Viscoelastic solution for posterior hyaloid contrast enhancement

FIELD: medicine.

SUBSTANCE: viscoelastic solution for the posterior hyaloid contrast enhancement contains a colouring agent, methyl cellulose, hyaluronic acid, low polyvinyl pyrrolidone and injectable water. The colouring agent is presented by trypan blue and/or brilliant blue. The ingredients are used in the declared ratio.

EFFECT: lower toxic effect of the retina, improved intraoperative visualisation of cortical layers of the vitreous body.

3 ex

 

The invention relates to medicine, more specifically to ophthalmology, and can be used in surgery of the vitreous body.

The closest analogue is the solution for the contrasting structures of the vitreous body through the introduction of indocyanine green 0.3% concentration in methylcellulose, which is injected in subhyaloid space (patent RF №2222297).

However, this solution has some significant drawbacks, such as indocyanine green is highly toxic to structures of the posterior segment of the eye and its use can lead to toxic damage to the retina.

Thus, there is still a problem of visualization of the posterior hyaloid membrane (SGM) for the purpose of its atraumatic removal and reduce the toxic effects of the dye on the inner structure.

The objective of the invention is to develop a solution for contrasting the back layer of the vitreous body during vitreoretinal surgery.

The technical result is the reduction of toxic effects on the retina, improved intraoperative visualization of the cortical layer of the vitreous body.

The technical result is achieved by the fact that a viscoelastic solution for contrasting the posterior hyaloid membrane containing the dye and methylcellulose, according to the invention as a dye with the holding trepany blue and/or blue diamond and additionally contains hyaluronic acid, polyvinylpyrrolidone low molecular weight and injecting water in the following ratio, wt.%:

dye trepany blue and/or blue diamond0.05 to 2
the methylcellulose0,3-3
hyaluronic acid0.1 to 2
polyvinylpyrrolidone low molecular weight0.1 to 2
injecting waterrest

Dye trepany blue and/or blue diamond is designed to contrast the posterior hyaloid membrane at subhyaloid the introduction of the drug. These dyes are less toxic than used in the near equivalent of indocyanine green, not inferior to him in the degree of visualization of the posterior hyaloid and the inner edge of the membrane. When concentration of the dye is less than 0.05% decreases the degree of staining of the posterior hyaloid and the inner boundary membrane and degraded their visualization. When the concentration of dye than 2% manifest toxic effects of the dye.

The methylcellulose is designed to give the dye viscoelastics the x properties and ensures the stability of the posterior hyaloid membrane with the introduction of dye subhyaloid. When the concentration of methylcellulose less than 0.3% solution loses its viscoelastic properties, and the concentration of methylcellulose more than 3% may occur postoperative ocular hypertension.

Hyaluronic acid is designed to give pseudoplasticity and more complete distribution of a viscoelastic solution structure of the vitreous body. When the concentration of hyaluronic acid is less than 0.1% solution loses pseudo-plastic properties, and the concentration of hyaluronic acid than 2%, you may experience postoperative ophthalmoparesis.

Polyvinylpyrrolidone low molecular weight (20000-40000 Yes) is designed for reversible binding of a viscoelastic drug from the rear of the hyaloid and the inner boundary membrane. When the concentration of the polyvinylpyrrolidone less than 0.1% solution does not have sufficient adhesion, when the concentration of the polyvinylpyrrolidone more than 2% solution has excessive adhesion.

A viscoelastic solution for contrasting the posterior hyaloid membrane is obtained by simple aseptic mixing, incubation at a temperature of +4 degrees Celsius and sterilization aseptic filtration.

The contrast is as follows:

Under local anesthesia perform vitrectomy, posterior hyaloid membrane perform discipio, and then with the help of the cannula in subhyaloid space impose painted a viscoelastic solution in an amount of from 0.1 to 0.9 ml. After reaching a good visualization of the posterior hyaloid membrane is excised completely. Further tactics of surgical intervention is determined by the severity of the initial condition of the eyeball.

The method is illustrated by the following examples:

Example 1

Patient T., 73.

Diagnosis - vitrectomy traction syndrome of the left eye.

Visual acuity of the left eye of 0.6.

The height of the partial detachment of the posterior hyaloid membrane 254 microns.

Underwent surgical treatment - Subtotal vitrectomy left eye, dosed with destruction of the posterior hyaloid membrane and preservation of epiretinal structures above the maximum traction of foveola, when the operation used the solution in the following ratio, wt.%:

diamond blue0,05
The methylcellulose0,3
hyaluronic acid0,1
polyvinylpyrrolidone low molecular weight0,1
injecting waterrest

Partial removal of SGM was possible thanks to the use of subgoal odnogo introduction painted a viscoelastic solution and contrasting the posterior hyaloid membrane, that allowed us to visualize the place of fixation of the posterior hyaloid membrane to foveola.

The postoperative period was uneventful. After 1 month, visual acuity of the left eye of 0.8.

Example 2

Patient A., 62.

Diagnosis - vitrectomy traction syndrome of the left eye. Visual acuity of the left eye of 0.4.

The height of the partial detachment of the posterior hyaloid membrane to 245 μm.

Underwent surgical treatment - Subtotal vitrectomy left eye, dosed with destruction of the posterior hyaloid membrane and preservation of epiretinal structures above the maximum traction of foveola, when the operation used the solution in the following ratio, wt.%:

trepany blue2
the methylcellulose3
hyaluronic acid2
polyvinylpyrrolidone low molecular weight2
injecting waterrest

Partial removal of SGM was possible thanks to the use of subgoaling introduction painted a viscoelastic solution and the contrast C the days of the hyaloid membrane, that allowed us to visualize the place of fixation of the posterior hyaloid membrane to foveola.

The postoperative period was uneventful. After 1 month, visual acuity of the left eye of 0.7.

Example 3.

Patient Y., 67.

Diagnosis - vitrectomy traction syndrome of the left eye. Visual acuity of the left eye of 0.6.

The height of the partial detachment of the posterior hyaloid membrane to 310 μm.

Underwent surgical treatment - Subtotal vitrectomy left eye, dosed with removal of the posterior hyaloid membrane and preservation of epiretinal structures above the maximum traction of foveola, when the operation used the solution in the following ratio, wt.%:

diamond blue and trepany blue1
methylcellulose2
hyaluronic acid1
polyvinylpyrrolidone low molecular weight1
injecting waterrest

Partial removal of SGM was possible thanks to the use of subgoaling introduction painted a viscoelastic process is but the contrast of the posterior hyaloid membrane, that allowed us to visualize the place of fixation of the posterior hyaloid membrane to foveola.

The postoperative period was uneventful. After 1 month, visual acuity of the left eye of 0.6.

A viscoelastic solution for contrasting the posterior hyaloid membrane containing the dye and methylcellulose, characterized in that the dye contains trepany blue and/or blue diamond and additionally contains hyaluronic acid, polyvinylpyrrolidone low molecular weight and injecting water in the following ratio, wt.%:

dye trepany blue and/or blue diamond0.05 to 2
the methylcellulose0.3-3
hyaluronic acid0.1 to 2
polyvinylpyrrolidone low molecular weight0.1 to 2
injecting waterrest



 

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