technical result can be obtained only when using the entire set of techniques proposed method.

The method is as follows. Spend transpupillary exposure of intraocular neoplasms of low-intensity laser radiation with a wavelength of 633 nm at a dose of 2.5 j or with a wavelength of 890 nm at a dose of 1.2 joules. Then intravenously injected photosensitizer chlorin number, for example Photolon, Radachlorin, photoditazine, at a dose of 0.8-1.1 mg/kg over 10 minutes. After 15-20 minutes after intravenous FS start spectral-fluorescent diagnostics accumulation of PS in the tumor. Registration of fluorescence is carried out, for example, using an interference filter with a transmission range 665-800 nm. During spectral-fluorescent diagnostics control the contrast accumulation FS in intraocular tumors, and the appearance of fluorescence in the tumor compared with the surrounding tissue transpupillary irradiate the tumor by laser radiation with a wavelength corresponding to the maximum absorption of the photosensitizer, light radiation, for example, with a wavelength of 660-666 nm when using FS chlorophyll-type, when the energy density of 100 to 120 j/cm2 moreover , irradiation is carried out fields in a circle from the periphery to the centre with neighbouring fields on 5% of the area. Then perlimplin perform a small incision in the conjunctiva and tenon's membrane, Sultanova space form the tunnel and extend it to match the projection of the boundaries of the base of the tumor. In educated enter the tunnel curved optical transscleral probe, and through the advanced pupil visualize the glow of the red laser driver in the fundus or on the surface of tumors, glow set the tool in the desired position, and transscleral spend thermotherapy of tumors fields diode laser with the standard parameters of laser radiation: wavelength range 810-1060 nm, the diameter of the light spot of 2.0 to 3.0 mm, in a continuous mode with an exposure time of 1-2 min on one field, the radiation power 500-800 mW.

All actions of the photosensitizer are dimmable, providing the impossibility of access to the premises to direct sunlight. This condition is well known and standard for sessions of PDT.

The invention is illustrated by the following examples.

Example 1. Patient T., aged 63. Entered the KF of IRTC "MG" with a referring diagnosis: Central involutional dystrophy AOI. The initial cataract OI.

The result is e comprehensive ophthalmic examination was diagnosed with melanoma of the choroid (MX) left eye. When the examination of the ocular paracentral in the upper temporal side of the macular area was determined rounded, prominere in the vitreous hearth grey slate colour. Carrying PHAGE fundus allowed to verify the diagnosis (MX), given the presence of characteristic MX heterogeneous ("spotted") hyperfluorescence. Ultrasonic b-scanning enabled to specify the size of the tumor: base diameter - 8 mm; thickness at the top of tumor - 4 mm.

The patient is treated under the proposed method.

Spent transpupillary exposure of intraocular neoplasms of low-intensity laser radiation with a wavelength of 890 nm at a dose of 1.2 joules. Then intravenously introduced Radachlorin at a dose of 1.1 mg/kg Over 20 minutes after intravenous FS spent spectral-fluorescence diagnosis and the appearance of fluorescence intraocular tumors compared to surrounding tissue transpupillary irradiated tumor by laser radiation with a wavelength of 666 nm when the energy density of 120 j/cm2. Then transscleral spent thermotherapy of tumors with the following parameters of laser exposure wavelength of 1060 nm, the diameter of the light spot 3.0 mm, in a continuous mode with an exposure time of 2 min on one field, the radiation power of 500 mW.

When the control ultraslo the new B-scan in a remote period showed a significant regression of tumors, a decreasing value of prominence tumors: up to 1.5 mm to 3 months and up to 1 mm to 6 months after surgery. In the follow-up period (up to 1.5 years) noted positive dynamics in the form of a further flattening of the scar.

Signs of recurrence of tumors and metastasis was not detected.

Example 2. Patient M., 59 years old. Entered the KF of IRTC "MG" with a referring diagnosis: melanoma of the choroid (MX) left eye.

Diagnosis the MX was verified ophthalmoscopically, angiographic and ultrasound B-scan. The tumor was located in the paracentral region of the fundus. Its dimensions, according to the ultrasonic B-scan, were as follows: base diameter - 7 mm; thickness at the top of tumor - 2.5 mm

The patient is treated under the proposed method.

