Method of combined treatment of diabetic diffuse macular edema

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology and can be used for treatment of diabetic diffuse macular edema. For this purpose 0.5 ml of 1% dexason solution and 0.5 ml of emoxipin are successively introduced in injection into parabulbar space and magnetic stimulation of optic analyser is performed. Magnetic stimulation is performed by pulse alternating magnetic field with growing strength within 6-12 mT with 50 Hz frequency and 10 min duration. Course of treatment constitutes 10 sessions.

EFFECT: method ensures efficient non-traumatic treatment of the last stage of proliferative diabetic retinopathy.

24 dwg, 4 ex

 

The invention relates to medicine, in particular to ophthalmology, and can be used to prevent blindness in patients with diabetes mellitus.

Diabetic macular edema (DME) occurs in 25-30% of patients with diabetes with experience more than 20 years and is the main cause of deterioration of Central vision in this pathology (Mazurina NICHOLAS Moscow "Diabetic macular edema. Modern approaches to treatment", http://www.organum-visus.com/school-of-the-patient-glaucoma/diabetes-eve-complicationhtm/).

DHS develops in diabetic retinopathy (DR) on the background of morphological changes: thickening of the retina within 1 disk diameter of the optic nerve from the center of the macula, cystic changes, vitreoretinal traction, fibrosis or macular breaks. With increasing severity, ETC, the incidence of DME increases from 3% at angiopathy, with nonproliferative DR - up to 38% of patients, and proliferative Dr to 71% ("Ocular manifestations of diabetes" edited Lieblich, St. Petersburg, publishing house of St. Petersburg maps, 2009, p.132).

DIR can be focal and diffuse. Focal edema is due to local diffusion of microaneurysms, extends to the center of the macula, and its size does not exceed 2 disc diameters of the optic nerve. According to the available clinical data focal edema, usually treatable with lattice hole the nuclear biological chemical (NBC coagulation. With diffuse edema, thickening of the retina reaches size 2 or more diameters of the optic nerve. Edema develops as a result of hyperprolinemia all perimacular zone and extends to the center of the macula (Romanenko I.A., Cherkasova V.V. Egorov E.A. "Diabetic macular edema. Classification, clinical course, treatment", http://www.rmi.ru/articles 6960htm).

There is a method of treatment of macular edema of various origins, involving the use of exchange plasmapheresis and subsequent intravitreal injections antimajoritarian drug Avastin or Lucentis (Babkov M.M., Altynbaev OR, Malikova A.L. Patent RF №2393824, Z. 14.04.2009).

The disadvantages of the method are the complexity and invasiveness of the procedure, the high cost of medications and lack of effectiveness of the treatment.

One of the promising methods for the treatment of DME is intravitreal injections of drugs - synthetic analogues of steroids - hormones, such as triamcinolone acetate (kenalog) and dexamethasone. With the same purpose enter antagonists of vascular endothelial growth factor (VEGF) - "Avastin and Lucentis". The most effective recognized combined treatment - a combination of intravitreal drugs and laser coagulation of the retina.

However, the use of these drugs calls the AET side effects cataract and increased intraocular pressure, the need for repeated injections. Furthermore, the drugs are quite expensive, and their injection traumatic (http://www.organum-visus.coni/school-of-the-patient-glaucoma/diabetic-eye-complications htm/).

Most widely for the prevention and treatment of different forms of DME is used coagulation in various modifications (Patent RU №2308920 from 14.10.2005, from 27.10.2007, Balashevich L.I., Siskin L.V., Gaza MV and patent RU No. 2393824 from 14.09.2009,).

Approximately in Russia the need for laser photocoagulation DIR - 0,2/0,8 million patients (Balashevich L.I. "Ocular manifestations of diabetes" SPb. Publishing house of St. Petersburg maps, 2004, P.132-133).

However, the laser exposure may cause damage to the photoreceptors and blood vessels of the choroid, the subretinal neovascularization, as well as the development of epiretinal fibrosis, macular region (Navfacengcom, Whanaunga, Aphtharsia, Aircool. Institute of eye diseases and tissue therapy named after. V.P. Filatov, Odessa Ukraine, Odessa. Cm. http://maculo.ru/view page.php?page=38&YD=0).

