Device for contact transscleral eye irradiation and method of application at photodynamic therapy of intraocular neoplasms
SUBSTANCE: said device contains a transparent cylindrical support case, a retainer ring and a lock nut. The support case comprises a necked top with an external thread and a light guide port, and a hollow bottom with a circular marking edge at the end face. When the device is applied for photodynamic therapy of intraocular neoplasms, the marking edge is covered with brilliant green. The device is mounted with its end face of the bottom with a marking edge on sclera exposed to contact transscleral laser irradiation herewith covering the adjacent fields by 15-20% of the area through sequential relocation of the device from periphery to the middle within projection of tumour base on sclera and covering 2 mm of adjacent tissues.
EFFECT: application of group of inventions provides limitation of the area of one laser radiation spot in specified dimensions, herewith maintaining constant distance of the light guide end face to irradiated surface within procedure, accurate visualisation of the irradiated sites, with limiting the area of a laser irradiation by desired region.
2 cl, 1 dwg
The invention relates to medicine and can be used in ophthalmology and oftalmologii for contact transscleral exposure of the eyes in photodynamic therapy of intraocular tumors prequaternary and Equatorial localization, and localization in the region of the ciliary body.
At the present stage of development of oftalmologii preferred conservative treatment of intraocular tumors, the main requirement which is the principle of maximum radicalism in relation to the tumor with minimal adverse impact on surrounding healthy tissue.
One of the promising methods for the treatment of intraocular tumors is photodynamic therapy (PDT). Photodynamic therapy is based on the selective accumulation of injected systemically photosensitizers (PS) in vessels and stroma of the tumor, which in the subsequent laser irradiation with a wavelength corresponding to the peak absorption of this FS, causes phototoxic damage to the vascular system and tumor cells. The efficacy of PDT depends on many factors, including the dose of laser irradiation. In addition, the principle is the strict limitation of the irradiation zone boundaries of the target zone in order to avoid phototoxic damage to the healthy surrounding tissue is th.
Standard laser irradiation photodynamic therapy of intraocular tumors spend transpupillary, fields, consistently, with overlapping of adjacent fields 15-20% of the area (Waily, Averescu, Pulmology, Mailan. Photodynamic therapy derivative of chlorin E6 in the treatment of small choroidal melanomas. // Refractive surgery and ophthalmology. - 2007. - V.7. No. 3. - Pp.33-40). However transpupillary PDT intraocular tumors is effective for tumor localization in the posterior pole of the eye, whereas prequaternary, Equatorial and localization in the region of the ciliary body is the most preferred transscleral approach, moreover, that transpupillary to irradiate the entire surface of the tumor in these cases, it's almost impossible. At the same time, in the event transscleral PDT using conventional laser optical fiber, it is impossible to accurately control the distance to the irradiated surface, which causes the change in delivered dose of laser energy, as well as to visualize the irradiated areas, limiting the scope of the irradiation target area. All this adversely affects the efficiency of PDT.
Therefore, development of the device for contact transscleral exposure of the eye and method of its use in photodynamic therapy of intraocular tumors prequaternary, aquat the branches and localization in the region of the ciliary body is relevant.
A device for laser irradiation of the anterior eye segment (RF patent 2278706), comprising a cylindrical casing-stop. However, the use of this device it is impossible for local irradiation sections of arbitrary shape (the target zone), which inevitably leads to uncontrolled radiation exposure to surrounding healthy tissue.
The objective of the invention is to develop a device for contact transscleral exposure of the eye and method of its use in photodynamic therapy of intraocular tumors.
The technical result is to limit the area of a single spot of laser radiation set sizes, maintaining a constant distance from the end face of the fiber to the irradiated surface during the procedure, a clear visualization of the irradiated areas, limiting the field of laser irradiation of the target area.
