JP2018503433A - 生体の組織において薬剤に対する反応性を回復させるプロセス - Google Patents
生体の組織において薬剤に対する反応性を回復させるプロセス Download PDFInfo
- Publication number
- JP2018503433A JP2018503433A JP2017533206A JP2017533206A JP2018503433A JP 2018503433 A JP2018503433 A JP 2018503433A JP 2017533206 A JP2017533206 A JP 2017533206A JP 2017533206 A JP2017533206 A JP 2017533206A JP 2018503433 A JP2018503433 A JP 2018503433A
- Authority
- JP
- Japan
- Prior art keywords
- laser
- sdm
- laser beam
- treatment
- retinal
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 239000003814 drug Substances 0.000 title claims abstract description 87
- 229940079593 drug Drugs 0.000 title claims abstract description 86
- 238000000034 method Methods 0.000 title claims abstract description 48
- 230000004043 responsiveness Effects 0.000 title claims abstract description 6
- 230000008569 process Effects 0.000 title abstract description 17
- 230000002207 retinal effect Effects 0.000 claims abstract description 45
- 230000003287 optical effect Effects 0.000 claims abstract description 28
- 238000011282 treatment Methods 0.000 claims description 119
- 210000001525 retina Anatomy 0.000 claims description 49
- 210000004087 cornea Anatomy 0.000 claims description 5
- 230000000737 periodic effect Effects 0.000 claims description 4
- 210000001747 pupil Anatomy 0.000 claims description 4
- KCLANYCVBBTKTO-UHFFFAOYSA-N Proparacaine Chemical compound CCCOC1=CC=C(C(=O)OCCN(CC)CC)C=C1N KCLANYCVBBTKTO-UHFFFAOYSA-N 0.000 claims description 3
- 239000012530 fluid Substances 0.000 claims description 3
- 229960003981 proparacaine Drugs 0.000 claims description 3
- 230000000699 topical effect Effects 0.000 claims description 3
- 230000000916 dilatatory effect Effects 0.000 claims description 2
- 238000007493 shaping process Methods 0.000 claims 3
- 210000001519 tissue Anatomy 0.000 description 52
- 210000003583 retinal pigment epithelium Anatomy 0.000 description 44
- 230000000694 effects Effects 0.000 description 35
- 230000001225 therapeutic effect Effects 0.000 description 29
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 28
- 201000010099 disease Diseases 0.000 description 24
- 102000002812 Heat-Shock Proteins Human genes 0.000 description 23
- 108010004889 Heat-Shock Proteins Proteins 0.000 description 23
- 210000004027 cell Anatomy 0.000 description 23
- 208000017442 Retinal disease Diseases 0.000 description 22
- 108090000695 Cytokines Proteins 0.000 description 21
- 102000004127 Cytokines Human genes 0.000 description 21
- 206010012688 Diabetic retinal oedema Diseases 0.000 description 21
- 206010059866 Drug resistance Diseases 0.000 description 21
- 201000011190 diabetic macular edema Diseases 0.000 description 21
- 230000000649 photocoagulation Effects 0.000 description 21
- 206010012689 Diabetic retinopathy Diseases 0.000 description 16
- 108010073929 Vascular Endothelial Growth Factor A Proteins 0.000 description 16
- 102000005789 Vascular Endothelial Growth Factors Human genes 0.000 description 16
- 108010019530 Vascular Endothelial Growth Factors Proteins 0.000 description 16
- 206010064930 age-related macular degeneration Diseases 0.000 description 16
- 238000002560 therapeutic procedure Methods 0.000 description 16
- 229960002833 aflibercept Drugs 0.000 description 15
- 108010081667 aflibercept Proteins 0.000 description 15
- 208000002780 macular degeneration Diseases 0.000 description 15
- 230000007246 mechanism Effects 0.000 description 15
- 230000006378 damage Effects 0.000 description 14
- 238000002647 laser therapy Methods 0.000 description 14
- 206010057430 Retinal injury Diseases 0.000 description 12
