Method of treatment of subepithelial crape of cornea after photorefractive keratectomy

FIELD: medicine; ophthalmology.

SUBSTANCE: after carrying out of photorefractive keratectomy (PRK), at revealing of complication in the form of a subepithelial crape, carry out lymphotropic therapy by performance of pterygopalatine blockades (PPB) course of 4-6 procedures, with an interval in day, with use of the medicinal admixture containing: 30-50 mg of lidocaine, 16-32 un of lydasums, 2-4 mg of histochrome, 0.5-1.0 mg of dalargin. The pterygopalatine blockades are carried out on the side of the damaged eye that provides fast entering and accumulation of medicinal substances in lymphatic region of an orbit.

EFFECT: increase of treatment efficiency.

2 ex

 

The invention relates to medicine, in particular to ophthalmology, and can be used for the treatment of subepithelial flair of the cornea after photorefractive keratectomy (PRK).

Despite the obvious and proven effectiveness, predictability, security and stability of the immediate outcomes excimer laser photorefractive keratectomy (PRK) and laser assisted in situ Keratomileusis (LASIK) in the treatment of myopia and astigmatism, all refractive surgeons registered with the formation of the cornea, which is the cause of the deterioration of the refractive operations, clinically defined as regression.

Epithelial hyperplasia, partial loss of corneal transparency is one of the common and dangerous complications of PRK, called "Fleur", some authors call it the subepithelial fibroplasia. Biomicroscopy of Fleur looks like subepithelial corneal opacities of varying intensity and uniformity and is 1.3 to 4.0% among complications.

There is a method of treatment of complications such as flair after surgery, photorefractive keratectomy, including the use of a 1%solution of dexamethasone on 3-4 times a day and voltaren or indomethacin 1 tablet 0,025 3 times per day rate from 4 weeks to 6 months (Baek S.., Kim W.J. Chang J.H. et al. The effect of topical corticosteroids on refractive outcome and coneal haze after excimer laser photorefractive keratectomy: comparison of the effect on low-to-moderate and high myopia groups // lnvest. Ophthalmol. Vis. Sci. - 1995. - Vol.36, No. 4 - P.713).

The most closest to the claimed method - prototype - is a method of treatment of erosions of the cornea after excimer laser photorefractive keratectomy (PRK), which consists in the introduction of a freshly prepared mixture of autologous blood in the amount of 6.0-8.0 ml and immunomodulator poludana (100 ME) as subconjunctival injection and instillation in the conjunctival cavity eyes 4-5 times a day (Patent RF №2122386, CL A61F 9/00, publ. 27.11.98).

The disadvantages of this method are the complexity of the manufacture and storage of freshly prepared mixture of autologous blood, possible unpredictable allergic reactions, and possible complications in the form of subconjunctival hemorrhages (this cosmetic complication will increase the time the rehabilitation of patients, as it has for a very long time resorption).

An object of the invention is to increase the effectiveness of treatment and reducing the risk of complications.

The goal of the project is achieved by the proposed method lies in the following.

After conducting PRK and detection of complications such as subepithelial flair exercise lymphotropic therapy by performing the pterygopalatine blockades (CSS) course of 4-6 treatments at intervals through the day. In the medicinal composition of the mixture consists of the following drugs: idomain (30-50 mg), lydasum (16-32 Ed), histogram (2-4 mg), dalargin (0.5-1.0 mg).

The pterygopalatine blockade carried out on the side of the affected eye, which provides a quick receipt and accumulation of medicinal substances in the lymph region of the orbit.

The defining difference of the proposed method from the prototype is that exercise lymphotropic therapy this regional lymph collector on the side of the affected eye by performing the pterygopalatine blockades using experimentally selected medicinal composition that improves the efficiency of treatment by improving microcirculation, lymphocirculation, lymphatic drainage of the region of the affected eye.