The technical result is achieved due to the fact that:
1) the fiber is tightly secured in the channel of the upper part of the body-lock through the locking ring and the locking nut that provides a constant distance from the end face of the fiber to the irradiated surface;
2) the inner diameter of the bottom part of the device is chosen accordingly to the required diameter of the laser spot, and the area of one spot laserdog the radiation, accordingly, the limited internal space of the case base-emphasis;
3) the presence of the circular edge of the timer at the end of the transparent housing-rest allows using a deposited dye to identify and visualize the irradiated areas;
4) conducting contact transscleral tumor radiation fields, with overlapping of adjacent fields at 15% to 20%, by successively moving the device from the periphery to the center within the previously planned area of projection of the base of the tumor on the sclera with capture the surrounding tissue 2 mm helps limit the field of laser irradiation of the target area.
The device comprises a transparent cylindrical body-emphasis, the locking ring and the locking nut. Case-emphasis consists of the upper part of the neck, which is applied to male threads, and the lower hollow part. In the upper part of the body-stops along the axis of rotation is a through channel for the introduction of the fiber, the lower part of the body-emphasis intended for contact with the irradiated surface and ends in a circular edge-timer at the end. The fiber is tightly secured in the channel of the upper part of the body-lock through the locking ring and the locking nut, which is wrapped around the threads of the neck of the upper part of the body-rest, while the end face of the optical fiber extends into the cavity housing-at the ora.
The size of emphasis: length - 40 mm, 24 mm - length top, 6 mm is the length of the neck; diameter, except cervix is 8 mm, the diameter at the neck top - 5 mm. Internal diameter of the bottom part of the device is chosen accordingly to the required diameter of the laser spot and is from 4 to 6 mm. Thickness circular edge-timer - 0,3 mm Diameter through the channel of the upper part of the body should be sufficient for introducing the fiber.
Case-emphasis can be performed, for example, polymethyl methacrylate, polaroplast-4, the retainer ring is made of silicone, lock nut - stainless steel.
When conducting photodynamic therapy of intraocular tumors prequaternary, Equatorial and localization in the region of the ciliary body during transscleral laser irradiation device is used as follows.
Calculate the required therapeutic dose of laser irradiation and verify it by measuring the output power of the device using a power meter. If necessary, correct the settings of the laser.
After the introduction of the FS transscleral diaphanoscopy precise localization and the size of the base of the tumor, define the boundaries of the projection of the base of the tumor on the sclera and denote them by 1% water-alcohol solution of the brilliant green. Then put a solution of brilliant green on the edge-timer, set the device to the sclera by the end of the lower part of the edge-timer and hold the contact transscleral radiation fields, with overlapping of adjacent fields at 15% to 20%, by successively moving the device from the periphery to the center within the target area (the projection area of the base of the tumor on the sclera with capture the surrounding tissue 2 mm). The boundaries of each field are visualized by coloring matter.
The invention is illustrated in the drawing, which shows a device for contact exposure of the anterior eye segment with a transparent case-emphasis 1, including upper solid part 2 neck 3 screw 4 and the lower hollow portion 5 with a circular edge, the timer 6 at the end, the locking ring 7 and the lock nut 8, which is wrapped around a neck 3 of the casing-lock 1 by thread 4. Through the channel 9 of the upper part of the body-fixed focus light guide 10.
The invention is illustrated by the following data.
Photodynamic therapy using the proposed device and method of its application was held on 7 patients with intraocular tumors prequaternary, Equatorial and localization in the region of the ciliary body. Used buildings-stops with an inner diameter ranging from 4 mm to 6 mm during the procedure in all cases: the distance from the end face of the fiber to the irradiated surface remained unchanged, the area of a spot of laser radiation is visually consistent with the internal space of the case base-emphasis irradiated areas were clearly marked by the dye deposited on the edge-timer, which helped to limit the scope laser irradiation of the target area (projection area of the base of the tumor on the sclera with capture the surrounding tissue 2 mm).
