RU2218896C1 - Method for treating the cases of post-inflammation bullous keratopathy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering curative mixture into lymphatic orbit region on the injured eye side by means of pterygopalatine blockades. The mixture is composed of Lidocaine 20-40 mg, Dexazone 4-8 mg, Taufon 40-80 mg, Dalargin 1-2 mg, lidase 16-32 active units and distilled water 3-6 ml. 3-6 blockade treatments are applied with 1 day long pauses. EFFECT: enhanced effectiveness of treatment; accelerated treatment course. 2 cl

Description

 The invention relates to medicine, namely to ophthalmology, and is intended for the treatment of post-inflammatory keratopathy.

 Bullous keratopathy (CD) is a polyetiological disease associated with the defeat of the endothelial monolayer covering the posterior surface of the cornea and having low regenerative ability. CD, along with herpesvirus keratitis, is currently the most frequent supplier of corneal disabling sore throats. A radical method of its treatment is through keratoplasty.

 There is a method of treating corneal erosion after excimer laser photorefractive keratectomy (PRK), which consists in introducing a freshly prepared mixture of autoblood and immunomodulator half-dan in the form of subconjunctival injections and instillations into the conjunctival cavity of the eye (Patent RF 2122386, class A 61 F 9/00. 98).

 The method allows to reduce the treatment time for corneal erosion after PRK, i.e. affect the epithelium, and not its endothelium.

 The closest to the claimed method, the prototype is a method of treating post-inflammatory CD by introducing into the anterior chamber a mixture of autoplasma and an immunomodulator half-dan and also under the conjunctiva of the eye - a freshly prepared mixture of autoblood and half-dan (Patent RF 2165747, class A 61 F 9/00, publ. 27.04. .2001). The method is as follows. Autoblood is taken from the patient's vein, followed by mixing it with a solution of half-dan. Next, the blood taken is subjected to centrifugation and the upper layer of the formed plasma is taken in a syringe. In the operating room, under the control of an operating microscope, after preliminary corneal paracentesis and washing of the patient’s anterior chamber with balanced physiological saline, autoplasma is introduced into it. Excess autoplasma is administered paralymbally. Repeated intracameral administration is carried out with an interval of 3-6 days, their number is from 1 to 4.

 The disadvantages of the method are the duration and complexity, as it is performed in the operating room using microsurgical equipment and instruments and is equivalent to surgical intervention.

 An object of the invention is to increase the effectiveness of treatment, reducing the time of postoperative rehabilitation for inflammatory bullous keratopathy.

 The stated technical problem is achieved by the fact that to create a depot of drugs in the region of the "target organ", lymphotropic lymphostimulating therapy of this regional lymphatic collector is performed on the side of the affected eye by performing pterygopalatine blockade using a treatment mixture. The therapeutic effect is realized due to the formulation of the therapeutic mixture, including: lidocaine 20-40 mg, dexazone 4-8 mg, taufon 40-80 mg, dalargin - 1-2 mg, lidase - 16-32 units, water - 3-6 ml , and the topography of its introduction. This mixture contains a complex of pharmacological agents that have a pronounced anti-inflammatory and lymphostimulating effect.

 The technique of performing pterygopalatine blockade is as follows. The patient is in a supine position, head turned to one side. Directly under the zygomatic arch, in the middle of the distance between the ear tragus and the edge of the orbit, an injection is made. Then change the angle of the needle by 30 degrees, the needle is advanced past the pterygoid processes of the main bone to a depth of 4-5 cm, falling into the pterygopalatine fossa. This feels like a “dip”, a sharp drop in resistance to needle movement. Pulling the piston toward itself and making sure that there is no blood, the treatment mixture is injected, which leads to the blocking of the second branch of the trigeminal nerve and the pterygopalatine node and the creation of a depot of drugs.

The defining hallmarks of the proposed method, compared with the prototype, are:
- the drug mixture is injected into the lymphatic region of the orbit on the side of the affected eye by pterygopalatine blockade, which allows you to create a depot of drugs that provides quick relief of inflammation and stimulation of reparative processes;
- as a treatment mixture, an experimentally selected, optimal combination of a mixture of drugs taken in the following ratios is used: lidocaine 20-40 mg, dexazone 4-8 mg, taufon 40-80 mg, dalargin 1-2 mg, lidase 16-32 units. act., water 3-6 ml, which allows to increase the effectiveness of treatment, to increase the intensity and speed of reparative processes in the cornea.

