RU2290191C2 - Method for treatment of tuberculosis uveitis - Google Patents

Abstract

FIELD: medicine, phthisiology.

SUBSTANCE: method involves administration of vilon by parabulbar route in the dose 5 mg, every other day, by course for 10 procedures. Invention promotes to prevention of excessive scarring in the tuberculosis inflammation focus that, in turn, promotes to retention of visual function of eye based on penetration of vilon representing a peptide regulator through the blood-brain barrier being into eye posterior region tissues directly. Invention can be used in treatment of tuberculosis uveitis.

EFFECT: improved method of treatment.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in the complex treatment of tuberculous uveitis.

There is a method of treating tuberculous uveitis, consisting in parabulbar lymphatic administration of anti-tuberculosis antibacterial drugs (E. Lyanenko. Possibilities of lymphatic administration of drugs in the complex treatment of uveitis. Abstract for the degree of candidate of medical sciences St. Petersburg. 2000). The specified method of treatment makes it possible to reduce the drug load on the patient and reduce the time of treatment. However, this method does not allow to avoid the side effects of anti-TB drugs on healthy cells of the retina, which leads to gross tissue fibrosis not only in the area of tuberculous granuloma, but also in the perifocal region, which with central localization does not allow to increase visual acuity.

A known method of treating pulmonary tuberculosis through intramuscular administration of a drug that allows to stimulate the patient's immunity and partially neutralize the side effects of anti-TB drugs that lead to excessive scarring of tissues. (Khudzik L.V., Salina T.Yu. Parolina L.E. et al. Experience in the use of bioregulators and immunocorrectors in patients with tuberculosis // Tuberculosis today. Materials of the 7th Russian Congress of TB Specialists. - Moscow 2003. - P.305.) However with intramuscular injection, the concentration of the drug in the tissues of that organ in which it is required to suppress excessive scarring is extremely low.

There is a method of treating eye diseases by parabulbar administration of a peptide of a nature that inhibits angiogenesis (Khavinson V.Kh., Hokkanen V.M., Trofimova S.V., Malinin V.V. Agent for inhibiting angiogenesis in diseases of the organ of vision. RF patent RU 2177801 C1. Priority from 01.25.01). However, the known properties of the drug do not have an obvious relationship with the newly identified property - the ability of the drug to inhibit fibrosis in tuberculous uveitis, which is objectively confirmed by the following examples. In addition, the disadvantages of this method are the relatively long duration of treatment and a large drug load on the patient. In patients with tuberculous uveitis, this drug was not used.

The aim of the invention is to increase the effectiveness of the treatment of tuberculous uveitis by suppressing (inhibiting) fibrosis in the area of the tuberculosis focus, which leads to a sufficient flow of anti-TB drugs to the tuberculosis focus directly, thereby contributing to a reduction in the size of the lesion and, as a result, an increase in visual functions while reducing the drug load on the patient.

The goal is achieved by parabulbar administration of a peptide bioregulator against the background of ongoing antibacterial anti-tuberculosis therapy. Consider the proposed method for the treatment of tuberculous chorioretinitis. The drug Vilon was used as a peptide bioregulator. It is believed that the mechanism of action of the bioregulator is to activate and regulate protein biosynthesis in the cell, which leads to the stimulation of cell division of the retina, including photoreceptors. The latter circumstance determines the preservation or restoration of visual acuity.

It has been established that the following pathogenetic factors hinder the achievement of success in the antibacterial treatment of tuberculous uveitis: microcirculation disorders, including avascularity of caseous-necrotic foci; the stability of caseous masses, poorly amenable to resorption and elimination from the body; excessive fibrosis, causing functional impairment and leading to insufficient intake of anti-TB drugs to organs, tissues and tuberculosis foci directly. Therefore, it is important to use pathogenetic agents that can affect the above factors that impede healing.

In addition, with tuberculous chorioretinitis in the area of tuberculous granuloma, there is an extensive zone of reversible perifocal changes in the retina and choroid. If a bioregulator is used in this zone, photoreceptors and other retinal cells multiply. Thus, functional rehabilitation of the affected eye is achieved, which leads to a reduction in patients with disabilities.

The method is as follows. The patient is examined ophthalmoscopic status before the introduction of the peptide bioregulator. Then, against the background of the ongoing general and local anti-tuberculosis therapy, the Vilon bioregulator is administered according to the formula: parabulbar 5.0 μg every other day, the course of treatment is 10 procedures. Tuberculosis therapy includes the systemic administration of three anti-TB drugs (isoniazid + pyraznamide + rifampicin) and the mandatory local administration of one anti-TB drug (isoniazid). Ophthalmoscopy and fluorescence fundus angiography (FAGD) methods were used to control the effectiveness of treatment. At the end of treatment, ophthalmoscopic changes in dynamics are studied after 2 weeks, after 1 month, after 3 months: the area of the chorioretinal focus, its prominence, contour contour, the area of perifocal changes, the severity of fibrosis in the inflammation zone, the change in visual acuity and the area of pathological cattle in the field vision before and after treatment with a peptide bioregulator.

Confirmation of the effectiveness of the proposed method are the data obtained in clinical studies in 23 patients (30 eyes) with tuberculous chorioretinitis in the period of stable subsidence of the active phase. The studies were conducted on the basis of the Vyborg - 3 Tuberculosis Sanatorium. The treatment of patients with a bioregulator was carried out against the background of general and local anti-tuberculosis therapy. Two groups were distinguished: the experimental group — the use of a peptide bioregulator against general and local anti-tuberculosis therapy, group 2 control - traditional deystrophic therapy with emoxipin (retinoprotector, not a bioregulator) against the background of general and local anti-tuberculosis therapy.