As a result of photodynamic therapy in all 7 cases, 6 months, there was complete regression of the tumors with the formation ophthalmoscopically flat or slightly prominere (up to 0.8 mm) chorioretinal scar with moderately severe uneven pigmentation and perifocal chorioretinal atrophy. Angiographic, as were extensive fluorescently area with negligible inhomogeneous fluorescence, due to fibrotic changes on the spot irradiated tumors. According to the energy Doppler mapping 6 months after treatment in all cases was noted the absence of intratumoral blood flow. According to localization of the irradiated melanoma was determined avascular lesion, testified to the destruction of the vascular system of the tumor.
Thus, the claimed invention provides for limiting the area of a single spot of laser radiation, C is the data size, maintaining a constant distance from the end face of the fiber to the irradiated surface during the procedure, a clear visualization of the irradiated areas, limiting the field of laser irradiation of the target area.
1. Device for contact transscleral exposure of the eye, comprising a transparent cylindrical body-emphasis, the locking ring and the locking nut, in this case the emphasis consists of the upper part of the neck, which is applied to male threads, and a channel for the introduction of fiber and lower hollow part with a circular edge-timer at the end.
2. The application of the device according to claim 1 in photodynamic therapy of intraocular tumors, namely, that the edge-timer put a solution of brilliant green, install the device side bottom part with edge-timer on the sclera and hold the contact transscleral laser irradiation fields, with overlapping of adjacent fields at 15% to 20%, by successively moving the device from the periphery to the centre within the area of the projection of the base of the tumor on the sclera with the capture of the surrounding tissues at 2 mm.
SUBSTANCE: invention concerns medicine, particularly obstetrics and hestosis treatment for the pregnant. Method involves endovascular laser irradiation of blood for six days. Further, polyphepan is administered internally for eight days in the dosage of 0.5 g per kg of pregnant body weight for 3-4 times per day.
EFFECT: therapeutic effect with reduced treatment duration and medication load on organism of the pregnant due to the selected regimen.
SUBSTANCE: invention concerns medicine, laser medicine, and can be applied in treatment of trophic ulcers of venous etiology. Method involves processing of ulcer surface and skin around ulcer by air and gas flow with nitrogen oxide content 2000 ppm or more at 40°C, with 10 second exposition per 1 cm2. Further, 0.1% Radachlorine gel is applied as photo sensitiviser in amount of 0.2 g per 1 cm2 with 60 minutes exposition. Then laser emission of 0.665 mcm wavelength and light energy dosage of 150-200 J/cm2 is applied at 3-5 mm distance from wound surface. Afterwards intravenous blood irradiation is performed over cubital vein by laser emission of 0.632 mcm wavelength and radiation power of 5 mW with 15 minutes exposition. Treatment course comprises 10 daily procedures of air and gas flow processing and intravenous blood irradiation and 5-8 photodynamic therapy procedures performed over 2 day interval.
EFFECT: improved neurotrophic regulation of damaged tissues, antimicrobe effect, reduced frequency of purulent complications, improved blood flow properties, prevented resistance of ulcer microflora to antibiotics and drugs, prevented dysplasia, cicatrical changes and skin malignisation around trophic ulcer.
4 cl, 1 ex
FIELD: medical equipment.
SUBSTANCE: invention concerns medical equipment and can be applied in cancer tissue treatment in various organs of biological objects. Device includes semiconductor laser diode, clock generator, semitransparent mirror, comparator, first, second and third direct current amplifiers, differentiating amplifier, discriminating amplifier, first and second photo receivers, delay line, analog to digital converter, programmed permanent memory, first and second binary code comparators, first and second control systems of secondary power sources, first and second secondary power sources and light panel/indicator. Biological object is positioned in line between semiconductor laser, semitransparent mirror and second photo receiver.
EFFECT: extended range of technical devices for laser cancer therapy.