 The inventive method allows to stimulate lymph flow, normalize lymphatic drainage, restore microcirculation in the orbit region, restore normal conditions of eye hydrodynamics, which is manifested in the relief of inflammation and stimulation of reparative processes. A pronounced therapeutic effect manifested in the relief of manifestations of inflammatory bullous keratopathy (corneal syndrome, the disappearance of pericorneal injection, bullous changes in the cornea, swelling of the corneal tissue and increase its transparency, resorption of precipitates and exudate, normalization of intraocular pressure, increased visual acuity) was achieved in all cases the shortest time from 6 to 9 days.

 The effect is explained by a faster and more effective relief of the inflammatory period in the initial stages, by the positive effect of dalargin and taufon on the reparative process by stimulating proliferation, and subsequently, differentiation of cellular elements. This is due to the protective effect of dalargin, which stimulates collagen synthesis through activation of macrophages, as well as with an increase in macrophage fibroblastic contacts.

 The invention is illustrated by the following examples of specific performance.

 Example 1. Patient B., 59 years old, was operated on for open-angle glaucoma of the right eye. An operation of non-penetrating deep sclerectomy was performed. On the second day, the postoperative period was complicated by the phenomena of inflammatory bullous keratopathy: decreased vision, photophobia, lacrimation and pain in the operated eye appeared. On examination: severe corneal syndrome, a mixed injection of the eyeball. The corneal epithelium is swollen in the form of blisters in the central zone. A section of the cornea is 1.5 times thickened compared to the norm, uneven due to folds of the descemet membrane. The stroma and endothelium of the cornea are edematous, the imposition of precipitates on it. The moisture in the anterior chamber opalesces. Intraocular pressure (+) 1. Visual acuity = 0.5. On the first day I received traditional therapy: antibiotics, steroidal and non-steroidal anti-inflammatory drugs, antihistamines, actovegin without positive dynamics.

 On the second day in the lymphatic region of the orbit, pterygopalatine blockade was performed by the claimed method using a mixture of drugs, including: lidocaine - 20 mg, dexazone - 4 mg, taufon - 40 mg, dalargin - 1 mg, lidase - 16 units. act., distilled water - 3 ml. In total, 3 blockades were performed with an interval every other day. On the sixth day, the phenomena of inflammatory bullous keratopathy completely stopped. Visual acuity = 1.0.

 Example 2

 Patient B, 59 years old, was operated on for open-angle glaucoma of the left eye. An operation of non-penetrating deep sclerectomy was performed. On the second day, the postoperative period was complicated by severe symptoms of inflammatory bullous keratopathy. Intraocular pressure (+) 1.

 Starting from the second day, the drug mixture was introduced into the lymphatic region of the patient’s orbit by performing pterygopalatine blockade by the claimed method. In total, 6 blockades were performed with an interval of one day using a therapeutic mixture of the following composition: lidocaine - 40 mg, dexazone - 8 mg, taufon - 80 mg, dalargin - 2 mg, lidase - 32 units, water - 6 ml.

 On the tenth day, the phenomena of post-inflammatory bullous keratopathy are completely stopped.

 Thus, the use of lymphotropic lymphostimulating therapy using a therapeutic mixture of drugs, including a complex of mediators of immunity and anti-inflammatory drugs with a pronounced reparative effect, provides the ability to effectively and quickly treat inflammatory bullous keratopathy.

Claims (2)

1. A method of treating post-inflammatory bullous keratopathy, comprising administering drugs, characterized in that the drug is administered into the lymphatic region of the orbit on the side of the affected eye by performing pterygopalatine blockade, and a therapeutic mixture containing lidocaine 20-40 mg is used as the medicine, dexazone 4-8 mg, taufon 40-80 mg, dalargin 1-2 mg, lidase 16-32 units. act., distilled water 3-6 ml. 2. The method according to claim 1, characterized in that they carry out 3-6 blockades with an interval every other day.