- 230000004044 response Effects 0.000 description 12
- 201000004569 Blindness Diseases 0.000 description 11
- 238000002347 injection Methods 0.000 description 11
- 239000007924 injection Substances 0.000 description 11
- 238000004519 manufacturing process Methods 0.000 description 11
- 238000001126 phototherapy Methods 0.000 description 11
- 230000004438 eyesight Effects 0.000 description 10
- 230000001976 improved effect Effects 0.000 description 10
- 230000004243 retinal function Effects 0.000 description 10
- 230000000638 stimulation Effects 0.000 description 10
- 230000008901 benefit Effects 0.000 description 9
- 230000006870 function Effects 0.000 description 9
- 230000001965 increasing effect Effects 0.000 description 9
- 238000012014 optical coherence tomography Methods 0.000 description 9
- 230000004393 visual impairment Effects 0.000 description 9
- XKRFYHLGVUSROY-UHFFFAOYSA-N Argon Chemical compound [Ar] XKRFYHLGVUSROY-UHFFFAOYSA-N 0.000 description 8
- 208000001344 Macular Edema Diseases 0.000 description 8
- 230000001404 mediated effect Effects 0.000 description 8
- 208000003569 Central serous chorioretinopathy Diseases 0.000 description 7
- 208000024891 symptom Diseases 0.000 description 7
- 238000012360 testing method Methods 0.000 description 7
- 230000009286 beneficial effect Effects 0.000 description 6
- 238000010586 diagram Methods 0.000 description 6
- 238000002651 drug therapy Methods 0.000 description 6
- 230000006872 improvement Effects 0.000 description 6
- 238000002428 photodynamic therapy Methods 0.000 description 6
- 201000007914 proliferative diabetic retinopathy Diseases 0.000 description 6
- 230000002829 reductive effect Effects 0.000 description 6
- 230000008439 repair process Effects 0.000 description 6
- 230000000451 tissue damage Effects 0.000 description 6
- 231100000827 tissue damage Toxicity 0.000 description 6
- 230000006711 vascular endothelial growth factor production Effects 0.000 description 6
- 206010058202 Cystoid macular oedema Diseases 0.000 description 5
- 206010043087 Tachyphylaxis Diseases 0.000 description 5
- 230000005856 abnormality Effects 0.000 description 5
- 230000008859 change Effects 0.000 description 5
- 230000001684 chronic effect Effects 0.000 description 5
- 201000010206 cystoid macular edema Diseases 0.000 description 5
- 230000017525 heat dissipation Effects 0.000 description 5
- 206010061218 Inflammation Diseases 0.000 description 4
- 206010025421 Macule Diseases 0.000 description 4
- 206010038848 Retinal detachment Diseases 0.000 description 4
- 230000004913 activation Effects 0.000 description 4
- 229910052786 argon Inorganic materials 0.000 description 4
- 230000005779 cell damage Effects 0.000 description 4
- 208000037887 cell injury Diseases 0.000 description 4
- 230000001627 detrimental effect Effects 0.000 description 4
- 239000000835 fiber Substances 0.000 description 4
- 230000004054 inflammatory process Effects 0.000 description 4
- 230000001575 pathological effect Effects 0.000 description 4
- 230000000144 pharmacologic effect Effects 0.000 description 4
- 238000011321 prophylaxis Methods 0.000 description 4
- 238000011268 retreatment Methods 0.000 description 4
- 102000015696 Interleukins Human genes 0.000 description 3
- 108010063738 Interleukins Proteins 0.000 description 3
- 206010025415 Macular oedema Diseases 0.000 description 3
- 208000014139 Retinal vascular disease Diseases 0.000 description 3
- 206010070834 Sensitisation Diseases 0.000 description 3
- 238000010521 absorption reaction Methods 0.000 description 3
- 238000009098 adjuvant therapy Methods 0.000 description 3