SUBSTANCE: invention refers to medicine, namely to laser therapy. The first stage of the therapy involves introduction of medicines and intravenous laser blood exposure by installing a needle in one solution transfusion system for quartz fibre of diametre 0.7 mm through which the patient is exposed to helium-neon laser of power 1.2 mW at exposition 90 minutes within seven daily procedures. The second stage includes paravertebral block within herniated disk localisation in projection of herniated disk. Quartz fibre of diametre 0.7 mm is introduced through a puncture needle to the level of surface musculofascial layer. Injection of solution is immediately followed with irradiation with helium-neon laser of power 1.2 mW at exposition 80 minutes within seven daily procedures. Medicines within solution transfusion system are as follows: Trental 5 ml, Actovegin 5 ml, 15% Xantinol Nicotinate 2 ml, vitamin B1 2 ml alternated with vitamin B6 2 ml, 5% vitamin C 3 ml dissolved in physiologic saline 150 ml. Paravertebral block of the first day includes 5% glucocorticoid Diprospan 1 ml combined with 2% Lidocaine. For the following days 2% Lidocaine is used.
EFFECT: method allows terminating inflammatory process, ensuring stable pain management.
SUBSTANCE: therapy of secondary lower limb lymphodema refers to medicine, namely to clinical lymphology. The oatient is exposed to laser light of wavelength 0.6328 mcm combined with intravenous laser irradiation of power 1.2 mW and exposition 90 minutes and intravenous introduction of medicine solutions: Trental, Actovegin, Pheopolyglukine, vitamin B, C complexes, 0.15% xantinol nicotinate. Procedures are daily at seven procedures per course.
EFFECT: therapy provides stable reduction of secondary lower limb lymphodema without therapeutic by-effects, prevents recurrence.
2 cl, 2 ex
SUBSTANCE: invention refers to medicine, to neurology. The therapy involves taking the medicines improving cerebral blood circulations. Pharmacotherapy is combined with exposure to laser light within anconeus and popliteal fold regions. Laser puncture covers the points VB 20 and VB 21 symmetrically downright. Laser light is characterised with wavelength 0.89 mcm, power 3 mW and frequency 600 Hz. Herewith light exposure is 1 minute per each point and 2-3 minutes per elbow and popliteal folds. Therapeutic course is 10 days twice every second month.
EFFECT: method reduces treatment time.
3 ex, 1 tbl
SUBSTANCE: invention relates to medicine, oncology, surgery, radiology, physical therapy and can be used for treating patients with larynx cancer. Area of radiation and surrounding tissues is exposed to infrared laser irradiation. From first day of radioreaction diagnostics, exposure to infrared laser irradiation with constant magnetic field with magnetic induction intensity within 20 mTa, recurrence frequency of pulse laser irradiation of infrared spectrum within 80 Hz, power 0.5-1.0 W on all zone of irradiation is performed with defocused ray for 30-120 seconds. Course includes 3-8 procedures with further application on irradiation zones and intake of a teaspoon of cedar nut oil and before going to bed daily during the whole course of radiation therapy.
EFFECT: method allows to increase efficiency of treatment of early radioreactions and prevent development of later radiation damage reducing severity and frequency of their development.
SUBSTANCE: invention relates to field of medicine, namely to ophthalmology. Laser stroboscopy is carried out during 5 days, 2 times a day with 1 hour interval. First 10 minutes each eye is influenced in turn, then for 5 minutes both eyes are influenced simultaneously. Distance to speckle is 1 m.
EFFECT: recovering binocular functions with elimination of anisoaccomodation, enhancing binocular interaction, increasing visual acuity.
3 cl, 2 ex
SUBSTANCE: invention refers to medicine and aims at epilepsy management. Carotid and vertebral arteries are sequentially exposed to IR laser light, infra-red laser radiation to the right and to the left each for 5 minutes. Frontal, temporal, parietal and occipital lobes are exposed to magnetic field and microwave radiation to the right and to the left each for 3 minutes. And visual analyser is exposed to IR waves within 30 minutes. It is combined with electroencephalographic training with course of treatment 15 procedures.