When comparing the treatment results in patients of group 1 fibrosis (severe scarring) and dystrophic changes in the area of chorioretinal foci disappeared on average after 13.0 ± 2.4 days compared with group 2 (18.0 ± 3.1 days). In 68% of patients of group 1, two weeks after the end of the course of the bioregulator, the area of chorioretinal lesions decreased by an average of 57%, their contours became clearly defined, the prominence decreased by an average of 1.0 diopters, the perifocal retinal pigmentation became smoother, and the area decreased accordingly pathological cattle (on average by 42%) and increased visual acuity by 0.3 ± 0.06. In 32% of patients, these changes were observed within 1 month after the end of the course. In group 2, during these periods, no significant dynamics were observed: visual acuity increased only by 0.07 ± 0.04 and a decrease in the area of pathological cattle was determined only in 33% of patients. In 47% of patients, these changes were observed on average after 2-2.5 months after the end of the course of treatment with emoxipin.

From the above data it can be concluded that the claimed method of treatment has a positive effect, namely, inhibition of fibrosis in the area of the tuberculosis focus, with a reduced drug load on the patient, thus contributing to the preservation or increase of visual functions of the eye. The results obtained suggest the advisability of including this method in the complex etiopathogenetic treatment of tuberculous uveitis.

Examples of the implementation of the proposed method

Example 1 (1 group-experienced)

Patient K., 56 years old, and / b No. 43, was admitted to the sanatorium with a diagnosis of paracentral focal chorioretinitis of the left eye of tuberculous etiology. At the place of residence, he received the main course of complex anti-tuberculosis chemotherapy. The sanatorium was sent for a seasonal anti-relapse course.

Ophthalmoscopic status before treatment with a bioregulator (Vilon): in the paramacular zone, a chorioretinal focus with an area of 1.0 DD with a prominence of 0.5 diopt., With slight pigmentation in area, with clear contours and an extensive area (up to 2.0 DD) of perifocal post-inflammatory chorioretinal dystrophy in the form of disintegration and a fibrous preretinal membrane in the zone of these changes. Visual acuity of the left eye = 0.4, in the field of view is determined by paracentral scotoma (5-7 °). On the fluorescence angiogram of the fundus, a portion of hyperfluorescence with a size of 2.0 DD × 1.5 DD is recorded, corresponding to the zone of post-inflammatory changes.

Given the vastness of these changes in the eye membranes, a course of Vilon peptide bioregulator was prescribed. The drug was used in the form of parabulbar injections of 5 μg every other day with a course of 10 procedures against the background of general and local anti-tuberculosis chemotherapy. The drug is well tolerated; local allergic reactions were not observed. After the procedures were completed, on the 12th day, visual acuity increased from 0.4 to 0.7, metamorphopsies disappeared, the absolute paracentral scotoma decreased to 3-4 °; ophthalmoscopically in the fundus, the fibrous preretinal membrane has resolved; at the site of the chorioretinal lesion, a site of atrophy without prominence remained, and the area of perifocal changes decreased by 1.5 times (according to FAGD).

1 month after Vilon's course, visual acuity increased to 1.0, and absolute paracentral scotoma disappeared. Ophthalmoscopically, the focus of tuberculous inflammation has not changed, but the area of perifocal changes has sharply decreased to 1.0 DD, macular reflexes have been restored, a normal avascular macula with the presence of a paramacular focus without angiographic signs of activity is determined on the fluorescence angiogram.

Example 2 (2 group - control)

Patient N., 43 years old, and / b No. 352, was admitted to the sanatorium with a diagnosis of peripapillary focal tuberculous chorioretinitis of the right eye, for an anti-relapse course. At the place of residence, she received the main course of complex anti-tuberculosis chemotherapy. Visual acuity of the right eye = 0.03. In the field of view is the central absolute scotoma (10 °). Ophthalmoscopically on the fundus is determined a chorioretinal focus area of 1.0 DD, adjacent to the optic nerve disk from the temporal side with clear pigmented contours, with a prominence of 0.5 diopt. and the perifocal zone (more than 3.5 DD) of chorioretinal dystrophy with elements of macular fibroplasia. On the fluorescence angiogram of the fundus, there is a portion of hyperfluorescence measuring 3.0DD × 2.0DD corresponding to the perifocal zone.

The patient received parabulbar injections of emoxipin as a dedistrophic therapy with a course of 20 procedures daily on the background of a similar general and local anti-TB treatment.

When viewed after 2 weeks from the end of treatment, visual acuity is 0.03 n / k, metamorphopsies and a central absolute scotoma in the field of view are preserved, the proination of the chorioretinal focus was the same - 0.5 diopt. On the control FAGD, the hyperfluorescence site of the same size is preserved. After 1 month after treatment, visual functions remained unchanged, the state of the chorioretinal focus in the fundus and perifocal secondary dystrophy was unchanged.

Claims (1)

A method for the treatment of tuberculous uveitis, which consists in carrying out general and local antibacterial anti-tuberculosis therapy, characterized in that, in order to inhibit fibrosis in the area of the tuberculous focus in the eye, 5 mg parabulbular infusion is administered every other day with a course of 10 procedures.