RU2264241C2 - Method for treating lesions of visual analyzer - Google Patents

Abstract

FIELD: medicine, neuroophthalmology.

SUBSTANCE: the present innovation deals with treating patients with lesions of visual tract of different etiology. One should transsclerally affect pre-limbic area with scanning low-intensity laser radiation of red range, through temporal and nasal areas of patient's eyeball - with scanning low-intensity laser radiation of red range, retinal vessels and vascular membrane of eyeball's posterior department for 5-45 sec/field. Impact time should be increased per seance. Therapy course consists of 5-10 procedures. The innovation provides increased vision field and improved acuity.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely, neurology, laserology, rehabilitation, neurosurgery, neuroophthalmology, and can be used to treat patients with optic lesions of various etiologies, excluding oncopathology, arterial aneurysms, carotid-cavernous anastomoses and arteriovenous malformations.

A known method of treating lesions of the visual analyzer (RF patent No. 2128485, 1999). In this case, the patient undergoes transcranial magnetic stimulation of the projection of the visual cortex by a pulsed magnetic field of 0.1-0.25 T at the same time as percutaneous electrical stimulation of the eyelid region, with photostimulation daily, for 15-20 minutes. The course of treatment is 10-15 sessions.

However, the method is time-consuming, multi-stage, requires highly qualified medical staff to conduct the treatment procedure. In addition, it can stimulate paroxysmal brain activity.

A known method of treating lesions of the visual analyzer (RF patent No. 2200523, 2001). In this case, transcutaneous irradiation of the common carotid artery zone on the side of the affected eye is performed. The pulsed low-intensity laser radiation (LLLT) of the infrared range is used, the wavelength is 800-950 nm, the pulse power is from 4 to 10 W, the pulse duration is 70-300 ms, and the pulse repetition rate is 100-3000 Hz. The exposure is selected from an interval of 5-10 minutes, with a frequency of 1-2 times a day. The course of treatment is 5-10 sessions.

However, in this method, LLLT irradiation is conducted to the common carotid artery, activating blood flow, primarily in the vascular bed of the common carotid artery. As a result, the energy of laser radiation is gradually dissipated with the blood flow and does not reach the optimal power of exposure to the orbital artery. And if the patient has difficulty in blood flow through the common carotid artery, for example, as a result of an atherosclerotic disease or other factors, the power of the effect on the blood flow in the system of the visual analyzer is further reduced. In addition, with a pulse power of 4 to 10 W, the thermal effect of laser radiation is large, which is a side effect.

The prototype of the proposed method is a method of treating lesions of the visual analyzer (RF patent No. 2155565, 1998). In amblyopia with central fixation, the pathologically altered region is exposed to a fixed laser beam with a wavelength of 0.63 μm with energy illumination of the retina, which is changed according to the law of the meander from 0 to 25 mW / cm ² with a frequency of 1-3 Hz. With amblyopia without central fixation and pathologies of the retina, congenital unoperated bipolar cataracts, the area of pathological changes is affected by a scanning laser beam with a power of 50 mW / cm ² , previously expanding the pupil by instillation of mydriatic. The duration of each procedure is 60-180 seconds, daily. The course of treatment is 5-7 sessions.

The disadvantage of the prototype is the effect of LLLT on pathologically altered retinal tissue with blood vessel dysfunction in this area, which reduces the effectiveness of the exposure and suggests an increase in the laser power up to 50 mW / cm ² , not counting the change in illumination according to the law of the meander and scan. In addition, the method is time-consuming, requires the use of additional tools (instillation of mydriatics in the eyes), changes in the power of laser radiation, which leads to additional time costs. In parallel, a side effect from the cornea and lens is possible.

The invention is aimed at creating a method for treating lesions of the visual analyzer, which provides increased treatment efficiency, elimination of undesirable side effects on the eye structures that are not subjected to therapeutic stimulation, and also reduces labor intensity.

The essence of the invention lies in the trans-scleral effect of laser radiation. They act prelimbally, through the temporal and nasal areas of the eyeball, on the retinal vessels and choroid of the posterior part of the eyeball with a laser beam with a wavelength of 0.67 μm, a power of 0.5 mW, with a scanning frequency of 330 Hz, for 5-45 sec field. The exposure time is extended by the session. The course of treatment is 5-10 sessions.

The inventive method differs from the prototype in that it acts prelimbally, through the temporal and nasal areas of the eyeball, on the vessels of the retina and choroid of the posterior part of the eyeball for 5-45 seconds on the field, increasing the exposure time by session, the course of treatment is 5-10 procedures.

