Method of treating bullous keratopathy

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to ophthalmopathy, and can be used in treating endothelial-epithelial corneal dystrophy. That is ensured by de-epithelisation, 12-o'clock corneal incision and splitting, administration of a biologically active substance into a stromal pocket of the cornea. The biologically active substance is poludan-activated autoplasma. Before the epithelisation is completed, a soft contact lens is placed on the cornea. The operation is followed by instillations of ciprofloxacin, diclofenac 6 times a day and infusions of cornegel.

EFFECT: method provides reducing the intraoperative injuries and the length of patients' treatment, including by local (intrastromal) autocytokinotherapy.

2 ex

 

The invention relates to medicine, in particular to ophthalmology, and can be used in the treatment of endothelial-epithelial corneal dystrophy.

A method of treating eej corneal proposed Temirova N. E., The Tkacheva M. S. (Proc. Dokl. VII Congress of ophthalmologists of Russia. Moscow, 2000, p. 47), which consists in intralaminar keratopathy as a decongestant barrier polyacrylamide hydrogel.

The disadvantage of the proposed method are possible complications associated with damage to the descemet's membrane of high density polyacrylamide hydrogel, the development of secondary hypertension, recurrent bullous keratopathy.

The closest in technical essence is a method of treating bullous keratopathy proposed Gorban, A. I. et al. (Coll. nauch. Tr., 1989, p. 36-38), comprising vnutrirodovoe the introduction of autologous blood.

A disadvantage of the proposed method of treatment are possible complications associated with damage to the descemet membrane (rupture), the subsequent penetration of blood in the anterior chamber, lock the angle of the anterior chamber and pupillary area elements of the blood and the development of secondary glaucoma, relapse process ectasia of the cornea, the lack of efficiency associated with limited distribution autologous blood formed only on the channel neces�ü sutures to secure the edges of the cut.

The object of the invention is the reduction of surgical trauma surgery, reduction of terms of treatment of patients with endothelial-epithelial corneal dystrophy by local (intratumoral) autocatakinetic.

The invention consists in that in the method for the treatment of bullous keratopathy, including decapitalization, the incision of the cornea in a pre-selected Meridian, for example for 12 hours in 0.5 plasma of the patient, activated poludanom using the methodology described in 2001 Kasparov A. (Kasparov, A. A., Kasparov E. A., Pavlyuk, A. S. West. Ophthalmology, 2004, vol. 120, No. 1, p. 29).

The method of activation is as follows: from the vein of the patient into the test tube take 5,0-6,0 ml of autologous blood with subsequent mixing with 1.0 ml of a solution of paludina (200 units) in distilled water. Taken mixture is subjected to centrifugation and then take away from the tube into the syringe formed of the upper transparent layer of blood plasma in a volume of 1.5-2.5 ml.

Pronounced therapeutic effect, manifested in the relief of signs eej (corneal syndrome, the disappearance of the pericorneal injection, bullous changes, corneal edema corneal tissue and increasing transparency, improving visual acuity) is explained in more intensive production of interferons α, β and γ in response to the introduction of paludina in culture of blood cells (intras�romalee and subconjunctival depot), causing secretion cascade of complex cytokine with activity of interleukins 1, 2, 8, tumor necrosis factor, and growth factors, as well as proven antiapoptosis action Paludan in the culture of cells. The complex of cytokines contributed to the relief of inflammation and stimulate the regeneration of the corneal endothelium. This method allows a direct impact on the damaged structures of the cornea (Mityagin O. N., Pavlyuk A. S. Effect of immunomodulator "paludina" on cellular regeneration and condition of apoptosis in the experiment // Abstracts of the 1st Russian Symposium on refractive surgery M., 1999, p. 66).

Example 1. Patient D. was admitted to inpatient treatment in the ophthalmology Department of the Amur oblast clinical hospital with the diagnosis of Endothelial-epithelial corneal dystrophy article 3, posterior chamber pseudophakia the left eye. From history - operated in 2011 cataract surgery with implantation of a posterior chamber intraocular lens is 1 mm from the limbus, its peel, the introduction of 0.5-1.0 ml of biologically active substances in stromal corneal pocket, the introduction of an excess of autoplasma of 1.0-1.5 ml under the conjunctiva paralambano, areas on the cornea until complete epithelialization of soft contact lenses and innstillingane after surgery in the conjunctival cavity solution ciprof�oxazine 6 times a day, solution of diclofenac 6 times a day, laying corneregel 6 times a day for 14 days, as a biologically active substance is introduced into the stromal pocket of the cornea and conjunctiva paralambano use autoplasma, activated poludanom.

Introduction as a biologically active substance of autoplasma, activated poludanom, allows you to create depot in the "target organ" of the complex mediators of immunity - of cytokines with anti-inflammatory and stimulant properties (Kasparov, A. A., Kasparov E. A., Pavlyuk, A. S. West. Ophthalmology, 2004, vol. 120, No. 1, p. 29).

