Device for contact transscleral eye irradiation and method of application at photodynamic therapy of intraocular neoplasms

FIELD: medicine.

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.



 

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