It is known that the choroid of the eye consists of the iris (iris), ciliary body (corpus ciliare) and the choroid itself (chorioidea) and is connected with the retina throughout its length. The optically inactive - the blind part of the retina, consisting of two layers, is associated with the iris and ciliary body. The choroid itself is closely related to the optically active - the visual part of the retina, consisting of 10 microscopic layers. The chorioidea proper makes up 2/3 of the vasculature and receives blood, mainly from the posterior short ciliary arteries, which, after passing through the sclera, disintegrate into a dense network of small arterioles and capillaries, the total lumen of which is many times larger than the lumen of the adducting vessels, which slows down the flow of blood. A large amount of blood circulating in the choroid proper, which is intimately associated with neuroepithelium, ensures the restoration of the constantly decaying visual substance in the neuroepithelium, due to which the photochemical process is maintained at a constant level. Under the influence of LLLT on the vessels of the retina and choroid of the posterior part of the eyeball, without affecting the cornea, the choroid of the eye is exposed to laser radiation practically throughout its entire length, since the LLLT of the red range penetrates to a depth of 2.5 cm, and the anteroposterior size of the eyeball is an average of 24 mm.

The method is as follows. The course of treatment is carried out using a laser unit generating a LLLT wavelength of 0.67 microns (semiconductor laser) with a slit lamp. Frame No. 9, size 0.8 × 0.8, 0.5 mW, which scans with a frequency of 330 Hz for retinal vessels and the choroid of the posterior part of the eyeball for 5-45 seconds, is transsclerally acting on the prelimb region with a remotely continuous laser beam on the field, gradually increasing the exposure time - 1 day 5 sec, 2 day 10 sec, 3 day 15 sec, etc. The total duration of the procedure does not exceed 3 minutes. The course of treatment is 5-10 procedures. Before and after the course of treatment, the patient is examined for visual evoked potentials (VEP) and a neuroophthalmologist is examined.

The inventive method is developed in RNHI them. prof. A.L. Polenova and passed clinical trials in the treatment of 25 patients. The main group of patients consisted of patients with traumatic brain injury of varying severity from the age of 25 to 60 years. 2 patients were treated with a concomitant diagnosis of cerebral arachnoiditis, 5 patients with vascular pathology. Among them, 19 patients were operated on. The remaining 6 patients received only traditional drug treatment and laser therapy (RT) according to the proposed method. In this case, laser stimulation was carried out at various times after the operation: from 10 days to 1 year. Patients were admitted to RT only in a somatically compensated state, on average 7-10 days after an injury or surgery.

A study of patients of the main group (with a craniocerebral trauma) before the RT course showed that the amplitude of the VIZ varied within the limits: N75-P100 2.37-9.27 μV, P100-N145 0.65-7.98 μV. On average, the amplitude of VIZ before treatment was N75-P100 5.82 μV, P100-N145 4.3 μV, which is 2 times lower than normal. Normal amplitudes are on average N75-P100 9.8 μV, P100-N145 8.4 μV. Minimum P100 amplitude value by J.Kjaer 6.5 μV.

After the RT course, the amplitude of the VIZ increased: N75-P100 6.46-24.5 μV, P100-N145 2.15-24.5 μV. After treatment, the average VIZ amplitude after treatment was N75-P100 15.48 μV, P100-N145 13.32 μV, which was almost 50% higher than the initial values. All patients experienced an increase in amplitude indicators by a factor of 2–3, while latency decreased on average by 5–10%.

In the group of patients with vascular pathology, the initial values of the peak amplitude of N75-P100 exceeded the norm by an average of 15-20 μV, P100-N145 by 30-40 μV, which indirectly testified to irritation of the cortical level of the visual analyzer and was confirmed by EEG data. After RT, normalization of the amplitude indices of VIZs N75-P100 to 7-9 μV, P100-N145 to 7-10 μV was observed, which is 36-44% lower than the initial data, and latency indices decreased by 1-3%. On the EEG after the course of treatment of LLLT, the bioelectric activity of the brain was stabilized, the number of slow theta waves in the posterior parts of the hemispheres decreased, and the vegetative instability decreased.

During an ophthalmological examination, an improvement in visual functions was observed in all patients — an expansion of the visual fields and an increase in visual acuity by 0.1-0.3-0.5. Moreover, the positive dynamics continued after the course of LLLT treatment for 2-3 months, which is regarded as the “aftereffect” of laser radiation.

The high efficiency of the proposed method of treatment is explained by the peculiarities of the effect of LLLT as a factor that energetically stimulates metabolic processes in patients with traumatic brain injury and normalizes the activity of metabolic processes in biological tissues in patients with vascular diseases. We give examples of extracts from the medical history.

