Method for prophylaxis of myopia progressing

FIELD: medicine, in particular, ophthalmology.

SUBSTANCE: invention relates to prophylaxis of myopia progressing. Biopolymer in amount of 1 ml is administered through cannula in Tenon's space to posterior eye pole, wherein said biopolymer represents 2 % chitosan ascorbate hydrogel solution having deacetilation ratio of 94-98 %, molecular mass of 100-700 kD, containing per 1 l of solution 200 mg of hyaluronic acid, 2g of chondroitin sulfuric acid, 110-440 mug of cattle serum growth factor, and 50 g of heparin.

EFFECT: effective prophylaxis of myopia progressing; due to improved blood circulation in posterior eye pole and building up of sclera tissue followed by biodegradation of biopolymer.

1 tbl, 1 ex

 

The invention relates to medicine, namely to ophthalmology, and can be used for the prevention and treatment of progressive myopia.

To prevent the progression of myopia are different auto-, ALLO-, xenopeltidae and synthetic materials (explants) in the form of suspensions and suspensions injected into the tenon's space of the eye.

Remizov, MS, Gryaznov A.I. proposed to the rear pole in the tenon's space blunt curved cannula 0.3-0.4 ml suspension digested allostery or holograma in saline solution at 4 meridians [1]. After 7-10 days, there is a weakening of refraction on average 0.66 diopters, long-term (6 months - 2.5 years) - to 0.44 diopters. The progression of myopia stopped 95% of patients. The increase of visual acuity, the authors explain the increased vascularization and blood supply to the posterior pole of the eye, which was confirmed by experimental histological studies.

The disadvantage of this method is the use of donor tissue for which it is necessary to conduct a series of laboratory studies to exclude viral (HIV, HBV, HCV and other) infections of the material, and also to carry out the harvesting and storage of tissues in accordance with the proposed methodology, which can cause certain difficulties in the absence of the tvii Bank canned donor tissue.

Closest to the proposed method of strengthening the sclera is a method where the use of expandable polymer composition, administered at a volume of 0.1-0.2 ml of a sterile solution, a curved needle for intramuscular injection under the tenon capsule so that spreading of the foam located in the posterior-external part of the sclera, the most tensile myopia. This method of treatment of patients with progressive myopia has allowed to achieve the following results: visual acuity improvement in average 0.15, lowering of refraction of 1.5 diopters 27% of treated patients. All patients achieved stabilization of progressive myopia during the two years of observations [2].

The disadvantages of this method is long formed resorption of the implant and the late start education episcleral connective tissue by transforming the granuloma foreign body.

The objective of the invention is the stabilization or slowing the progression of myopia in a short time.

The task to solve due to the fact that once injected with 1.0 ml 2% combined hydrogel solution of ascorbate chitosan with deacetylation 94%-98%, a molecular weight of between 100 to 700 kDa, containing 1 liter of a solution of 200 mg of hyaluronic acid, 2 g chondroitinase acid, 110-440 μg of serum facto is and the growth of cattle, 50 mg of heparin.

The method is as follows.

Patients in the tenon's space in the lower-outer quadrant retrobulbarno injected through the cannula 1.0 ml of water-soluble 2% hydrogel solution of ascorbate chitosan with deacetylation 94%-98%, a molecular weight of between 100 to 700 kDa, containing 1 liter of a solution of 200 mg of hyaluronic acid, 2 g chondroitinase acid, 220 mcg whey growth factor cattle, 50 mg of heparin. In the postoperative period as a standard anti-inflammatory therapy, patients receive drops: Sol. Dexamethasoni Of 0.1%, Sol. Cipromedi of 0.3%, parabulbarno: Sol. Dexamethasoni 2 mg, Sol. Gentamycini sulfatis 4% to 0.5 ml for 7 days.

It was treated 3 patients (1 male and 2 females) aged 16 to 45 years. Patients were determined visual acuity, critical frequency of flicker fusion, the lability of the optic nerve, was conducted biomicroscopy, ophthalmoscopy, biometrics, Refractometer, electroretinography, tonography, tonometry, perimetry, the study of the Central visual field, rheoophthalmography with cold break, before surgery, after surgery (at discharge), after 1, 3 and 6 months.

Observation of patients lasted from 1 to 6 months after the operation.

The immediate and remote results showed the effectiveness of the proposed treatment. The following table about lieverse positive dynamics of electrophysiological parameters and visual functions.

