RU2012295C1 - Method of treating optical nerve atrophy - Google Patents

Abstract

FIELD: medicine, particularly, ophthalmology. SUBSTANCE: this method prescribes blocking periarterial plexuses of vertebral arteries using 2-percent solution of marcaine to be taken in dose of 2 to 3 mg/kg in combination with cavintone to be taken in amount of 1 mg/kg. Blockades are to be made daily during 7 to 10 days alternately on right-hand and left-hand sides. EFFECT: improved visual functions and treatment period cut down by 10 to 20 days.

Description

 The invention relates to medicine, namely to ophthalmology, and is proposed for the treatment of patients with optic atrophy.

 The prototype of the invention is "The effectiveness of local use of compliance and ATP in the treatment of patients with primary and secondary atrophy of the optic nerve." N. And, Shpak, L.I. Fedorova, V.V. Savko, N.V. Konovalova. Ophthalmological Journal, N 3, 1985. In order to achieve a positive therapeutic effect, they use locally, under the skin of the temples 0.1 ml each and simultaneously ATP parabulbar 0.1 ml each on the background of tissue and vitamin therapy (10-12 injections for each eye every other day).

 The disadvantages of this method are its low efficiency, with initial values of visual acuity below 0.1-0.2, the therapeutic effect is negligible, in addition, the course of treatment is long (3-4 weeks), prolonged use of compliant containing nicotinic acid can lead to fatty degeneration of the liver and cause intestinal paresis. In addition, manifestations of individual intolerance are possible.

 The aim of the invention is to improve visual function and reduce treatment time.

 This goal is achieved by the fact that in order to improve visual function and reduce treatment time, the periarterial plexus of the vertebral arteries is blocked by injections with a 2% solution of marcaine at a dose of 2-3 mg / kg in combination with cavinton (1 mg / kg), which is carried out daily for 7-10 days alternately on the right and left side.

 The proposed set of distinctive features determines the appearance of the claimed method of properties that, by eliminating the pathological irritation of the periarterial plexus of the vertebral arteries, lead to vasodilation in the system of vertebral arteries, significantly increases the linear and volumetric blood flow velocity in them, which in turn through a. basilaris and the system of connective arteries increases blood flow in the orbital artery, thereby improving the blood supply to the optic nerve.

 In the pathogenesis of optic atrophy, the main role is played by disturbances in microcirculation and metabolism.

 The method is based on a pharmacological blockade, which eliminates the pathological irritation of the periarterial plexus of the vertebral arteries, causes the vessels of the pool of vertebral arteries to expand, significantly increases the blood flow velocity in them, and therefore improves the blood supply to the optic nerve through the system of basilar arteries. Cavinton - has a selective cerebral vasodilator and antivasoconstrictor effect, without affecting the general blood circulation, promotes oxygen transport in the brain tissue, increases the absorption and utilization of glucose and oxygen by the brain tissue, and enhances brain metabolism.

 A dosage of markain less than 2 mg / kg is insufficient, and more than 3 mg / kg is undesirable, due to possible toxic effects. At a dose of cavinton less than 1 mg / kg, the clinical effect of the drug is poorly expressed, and a dose of more than 1 mg / kg is not recommended.

 The proposed method is as follows. The patient’s position on the back with a small roller under the shoulder blades is the head allotted in the direction opposite to the puncture. Blood pressure (BP), heart rate (HR), respiratory rate (ES) are measured using a CARDIOCAP monitor (Finland). A 2% solution of marcaine 2-3 mg / kg, cavinton 1 mg / kg are collected in a 20 ml syringe, diluted with saline to 15 ml, combined with a standard needle 5 cm long and 0.6 mm in diameter. The skin at the puncture site is treated twice with alcohol. Through the anesthetized area of the skin 4 cm above the clavicle, at the posterior edge of the sternocleidomastoid muscle, the needle is pierced perpendicularly and brought to the spine. Enter 2 ml of solution. Then the needle is pulled a few millimeters and pulling on the piston of the syringe, and making sure that there is no blood, the remaining solution is injected. The needle is removed, an aseptic sticker. Blood pressure, heart rate, BH, IOP are measured, assessing the clinical condition, patients are left in a horizontal position for an hour.