Example 1

Patient S., 51 years old, medical history No. 1668-2003. Diagnosis: Atherosclerosis of cerebral vessels. Repeated ischemic strokes in the vertebro-basilar basin in 2000. Stenosis of the main artery. The defeat of the central neuron of the visual pathway in the right hemisphere. Before treatment, Vis OD = 0.2, Vis OS = 0.2. Central absolute scotomas on a white object 2 mm and red. Conducted 10 treatment sessions by the proposed method. The course of treatment was carried out using a laser unit generating a LLLT with a wavelength of 0.67 μm (semiconductor laser) with a slit lamp. They acted transsclerally on the prelimb region, remotely continuous laser beam frame No. 9, size 0.8 × 0.8, power 0.5 mW, which scans with a frequency of 330 Hz on the vessels of the retina and choroid of the posterior part of the eyeball for 5-45 seconds on the field, gradually increasing the exposure time: 1 day - 5 sec, 2 day - 10 sec, 3 day - 15 sec, etc. The total duration of the procedure did not exceed 3 minutes. The curve obtained in the study of VIZ before treatment is presented in figure 1, after treatment - figure 2. After treatment: Vis OD = 0.3, Vis OS = 0.3, the central scotoma decreased by red and the white mark to 1 mm, the lower border of the field of view increased by 10 °, the outer - by 5 ° bilaterally. The dynamics of the latency of the VIZ are presented in table 1. The dynamics of the amplitude of the VIZ are presented in table 2.

Table 1. Stimulus Channel Component Latency, ms Change
latency ms % before after Left eye 30 ms 1 N75 70 68.7 -1.3 1.8 P100 90 87.5 -2.5 2.7 N145 120 115 -5 4.2 Right eye 30 ms 1 N75 71.3 70 -1.3 1.8 P100 92.7 88.1 -4.6 4.96 N145 120 120 0 0 Table 2. Stimulus Channel Components Amplitude, μV Amplitude change μV % before after Left eye 30 ms 1 N75-P100 28.6 10.1 -18.5 6.4 P100-N145 60.6 18.5 -42.1 69,4 Right eye 30 ms 1 N75-P100 26.3 10.1 -16.2 61.5 P100-N145 55.3 16.9 -38.4 69,4

Example 2

Patient F., 42 years old, medical history No. 5-2003. Diagnosis: Consequences of severe combined head injury. Cerebral arachnoiditis. Simple atrophy of the optic nerves. The defeat of the intracranial part of the left optic nerve and chiasm. Vis OD = 1.0, Vis OS = 0.01, complete bitemporal hemianopsia with a sharp narrowing of the visual fields across all meridians on the OS, absolute central scotoma on the OS. Conducted 10 treatment sessions by the proposed method. They acted transsclerally on the prelimb region, remotely continuous laser beam frame No. 9, size 0.8 × 0.8, power 0.5 mW, which scans with a frequency of 330 Hz on the vessels of the retina and choroid of the posterior part of the eyeball for 5-45 seconds on the field, gradually increasing the exposure time: 1 day - 5 sec, 2 day - 10 sec, 3 day - 15 sec, etc. The total duration of the procedure did not exceed 3 minutes. The curve obtained in the study of VEP before treatment is presented in figure 3, and after treatment is shown in figure 4. After treatment: Vis OD = 1.0, Vis OS = 0.7, the central scotoma on the OS disappeared, the peripheral borders of the visual field expanded first on the OS, then the visual field appeared in the upper temporal quadrants along the two meridians at 10-15 ° bilaterally . The dynamics of the latency of the VIZ are presented in table 3. The dynamics of the amplitude of the VIZ is presented in table 4.

Table 3. Stimulus Channel Component Latency ms Latency change before after ms % Left eye 30 ms 1 N75 109 76.7 -32.3 29.6 P100 144 99.7 -44.3 30.7 N145 160 145 -fifteen 9.3 Right eye 30 ms 1 N75 103 76.7 -26.3 25.5 R 100 139 103 -36 25.8 N 145 181 148 -33 18.2 Table 4. Stimulus Channel Components Amplitude, μV Amplitude change μV % before after Left eye 30 ms 1 N75-P100 2,37 6.58 +4.21 63.9 P100-N145 0.651 15.9 +15,249 95.9 Right eye 30 ms 1 N75-P100 5.08 13.1 +8.02 61.2 P100-N145 5.5 14.6 +9.1 62.3

Using the proposed method improves the effectiveness of the treatment of patients with traumatic and vascular lesions of various sections of the visual pathway.

Claims (1)

A method for the treatment of lesions of the visual analyzer, including transscleral exposure with scanning low-intensity laser radiation of the red range, characterized in that they act prelimbally through the temporal and nasal regions of the eyeball on the vessels of the retina and the choroid of the posterior part of the eyeball for 5-45 s on the field, increasing seedingly exposure time, course of treatment 5-10 procedures.

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