Spent transpupillary exposure of intraocular neoplasms of low-intensity laser radiation with a wavelength of 633 nm at a dose of 2.5 j. Then intravenously introduced photoditazine at a dose of 0.8 mg/kg Over 15 minutes after intravenous FS spent spectral-fluorescence diagnosis and the appearance of fluorescence intraocular tumors compared to surrounding tissue transpupillary irradiated tumor laser with a wavelength of 660 nm at a fluence of 100 j/cm2. Then transscleral spent thermotherapy Novo is obrazovaniya with the following parameters laser radiation: wavelength 810 nm, the diameter of the light spot 2.0 mm, in continuous mode with exposure time 1 min on one field, the radiation power of 800 mW.

When the control ultrasonic B-scan in a remote period showed a significant regression of tumors, with a decreasing value of prominence tumors: up to 2.0 mm to 3 months and up to 1.5 mm to 6 months after surgery. In the observation period up to 2 years signs of recurrence of tumors and metastasis was not detected.

Thus, the invention improves the efficiency of photodynamic therapy in the treatment of intraocular tumors, dosed conduct treatment sessions, full stop tumor growth.

1. The method of photodynamic therapy of intraocular tumors, including intravenous administration of a photosensitizer (PS) and transpupillary laser irradiation of tumors, characterized in that the first conducting transpupillary irradiation of tumors of low-intensity laser radiation with a wavelength of 633 nm at a dose of 2.5 j or with a wavelength of 890 nm at a dose of 1.2 j, and as FS intravenous FS chlorophyll-type at a dose of 0.8-1.1 mg/kg over 10 min, 15-20 min after injection FS start spectral-fluorescence detection (IFD) accumulation FS in intraocular tumors with registration fluorescence, and transpupillary La the black irradiation of tumors is carried out at the appearance of fluorescence in the tumor compared with the surrounding tissue by laser radiation with wavelength, corresponding to the maximum absorption of the photosensitizer, light radiation, the energy density of 100 to 120 j/cm, and irradiation is carried out fields in a circle from the periphery to the centre with neighbouring fields on 5% of the area, then transscleral conduct therapy of intraocular tumors.

2. The method according to claim 1, characterized in that the registration of fluorescence is performed with the use of an interference filter with a transmission range 665-800 nm.



 

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1 ex

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FIELD: medicine.

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4 cl, 3 dwg, 9 ex

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3 cl

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

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.

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

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

FIELD: medicine.

SUBSTANCE: method involves intrastromally introducing chlorine row photosensitizer into tumor in 0.35-0.5% solution in the amount of 0.1-0.5 ml, intravitreally applying to tumor in 1.0-2.0% gel in the amount of 0.2-0.3 ml and intravenously introducing at a dose of 0.5-0.8 mg/kg. Intravenous laser irradiation with wavelength corresponding to maximum light emission absorption on photosensitizer part is concurrently applied with Intravenous photosensitizer introduction during 10-15 min with power of 20-500 mW. Intravenous laser irradiation being over, spectral fluorescence diagnostic of neoplasm is applied. Intravitreal laser irradiation of neoplasm is carried out with wavelength corresponding to maximum light emission absorption on photosensitizer part under power density of 100-120 J/cm2. Then, intraocular neoplasm is intravitreally removed. Retina is smoothed with perfluororganic compound. Photosensitizer is repeatedly introduced 7-14 days later after removing neoplasm and spectral fluorescence diagnostic is applied. The fluorescent regions are exposed to laser radiation with wavelength corresponding to maximum light emission absorption on photosensitizer part and power density equal to 50-80 J/cm2. The perfluororganic compound is substituted with silicon oil. Intravenous photosensitizer introduction and intravenous laser irradiation of blood are repeated 3 months later.

EFFECT: enabled complete intraocular neoplasm removal; reduced risk of viable tumor cells being retained in operation field or disseminated; reduced risk of relapses and metastases applied; completely stopped tumor growth.

2 cl

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