In addition, for carrying out laser photocoagulation necessary transparent medium of the eye, which limits its application in the presence of cataract. Contraindications include the presence of vertical and horizontal tractions or exudates in foveola.

Known combined method of treatment of diffuse DIR involving the use of "lattice" laser photocoagulation of the retina and pogledaliinformacije introduction triamcinolone dose of 4 mg once. The treatment efficiency is achieved in 76% of cases (Upholland, Nialexander, Salamin, Iveco "analysis of the effectiveness of the treatment of diabetic macular edema" In materials science.-the practical. conference of ophthalmologists "Filatov reading" Ukraine, Odessa, may 26-27, 2011 s, prototype)

The disadvantages of the prototype are the trauma, the high cost of triamcinolone acetate, as well as the disadvantages of laser coagulation of the retina.

In addition, it is known that this drug causes rapid progression of cataract, increased intraocular pressure, retinal detachment, hemophthalmus and enditall (Suuroja, Eourope, Nearonova, Gaidarova, Ohagan (W. "Ophthalmology", 2011, vol. 8, No. 3, p.9-12)).

The objective of the invention was to develop an effective noninvasive method of treatment of diffuse diabetic macular edema.

The essence of this invention lies in the fact that in the presence of DME in parabulbar space eyes injected with the injection of 0.5 ml of 1%aqueous solution of dexasone and 0.5 ml of emoxipin, followed by the impact on the visual analyzer pulsed alternating magnetic field with increasing tensions within 6-12 MT with a frequency of 50 Hz during 10 sessions lasting 10 minutes

The technical result achieved by implementation of the proposed method:

- manufacture the Xia visual acuity,

- reduced size DIR (thickness and volume) due to the reabsorption of fluid in the vessels of the choroid

- reduces the number of hard exudates and microhemorrhage,

- lowers blood pressure and blood sugar without the use of additional drugs,

- normalizes vascular permeability at the level of terminal vascular beds,

- decreases the amount of fluid propoaala through the walls of capillaries.

The proposed method is as follows: at the time of admission and after treatment are examined, including refractometry, visiometry, pneumotonometry, contact biomicroscopy, optical coherence tomography (OCT). In addition, determine the sugar content in the blood and the blood pressure value. After diagnosis prescribe the patient 10 sessions of combined treatment according to the scheme: parabulbar injection of 0.5 ml of dexasone, 0.5 ml of 1%emoxipin, and magnetic stimulation of the visual analyzer pulsed alternating magnetic field with a frequency of 50 Hz during 10 min daily.

When conducting FMS uses a gradual increase in magnetic field strength (MT)

1 session - 6

2 - 9

3 - 12

If tolerated by the patient of the magnetic field with a strength of 12 MT remaining sessions about the W ill result in 12 MT. In case of discomfort - 9 MT.

The method is illustrated by clinical examples.

Example 1.

Patient I., born in 1953 AK No. 292205, appealed with complaints about low vision.

Examination before treatment:

Vis OD - 0.03, n/a

Vis OS - 0.25+1.5D; -0.5Dax90°=0.35

IOP OD - 14.5 mm Hg

OS - 14,1 mm Hg

The level of glucose in the blood - 12.3 mmol/L.

Ophthalmoscopy:

OU: the fundus of the eye: optic nerve disc pale pink, clear boundaries.

According to the OCT there is diffuse swelling in parafoveal the field in both eyes height OD - 624 n, OS - 430 n.

On OD in the area of the fovea - haemorrhage.

Diagnosis: preproliferative diabetic retinopathy, diabetic maculopathy developed.

The patient treated in accordance with the invention.

Examination after treatment:

Vis OD - 0.06 n/a

Vis OS - 0.13+1.5D; -0.5Dax90°=0.5

IOP (mm Hg) OD - 11,2

OS - 9,8

The glucose level was 7.3 mmol/l

The fundus of the eye - the optic nerve disc pale pink, clear boundaries.