- 230000007012 clinical effect Effects 0.000 description 3
- 238000002485 combustion reaction Methods 0.000 description 3
- 230000016396 cytokine production Effects 0.000 description 3
- 230000002939 deleterious effect Effects 0.000 description 3
- 238000011161 development Methods 0.000 description 3
- 206010012601 diabetes mellitus Diseases 0.000 description 3
- 208000035475 disorder Diseases 0.000 description 3
- 238000009826 distribution Methods 0.000 description 3
- 230000000857 drug effect Effects 0.000 description 3
- 230000004064 dysfunction Effects 0.000 description 3
- 229940090044 injection Drugs 0.000 description 3
- 230000003902 lesion Effects 0.000 description 3
- 231100000518 lethal Toxicity 0.000 description 3
- 230000001665 lethal effect Effects 0.000 description 3
- 201000010230 macular retinal edema Diseases 0.000 description 3
- 239000013307 optical fiber Substances 0.000 description 3
- 239000000049 pigment Substances 0.000 description 3
- 238000004393 prognosis Methods 0.000 description 3
- 230000005855 radiation Effects 0.000 description 3
- 230000009467 reduction Effects 0.000 description 3
- 230000008313 sensitization Effects 0.000 description 3
- 238000009097 single-agent therapy Methods 0.000 description 3
- 210000002301 subretinal fluid Anatomy 0.000 description 3
- 230000004304 visual acuity Effects 0.000 description 3
- 206010003694 Atrophy Diseases 0.000 description 2
- 208000005590 Choroidal Neovascularization Diseases 0.000 description 2
- 206010060823 Choroidal neovascularisation Diseases 0.000 description 2
- 208000027418 Wounds and injury Diseases 0.000 description 2
- 230000002159 abnormal effect Effects 0.000 description 2
- 230000009471 action Effects 0.000 description 2
- 230000002411 adverse Effects 0.000 description 2
- 229940027545 aflibercept injection Drugs 0.000 description 2
- 238000013459 approach Methods 0.000 description 2
- 230000037444 atrophy Effects 0.000 description 2
- 229960000397 bevacizumab Drugs 0.000 description 2
- 230000004071 biological effect Effects 0.000 description 2
- 230000001413 cellular effect Effects 0.000 description 2
- 238000006243 chemical reaction Methods 0.000 description 2
- 230000015271 coagulation Effects 0.000 description 2
- 238000005345 coagulation Methods 0.000 description 2
- 230000008878 coupling Effects 0.000 description 2
- 238000010168 coupling process Methods 0.000 description 2
- 238000005859 coupling reaction Methods 0.000 description 2
- 238000005520 cutting process Methods 0.000 description 2
- 230000000254 damaging effect Effects 0.000 description 2
- 238000003745 diagnosis Methods 0.000 description 2
- 231100000673 dose–response relationship Toxicity 0.000 description 2
- 230000005611 electricity Effects 0.000 description 2
- 238000005516 engineering process Methods 0.000 description 2
- 230000009931 harmful effect Effects 0.000 description 2
- 230000028993 immune response Effects 0.000 description 2
- 230000001939 inductive effect Effects 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 230000010354 integration Effects 0.000 description 2
- 230000005923 long-lasting effect Effects 0.000 description 2
- 230000007774 longterm Effects 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 230000010534 mechanism of action Effects 0.000 description 2
- 210000004379 membrane Anatomy 0.000 description 2
- 239000012528 membrane Substances 0.000 description 2
- 230000002503 metabolic effect Effects 0.000 description 2
- 210000001328 optic nerve Anatomy 0.000 description 2
- 230000036961 partial effect Effects 0.000 description 2
- 230000002688 persistence Effects 0.000 description 2
