RU2185176C2 - Method for treating dystrophic corneal diseases and cornea transplantation diseases - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering intramuscular injections of Dalargin preparation at a dose of 3 mg during 10 days in combination with intravenous administration of 10% Perfluoran emulsion. Premedication including 1.0 ml of Relanium and 65 mg of hydrocortisone is carried out 10-15 min before administering Perfluoran emulsion. Then wet oxygen is administered for breathing through mask in a flow of 6 l/min discharge rate. 10% Perfluoran emulsion is administered after testing allergic response at a rate of 40 drops per 1 min. No allergic response being observed, the rate is increased to 60 drops per 1 min. Oxygen supply is continued during the whole procedure of Perfluoran emulsion administration. 100 ml of Perfluoran emulsion is given during one session. Then Perfluoran emulsion administration is repeated 1-3 days later. EFFECT: stable clinical effectiveness.

Description

 The invention relates to medicine, namely to ophthalmology, and can be used to treat degenerative diseases of the cornea and corneal transplant disease.

 A known method of treating degenerative diseases of the cornea and corneal transplant disease by the appointment of desensitizing therapy (suprastin, tavegil, etc.) subconjunctival injections of riboflavin, heparin, as well as the appointment of antimetabolites (imuran), or cyclophosphamide, contrikal, gordoksa. These types of treatment are combined with steroid therapy in instillations or subconjunctival injections (M.M.Dronov "Guide to keratoplasty", St. Petersburg, 1997, p. 116).

 However, it does not always give a positive effect, does not remove the inflammatory process, which leads to relapse of the disease.

 The objective of the invention is to provide a method for the treatment of degenerative diseases of the cornea and corneal graft disease to achieve a stable clinical recovery of the eyeball.

 The technical result is achieved by the fact that in the method of treating degenerative diseases of the cornea and corneal transplant disease, intramuscular injections of 3 mg dalargin are combined once daily for 10 days and intravenous drip of a 10% emulsion of perfluororganic compounds (PFOS) is perfluoran. In this case, 10-15 minutes before the administration of the perfluoran emulsion, premedication is carried out, including the administration of 1.0 ml of Relanium and 65 mg of hydrocartisone, then the patient is allowed to breathe moistened oxygen through a mask in a flow of 6 liters per minute, and after testing for an allergic reaction, 10 % perftoran emulsion at a rate of 40 drops per minute, in the absence of an allergic reaction after 20-30 minutes, the injection rate is increased to 60 drops per minute, while oxygen is supplied during the entire administration of the perftoran emulsion in just one session 100 ml of a 10% perftoran emulsion, then after 1-3 days re-administration of 100 ml of a 10% perftoran emulsion is carried out.

 The drug dalargin has the ability to stimulate the regeneration of epithelial cells, thereby restoring the function of tissues and organs.

Perftoran plasma substitute from the group of organofluorine compounds with gas transport function has the following positive properties:
1. The ability to dissolve and transfer oxygen to tissues with improved diffusion of blood gases between capillaries and tissue cells.

 2. Surfactants (emulsifiers) contained in the emulsion perfluorane prevents the aggregation of both the particles of the emulsion and the formed elements of the blood, improve its rheology, ie accelerate blood flow, and also increase the number of actively functioning microvessels of the eye.

 3. The membrane-stabilizing effect, due to both the direct influence of perfluorocarbons on membrane phospholipids and their interaction with hydrophobic portions of membrane proteins, which has a positive effect on the restoration of the state in a damaged but still viable cell.

 Perftoran is produced by OAO NPF "Perftoran", Pushchino, Moscow Region.

 The method is as follows.

 At the beginning, dalargin 3 mg is prescribed once daily intramuscularly for 10 days.

 Against the background of the use of the drug, dalargin proceeds to the intravenous drip of a 10% perftoran emulsion according to the following scheme.

 Stage I premedication: 10-15 minutes before the administration of the perfluorane emulsion, 1 ml of Relanium solution and 65 mg of hydrocortisone solution are intravenously administered.

 After premedication, humidified oxygen is supplied through the mask in a flow of 6 L per minute during the entire administration.

 Stage II: conduct three biological tests for an allergic reaction to a 10% perftoran emulsion, during which biological samples are injected with 10 ml of perfluoran at a rate of 10 drops per minute at a time.

