RU2161023C2 - Method for performing continuous controlled introduction of drugs into the tenon' space - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing collagen infusion system into the subtenon space. Herringbone-shaped sponge is applied. The sponge is attached to the catheter with single interrupted suture. The preparations are introduced in the amount of 10 ml once a day. EFFECT: reliable position of implant in the subtenon space; simplified microcatheter fixation. 1 dwg

Description

 The invention relates to medicine, namely to ophthalmology, and relates to methods of introducing drugs into the membranes and the environment of the eye.

 Known methods for local injection of drugs into the membranes of the eye: a method for introducing drugs into the suprachoroid space [1], a method for administering drugs for diseases of the posterior segment of the eye [2], a method for continuous perfusion of the vitreous body with an antibiotic solution [3], a method for administering drugs to subtenon space [4].

 However, these methods have several disadvantages: the impossibility of prolonged, repeated and dosed administration of drugs during the day, the danger of damage to the lens by a cannula (microcatheter), the occurrence of ciliochoroid detachment, the inability to ensure a high constant concentration of drugs in the posterior segment of the eye, the need for constant qualified monitoring of the patient.

 As a prototype taken the method of introducing drugs into the subtenon space [4].

 The essence of this method consists in introducing an implant into the subtenon space, which is called the collagen infusion system and consists of a strip of collagen sponge and a silicone tube connected to it. The tube has a length of 9-10 cm and a diameter of 1-1.5 mm. Sterile hemostatic collagen sponge is commercially available in the form of plates 5x5 cm in size and 6 mm thick. After wetting and squeezing the liquid, the thickness of the sponge decreases to 1-1.5 mm. A strip of about 30 mm long and 5-6 mm wide is cut from this plate on the operating table. The sponge strip is moistened in isotonic saline or drug solution and folded in half around one end of the silicone tube. A mattress seam (6 / 0-8 / 0) is drawn through both sheets of the collagen strip so that one of the threads passes through the tube. The suture is tied, thus fixing all elements of the implant.

 However, this method does not provide a constant maximum concentration of drugs in the lesion and the reliability of fixation of the implant in the subtenon space.

 The aim of the invention is to provide a continuous dosed flow of drugs into the membranes of the eye, to ensure reliable fixation of the implant in the subtenon space, to reduce the morbidity and to ensure higher safety of the technique by simplifying it.

 The drawing shows a schematic representation of our proposed implant and its location in the subtenon space.

 The method according to the invention is implemented in the following sequence.

 We introduce an implant into the subtenon space, consisting of a strip of collagen sponge 1 with a size of 15x10 mm and a polyvinyl chloride microcatheter 2 connected with it with a diameter of 0.2 mm. Separate the sponge with a blade at one end to a distance of 8 mm. Between the leaves of the sponge we introduce a microcatheter and through both sheets we conduct the nodal suture 3 (8 / 0-9 / 0) so that one of the threads passes through the microcatheter. On the implant we make two cuts on each side in the form of a “herringbone” 4, which ensure a stable location of the implant in the subtenon space. In addition, on the wall of the microcatheter part located inside the collagen sponge, we make 3-5 holes 5 with a diameter of 0.3 mm for a more uniform irrigation of the sponge itself and the subtenon space.

 After local anesthesia with a 1% solution of dicain, we make an incision of the conjunctiva and tenon capsule in the upper-outer quadrant of the eyeball 8 mm from the limb 6-8 mm long. Using a spatula, we form a channel in the subtenon space for the implant, which is inserted with curved tweezers. A continuous suture is placed on the conjunctiva and tenon capsule, stitching the microcatheter. The free end of the microcatheter is connected to the infusion system, represented by a standard minivan-type catheter with a diameter of 0.6 mm. The infusion system is connected to the outlet fitting of the dispenser hydraulic unit, with the help of which the continuous administration of medicinal mixtures (ciprolet, dexamethasone, taufon, gentamicin, hemodes, dimexide) is carried out into the subtenon space from a 10 ml tank. An isotonic sodium chloride solution is used as the basis for the preparation of the perfusion solution.

 Example.

 Patient B. born in 1978 He was admitted to hospital treatment with a diagnosis of focal endophthalmitis of the II-III degree, traumatic cataract, post-traumatic scar of the cornea of the left eye. Visual acuity at admission: the right eye is 1.0, the left is the count of fingers in the face. The operation was carried out: left eye levitrectomy with catheterization of the subthenon space and the connection of a dispenser. Treatment with a dispenser was carried out for 6 days, every day the patient received 1.5 ml into the subtenon space through the gentamicin system, 0.5 ml dexamethasone per 8 ml of saline. On the 2nd day after the operation, the hypopion completely dissolves, the pupil is wide, round, the reflex from the fundus is satisfactory. The patient was discharged from the hospital with an improvement in visual acuity of the left eye of 0.2 with aphakic correction of sph. + 15.0 diopters

 Thus, the method provides a more reliable location of the implant in the subtenon space due to the shape of the sponge with notches in the form of a herringbone, simplifying the fixation of the microcatheter in the sponge by delaminating it and passing one nodal suture through all elements of the implant, uniform irrigation and distribution of drugs in the subtenon space through additional side holes in the wall of the microcatheter portion located in the sponge. In addition, the use of a soft polyvinyl chloride catheter eliminates discomfort during treatment.

Sources of information:
1. Penkov M.A. Materials scientific and practical. conferences, Kharkov, - 1968.

 2. Copyright certificate SU 1409264 A1.

 3. Yuzhakov A. M. Prevention and treatment of intraocular bacterial infections. Abstract. dis. ... doc. honey. Sciences: - Moscow, 1984. - S. 4-8.

 4. Nesterov A.P., Basinsky S.A. // Vestn. ophthalmol. - 1991. - N 5. - S. 49-51. (prototype).

Claims (1)

 The method of continuous dosed introduction of drugs into the tenon space, including the introduction of a collagen infusion system into the subthenon space, characterized in that a herringbone-shaped collagen sponge is used, while it is attached to the catheter with one nodal suture, and the preparations are administered in an amount of 10 ml 1 once a day.