RU2032391C1 - Method for arresting acute attack of glaucoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: essence of this method resides in carrying out local anesthesia in patient suffering from acute fit of glaucoma and then conjunctively (injection) administering 0.2-percent solution of pilocarpine in amount of 0.3 ml. EFFECT: preservation of visual functions by stepping up rate of reduction of intraocular pressure, maintenance of intraocular pressure at stable level and prompt stricture of pupil in event of acute attack of glaucoma.

Description

 The invention relates to medicine, namely to ophthalmology. Known methods for the relief of acute attacks of glaucoma with complex therapy with the mandatory use of pilocarpine. These include the following methods: the use of diacarb 0.25 g orally and pilocarpine in drops, injection of Lasix intravenously or intramuscularly, and drops of pilocarpine.

 Closest to the proposed invention is the relief of acute attacks of glaucoma with drops of pilocarpine. The essence of the method is to reduce intraocular pressure.

 The disadvantage of this method is the slow decrease in intraocular pressure during an acute attack of glaucoma, the inability in most cases to maintain intraocular pressure at the compensation level. As a result of this, an insufficient (up to the initial norm of 3 mm) pupil constriction occurs, which leads to light scattering and helps to reduce visual acuity.

 The aim of the invention is to increase the efficiency of preservation of the visual functions of the eye by increasing the rate of decrease in intraocular pressure, maintaining it steadily at the level of compensation, rapidly narrowing the pupil.

 This goal in the method of stopping acute attacks of glaucoma by introducing pilocarpine is achieved by the fact that after local anesthesia of the eye, a 0.2% solution of pilocarpine in a dose of 0.3 ml is injected subconjunctively.

 Injection of subconjunctival administration of pilocarpine creates a depot under the conjunctiva, which contributes to an increase in the rate of decrease in intraocular pressure and its persistent retention at the compensation level. 0.2% pilocarpine helps to reduce intraocular pressure as much as possible, which increases the reliability of the relief of an acute attack of glaucoma. A dose of 0.3 determines the duration of compensation of the ophthalmotonus.

 The method is as follows.

 In an ophthalmic or outpatient setting, a clinical examination of the patient is performed: the studied visual acuity, intraocular pressure, the anterior part of the eye, the internal environments, and the fundus are examined. When diagnosing an acute attack of glaucoma, the patient undergoes local anesthesia, after which 0.3 ml of a 0.2% solution of pilocarpine is administered subconjunctively.

 PRI me R 1. Patient B. 49 years old was hospitalized in a glaucoma center with a clinic of an acute attack of glaucoma in his right eye. On admission, visual acuity of the right eye is 0.02, congestive injection of the eye, corneal edema, intraocular pressure of 49 mm Hg severe pain in the eye, headache in the right half, nausea, vomiting, pupil wide 8 mm, the fundus is not ophthalmoscopic. Upon admission, the patient was administered a 0.2% solution of pilocarpine at a dose of 0.3 ml subconjunctival. After 30 minutes, intraocular pressure decreased to 32 mmHg. Art. after 1 h to 27 mm Hg after another half hour to 17 mm Hg the pupil narrowed to normal (3 mm), an acute attack was stopped, visual acuity was restored to 1.0. The next day, a laser iridectomy was performed on the right eye, the patient was discharged for outpatient treatment. Two weeks later, a laser iridectomy was performed on the left eye.

 PRI me R 2. Patient 62 years. He has been suffering from glaucoma since 1985, used pilocarpine 2 times a day in both eyes, intraocular pressure did not increase. In 1988, after a strong nervous experience, an acute attack of glaucoma occurred in the left eye: severe pain, decreased vision, stagnant injection of the eye, intraocular pressure 51 mm Hg visual acuity due to fingers of the face, the pupil is as wide as possible, irregular in shape. At home, the patient instilled pilocarpine 1% six times a day, without effect. Delivered to the glaucoma center. At the time of hospitalization, an injection of a 0.2% solution of pilocarpine in a dose of 0.3 ml was made subconjunctival. After half an hour, the state of health significantly improved, intraocular pressure decreased to 30 mm Hg. an hour later, up to 25 mm RT. Art. vision was restored to 0.6, the pain was gone. In addition, diacarb 0.25 g was given, after 6 hours the intraocular pressure decreased to 18 mmHg. visual acuity recovered to 0.8. The next day, the patient was operated on against a background of normal intraocular pressure. The operation went without complications. Three days later, a laser iridectomy was performed on the other eye. The patient was discharged from the department on another day.

 The dosage of the drug was established by an experiment on rabbits. The method was tested on 20 patients with primary glaucoma (12 women) at the time of an acute attack of glaucoma. The age of patients is from 45 to 69 years. The drug is well tolerated, in no case was there any side effects in the form of allergic edema, hemorrhage, conjunctival necrosis. Intraocular pressure decreased during the first hour in 18 patients, two patients after eight hours, the injection was repeated due to the fact that intraocular pressure was not reduced enough. The attack was stopped in all patients within one day. The next day, in 16 patients, against the background of normal intraocular pressure, an operation was performed, and four patients underwent laser iridectomy. The operations were performed to exclude repeated acute bouts of glaucoma.

 The proposed method, as shown by clinical testing, leads to a more rapid relief of an acute attack of glaucoma and narrowing of the pupil, which creates the conditions for better functional outcomes. In addition, this method can also be used for eye diseases, in cases where there is a need to quickly reduce intraocular pressure and narrow the pupil: with an acute attack of secondary glaucoma, traumatic mydriasis, pinching of the iris with peripheral limbal penetrating wound, pupil massage in the postoperative period with the goal of breaking the rear ennechies.

Claims (1)

 METHOD OF CUPING ACUTE GLAUCOMA ACTION by local use of pilocarpine, characterized in that they use a 0.2% solution of pilocarpine in the form of subconjunctival injections.