RU2299065C1 - Method for treating patients for recurrent uveitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing medicinal mixture containing Lidocaine - 20-40 mg; Mexidol - 50-100 mg; Dalargin - 1-2 mg; Lidase - 16-32 units; Gemase 2500-5000 units and also a mixture containing: Lidocaine - 30-50 mg; Hystochrome (0.02%) - 2-4 mg; Lidase - 16-32 units into lymphatic region of injured eye orbit - into pterygopalatine fossa zone and retroaural zone alternatively in 4-5 h long pause in daily course of 6-8 procedures. Then 3-5 discrete plasmapheresis procedures are applied using no more than 20-25% of circulating plasma volume for exfusion with cellular mass being divided into two parts, one of which is activated by incubating with 3-6 mg of Polyoxydonium and the second one about 500-750 mg of Claforan at temperature of 36.8 37.0°C within 30-40 min. Ultraviolet radiation treatment is applied during reinfusion.

EFFECT: significant improvement of visual functions; stable prolonged remission period; improved lymph drainage and micro- and lymph circulation in carrying out lymphotropic therapy; increased antioxidant blood activity; inhibited free radical lipid peroxidation under ultraviolet radiation blood treatment.

Description

The invention relates to medicine, in particular to ophthalmology, and can be used in the treatment of recurrent uveitis.

Despite the wide arsenal of drugs, the treatment of endogenous, post-traumatic and postoperative uveitis remains one of the most difficult problems in ophthalmology. Often, uveitis goes into a chronic, recurring form, in the pathogenesis of which the leading role belongs to autoimmune reactions induced by the eye's own tissue antigens. In this regard, for the treatment and prevention of recurrent uveitis, corticosteroids and non-steroidal anti-inflammatory drugs are mainly used to suppress autoimmune reactions.

However, such immunosuppressive therapy is ineffective in 1/3 of patients, and therapy with corticosteroid drugs leads to the development of secondary immunological deficiency.

A known method of treating endogenous and postoperative uveitis with Immunofan by subconjunctival injection of the drug with anterior uveitis and parabulbar injection with posterior uveitis at a dose of 0.5 ml of a 0.0005% solution once a day, daily, with a course of 5-15 injections (RF Patent No. 2107480 , CL A 61 F 9/00, publ. 03/27/98).

The disadvantages of this method are the need for a preliminary assessment of the immune status of patients, the duration and complexity of research methods of immune status and low efficiency of the method, since the fluids and tissues of the eyeball contain a small amount of immunocompetent cells.

There is a method of treating post-traumatic uveitis with low-intensity laser radiation (G.A. Vinkova, and other Bulletin of Ophthalmology, 1999, No. 5, p.20-21). This method includes local exposure to the eye region with low-intensity infrared laser radiation in combination with intravascular laser irradiation of blood with a helium-neon laser.

The disadvantage of this method is that not only the choroid of the eye, but also other media, the reaction of which to the intensity and duration of the laser exposure is ambiguous, which causes side effects, enters the zone of the infrared laser.

The closest to the claimed method - the prototype, is a method of treating anterior uveitis (RF Patent No. 2189801, class A 61 F 9/00, publ. 09/27/2002), which consists in the following: the drug is injected into the projection of the identified ciliary soreness under the conjunctiva in an amount of 0.5-1.0 ml, while anesthetics (0.5% solution of marcaine, 1% solution of lidocaine, 0.5% solution of novocaine) and corticosteroids (diprospan, celeston), antibiotics (gentamicin , 10 mg) or antiviral drugs (half-day 50 ME). Repeated injections are performed until complete relief of uveitis.

The disadvantage of this method is the low therapeutic effect due to the effect of drugs only on the anterior part of the eyeball, elimination of only local manifestations of the inflammatory process, the absence of the pathogenetic orientation of this method and, as a result, a short remission.

An object of the invention is to increase the efficiency of the method by restoring the function of the organ of vision and lengthening the period of remission of uveitis.

The technical task is achieved by the proposed method, which consists in the following. The patient is given a comprehensive treatment consisting of lymphotherapy through pterygopalatine and submastoid blockade, discrete plasmapheresis in combination with extracorporeal pharmacotherapy and photomodification of blood.

