RU2253423C1 - Combined method for removing intraocular neoplasm - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out vitrectomy, retinotomy, exposing the intraocular neoplasm, surgically removing the intraocular neoplasm, smoothing retina with perfluororganic compound and substituting the perfluororganic compound with silicon oil. After having removed the perfluororganic compound, 10% ozonized Perfluoran emulsion having ozone concentration of 2-4 mg/l is intravenously introduced. Photosensibilizer agent is introduced into cubital vein of the same arm during 5-10 min. Intravenous laser radiation treatment of blood in 5-15 min after beginning photosensibilizer agent injection with wavelength corresponding to maximum light absorption value characteristic of the photosensibilizer agent within 10-45 min under radiation power required for activating photochemical process. Smoothing retina with perfluororganic compound being completed, separating endoscopic laser coagulation of retinotomy region is carried out with diode laser. 1-3 months later, ozonized Perfluoran emulsion, photosensibilizer agent and intravenous laser radiation treatment are repeatedly applied.

EFFECT: enhanced effectiveness of treatment; reduced risk of tumor cell dissemination.

Description

The invention relates to medicine, and more specifically to ophthalmology, and can be used to remove intraocular neoplasms, as well as for the prevention of metastasis.

A known method of destroying intraocular neoplasms with transpupillary photodynamic therapy (Barbazetto IA, Lee TC, Rollins IS, Chang S, Abramson DH. Treatment of choroidal melanoma using photodynamic therapy. Am J Ophthalmol. - 2003. - Vol. 135. - No. 6. - P . 898-899), including intravenous administration of a photosensitizer. However, when using this method in half the cases it is not possible to stop the growth of the intraocular neoplasm.

Closest to the claimed is a method of surgical removal of intraocular neoplasms (JOSE GARCIA-ARUMI, MD, LAURA SARAROLS, MD, VINCENTE MARTINEZ, MD, BORJA CORCOSTEGUl, MD. VITREORETINAL SURGERY AND ENDORESECTION IN HIGH POSTERIELOROROROROR. Vol. 21. - No. 5. - P. 445-452), including vitrectomy, retinotomy, exposure of an intraocular neoplasm, surgical removal of an intraocular neoplasm, retinal expansion with a perfluororganic compound (PFOS), and replacement of PFOS with silicone oil (SM).

The disadvantage of this method is that it does not interfere with the dissemination of tumor cells and subsequent metastasis.

The objective of the invention is to provide an effective method for the combined removal of intraocular neoplasms.

The technical result is to reduce the risk of dissemination of tumor cells and subsequent metastasis, increase the effectiveness of the action of the photosensitizer on tumor cells migrating in the bloodstream and pathological focus.

The technical result is achieved by the fact that in the method of combined removal of an intraocular neoplasm, including vitrectomy, retinotomy, exposure of an intraocular neoplasm, surgical removal of an intraocular neoplasm, straightening of the retina with an organofluorine compound (PFOS), replacing PFOS with silicone oil (CM), according to the invention after surgical removal intraocular neoplasm for the destruction of tumor cells remaining in the focus and not amenable to surgical removal as well as tumor cells whose migration through the bloodstream was triggered by surgical removal, an additional dropwise intravenous injection of 40 ml of 10% Perftoran ozonized emulsion with an ozone concentration of 2-4 mg / l is carried out, then intravenously into the cubital vein of the same arm for 5 -10 minutes, a photosensitizer (PS) is administered at a concentration and dose allowed for intravenous administration, for example, a 0.1-1% aqueous solution of a chlorine-type FS, selected from the group of photolon, radachlorin or photoditazine, at a dose of 0.2-0.5 mg / kg or 0.2-1% aqueous growth Op gematoporfinovogo FS number, e.g. Photohem at a dose of 0.2-1 mg / kg. 5-15 minutes after the introduction of the FS into the cubital vein of one arm, the laser waveguide conducts intravenous laser blood irradiation (VLOK) with a wavelength corresponding to the maximum absorption of light radiation by the photosensitizer, for example, with a length waves of 661-666 nm when using aqueous solutions of the chlorine series as FS or with a wavelength of 630-633 nm when using aqueous solutions of the hematoporphyrin series as FS. Intravenous laser irradiation is carried out for 10-45 minutes at the irradiation power necessary to activate the photochemical process, for example, at a power of 20-50 mW when using both aqueous solutions of the chlorine and hematoporphyrin series as PS. All stages of an abdominal surgery following the removal of an intraocular neoplasm are carried out in parallel with the intravenous administration of the Perftoran ozone emulsion, the intravenous administration of a photosensitizer and the intravenous laser irradiation of blood. Abdominal surgery, intravenous administration of Perftoran ozone emulsion, intravenous administration of FS and VLOK are completed independently of each other.

