RU2122385C1 - Method of preventing excessive cicatrization during antiglaucomatosis operations - Google Patents

Abstract

FIELD: ophthalmology. SUBSTANCE: invention consists in instillation, into conjuctival space during early postoperative period, of autologic natural complex of cytokines obtained from the blood of the same patient. EFFECT: reduced intensity of aseptic inflammation and development of rough cicatrization in filtration zone.

Description

 The invention relates to ophthalmology, and in particular to methods of preventing excessive scarring in anti-glaucomatous operations.

 One of the reasons leading to the loss of visual function in glaucoma is an increase in intraocular pressure. Therefore, the main goal of any anti-glaucomatous operation is to reduce and stable normalization of ophthalmotonus, which creates conditions for the stabilization of visual functions. Another thing is also known: at different times after surgery, in some cases, intraocular pressure rises again. In 15 - 35% of cases, the cause of failure of antiglaucomatous surgery is excessive scarring in the area of the newly created outflow paths. The reasons for this may be: an individual reaction of the eye tissue to surgical trauma, possible intra- and postoperative complications.

 There are a large number of techniques, manuals, methods aimed at preventing excessive scarring. However, many of them have certain disadvantages, which in some cases can lead to serious side effects. The use of, for example, steroid therapy may increase the predisposition to secondary infection; the use of cytostatics, such as 5-fluorouracil, is often associated with the occurrence of corneal complications; when using metamycin there is no technique that allows you to accurately dose the drug.

 To influence the reparative processes in order to reduce scarring in the surgical area, it is proposed to use laser exposure and cryoapplication. But these methods are either extremely difficult to perform (laser), or not very effective (laser, cryoapplication).

 The prototype of the invention is a method of using 5-fluorouracil drug cytostatic action. The method of use is subconjunctival injection of the drug for 5 to 7 days. One of the significant disadvantages of this method are corneal complications that can occur after the first injection [4].

 Recent studies [3] point to the possibility of using natural cytokine complexes for therapeutic purposes. These are natural regulators of the inflammatory process. They are produced in the body of this patient, are not foreign, do not cause an allergic state. They are the optimal natural complex for local use, regulating the repair process. It is important that these complexes are autologous, provide fast and directed action at low doses, ensuring optimal concentration.

 Autolymphokine therapy has been tested in dentistry and obstetrics. The use of natural cytokine complexes is aimed at suppressing the inflammatory response.

 The use of cytokines in ophthalmology is known both from leukocyte mass and from mononuclear cells. In the first case, they were used in the complex treatment of penetrating eye injuries (P.V. Makarov, 1995). Found: cytokine therapy does not have any toxic effect on the eye tissue, accelerates the relief of edema and epithelization of the corneal wound. There are observations of the positive effect of cytokines in stopping the inflammatory reaction after extraction of prussic and diabetic cataracts (L.V. Kovalchuk, D.V. Gankovskaya et al., 1993).

 A method of obtaining cytokines from autologous blood is known [2].

 Known knowledge about the effect of cytokines on the wound process suggested the possibility of their use in anti-glaucomatous operations with the aim of preventing excessive scarring in the zone of newly created outflow paths, which suggests ensuring the persistence of the hypotensive effect in the long term after the operation.

 The technical result of the method is to obtain a stable normalization of ophthalmotonus, which can be achieved by preventing excessive scarring in the area of newly created outflow pathways of the intraocular fluid due to the effect on reparative processes when performing anti-glaucomatous operations.

 The method is as follows: 1 day before surgery, 20 ml of blood from the cubital vein is taken from a patient into a sterile silicone tube containing an anticoagulant - heparin (500 PIECES per 20 ml of blood). Freshly isolated blood (storage not more than 1 hour) is used to obtain cytokines from mononuclear cells by a known method (see above).

Prior to use, the obtained supernatant containing a natural complex of cytokines is stored at 18 - 20 degrees Celsius, with 5 • 10 ⁶ mononuclear cells in 1 ml of the supernatant.

 Clinical experience with the drug in patients has shown that its instillation into the conjunctival cavity 3 to 5 times a day in the early postoperative period prevents excessive scarring. Confirmation of this is the state of hydrodynamics of the eyes in the long term observation, as well as the state of the filtering pad.

 The drug is used during the entire early postoperative period, which ensures stable normalization of intraocular pressure.

 Example. Patient G., 40 years old, medical history N 3269. Diagnosis: juvenile III glaucoma of the right eye. Intraocular pressure up to 30 mm Hg Electronic tonography: Po - 27.16; C is 0.11; F is 1.05; KB - 226.

 Performed operation: sinturatorbekuloektomiya. The operation and the postoperative period without complications. From the second day after surgery received a natural complex of cytokines 4 times a day, 1 drop. Received stable normalization of intraocular pressure: 19 mm Hg Electronic tonography data 14 months after surgery: Po - 13.81; C 0.25; F - 0.95; KB - 55.

Bibliography:
1. Kovalchuk L.V., Gankovskaya L.V., Kraynova T.G., Egorova E.V., Vlasova T.I., Ioshin I.E., Autolymphokine therapy in stimulation of reparative processes of eye tissues, Vestn. Ophthalmol., 1993, N 3, p. 8 - 9.

2. Kovalchuk L.V., Gankovskaya L.V., Gvozdeva N.A., Kraynova T.A., Khalaeva Yu.A., Strezhova N.V. A method for treating purulent wounds; author. testimonial. N 1498498 from 08.04.89
3. Makarov P.V. The method of local immunocorrection is autolymphokine therapy in the complex treatment of penetrating eye injuries. Abstract. diss. ... cand. honey. Sciences, - M., 1994.

 4. Alekseev B.N. et al. Clinical method for assessing postoperative scarring and preventive therapy with cytostatics after antiglaucomatous operations, - Vestnik Ophthalmology, 1989, N 6, p. 15 - 20.0

Claims (1)

 A method for the prevention of excessive scarring in the zone of newly created outflow pathways during antiglaucomatous operations, including the use of instillations of a drug that suppresses reparative processes, characterized in that after the operation 3-5 times a supernatant of cultured autologous mononuclear cells stimulated with phytohemagglutinin is instilled.