- 239000012660 pharmacological inhibitor Substances 0.000 description 2
- 230000000886 photobiology Effects 0.000 description 2
- 238000006303 photolysis reaction Methods 0.000 description 2
- 230000015843 photosynthesis, light reaction Effects 0.000 description 2
- 230000003389 potentiating effect Effects 0.000 description 2
- 230000002062 proliferating effect Effects 0.000 description 2
- 229960003876 ranibizumab Drugs 0.000 description 2
- 208000004644 retinal vein occlusion Diseases 0.000 description 2
- 230000002441 reversible effect Effects 0.000 description 2
- 230000035945 sensitivity Effects 0.000 description 2
- 230000003595 spectral effect Effects 0.000 description 2
- 230000035882 stress Effects 0.000 description 2
- 239000000126 substance Substances 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 230000008685 targeting Effects 0.000 description 2
- 230000002792 vascular Effects 0.000 description 2
- 229960003895 verteporfin Drugs 0.000 description 2
- ZQFGRJWRSLZCSQ-ZSFNYQMMSA-N verteporfin Chemical compound C=1C([C@@]2([C@H](C(=O)OC)C(=CC=C22)C(=O)OC)C)=NC2=CC(C(=C2C=C)C)=NC2=CC(C(=C2CCC(O)=O)C)=NC2=CC2=NC=1C(C)=C2CCC(=O)OC ZQFGRJWRSLZCSQ-ZSFNYQMMSA-N 0.000 description 2
- 230000000007 visual effect Effects 0.000 description 2
- CZLVPINBLDRZCJ-UHFFFAOYSA-N 2,3,4,4,5,5,6,6-octachlorocyclohex-2-en-1-one Chemical compound ClC1=C(Cl)C(Cl)(Cl)C(Cl)(Cl)C(Cl)(Cl)C1=O CZLVPINBLDRZCJ-UHFFFAOYSA-N 0.000 description 1
- 238000012935 Averaging Methods 0.000 description 1
- 206010010356 Congenital anomaly Diseases 0.000 description 1
- 206010061818 Disease progression Diseases 0.000 description 1
- 206010013709 Drug ineffective Diseases 0.000 description 1
- 108050001049 Extracellular proteins Proteins 0.000 description 1
- 208000008069 Geographic Atrophy Diseases 0.000 description 1
- 208000010412 Glaucoma Diseases 0.000 description 1
- 241000282412 Homo Species 0.000 description 1
- 206010020843 Hyperthermia Diseases 0.000 description 1
- 102000002274 Matrix Metalloproteinases Human genes 0.000 description 1
- 108010000684 Matrix Metalloproteinases Proteins 0.000 description 1
- 206010034133 Pathogen resistance Diseases 0.000 description 1
- 206010066901 Treatment failure Diseases 0.000 description 1
- 239000002671 adjuvant Substances 0.000 description 1
- 230000002776 aggregation Effects 0.000 description 1
- 238000004220 aggregation Methods 0.000 description 1
- 238000004458 analytical method Methods 0.000 description 1
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 1
- 230000006399 behavior Effects 0.000 description 1
- 230000008512 biological response Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 210000004204 blood vessel Anatomy 0.000 description 1
- 210000004155 blood-retinal barrier Anatomy 0.000 description 1
- 230000004378 blood-retinal barrier Effects 0.000 description 1
- 210000004556 brain Anatomy 0.000 description 1
- 230000015556 catabolic process Effects 0.000 description 1
- 238000006555 catalytic reaction Methods 0.000 description 1
- 230000030833 cell death Effects 0.000 description 1
- 230000003915 cell function Effects 0.000 description 1
- 230000004637 cellular stress Effects 0.000 description 1
- 238000003776 cleavage reaction Methods 0.000 description 1
- 230000004456 color vision Effects 0.000 description 1
- 238000012790 confirmation Methods 0.000 description 1
- 230000001276 controlling effect Effects 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- 230000003013 cytotoxicity Effects 0.000 description 1
- 231100000135 cytotoxicity Toxicity 0.000 description 1
- 230000006735 deficit Effects 0.000 description 1
