Method for treating terminal and gone-too-far glaucoma

FIELD: medicine.

SUBSTANCE: method involves doing vitrectomy, withdrawing posterior hyaline membrane, making radial optical neurotomy, trans-sclerally irradiating ciliary body regions field-by-field between direct muscles in four quadrants 1.5-2 mm far from limb using 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. Chlorine row photosensitizer is intravenously introduced and ciliary body regions are trans-sclerally irradiated field-by-field with neighboring fields overlapping by 5% of area between direct muscles in four quadrants 1.5-2 mm far from limb using laser radiation of wavelength corresponding to maximum light emission absorption on photosensitizer part and power density equal to 50-80 J/cm2 5 min later after having introduced the photosensitizer. Another embodiment of the invention involves doing vitrectomy, withdrawing posterior hyaline membrane, making radial optical neurotomy, trans-sclerally irradiating the whole zone of ciliary body field-by-field 1.5-2 mm far from limb using 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. Chlorine row photosensitizer is intravenously introduced and ciliary body regions are irradiated field-by-field with neighboring fields overlapping by 5% of area using laser radiation of wavelength corresponding to maximum light emission absorption on photosensitizer part and power density equal to 40-50 J/cm2 5 min later after having introduced the photosensitizer.

EFFECT: dosed action upon ciliary body; reduced risk of traumatic complications; stable ophthalmotonus compensation; improved microcirculation in optic nerve; improved vision function.

2 cl

 

The invention relates to medicine, namely to ophthalmology, and can be used to treat severe and terminal glaucoma.

There is a method of treatment of glaucoma (material V.F., Krasnov, M.M., E. Bridge. Decompression surgery for optic nerve in glaucoma // Vestnik of ophthalmology. - 1989. No. 5. - P.8-12), including transvitreal the dissection of the scleral ring side of the optic nerve. The disadvantage of this method is the high invasiveness and lack reliable normalization of IOP in the late postoperative period.

Closest to the claimed is a method of treating glaucoma comprising laser irradiation of the ciliary body (Kachanov, A. B. Diode-laser transscleral contact cyclotouriste in the treatment of various forms of glaucoma and ophthalmoparesis, dissertation CMN Moscow - 1995, pp.2-3). As a result, the part of the ciliary body coagulums, which leads to decreased production of watery mist. The disadvantage of this method is negazirovannoy impact, in some cases, insufficient and short-term effect, which requires repeated courses, the lack of positive impact of the operation on visual function, in particular on the state of the field of view, which particularly affected in glaucoma. Of complications in the early postoperative period is e marked exudative reaction in the anterior chamber and the formation of givemy in the anterior chamber.

The technical result of the proposed method is dosed effect on the ciliary body, reducing the morbidity of laser irradiation on the ciliary body, persistent compensated intraocular pressure, improve microcirculation in the optic nerve and, as a consequence, the improvement of visual functions. The technical result is achieved due to the fact that:

1. Remove SGM aimed at preventing the progression of proliferative vitreoretinopathy;

2. Conducting radial optical neurotomy from the nasal side of the optic nerve contributes to the improvement of visual functions by improving the volumetric blood flow velocity in the optic nerve in the dissection of the laminar plates and expansion of the scleral canal, the occurrence of chorioretinal anastomoses in the postoperative period;

3. Transscleral irradiation areas of the ciliary body of low-intensity laser irradiation improves blood circulation in the irradiated area, which leads to more intensive accumulation of FS in the vessels of the ciliary body;

4. Applied photosensitizers (PS) chlorophyll-type high purity, low toxicity, have high photochemical activity during laser irradiation even in small doses;

5. Following after intravenous FS transscale the actual radiation fields areas of the ciliary body laser radiation with the given parameters (photodynamic therapy (PDT)) has dosed photocytotoxicity and photodestructive effect on the vessels of the ciliary the body, which leads to decreased production of watery mist;

6. The neighbouring fields on 5% of the area under transscleral irradiation areas of the ciliary body makes it possible to irradiate them evenly;