Pterygopalatine (CBN) and submastoid (SMB) blockages are performed alternately on the side of the affected eye, daily, with a time interval of 4-5 hours, a course of 6-8 blockades.

The formulation of the drug mixture for the CBN:

Lidocaine 20-40 mg Mexidol 50-100 mg Dalargin 1-2 mg Lidase 16-32 units Gemaza 2500-5000 ME

The formulation of the medicinal mixture for SMB:

Lidocaine 30-50 mg Histochrome 2-4 mg Lidase 16-32 units

Discrete plasmapheresis is carried out in an amount of 3-5 procedures with a time interval of 48-72 hours, exfusion is carried out in two hemacons in an amount of 20-25% of the volume of circulating blood. The cell mass of one hemacone is activated by incubation with 3-6 mg of the polyoxidonium immunomodulator, and the second hemacone is activated by incubation with 500-750 mg of claforan antibiotic, and activation is carried out in a heating cabinet at a temperature of 36.8-37.0 ° C for 30-40 minutes . Reinfusion is carried out intravenously, while ultraviolet irradiation of the blood (UFO) is performed using the HVAC-3 apparatus in the spectral range of 350-600 nm.

The defining difference of the proposed method compared to the prototype is that they carry out complex treatment consisting of lymphotherapy through pterygopalatine and submastoid blockade, discrete plasmapheresis in combination with extracorporeal pharmacotherapy and UFOK, which allows to increase the efficiency of the method by increasing the regional concentration and exposure of drugs, improve blood and lymph circulation in the uveal tract, eliminate endotoxemia in the regional, organ and systemic body ur Aries, immunomodulation.

In this case, as a medicinal mixture for KNB, an optimally selected composition is used, including the peptide bioregulator dalargin, lymphostimulants - lidocaine and the enzyme lidase, the hematase fibrinolytic enzyme, as well as the antioxidant mexidol, and for SMB - lidocaine, histochrome and lidase, which allows to achieve rapid relief of the inflammation due to the wide spectrum of anti-inflammatory, metabolic and fibrinolytic effects of the mixtures used and the topography of their administration. With the introduction of the drug mixture into the lymphatic region of the orbit, its pharmacokinetics changes significantly, expressed in the selective accumulation of drugs in the focus of inflammation and the long-term maintenance of their high therapeutic concentration.

Dalargin can significantly stimulate the reaction of antibody formation, which in turn leads to an increase in the body's immune response to the inflammatory process and shortens the rehabilitation time of patients.

Mexidol is an inhibitor of free radical processes, a membrane protector that has antihypoxic, stress-protective, nootropic effects, increases the body's resistance to various damaging factors to oxygen-dependent pathological conditions.

Hemase catalyzes the conversion of plasminogen to plasmin, a serine protease capable of lysing fibrin clots, has low toxicity and good tolerance, as well as high thrombolytic and fibrinolytic activity.

Histochrome is an antioxidant that stabilizes cell membranes and intercepts free radicals.

Lymphotropic therapy provides a high regional exposure and concentration of drugs, minimal drug burden on the body, improved microcirculation, lymphatic circulation, and lymphatic drainage of the region.

Plasmapheresis provides detoxification, hemorheological and immunotropic effects.

Ultraviolet irradiation of the blood provides correction of hormonal regulation, reduction of hypoxia and hypoxemia, increase of antioxidant activity of the blood, stimulation of the immune system, improvement of microcirculation, normalization of hemodynamics, and inhibition of free radical LP.

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

Example 1

Patient L., husband. 50 years old, he was admitted to the Scientific Research Institute of Microbiology Eye Microsurgery with a diagnosis of chronic recurrent uveitis of the right eye (OD), severe, recurrence of recurrence over the past two years was three months, and vision decreased to 0.1. Complaints of pain, photophobia, lacrimation. Clinically: severe hyperemia of the eyeball conjunctiva, injection of the perilimbal vasculature, cornea edematous, deep infiltrates, sensitivity decreased, precipitates on the endothelium, serous-fibrinous exudate in the anterior chamber moisture (Tyndall syndrome 2+). In the vitreous humor (4+), the fundus is not ophthalmoscopically. On ultrasound, a thickening of the choroid is noted.