As a medicinal mixture lymphotropic therapy using optimally balanced composition comprising the peptide bioregulator dalargin, infostealer (lidocaine and enzyme lydasum), as well as antioxidant agent histogram that allows you to achieve rapid resorption flair due to the used mixture, improves trophic tissues and stimulates the proliferation of epithelial cells, and the topography of its introduction. With the introduction of drug compound in lymphatic region of the orbit significantly changing its pharmacokinetics, as expressed in the election accumulation of drugs in inflammation and long-term support is assured of their high therapeutic concentrations.

Histogram relates to antioxidant drugs, stabilizes cell membranes, is the interceptor free of reactive oxygen species, free radicals, accelerates epithelization of the cornea.

Dalargin can significantly stimulate the reaction of the antibody productions, which in turn leads to increase the immune response of the organism to the inflammatory process and reduces the time resorption flair.

The invention is illustrated by the following examples of specific performance.

Example 1.

Patient B., 32, entered the Novosibirsk branch of IRTC "eye microsurgery" with a diagnosis of myopia of an average degree OS.

Visus OS = 0,1 sph - 1,5 D = 1,0.

Surgery - PRK OS (27.02.2002,).

After the operation assigned to the standard treatment: chloramphenicol 0.25% for 3 times, naclof 1% - 3 times, Bulacan - 3 times a day.

On the fifth day after complete epithelialization and removing contact lenses found total Fleur intensity 2 points.

Visus OS=0,6 b/K.

The treatment of the inventive method: the pterygopalatine blockade (CSS) course 4 of the procedure in the following way: on the side of the operated eye, just below the zygomatic arch, in the middle of the distance between the tragus of the ear and the edge of the orbit produced vcol needle with a diameter of 0.6-0.7 mm and a length of 45-55 mm, then changed the angle of the needle 30 degrees, pushed the needle past the pterygoid processes of the main bone to a depth of 4-4,5 cm, getting into the pterygopalatine fossa. Then through the needle into the cavity of the orbit has established the catheter was fixed to the skin with adhesive tape. Later in the lymphatic region of the orbit through a fixed catheter at intervals through the day was administered medicinal mixture containing: 50 mg of lidocaine, 32 Ed lidz, 4 mg histogram, 1 mg of dalargin.

A week later, the intensity flair dropped to 1 point, two weeks later, Fleur resorbed.

Visus OS=1,0 b/K.

Example 2.

Patient G., aged 26, arrived in Novosibirsk branch of IRTC "eye microsurgery" with a diagnosis of complex myopic astigmatism. Myopia of an average degree OD.

Visus OD = 0,05 sph - 4.0 D cyl - 0.5 D = 1.0 in.

Surgery - PRK OD.

Treatment: chloramphenicol 0.25% for 3 times, Bulacan - 3 p.

On the second day after PRK identified Fleur, inflammatory infiltrate, edema of the cornea (SARS).

Visus OD = 0,09 W/K.

Made lymphotropic therapy by performing the pterygopalatine blockades course of 6 treatments, with intervals through the day, using medicinal mixtures containing 30 mg of lidocaine, 16 Units lidz, 2.0 mg of histogram, 0.5 mg of dalargin.

On the 9th day of edema no, the cornea is transparent, the patient was discharged.

Visus OD=0,8 b/K.

The half - transparent cornea.

Visus OD = 0,8 sph - 0,75 = 1,0.

The proposed method can improve the effectiveness of treatment, to reduce the risk of adverse complications, to achieve stable, long to imicheskogo effect.

A method for the treatment of subepithelial flair of the cornea after photorefractive keratectomy, including the introduction of a drug, wherein the drug delivery is carried out in lymphatic region of the orbit on the side of the affected eye by performing the pterygopalatine blockades, rate 4-6 blocks at intervals through the day, and in the quality of medicines use therapeutic mixture containing

lidocaine30-50 mg
hyaluronidase16-32 Units
histogram2-4 mg
dalargin0.5-1.0 mg



 

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