- 230000003412 degenerative effect Effects 0.000 description 1
- 238000006731 degradation reaction Methods 0.000 description 1
- 230000003111 delayed effect Effects 0.000 description 1
- 238000013461 design Methods 0.000 description 1
- 238000009792 diffusion process Methods 0.000 description 1
- 230000006806 disease prevention Effects 0.000 description 1
- 230000005750 disease progression Effects 0.000 description 1
- 208000011325 dry age related macular degeneration Diseases 0.000 description 1
- 230000008482 dysregulation Effects 0.000 description 1
- 238000002571 electroretinography Methods 0.000 description 1
- 230000008030 elimination Effects 0.000 description 1
- 238000003379 elimination reaction Methods 0.000 description 1
- 230000002124 endocrine Effects 0.000 description 1
- 239000002360 explosive Substances 0.000 description 1
- 210000000416 exudates and transudate Anatomy 0.000 description 1
- 230000008713 feedback mechanism Effects 0.000 description 1
- 230000002496 gastric effect Effects 0.000 description 1
- 238000001415 gene therapy Methods 0.000 description 1
- 125000001475 halogen functional group Chemical group 0.000 description 1
- 238000005338 heat storage Methods 0.000 description 1
- 210000003958 hematopoietic stem cell Anatomy 0.000 description 1
- 230000013632 homeostatic process Effects 0.000 description 1
- 201000001421 hyperglycemia Diseases 0.000 description 1
- 230000036031 hyperthermia Effects 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 210000002865 immune cell Anatomy 0.000 description 1
- 230000028709 inflammatory response Effects 0.000 description 1
- 238000011221 initial treatment Methods 0.000 description 1
- 230000003993 interaction Effects 0.000 description 1
- 238000001990 intravenous administration Methods 0.000 description 1
- 238000012153 long-term therapy Methods 0.000 description 1
- 238000002483 medication Methods 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 230000004660 morphological change Effects 0.000 description 1
- 230000017074 necrotic cell death Effects 0.000 description 1
- 210000002569 neuron Anatomy 0.000 description 1
- 239000002547 new drug Substances 0.000 description 1
- 210000002445 nipple Anatomy 0.000 description 1
- 238000010606 normalization Methods 0.000 description 1
- 230000000414 obstructive effect Effects 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 238000012261 overproduction Methods 0.000 description 1
- 239000001301 oxygen Substances 0.000 description 1
- 229910052760 oxygen Inorganic materials 0.000 description 1
- 239000002831 pharmacologic agent Substances 0.000 description 1
- 238000011422 pharmacological therapy Methods 0.000 description 1
- 238000001050 pharmacotherapy Methods 0.000 description 1
- 230000019612 pigmentation Effects 0.000 description 1
- 238000003825 pressing Methods 0.000 description 1
- 238000002203 pretreatment Methods 0.000 description 1
- 208000037821 progressive disease Diseases 0.000 description 1
- 230000000750 progressive effect Effects 0.000 description 1
- 230000006432 protein unfolding Effects 0.000 description 1
- 108090000623 proteins and genes Proteins 0.000 description 1
- 102000004169 proteins and genes Human genes 0.000 description 1
- 230000001172 regenerating effect Effects 0.000 description 1
- 230000001105 regulatory effect Effects 0.000 description 1
- 230000008263 repair mechanism Effects 0.000 description 1
- 238000011160 research Methods 0.000 description 1
- 210000001533 respiratory mucosa Anatomy 0.000 description 1
- 230000004283 retinal dysfunction Effects 0.000 description 1