Table

The results of studies of patients with progressive myopia in different terms
IndicatorsAverage electrophysiological indices
before the treatmentafter surgeryat 1 month after surgery3 months after surgery6 months after surgery
Visual acuity without correction0,2±0,150,26±0,220,34±0,250,33±0,230,34±0,2
Refraction, diopter-11,17±5,4-11,58±5,4-10,45±5,7-10,44±5,5-10,43±5,6
Visual acuity with correction0,67±0,180,63±0,190,78±0,140,79±0,170,78±0,15
Biometrics, mm27,25±1,727.18 per±1,727,16±1,827,17±1,727,17±1,8
The average deviation of the sensitivity of the nerve from the age limit-6,6±3,6-5,1±1,6-3,3±2,1-3,1±1,8-3,2±1,1
The sum of the degrees of the peripheral field of view, degrees429±33448±9460±12463±14462±10
The sensitivity threshold of the optic nerve, mA210±26227±37210±32207±24209±21
Lability, Hz4040404040
The critical frequency of flicker fusion, Hz4040404040
The electroretinography wave and, mA46±1863±2572±1570±2073±21
The electroretinography wave b, mA153±51175±38198±41195±36196±34
The intraocular pressure8±19±27±18±27±2
Ease outflow0,16±0,080,19±0,090,18±0,070,21±0,100,17±0,09
The coefficient Becker26±1424±12 23±1125±1424±12
The geographical factor1,0±0,131,6±0,71,4±0,91,5±0,61,4±0,3
Pulse volume Kedrova7,3±0,9111,4±5,212,7±2,111,1±1,711,8±2,7

The table shows that within a few days after surgery improves visual acuity without correction and with correction decreases the refractive power of the eye, expanding the boundaries of fields of view, increases the sensitivity of the optic nerve, increases the amplitude of the waves a and b of electroretinography increases eographically coefficient and pulse volume, the remaining parameters are slightly changed. These changes indicate an increase in the sensitivity of the retina, due to increased blood flow, and increase of these parameters continues through the month after surgery, and their values are stored during 6 months of follow-up, also remain stable refraction and anteroposterior dimension (biometrics) eyes.

Clinical example: Patient U., 20 years. Diagnosis: high Myopia, chorioretinal progressing both eyes set on the basis of complaints, anamnesis, biomicroscopic, Ophthalmoscope, electrophysiologically research. Before treatment, the visual acuity of the left eye without correction of 0.01, visual acuity with correction (field (-)16,0 diopters) equal to 0.5, the average deviation of the sensitivity of the nerve from age norms -11,78 dB, the sum of the degrees of peripheral fields of vision 431, the sensitivity threshold of the optic nerve 260 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the wave and electroretinography 50 mA, wave b of electroretinography 75 mA, biometrics eyes of 29.3 mm, the intraocular pressure of 9 mm Hg, ease of intraocular fluid 0,19, production of intraocular fluid 0, the coefficient Becker 47,0, eographically coefficient of 0.77, pulse volume Kedrova 5,6.

The patient entered into the tenon's space, in the lower-outer quadrant retrobulbarno via cannula 1.0 ml of water-soluble 2% hydrogel solution of ascorbate chitosan with deacetylation 98%, molecular weight of 700 kDa, containing 1 liter of a solution of 200 mg of hyaluronic acid, 2 g chondroitinase acid, 220 mcg whey growth factor cattle, 50 mg of heparin. In the postoperative period the patient received drops: Sol. Dexamethasoni Of 0.1%, Sol. Cipromedi of 0.3%, parabulbar injection: Sol. Dexamethasoni 2 mg, Sol. Gentamycini sulfatis 4% to 0.5 ml.

On the 7th day after surgery, at discharge, the patient registered the following electrophysiological indices of left g the Aza: visual acuity without correction of 0.01, visual acuity with correction (field (-)16,0 diopters) equal to 0.5, the average deviation of the sensitivity of the nerve from age norms -7,14 dB, the sum of the degrees peripheral vision fields 451 degrees, the sensitivity threshold of the optic nerve 280 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the wave and electroretinography 100 mA, the wave in electroretinography 125 mA, biometrics eyes of 29.3 mm, the intraocular pressure of 12 mm Hg, ease of intraocular fluid 0,29, production of intraocular fluid of 0.65, the ratio Becker 41,0, eographically ratio of 1.63 pulse volume Kedrova 9,4.

These changes are indicators point to improvement in the sensitivity of the optic nerve, the retina, increasing the outflow of aqueous fluid, increased intraocular blood circulation to 7 days after surgery.

