Method for treatment of glaucoma discirculatory variant in patients with myopic refraction

FIELD: medicine, ophthalmology.

SUBSTANCE: method involves administration of the preparation "Ginkor-Fort" in the dose 1 tablet, 2 times per a day for 2 weeks and after one month break the preparation "Diovenor" is administrated in the dose 1 tablet, once per a day for 2 weeks at the constant instillation of the preparation "Ksalatan" in the dose 1 drop, once time before night. Such schedule of the method provides the stable normalization of intraocular pressure based on improvement of venous orbital and cerebral circulation. Invention is designated for medicinal treatment of glaucoma discirculatory variant.

EFFECT: improved method of treatment.

2 tbl, 1 ex

 

The invention relates to medicine, namely to ophthalmology, and can be used for medical treatment dyscirculatory variant of glaucoma in individuals with myopic refraction.

Glaucoma in individuals with myopic refraction can have different clinical manifestations, depending on the leading pathogenetic link. It is known that the signs of dysgenesis in the anterior chamber angle is accompanied by the development of myopia and child or juvenile glaucoma (AppStore, Glaucoma. M., 1995, s-84).

When the violation of the hemodynamic relationship between Central and orbital circulation with an obstruction of the venous outflow from the orbit in the skull cavity develops glaucoma and is dyscirculatory character, approaching in its pathogenesis to playboymansion secondary glaucoma (AppStore, Glaucoma. M., 1995, p.85-86).

Treatment of this form of primary open angle glaucoma should include not only the reduction of IOP, but also improve venous drainage of the orbit. There are many methods of medical treatment of open-angle glaucoma in reducing IOP.

There is a method of treatment of primary open-angle glaucoma by installations nonselective β-adrenoblokatorov: optimal, timolol, etc. as antihypertensive drugs (AppStore, Glaucoma. M., 1995, s-198). Under taccom of this method is to reduce the secretion of intraocular fluid under the action of these drugs but against the background of impaired hemodynamics in patients with glaucoma and myopia efficacy will be low.

There is a method of enhancing visual acuity (RF Patent No. 2161465, 2001, bull. Fig. No. 1), providing pressure on the tissues of the orbit and the cervico-occipital region from +5 to -5 kPa sinusoidal with a frequency of 30-240 oscillations per minute and an amplitude of up to 10 kPa, which allows to improve venous outflow vessels of the eyeball and orbit, and to normalize the outflow of intraocular fluid. The disadvantage of this method is its short-term effect due to the mechanical principle of improving venous outflow.

There is a method of treating glaucoma in reducing IOP and improving venous outflow (RF Patent No. 2197206, 2003, bull. Fig. No. 3) by osteoplastic trepanation in the frontal area over the affected eye by trepanning the top wall of the orbit to ensure the outflow of the orbit in the space beneath the Dura mater and the venous system of the head. The main disadvantage of this method is its significant trauma, as done neurosurgical operation.

The closest analogue to the claimed method is a method of complex treatment of glaucoma (RF Patent No. 2176501, 2001, bull. Fig. No. 34), taken as a prototype. The essence of the method is the assignment of a group of medicines: vitamins a, C, E, extract of the leaves "it-Biloba", monomineral selenium routine, which improve microcirculation vascular bed eyes. The disadvantage of this method is the lack of hypotensive effect in patients, as it does not provides for the appointment of the preparations reducing intraocular pressure.

The objective of the invention is to develop a drug treatment dyscirculatory variant of glaucoma in individuals with myopic refraction. The technical result is the normalization of IOP, improving Central and orbital hemodynamics, stabilization of visual functions in patients with dyscirculatory glaucoma in myopic refraction. The technical result is achieved in that in the method of treatment dyscirculatory form of glaucoma in individuals with myopic refraction is medical treatment, characterized in that the prescribed Ginkor Fort in combination with drug Divisor 1 tab. 2 times a day for 2 weeks with a break between 1 month and repeat this treatment 2-3 times per year at constant instillation of Xalatan 1 drop 1 at night. Technically, the result is explained by the fact that the instillation of Xalatan reduces intraocular pressure by improving uveal path of the outflow chamber moisture.

Drugs: Ginkor Fort, containing the leaf extract "it-Biloba", Heptaminol guide chlorid, Troxerutin and Divisor (Diosmin) my veno-tonic and angioprotective action, improve venous drainage and microcirculation orbital and cerebral blood flow. The method is as follows: patients with dyscirculatory option primary open-angle glaucoma on the background of myopia appoint Ginkor Fort on 1 tab. 2 times a day for 2 weeks, a month - Divisor 1 tab. 1 time a day for 2 weeks on the background of constant instillation of Xalatan 1 time per day. The proposed method treated 18 patients with dyscirculatory option of open-angle glaucoma on the background of myopia medium and high. 15 came normalization of IOP, improved hemodynamic performance, the effectiveness of the treatment was 83,3%.