- 230000004253 retinal exposure Effects 0.000 description 1
- 210000001210 retinal vessel Anatomy 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 230000007017 scission Effects 0.000 description 1
- 239000004065 semiconductor Substances 0.000 description 1
- 201000003772 severe nonproliferative diabetic retinopathy Diseases 0.000 description 1
- 238000009168 stem cell therapy Methods 0.000 description 1
- 238000009580 stem-cell therapy Methods 0.000 description 1
- 230000004936 stimulating effect Effects 0.000 description 1
- 230000009885 systemic effect Effects 0.000 description 1
- 230000004797 therapeutic response Effects 0.000 description 1
- 230000008719 thickening Effects 0.000 description 1
- 210000001585 trabecular meshwork Anatomy 0.000 description 1
- 238000011269 treatment regimen Methods 0.000 description 1
- 230000001960 triggered effect Effects 0.000 description 1
- 230000001228 trophic effect Effects 0.000 description 1
- 230000003827 upregulation Effects 0.000 description 1
- 239000002525 vasculotropin inhibitor Substances 0.000 description 1
- 230000002227 vasoactive effect Effects 0.000 description 1
- 238000012795 verification Methods 0.000 description 1
- 239000008154 viscoelastic solution Substances 0.000 description 1
- 230000004382 visual function Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/06—Radiation therapy using light
- A61N5/0613—Apparatus adapted for a specific treatment
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/06—Radiation therapy using light
- A61N5/067—Radiation therapy using light using laser light
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
- A61F2009/00863—Retina
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/0008—Introducing ophthalmic products into the ocular cavity or retaining products therein
- A61F9/0017—Introducing ophthalmic products into the ocular cavity or retaining products therein implantable in, or in contact with, the eye, e.g. ocular inserts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/00727—Apparatus for retinal reattachment
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/06—Radiation therapy using light
- A61N2005/063—Radiation therapy using light comprising light transmitting means, e.g. optical fibres
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/06—Radiation therapy using light
- A61N2005/0635—Radiation therapy using light characterised by the body area to be irradiated
- A61N2005/0642—Irradiating part of the body at a certain distance
Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Veterinary Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Ophthalmology & Optometry (AREA)
- Physics & Mathematics (AREA)
- Optics & Photonics (AREA)
- Pathology (AREA)
- Radiology & Medical Imaging (AREA)
- Vascular Medicine (AREA)
- Heart & Thoracic Surgery (AREA)
- Surgery (AREA)
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
- Laser Surgery Devices (AREA)
Abstract
Description
本発明は、一般に生物組織の光線療法または光刺激に関する。より具体的には、本発明は、医学的に無反応な又は病変した組織、特に網膜および類似した組織の感作または再感作のための閾値以下のダイオードマイクロパルス(sub−threshold diode micropulse)(SDM)レーザー治療の方法を含む、生体組織における保護および疾患予防のためのレーザーアジュバント療法での処置の方法に関する。
特に好ましい実施形態では、小さなレーザースポットが使用される。これは、より大きなスポットが、大きなレーザースポット内の不均一な熱分布および不十分な熱放散に寄与し得るという事実が原因であり、これは、組織損傷またはより大きなレーザースポットの中心への組織破壊さえ引き起こす可能性がある。この用途において、「小さな」は、一般に直径1mm未満のスポットに当てはまる。しかしながら、スポットが小さければ小さいほど、熱放散および均一なエネルギー応用がより理想的になる。したがって、上に記載されるパワー強度および曝露期間では、レーザーの波長の大きさに沿ったスポットなどの小さなスポット、または小さな幾何学的ラインあるいは他のオブジェクトが、組織損傷を回避するべく均一な熱分布および熱放散を最大限にするために好まれる。
<近似方程式からのアレニウス積分に対する結果>
