RU2275933C2 - Method for treatment of chorioretinitis - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: invention relates to a method for treatment of patients suffering from chorioretinitis. Method involves using cycloferon as 12.5% solution. Cycloferon is administrated in body by the combined methods: by the parabulbar route in the dose 0.5 ml through lower eyelid skin and by the intramuscular injection in the dose 1.5 ml by the following schedule: on 1, 2, 4, 6, 8, 11 and 14 day. Method allows decreasing the treatment period due to providing high concentration of the medicinal preparation in reticulated and vascular membranes of eye.

EFFECT: improved method for treatment.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in the treatment of chorioretinitis.

There are various treatments for chorioretinitis. They mainly boil down to the timely use of the most effective anti-inflammatory drugs, the so-called basic therapy: corticosteroids, broad-spectrum antibiotics (gentamicin, claforan, kefzol, sumamed, abactal, ciprobact, maxaquin, etc.) or antiviral drugs (half-dan, interferon , acyclovir, foscarnet, etc.), in combination with antifungal, non-steroidal anti-inflammatory and antihistamines. Due to the growth of infectious and inflammatory diseases characterized by a protracted, recurrent course against the background of poor effectiveness of the basic therapy, immunotherapy occupies an important place in the pathogenetic treatment of chorioretinitis (Katsnelson L.A., Tankovsky V.E. Uveitis (clinic, treatment). M ., 1998, 208 pp .; Belogubko EI Pathogenetic approaches to the treatment of eye diseases of viral etiology. - Ophthalmol. Journal. - 1991. - No. 4. - P.193-198; Maychuk Yu.F. Therapy of infectious eye diseases . - Ophthalmol. Journal., 1996, No. 4, p. 195).

The closest in technical essence is the method of treatment of chorioretinitis using non-specific immunomodulating therapy - 2 ml of a 12.5% solution of cycloferon intravenously or intramuscularly according to the scheme for 1 month (Polunin G.S., Vorobyova OK. Modern approaches to the complex treatment of chorioretinitis of various etiologies. - Clinic. Ophthalmol. - 2002. - T.3. - No. 1. - S.16-18).

However, the disadvantage of the above method of using cycloferon in the treatment of chorioretinitis is the lack of anatomical proximity between systemic administration of cycloferon and the development of chorioretinitis, resulting in a low concentration of the active substance in the retina and choroid.

The aim of the invention is to increase efficiency, reduce the treatment time of chorioretinitis and reduce the number of relapses.

The technical result is achieved by the method of treatment of chorioretinitis by introducing a 12.5% solution of cycloferon into the body, characterized in that the cycloferon solution is administered parabulbularly through the skin of the lower eyelid along the lower external corner of the orbit of 0.5 ml with a simultaneous intramuscular injection of 1.5 ml of Scheme for 1, 2, 4, 6, 8, 11, 14 days.

The treatment method is as follows.

The traditional treatment regimen for chorioretinitis is used: 40% glucose is injected intravenously with 5% ascorbic acid solution 4 ml, intramuscularly 12.5% dicinone solution 2 ml, oral diacarb 250 mg, retrobulbar administration of 0.2 ml heparin cocktails with 0.4% a solution of dexamethasone 0.5 ml and heparin 0.2 ml with a 12.5% solution of dicinone 0.5 ml. Then, a parabulbar through the skin of the lower eyelid along the lower outer corner of the orbit is injected with a 12.5% solution of cycloferon 0.5 ml with its simultaneous administration intramuscularly in 1.5 ml according to the scheme for 1, 2, 4, 6, 8, 11, 14 days .

According to the proposed method, 8 patients (11 eyes) with chorioretinitis aged 23 to 46 years were treated. All patients received a positive therapeutic effect with an average treatment duration of 13.4 ± 1.5 days. No relapse was observed. It was proved to improve visual acuity, the expansion of visual fields or the stabilization of visual functions during the observation period from 2 to 18 months.

In the control group (31 patients), intramuscular use of 12.5% cycloferon solution of 2 ml, which was administered according to the generally accepted scheme for 1 month, led to clinical recovery with an average treatment period of 26 ± 1.8 days. In 4 (12.9%) patients, the disease recurred after 3 months, requiring a second course of treatment.

Example 1

Patient S., born in 1951, was sent to the Ufa Research Institute of Eye Diseases with a diagnosis of Subretinal hemorrhage of the right eye. The left eye is healthy. According to the patient, about 10 years ago, central serous chorioretinitis of the right eye was first diagnosed. The course of anti-inflammatory treatment restored visual acuity to 1.0.

After suffering stress and intense visual stress, I noticed a decrease in vision and a spot in front of my right eye about 1 month ago. Worried about photos and metamorphopsies. After an outpatient course of treatment (absorbable, vasoconstrictive and hormonal), visual acuity decreased.

