Method of treating keratoconus in patients with thin cornea

FIELD: medicine.

SUBSTANCE: corneal deepithelialisation and 0.1% riboflavin saturation is followed by applying a soft contact lens at least 100 mcm thick without an UV filter. The cornea is exposed to ultraviolet rays at wavelength 365-375 nm for 30 minutes.

EFFECT: method enables enhancement and eliminates the damaging action of ultraviolet on the corneal endothelium by increasing total thickness of the cornea.

3 cl, 2 ex

 

The invention relates to ophthalmology, and can be used for the treatment of keratoconus cornea.

Keratoconus or ectasia of the cornea is a degenerative disease, when the strength of the collagen fibrils of the cornea is weakened to about half of normal values, which leads to the formation of the conical shape of the cornea and the displacement of its center and astigmatism. The etiology and pathogenesis of keratoconus poorly understood. This disease can be primary, genetically determined, or secondary, which is one of the most serious complications of refractive surgery.

In recent years, for stabilization of the pathological process keratoconus was offered a new way of treatment, based on cross-linking (cross-linking) is a term used in chemistry and bioengineering to indicate chemical-physical effects on tissues, resulting in "seal" or increasing the strength of the structural elements of this tissue. The effect of low-intensity ultraviolet light to the tissue stroma of the cornea in the presence of a photosensitive substance - Riboflavin (vitamin B2) - increases the production of short-lived free radicals of oxygen that is liberated, causing the formation of relationships-bridges between isolated until the collagen fibrils of the stroma, the volume of the blue into a single durable network increasing the strength of the cornea from 3 to 6 times.

However, not all patients with keratoconus may be performed corneal crosslinking or democraticleaning. A limitation in the operation is the corneal thickness less than 400 μm after decapitalization due to the high risk damaging effect of ultraviolet radiation on endothelial layer of the cornea. And this is sufficient large percentage of patients, as patients are often treated for possible treatment sufficiently advanced form of the disease with significant thinning of the cornea.

There is a method of treatment of keratoconus, namely, that after decapitalization of the cornea in the conjunctival cavity buried photosensitizer and produce the irradiation of the cornea with ultraviolet light with a wavelength of 365-375 nm, as a photosensitizer use a 0.2% solution "Photosense" (patent RU 2388436, op. 10.05.2010).

The disadvantage of this method is the limited functionality, because this method cannot be treated in patients with thin cornea.

There is a method of treatment of keratoconus, namely, that carry out local saturation of the cornea with Riboflavin solution in the zone of thinning by application of Riboflavin in a pre-formed corneal pocket, and corneal is Arman form using a femtosecond laser through a two-stage resection, first make a circular incision at a depth of 150 to 170 μm, and then the input section in the radial direction, from 0° for the left eye to 180° for the right length 2.5-3 mm, starting at a depth of tunnel and ending on the outer surface of the cornea, followed by ultraviolet irradiation (patent RU 2456971 C1, op. 27.07.2012).

The disadvantage of this method is the high cost of operation due to the use of expensive femtosecond laser, which becomes an insurmountable obstacle for bolsista ophthalmology departments of the country.

There is a method of treatment of keratoconus, including the removal of the epithelial layer of the cornea by the method of excimer laser ablation at a depth of not more than 2/3 of its thickness, the saturation of the cornea of 0.1%Riboflavin solution by multiple installations and ultraviolet irradiation of the cornea with a wavelength of 365 nm for 30 min (patent RU 2434616 C1, op. 27.11.2011).

The disadvantages of this method are the need of expensive equipment, in particular optical coherence tomography spectral type with a high resolution, for accurate estimation of the thickness of the corneal epithelium, as well as the risk of possible complications from the endothelial layer of the cornea and the inability to perform this procedure in patients with thin cornea.

Closest to the claimed methods for the in - the prototype is a method of treatment of keratoconus in patients with thin cornea, including decapitalization cornea, serial soaking her first 0.1% of the ISO-osmolar Riboflavin solution mixed with dextran T500 every 3 minutes for 30 minutes, then 0.1% of the Hypo osmotic swelling solution of Riboflavin every 20 seconds for 5 minutes and the irradiation of the cornea with ultraviolet light with a wavelength of 365-375 nm within 30 minutes. During irradiation conduct periodic instillation of 0.1% Hypo osmotic swelling of Riboflavin solution to the surface of the cornea. After installations Riboflavin perform multiple pachymetry with the registration of the increase of corneal thickness ≥400 μm. At the end of the procedure, buried antibiotic and impose a therapeutic soft contact lens (Farhad Hafezi, P., Mrochen m, Iseli H., Seiler T., Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas // J. Cataract Refract Surg 2009; 35:621-624 Q 2009 ASCRS and ESCRS).

The disadvantages of this method are low predictability caused by edema of the stroma, sharply reduced postoperative visual acuity caused by postoperative swelling, and hence long-term rehabilitation of patients. In addition, for the registration of the fact of increasing the thickness of the cornea (corneal thickness more >400 μm), requires repeated intraoperative pachymetry of the cornea, on the TES measurement contains some degree of error, which can be increased during the exposure of ultraviolet light due to the dehydration of the corneal stroma because of its heat.

The objective of the invention is to develop a method that provides the ability to perform procedures corneal crosslinking in patients with thin cornea, reducing the duration of the method and the exception complications.

Effect: enhanced functionality of way, reducing the duration of the method, the exception complications.

This object is achieved by the proposed method lies in the following.

