Method for preventing subepithelial fibroplasia from occurring after photorefraction keratectomy

FIELD: medicine.

SUBSTANCE: method involves administering drugs usable for hindering keratoleukoma occurring after carrying out excimer laser keratectomy with an antioxidant agent being added. The agent is used for jet irrigating cornea before setting lens.

EFFECT: enhanced effectiveness in reducing lipid peroxidation products quantity; accelerated cornea epithelialization.

2 cl, 2 tbl

 

The invention relates to medicine, namely to ophthalmology, and can be used for the prevention and treatment of subepithelial fibroplasia after photorefractive keratectomy.

It is known that excimer laser ablation of the cornea when performing photorefractive keratectomy (PRK) is accompanied by the development of sufficiently expressed surgical stress, and thus the subsequent formation of a number of pathogenetically important reactions, such as inadequate inflammatory response, activation of lipid peroxidation (LPO), the development of secondary immunodeficiency States, which subsequently can lead to the development of subepithelial flair (turbidity) of the cornea. This complication occurs in up to 30-40% of cases after conducting PRK, especially when using excimer plants of the first generation, and represents a separate subepithelial corneal opacities of various localization and duration of existence.

Known way to prevent these complications by appointment after PRK drops dexamethasone 4 times a day for at least 2-3 months (Kurenkov CENTURY Guide to excimer laser surgery //Moscow, Ed. The RAMS. - 2002 - 383 S.).

The disadvantage of this method is the duration of treatment, increased consumption of drugs and perhaps the improving eye pressure.

Known way to prevent such complications, involving the use of human amniotic membrane containing the suppressor various tissue growth factors that prevent rough scarring, and also contribute to the differentiation of the corneal epithelium, which leads to rapid epithelialization and, subsequently, the recovery of corneal transparency (Kalinikova YOU, Doga A.V. and other abstracts of the VII Congress of ophthalmologists of Russia //M, 2000 - S).

The disadvantage of this method is a certain complexity of the acquisition, procurement and storage of human amniotic membrane for application to the cornea in the postoperative period and the high cost of the membrane, which makes this method of prevention inaccessible.

Closest to the proposed method is a way to prevent the subepithelial fibroplasia by introducing before PRK using excimer laser vision correction and polishing of the cornea, complex mediators natural stress-limiting systems: α-tocopherol acetate (antioxidant drug); ciloxan (antimicrobial); naclof (anti-inflammatory drug); dalargin and other drugs to limit surgical stress (Ague, Bchantecail and other Clinical ophthalmology //Vol.2, No. 3. - 2001 - P.87-90).

This act is about to take for the prototype. The disadvantages of this method are the use of complex multidisciplinary treatment, affecting the whole body and at least locally for elimination of defects epithelization of the cornea:

- α-tocopherol acetate has no lipoic action, which provides anti-ischemic and epigenetically effect in complex prophylaxis;

- α-tocopherol acetate intramuscularly, causing additional discomfort to the patient.

The basis of the invention tasked to develop a pathogenetically grounded and accessible to a wide range of patients a way to prevent the subepithelial fibroplasia after photorefractive keratectomy, increasing the effectiveness of prevention, reduce the costs of prevention and the timing of its implementation.

The solution of this problem provides a method of preventing the subepithelial fibroplasia after photorefractive keratectomy, including excimer laser vision correction, polishing the affected area of the cornea, its covering of soft contact lens and the introduction of antioxidant, antimicrobial and anti-inflammatory drugs due to the fact that, as an antioxidant drug used eye drops thiotriazoline. The solution thiotriazoline injected into gasparetto jet irrigation of the cornea after grinding and by instillation after her cover soft contact lens.

As an antimicrobial agent is used ciloxan, and as a means of anti - naclof.

On the first day after surgery solutions thiotriazoline, siloxane and naclof install two drops of each drug per hour, and in the next 3-5 days - 8 instillations per day. However, depending on the results of vision correction, eye drops are used thiotriazoline.

Thiotriazoline - drug, an inhibitor of lipid peroxidation (LPO) and is a highly effective drug with broad spectrum of action, non-toxic, has a membrane-stabilizing, anti-ischemic, stimulating cell regeneration, wound healing, immunomodulatory, antiviral and other activities.

Technical and economic effect from the use of the invention is to improve the effectiveness of prevention, the reduction of the period of stay of patients in hospital, the consumption of drugs and reducing overall treatment costs.

The invention is illustrated below by the description and examples of clinical studies.

Clinically studied the activity of LPO products before and after use of excimer laser correction PRK in tear fluid using the method according to izaberete the Oia.

Surveyed 228 patients (415 eyes) aged 21-42 years with myopic refraction from 2.0 to 14.0 diopters. All patients were divided into 3 groups: group I - control (70, 120 eyes), who underwent photorefractive keratectomy without the use of thiotriazoline, group II - 93 patient, 172 eyes, which thiotriazoline appointed after PRK in installations 6-8 times a day for the first week, group III consisted of 65 patients, 123 eyes, which were conducted intraoperative irrigation thiotriazoline cornea immediately after laser ablation and resurfacing and subsequent drug was administered at installations on the same pattern as in the second group. The FLOOR level in the tear was assessed by the activity of primary and secondary products of peroxidation - diene conjugates (DC) and transitonal (TC). The determination of the activity of DC and TC was carried out by direct spectrophotometry.

Photorefractive keratectomy was performed on the excimer laser MEL-60 by Aesklepion Meditec, Germany). Estimated terms of reepithelization of the cornea and the number and severity of subepithelial flair.

