Method of inducing posterior detachment of vitreous body with miniplasmin

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for inducing posterior detachment of vitreous body. For this purpose 0.1 ml of miniplasmin solution is introduced endovitreally in 4 mm from limb. Preliminarily before introduction, solution of buffer salts up to pH values of 6.8-8.0 with osmolarity 280-320 mOsm to concentration of miniplasmin in solution 1 mg/ml is added into miniplasmin, mixed, heated to temperature 37C and kept at said temperature for from 5 to 15 minutes.

EFFECT: method ensures reduction of toxic impact on retina and vitreous body, improvement of proteolytic properties of miniplasmin and, therefore, more complete detachment of vitreous body with reduction of interference trauma.

3 ex

 

The invention relates to medicine, namely to ophthalmology.

In various diseases of the posterior eye segment are of great importance pathological processes developing in the field of vitreoretinal connection. According to current data, vitreoretinal connection formed by the posterior hyaloid layer of the vitreous body (LSS ST) and the inner boundary membrane of the retina (VPM).

LSS ARTICLE is the outer layer of vitreum thickness of 100-200 microns, having a higher density of collagen fibers and a larger concentration of hyaluronic acid, in comparison with the Central part of the vitreous cavity.

VPM is a basal membrane internal processes Millerovskij cells of the retina. Morphologically is randomly interwoven collagen fiber 4 type associated with glycoproteins. The thickness of the PTO depends on the location and changes with age. On the extreme periphery of the retina it is thin - 50 nm. In the center of the retina it thickens 360 nm in the region of the equator.

Special attention to understand the importance of the vitreoretinal relationship in the pathogenesis of diseases of the posterior segment of the eye is the fact that in the eyes with the available rear vitreous detachment (SOEST) does not develop proliferative diabetic retinopathy, in addition, in patients with edematous-gemmorah the standard form of diabetic retinopathy after the occurrence of spontaneous SOEST not observed progression of swelling and hemorrhagic changes in the retina, do not develop neovascularization and even observed decrease retinal edema with improvement of visual functions.

With this severe disease, posterior eye as idiopathic macular breaks (WRI) adjacent LSS ARTICLE is given a leading role in the pathogenesis of the formation of end-to-end macular defect. An interesting fact is that the risk of macular rupture in the presence of the SOEST less than 1%.

There is a method of induction SOEST using miriplatin (U.S. patent 7914783).

The method is endometrial the introduction of 4 mm from the limbus 0.1 ml of miriplatin at a concentration of 1.25 mg/ml using an insulin syringe with needle 27 G.

However, this method has several disadvantages due to the use of high concentrations of miriplatin, which can have toxic effects on the retina and the vitreous body which may be exudative reaction, and the death of nerve fibers in the retina, which leads to low visual functions after the introduction of miriplatin, and also increases the period of rehabilitation of the patient after the injection.

The objective of the invention is to develop a less traumatic way of induction SOEST using miriplatin and prevention of postoperative complications.

The technical result achieved when using the proposed the constituent of the invention is the induction of a more complete SOEST, reducing toxic effects on the retina and the vitreous body, the acceleration period of rehabilitation by improving the proteolytic properties of miriplatin.

The technical result is achieved in that in the method of induction of posterior vitreous detachment of the body, including endometrial introduction to 4 mm from the limbus 0.1 ml of miriplatin, according to the invention in miniplates before introduction, add a solution of a buffer salt to pH values of 6.8 to 8.0 with osmolarity 280-320 mOsm to the concentration of miriplatin in solution 1 mg/ml, is stirred, heated to a temperature of 37C and maintained at this temperature from 5 to 15 minutes.

Complete manipulation instillation of corticosteroids.

Drug miniplates to his endometrial injection is prepared as follows. The frozen solution miriplatin with a concentration above 1 mg/ml defrost with the temperature control thermostat to the calculated values, add a solution of a buffer salt, bringing the concentration of miniplates in the solution to 1 mg/ml, and then use.

The method differs from the closest analogue that allows you to induce a more complete SOEST, to reduce toxic effects on the retina and the vitreous body, to accelerate the rehabilitation period due to the fact that miniplates is activated when the specified values of temperature and time is neither, in optimally balanced in acidity and osmolarity condition. Activation of miriplatin allowed to reduce its concentration in the nearest similar miniplates is injected into the vitreal cavity at a concentration of 1.25 mg/ml, and in the proposed method, miniplates is introduced in a concentration of 1 mg/ml

Example 1

Patient U., 73. Diagnosis: right eye - artiphakia, vitreomacular traction syndrome, left eye - the initial cataract.

Right eye:

Visual acuity of 0.1 not corrects

Tonometry - 18 mm Hg

According to optical coherence tomography (OCT) in my right eye vitreomacular traction syndrome.

To eliminate this disease in my right eye was performed induction of posterior detachment of the vitreous body according to the invention. Pre-operation miriplatin was heated at 37C for 5 minutes, the pH of which is to 7.0 with osmolarity of 280 mOsm.

The operation and the postoperative period was uneventful. On the 2nd day acuity of 0.2 not corrects.

Tonometry - 15 mm Hg

After 3 months, visual acuity of 0.4 not corrects.

Tonometry - 16 mm Hg

According to the OCT on the right eye vitreomacular traction no, SOEST.

Example 2

Patient B., 53. Diagnosis: right eye - proliferative diabetic retinopathy, diabetic macular about the EC, left eye - proliferative diabetic retinopathy, a condition after coagulation of the retina.

The patient on the right eye according to the OCT Central retinal edema.

Right eye:

Acuity of 0.05 not corrects.

Tonometry - 18 mm Hg

To eliminate this disease in my right eye was performed induction of posterior detachment of the vitreous body according to the invention. Pre-operation miriplatin was heated at 37C for 10 minutes, pH 7.5 with osmolarity of 300 mOsm.

The operation and the postoperative period was uneventful. On the 5th day acuity of 0.1 not corrects

Tonometry - 15 mm Hg

After 3 months acuity of 0.2 not corrects.

Tonometry - 16 mm Hg

According to the OCT on the right eye retinal edema in the heart less, SOEST.

Example 3.

Patient W., 60 years. Diagnosis: right eye - artiphakia, the left eye - epiretinal fibrosis, artiphakia.

The patient's left eye according to the OCT Central epiretinal fibrosis of the retina.

Right eye:

Acuity of 0.2 not corrects.

Tonometry - 20 mm Hg

To address this pathology on the left eye was performed induction of posterior detachment of the vitreous body according to the invention. Pre-operation miriplatin was heated at a temperature of 37C during 15 minutes, pH which 8,0 with osmolarity of 320 mOsm.

The operation and the postoperative period was uneventful. On the 10th day visual acuity of 0.3 not corrects.

Tonometry - 20 mm Hg

After 3 months, visual acuity of 0.4 not corrects.

Tonometry - 20 mm Hg

According to OCT left eye epiretinal fibrosis no, SOEST.

Method of induction of posterior vitreous detachment of the body, including endometrial introduction to 4 mm from the limbus 0.1 ml of miriplatin, characterized in that miniplates before introduction, add a solution of a buffer salt to pH values of 6.8 to 8.0 with osmolarity 280-320 mOsm to the concentration of miriplatin in solution 1 mg/ml, is stirred, heated to a temperature of 37C and maintained at this temperature from 5 to 15 minutes



 

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