The ozone concentration of 2-4 mg / l is non-toxic, approved for intravenous administration (Ozone therapy in ophthalmology. A manual for doctors / Borzenok S.A., Moroz Z.I., Zmyzgova A.V. - M., 2000).

Intravenous administration of FS for 5-10 minutes is due to the period of time necessary for the accumulation of FS in tumor cells.

The time interval of 5-15 minutes from the beginning of the intravenous administration of FS to VLOK is sufficient for the accumulation of PS in tissue cells with high mitotic activity.

The choice of VLOK duration of 10-45 minutes and the laser radiation power of 20-50 mW depends on the size of the intraocular neoplasm and the depth of its germination in the sclera, which determines the risk of dissemination and migration of tumor cells.

The technical result is achieved due to the fact that:

1. The use of Perftoran ozone emulsion allows enhancing the effect of the induced photochemical reaction during VLOK with a wavelength corresponding to the maximum absorption of light by the photosensitizer due to an increase in the number of reactive oxygen species (ozone therapy + Perftoran), and the cytotoxic effect of ozone on cells with high mitotic activity and improve the penetration of FS into the cell (RF patent 2160615).

2. Intravenous FS, due to its selective properties (Woodburn KW, Engelman CJ, Blumenkranz MS. Photodynamic therapy for choroidal neovascularization: a review // Retina. 2002 Aug; 22 (4): 391-405), accumulates in cells with high mitotic activity both in the pathological focus and in those migrating along the bloodstream is activated under the influence of intravenous laser irradiation of blood of the appropriate wavelength, which leads to the process of light-induced chemotherapy, which destroys these cells and thus prevents their dissemination and subsequent metastasis vanyu.

The method is as follows. After processing the surgical field and conducting regional anesthesia by a standard technique, vitrectomy and retinotomy are performed with exposure of the intraocular neoplasm. Then, with the help of a vitreotome, the intraocular neoplasm is intravitreally removed, after the removal is completed, intravenous drip of the Perftoran ozone emulsion is carried out, after which the FS is injected into the cubital vein of the same arm for 5-10 minutes, and 5-15 minutes after the start of the introduction of FS into the cubital vein of one hand through a laser fiber installed before the introduction of an aqueous solution of FS into the cubital vein of the other hand, an intravenous laser irradiation of blood is carried out for 10-45 minutes at a power of 20-50 mW. In parallel with the intravenous administration of the ozone emulsion “Perftorana” by the intravenous administration of the photosensitizer and the intravenous laser irradiation of blood, the following stages of cavity surgery are performed: the retina of PFOS is expanded and pressed, for example, perfluoropolyether or perfluorotributylamine, then a restrictive endothelial diode laser is performed; the operation is completed by suturing the areas of sclerotomy and the conjunctiva. The abdominal surgery, the intravenous administration of the Perftoran ozone emulsion, the intravenous administration of FS and VLOK are completed independently of each other.

In order to prevent metastasis, after 1-3 months, the intravenous administration of the ozonized Perftoran emulsion, the intravenous administration of FS and VLOK are repeated.

The invention is illustrated by the following examples.

Example 1

Patient V., 60 years old, was admitted to the Kaluga branch of GU MNTK “Eye Microsurgery” with suspicion of the presence of neoplasm of the choroid of the right eye. During the examination, choroid melanoma was diagnosed. The localization of the neoplasm is in the region of the posterior pole of the eye. Tumor size according to ultrasound B-scan: 9 by 10 mm, the size of the prominence - up to 6 mm. When performing fluorescence angiography (FAG), a characteristic “spotted” fluorescence was detected in the neoplasm. Preliminarily, the true boundaries of the tumor were clarified by the method of transillumination.

