Method for complex treating ischemic variant of glaucoma in patients with myopic refraction

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with medicinal treatment of ischemic variant of primary glaucoma in case of stable normalization of intraocular pressure (IOP) in patients with myopic refraction. For this purpose, it is necessary to carry out electromagnetic impact successively onto cerebral orbital, temporal and occipital areas, carotid sinuses of cervical autonomic plexus, and, also, one should additionally inject gliatilin per 1.0 in combination with instillations of 0.5%-betaxolol solution per 2 drops twice daily into ocular conjunctival cavity. Therapy should last for 10 d at repeating the course once or twice annually. The method provides stable normalization of IOP, improves cerebral and orbital hemodynamics and stabilization of visual functions.

EFFECT: higher efficiency of therapy.

1 ex, 5 tbl

 

The invention relates to medicine, namely to ophthalmology, and is intended for medical treatment of ischemic variant of primary glaucoma, with no persistent normalization of intraocular pressure (IOP)in patients with myopic refraction.

Primary open-angle glaucoma (POAG) is attributed to multifactorial diseases with a threshold effect, which are distinguished by the fact that there is no definite cause of disease. The main pathogenic factors in POAG include deterioration of intraocular fluid from the eye, increased IOP, ischemia and hypoxia of intraocular structures (AppStore - In the book. Modern technologies of treatment of glaucoma, M., 2003, C-14).

In this regard, well-known different ways to treat glaucoma, aimed at improving some isolated pathogenesis of this pathology. Since the set of pathogenetic characteristics leads to increased IOP, which in turn enhances the development of degenerative changes in the eyeball and the disintegration of the visual functions, most treatments include different drugs that reduce IOP.

Glaucoma that develops in patients with moderate and high myopia degree is negative. Formally, this glaucoma is diagnosed as open, but determined different ways hemodynamically the violations, or ischemic option, with a predominance of arterial insufficiency, or dyscirculatory option, with a predominance of difficulty of venous outflow. In this regard, to achieve therapeutic effect of medical treatment of such patients should be individual, taking into account features of hemodynamic changes.

There is a method of treatment of open-angle glaucoma through the consistent use of instillation taufona and blocker - practolol (RF Patent No. 2173123, bull. Fig. No. 25, 2001). The disadvantage of this method is to reduce the production chamber moisture when using these drugs, which will contribute to the progression of degenerative processes and reduction of visual functions in patients with combined pathology of glaucoma and myopia.

There is a method of treatment of glaucoma (RF Patent No. 2131233, bull. Fig. No. 16, 1999), which provides for the installation of drugs that lower IOP and applying to the skin of the forehead bandage impregnated with a mixture comprising a solution of novocaine, nicotinic acid, taufona and Dimexidum for 40-60 minutes. The disadvantage of this method is to achieve vasodilatating effect primarily at the level of extraocular tissues. In this regard, the effectiveness of its therapeutic actions for patients with glaucoma m is epicheskoi refraction is very low.

The closest technical solution and taken for the prototype is a method of treating glaucoma (RF Patent No. 2135131, bull. Fig. No. 24, 1999), providing for percutaneous magnetic effects in the projection of the temporal, occipital arteries and carotid sinuses for 2-3 minutes, in the projection of the cervical sympathetic plexus on both sides for 5-7 minutes. The disadvantage of this method of treatment is focused on the improvement of microcirculation and exclusiveness for patients previously operated with normalized IOP.

The objective of the invention is to develop a conservative method of complex treatment of ischemic variant of glaucoma in individuals with myopic refraction.

The technical result is persistent normalization of IOP, improving cerebral and orbital hemodynamics, stabilization of visual functions. The technical result is achieved in that in the method of treatment of ischemic variant of glaucoma in individuals with myopic refraction is used transcutaneous electromagnetic effects in the projection of the orbit, temporal, and occipital arteries, carotid sinuses, cervical sympathetic plexus on both sides, characterized in that the impact begins with the area of the orbits, with the induction of 20 MT, with a duration of 5 min in each zone on the background of additional nutriv is spent introducing gliatilin of 1.0 within 10 days 1-2 times per year, when permanent instillation of 0.5% solution of betaxolol 2 drops 2 times a day in the conjunctival cavity of the eye.

The choice of drugs is due to the fact that betaxolol is only a beta blocker with vasodilatation and neuroprotective effect, and gliatilin intravenous increases the linear velocity of blood flow in cerebral arteries.

In the combined magnetic therapy and pharmacological effects of drugs is pathogenetic focus on the basic pathogenesis of glaucoma and myopia in patients with combined pathology, namely reduced IOP, improves hemodynamics, increased functional bioelectric activity of the peripheral and Central section of the visual analyzer. The set of positive factors of the proposed method explains the improvement in visual function in treated patients.

The proposed method treated 24 patients, 22 (91,7%) of them showed a significant (Rho<0,5) improve hemo - and hydrodynamic performance and visual functions.

Example 1. Patient N. 44 years, suffering from myopia school years. The last 2 years notes blurred vision and increased myopia.

VOD-0,06 Sph(-)7,0 D=0,8

VOS-0,04 Sph(-)7,5 D=0,6

Daily tonometry showed increased IOP in the right g the ABC to 26.0 mm Hg, in the left eye to 28.0 mm Hg Data monografii: OD-Ro=19,5, C=0,10, F=0.95, And Po/c=195; OS-Ro=19,5, C=0,07, F=0,67, Po/c=279. Gonioskopy eye - anterior chamber angle is open, wide profile, degeneration of the root of the iris, single lig. pectinatum, moderate pigmentation trabeculae and schlemm's canal. The fundus of both eyes: pale optic nerve disc, expanded flat excavation of e/D=0,6 right, 0,7 - left, shift vascular bundle, peripapillary chorioretinal degeneration, the arteries narrow, the ratio of the caliber of retinal vessels:At=1:3. Computerized static perimetry revealed from 125 entry points visible 83 (66,4%) in the right eye and 65 (52%) in the left eye, scotomas were located mainly in the upper and the nasal half of the visual field.