 The interval between bioassays is 8-10 minutes and in the absence of allergic reactions, the third stage begins.

 Stage III: 10% perftoran emulsion is introduced at a rate of 40 drops per minute. In the absence of an allergic reaction after 20-30 minutes, the transfusion rate is increased to 60 drops per minute. In one session, 100 ml of perftoran is administered.

 Then after 1-3 days, re-introduction of 100 ml of 10% perftoran emulsion is carried out.

 The method is illustrated by examples.

 Example 1. Patient K., 19 years old.

 Diagnosis: dystrophy of the cornea of the right eye due to a burn with an alkaline solution (3 months ago). She was treated at the place of residence without visible improvement. Complaints of severe lacrimation, photophobia, blepharospasm. Visual acuity of 0.1 does not correct. Biomicroscopy revealed an almost complete absence of corneal epithelium, a pronounced mixed injection, activation of the vessels of the perilimbal zone with a tendency to grow into the cornea.

 The left eye is healthy. Visual acuity - 1.0.

 October 30, 1997 and October 31, 1997, treatment was carried out according to the proposed method. The course of treatment with perftoran emulsion was combined with the course of intramuscular injections of dalargin.

 After the first trapefusion of perftoran, lacrimation and photophobia of the affected eye decreased.

 After the course of treatment in the hospital, the surface of the cornea was almost completely covered with epithelium, the active vessels of the perilimbal zone disappeared, the injection of the eyeball disappeared. At discharge, visual acuity - 0.3 does not correct. After 6 months, visual acuity increased to 0.6 does not correct, the eye is calm.

 Example 2. Patient S. 42 years.

 Diagnosis: vascularization of a corneal transplant on the right eye. Two months earlier, the patient underwent a through subtotal corneal transplant for vascular burn burns.

 With biomicroscopy, vessels are identified in the area of the postoperative scar with the germination of single vessels in the graft. In the center, the graft is transparent. Visual acuity - 0.4 does not correct.

 On March 15, 1999 and March 16, 1999, treatment was carried out according to the proposed method — 100 ml of perytoran emulsion was administered intravenously in a dropper in combination with intramuscular injections of dalarin according to the described procedure.

 A positive effect appeared after the first transfusion of perftoran. The vessels in the transplant disappeared.

 After the course of treatment, the vessels in the postoperative scar practically disappeared, the number of vessels in the own cornea decreased sharply.

 Visual acuity increased to 0.5 does not correct. After 8 months, the state of the paraplant is stable.

 Example 3. Patient S. 43 years.

 Diagnosis: corneal graft, artifactilla eye disease. Complaints of lacrimation, photophobia. With biomicroscopy - the eye is disordered, a mixed injection of conjunctival vessels. Transplant - edema of the epithelium and stroma, folds of the descemet shell.

 Earlier (2 months), the patient underwent a through subtotal corneal transplant for epithelial-endothelial corneal dystrophy.

 Visual acuity - 0.05 does not correct.

 On April 21, 1999 and April 22, 1999, 100 ml perftoran emulsion was administered intravenously in combination with intramuscular injections of dalargin according to the described procedure. After 1 week - the eye is almost calm, the swelling of the transplant epithelium has disappeared, and the stromal edema has decreased. Visual acuity increased to 0.5.

 Thus, the application of the proposed method allows to achieve a stable clinical effect in the treatment of degenerative diseases of the cornea and corneal transplant disease.

Claims (1)

 A method for the treatment of dystrophic diseases of the cornea and corneal transplant disease, comprising administering drugs, characterized in that intramuscular injections of 3 mg dalargin are prescribed for 10 days in combination with intravenous administration of a 10% perftoran emulsion, for 10-15 minutes Prior to the introduction of the perftoran emulsion, premedication is carried out, including the introduction of 1 ml of Relanium and 65 mg of hydrocortisone, then the patient is allowed to breathe moistened oxygen through a mask in a flow of 6 L per minute and after tests for an allergic reaction May 10% perftoran emulsion is introduced at a rate of 40 drops per minute, in the absence of an allergic reaction after 20-30 minutes the injection rate is increased to 60 drops per minute, while oxygen is supplied during the entire administration of the perfluoran emulsion, in just one session 100 ml of perftoran emulsion is introduced, then after 1-3 days reperfusion of perftoran is carried out.