7. The used dose ranges FS and parameters of laser radiation are necessary and sufficient for the implementation of svetoindutsirovannoi photochemical reactions with therapeutic effect required 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. At the preparatory stage process operative field, conduct standard anesthetic management. Perform vitrectomy according to the standard procedure, remove the rear of the hyaloid membrane. Using intravitreal knife from the nasal side of the optic nerve perform radial optical neurotomy, then scleractinia hole seal. Then transscleral, departing 1.5-2 mm from the limbus, irradiate the entire area of the ciliary body fields of low-intensity laser radiation with a diameter of 300 microns 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 (PS) chlorine is the first number, for example Photolon, Radachlorin, photoditazine, at a dose of 0.8-1.1 mg/kg for 5-7 minutes. After 5 minutes after the introduction of the Federal Assembly of transscleral, departing 1.5-2 mm from the limbus, is irradiated areas of the ciliary body between the straight muscles in the four quadrants fields of laser radiation with a diameter of 300 microns with a wavelength corresponding to 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 50-80 j/cm2.

The invention is illustrated by the following examples.

Example 1. Patient M., 59 years old. Diagnosis of open-angle glaucoma IIIc left eye. Visual acuity OS is 0.1. Field of view at OS narrowed to 10° from the point of fixation. IOP - 36 mm Hg

The patient treated by the proposed method. After radial optic neurotomy transscleral, departing 2 mm from the limbus, irradiated area of the ciliary body fields of low-intensity laser radiation with a diameter of 300 microns with a wavelength of 890 nm at a dose of 1.2 joules. Then intravenously injected Photolon at a dose of 1.1 mg/kg over 5 minutes. After 5 minutes after the introduction of the Federal Assembly of transscleral, departing 2 mm from the limbus, were irradiated areas of the ciliary body between the straight muscles in the four quadrants fields of laser radiation with a diameter of 300 microns with a wavelength of 660 nm at a fluence of 50 j/cm2.

6-the days after treatment visual acuity on OS was - 0,1. The intraocular pressure of 23 mm Hg After 1 month, visual acuity - 0,12; IOP decreased to 19 mm Hg; the marked expansion of the fields of view of up to 15°.

Example 2. Patient O., 75 years. Diagnosis of open-angle glaucoma IIIc on OD. Visual acuity OD - 0,08. Field of view at OD abruptly narrowed to 5° from the point of fixation from the nasal side up to 10° top and temporal. IOP OD - 35 mm Hg

The patient is treated under the proposed method. After radial optic neurotomy transscleral, departing 1.5 mm from the limbus, irradiated area of the ciliary body fields of low-intensity laser radiation with a diameter of 300 microns with a wavelength of 633 nm at a dose of 2.5 j. Then intravenously injected photoditazine at a dose of 0.8 mg/kg for 7 minutes. After 5 minutes after the introduction of the Federal Assembly of transscleral, departing 1.5 mm from the limbus, were irradiated areas of the ciliary body between the straight muscles in the four quadrants fields of laser radiation with a diameter of 300 microns with a wavelength of 666 nm at a fluence of 80 j/cm2.

At discharge, visual acuity on the OD was 0.1. Intraocular pressure OD - 24 mm Hg After 1 month, visual acuity OD - 0,1; IOP OD dropped to 18 mm Hg, is also marked by the expansion of the boundaries of the fields of view from 15 to 20° at the top and the side, respectively.

Thus, the inventive method provides a dosage effect on the ciliary body, the picture is giving the morbidity of laser irradiation on the ciliary body, persistent compensation of intraocular pressure, improve microcirculation in the optic nerve and, as a consequence, the improvement of visual functions.

The invention relates to medicine, namely to ophthalmology, and can be used to treat severe and terminal glaucoma.

There is a method of treatment of glaucoma (material V.F., Krasnov, M.M., E. Bridge. Decompression surgery for optic nerve in glaucoma // Vestnik of ophthalmology. - 1989. No. 5. - P.8-12), including transvitreal the dissection of the scleral ring side of the optic nerve. The disadvantage of this method is the high invasiveness and lack reliable normalization of IOP in the late postoperative period.

Closest to the claimed is a method of treating glaucoma comprising laser irradiation of the ciliary body (Kachanov, A. B. Diode-laser transscleral contact cyclotouriste in the treatment of various forms of glaucoma and ophthalmoparesis, dissertation CMN Moscow - 1995, pp.2-3). As a result, the part of the ciliary body coagulums, which leads to decreased production of watery mist. The disadvantage of this method is negazirovannoy impact, in some cases, insufficient and short-term effect, which requires repeated courses, the lack of positive impact of the operation on the optic f is NCLI, in particular on the state of the field of view, which particularly affected in glaucoma. Of complications in the early postoperative period marked exudative reaction in the anterior chamber and the formation of givemy in the anterior chamber.

