RU2122384C1 - Method of treating occluding injuries of corneal and optic-nerve vessels - Google Patents

Abstract

FIELD: ophthalmology. SUBSTANCE: treatment consists in complex therapy using 1-2.5% thiotriazoline solution as antioxidant, which is administered intravenously or as intramuscular injections in combination with parabulbar injections. EFFECT: assured antiischemic effect. 2 cl

Description

 The invention relates to medicine, in particular to the means used in the clinic and scientific research.

 It is known that vascular pathology is one of the urgent problems of modern medicine. In case of circulatory disorders in the vessels of the retina and optic nerve, a significant role belongs to a decrease in the activity of the antioxidant system of the eye, activation of lipid peroxidation (LPO), excessive accumulation of lipid peroxides and the associated toxic damage to the tissue of the retina and optic nerve. It is known that in the retina in case of circulatory disturbance in the vessels, the protective mechanisms are weakened, the action of which is aimed at stabilizing the activity of LPO. In this regard, in clinical practice, lipid peroxidation inhibitors are increasingly used (D.G. Plyushko, L.K. Voskresenskaya, V.V. Kornienko - O.Zh., 1988, N 7, pp. 427 - 429, N .M. Efendiev, A.I. Dzhafarov, I.A. Zargaryan, E.K. Neiman-Zade - Vestn. Ofialmol., 1988, No. 5, p. 67 - 69, A.M. Soldatova, O.N. Maletskaya, O.N. Voskresensky - Clinical Vitaminology: Abstracts of the All-Union Conf., June 18 - 20, 1991 - M., 1991, p. 188).

 The disadvantages of using LPO inhibitors used in the treatment of vascular pathology of the retina and optic nerve include the lack of versatility, the difficulty of accurately determining all physiological parameters of the oxidative system, low efficiency, the inability to use antioxidant drugs in local therapy in the form of bulbar injections, which limits the possibility of creating their maximum concentration in the tissues of the eye.

 The known method and.with. USSR N 1799577, class A 61 F 09/00, improvement of visual functions in diseases of the optic nerve and retina by electrical stimulation, in which a receiver made in the form of an inductor is implanted on the sclera of the posterior segment of the eyeball, one of the findings of which is placed on the dura mater of the optic nerve and the other fixed on the sclera with subsequent exposure to the receiver by a pulsed magnetic field.

 This method is difficult to perform, painfully perceived by patients, does not exclude the injured eye during implantation of the receiver and is long-lasting, because the course of treatment requires repetition and all this time the receiver is not removed from the eye.

 A known method for A.S. USSR N 1745239, class A 61 F 9/00, modeling of optic atrophy by orbitotomy followed by a cut of the optic nerve, in which, after an arbitotomy, the optic nerve trunk is isolated and tissue incisions of various depths are applied.

 This method requires surgical intervention, does not exclude postoperative complications and is not effective for the combined disease of the optic nerve and retina.

 A known method for A.S. USSR N 1833730, class A 61 F 9/00, the treatment of retinal dystrophy by the use of antioxidants, in which the indicators of the physiological antioxidant system are preliminarily determined: red blood cell peroxide resistance, malondialdehyde content, glutathione peroxidase activity and red blood cells and blood plasma and, depending on the results, a combination of drugs is used that are direct antioxidants, or a combination of direct and indirect antioxidants.

 The disadvantages of this method are: lack of versatility, low efficiency, the difficulty of accurately determining all physiological parameters of the oxidative system, the duration of treatment.

 A known method of treating sclerotic macular degeneration a. from. USSR N 1650129, which consists in the combined use of antioxidants / alpha-tocopherol acetate, ascorutin, lipoic acid, methyl methionine /, namacite, ENKAD phonophoresis, photostimulation with low-energy yellow pulsed light. This method is accepted by us as a prototype.

 However, the use of this method for correcting LPO processes has a number of significant drawbacks.

 1. The inability to use the proposed antioxidants in local therapy in the form of parabulbar injections, which limits the ability to create the maximum concentration of drugs in the tissues of the eye.

 2. A 5% oily solution of alpha-tocopherol is used in practice in the form of instillations, or inside in an amount of 5-10 drops 3 times a day. The prescribed doses of the drug do not provide the necessary concentration in the blood, which explains the lack of normalization of lipid peroxidation activity during treatment.

 3. According to the mechanism of action, the proposed antioxidants do not have a membrane-protective effect, which provides an anti-ischemic, antihypoxic effect in the complex treatment of patients with circulatory disorders in the vessels of the retina and optic nerve.

 4. The complex is complex, requires clinical conditions, it is impossible to use in wide medical practice, especially with outpatient treatment in the outpatient departments of the central hospital.

 The basis of the invention is the task of increasing the effectiveness of treatment of patients with occlusive lesions of the vessels of the retina and optic nerve by correcting the processes of lipid peroxidation and reducing the toxic effects of peroxides on the tissue of the retina and optic nerve.

 The solution to this problem provides a method for the treatment of occlusive lesions of the vessels of the retina and optic nerve, including complex therapy using an antioxidant drug, due to the fact that it is used as a 1% -2.5% solution of Thiotriazolinum administered intravenously or intramuscularly in combined with parabulbar injections.

 "Thiotriazolin" is a new drug registered by the Ministry of Health of Ukraine by order N 85 of 05.31.94, as a cardioprotective and hepatoprotective agent.

 Titriazolin possesses wound healing, antioxidant, membrane stabilizing, anti-ischemic, immunomodulatory effects, does not cause side effects and is non-toxic.

