Method for repairing filtering-type anti-glaucomatous operation zone with anti-metabolites in intraocular pressure recurrence cases

FIELD: medicine.

SUBSTANCE: method involves introducing Mytomycin C metabolite into eyes where compensated and subcompensated intraocular pressure being achieved as a result of maximum hypotensive therapy application. The preparation is introduced 4 weeks in advance before operation in initial and advanced glaucoma stages and 2-3 weeks in advance in cases gone too far. The dose to be introduced is equal to 0.1 ml with concentration equal to 0.15 mg/ml. Additional Mytomycin C injection of the same volume and concentration of 0.2 mg/ml is introduced after having finished the reparative operation.

EFFECT: enhanced effectiveness of treatment; prolonged intraocular pressure stabilization.

1 tbl

 

The invention relates to medicine, namely to ophthalmology, and can be used when restoring a surgically formed ways of intraocular fluid (MIC) after antiglaucoma operations of the filter type by their reconstruction with the use of antimetabolites.

Failure in glaucoma surgery related to the fact that in some patients after antiglaucoma operations filter type due to excessive scarring of the tissue in the area of the incision with recurrence of persistent rise in intraocular pressure (IOP). One approach to treatment is to reconstruct a surgically formed the outflow path.

However, the effectiveness of such interventions is about 50%. In order to increase efficiency in recent years began to use antimetabolites. The greatest distribution was received mitomycin C, proposed in ophthalmology in 1981, Chen CW, and 5-fluorouracil proposed Parrish RK with co-workers in 1984. These drugs have found their place in glaucoma surgery how to reduce postoperative scarring surgically formed ways of intraocular fluid. The introduction of these drugs are produced or by sponge soaked antimetabolite, or drainage, containing in its composition mitomycin C (RF Patent No. 2233158), or subkonyunktivalno by injecti the (Peng T. Khaw "Current techniques in wound healing modulation in glaucoma surgery", 1996, Ophthalmology, 7,2: p.24-33). Rehabilitation reconstruction operations often used subconjunctival injection of antimetabolite.

Known technology recovery outflow of fluid from the anterior chamber under the conjunctiva by transconjunctival revisions zone antiglaucoma surgery with intraoperative use of mitomycin C by injection (RK Shetty, Wartluft L, Moster MR "Slit-lamp needle revision of failed filtering blebs using high-dose mitomycin C, J Glaucoma, 2005 Feb; 14(1): 52-6 - PROTOTYPE). The technique is as follows. After local anesthesia of 4-5 mm from the border scleral flap subkonyunktivalno inserting a needle on an insulin syringe, which is encapsulated in the filter cavity, destroying one of its walls, making recovering filtration path (reconstructed the ways of outflow). At the end of operation in the resulting filtration pillow is introduced a mixture of 0.1 ml of mitomycin C, a concentration of 0.4 mg/ml and 0.1 ml of 1% lidocaine. The effectiveness of such technology is averaged according to the literature - 67%.

In our practice, using the intraoperative mitomycin C in reconstructive antiglaucoma operations, we have seen the lagged effect of mitomycin C. That is, in cases when going for another operation in the area, where during the previous the operations used mitomycin C, it was noted almost 100% success, in other words, was found to slow the effects of antimetabolite. The proof of this is found in the work of the GT Khaw, J.W. Doyle, M.B. Sherwood (Prolonged localized tissue effects from 5-minute exposure to fluorouracil and mitomycin /Archives of ophthalmology, February 1993, Vol.111 No.2, p.263-267), which says that the action of antimetabolites on fibroblasts tenon's capsule and the sclera has a deferred nature. Thus, the minimum response of tissues to injury (operating injury) will be one month since the introduction of mitomycin C and 5-fluorouracil.

In the references we have found that the antimetabolites when antiglaucoma operations used during operation, and the introduction of antimetabolite was carried out subkonyunktivalno by injection into the area of filter bags, and the introduction could be both before surgery and after, and in some sources, the introduction of the metabolite was performed before and after surgery. When this did not advocate any one of the options.

The objective of the invention is to develop a more effective method of reconstruction zones antiglaucoma operations with the use of antimetabolites at relapse IOP.

The technical result for the solution of this task is to achieve long-term stabilization of intraocular pressure.

At asany technical result can be obtained, if in the way of reconstruction zones antiglaucoma operation filter type with the use of antimetabolites at relapse IOP, consisting in the introduction subkonyunktivalno in the area of filtration pillows antimetabolite and perform the reconstruction of surgically formed ways of outflow, an antimetabolite imposed in advance on the eyes, which managed to get compensated and subcompensated pressure due to the maximum antihypertensive therapy, and in initial and advanced stages of glaucoma, administered 4 weeks prior to surgery and during severe for 2-3 weeks, while the volume is 0.1 ml, and the concentration 0.15 mg/ml, and after reconstructive surgery of introducing more antimetabolite in the same the volume concentration of 0.2 mg/ml As a private option is offered as an antimetabolite to use mitomycin C.