The technical result of the proposed method is dosed effect on the ciliary body, reducing the morbidity of laser irradiation on the ciliary body, persistent compensated intraocular pressure, improve microcirculation in the optic nerve and, as a consequence, the improvement of visual functions. The technical result is achieved due to the fact that:

1. Remove SGM aimed at preventing the progression of proliferative vitreoretinopathy;

2. Conducting radial optical neurotomy from the nasal side of the optic nerve contributes to the improvement of visual functions by improving the volumetric blood flow velocity in the optic nerve in the dissection of the laminar plates and expansion of the scleral canal, the occurrence of chorioretinal anastomoses in the postoperative period;

3. Intravitreal radiation fields of the ciliary body of low-intensity laser irradiation improves blood circulation in the irradiated area, which leads to more intensive accumulation of FS in the vessels of the ciliary body;

4. Applied photosensitizers (PS) chlorine is the model number have a high degree of purity, low toxicity, have high photochemical activity during laser irradiation even in small doses;

5. Following after intravenous FS intravitreal endoscopic irradiation areas of the ciliary body laser radiation with the given parameters (photodynamic therapy (PDT)) has photocytotoxicity and photodestructive effect on the vessels of the ciliary body, which leads to decreased production of watery mist;

6. The neighbouring fields on 5% of the area with intravitreal endoscopic exposure of the ciliary body makes it possible to irradiate it evenly;

7. The used dose ranges FS and parameters of laser radiation are necessary and sufficient for the implementation of svetoindutsirovannoi photochemical reactions with therapeutic effect required 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. At the preparatory stage process operative field, conduct standard anesthetic management. Perform vitrectomy according to the standard procedure, remove the rear of the hyaloid membrane. Using intravitreal knife with a nose is part of the optic nerve perform radial optical neurotomy. Then intravitreal irradiate the entire area of the ciliary body fields of low-intensity laser radiation with a diameter of 300 microns 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 (PS) chlorophyll-type, for example Photolon, Radachlorin, photoditazine, at a dose of 0.8-1.1 mg/kg for 5-7 minutes. After 5 minutes without access to light after the introduction of the Federal Assembly of intravitreal endoscopically irradiated areas of the ciliary body is irradiated with 0-30 to 2-30 hours, not irradiated with to 2-30 3-30, irradiated with 3-30 to 5-30, not irradiated with 5-30 to 6-30, etc. to 11-30, fields of laser radiation with a diameter of 300 μm, with overlapping of adjacent fields on 5% of the area, with the wavelength corresponding to 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 40-50 j/cm2. The surgery is completed by suturing on scleractinia holes and conjunctiva.

This scheme intravitreal endoscopic exposure areas of the ciliary body due to the location of direct muscles to prevent them photodynamic damage.

The invention is illustrated by the following examples.

Example 1. Patient K., aged 60. Diagnosis of open-angle glaucoma IIIc left eye. Visual acuity OS - 0,05. Field of vision on OS narrowed to 10#x000B0; from the point of fixation. IOP OS - 37 mm Hg

The patient is treated under the proposed method. After radial optic neurotomy intravitreal irradiated ciliary body fields of low-intensity laser radiation with a diameter of 300 microns with a wavelength of 633 nm at a dose of 2.5 j. Then intravenously injected Radachlorin at a dose of 1.1 mg/kg for 7 minutes. After 5 minutes without access to light after the introduction of the Federal Assembly of intravitreal endoscopically were irradiated areas of the ciliary body from 0-30 to 2-30 hours, 3-30 to 5-30 etc. until 11-30, fields of laser radiation with a diameter of 300 μm, with overlapping of adjacent fields on 5% of the area, with a wavelength of 666 nm at a fluence of 40 j/cm2. The operation was finished suturing on scleractinia holes and conjunctiva.