The data of ULTRASONIC scanning of the main arteries of the base of the brain

vessels (lbfv, cm/sec)rightleft
anterior cerebral artery (ACA)6660
middle cerebral artery (MCA)7168
posterior cerebral artery (PCA)6461
the ophthalmic artery (HA)2826
vertebral artery (PA)5250
basilar artery (BA)55
Conclusion. ISC was reduced on average by 30% on the right and 35% left.

The data of ULTRASONIC scan of the orbital vessels (lbfv cm/sec - IR)

vessels (lbfv, cm/sec)rightleft
the ophthalmic artery (HA)28 - 0,6626-0,68
the Central artery of the retina (CAS)9-0,648-0,66
posterior short ciliary artery (SCCA)11 - 0,6610-0,66
the ophthalmic vein (HW)10-0,5012-0,52
the Central retinal vein (PCV)9 - 0,489-0,50
choroidal vein (HV)8 - 0,468-0,46
Conclusion. BFV reduced in the cars, SCCA 40% to the right, by 46% to the left, with increased tone of the arteries CAC, SCCA 10% on the right and 15% to the left.

On the basis of the aggregate ophthalmologic signs diagnosed with glaucoma about/developed with moderately elevated IOP, high myopia in both eyes.

Data orbital and Central blood flow in the examined patient is reduced by 30-35% in the arteries of the base of the brain and 40-46% in about the of betulinic arteries in relation to the physiological norm with normal venous outflow. Derived hemodynamic parameters confirm ischemic option of glaucoma in this patient. Patient treatment: instillation of 0.5% solution of betaxolol 2 times a day within 10 days intravenously at 1.0 gliatilin in combination with magnetic therapy apparatus Gradient intensity of 20 MT successively on the area of the orbit projection, temporal, and occipital arteries, carotid sinus and cervical sympathetic plexus in 5 minutes, just exposure to electromagnetic exposure was 25 minutes the Patient was well tolerated treatment, complications were noted.

After course of treatment the patient noted improvement in vision and visual performance, improvement of General condition.

Examination revealed positive dynamics of visual functions, hydro - and hemodynamic parameters.

VOD=0,06 Sph(-)7,0 D=0,9 IOP=22,0

VOS=0,04 Sph(-)7,5 D=0,8 IOP=23,0

The data of ULTRASONIC scanning of the main arteries of the base of the brain:

vessels (lbfv, cm/sec)rightleft
anterior cerebral artery (ACA)8078
middle cerebral artery (MCA)8682
posterior cerebral artery (PCA)786
the ophthalmic artery (HA)3533
vertebral artery (PA)6866
basilar artery (BA)70

Perimetry: 125 required points become visible in the right eye 102 points (81,6%), in the left - 92 points (73,6%).

These monografii:

ODOS
Ro15,4the 17.3
0,240,18
F1,31,3
Ro/S6496

The data of ULTRASONIC scan of the orbital vessels (lbfv, cm/sec - IR)

vessels (lbfv, cm/sec)rightleft
the ophthalmic artery (HA)35-0,6033-0,60
the Central artery of the retina (CAS)14-0,6012-0,60
posterior short ciliary artery (SCCA)15-0,5813-0,58
the ophthalmic vein (HW)11-0,5012-0,50
the Central retinal vein (PCV)9-0,489-0,48
choroidal vein (HV)9-0,468-0,46

Thus, the analysis of treatment results showed that IOP is normalized in 91.6% of patients treated, with the churn increased to 2.5 times the minute volume chamber moisture increased almost in 2 times. Visual acuity improved by 0.1-0.2 and the data field of vision improved by 20-22%. BFV has intensified in the main cerebral arteries by 25-30%, and in the orbital arteries by 20% in ophthalmic and by 45% in cars, and 36.4% in SCCA.

The proposed method allows you to work simultaneously on three important link in the pathogenesis of glaucoma, myopia: to improve Central and orbital arterial hemodynamics, to improve key indicators of hydrodynamics: C and F, to provide a neuroprotective effect on the visual analyzer.

Re-examine the patient after 3 and 6 months showed the presence of a stable normalization of IOP, but since the coefficient ease of movement and minute volume chamber moisture decreased after 6 months, respectively, up to C=0,15; F=0,76 and BFV in orbital vessels also declined by 15%, however, all indicators remained above baseline values, was carried out a second course of treatment, which has helped to improve all indicators to the immediate results after the first course.

The proposed method of treatment ishemic the someone option of glaucoma in individuals with myopic refraction - non-invasive, easy to perform, is quite highly effective and pathogenetically versatile, allowing to stabilize the collapse of visual functions in this category of patients.

The method of complex treatment of ischemic variant of glaucoma in individuals with myopic refraction by electromagnetic influence on the temporal, and the occipital region of the brain, the carotid sinuses cervical sympathetic plexus, characterized in that the first > for additional background introduction gliatilin at 1.0 in combination with installations of 0.5%solution of betaxolol 2 drops 2 times a day in the conjunctival cavity of the eye, carry out electromagnetic impact on the region of the orbit within 10 days, treatment 1-2 times per year.



 

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