After decapitalization cornea and saturation of 0.1% Riboflavin solution for 15-30 minutes, impose hydrogel soft contact lens with a thickness of less than 100 microns without UV filter (UV). Preferably use a contact lens, made of 2-hydroxyethylmethacrylate with a water content of from 53-57%, and with bandwidth ≥90% of long-wave ultraviolet ≈400 nm (UV-A). Then, according to the conventional method of producing the irradiation of the cornea with ultraviolet light with a wavelength of 365-375 nm within 30 minutes. During irradiation conduct periodic instillation of 0.1% Riboflavin solution on the surface of soft contact lenses. After the procedure is complete, remove the lens, in the conjunctival cavity of sacap is its antibiotic and impose a therapeutic soft contact lens.

The defining difference of the proposed method from the prototype is that after decapitalization cornea and saturation of 0.1% solution of Riboflavin produce overlay on the cornea hydrogel soft contact lens with a thickness of less than 100 microns without UV filter, and then produce the irradiation with ultraviolet light, which allows operation in patients with thin cornea by increasing the total thickness of the cornea and eliminate the damaging effect of ultraviolet radiation on endothelial layer of the cornea.

The proposed method is illustrated by the following examples.

Example 1

Patient K., 24, asked for advice in the Novosibirsk branch of IRTC "eye microsurgery" with complaints of decreased vision. From history revealed that the deterioration of vision was about 2 years. Ocular correction was not performed.

A full eye examination. The diagnosis of Keratoconus first degree of the right eye, the II degree of the left eye.

Diagnostic data before the operation:

Visual acuity: right eye with 0.6 Corr. Sph - 0.0 cyl-0.75 ax 90=0.7

left eye 0.5 n/a

Refractometry: right eye Sph-1.00 cyl - 2.75 ax 92

left eye Sph - 1.25 cyl - 1.50 ax 126

Keratometry: right eye Wermer. 45.00 ax 163 Gormer. 44.00 ax 73

left eye Wermer. 48.25 ax 38 Gormer. 46.25 ax 128

Pachymetry: right eye, the center 469 mcm

left g is Aza, center 389 mcm

The patient has completed the treatment of keratoconus by the claimed method.

After decapitalization corneal her saturated with 0.1%Riboflavin solution by repeated installations every 2-3 minutes for 30 minutes to diffuse staining corneal stroma and impregnation of the cornea with Riboflavin. Next on the cornea imposed hydrogel soft contact lens of Concor LBT (Russia) with a thickness of 100 μm, a diameter of 14 mm, with a moisture content of 55% without UV filter and performed the irradiation of UV light with a wavelength of 365 nm, with a capacity of 3 mW/cm2within 30 minutes. At the end of the operation, the lens was replaced with a therapeutic contact lens, poured non-steroidal anti-inflammatory drug (Diclof) and antibiotic (Floxal).

Complete epithelialization of the cornea was achieved through 68 hours after the operation.

Visual acuity of the left eye after removal of therapeutic soft contact lenses without correction -0,1 and/K.

Visual acuity in 2 months: OS 0.5 Corr. Sph - 0.75 cyl - 1.00 ax 132=0.6., after 3 months: 0.6 Corr. Sph - 0.0 cyl - 1.00 ax 145=0.8

Example 2

The patient Was 21 years asked for advice in the Novosibirsk branch of IRTC "eye microsurgery" complaining of decreased vision in the left eye. From history revealed that the deterioration of vision was about 2 years. Ocular correction was not performed.

A full eye examination. Di is the prognosis: Keratoconus first degree of the right eye, III degree of the left eye.

Diagnostic data before the operation:

Visual acuity: right eye 1.0

left eye 0.04 of 0.75 Sph cyl - 6,0 ax 124

Refractometry: right eye Sph - 0,50 cyl - 0.0 ax 0

left eye Sph - 1.25 cyl - 7.25 ax 124

Keratometry: right eye Wermer. 44.25 ax 101 Gormer. 43.50 ax 11

left eye Wermer. 49.5 ax 29 Gormer. 42.5 ax 119

Pachymetry: right eye, the center 498 mcm

the left eye, the center 376 mcm

The patient has completed the treatment of keratoconus by the claimed method as in example 1. Visual acuity at 1 month: OS 0.2 Corr. Sph - 0.00 cyl - 4.00 ax 120=0.4.

According to keratotopografii after 2 months there was a marked decrease in irregularity and flattening of the corneal curvature.

The use of the proposed method will allow you to perform the procedure of linking patients with keratoconus in cases when the Central corneal thickness less than 400 μm after decapitalization. The proposed method will allow you to extend the indications for this method of treatment, which does not require expensive equipment and can become active preventive measure to ensure the progression of keratoconus in the regions, given the current difficult situation in the country holding keratoplasty.

1. A method of treatment of keratoconus in patients with thin cornea, including decapitalization cornea, soaking her with 0.1% Riboflavin solution and irradiation of rogove the s beam of ultraviolet light with a wavelength of 365-375 nm within 30 minutes, characterized in that before the irradiation of the cornea on it imposes a soft contact lens with a minimum thickness of 100 microns without UV filter.

2. The method according to claim 1, characterized in that the quality of the lenses used hydrogel soft contact lens made of 2-hydroxyethylmethacrylate with a water content of 53-57%, and with bandwidth ≥90% of long-wave ultraviolet light.

3. The method according to claim 2, characterized in that as the lens using a soft contact lens of Concor LBT (Russia).



 

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