At discharge visual acuity on OS amounted to 0.08. Intraocular pressure of 22 mm Hg After 1 month, visual acuity of 0.1; IOP decreased to 19 mm Hg; the marked expansion of the fields of view of up to 15°.

Example 2. Patient L., 74 years. Diagnosis of open-angle glaucoma IIIc on OD. Visual acuity OD - 0,08. Field of vision narrowed sharply to 5° from the point of fixation. IOP OD - 35 mm Hg

The patient is treated under the proposed method. After radial optic neurotomy intravitreal irradiated ciliary body fields of low-intensity laser radiation with a diameter of 300 microns with a wavelength of 890 nm at a dose of 1.2 joules. Stimulation introduced photoditazine at a dose of 0.8 mg/kg over 5 minutes. After 5 minutes without access to light after the introduction of the Federal Assembly of intravitreal endoscopically were irradiated areas of the ciliary body from 0-30 to 2-30 hours, 3-30 to 5-30 etc. until 11-30 fields of laser radiation with a diameter of 300 μm, with overlapping of adjacent fields on 5% of the area, with a wavelength of 660 nm at a fluence of 40 j/cm2. The operation was finished suturing on scleractinia holes and conjunctiva.

At discharge visual acuity on the OD was 0.1. Intraocular pressure OD - 22 mm Hg After 1 month, visual acuity of 0.1; on OD IOP decreased to 18 mm Hg, is also marked by the expansion of the boundaries of the fields of view of up to 15°.

Thus, the inventive method provides a dosage effect on the ciliary body, reducing the morbidity of laser irradiation on the ciliary body, a strong compensation of intraocular pressure, improve microcirculation in the optic nerve and, as a consequence, the improvement of visual functions.

1. A method for the treatment of severe and terminal glaucoma, including laser irradiation of the ciliary body, characterized in that the first conducting vitrectomy, remove the back of the hyaloid membrane, spend radial optical neurotomy from the nasal side of the optic nerve, and transscleral irradiation of the ciliary body, departing 1.5-2 mm from the limbus, conduct low-intensity laser fields radiated by the I 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 irradiate the entire area of the ciliary body, and then intravenously injected photosensitizer (PS) chlorophyll-type at a dose of 0.8-1.1 mg/kg, and after 5 minutes after the introduction of the Federal Assembly, departing 1.5-2 mm from the limbus, conduct transscleral irradiation areas of the ciliary body between the straight muscles in the four quadrants fields of laser radiation with a wavelength corresponding to maximum absorption of the photosensitizer, light radiation, the energy density of 50-80 j/cm2with neighbouring fields on 5% of the area.

2. A method for the treatment of severe and terminal glaucoma, including laser irradiation of the ciliary body, characterized in that the first conducting vitrectomy, remove the back of the hyaloid membrane, spend radial optical neurotomy from the nasal side of the optic disc, and the laser irradiation of the ciliary body hold intravitreal fields 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 irradiate the entire area of the ciliary body, and then intravenously injected photosensitizer (PS) chlorophyll-type at a dose of 0.8-1.1 mg/kg, and after 5 min after injection FS intravitreal endoscopically conduct the irradiation areas of the ciliary body fields of laser radiation with a wavelength corresponding to maximum absorption photosensor what lyst light radiation, when the energy density of 40-50 j/cm with neighbouring fields on 5% of the area.



 

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FIELD: medicine.

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2 cl

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7 cl

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6 cl, 1 dwg

FIELD: medical equipment.

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11 cl, 6 dwg, 1 tbl, 3 ex

FIELD: organic chemistry, medicine.

SUBSTANCE: invention relates to a photosensibilizing compound representing phenylthio-substituted derivative of phthalocyanine of the general formula (I): wherein R means hydrogen atom (H), t-C4H9; M means HH, AlOH, Zn. Also, invention relates to its liposomal formulation representing the composition of mixture of lipids (lecithin, cholesterol, cardiolipin) and a photosensibilizing agent, and to a method for carrying out the photodynamic therapy using this formulation. Photosensibilizing agents show high elimination rate from normal tissues, provide the deep therapeutic effect on tumor tissues, non-toxic properties and perspective for their using in oncology and other branches of medicine.

EFFECT: valuable medicinal properties of compound.

4 cl, 3 dwg, 9 ex

FIELD: medical engineering.

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

3 cl

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.

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 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

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