Method for glaucoma treatment with non-stabilized visual functions

FIELD: medicine, ophthalmology.

SUBSTANCE: method involves administration of chitosan sponge with square up to 2 cm2 into sub-Tenon's space wherein chitosan sponge shows the deacetylation degree 98%, its molecular mass is 1000 kDa and it comprises 2.8 x 10-9 g of hyaluronic acid, 27.8 x 10-8 g of chondroitinsulfuric acid, 3.06 x 10-11 g of cattle serum growth factor and 7 x 10-9 g of heparin per 1 mm2 of chitosan sponge. Method provides stabilizing visual function, to improving vision and expanding vision field based on enhancing sensitivity of optic nerve as result of blood stream enhancing. Invention can be used in treatment of progressing glaucoma with non-stabilizing functions.

EFFECT: improved method of treatment.

1 tbl, 1 ex

 

The invention relates to medicine, namely to ophthalmology, and can be used for the treatment of glaucoma with unstabilized visual functions. In the treatment of glaucoma with unstabilized visual functions is proposed and applied to various auto-, ALLO-, xenopeltidae and synthetic materials (explants), enter extrascleral in the tenon's space [1].

Wet, Iascacwv [2] proposed to the rear pole of the eye in the tenon's space of the eye to enter sequentially 0,12 ml of 10% solution of trichloroacetic acid and 80-120 mg crystalline talc. After surgery in patients with glaucoma severe stage after the operation were achieved: stabilization of visual acuity in 82.2% of patients, the field of view at 84.2 per cent, increase eographical coefficent from 0.77±0.09 to operations and to 1.27±0,14 in the near and up to 1,29±0,09 in the late postoperative period.

The disadvantages of this method are used in the work of corrosive materials such as acid, a special type of talc.

In ophthalmology are used way Mwikali et al. [3], its essence consists in the introduction into the tenon's space umbilically tissue.

Closest to the proposed method is proposed Avivians et al. [4], where stimulation of the visual function in glaucoma with various the stages used crushed mechanically hologram, which added 0.3 ml of dexasone and 0.3 ml of 1% solution of kanamycin and this paste was injected into the tenon's space. Long-term managed to achieve stabilization of visual functions in 81,9% of patients. Continued therapeutic effect was observed for several months and even years.

The disadvantages of these methods is the use of donor tissue for which it is necessary to conduct a series of laboratory studies to exclude infection material (HIV, HBV, HCV and others), to conduct the procurement, processing, storage of tissues by authors suggest a methodology that can be difficult in the absence of donor tissue Bank.

The objective of the invention is the slow deterioration of visual functions or their stabilization in patients with unstabilized glaucoma.

The task to solve due to the fact that as a biopolymer once injected into subtenons space sponge chitosan measuring up to 2 cm2with a degree of deacetylation of chitosan 98%, molecular weight of 1000 kDa, containing 1 mm228·10-9g hyaluronic acid, 27,8·10-8g chondroitinase acid, 3,06·10-11g whey growth factor cattle, 7·10-9g heparin.

The method is as follows.

Patients in the lower-outer or lower-inner Quadrante 5-6 mm from the limbus and parallel to spend incision of the conjunctiva long, 6-8 mm. Form a tunnel in the tenon space to the posterior pole of the eye in the direction of the optic nerve. Cut out the flap of collagen-chitosan sponges measuring up to 10 mm × 20 mm with a degree of deacetylation of chitosan 98%, its molecular weight of 1000 kDa, containing 1 mm228·10-9g hyaluronic acid, 27,8·10-8g chondroitinase acid, 3,06·10-11g whey growth factor cattle, 7·10-9g heparin, and with the help of forceps and spatula cut the flap injected into the formed tunnel to the optic nerve and straighten. The conjunctival wound is closed with sutures. In the postoperative period as a standard anti-inflammatory therapy in patients prescribed drops: Sol. Dexamethasoni Of 0.1%, Sol. Cipromedi of 0.3%, parabulbarno: Sol. Dexamethasoni 2 mg, Sol. Gentamycini sulfatis 4% - 0,2 ml, for 7 days.

Was treated 15 patients (8 men and 7 women) aged from 66 to 76 years. Patients were determined by the visual acuity of the total boundaries of the field of view, the critical frequency of flicker fusion, the lability of the optic nerve, were biomicroscopy, ophthalmoscopy, topography, tonometry, revitalizatio before surgery, after surgery (at discharge), after 1,3 and 6 months.