The patient is treated according to the proposed method. 40 ml of a 10% ozonized Perftoran ozone emulsion with an ozone concentration of 2 mg / L were administered dropwise. A 0.2% aqueous solution of photogem at a dose of 0.2 mg / kg, which was administered intravenously for 5 minutes, was used as a PS. Laser irradiation of blood was performed 5 minutes after the start of the introduction of PS with a wavelength of 633 nm for 10 minutes at an irradiation power of 50 mW.

In the control ultrasound B-scan after 6 months, a dense scar up to 1 mm thick was determined at the site of the neoplasm.

The patient was observed for 3 years. For the entire period of observation according to x-ray, computed tomography, nuclear magnetic resonance and ultrasound diagnostics metastasis was not found.

Example 2

Patient P., 62 years old, was admitted to the Kaluga branch of GU MNTK “Eye Microsurgery” with suspicion of the presence of neoplasm of the choroid of the right eye. During the examination, choroid melanoma was diagnosed. The localization of the neoplasm is in the region of the posterior pole of the eye. Tumor size according to ultrasound B-scan: 11 by 12 mm, the size of the prominence ~ up to 7 mm. During phage, a characteristic “spotted” fluorescence was detected in the neoplasm. Preliminarily, the true boundaries of the tumor were clarified by the method of transillumination.

The patient is treated according to the proposed method. Drip intravenous administration of 40 ml of a 10% ozonized Perftoran emulsion with an ozone concentration of 4 mg / L was carried out. As a PS, a 0.1% aqueous solution of radachlorin in a dose of 0.5 mg / kg was used, which was administered intravenously for 10 minutes. Laser irradiation of blood was performed 15 minutes after the start of the introduction of PS with a wavelength of 661 nm for 45 minutes at an irradiation power of 20 mW.

In the control ultrasound B-scan after 6 months, a dense scar up to 1 mm thick was determined at the site of the neoplasm.

The patient was observed for 3 years. For the entire period of observation according to x-ray, computed tomography, nuclear magnetic resonance and ultrasound diagnostics metastasis was not found.

Thus, the invention is an effective method of combined surgical removal of an intraocular neoplasm, providing a significant reduction in the risk of dissemination of tumor cells and subsequent metastasis.

Claims (1)

A method for combined removal of an intraocular formation, including vitrectomy, retinotomy, exposure of an intraocular neoplasm, surgical removal of an intraocular neoplasm, retinal expansion with a perfluororganic compound (PFOS), replacing PFOS with silicone oil (SM), characterized in that after surgical removal of the intraocular neoplasm for cells remaining in the focus and not amenable to surgical removal, as well as tumor cells whose migration along surgical removal was triggered by the venous bed, an additional 10% ozonized Perftoran ozone emulsion was administered intravenously with an ozone concentration of 2-4 mg / l, then a photosensitizer (PS) was introduced into the cubital vein of the same arm for 5-10 minutes at a concentration and dose approved for intravenous administration; then, 5-15 minutes after the start of the introduction of FS, intravenous laser blood irradiation (VLOK) is carried out with a wavelength corresponding to the maximum absorption of light radiation by the photosensitizer for 10-45 min at the irradiation power necessary to activate the photochemical process, while all the stages of the cavity surgical the operations following the removal of the intraocular neoplasm are carried out in parallel with the intravenous administration of the ozonated Perftoran emulsion, intravenous administration of the photosensitizer and intravenous laser laser irradiation of blood, and after straightening of the retina PFOS, a restrictive endolasercoagulation of the retinotomy site with a diode laser is performed, with abdominal surgery, intravenous administration of the Perftoran ozone emulsion, intravenous administration of FS and VLOK complete independently of each other, after 1-3 months repeatedly carry out intravenous administration of the ozonized emulsion “Perftoran”, intravenous administration of FS and VLOK.