At the time of admission to the hospital of the Ufa Research Institute of Eye Diseases, visual acuity OD / OS = 0.06 / 1.0. IOP 12/13 mm Hg Perimetry revealed: OD - narrowing of the visual field by 5-10 ° along the periphery and central scotoma within 20 °, OS - physiological scotoma. The field of view on the color of the affected eye was narrowed.

Objectively: with biomicroscopy, the anterior segment of both eyeballs without pathological changes. Ophthalmoscopically revealed destruction of the vitreous body in the posterior parts of the right eye. The picture of the fundus of the right eye - optic nerve discs are pale on the temporal side, the boundaries are clear, physiological excavation, the ratio of the caliber of arteries and veins is 1: 2.5. In the macular region of the right eye there was an extensive yellowish-white focus with fuzzy contours, a diameter of about 0.7 of the diameter of the optic disc and a corolla of subretinal hemorrhage. The periphery of the retina is sharply thinned with the transmission of the choroid vessels. Ophthalmoscopy of the fundus of the left eye revealed no pathology.

On the electrooculogram - adaptation to the light of the right eye is reduced compared to the left with an Arden coefficient of 200/214%. Electroretinographic - subnormal variant of OD under normal OS wave. The visually evoked potentials on a black-and-white pattern were accompanied by a violation of the excitation along the optic tract of the right eye with a variant of the norm of the left.

Based on the examination, the patient was diagnosed with: OD - focal chorioretinitis with hemorrhagic syndrome. Ascending partial atrophy of the optic nerve. OS is healthy.

Complex treatment was carried out. Parabulbarly through the skin of the lower eyelid along the lower-outer corner of the orbit, a 12.5% solution of cycloferon 0.5 ml was administered with its simultaneous administration of 1.5 ml intramuscularly according to the schedule for 1, 2, 4, 6, 8, 11, 14 days.

After the course of treatment, according to the patient, the spot in front of the right eye decreased in size and brightened, photopsies disappeared. Visual acuity reached 0.1. Ophthalmoscopically on the fundus, the edema around the focus has resolved, the hemorrhagic corolla has decreased in size. The patient was discharged with clinical recovery on the 15th day of treatment.

Example 2

Patient E., 44 years old, was admitted to the Ufa Research Institute of Eye Diseases with a diagnosis of OU - central serous chorioretinitis. Concomitant diagnosis: Neurocirculatory dystonia of the hypertonic type.

According to the patient, about two months ago, he noticed a deterioration in the right eye vision. In recent days, “fog” has appeared in front of both eyes, the vision of the left eye has decreased. Visual acuity at admission OD = 0.6 OS = 0.9. In the field of view of both eyes, a central scotoma was determined within 10 °. Examination of the central field of view revealed an expansion of the physiological scotoma. Dark adaptation and Arden's coefficient on electrooculography are reduced. Evoked potentials on a black and white pattern - a variant of the norm. Conclusion of the ERG: the functional state of the outer layers of the retina of both eyes is reduced in the central section. On the fundus of the OU: optic nerve discs are pale pink, the borders are clear, the vessels of medium caliber, in the macular region, the swelling is more on the right.

After the course of treatment with parabulbar (through the skin of the lower eyelid along the lower outer corner of the orbit) and intramuscular injection of 12.5% cycloferon solution in 0.5 and 1.5 ml, respectively, according to the scheme for 1, 2, 4, 6, On days 8, 11 and 14, the visual acuity of both eyes recovered to 1.0. The “fog” has cleared before my eyes. On the perimetry is the physiological scotoma of both eyes. On the fundus, the optic nerve discs are pale pink, the borders are clear, the vessels of medium caliber, OD are traces of edema in the macular region, OS is the macular reflex preserved.

Thus, during clinical use it was found that parabulbar injections of cycloferon do not cause negative properties in the form of irritating, allergic and sensitizing effects. In addition, cycloferon with this method of administration helps to reduce the severity of the inflammatory process and accelerate its subsidence compared to its intramuscular use only, which reduces the duration of treatment of patients by an average of 9-15 days, prevents the development of complications and reduces the number of relapses.

The method is applicable for the treatment of patients with chorioretinitis of various etiologies and is especially indicated in severe and protracted cases, accompanied by a decrease in local and general immunity.

Claims (1)

A method of treating chorioretinitis by introducing a 12.5% cycloferon solution into the body, characterized in that the cycloferon solution is administered 0.5 ml parabulbularly through the skin of the lower eyelid with its simultaneous administration of 1.5 ml intramuscularly according to the 1, 2, 4, 6, 8, 11, 14 day.