The immediate and remote results showed the effectiveness of the proposed treatment. In the table above, it can be traced camera is global indicators of visual functions, electrophysiological parameters and hydrodynamics of the operated eye.

Table

The results of studies of patients with non-stabilized form of glaucoma
Indicators
before the treatmentafter 10 daysat 1 month after surgery3 months after surgery6 months after surgery
Visual acuity without correction0,15±0,250,18±0,150,17±0,110,15±0,190,16±0,18
Visual acuity with correction0,21±0,180,24±0,120,24±0,150,25±0,120,24±0,14
The sum of the degrees of the peripheral field of view, degrees254±33265±29280±0,24284±0,26281±0,20
The sensitivity threshold of the optic nerve, mA362±26360±28340±20310±21315±23
Lability, Hz3030323031
GNC is reglaze pressure, mm Hg22,51±1,9523,12±2,1022,11±1,8422,10±1,1222,12±2,11
Intraocular pressure, mm Hg18,21±1,5119.01 in±2,1018,02±1,1218,18±1,4118,11±1,16
Ease outflow, mm3/min/mm Hg0,13±0,080,12±0,120,14±0,090,13±0,070,13±0,17
The coefficient Becker145±14158±16136±13132±12139±15
The geographical factor1,17±0,131,26±0,111,30±0,131,22±0,091,20±0,07
Pulse volume Kedrova7,3±0,918,40±2,218,75±1,258,83±1,108,43±1,7

The table shows that within a few days after surgery improves visual acuity without correction and with correction, expanding the boundaries of fields of view, increases eographically coefficient and pulse volume, the sensitivity threshold of the optic nerve, the remaining parameters are slightly changed. These changes indicate that p is increasing the sensitivity of the optic nerve due to increased blood flow, besides, the growth of these options continues through the month after surgery, and their values are stored during 6 months of follow-up, remain stable indicators of hydrodynamics.

Clinical example: Antonov NF 76 years. Diagnosis of open-angle developed with compensated intraocular pressure operated glaucoma, immature age-related cataract, hypermetropia weak right eye; open-severe operated unstabilized glaucoma, immature age-related cataract, hypermetropia weak left eye, diagnosed on the basis of complaints, anamnesis, biomicroscopic, Ophthalmoscope, electrophysiological studies, state intraocular pressure and hydrodynamics of the eye.

Before treatment, the visual acuity of the left eye without correction of 0.5, visual acuity with correction (field (+)to 1.0 diopters) equal to 0.6, the sum of the degrees peripheral vision fields 389, 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 intraocular pressure of 13.0 mm Hg, the ratio of the lightness of intraocular fluid - 0.15 mm3/min/mm Hg, the production of intraocular fluid 0,5 mm3/min, the coefficient of Becker - 86,67, eographically factor of 1.4, pulse volume Kedrova 8,4.

p> The patient in the lower-outer quadrant of 5-6 mm from the limbus in parallel he made the incision of the conjunctiva 6-8 mm. Formed tunnel in the tenon space, to the rear pole of the eye in the direction of the optic nerve. Cut the flap of collagen-chitosan sponge 10 mm × 20 mm with a degree of deacetylation of chitosan 98%, its molecular weight of 1000 kDa, containing 1 mm228·10-9g hyaluronic acid, 27,8·10-8g chondroitinase acid, 3,06·10-11g whey growth factor cattle, 7·10-9g of heparin, with the help of forceps and spatula entered educated in the tunnel in the direction of the optic nerve and straightened. The conjunctival wound is sutured. In the postoperative period as a standard anti-inflammatory therapy the patient received drops: Sol. Dexamethasoni Of 0.1%, Sol. Cipromedi 0,3%; parabulbarno: Sot. Dexamethasoni 2 mg, Sol. Gentamycini suifatis 4% - 0,2 ml, for 7 days.

On day 10 after surgery, the patient has identified the following indicators of the left eye: visual acuity without correction of 0.5, visual acuity with correction (field (+)to 1.0 diopters) equal to 0.6, the sum of the degrees peripheral vision fields 395 degrees, the sensitivity threshold of the optic nerve 240 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the intraocular pressure of 12 mm Hg, the ratio is easily the ti outflow of intraocular fluid - 0.17 mm3/min/mm Hg, the production of intraocular fluid 0.65 mm3/min, the coefficient Becker 70,59, eographically ratio of 1.63 pulse volume Kedrova 8,9.

