Method of treating corneal ectatic disorders

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology. The method involves a transepithelial corneal collagen crosslinking. That is preceded with a single bath electrophoresis with 1% riboflavin mononucleotide. That is ensured by an initial current of 0.2 mA to be increased gradually to 1 mA, at a pitch of 0.2 mA for 2 minutes. That is followed by an ultraviolet corneal exposure. The exposure is conducted at wave length 370 nm, power 3 mWt/cm2 and combined with instillation of a riboflavin solution. The solution contains 0.1% riboflavin mononucleotide and 20% dextran.

EFFECT: method provides more effective riboflavin delivery to the corneal stroma for one procedure providing the intraocular protection against ultraviolet light.

2 cl, 1 ex

 

The invention relates to medicine, in particular to ophthalmology, and can be used for the treatment of keratectasia.

The prototype of the invention is a method of treatment of keratoconus, which consists in the exposure of the cornea to ultraviolet radiation in the spectral range of UV And after preliminary electrophoresis of the cornea using baths with 2-5% solution of Riboflavin. When electrophoresis is carried out daily or at intervals of 1-2 days. After the procedure of electrophoresis on a background of drug Misa carry out ultraviolet irradiation of the cornea wavelength of 370 nm and a power of 3 mW/cm2the total duration of 30 minutes [patent RU 2345738, 2009]. The disadvantages of this method are: first, the multiplicity of conducting vannochkovogo electrophoresis; second, the high concentration of Riboflavin solution; third, the need for solutions miotikov to protect smash of deep structures of the eye from exposure to ultraviolet radiation; fourthly, during the procedure of UV irradiation on the surface of the cornea may be insufficient Riboflavin, due to its leaching tear of the patient.

The present invention solves the problem of improving a method of treating keratectasia method of linking collagen horn is vitsy.

The technical result consists in increasing the efficiency of delivery of Riboflavin into the corneal stroma in sufficient quantity during one procedure, ensuring the protection of intraocular structures from exposure to ultraviolet radiation due to the additional protection of the cornea through permanent installations of a solution containing 0.1% Riboflavin-mononucleotide with 20% dextran.

The proposed method for the treatment of keratoconus method of linking of the cornea is performed as follows. Establish the diagnosis and identify the documented progression of the disease recommend the procedure transepithelial corneal collagen cross-linking.

The first phase will vannochkovogo electrophoresis with saturation of the cornea of 1.0% solution of Riboflavin-mononucleotide apparatus "Thread-1" (Russia), generating a continuous current. In this method, the electrophoresis electrode - bath (active electrode) with a capacity of 3-5 ml is applied to the eyelids open eye slits and is fixed with an elastic bandage. This bath and closely adapted to the skin surface, respectively orbital edges, without exerting pressure on the eyeball. Pre-bath is filled with a 1.0% solution of Riboflavin-mononucleotide through existing vertical cannula. During pried the market corneoscleral part of the eyeball is in direct contact with the contents of the trays. During the procedure according to the described method the patient is in the sitting position. The machine starts with an installed power current 0.2 mA with subsequent gradual (within 2 minutes) increasing to 1.0 mA; increments of 0.2 mA. The total time of saturation of the corneal stroma with a solution of Riboflavin by electrophoresis of 10 minutes. The efficiency of penetration of Riboflavin into the corneal stroma is checked on the slit lamp under the blue - cobalt blue filter (yellow glow in the anterior chamber).

The second stage, under local anesthesia, conduct corneal collagen cross-linking without decapitalization - ultraviolet irradiation of the cornea device "Uplink" 6 cycles of 5 minutes with simultaneous installations of a solution containing 0.1% Riboflavin-mononucleotide with 20% dextran, providing the viscosity of the solution. Ultraviolet irradiation is carried out with a wavelength of 370 nm, with a capacity of 3 mW/cm2. The total time of ultraviolet irradiation for 30 minutes. After the procedure, the cornea was washed with saline solution, buried antibacterial drug and in the early postoperative period prescribed installation corticosteroid eye drops. In the following within 1 month is anti-inflammatory, anti-edematous and antiexudative therapy.

Clinical example. Patient O., 32 years. Di is the prognosis: OD - keratoconus stage I, OS - keratoconus stage II according to the classification of Amsler. Visual acuity of the right eye of 0.8. Visual acuity of the left of the operated eye 0,6; S. Kaliev s - 1,25D ax 127=0,9. Ectasia of the cornea in the lower outer quadrant 50 D. the Patient in the treatment room prior to the execution of the linking held vannochkovogo electrophoresis with a 1% solution of Riboflavin and maximum power current of 1 mA for 10 minutes Then on the slit lamp under the blue - cobalt blue filter (yellow glow in the anterior chamber), tested the efficacy of "soaking" stroma of the cornea with Riboflavin. It was further held ultraviolet irradiation of the cornea device "Uplink" 6 cycles of 5 minutes with simultaneous installations of a solution containing 0.1% Riboflavin-mononucleotide with 20% dextran. Ultraviolet irradiation is carried out with a wavelength of 370 nm, with a capacity of 3 mW/cm2. The total irradiation time is 30 minutes. After the procedure, the cornea was washed with saline, was prescribed eye drops "Normals" (3 mg/ml norfloksatsina).

After 1 day after surgery, eyes calm, pain was absent, visual acuity without correction - 1,0; keratometry in the area of ectasia 49 D. 6-12 months after surgery, the visual acuity of the left eye of 1.0 without correction, keratometry in the area of ectasia 46,0 D. Biomicroscopic the cornea transparent. Any Oslo the events after during and after the procedure transepithelial corneal collagen cross-linking was not observed.

1. A method of treating keratectasia, including transepithelial corneal collagen crosslinking by conducting vannochkovogo electrophoresis with a solution of Riboflavin for 10 minutes and subsequent UV irradiation of the cornea with a wavelength of 370 nm, with a capacity of 3 mW/cm2with a total exposure time of 30 minutes, characterized in that for a single electrophoresis using 1% solution of Riboflavin-mononucleotide with an initial current of 0.2 mA with subsequent gradual increase up to 1 mA with a step of 0.2 mA for 2 minutes, and ultraviolet irradiation is carried out with simultaneous instillation of a solution containing 0.1% Riboflavin-mononucleotide with 20% dextran.

2. The method according to claim 1, characterized in that the ultraviolet irradiation is 6 cycles of 5 minutes each.



 

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2 ex

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