Analysis of the obtained biochemical data showed that patients immediately after excimer laser correction PRK noted a dramatic increase in the FLOOR in tears: DC 8.4 times, the TK - 19.8 times p is compared with a control group of patients. In the group of patients in the postoperative period were appointed installations in the conjunctival cavity of eye drops thiotriazoline, the activity of DC and TC one hour after PRK in the tear fluid becomes respectively 3.3 and 2.3 times lower than in patients who install the thiotriazoline was not carried out, and in a day when using thiotriazoline activity DK almost returned to the level of the control group, and the activity of the LC remained at 1.6 times higher than in the control group mappings.

The use of eye drops thiotriazoline intraoperative and early postoperative period promotes rapid epithelialization of the cornea (2-3 days), the lack of formation of the flair of the cornea.

Example 1. Conducted excimer laser vision correction using photorefractive keratectomy. After sanding the affected area of the cornea was now covered in soft contact lenses.

Patients as prophylaxis was prescribed installation 2 drops of antimicrobial drug - ciloxan, anti - naclof who was administered the first day of every hour, and the subsequent 3-5 days - 8 installations per day.

Before surgery and one hour after surgery and the next day was determined by the content of diene and transconjugation in the tear fluid. And after a month the presence or absence of Cuba italianno flair (blurred).

The results are shown in tables 1 and 2.

Example 2. Conducted excimer laser vision correction using photorefractive keratectomy. After sanding the affected area of the cornea was now covered in soft contact lenses.

Patients as prophylaxis was prescribed installation 2 drops of antimicrobial drug - ciloxan, anti - naclof, antioxidant - thiotriazoline who was administered the first day of every hour, and the subsequent 3-5 days - 8 installations per day.

Before surgery and one hour after surgery and the next day was determined by the content of diene and transconjugation in the tear fluid. A month later the presence or absence of subepithelial flair (blurred).

The results are shown in tables 1 and 2.

Example 3. Conducted excimer laser vision correction using photorefractive keratectomy. After sanding the affected area of the cornea treated inkjet eye drops thiotriazoline, the cornea is covered with soft contact lenses.

Patients as prophylaxis was prescribed installation 2 drops of antimicrobial drug - ciloxan, anti - naclof, antioxidant - thiotriazoline who was administered the first day of every hour, and the subsequent 3-5 days - 8 installations per day.

Before surgery and one hour after surgery and the next day was determined by the content of diene and transconjugation in the tear fluid. A month later the presence or absence of subepithelial flair (blurred).

The results are shown in tables 1 and 2.

The proposed method can be used as a means of local antioxidant protection when performing excimer operations, which prevents the formation of subepithelial fibroplasia corneal 2-2,3 times (see table 1), as well as a sharp decrease in tear fluid through the day dancoyote - 8.3-9.1 times, and transconjugation - 2-3,2 times (see table 2).

Table 1

DYNAMICS of development of SUBEPITHELIAL HAZE (HASE) IN PATIENTS AFTER PRK
Categories, sickWITHOUT THIOTRIAZOLINE GROUP 1With THIOTRIAZOLINE GROUP 2, 3
The number of patientsThe number of eyesObserved opacityIn the postoperative periodIntraoperative and postoperative period
The number of patientsThe number of eyesObserved opacityThe number of patientsThe number of eyesObserved turbidity
Myopia up to 3.0 D8133712112-
Myopia from 3.0 L to 6.0 D812410193471
Myopia more 6,0 D61051118512224
Myopic astigmatism4885286512320489213
TOTAL7012040 (33,3%)9317229 (16,9%)6512318 (14,6%)

Table 2

The CHANGING CONCENTRATIONS of the DC And TC IN TEAR FLUID AFTER EXCIMER photorefractive keratectomy (PRK)
The studied parameters1st group without thiotriazoline2nd group (thiotriazoline in the postoperative period)Group 3 (thiotriazoline in intraoperative and after perational periods)
Ex.In an hourAfter 1 dayEx.In an hourAfter 1 dayEx.In an hourAfter 1 day
DK (mol/l)0,0083±0,00040,07±0,0040,079±0,000250,0085±0,00070,071±0,00090,0097±0,00010,0081±0,00050,0208±0,00010,0084±0,0003
Reliability of differencesP1<0,001P1<0,001P2>0,05P1<0,001

P2>0,05
P1>0,05

P2<0,01
P2>0,05

P3>0,05
P1<0,01

P2<0,01

P3<0,01
P1>0,05

P2<0,01

P3<0,01
TC (mol/l)0,0028±0,00000320,035±0,00080,018±0,000130,0029±0,000150,031±0,000110,009±0,000130,0027±0,000210,021±0,000140,0056±0,00011
Reliability of differencesP1<0,001P1<0,001P2<0,001P1&l; 0,01

P2<0,01
P1<0,001

P2<0,01
P2<0,01

P3<0,01
P1<0,01

P2<0,01

P3<0,01
P1<0,001

P2<0,001

P3<0,001
Notes: P1- value significant differences between the test and the reference indices;

P2- value significant differences between the analyzed and the corresponding figures in the first group;

P3- value significant differences between the analyzed and the corresponding figures in the second group.

1. The way to prevent the subepithelial fibroplasia, including excimer laser vision correction, polishing the affected area of the cornea, its covering of soft contact lens and instillation solutions antioxidant, anti-inflammatory and antimicrobial drugs, characterized in that after sanding, before installing the lens, the cornea is washed through trickle irrigation her solution of the antioxidant drug.

2. The method according to claim 1, characterized in that for irrigation and instillation using 1%solution of thiotriazoline, and as anti-inflammatory and antimicrobial solutions naclof and siloxane.



 

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