Antiglaucomatous drainage

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with a drainage for treating glaucoma that includes collagen types II-III immobilized in polymer of acrylic and vinyl rows, includes a cytostatic covalently bound with collagen types II-III, hypotensive preparation and not less than one rigidity rib at certain ratio of components. The innovation provides improved ocular hydrodynamics, suppression of reparative and cicatricial processes around the drainage suggested.

EFFECT: higher efficiency.

6 dwg, 3 ex

 

The invention relates to medicine, more specifically to ophthalmology, and is a drainage for the treatment of glaucoma.

There are various types of drains used for the treatment of secondary glaucoma, which help to keep the way of the outflow created during surgical intervention, thereby to stabilize the intraocular pressure (U.S. Pat. Of the Russian Federation No. 2175535).

Known explanting from polymeric materials. This drainage has a high percentage of water and aqueous buffer shell, has a softness and elasticity and the ability to filter the water, which leads to optimal biological tolerance of the material body tissues (Cheglakov Y.A the dissertation on competition of a scientific degree of the doctor honey. of Sciences, Moscow, 1989, p.19).

However, according to the author, persistent normalization of IOP could only be achieved in 70% of cases.

The cause of the failures are mostly hemorrhagic complications and inflammatory reaction in the eye, inducing processes scarring in the area of surgical intervention, which leads to obliteration of established ways of outflow and increased IOP. The closest analogue is the drainage for the treatment of neovascular glaucoma (RF patent No. 2239399)comprising a polymer and containing collagen II-III types, immobilized in a polymer of acrylic and/or vinyl series.

However, on the config drainage does not allow to fully compensate the intraocular pressure in cases of high reparative activity of the sclera in the area of operation, in addition, the absence of ribs in drainage is not possible adequately to resist the formation of soedinitelnotkannoy capsules around him in the process postoperative scarring and, accordingly, deterioration of the intraocular fluid outflow in the late postoperative period.

The technical task of the invention is to provide drainage for the treatment of glaucoma, containing components that suppress reparative activity in the area of operations, and structurally reinforced ribs for resistance to the formation of dense soedinitelnotkannoy capsule around it.

The technical result is to improve the hydrodynamics of the eye, the suppression of the repair and scarring process around drainage.

The technical result is achieved by the fact that the drainage for the treatment of glaucoma, including collagen II-III types, immobilized in a polymer of acrylic and/or vinyl series, further comprises a cytostatic agent covalently attached to the collagen II-III types of anti-hypertensive drug and at least one of the ribs in the following ratio of components:

Collagen II-III types - 0.1-50%

The cytostatic agent is 0.01-3

Antihypertensive drug - 0-2%

Polymers of acrylic and/or vinyl series - the rest

The polymer base of the drainage contributes to the sustainability of drainage to resorption and his hundred the bones for a long period of time. Additional collagen content, which gradually and gradually released in the postoperative period, improves the filtration properties of drainage, increases the level of filtering intraocular fluid and prevent the obliteration of established ways of outflow.

The presence of the cytostatic agent covalently attached to the collagen II-III types, will prevent the migration of cells near the surface and in the thickness of the drainage that will allow you to maintain normal postoperative tone of the eyeball.

The presence of at least one of the ribs will mechanically prevent the formation of dense soedinitelnotkannoy capsules in the late postoperative period and, accordingly, to save a generated path outflow of intraocular fluid.

The presence of anti-hypertensive drug in the drainage is needed in cases of increased production of intraocular fluid associated with traumatic, nutritional, or other lesions of the ciliary body.

The concentration of collagen II-III types may not be less than 0.1% due to a slight therapeutic effect and may not be more than 50% due to possible allergic reactions.

The total concentration of covalently attached to the collagen of the cytostatic agent may not be less than 0.01% of the low therapeutic effect and may not be more than 3% because p is increased risk of the formation of local necrotic changes in the surrounding tissues, due to its toxic effect. As cytostatic preferable to use drugs Mitomycin, Mitotix and their equivalents.

The concentration of anti-hypertensive drug may not be more than 2%in order to avoid sustained hypotension. As a hypotensive drug is preferable to use the drugs from the group of a - or b-blockers, such as Proxool, Practolol.

Ribs formed in the process of copolymerization of collagen and polymers of acrylic and/or vinyl series. The most preferred form of drainage with ribs presented in Fig.1-6. Figure 1 rib presents a view of drainage from above, figure 2 - incision And drainage of figure 1; figure 3 - type of drainage from above, figure 4 - the section on B-B; figure 5 - type of drainage from above, figure 6 - the section C-C.

Brief production technology. By chemical crosslinking cytostatic attach to collagen II-III types, mixed with Monomeric or oligomeric mixture of acrylic and/or vinyl mono - or oligomers and polimerizuet, pouring the mixture into molds. Form repeats the most preferred designs of drainage, shown in Fig 1-6. Ribs are formed in the polymerization process of the drainage material. Drainage is extracted from the mold, if necessary, soak in a solution of a hypotensive drug, sterilized.

Example 1.

Hurt Is A. OS - glaucoma 2-3rd degree, compensated IOP 33 mm Hg were non penetrating deep sclerectomy with implantation of drainage according to the invention of the following composition, wt.%:

Collagen II-III type - 6

Mitomycin C - 0.1

Polipropilenglicol - 93.9

2 ribs

In the early and late postoperative period eye pressure did not exceed 23 mm Hg, hypotension was not observed. Cicatricial changes were not observed.

Example 2.

Patient J. OD - glaucoma 4-th degree, compensated IOP 46 mm Hg were non penetrating deep sclerectomy with implantation of drainage according to the invention of the following composition, wt.%:

Collagen II-III type - 30

Mitotix - 3

Proxool - 2

Poly-2-hydroxyethylmethacrylate - 65

4 ribs

In the late postoperative period IOP was not more than 23-24 mm Hg, in the early postoperative period observed a slight hypotension within 17-18 mm Hg Cicatricial changes were not observed.

Example 3.

Patient A. OS - glaucoma 2-nd degree, compensated IOP of 24 mm Hg were non penetrating deep sclerectomy with implantation of drainage according to the invention of the following composition, wt.%:

Collagen II-III types - 0.1

Mitomycin C - 0.01

Polyvinylpyrrolidone-99.89

1 rib

In early the late postoperative period, IOP was 20-21 mm Hg Hypotension was not observed. Reparative processes in the area of operation is not detected.

Just using drainage according to this invention is operated 24 patients with varying degrees of open-angle, angle-closure, and refractory neovascular glaucoma. Compensation intraocular pressure was achieved in 100% of cases, any specific complications, excessive scarring, protrusion of drainage and so on, are identified. Thus, the drainage according to the invention can be recommended for wide use in glaucoma surgery.

Drainage for the treatment of glaucoma, including collagen II-III types, immobilized in a polymer of acrylic and/or vinyl series, characterized in that it further comprises a cytostatic, Kovalenko attached to the collagen II-III types of anti-hypertensive drug and at least one of the ribs of a material which is chemically identical to the drainage material and formed in the process of its manufacture in the following ratios, wt%:

Collagen II-III typesof 0.1-50
The cytostatic0.01 to 3
Anti-hypertensive medication0-2
Polymers of acrylic and/or vinyl seriesRest



 

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