According to OCT:

OD - in the macular area of hard exudates, hemorrhages, swollen,

OS - microaneurysms, hemorrhages, focal edema with hard exudates.

According to OCT edema decreased in parafoveal area

OD from 624 to 495 n

OS 390 430 to n

The treatment results in improved visual acuity, decreased blood sugar level.

Example 2.

Patient T., born in 1956 AK No. 197003, complaints fog OU, the lack of sharpness of vision.

Examination before treatment:

Ophthalmoscopy: OU - optic nerve disc pale pink, clear contours, in the macular area - diffuse racemose edema

Vis OD - 0.125; Vis OS - 0.08

IOP (mm Hg) OD - 18,6, OS - 17,3

The diagnosis of proliferative diabetic retinopathy, moderate diabetic maculopathy developed in both eyes.

OCT: the height of the swelling was in the foveolar area: OD - 568 n, OS - 536 n.

The patient is given a comprehensive treatment in accordance with the proposed method.

Examination after treatment:

Vis OD - 0.125 n/a, Vis OS - 125

Subjectively marked improvement in the sharpness of vision in both eyes.

According to OCT: preserved diffuse kistovidnye swelling, but its height was reduced to 396 and 361 n respectively.

Example 3.

Patient G., born in 1956, AK No. 239020.

The patient complained of poor vision, distortion of objects in front of the left eye.

Survey data at entry:

Vis OD - 0.9,

Vis OS - 0.45 n/K.

AD - 150-140/100-90 mm Hg

The fundus of the eye: OU - optic nerve disc pale pink, clear contours.

According to the OCT in macular area OU - diffuse macular edema, hard exudates.

The diagnosis of proliferative diabetic retinopathy, diabetic maculopathy.

The patient completed the treatment by the proposed method.

These OCS is adowanie after treatment:

Vis OD=1, Vis OS - 0.7 n/a

AD=130-120/90-80 mm Hg

The fundus of the eye: optic nerve disc OU pale pink, clear contours.

According to the OCT in macular area OD edema is absent; there are hard exudates, OS swelling decreased in the periphery remain microhemorrhage and microaneurysms.

The treatment results in improved visual acuity, decreased distortion of objects in front of the left eye improved General condition, normalized HELL.

Example 4.

Patient M., born in 1949, the AK No. 241013, complaints of decreased vision at distance and near, difficulty reading.

Examination before treatment:

Vis OD - 0.05-6.5Dcyl-1.0DAh°=0.45

Vis OS - 0.05-6.5Dcyl-1.0Daxl27°=0.45

IOP (mm Hg) OD - 19.3

OS - 18.4

The fundus of the eye: OU - optic nerve disc pale pink, in the macular area - krupnolistnye diffuse swelling, minor hard exudate, microhemorrhage, intraretinal microsomal in the macular area and the four quadrants.

Diagnosis: preproliferative diabetic retinopathy, advanced diabetic maculopathy in both eyes.

The patient held panretinal laser coagulation of the retina with the aim of preventing vascularization. Then the treatment in accordance with the proposed method.

Examination after treatment:

Vis OD - 0.05-6.5Dcyl-1.0Dax50°=0.45

Vis OS - 0.05-6.5Dcyl-1.0Dax113°=0.6

IOP - OD - 1,06, OS - 17, mm Hg

The fundus of the eye: OU - optic nerve disc pale pink.

According to OCTOBER (see figure 1-24).

OD - in the macular area of the swelling has decreased considerably, minor exudate,

OS - in the macular area swelling is virtually absent, slight exudate.

The method of combined treatment of diffuse diabetic macular edema involving physiotherapeutic effect in combination with drugs, characterized in that sequentially carry out the injection of 0.5 ml of 1%aqueous solution of dexasone and 0.5 ml of emoxipin in parabulbar space and the FMS of the visual analyzer pulsed alternating magnetic field with increasing tensions within 6-12 MT with a frequency of 50 Hz during 10 sessions lasting 10 minutes



 

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