EFFECT: disclosed method allows for improved mental measurements, relieved remove proneness to convulsive activity, suppressed epileptogenic zones, improved metabolic and energy cerebral processes, normalised cerebral blood flow regulation, recovered cortical neurodynamic disorders.
SUBSTANCE: invention refers to medicine, oncology and to be used for neoadjuvant chemoradiotherapy in the patients suffering from thoracic oesophagus cancer. Said therapy is ensured by introduction of cisplatin and leucovorin, and continuous intravenous infusions of fluorouracil dosed 300 mg/m2. Cisplatin solution is introduced intravenously drop-by-drop and dosed 6 mg/m2 daily once a day within 1 hour. Leucovorin is injected intravenously jet-like and dosed 30 mg/m2. Radiotherapy involves daily fractions 3 Gy to total basic dose 30 Gy. The course dose of fluorouracil is 3600 mg/m2, of cisplatin is 72 mg/m2, of leucovorin 360 mg/m2. Chemotherapy and radiotherapy are to be started the same day.
EFFECT: disclosed method allows for considerably reduced toxicity of treatment to be continuous, treatment of the patients originally of bad performance status, for doubly reduced time of neoadjuvant treatment with maintaining high clinical effectiveness.
SUBSTANCE: invention refers to medicine, namely to ophthalmology. The therapy starts with photorefraction and phototherapeutic keratectomy with cornea exposed to excimer laser of wavelength 193 nm, exposure depth 50 mcm and diametre 9.0 mm. It is followed with circular laser thermokeratoplasty with cornea exposed to ytterbium-erbium laser light of wavelength 1540 nm, exposure depth 600 - 700 mcm. Herewith cornea periphery is covered with coagulates in staggered rows comprising two-three rings of diametre 8.0 - 10.0 mm.
EFFECT: method provides cornea fixation within ectasia with recovered sphericity and improved visual acuity thus developing the support function along the whole circle through cornea depth.
1 dwg, 2 ex
SUBSTANCE: invention refers to ophthalmology and aims at external surgery of vertical genu of lacrimal passages. The surgery involves incision of soft tissues followed by application of an irrigation aspirator A-250 (Eleps, Russia) within forming a hole in the bone and tissue suturing. The aspirator is joined with a working part that is a suction cannula.
EFFECT: improved visualisation of operative field, higher manipulation accuracy and reduced operation length.
SUBSTANCE: invention refers to ophthalmology and covers elimination of total Symblepharon. Conjunctival fornix is grafted with automucosa. Thus bulbar conjunctiva is grafted with the flaps of the area 3/4 of the area prepared within eye surface surgery for grafting. The grafting is followed with limbal allo- or autotransplantation.
EFFECT: mucous autografting from the patient's lip reduces intraoperative injuries; restoration of conjunctival fornix, qualitative cornea epithelisation that causes first possibility to prevent dystrophic changes of the proper cornea and secondly thus arranging adequate conditions for the following penetrating keratoplasty.
SUBSTANCE: invention concerns medicine, particularly surgical ophthalmology, and can be applied in anesthetic support of scleroplasty operation for 9 to 14 years old children. Method involves administration of local anesthetic immediately before operation by triple instilling of visityl and alcaine mix in 1:1 ratio over 5 minutes to the eye to be under surgery. Mix of 0.5% seduxen solution and fentanyl solution mix is injected intravenously during surgical intervention. Each drug in the mix is taken in half amount of calculated dosage corresponding to age and weight of patient.
EFFECT: adequate anesthesia and sedation without loss of consciousness during surgical intervention, prolonged post-operation anesthesia due pre-operation administration of visityl and alcaine mix at definite ratio.
