RU2258492C1 - Method for treating dystrophic diseases of posterior ocular pole - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: one should perform conjunctival incision and blunt separation of Tenon's capsule up to posterior ocular pole. In area of optic nerve one should perform chemical irritation with 10%-trichloroacetic acid solution and crystalline talc due to introductions in three directions - at positions of 3, 6 and 9 o'clock around optic nerve. Then, additionally, one should introduce about 0.8-1.0 ml suspension of autologous mononuclear cells out of bone marrow into area of patient's optic nerve at the quantity of (15 - 17.5) x 10⁷ alive cells. The suggested innovation improves blood circulation in area of optic nerve and enables to apply one's own restorative body reserve.

EFFECT: higher efficiency of therapy.

2 cl, 2 ex

Description

The invention relates to medicine, more specifically to ophthalmology, and can be used to improve vision and stabilize visual functions in patients with degenerative diseases of the posterior pole of the eye.

Dystrophic diseases of the posterior pole of the eye are one of the main causes of blindness and low vision in the elderly, however, the classical methods of drug therapy do not allow a stable and long-lasting effect on blood circulation in the vessels of the eye. Combined methods are more effective, including electrical stimulation and drug therapy or surgical treatments.

A method for treating optic atrophy is known, including direct electrical stimulation of the optic nerve, characterized in that a permanent catheter is inserted into the retrobulbar space, through which electrical stimulation is performed once a day, and 1 ml of 10% is introduced into it 40 minutes before it. -th solution of piracetam, and subsequently the necessary medications 4 times a day (RF Patent No. 20088859, CL A 61 F 9/00, 1994).

The disadvantages of the method are its invasiveness and the duration of treatment, which is 21-28 days.

A known surgical method for the treatment of optic atrophy and macular degeneration is that in the lower outer quadrant, 10 mm from the limb, an incision is made of the conjunctiva and tenon membrane, a pocket is formed in the projection area of the macular and paramacular region with the capture of areas adjacent to the optic nerve from the upper, lower and outer sides, then a graft is implanted in the form of a film obtained from the pericardium of farm animals, through an incision in the lower outer quadrant of the eye in the projection of the macular region STI However, the method has a low revascularizing effect, the possibility of immunological incompatibility and, as a result, complications in the form of allergic reactions with subsequent scarring.

Closest to the claimed method, the prototype is a method for treating dystrophic diseases of the posterior part of the eye, including a conjunctival incision, access to the optic nerve through which 0.05 ml of 10% trichloroacetic acid (TCA) and 0.005 g of fine-grained talc are brought to the last ( A.S. USSR, No. 1391644, class A 61 F 9/00, 1988).

The disadvantage of the prototype is the lack of effectiveness of the method.

An object of the invention is to increase the effectiveness of treatment.

The technical task is solved by the proposed method, which consists in the following.

After preparation of the surgical field and local anesthesia, the conjunctiva is incised in the lower-internal at 4-30 hours (OD) or the lower-external at 7-30 hours (OS) quadrant 4-7 mm from the limb, 3-5 mm long. A spatula is inserted into the incision and a blunt separation of the tenon capsule is carried out to the posterior pole of the eye to provide access (channel) to the optic nerve. Using a special curved dosed syringe in three directions around the optic nerve: at 3, 6 and 9 hours, a sequential injection of 0.1 ml of a 10% solution of trichloroacetic acid (TCA) is performed. After each administration of TCA, 20 mg of crystalline talcum powder are then added. Exposure is 10-12 minutes. Then, 0.8-1 ml of a suspension of autologous mononuclear cells from the bone marrow in the amount of (15-17.5) × 10 ⁷ living cells is injected into the region of the posterior pole of the eye into the region of the optic nerve. Autologous mononuclear cells are taken from the patient on the day of surgery using special technology. Impose 1-2 nodal suture on the conjunctiva. 0.2 ml of gentamicin solution is injected into the lower conjunctival arch.

The basis of the proposed method is the improvement and stabilization of the functional state of the retina and optic nerve associated with the formation around the last talc granuloma with prolonged hyperemia of the posterior pole of the eye with the simultaneous acceleration of organ-specific restoration of the functions of the optic nerve using autologous mononuclear cells from bone marrow.

Salient features of the proposed method, compared with the prototype, are:

- the introduction of 10% TCA and the formation of talc granulomas is carried out in three directions from the optic nerve - at 3, 6 and 9 hours, which improves the efficiency of the method by improving hemocirculation in the optic nerve, as well as increasing linear and volume velocity blood flow in the membranes of the optic nerve;

- additionally, a suspension of autologous mononuclear cells from the patient’s bone marrow is introduced into the posterior pole of the eye, which allows stimulating angiogenesis and restoring some of the lost nerve cells.