薬物耐性のNAMDのSDM療法に関する具体的な研究において、本発明者は、特定の選択基準に従って患者を選択した。SDM療法に対する候補は、初期の投薬の有効性および続く薬物無反応性の発達とともに抗VEGF薬剤の硝子体内注入を必要とするNAMDであると診断されたに違いない。該診断は、数週間空けて与えられたアフリベルセプトの少なくとも3回連続の注射を含む、少なくとも4回連続の抗VEGF注射にもかかわらず、スペクトルドメインの光干渉断層撮影(OCT)によって網膜下液(SRF)及び/又は類嚢胞黄斑浮腫(CME)の持続または悪化によって定義されたに違いない。その後、患者は、薬物耐性の診断後にSDM療法を受け、SDMの単一の処置セッションの1か月後におよびSDM療法の少なくとも2か月後のフォローアップにアフリベルセプトを再び注射された。
別の研究では、すべての抗VEGF薬剤に無反応であった連続する眼においてSDMを実行した。薬物反応の損失、または薬物に対する耐性は、アフリベルセプトの少なくとも2回の連続する最終的な毎月の注射を含む、OCTによる改善のない少なくとも4回の連続する毎月の薬物注射をとして定義された。最後の無効性のアフリベルセプト注射の1か月後に、SDM処置を実行した。RPEに対するSDMの効果の発達を妨害しないようにSDM処置の時には抗VEGF薬物を注射しなかった。SDM処置の1か月後に、各眼をOCTによって再評価し、毎月のアフリベルセプト治療を再開した。
このシステム40’において、複数の光源42は、前のシステム40に記載されたものと類似した経路に従う、つまり、コリメートし、回折され、再びコリメートし、およびステアリング機構を用いて網膜へと配向される。これでは、代替的なシステム40’において、回折素子は、通る光の波長に依存して、前に記載されたものとは異なって機能しなければならず、これは、結果としてパターンのわずかな変化につながる。その変化は、回折されている光源の波長と直線状になっている。一般に、回折角の差は、異なる重複パターンが、処置のためにステアリング機構46を通って網膜48に向かう同じ光路に沿って配向されるのに十分な小さな差である。回折角のわずかな差は、ステアリングパターンがどれほどの網膜の適用範囲を達成するかに影響を与える。
システム40’’は、処置に使用されている光の波長と同じくらい多くのチャネル80a、80b、80cなど及びビームスプリッター78a、78b、78cなどを使用し得る。
Claims (18)
- 網膜組織において投薬に対する反応性を回復させる方法であって、該方法は、
レーザー源から集密的な近接するレーザー光線を生じさせる工程;
光学レンズまたはマスクを介してレーザー光線を光学的に形作る工程;
網膜組織をレーザー光線に曝露する工程;および
予め決められた期間の間、網膜組織を回復させ、その後、網膜組織が無反応であった場所に投薬を行う工程を含む、方法。 - 網膜組織を含有している眼の瞳孔を散大させる工程を含む、請求項1に記載の方法。
- 局所用プロパラカインを眼の角膜に適用する工程をさらに含む、請求項1に記載の方法。
- 黄斑用のコンタクトレンズに粘弾性流体を適用する工程をさらに含む、請求項1に記載の方法。
- 黄斑用のコンタクトレンズが1.05×の拡大率を有する、請求項5に記載の方法。
- 曝露工程が、レーザー光線を網膜全体に曝露する工程を含む、請求項1に記載の方法。
- 集密的な近接するレーザー光線が、閾値以下のダイオードマイクロパルスレーザー光線を含む、請求項1乃至6のいずれかに記載の方法。
- 閾値以下のダイオードマイクロパルスレーザー光線が、300ミクロンの治療部位当たり400から1200の間のスポットを含む高密度を有している、請求項7に記載の方法。
- 閾値以下のダイオードマイクロパルスレーザー光線が、2.0ワットで750nm−1300nmの間の波長を有している、請求項7に記載の方法。
- 波長がおよそ810nmである、請求項9に記載の方法。
- 閾値以下のダイオードマイクロパルスレーザー光線が、10%未満のデューティーサイクルおよび0.02秒の曝露期間を有している、請求項7に記載の方法。
- デューティーサイクルがおよそ5%である、請求項11に記載の方法。
- 閾値以下のダイオードマイクロパルスレーザー光線が、500ミリ秒以下のパルス長を有している、請求項7に記載の方法。
- パルス長が20ミリ秒である、請求項13に記載の方法。
- 予め決められた期間が1か月である、請求項1に記載の方法。
- 光学的に形作る工程が、周期的パターンをもたらすようにレーザー光線を回折する工程を含む、請求項1に記載の方法。
- 周期的パターンが大量の別々のスポットを含む、請求項16に記載の方法。
- 光学的に形作る工程が、網膜組織を完全にカバーするように大量の別々のスポットを順次オフセットする工程を含む、請求項17に記載の方法。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/607,959 | 2015-01-28 | ||
US14/607,959 US9168174B2 (en) | 2012-05-25 | 2015-01-28 | Process for restoring responsiveness to medication in tissue of living organisms |
PCT/US2015/049090 WO2016122717A1 (en) | 2015-01-28 | 2015-09-09 | Process for restoring responsiveness to medication in tissue of living organisms |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2018503433A true JP2018503433A (ja) | 2018-02-08 |
JP6527946B2 JP6527946B2 (ja) | 2019-06-12 |
Family
ID=56544118
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2017533206A Active JP6527946B2 (ja) | 2015-01-28 | 2015-09-09 | 生体の組織において薬剤に対する反応性を回復させるプロセス |
Country Status (8)
Country | Link |
---|---|
EP (1) | EP3250166A4 (ja) |
JP (1) | JP6527946B2 (ja) |
CN (1) | CN107205846A (ja) |
AU (1) | AU2015380376B2 (ja) |
BR (1) | BR112017016255A2 (ja) |
CA (1) | CA2972420A1 (ja) |
SG (1) | SG11201705655TA (ja) |
WO (1) | WO2016122717A1 (ja) |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP4248923A1 (de) * | 2022-03-25 | 2023-09-27 | OD-OS GmbH | System, vorrichtung und verfahren zur erstellung von planungsdatensätzen für die gewebebehandlung der netzhaut eines patienten |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20090287138A1 (en) * | 2008-05-14 | 2009-11-19 | Latina Mark A | Laser assisted therapeutic agent delivery into a targeted tissue |
WO2013176810A1 (en) * | 2012-05-25 | 2013-11-28 | Luttrull Jeffrey K | System and process for retina phototherapy |
Family Cites Families (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