SUBSTANCE: invention concerns ophthalmology and can be applied in evisceroenucleation. Vertical 3-6 mm long cut is made in retina, and scleral capsule content is removed through it. Further at least two meridian cuts of posterior sclera surface are made from inside of scleral cup. The cuts are symmetrical against visual nerve disc and run from equator to visual nerve disc. The cuts are perpendicular. Further visual nerve is cut at 5 mm distance from posterior pole of scleral capsule. Endoprosthesis is implanted to scleral cup through cut made in cornea in advance. To finish the operation, cornea is stitched.
EFFECT: reduced trauma rate of operation due to reduced cornea cut length, leaving conjunctiva and Tenon's shell intact, and preservation of anatomic and topographic structure of sclera and reduction of operation duration.
1 dwg, 2 ex
SUBSTANCE: invention concerns ophthalmology and can be applied in surgical intervention in case of cataract. Hydrodissection utilises L-shaped cannula with bent distal end length of 0.5 mm. Cannula is brought under anterior capsule folium through capsulorexis and advanced towards crystalline lens equator opposite to access point. Cannula is positioned in vertical plane with outlet orifice down. Distal cannula end is brought behind crystalline lens body, and a portion of irrigation solution is delivered to posterior capsule until characteristic 'hydrodissection wave' appears. Then crystalline lens body is dislocated mechanically by tool towards equator at irrigation solution delivery point. Effort is applied to crystalline lens body in capsulorexis zone at access point side. Further irrigation liquid is delivered again under crystalline lens body so that it floats in capsule sac. Crystalline lens body is rotated around its axis.
EFFECT: efficient separation of crystalline lens body from posterior capsule by single delivery of irrigation solution, resulting in fast and trauma-free performance of hydrodissection with minimum manipulations and solution volume.
SUBSTANCE: invention concerns ophthalmology and can be applied in defining indications for surgical treatment of central retinal vein branch thrombosis (CRVBT) combined with macular edema (ME). Examination is performed at the acute stage of CRVBT before and in 10 days after medicament treatment. For original macula volume up to 8.0 mm3 and further volume preservation, reduction or increase by up to 0.12 mm3, favourable disease course is prognosed. For original macula volume over 8.0 mm3 and further absence of changes or edema increase by more than 0.12 mm3, adverse disease course is prognosed, and surgical treatment is considered necessary.
EFFECT: possible defining of indications for surgical treatment at acute stage of CRVBT, prognosis of surgical treatment result.
3 ex, 1 tbl
SUBSTANCE: invention concerns ophthalmology and is intended for improvement of chronic post-operation eye hypotension treatment. If cyclodialysis cleft edge divergence exceeds 0.5 mm at respective meridians, temporal episcleral filling is performed with the use of silicon filling, followed by laser coagulation. In 10-14 day time the filling is removed.
EFFECT: enhanced efficiency of chronic eye hypotension treatment in cases when cyclodialysis cleft edge divergence does not allow forming strong commissure between ciliary body edge and sclera.
SUBSTANCE: invention claims implants and microimplants containing homogenous mixes of active component and biodegradable polymer, including microimplants with 0.019 inch diametre or less and 1 mm length or less, which can be inserted into an eye by methods based on eye self-recovery. Also invention claims methods of implant and microimplant manufacturing allowing obtainment of uniform implant and microimplant batches with extremely narrow tolerance range.
EFFECT: novel implants and methods of implant manufacturing.
38 cl, 1 tbl, 3 ex
SUBSTANCE: retainer accommodates an open ring or its part comprising a segment of the radius corresponding to that of capsular sac, and haptic elements. At least one haptic element comprises a hook across the ring generatrix with "П"-shaped or semiannular end at its top, made of a wire piece, with ring rakers of its ends located at the bottom of the ring and mounted so that, at least the hook end within ring plane transcends.
EFFECT: retainer allows improving vision quality due to relocation of ligature attaching point outside of a ring or a convex part of the segment with high-quality capsular support of intraocular lens.
2 cl, 4 dwg
SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.
EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.
3 cl, 5 dwg