Among the essential features that characterize the way, distinctive are:

- an antimetabolite imposed in advance on the eyes, which managed to get compensated and subcompensated pressure due to the maximum antihypertensive therapy,

- at the initial and advanced stages of glaucoma, an antimetabolite administered for 4 weeks before surgery

- when severe stage for 2-3 weeks,

- proactively introduce an antimetabolite in the amount of 0.1 ml concentrate the radio 0.15 mg/ml,

after reconstructive surgery of introducing more antimetabolite in the same volume (0.1 ml), a concentration of 0.2 mg/ml

Between the set of essential features and achievable technical result there is a causal relationship.

To date in the treatment of glaucoma used antimetabolites, but used intraoperatively, not given their prolonged action when injected drug you can get the maximum effect. Our technology speaks for many weeks before the operation, you must enter an antimetabolite, to get the original low inflammatory response to surgery, and therefore, to avoid scarring. This term depends on the revision of urgency, in other words, from the ability to compensate for intraocular pressure using a therapy for a certain period of time and the stage of glaucoma (primary, advanced, severe). Reconstructive surgery of this technology should only be done on the eyes, which managed to get compensated (up to 26 mm Hg) or subcompensated (27-32 mm Hg) pressure due to the maximum antihypertensive therapy. The percentage of such eye sufficiently large to 70%. On the eyes, where the pressure cannot be reduced by therapy and it remains above 32 mm RT.) - Rev. so, this technology cannot be applied, the reconstruction of the outflow path is executed immediately. Otherwise, can develop irreversible atrophic processes of the optic nerve.

In the table presented in figures time (in weeks) administration of the antimetabolite prior to surgery depending on the stage of glaucoma and pressure level.

Stage glaucoma

The pressure level

(mm Hg)
The initial stageDeveloped stageSevere stage
Compensation (up to 26)442-3
Subcompensated (27-32)442-3
Decompensation (above 32)000

The mechanism of action of antimetabolite (e.g., mitomycin C) is that it inhibits the proliferation of fibroblasts level episclera and tenon's membrane, which in turn blocks the active inflammation, i.e. the formation of scars. Because of these properties it has been applied in antiglaucoma surgery. However, there are side effects that can occur due to careless use of the drug (the surface is high concentration, unnecessarily inflated volume): corneal edema, scleromalacia, endophthalmitis, etc. In the invention it is proposed to introduce an antimetabolite 4 weeks before surgery for the initial or advanced stages of glaucoma, and for 2-3 weeks at severe stage (2 or 3 weeks to be determined individually in each clinical case depending on the degree of narrowing of the field of view), and in a volume of 0.1 ml and a concentration of 0.15 mg/ml This early introduction, let's call it a basic introduction of antimetabolite that provides for prevention of scar growths. Thus where there was the possibility of introducing a antimetabolite 4 weeks before surgery, prevention was the most effective. To avoid side effects was reduced concentration of preoperative doses up to 0.15 mg/ml (from the literature that the most common intraoperative use concentration of antimetabolite 0.2-0.4 mg/mm). But to curb the inflammatory process in a long time (prolongirovanne) reference dose is not enough, you need intraoperatively, i.e. in the period of active inflammation, which is the dissection of tissue, to introduce additional dose of antimetabolite. An additional dose is given intraoperatively, after the reconstruction of the tracks of the outflow in the amount of 0.1 ml and a concentration of 0.2 mg/ml Introduction extra the second dose is performed after the reconstruction of the tracks of the outflow, not to get complications, such as excessive filtering. As a result of these actions, enhancing the response of tissues to the introduction of additional portions of the antimetabolite, increasing prolongation of action of the drug, while the total concentration of the two-stage introduction of antimetabolite does not exceed a concentration of 0.4 mg/ml Therefore, postoperative complications from the introduction of antimetabolite according to this technology, one should not fear. Our practice confirms this. The concentration and volume of administered drug are within practice standards, and the tissue of the eye in the two-stage introduction of antimetabolite acquire properties that allow to eliminate scarring and, therefore, to provide a stable outflow of intraocular fluid.

Thus, between the set of essential features and the proposed technical solution there is a causal relationship.