Bone marrow mononuclear cells contain stem cells, which are the precursors of all body cells. As you know, the bone marrow, first of all, is the bridgehead of hematopoiesis, it is the source of two types of stem cells: those that make up the entire known variety of blood cells (the so-called hematopoietic stem cells), and stromal stem cells. In addition to bone marrow, a small number of stem cells (the so-called stem tissue cells) are present directly in the tissues: muscle (myoblasts), bone (osteoblasts) and others. It has been established that two types of stem cells are involved in regeneration - specialized tissue and universal bone marrow stromal cells. If tissue stem cells are used to repair damaged areas only in a given place and for a certain type of tissue (bone - for bones, muscle - for muscles, etc.), then stromal stem cells of the bone marrow are universal. They enter the damaged organ or tissue through the bloodstream and, in place, under the influence of various signaling substances, they turn into the necessary specialized cells that replace the dead.

Thus, the method allows to improve metabolism in the pathological focus, stabilize the pathological process, improve the performance of visual functions in patients with optic atrophy, retinal degeneration and other dystrophic vascular diseases of the posterior pole of the eye.

Search and analysis of sources of known scientific, technical and patent information showed that the claimed technical solution meets the criteria of the invention of "novelty and inventive step", since a similar method that matches the distinguishing features of the proposed method was not found.

The invention is illustrated by the following examples of clinical performance of the method.

Example 1

Patient I., 55 years old, was admitted to the hospital with a diagnosis of open-angle (IVc) glaucoma of the right eye and open-angle (IIIa) glaucoma of the left eye stabilized by surgery.

The fundus of the left eye is a disc of the optic nerve pale, total marginal excavation, vasoconstriction (severe partial atrophy of the optic nerve). The central and peripheral areas of the retina are normal. Visual acuity of 0.01 is eccentric.

The patient underwent an operation by the claimed method.

After preparing the surgical field and local anesthesia with a 2% lidocaine solution, the conjunctiva was cut in the lower outer quadrant at 7-30 hours 4 mm from the limb, 3 mm long. A spatula curved along the curvature of the eye was introduced into the incision, and a blunt separation of the tenon capsule was made to the posterior pole of the eye. Then, using a special curved dosing syringe in three directions around the optic nerve: at 3, 6 and 9 hours, a sequential injection of 0.1 ml of a 10% solution of trichloroacetic acid (TCA) was performed. After each administration of TCA, 20 mg of crystalline talcum powder were added. Exposure is 10 minutes. Then, 0.8 ml of a suspension of autologous mononuclear cells from the patient’s bone marrow in the amount of 15 × 10 ⁷ living cells was introduced into the region of the posterior pole of the eye into the region of the optic nerve. 2 nodal sutures of 8.0 silk were applied to the conjunctiva. Under the conjunctiva, 0.2 ml of gentamicin solution was administered.

On the first postoperative day, the patient already noted the "brightness" of the perception of objects, on the second day, when examined, visual acuity of 0.02, and when examined after a month, visual acuity of 0.2.

Example 2

Patient M., 75 years old, was admitted to the hospital with a diagnosis of open-angle (IIIa) surgery-stabilized glaucoma of the right eye (OD), artifactia OD, anophthalmos OS. The fundus of the right eye is a pale optic disc, total marginal excavation, vasoconstriction (severe partial atrophy of the optic nerve). The central and peripheral areas of the retina are normal. Visual acuity of 0.005 is eccentric.

The patient underwent an operation by the claimed method.

After preparing the surgical field and local anesthesia with a 2% lidocaine solution, the conjunctiva was cut in the lower inner quadrant at 4-30 hours 7 mm from the limb, 5 mm long. A spatula curved along the curvature of the eye was introduced into the incision, and a blunt separation of the tenon capsule was made to the posterior pole of the eye. Then, using a special curved dosing syringe in three directions around the optic nerve: at 3, 6 and 9 hours, a sequential injection of 0.1 ml of a 10% solution of trichloroacetic acid (TCA) was performed. After each administration of TCA, 20 mg of crystalline talcum powder were added. Exposure is 12 minutes. Then, 1.0 ml of a suspension of autologous mononuclear cells from the patient’s bone marrow in the amount of 17.5 × 10 ⁷ living cells was introduced into the posterior pole of the eye. 2 nodal sutures of 8.0 silk were applied to the conjunctiva. Under the conjunctiva, 0.2 ml of gentamicin solution was administered.

On the first postoperative day, the patient already noted the "brightness" of the perception of objects, on the second day when examined, visual acuity of 0.03.

Using the proposed method will improve the effectiveness of treatment due to stem cell transplantation and use your own regenerative reserve of the body.

Claims (3)

1. A method of treating dystrophic diseases of the posterior pole of the eye, including a conjunctival incision, bluntly separating the tenon capsule to the posterior pole of the eye and applying chemical irritation in the optic nerve with 10% trichloroacetic acid and crystalline talc, characterized in that trichloroacetic acid and talc are administered in three directions - at 3, 6 and 9 hours around the optic nerve and additionally 0.8-1.0 ml of suspension of autologous mononuclear cells from the bone marrow is injected into the optic nerve region amount (15-17.5) · 10 ⁷ living cells. 2. The method according to claim 1, characterized in that 0.1 ml of a 10% solution of trichloroacetic acid and 20 mg of talc are administered three times. 3. The method according to claim 1, characterized in that a suspension of mononuclear cells is administered after exposure lasting at least 10 minutes