Method of treatment of glaucoma optic neuropathy

FIELD: medicine.

SUBSTANCE: Invention relates to ophthalmology, and can be used for treatment of glaucoma optic neuropathy. Dibicor in dose 0.5g two times a day during 1 month, then cortexin and retinalamin in dose 10 mg intramuscular every second day during 20 days are prescribed. Method allows to increase electrophysiological activity of visual analyser in patients with primary open-angular glaucoma due to pathogenically grounded successive application of said medications, on the first stage of treatment intracellular exchange in ganglionar cells of retina improves, then synaptic lesions and transmission of nerve impulse from retina to cortical centre of visual analyser are activated.

EFFECT: increase of electrophysiological activity of visual analyser in patients with primary open-angular glaucoma.

1 tbl, 1 ex

 

The invention relates to medicine, namely to ophthalmology, and can be used for the treatment of glaucomatous optic neuropathy.

Primary open-angle glaucoma (POAG) is the most common eye disorders among the adult population and is the 1st rank among causes of disability in many regions of Russia (Libman E.S., Shakhova E.V. Blindness and visual disability in the population of Russia. // Proc. Dokl. VIII Congress of ophthalmologists of Russia. - M., 2005. - p.78-79).

For patients with POAG is characterized by the progression of the pathology of the optic nerve in optic neuropathy, despite the normalization of the IOP local antihypertensive agents or microsurgical or laser treatment.

To improve visual function in the pathology of the visual analyzer of different Genesis in recent years, the use of complex peptide drugs (Cortexin, ritalin, the medication).

There is a method of treatment of amblyopia (RF Patent 2205042, 2003, bull. Fig. No. 15), which provides for the appointment of Cortexin in the form of endonasal electrophoresis in combination with magneto and electrostimulated optic nerve.

The disadvantage of this method is its low efficiency in the treatment of patients with POAG, which has a complex pathogenesis with the main link in the form of reduced antioxidant is the first system of the body (Smith E.A., Alekseev, V.N. and other Pathogenetic aspects of treatment of primary otkrovennoi glaucoma. - M., 2001. - p.42-43).

There is a method of treatment of amblyopia in children with delayed cognitive development (RF Patent 22726442, 2006, bull. Fig. No. 9), the essence of which consists in the introduction of Cortexin intramuscularly, a course of 10 treatments with simultaneous application of neuroprotective drug - Semax in the form of intranasal installations.

The disadvantage of this method is incomplete, the validity of his appointment with glaucoma, as the basis for the development of glaucomatous optic neuropathy lies initial loss of ganglion cells of the retina with subsequent defeat them appendages of the optic nerve fibers, and amblyopia decrease in visual acuity observed without organic lesions of the visual and nervous system, as it was shown by Prof. Escavation (Avetisov AS Divinatory amblyopia and its treatment. - M.: Medicine, 1968).

Known method for improving the visual function of the eye by acting on neuroreceptors apparatus of the retina drug ritalin (RF Patent 2073518, 1997, bull. Fig. No. 1 "Means that restores the function of the retina).

The disadvantage of this method is its local impact on the metabolism of the cells of the retina, which limits its effectiveness in the treatment of glaucomatous optic neuropathy.

The known is the way, providing simultaneous use of complexes of peptide drugs: ritilin - parabulbarno and Cortexin and epithalamin intramuscularly (RF Patent "Method of treatment of diabetic retinopathy" No. 2157154, 2000, bull. Fig. "31).

The disadvantage of this method is the use of the preparation epithalamin, which (according to the Patent of the Russian Federation 944191, 1980, bull. Fig. No. 19, "Method of obtaining compounds having antitumor action) increases the sensitivity of the hypothalamus to endogenous influences that may contribute to increased intraocular pressure and reduction of visual functions in patients with glaucoma.

The closest technical solution to the claimed method and taken for the prototype is a Method of treating visual analyzer (RF Patent 2206299, 2003, bull. Fig. No. 18). The method consists in the use of ritilin, which is injected through the irrigation catheter into the retro-bulbar space in 0.5 ml of 5 times per day after 3 hours, additional intramuscularly Cortexin in 1.0 ml of 1 times a day, and spend svetonepronitsaemostyu of the visual analyzer in combination with the training of the accommodation on the computer one session a day for 10 days.

The disadvantage of this method is its invasiveness, potential for the development of vascular or inflammatory Oslon the deposits of the orbit. The disadvantages of this method include the need for treatment in the eye hospital, which limits its use compared to the ambulatory nature of the treatment.

The objective of the invention: improved efficiency and availability medicalmassage treatment of glaucomatous optic neuropathy.

The task is achieved by the fact that the first POAG patients with normalized intraocular pressure get Nik inside of 0.5 g per day for 1 month, then Cortexin and Retinalamin 10 mg intramuscularly every other day for 20 days.

In this way treated 23 patients (46 eyes) aged 54-65 years - the Core group with POAG advanced stage, with normalized intraocular pressure with 2-fold instillation of 0.5% solution of timolol.

As a comparison deals with the results of treatment in 24 patients (48 eyes) of similar age and condition of POAG who have an overall treatment included Cortexin 10 mg intramuscularly for 10 days in combination with a nootropic drugs (cinnarizin or piracetam) 1 tab. 3 times a day for 1 month. - Control group.

These regimens patients of the Main group repeated 2 times per year, patients in the Control group were repeated 3 times per year.

Treatment efficacy was analyzed after 1 year in all patients with POAG.