The method is as follows. Apply the method only to the eyes, which managed to get compensated or subcompensated pressure by applying the maximum antihypertensive therapy. Before reconstructive surgery for 4 weeks (in my eyes at the initial and advanced stages of glaucoma) or 2-3 weeks (on eyes with severe stage) in the area of filtration hearth of the key (this place out scleral flap 3-4 mm away from the side of the arch) subconjunctival injection introduces an antimetabolite, for example, mitomycin C, in the amount of 0.1 ml, a concentration of 0.15 mg/ml and Then, after 2-3 weeks it is on the eyes in severe stage glaucoma and after 4 weeks it is on the eyes at the initial and advanced stages of glaucoma, is reconstruction of the ways outflow: transconjunctival or transcardially revision zone antiglaucoma operations according to the standard technique. When introducing a new portion of antimetabolite subkonyunktivalno in the area of filter bags in a volume of 0.1 ml, the concentration of 0.2 mg/ml the Transaction is completed.

EXAMPLE. Patient N. born in 1939 with a diagnosis of open-angle severe operated with decompensated IOP on hypotensive drops glaucoma, arrived in Yekaterinburg Centre of IRTC "eye microsurgery" for surgical treatment.

From the anamnesis: 6 months ago OD was held glaucoma surgery NDSE, after which the intraocular pressure was compensated for 5 months, then back up to 38 mm Hg Held laser goniopuncture, IOP decreased to 34 mm Hg, the Patient was referred for surgical treatment in the EC IRTC.

During examination: visual acuity OD - 0,7; OS - 0,85. Field of view OD - narrowed to 10 degrees from the nasal side; OS - within normal limits; IOP OD - 34 mm Hg OS - 19 mm Hg

Ultrasound biomicroscopic slice of AOR is s previous antiglaucoma surgery of the right eye is observed volumetric intrasternally cavity, soamsawali with the front camera, the characteristics of the filter in the subconjunctival space is missing.

Held injection of mitomycin C (0.1 ml concentration of 0.15 mg/ml) subkonyunktivalno in the area of filtration bags and enhanced hypotensive therapy. As the stage of glaucoma was severe, and the level of intraocular pressure at maximum antihypertensive therapy was 28 mm Hg, then after 2 weeks the patient was performed reconstructive surgery transconjunctival revision in the area of operation. Upon completion of the operation, restoring the outflow of fluid and having a filtration pillow, under the conjunctiva in the area pillows introduced additional portion of mitomycin C in a volume of 0.1 ml and a concentration of 0.2 mg/ml In this operation was completed. Assigned to standard postoperative therapy. Upon examination after 1 month there is good work ways outflow: pillow spilled, IOP of 18 mm Hg

When viewed through 3 months IOP - 19 mm Hg

When viewed through 6 months IOP of 21 mm Hg, the Patient feels well.

In Yekaterinburg Centre of IRTC "eye microsurgery" by the claimed method operated 16 patients. 9 patients were administered an antimetabolite for 4 weeks prior to surgery (at initial and advanced stages of glaucoma). The results of all operations are successful - pressure is normal in the course of the sun the time of observation (up to 9 months). In other patients the introduction of antimetabolite was carried out for 2-3 weeks (patients with severe stage glaucoma) to reconstructive surgery. While the intraoperative antimetabolite was also introduced at the end of the operation. In all cases, managed to achieve long-term stabilization of the IOP.

The developed technology two-stage introduction of antimetabolite demonstrated good results of reconstructive operations. Complications associated with the introduction of antimetabolite in such amounts and in such concentration was not observed. The positive effect of the application of the technology consists in using the prolonged action of antimetabolite that more effectively prevents the development of scar growths and allows you to get long-term hypotensive effect.

The method of reconstruction zones antiglaucoma operation filter type with the use of antimetabolites at relapse intraocular pressure, consisting in the introduction subkonyunktivalno in the area of filtration pillows antimetabolite of mitomycin C and perform the reconstruction of surgically formed ways of outflow, characterized in that the mitomycin C administered in advance on the eyes, which managed to get compensated and subcompensated pressure due to the maximum antihypertensive therapy, etc is than at the initial and advanced stages of glaucoma, administered for 4 weeks before surgery and when severe for 2-3 weeks, while the volume is 0.1 ml, and the concentration 0.15 mg/ml, and after reconstructive surgery impose additional mitomycin C in the same volume, a concentration of 0.2 mg/ml



 

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9 cl

FIELD: medicine.