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 10 days after surgery.

At 1 month after surgery, the patient noted the following indicators left eye: visual acuity without correction of 0.5, visual acuity with correction (field (+)to 1.0 diopters) equal to 0.7, the sum of the degrees of the peripheral field of view 408 degrees, the sensitivity threshold of the optic nerve 240 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the intraocular pressure of 12 mm Hg, the ratio of the lightness of intraocular fluid - 0.16 mm3/min/mm Hg, the production of intraocular fluid 0.65 mm3/min, the coefficient Becker 75, eographically ratio of 1.60, pulse volume Kedrova 7,8.

These changes are indicators point to a stabilization and slight improvement of visual functions, increasing the sensitivity of the optic nerve, the preservation of enhanced blood circulation.

3 months after surgery, the patient is registered, the following indicators left eye: visual acuity without correction of 0.5, the OS is the company vision with correction (field (+)to 1.0 diopters) is equal to 0.65, the sum of the degrees of the peripheral field of view 404 C, and the threshold of the optic nerve 240 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the intraocular pressure is a 14.1 mm Hg, the ratio of the lightness of intraocular fluid - 0.13-mm3/min/mm Hg, the production of intraocular fluid 0,89 mm3/min, the coefficient Becker 108,46, eographically ratio of 1.53, pulse volume Kedrova 7,2.

These changes are indicators point to a stabilization of visual function, optic nerve sensitivity, level of hydrodynamics, intraocular circulation.

6 months after surgery, the patient is registered, the following indicators left eye: visual acuity without correction of 0.5, visual acuity with correction (field (+)to 1.0 diopters) equal to 0.6, the sum of the degrees peripheral vision fields 398 degrees, the sensitivity threshold of the optic nerve 240 mA, the lability of the optic nerve 40 Hz, the critical frequency of flicker fusion 40 Hz, the intraocular pressure of 12 mm Hg, ease of intraocular fluid 0.16 mm3/min/mm Hg, the production of intraocular fluid 0.84 mm3/min, the coefficient Becker 75, eographically factor of 1.57, pulse volume Kedrova 8,4.

These values indicate the gains made showing the firs 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.

The proposed method allows the stabilization of visual function, improve visual acuity with correction, to expand the field of view, to improve the sensitivity of the optic nerve, improve eographically ratio, pulse blood volume, to stop the progression of glaucomatous process. The result remains stable over a long observation time after the operation.

References

1. V.G. Abramov, Bacurin E.A., Kuryshev NI and other Revascularization for open-angle glaucoma // Ophthalmosurgery. - 1991. - N1. - C.32-35.

2. Lantukh CENTURIES, Iskakov IA Revascularization of the optic nerve in combination with one sinustrabeculectomia in patients with open-angle severe glaucoma // abstracts of the VI Congress of ophthalmologists of Russia. M., 1994. - S.

3. Tikovoi M.V., Perevoznikov AP,. Yakovlev NI preventing the progression of myopia by transplanting umbilically fabric // Oftalmol. log. - 1993. - N3. - S-158.

4. Svirin AV, Antipova O.A., Serebryakova T.V. Modification operations introduction suspensions of Komotini in the tenon's space at high progressive myopia, " Vestn. Ophthalmic is. - 1984. - N4. - P.31-34.

5. Tanaka Y., Tanioka, S., Tanaka, M., Tanigawa T., Kitamura Y., Minami, S., Okamoto Y., Miyashita M, Nanno M. Effects ofchitin and chitosan particles on BALB/c mice by oral and parenteral administration. Biomaterials. 1997. - Vol.18. - N8. - P.591-595.

A method of treating glaucoma with unstabilized visual functions, characterized in that through the operational opening in the conjunctiva in the tenon's space to the posterior pole of the eye exercise one introduction sponges measuring up to 2 cm2containing chitosan with deacetylation 98%, molecular weight of 1000 kDa, containing 1 mm228·10-9g hyaluronic acid, 27,8·10-8g chondroitinase acid, 3,06·10-11g whey growth factor cattle, 7·10-9g of heparin, followed by anti-inflammatory therapy, which consists in the introduction of drops of 0.1%solution of dexamethasone, a 0.3%aqueous solution of cipromed and parabulbarnom 2 mg solution of dexamethasone, 0.2 ml of 4%aqueous solution of gentamicin sulfate during therapy within 7 days.



 

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