 To confirm the effectiveness of the method, clinical studies were conducted in 18 patients with optic atrophy.

 PRI me R 1. Patient K., 34 years. For 5 years, it was treated conservatively, eyesight progressively worsened. In 1989, vision on the left eye sharply worsened. Surgical treatment was carried out: restrictive laser coagulation on the right eye. On the left there is a circlet, release of subretinal fluid, cryopexy.

 In MNTK "MG" was admitted with a diagnosis of: right eye - retinal pigmented chorioretinal dystrophy. The left eye is an atrophy of the optic nerve. Ophthalmostatus: the right eye - the optic disc is pale pink, the borders are clear, the vessels of ordinary caliber. Dystrophic changes in the periphery of the retina. Vis 0.8. The left eye - the retina is adjacent, chorioretinal dystrophy, atrophy of the optic nerve. Condition after laser coagulation surgery. Vis 0.04.

 Perimetry: the right eye - the boundaries of the visual field are normal, a single relative scotoma adjacent to the blind spot. The left eye is the limitation of the field of view to 20 degrees.

 The treatment for the proposed method.

 The position of the patient on the back with a small roll under the shoulder blades, the head is allotted in the direction opposite to the puncture, HELL 130 / 80mm RT. Art. , Heart rate of 80 in 1 min, BH of 17 in 1 min.

 A 2% solution of marcaine 2 mg / kg, cavinton 1 mg / kg are collected in a 20 ml syringe, diluted with saline to 15 ml, connected to a standard needle 5 cm long and 0.6 mm in diameter. The skin at the puncture site is treated twice with alcohol. Through the anesthetized area of the skin 4 cm above the clavicle, at the posterior edge of the sternocleidomastoid muscle, the needle is pierced perpendicularly and brought to the spine. Enter 2 ml of solution. Then we tighten the needle by a few millimeters and, pulling on the syringe plunger and making sure that there is no blood, inject the remaining solution. The needle is removed, an aseptic sticker.

 The treatment was carried out daily alternately on the right and left side for 7 days.

 After examination: Vis OD -1.0; OS - 0.3.

 Perimetry: OD - the blind spot is normal, there are no scotomas.

 OS - limiting the field of view to 40 degrees.

 PRI me R 2. Patient A., 65 years old, N a / c 67830. Sick for 7 years, conservative treatment in various clinics was ineffective. In the ISTC "MG" was admitted with a diagnosis of OD Maculodystrophy of the type of Cont-Unius. Atrophy of the optic nerve.

 OS Initial macular degeneration.

 Ophthalmostatus: Vis OD 0.01. Perimetry: OD limits the field of view to 10 degrees.

OS 0.5
OS two relative scotomas adjacent to the blind spot.

 A / D 160/90 mm RT. Art. , Heart rate 82 in 1 min, BH 17.

 The method is carried out according to the proposed method according to example 1: dose of marcaine 3 mg / kg, dose of cavinton 1 mg / kg The treatment was carried out daily, alternately from the right and left side for 10 days.

 After examination: Vis OD - 0.07.

 OS - 0.6.

 Perimetry: OD - restriction of the field of view to 30 degrees.

 OS - a blind spot is normal, no cattle.

 The method is indicated for vascular neuropathies of the optic nerve, pigmented chorioretinal retinal dystrophies, ultimately leading to optic atrophy.

 The method does not have absolute contraindications, relative contraindications in patients with anatomical changes in the neck.

 The method is safe, easy to implement, complications associated with the use were not observed.

 The method allows to improve visual function depending on the duration of the disease by 20-40% and reduce the treatment time by 10-20 days. (56) Ophthalmic Journal, 1985. N 3.

Claims (1)

 METHOD FOR TREATING AN ATTROPHY OF THE VISUAL NERVA, including the use of drugs, characterized in that, in order to reduce treatment time and improve visual functions, a 2% solution of marcaine at a dose of 2 - 3 mg / kg in combination with cavinton in dose of 1 mg / kg, which produce blockade of periarterial plexus daily for 7 to 10 days alternately on the right and left sides.