SUBSTANCE: method involves carrying out radical surgical intervention. Abdominal cavity lavage is carried out using lavage solutions during 15-20 min after having accomplished all surgical intervention stages. The lavage solution is removed from abdominal cavity. Draining silicon tubes are set into the right subdiaphragmal space, into the right subhepatic space and into the right lateral canal, into the left subdiaphragmal space, into the right lateral canal and into small pelvis. Abdominal reservoir is formed by suspending laparotomic wound edges by means of Seagal retractor. Polyethylene film having cruciform cut in its center is fixed on laparotomic wound edges. The abdominal reservoir is filled with isotonic solution on sodium chloride bases or on dialysis solution base or on Ringer-Lock solution base as perfusate. The solution contains primary and additional chemopreparations. Perfusion solution has Cysplatin or Platinol or Carboplatin at a dose of 50 mg/m2 of patient skin area or Mytomicin C at a dose of 20 mg/m2 of patient skin area as the primary preparation and 5-Fluorouracyl as the additional preparation at a dose of 1 mg/m2 of patient skin area. The perfusion solution is introduced via draining tubes at 44-46°C into upper regions of the abdominal cavity. The solution is evacuated from it at a temperature not lower than 42.5°C via draining tubes arranged in pelvic cavity and iliac regions. Perfusion solution chemopreparations temperature control is carried out by means of heat sensor transducers mounted in draining tubes. Chemotherapy is carried out with closed perfusion solution chemopreparations circulation during 60-120 min in abdominal cavity at a rate of 500-2000 ml/min concurrently manually mixing the chemopreparation solution. The abdominal cavity is tightly sutured after having applied the hyperthermic intraoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy is carried out in postoperative period daily from the first to the fifth day after the operation. To do it, chemotherapy preparation based on physiologic sodium chloride solution or on dialysis solution or on Ringer-Lock solution, containing 5-Fluorouracyl at a dose of 1 mg/m2 of patient skin area is introduced via retained draining tubes with its exposure time being equal to 8-12 h. Then the draining tubes are removed.

EFFECT: enhanced effectiveness of treatment; prevented abdominal cavity and small pelvis region from being inseminated; prolonged survival period; improved life quality.

9 cl

FIELD: medicine, ophthalmology.

SUBSTANCE: method involves intravenous administration of metypred in every other day being in the 1-st and 3-d days the dose is by 500.0 mg, in 5-th and 7-th day - by 250.0 mg, and in 9-th and 10-th day - by 125 mg. In onset of metypred administration dexamethasone in the dose 1.0 ml is administrated by retrobulbar route every day for 10 days. Also, method involves pterygopalatine blockade including dexamethasone, ketorol, emoxipine, lidocaine, dalargin in doses 1.0; 1.0; 1.0; 2.0 ml and 0.001 g every day for 5 days and then 3 blockades in every other day, one blockade per a day. Method expands assortment of therapeutic approaches in treatment of acute optical neuritis in patients with cerebrospinal sclerosis.

EFFECT: improved and enhanced treatment method.

1 tbl, 1 ex

FIELD: medicine, narcology.

SUBSTANCE: method involves alternating comatose therapy and electroshock therapy every other day. In day carrying out the comatose therapy eserine ointment is placed in conjunctival sacs to patient and in 30 min 2-2.5 mg scopolamine hydrobromide solution is administrated as its 0.5% solution. Then in 3-5 h of comatose state patient is recovered from coma and 15-30 mg of physostigmine, 6 g of pyracetam, 7.5 g of magnesium sulfate and 400 ml of sodium hypochlorite are administrated by intravenous drops. In each next séance of comatose therapy dose of scopolamine hydrobromide is increased by 0.5 mg and brought about to 5-6 mg. In day carrying out electroshock therapy 1 ml of 0.1% solution of atropine sulfate and 2 ml of cordiamine are administrated and preliminary narcosis is carried out by intravenous administration of 200-300 mg of sodium thiopental or 100 mg of ketamine with simultaneous administration of 3-4 ml 2% ditiline solution and electroshock therapy is carried out followed by artificial lungs ventilation. Method provides enhancing effectiveness of treatment and to prolong the remission period.

EFFECT: enhanced effectiveness of treatment.

3 ex

FIELD: organic chemistry, medicine, chemical-pharmaceutical industry, pharmacology, pharmacy.

SUBSTANCE: invention relates to a medicinal agent used for prophylaxis and treatment of diseases and disorders associated with dysfunction of benzodiazepine receptors. This medicinal agent comprises compound of the formula (I)

. Compound of the formula (I) elicits high cardioprotective, neurotrophic, renoprotective activity and enhanced bioavailability.

EFFECT: valuable medicinal properties of compounds.

5 cl, 1 tbl, 1 ex

FIELD: organic chemistry, medicine, chemical-pharmaceutical industry, pharmacology, pharmacy.

SUBSTANCE: invention relates to a medicinal agent used for prophylaxis and treatment of diseases and disorders associated with dysfunction of benzodiazepine receptors. This medicinal agent comprises compound of the formula (I)

. Compound of the formula (I) elicits high cardioprotective, neurotrophic, renoprotective activity and enhanced bioavailability.

EFFECT: valuable medicinal properties of compounds.

5 cl, 1 tbl, 1 ex

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