 When used in the claimed method, "Thiotriazolin" enhances the compensatory activation of anaerobic glycolysis, reduces the degree of inhibition of oxidative processes in the Krebs cycle while maintaining the intracellular fund of ATP, thereby stabilizing cell metabolism. The drug activates the antioxidant system of enzymes and inhibits lipid peroxidation in ischemic areas of the retina, improves the rheological properties of blood due to the activation of the fibronolytic system, and has a membrane-protective effect. The method was tested at the Department of Ophthalmology ZIUV with positive results of clinical trials. The course administration of the drug to patients with occlusive lesions of the vessels of the retina and optic nerve led to a decrease in the activity of free radical oxidation already on the fifth day of treatment, and upon its completion a decrease in the level of diene conjugates by 41 - 45%, trienketones by 46 - 58%, malondialdehyde by 40%, increase in alpha-tocopherol stock by 115 - 125% / P> 0.02 /, which indicates complete inhibition of lipid peroxidation and activation of anaerobic glycolysis in patients.

 Clinical studies have shown that the use of thiotriazolin in complex treatment in 52 patients with retinal vein thrombosis and ischemic opticopathies improves treatment outcomes in 85% of patients in the main group compared with 42% of patients in the control group who received alpha-tocopherol.

 Recovery, that is, visual acuity of 0.3 and higher, was achieved in 39 patients, / 75% / compared with 11 patients / 23% / of the control group.

 It was found that in the course of complex treatment, a decrease in the threshold of electric sensitivity for phosphene was noted by 20–30% in the main group and by 10–15% in the control group. The analysis of dopplerograms confirmed an increase in the linear velocity of blood flow in the suprablock artery by 450 ± 32 Hz / 30% / of the main group and an unreliable decrease in BFV in the control.

The invention is illustrated by the following examples:
Example 1. Patient M. / main group /, medical history N 3607, was hospitalized with a diagnosis of thrombosis of the central retinal vein of the right eye. Upon enrolment; visual acuity OD = 0.05 n / a, total field of view - 350, IOP - 22 mm RT. Art. the threshold of electrical sensitivity for phosphene is 80 mA, the retinal lability is 45 Hz, the rheographic coefficient is 1.77. In the blood test - diene conjugates - 1.72 μm / ml, trienketones - 0.53 μm / ml, malondialdehyde - 0.88 μm / ml, alpha - tocopherol - 1.18 μm / km. On the fundus - the optic disc is pale pink, the borders are edematous, blood vessels: arteries are narrowed, convoluted veins, full-blooded, along the vessels - hemorrhage, plasmoraggia, edema of the macular region. The patient received: topically - dexon, fibrinolysin n / a, conjunctival heparin, thiostriazolin 1% solution p / b 0.5, ultrasound with fibronolysin, endonosal electrophoresis with nicotinic acid, total etamzilate, nicotinic acid according to the scheme, papeverine v / m, aspirin 1 time per day, thiotriazolin 1% v / m N 12. At discharge: on Ch. bottom - optic nerve discs pale pink, clear borders, vessels: arteries narrowed, convoluted veins, full-blooded, half-absorbed hemorrhages along large vessels, macular region without features, visual acuity of OD - 0.3 n / k, total field of view 380, IOP - 22 mmHg, phosphene threshold of electric sensitivity 60 mA, lability 55 Hz, reographic coefficient 2.6 in blood analysis, diene conjugates - 1.24 μm / ml, trienketones - 0.38 μm / ml, malondialdehyde - 0.65 μm / ml, alpha-tocopherol - 2.03 μm / ml.

 Example 2. Patient K. / main group /, medical history N 2909, was hospitalized in the ophthalmic department of the RCCH with a diagnosis of thrombosis of the central retinal vein of the left eye. On admission: visual acuity OS - 0.9 n / a, the total field of view 420, IOP - 20 mm RT. century, the threshold of electrical sensitivity for phosphene 100 mA, the lability of 35 Hz, the reographic coefficient of 1.47. In the blood test: diene conjugates - 1.81 μm / ml, trienketones - 0.54 μm / ml, malondialdehyde - 0.92 μm / ml, alpha-tocopherol - 0.84 μm / ml. On the fundus of the optic disc is pale pink, the boundaries are clear. Vessels: arteries are narrowed, veins are convoluted, full-blooded, along the vessels and in the paramacular region - hemorrhage, edema of the macular region. In the department he received: topical dexon, fibrinolysin p / b, conjunctival heparin, ultrasound with fibrinolysin, total etamzilate, papaverine, nicotinic acid according to the high-pressure regimen, thiotriazoline 2.5% 2.0 iv. At discharge: visual acuity of OS - 0.2, total field of view 460, IOP - 20 mm Hg, threshold of electric sensitivity for phosphene 70 mA, lability 50 Hz, reographic coefficient 1.97. On the fundus: optic nerve discs pale pink, clear borders, vessels: arteries narrowed, convoluted veins, full-blooded, hemorrhages along large vessels, macular edema preserved. In the blood test: diene conjugates - 1.04 μm / ml, trienketones - 0.21 μm / ml, malondialdehyde - 0.51 μm / ml, alpha-tocopherol - 2.45 μm / ml.

The advantages of the proposed method:
1. Aqueous solutions of thiotriazolin can be used in the form of intravenous, intramuscular, and, most importantly, parabulbar injections, which makes it possible to create the maximum concentration of the drug in the tissues of the eye.

 2. Thiotriazoline significantly exceeds the action of alpha-tocopherol in antioxidant action.

 3. Thiostriazolin along with antioxidant properties has a membrane protective effect, which enhances the anti-ischemic effect.

Claims (2)

 1. A method of treating occlusive lesions of the vessels of the retina and optic nerve, comprising complex therapy using an antioxidant drug, characterized in that a solution of thiotriazoline is used as an antioxidant drug.  2. The method according to claim 1, characterized in that they use a 1 - 2.5% solution of "thiotriazoline", administered intravenously or intramuscularly in combination with parabulbar injection.