RU2068675C1 - Method for treating the cases of hemophthalmia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying endovascular laser irradiation of blood. Middle mass molecules concentration is concurrently determined in blood. The treatment is stopped during 2 days after normalization takes place. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to ophthalmology.

 Among the pathological conditions of the eyes, vitreous hemorrhage occupies a significant place, complicating the course of a number of diseases: eye injuries, hypertensive and diabetic angioretinopathies, retinovasculitis, operations, complicated myopia, etc. Such structural features of the vitreous as high hydrophilicity, low oncotic pressure, and the absence of blood vessels complicates the processes of blood resorption from this membrane of the eye.

 However, on the other hand, the abundance of microcirculatory anastomoses in the eye with slowed blood flow in them creates favorable conditions for the exit of formed elements or a complete hematoma into the vitreous body. For a long time, non-absorbable blood has a toxic effect on the retinal neuroepithelium, complicates the outflow of intraocular fluid, and creates a condition for traction forms of retinal detachment. Therefore, accelerating the evacuation of blood from the vitreous body is an important and far from always easily resolved problem.

 Currently, two main types of hemophthalmia therapy are generally accepted: surgical and conservative.

 Moreover, the first way of treatment is possible no earlier than 1.5-2 months from the time of hemorrhage (due to prolonged gaping of the vessels of the eye). However, radical vitrial surgery can have a positive effect exclusively with highly advanced surgical technique (available in single microsurgical cents).

 Therefore, due to the limitations of the surgical treatment method, the method of conservative treatment of hemophthalmus is widely used (V.I. Morozov, A.A. Yakovlev "Pharmacotherapy of eye diseases" M. 1989 (p. 116-117).

 To combat increased vascular permeability, angioprotectors (dicinone, etamsylate) are prescribed calcium preparations, corticosteroids. In order to activate fibrinolysis, topically enzyme preparations are used (fibrinolysis, collalysin, streptase, streptodecase, lidase, etc.). Widely used are tools that improve microcirculation and blood rheology (trental, cavinone, compliment, theonicol, etc.).

 For the same purpose, in recent years, physiotherapeutic agents have been widely used: ultrasound, electro- and phonophoresis.

 In this regard, the drug treatment method according to the mechanism of achieving the effect of stimulating the resorption of blood from the vitreous body, may be the closest analogue of the proposed method for the treatment of hemophthalmus of various etiologies.

 However, conservative treatment achieved by the method of long-term combined administration of many medications is possible only in a hospital setting, only in the early stages (up to 1 month) of hemophthalmus. Allergic local and general reactions to injected drugs are frequent. The traditional treatment regimen is presented without taking into account background diseases, the correction of which significantly affects the initial visual functions. The effectiveness of conservative therapy is primarily determined by the form (type) of hemophthalmus. With total hemophthalmia, especially with the presence of pronounced destructive processes in the vitreous body, the percentage of significant increase in visual acuity (up to 0.1-0.3) is small (30-50%).

 Naturally, there is a need to find a more effective and less complicated method of conservative treatment of hemophthalmus, but taking into account the pathogenetic features of this eye condition, which enhances the resorption of blood from the vitreous body. In recent years, laser therapy with low-energy radiation has become widespread, with local effects on organs and tissues, as well as on body fluids. It seems to us interesting the mechanism of endovascular laser irradiation of blood, contributing to the normalization of pathological changes in homeostasis. Laser photomodification of blood improves microcirculation, activates phagocytosis and fibrinolysis, and increases the antioxidant and antitoxic potential of blood (V.E. Illarionov, "Fundamentals of Laser Therapy", M. 1992). Considering the features of the blood-ophthalmic barrier, which cause a slowdown in the selection of hemolysis products from the vitreous body, the use of EVLOK for hemophthalmia is pathogenetically justified. The methods of this type of treatment have been developed for many diseases. For the treatment of hemophthalmus, EVLOC is used for the first time.

 The impact on the tissues of the eye through the changing properties of the blood is effective and harmless, provided that it simultaneously monitors changes in pathological processes and the dynamics of certain, certainly highly sensitive blood parameters. Taking into account the fact that blood resorption is accompanied by phenomena of tissue endotoxicosis, the level of molecules of average blood mass can objectively reflect the dynamics of activation of blood resorption from the vitreous body by endovascular laser therapy.

 An analysis of the literature data (Ageeva L.A. Rudykh I.V. Bolgov D.F. Kanus I.I. Rostovtsev V.N. et al.) Showed that the concept of medium-mass molecules combines components of various chemical structures released from the blood patients in the form of several fractions with a molecular weight of 300-500 d, with high biological activity. The composition of medium molecules includes substances of a polypeptide nature, oligosugar derivatives of glucuronic acid, alcohols, polyamines and other compounds. Given the high biological activity of medium molecules, the importance of their studies in order to identify patterns of development and treatment of toxic effects should be emphasized.