Given the importance of the process Perek the red lipid oxidation in the metabolism of structures of the visual analyzer, we have included a list of criteria for the effectiveness of the rate of activity of SOD (superoxide dismutase enzyme antioxidant system) along with the indicators of the air and fields of view that reflect the functional activity of the visual analyzer. The analyzed results are presented in the table.

IndicatorsThe main groupThe control group
The source dataAfter 1 month of treatmentThe source dataAfter 1 month of treatment
Field of view465,2°±3,3476,1°±2,4474°±3,7464,1°±2,8
P, % changeP<0,05↑ 0.2%P>0,05↓ 2%
The threshold EB retinal µa122±5,6to 114.7±3,9to 121.6±4,8134,0±4,1
% change PP<0,05↓ 6%P>0,05↑ 10%
The threshold E is maturing. nerve Hz32,2±1,133,5±2,032,4±1,631,3±1,8
% change, PP>0,05 ↑ 4%P>0,05↓ 3.4%
SOD (superoxide dismutase), u/askt/mn ER151,1±5,2of 180.5±5,3156,3± and 4.9168, 8mm±4,7
% change, PP<0,05↑ 19%P>0,05↑ 8%
The multiplicity of repeated courses2 times per year3 times a year

These tables show the advantage of the proposed method, which allows significantly (P<0,05) to improve visual function (electrophysiological indices, field of view) in patients with glaucoma, while patients in the Control group, a slight deterioration of these indicators, though the differences are not statistically significant (P>0,05)

The important thing is improving antioxidant defenses patients with glaucoma after proposed method of treatment, as evidenced by a significant (P<0,05) increase of SOD activity by 19% compared with the original data. In the Control group, although this figure increased by 8%, but the differences are not statistically significant (P>0,05).

The advantages of the proposed method can be attributed to a lower multiplicity of courses of treatment compared with the Control group, and for the efficiency of the treatment at home.

The positive results of the treatment by the proposed method confirm its pathological focus, because the consistent use of these drugs allows to correct major violations in the body and the visual analyzer patients with glaucoma.

Nik: the active drug substance is taurine, which is a natural product of the metabolism of sulfur-containing amino acids (cysteine, group probably facilitates methionine). The drug has a positive effect on the composition of the phospholipids of cell membranes, normalizes intracellular metabolism, improves the transport of calcium ions and potassium (Reference Vidal, 2005, s).

If we consider that the safety of the phospholipid membranes of neuroreceptors and ion transport provide the functional activity of the retina, the reception and processing of visual information (Samsonova A. M., Volkov V.V. Functional methods of research in ophthalmology. - M., 2004), this fact justifies the inclusion of the drug Nik treatment under the proposed method.

The inclusion of Retinalamin enhances electrogenic retina because of its stimulating effect on the photoreceptors and cellular elements of the retina, including the ganglion cells are the first to die in glaucoma.

Is valid and the inclusion of Cortexin, which which regulates the processes of lipid peroxidation in brain cells (Litvinenko N.A. Lipid peroxidation, physiological antioxidant system under various extreme conditions and their regulation of the polypeptide Cortexin: author. dis... Kida. the honey. Sciences. - Kharkov, 1992).

Thus, the proposed method for the treatment of glaucomatous optic neuropathy is pathogenetically justified, effective and has a number of advantages compared to traditional medicamentosas treatment of patients with glaucoma.

As confirmation of the results obtained here are clinical example.

Clinical example

B-Naya I. 56 years. Diagnosis: POAG, advanced stage with normalized intraocular pressure of both eyes. Visual acuity:

OD=0,7 Sph(+) 1,0D=1,0 IOP=18,0 mm Hg

OS=0,6 Sph(+) 1,0D=1,0 IOP=19,0 mm Hg

The fundus of both eyes: DOP b/pink; e/D=0,6-0,5; artery evenly narrowed.

B-Naya buries of 0.5% p-p of timolol in both eyes. During the year 3 times received registrationthe treatment (piracetam or cinnarizin 1 table 3 times a day for 1 month and additionally Cortexin 10 mg/m No. 10).

After 1 year u b-s And. worsened field of view a total of 8 meridians with 470° to 414°, i.e. by 12% in my right eye, and with 475° to 367, i.e. by 15% over his left eye.

The threshold E optic nerve decreased from 33 Hz to 32 Hz in both eyes. The threshold EB retina remained 120 µa in my right eye and 124 µa over his left eye. B-Neu were treated according to the SNO invention, Nik 0.5 g reg. OS 2 times per day for 1 month, then Cortexin and Retinalamin 10 mg/m every other day for 20 days. The treatment was repeated 2 times per year. A year later the visual acuity of both eyes is 1.0. The picture of the fundus has not changed. Field of view a total of 8 meridians increased to 485° on his right eye and 480° on the left, respectively, 10.3% above the original value on the right eye and by 10.2% in the left eye. The threshold E in both eyes was 34 Hz, i.e. increased by 10.6%, the threshold EB retina decreased in both eyes to 110 μa, which is 11.3% higher than the original data. Treatment was performed on an outpatient basis.

After 6 months treatment effect remained.

Application

Comparative characteristics of the patients with glaucoma and Control groups.

A method for the treatment of glaucomatous optic neuropathy, including the introduction of complexes of peptide drugs, characterized in that the first patients receive Nik 0.5 g 2 times a day for 1 month, then Cortexin and Retinalamin 10 mg intramuscularly every other day for 20 days.



 

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