Example 1. Patient K., 49 (East. bol. No. 115/2003) myopic school years. The last 3 years notes the deterioration of vision.

VOD=0.09 Sph (-)6.0D=0.8 IOP=25,0 mm Hg

VOS=0.04 Sph (-)7.0D=0.5 IOP=27.0 mm Hg

These monografii: OD - Ro-19.5, C=0.18, F=1.7, Po/c=108; OS - Ro=19.5, C=0.14, F=1.3, Po/c=139. Gonioskopy eye - anterior chamber angle is open, prolapse of the iris, the band clearnova body wide, moderate pigmentation trabeculae and schlemm's canal. Biomicroscopy allowed to install the extension, tortuosity, increased blood prelimarny vessels, more in the left eye. The fundus is boih eye: optic nerve disc pale pink, expanded the excavation of e/D=0,7, peripapillary chorioretinal degeneration, vein extended crownpointe, moderately twisted, caliber 2 times wider than arteries. Computerized static perimetry revealed scotomas 1, 2 and 3 level - from 125 entry points visible 78 (62.4 per cent) in the right eye and 65 (52%) in the left eye, scotomas were located mainly in the upper nasal quadrant of the visual field.

REG. In the pool the carotid arterial pulse volume in the normal asymmetry of pulse blood - 40,2%, the resistance of the arterioles left moderately increased to 11.3%, right in normal tone venules raised right by 32%, from left to 58%, venous outflow is obstructed right 40%, left - 67.6%. In the pool vertebral arteries pulse volume is moderately reduced and 11.6%resistance arterioles slightly raised on the right of 18.5%, left - to 26.6%, tone venules raised right by 35%, left - 61%, venous outflow is obstructed right by 31%, to the left is 45.8%.

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

vessels (lbfv, cm/sec)rightleft
the ophthalmic artery (HA)33-0,6430-0,66
the Central artery of the retina (CAS)12-0,6211-0,64
posterior short ciliary art is MII (SCCA) 14-0,6213-0,65
the ophthalmic vein (HW)6-0,506-0,52
the Central retinal vein (PCV)5-0,485-0,50
choroidal vein (HV)5-0,465-0,46

Conclusion. The orbital blood flow in the arteries is reduced by 20%in venous vessels of 45%.

Patient treatment: permanent instillation of Xalatan 1 drop 1 time a day at night, the drug Ginkor Fort on 1 tab. 2 times a day for 2 weeks, after 1 month Divisor 1 tab. 1 times a day for 2 weeks. Re-examination showed improvement in many indicators. Daily tonometry revealed fluctuations in IOP in the right eye within 18,0-22,0 mm Hg in the left eye 19,0-23.0 mm Hg Data monografii: OD - Ro=15.4, C=0.24, F=1.3, Ro/s=64; OS - Ro=16, p=0.19, F=1, Rho=84. Ophthalmoscopically found to reduce the diameter of the veins and the ratio of the caliber of the vessels approached the norm - 2:3. Data orbital hemodynamics showed improvement in venous blood flow.

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

vessels (lbfv, cm/sec)rightleft
the ophthalmic artery (HA)34-0,6231-0,63
the Central artery of the retina (the AU) 12-0,6212-0,62
posterior short ciliary artery (SCCA)12-0,6012-0,62
the ophthalmic vein (HW)9-0,508-0,52
the Central retinal vein (PCV)8-0,487-0,50
choroidal vein (HV)7-0,4678-0,46

Improve hemo - and hydrodynamic performance improved light sensitivity of the retina, because according to static perimetric studies increased the number of visible points of the presentation to 88 in the right eye (70,4%) and up to 80 in the left eye (64%).

Thus, the proposed method of treatment to improve hemo - and hydrodynamic parameters and visual function in patients with dyscirculatory option glaucoma, combined with myopia.

In the study at 6 months. in 8 patients reported a worsening of hemodynamic parameters and recommended to repeat General medical treatment.

The method of treatment dyscirculatory variant of glaucoma in individuals with myopic refraction by medical treatment, characterized in that sequentially designate Ginkor Fort 1 tablet 2 times a day for 2 weeks, then a break for 1 month prescribed Divisor 1 tablet 1 time a day for 2 weeks at constantly the instillation of Xalatan 1 drop 1 time a day at night.



 

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4 cl, 1 ex, 16 dwg, 16 tbl

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30 cl, 2 ex

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9 tbl, 3 ex

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9 tbl, 3 ex

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9 tbl, 3 ex

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9 tbl, 3 ex

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