A course of treatment of the claimed method.

First, lymphotropic therapy was carried out by alternately performing morning pterygopalatine and after 4-5 hours submastoid blockade, a course of 8 procedures, daily, using for KNB a medicinal mixture containing, in mg: lidocaine - 20; Mexidol - 50; dalargin - 1; lidase - 16 units; hemase 2500 IU, and for SMB a medicinal mixture containing, in mg: lidocaine - 30; histochrome (0.02%) - 2, lidase -16 PIECES.

Then, discrete plasmapheresis was performed: exfusion was carried out in two hemacons in an amount of 20% of the circulating blood volume. The cell mass of one hemacone was activated by 3 mg of the polyoxidonium immunomodulator, and the second hemacone was activated by 500 mg of claforan antibiotic, and activation was carried out in a heating cabinet at a temperature of 36.8 ° C for 40 minutes.

During intravenous drip reinfusion, an ultraviolet blood irradiation procedure was performed using an OVK-03 irradiator with a wavelength of 350 nm.

At the end of the course of treatment, the eyes are calm, the contents of the anterior chamber are clear, precipitates are resolved, the vitreous body without signs of opacification, the fundus is pink reflex, moderate venous plethora remains, visual acuity increased to 0.9. The duration of persistent remission is 10 months (observation period).

Example 2

Patient B., husband. 35 years old, was admitted with a diagnosis of chronic recurrent uveitis of the left eye (OS). During the year, a relapse of uveitis was observed three times, vision decreased to 0.4. Clinically OS: conjunctival hyperemia, corneal expressed endothelial edema, exudate in the anterior chamber (Tyndall syndrome 2+), adhesions along the anterior capsule, pupil of irregular shape, fundus under the fleur.

First, lymphotropic therapy was carried out by alternately performing morning pterygopalatine and after 4-5 hours submastoid blockade, in a course of 6 procedures, daily, using for KNB a medicinal mixture containing, in mg: lidocaine - 40; Mexidol - 100; dalargin - 2; lidase - 32 units; a hemase of 5000 IU, and for SMB a drug mixture containing, in mg: lidocaine - 50; histochrome (0.02%) - 4, lidase - 32 PIECES.

Then, discrete plasmapheresis was performed: exfusion was carried out in two hemacons in an amount of 25% of the circulating blood volume. The cell mass of one hemacone was activated with 6 mg of the polyoxidonium immunomodulator, and the second hemacone was activated with 750 mg of claforan antibiotic, and activation was carried out in a heating cabinet at a temperature of 37.0 ° C for 30 minutes.

During intravenous drip reinfusion, an ultraviolet blood irradiation procedure was performed using an OVK-03 irradiator with a wavelength of 600 nm.

At the end of the course of treatment, the eyes are calm, the contents of the anterior chamber are clear, the precipitates are resolved, the vitreous body without signs of opacification, the fundus is pink reflex, moderate venous plethora remains, visual acuity increased to 0.7. The duration of persistent remission is 11 months (observation period).

The proposed method allows to increase the effectiveness of treatment, to achieve significant improvement in visual functions, visual acuity, to achieve a persistent, long-term clinical effect.

Claims (1)

A method for the treatment of recurrent uveitis, including the introduction of drugs, characterized in that the introduction is carried out in the lymphatic region of the orbit of the affected eye - in the pterygopalatine fossa and behind the ear, while a mixture containing Lidocaine 20-40 mg Mexidol 50-100 mg Dalargin 1-2 mg Lidase 16-32 units Gemaza 2500-5000 ME and for introduction into the ear region, a mixture containing Lidocaine 30-50 mg Histochrome 2-4 mg Lidase 16-32 units moreover, the introduction of the mixture is carried out alternately, with an interval of 4-5 hours, daily, in a course of 6-8 procedures, and then 3-5 discrete plasmapheresis procedures are carried out using not more than 20-25% of the circulating plasma volume for exfusion, while the cell mass is separated into two parts and the first is activated by incubation with 3-6 mg of polyoxidonium, and the second with 500-750 mg of claforan at a temperature of 36.8-37.0 ° C for 30-40 minutes and irradiated with ultraviolet light during reinfusion using an HVAC-irradiator 03 with a wavelength of 350-600 nm.