At 1 month after surgery, the patient noted the following electrophysiological indices of the left eye: visual acuity without correction of 0.01, visual acuity with correction (field (-)16,0 diopters) of 0.65, the average deviation of the sensitivity of the nerve from age norms -7,03 dB, the sum of the degrees peripheral vision fields 461 degrees, the sensitivity threshold of the optic nerve 270 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the wave and electroretinography 50 mA, the wave of electroretinography 100 mA, biometrics eyes of 29.3 mm, the intraocular pressure of 6 mm Hg, the other parameters of hydrodynamics are not defined, eographically factor of 1.43, pulse volume Kedrova 7,4.

These changes are indicators point to a significant improvement of visual functions, increasing the sensitivity of the optic nerve, the retina, the preservation of enhanced blood circulation, conservation of refraction and the anteroposterior size of the eye 1 month after the operation.

3 months after surgery, the patient is registered, the following electrophysiological indices of the left eye: visual acuity without correction of 0.01, visual acuity with correction (field (-)16,0 diopters) equal to 0.6, the average deviation of the sensitivity of the nerve from age norms -5,93 dB, the sum of the degrees peripheral vision fields 464 degrees, the sensitivity threshold of the optic nerve 270 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the wave and electroretinography 50 mA, the wave in electroretinography 100 mA, biometrics eyes of 29.3 mm, the intraocular pressure of 9 mm Hg, ease of intraocular liquid 0,3, production of intraocular fluid 0,0, coefficient Becker 27,20, eographically ratio of 1.53, pulse volume Kedrova 8,2.

These changes are indicators point to a stabilization of visual functions, sensitivity behold inogo nerve, retinal levels of intraocular circulation, conservation of refraction and the anteroposterior size of the eye 3 months after the operation.

6 months after surgery, the patient reported following electrophysiological indices of the left eye: visual acuity without correction of 0.01, visual acuity with correction (field (-)16,0 diopters) equal to 0.6, the average deviation of the sensitivity of the nerve from age norms -5,73 dB, the sum of the degrees of the peripheral field of view 460 degrees, the sensitivity threshold of the optic nerve 280 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the wave and electroretinography 50 mA, the wave in electroretinography 110 mA, biometrics eyes of 29.3 mm, the intraocular pressure of 9 mm Hg, ease of intraocular liquid 0,3, production of intraocular fluid 0,0, coefficient Becker 27,20, eographically factor of 1.57, pulse volume Kedrova 9,4.

These values indicate a continuation of the indices of visual functions, the sensitivity of the optic nerve, the retina, the level of ocular blood flow and intraocular fluid dynamics, biometrics by 6 months after surgery.

Thus, after the operation there is an increase of visual acuity without correction and with correction, expansion of the field of view, increasing coustical the activity of the optic nerve and retina, increase eographical ratio, pulse volume, no progression of myopia. The result remains stable during 6 months of follow-up after surgery.

The advantages of the proposed method is combined hydrogel has no allergenic properties [3, 4], biodegration, minor trauma during implantation, in a short time is achieved stabilization of myopia, the improvement of visual functions and increased blood supply to the posterior pole of the eye.

Sources of information

1. Remizov, MS, Gryaznov A.I. Method of surgical treatment of progressive myopia. - Vestnik of ophthalmology, 1981, No. 3, p.26-29.

2. Avetisov AS, Khoroshilova I.P., Savitskaya NF, Vinetsky M.I., Iodine E.N., Nikolaev Christmas eve, Trotta H.E. non-Surgical way to strengthen the sclera in progressive myopia. Journal of ophthalmology, No. 2, 1985, pp.31-35.

3. Bolshakov, I.N., Nasibov S.M. Application of Chitose in the treatment of hypercholesterinemia. Siberian medical review, 2001, No. 1, p.9-15.

4. Tanaka Y., Tanioka, S., Tanaka M., Tanifawa T., Kitamura Y., Minami, S., Okamoto Y., Miyashita M., Nanno M. Effects of chitin and chitosan particles on BALB/c mice by oral and parenteral administration. Biomaterials. 1997. - Vol. 18. No. 8. - P. 591-595.

The way to prevent progressive myopia, including the introduction of biomaterial through the cannula into the tenon's space to the posterior pole of the eye followed the standard anti-inflammatory therapy, characterized in that the biopolymer once injected with 1.0 ml 2% gel solution of ascorbate chitosan with deacetylation 94-98%, a molecular weight of between 100 to 700 kDa, containing 1 l of a solution of 200 mg of hyaluronic acid, 2 g chondroitinase acid, 110-440 μg of serum growth factor cattle, 50 mg of heparin.



 

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