 The purpose of the invention is the development of a method that increases the effectiveness of the treatment of hemophthalmus of various etiologies by improving microcirculation of the eye, activating phagocytosis and fibmiolysis, stimulating and antioxidant and antitoxic potential of blood; reduction in the number of drugs used and medical manipulations, reduction in economic costs of treatment.

 This goal is achieved by the fact that a systemic effect on the microcirculatory bed of the eye is carried out by endovascular laser irradiation of blood, while the concentration of medium-weight molecules in the blood is determined simultaneously (Express Lowry method). For endovascular laser irradiation of blood, a helium-neon laser with a wavelength of 600 nm, a power of 0.5 MW and a Leukocyte fiber is used. The fiber is inserted into one of the cubital veins using an injection needle. Exposure continues daily for 40 minutes and ends after normalization of the molecules of average blood mass for 2 days.

 Example 1. Patient W. 44 years old was admitted with a diagnosis of hemophthalmus, circulatory disorders in the hormoid vessels of the right eye. Myopia of both eyes is mild. Complaints about a sharp decrease in vision of the right eye within 2 days. A history of coronary heart disease and myocardial infarction.

 During the examination: visual acuity of the right eye of 0.05 with 3.0-0.2. The eye is calm. The front section is not changed. In the vitreous body in the anterior sections there is diffuse turbidity, in the posterior sections there are blood clots. The fundus under the fleur, the optic disc is pale pink, the arteries are narrowed, the veins are full-blooded, in the equatorial area of the retina there is a section of ischemia with 6 disc diameters with hemorrhages around.

 Visual acuity of the left eye of 0.08 with 3.0-1.0. Refractive media in the fundus unchanged. The level of molecules of average weight was 0.600 srvc. Upon admission, treatment with EVLOK was immediately started, inside the patient received only narmidin. The control of the number of medium molecules was carried out daily with a simultaneous clinical study: visometry, ophthalmic and biamicroscopy, ultrasound.

 After the 5th EVLOK session, the level of medium molecules decreased to 0.150 conventional units. and for two days kept the achieved level. At the same time, significant enlightenment of the vitreous body was reliably determined. After 7 sessions of laser irradiation of blood, the visual acuity of the right eye increased with a correction of 3.0 D to 1.0.

 Example 2. Patient V., 56 years old, was admitted with complaints of a significant decrease in vision after psycho-emotional stress. Suffers from hypertension. Data on admission: visual acuity of the right eye of 0.9, the right eye without pathology, the fundus of the artery is narrowed, the veins are dilated.

 Left eye: visual acuity of 0.04, in the vitreous body almost complete hemophthalmus, ophthalmoscopy is difficult. The level of molecules of average weight was 0.480 srvc. units On the 3rd day of treatment, the level of medium molecules decreased to 0.260 srvc. units then again increased to 0.400 srvc. From the 6th day, the value of medium molecules began to gradually decrease. The seventh-eighth days of EVLOK were carried out at the level of 0.120 conventional units. medium molecules.

 After 8 days (8 EVLOC sessions), the visual acuity of the left eye was 0.7, hemophthalmus partially resorbed, remaining parietal in the lower sections.

 Example 3. Patient S., 28 years old, was operated on in the clinic for a penetrating wound of the cornea, limbus and sclera of the right eye. Visual acuity upon examination at the first dressing of 0.02 due to total hemophthalmus, visual acuity of the left eye of 1.0.

 From the first day in the postoperative period, endovascular laser therapy was started. The patient received only antibiotics intramuscularly and parabulbarly. The level of average molecules on the first day was 0.710 srvc. In the third procedure decreased to 0.180 srvc. However, daily fluctuations in the average molecules in the range of 0.180-0.450 conv.ed. Clinically, from the third procedure, a gradual resorption of hemophthalmus and an increase in visual acuity to 0.1 was noted. The stabilization of medium molecules was determined in 9-10 procedures (0.100 conventional units). Against the background of the treatment, after 14 days (10 EVLOC procedures), the visual acuity of the right eye was 0.3. No signals were detected echographically in the vitreous body, and only in the 7-hour sector were low-amplitude echo signals recorded (wound area). The lens and cornea in the optical zone were transparent, but due to irregular corneal astigmatism, spectacle correction did not improve visual acuity. 2 months after the removal of sutures and contact correction, the visual acuity of the right eye is 0.9, the left eye is 1.0.

 Thus, the described method of controlled endovascular laser therapy makes it possible to increase the treatment at minimal cost, while with traditional therapy, visual acuity increased to 0.1 after 10-14 days.

Claims (1)

 A method of treating hemophthalmus, including a systemic effect on the microcirculation of the eye, characterized in that the effect is carried out using endovascular laser irradiation of blood, while the concentration of medium-weight molecules is determined in the blood and after its normalization within 2 days, the effect is stopped.