The method is as follows. After local epibulbar anesthesia, microspatial decapitalizing the entire surface of the cornea. In a pre-selected Meridian, for example for 12 hours in 0.5-1 mm from the limbus, an incision to a depth of 2/3 of the corneal stroma with a length of 2.0 mm. Then disposable rasseivatele split your cornea over the entire area to a depth of 2/3 of the stroma. Produce paracentesis in the area of the notches with the release of moisture anterior chamber to create hypotonia of the eye and to prevent return of the outpouring of the plasma. In a pocket formed with a syringe and cannula injected with 0.5-1.0 ml of autoplasma, activated poludanom. The excess of autoplasma of 1.0-1.5 ml injected under the conjunctiva paralambano. To complete epithelialization on �agovice placed a soft contact lens, additionally, after the operation in the conjunctival cavity deployed the solution ciprofloxacina 6 times a day, the solution of diclofenac 6 times a day, laid corneregel 6 times a day for 14 days. Used (IOL). After the operation eyesight has not improved, the patient appeared subjective feeling of a foreign body, photophobia, watery eyes in the operated eye. Was repeatedly hospitalized for inpatient treatment. Improvement in the operated eye was kept on a short period of time and every exacerbation of the inflammatory process leading to decreased function of the eye, as well as the growth of corneal syndrome - photophobia, watery eyes, feeling of a foreign body in the eye. The patient was offered an operation of intrastromal certaintie of autoplasma, activated poludanom by the above proposed method. After surgery, the patient is assigned instaliranje in the conjunctival cavity solution ciprofloxacina 6 times a day, of a solution of diclofenac 6 times a day, the laying of corneregel 6 times a day for 14 days. The state of the left eye before surgery - mixed injection, expressed blepharospasm, photophobia, lacrimation. Bullous edema of the epithelium with erosion, diffuse swelling of all layers of the cornea. Front camera is of medium depth, the pupil is irregular, de�Ali and the position of the IOL is not visualized. The vision in the left eye - 0,01 not offset. The state of the left eye in the 1st day after surgery - eyes moderately annoyed, remains the corneal syndrome, biomicroscopic diffuse swelling of all layers of the cornea, in the deeper layers of the cornea, light yellow entered autoplasma, on the edge of the cornea restoration of the epithelial layer.

The state of the eye on the 8th day after the operation - at discharge. Gone are the complaints of pain, feeling of a foreign body in the eye. Eyes moderately annoyed, corneal syndrome is absent, completely restored the integrity of the epithelial layer in the layers of the cornea light yellow autoplasma. Increased transparency of the cornea. Visual acuity in the operated eye - 0,02 not offset.

The condition of the eye through 2 months after surgery - eyes calm, visual acuity in the range of 0.03 is not offset. Completely gone blepharospasm, photophobia and lacrimation. The superficial layers of the corneal epithelization and were transparent, noted the complete absence of bullous bubbles. In the optical zone of the cornea, in the deep layers is ill-defined opacity.

Example 2. Patient B. was admitted to inpatient treatment in the ophthalmology Department of the Amur oblast clinical hospital with the diagnosis of Endothelial-epithelial corneal dystrophy article 3, posterior chamber pseudophakia right eye. The visual acuity of the right - CQ�t of the fingers of a person. The state of the eye - the eye is irritated, expressed blepharospasm, photophobia, lacrimation. Extensive bullous bubbles with areas of erosion, swelling of all corneal layers, folds in descemet's membrane. Front camera is of medium depth, the pupil of the correct form, in pupillary area is viewed posterior chamber IOL. Patient V. produced by the operation of intrastromal certaintie of autoplasma, activated poludanom, according to the method described above. After surgery, the patient is assigned installation in the conjunctival cavity solution ciprofloxacina 6 times a day, of a solution of diclofenac 6 times a day, the laying of corneregel 6 times a day for 14 days. 24 hours after surgery, the patient's condition is satisfactory, the operated eyes moderately annoyed, swelling all layers of the cornea into the stromal layer is rendered introduced autoplasma. Front camera and the pupil area in detail not ophthalmoscopically. Within 5 days after the surgery the patient had no complaints. The operated eyes was almost calm, visual acuity 0,01 not offset. Slight swelling of all layers of the cornea, the epithelium is completely recovered. 1.5 months after surgery during the examination the patient had visual acuity of the operated eye within 0.02 not offset. The eye was completely calm, completely absent corneal syndrome.In the deeper layers was visualized fibrosis of the stroma.

Thus, the proposed method compared to known makes it possible to reduce the trauma due to the exclusion of stitches to secure the edges of the cut and to avoid possible complications in the postoperative period to reduce treatment time by creating a local depot of biologically active molecules (cytokines directly into the tissue of the cornea, which cropped inflammation, stimulates regeneration processes.

A method for the treatment of bullous keratopathy, including the execution of a corneal incision, the dissection of the cornea and the introduction of biologically active substances in stromal pocket, characterized in that you epitelizatia of the cornea, as a biologically active substance is introduced into the stromal pocket of the cornea and conjunctiva paralambano, use autoplasma, activated poludanom, and on the cornea until complete epithelialization placed a soft contact lens and install after surgery in the conjunctival cavity solution of ciprofloxacin 6 times a day, the solution of diclofenac 6 times a day and lay corneregel 6 times a day.



 

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