ES2536085T3 (es) * | 2010-10-26 | 2015-05-20 | Alcon Research, Ltd | Lente de contacto quirúrgica oftalmoscópica |
US10238541B2 (en) * | 2011-10-19 | 2019-03-26 | Iridex Corporation | Short duration pulse grid pattern laser treatment and methods |
US9381115B2 (en) * | 2012-05-25 | 2016-07-05 | Ojai Retinal Technology, Llc | System and process for retina phototherapy |
JP6439271B2 (ja) * | 2013-04-30 | 2018-12-19 | 株式会社ニデック | レーザ治療装置 |
-
2015
- 2015-09-09 CN CN201580074358.1A patent/CN107205846A/zh active Pending
- 2015-09-09 CA CA2972420A patent/CA2972420A1/en not_active Abandoned
- 2015-09-09 JP JP2017533206A patent/JP6527946B2/ja active Active
- 2015-09-09 BR BR112017016255A patent/BR112017016255A2/pt not_active Application Discontinuation
- 2015-09-09 AU AU2015380376A patent/AU2015380376B2/en active Active
- 2015-09-09 EP EP15880604.2A patent/EP3250166A4/en not_active Withdrawn
- 2015-09-09 WO PCT/US2015/049090 patent/WO2016122717A1/en active Application Filing
- 2015-09-09 SG SG11201705655TA patent/SG11201705655TA/en unknown
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20090287138A1 (en) * | 2008-05-14 | 2009-11-19 | Latina Mark A | Laser assisted therapeutic agent delivery into a targeted tissue |
WO2013176810A1 (en) * | 2012-05-25 | 2013-11-28 | Luttrull Jeffrey K | System and process for retina phototherapy |
Also Published As
Publication number | Publication date |
---|---|
WO2016122717A1 (en) | 2016-08-04 |
EP3250166A4 (en) | 2018-09-12 |
BR112017016255A2 (pt) | 2018-03-27 |
CN107205846A (zh) | 2017-09-26 |
SG11201705655TA (en) | 2017-08-30 |
CA2972420A1 (en) | 2016-08-04 |
AU2015380376A1 (en) | 2017-07-20 |
EP3250166A1 (en) | 2017-12-06 |
JP6527946B2 (ja) | 2019-06-12 |
AU2015380376B2 (en) | 2019-04-11 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US10278865B2 (en) | Process for neuroprotective therapy for glaucoma | |
US9381116B2 (en) | Subthreshold micropulse laser prophylactic treatment for chronic progressive retinal diseases | |
US9168174B2 (en) | Process for restoring responsiveness to medication in tissue of living organisms | |
US8210184B2 (en) | Controlled biothermotherapy | |
AU2021215167B2 (en) | System and process for retina phototherapy | |
AU2015380409B2 (en) | Subthreshold micropulse laser prophylactic treatment for chronic progressive retinal diseases | |
JP2022184907A (ja) | 近視の治療のためのシステムおよびプロセス | |
EP3451983B1 (en) | System for neuroprotective therapy for glaucoma | |
JP6527946B2 (ja) | 生体の組織において薬剤に対する反応性を回復させるプロセス |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20170913 |
|
A621 | Written request for application examination |
Free format text: JAPANESE INTERMEDIATE CODE: A621 Effective date: 20171120 |
|
A977 | Report on retrieval |
Free format text: JAPANESE INTERMEDIATE CODE: A971007 Effective date: 20180824 |
|
A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20180903 |
|
A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20181128 |
|
A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20190130 |
|
A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20190415 |
|
TRDD | Decision of grant or rejection written | ||
A01 | Written decision to grant a patent or to grant a registration (utility model) |
Free format text: JAPANESE INTERMEDIATE CODE: A01 Effective date: 20190422 |
|
A61 | First payment of annual fees (during grant procedure) |
Free format text: JAPANESE INTERMEDIATE CODE: A61 Effective date: 20190513 |
|
R150 | Certificate of patent or registration of utility model |
Ref document number: 6527946 Country of ref document: JP Free format text: JAPANESE INTERMEDIATE CODE: R150 |
|
R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |