Method of treating macular oedemas of various geneses

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology, and can be used in treating the patients with macular oedemas of various geneses. That is ensured by the therapy that starts with 6 sessions of plasma exchange every 2 days. It is followed by a single intravitreal introduction of antivasoproliferative preparation Avastin in dosage 1.25 mg or Lucentis in dosage 0.5 mg.

EFFECT: method allows improving clinical effectiveness combined with reduced intravitreal introduction of the antivasoproliferative preparations, due to involving pathogenetic mechanisms, namely elimination of pathological immune complexes, stabilisation of pro- and anti-inflammatory cytokines.

2 cl, 2 ex

 

The invention relates to medicine, namely to ophthalmology, and can be used in the treatment of macular edema of various origins.

Macular edema in such diseases as age-related macular degeneration (AMD), diabetic retinopathy, occlusion of the Central retinal vein, is one of the most common causes of sudden vision loss leading to disability in the elderly population (Abas Khadija, 1989; Hakobyan, B.C., 2004; Alekseeva L.L. and others, 1996; Astakhov US and others, 2004). Among the reasons for the development of macular edema detected by factors such as rheological, immunological, hypoxic, metabolic, hormonal, genetic and other, causing damage to the walls of the capillaries of the retina, vascular permeability and growth of newly formed vessels. The main method of treatment of macular edema today is laser coagulation in various modifications (Astakhov YU.S., 2000;

Balashevich L.I., 2005; Izmailov A.S., 2004; Katsnelson L.A., 1980). The method allows to achieve stabilization of the pathological process, but it has no effect on the pathogenic mechanisms of this disease. It is also difficult to produce coagulation with the lack of transparency of the optical media.

Among other methods of treatment are surgical methods (removal neovascular the second membrane, the excess traction of the posterior hyaloid membrane, vitrectomy). The disadvantages of surgical treatment methods are a violation of the anatomical structures of the eye, a considerable amount of interference in the vitreous body, the induction of proliferative vitreoretinopathy.

There are medical methods (antioxidant therapy, therapy aimed at improving the rheological properties of blood and hematocrit, immunomodulatory therapy). However, medical procedures does not affect neovascular membrane, is not the elimination of toxins and pathological immune complexes.

There is a way to treat the wet form of AMD, including intravitreal injections of the drug Avastin (bevacizumab) at a dose of 1.25 mg (Aviko, Averaging, Swieszkowski and other "First experience with the drug Avastin in the treatment of the wet form of age-related macular degeneration" // Modern technologies of treatment of vitreoretinal pathology - 2007. The collection of scientific articles of materials of scientific-practical conference (Moscow, March 23, 2007) / Under the editorship of theoretical information. Moscow, 2007, P.54-58). The disadvantage of this method is the short duration of drug action that requires multiple repeated injections. Also, the method has no effect on the causes of the pathological process (the imbalance of Pro - and FR is vospaliteleny cytokines, pathological immune complexes, impaired microcirculation, metabolism).

Closest to the claimed method is a method of treatment of maculopathy various origins and anterior ischemic opticoat method of plasmapheresis (United States Patent 6245038, 1997). With this method of treatment positive clinical effect was achieved by improving the retinal microcirculation, improve the rheological properties of blood by apheresis red blood cells in combination with the elimination of fibrinogen and protein of high molecular weight. However, the method does not affect the subretinal neovascularization

The objective of the invention is to increase the effectiveness of treatment and reducing the frequency of intravitreal injections antimajoritarian drugs due to the elimination from the blood pathological immune complexes, cytokines involved in angiogenesis and increases vascular permeability, improve choroidal and retinal microcirculation.

The technical result in the use of the invention is the elimination of pathological immune complexes, stabilization of Pro - and anti-inflammatory cytokines, reduce the frequency of intravitreal injection antimajoritarian drug.

The proposed method for the treatment of macular edema as follows. On the first the second stage, extracorporeal plasmapheresis, in which in the absence of contraindications side of the blood coagulation system, General condition of the patient hold the blood of the patient in the amount of 450-750 ml disposable plastic container with a preservative, an intravenous infusion of 200-400 ml isotonic. The container is placed in a centrifuge, where at a speed of 2500 rpm for 15 minutes sephirot, when removing the container from the centrifuge plasma was removed and the cell mass is added 150-200 ml of physiological solution, then do reinfusion diluted cell mass.

At the second stage, intravitreal injections antimajoritarian drugs (Avastin at a dose of 1.25 mg, Lucentis at a dose of 0.5 mg) through the flat part of the ciliary body in the conditions of an operating room under local anesthesia with 2% 2 ml lidocaine retrobulbarno. Prescribed antibiotics the day before surgery and five days after.

The follow-up period patients are week after administration of the drug, every month for 6 months. Evaluation results carried out by visual acuity, Central visual field, data HRT, ultrasound examination of the eyeball, immunological methods tears and blood of patients at each visit the patient's ophthalmologist. Next, if there maculare the swelling, subretinal fluid or permanent separation of the pigment epithelium is repeated injection of a drug or periods of observation extend, if determined obliteration neovascular membrane resorption of edema.

When the claimed method of treatment, the frequency of intravitreal injections is reduced due to the elimination from the blood pathological immune complexes, cytokines involved in angiogenesis and increases vascular permeability. Also improved the rheological properties of blood, the hematocrit, which improves choroidal and retinal microcirculation.

In the available scientific and medical and patent literature not found information about the popularity of the method for the treatment of macular edema, including exchange plasmapheresis course of 6 sessions conducted with an interval of 2 days, a single intravitreal injections antimajoritarian agent. Thus, the claimed invention meets the criterion of "novelty".

The authors proved that the conduct of the exchange plasmapheresis removes the imbalance of Pro - and anti-inflammatory cytokines contributes to the elimination from the blood of pathological immune complexes, and the subsequent single intravitreal injections antimajoritarian of drug resistant E. the effect of reducing swelling and reduction of neovascularization. Thus, the claimed invention meets the criterion of "inventive step".

The invention is illustrated by the following clinical examples.

Example 1

Patient W., 76 years old, diagnosis: OD - Age-related macular degeneration, dry form. The artiphakia. OS - Age-related macular degeneration, wet form. Immature age-related cataract. Visual acuity D=0.2 NK/ OS=0.01 Nicholas

OS - In the macular area, a significant prominence retinal exudative detachment of the neuroepithelium, neovascularization.

The data of ultrasound scan OS - B region of the optic nerve disc reticulated shell locally prominenet in the vitreous body to 2.0 mm

Data HRT OS - laser scan redintegratio the macular region are rendered nonuniform nonuniform reflexivity areas, parafoveal prominere to 1000 μm. Indicators thickness increased to 610 μm at the bottom, up to 862 ám in the forward sector. The swelling index increased to 5.03. The patient was treated by the proposed method.

In the first stage, held the rate of exchange plasmapheresis, which consisted of 6 sessions conducted with an interval of 2 days. Upon completion of the course the patient in the operating conditions under local anesthesia in the left eye intravitreal introduced 1.25 mg Avastin. Parabulbarno entered antibiotic solution with dexatrim. Epibulbar Intellinova the antibiotic solution. Antibiotic therapy was administered the day before surgery and five days after.

When viewed in the first day after surgery: OS - visual acuity = 0.01 (not correcting), the transparent cornea, anterior chamber average depth of the lens partly cloudy in the vitreal cavity slight strengthening of destruction, in the macular area of prominence retina, subretinal exudation, neovascularization.

At the control examination after 1 week visual acuity OS=0.03 (not correcting), the transparent cornea, anterior chamber medium, the lens partly cloudy in the vitreous body of minor destruction, retin-a slightly prominenet in the vitreous body in the area of the macula, marked resorption of subretinal fluid and neovascularization in the macular area, Druze and redistribution of pigment epithelium.

The data of ultrasound scan OS - In the area of the optic nerve disc reticulated shell locally prominenet in the vitreous body at 1.0 mm

Data HRT OS - laser scan redintegratio macular area in the dynamics reveals the decrease of thickness up to 678 μm in the lower sector of up to 508 microns. The swelling index is reduced to 4.26.

At the control examination after 1, 2, 3 months anatomical and functional results remained stable.

Example 2.

Patient L., aged 45, diagnosed with OU - Vozrastayuschey degeneration. OS - Wet form. OD - Scar form. Visual acuity D=0.01 Nicholas/ OS=0.07 Nicholas OS - In the macular area minor prominence retinal exudative detachment of the pigment epithelium, neovascularization.

The data of ultrasound scan OS - When the axial position of the probe below the optic nerve disc reticulated shell rough, prominenet in the vitreous body at 0.5 mm.

Data HRT OS - laser scan redintegratio macular area is visualized plot heterogeneous reflexivity, prominere in the foveal region to 477 mcm. The swelling index increased to 2.12. The patient was treated declared method.

In the first stage, held the rate of exchange plasmapheresis, which consisted of 6 sessions conducted with an interval of 2 days. Upon completion of the course the patient in the operating conditions under local anesthesia in the left eye intravitreal introduced 1.25 mg Avastin. Parabulbarno entered antibiotic solution with dexatrim. Epibulbar installieren antibiotic solution. Antibiotic therapy was administered the day before surgery and five days after.

When viewed in the first day after surgery: OS - visual acuity = 0.1 (not correcting), the transparent cornea, anterior chamber, the average depth, lens transparent, vitreal cavity slight strengthening of destruction, in the macular area minor p is Eminence retina, subretinal exudation, neovascularization. At the control examination after 1 week visual acuity OS=0.2 (not correcting), the transparent cornea, anterior chamber medium, a transparent lens, the vitreous body of minor destruction, exudative lesion in the region of the macula decreased, marked resorption of subretinal fluid, reduction of newly formed vessels.

The data of ultrasound scan OS - In the area of the optic nerve disc reticulated shell locally prominenet in the vitreous body of 0.3 mm

Data HRT OS - laser scan redintegratio macular area in the dynamics reveals the decrease of thickness up to 456 μm. The swelling index decreased to 1.8. At the control examination after 1, 2, 3 months anatomical and functional results remained stable.

Thus, the proposed method for the treatment of macular edema of various origins is pathogenetically justified and improves the efficiency of treatment, and reduce the frequency of intravitreal injection antimajoritarian drugs. The method is easily reproducible in the hospital and when it is achieved the specified technical result. Thus, the claimed invention meets the criterion of "industrial applicability".

1. Method for the treatment of macular edema of various origins,including exchange plasmapheresis course of 6 sessions carried out with an interval of 2 days, characterized in that after it is conducted additionally a single intravitreal injections antimajoritarian drug.

2. The method of treatment according to claim 1, characterized in that as antimajoritarian of the drug is injected Avastin at a dose of 1.25 mg or Lucentis at a dose of 0.5 mg.



 

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