RU2310452C1 - Method for immunorehabilitation at treating inflammations of anterior ocular segment - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: since the 1^st d of prescribing corticosteroids onto the skin of the upper and the lower eyelid it is necessary to apply "gel Relict 0.5" twice daily without rubbing it in. The gel mentioned should be applied and spread steadily with a layer of about 2-3 mm thickness, not les; the duration of therapy for every patients corresponds to the duration of the conducted corticosteroid therapy. The innovation provides prophylactics of local immunosuppression.

EFFECT: higher efficiency.

3 ex, 1 tbl

Description

The invention relates to ophthalmology and, in particular, to the local treatment of inflammation of the anterior segment of the eye and can be used to increase local immunity, inhibited by the use of corticosteroids.

Currently, corticosteroids are widely used in the local treatment of inflammation of the anterior segment of the eye of various nature, such as postoperative, post-traumatic, infectious iridocyclitis, keratitis, in the form of instillation of eye drops of 0.1% dexamethasone into the conjunctival cavity or injection into periocular tissues. The disadvantage of using corticosteroids is a decrease in the synthesis of interferon, acceleration of the catabolism of immunoglobulin, suppression of antibody production, i.e. the occurrence of immunosuppression. As a result, the link of nonspecific immunity in the inflammation zone, associated with phagocytosis reactions, suffers. (Kasparov A.A. “Ophthalmogerpes.” M.: Medicine, 1994; Katsnelson L.A. “Uveitis.” M., 4th branch of the Military Publishing House, 1998).

In turn, the inhibition of local immunity caused by the use of corticosteroids causes the activation of opportunistic microflora present in the conjunctival sac, which contributes to a longer course of inflammation, its transition to a chronic state. Against the background of immunodeficiency, there is a high risk of joining a secondary fungal or bacterial infection, activation of a viral infection with the formation of degenerative changes in the cornea and conjunctiva. The intensification of the inflammatory process and its generalization is associated with the occurrence of such serious complications as endophthalmitis, panophthalmitis with a complete loss of visual functions and even loss of the eye.

There are ways to increase immunity in ophthalmology when various immunotropic drugs are used (Maychuk Yu.F. Bulletin of Ophthalmology No. 6, 1988, Volume 104).

But their use has the following disadvantages:

- activation of not only the immune system, but also the pathological agent;

- additional tests to determine individual sensitivity to immunotropic drugs, because each patient has an individual sensitivity to certain drugs;

- the question of the duration of treatment with these immunotropic drugs has not been finally resolved;

- the existence of the danger of depletion of the reserve capabilities of the immune system;

- it is necessary to conduct expensive immunological studies in dynamics.

The closest analogue prototype is patent RU No. 2213545 C1, 10/10/2003, an immunocorrection method in which a 10% sterile solution of placental albumin is used for immunomodulation, which is administered parabulbarly in the treatment of endocrine ophthalmopathy.

Its disadvantage is:

- the drug enters and dilutes in the general bloodstream, and its insufficient concentration enters the eye;

- the injection method of administration of the drug causes additional physical and mental trauma to the patient, since the maximum course of treatment is 15-20 injections, while the duration of taking corticosteroids is 2.5-3 months;

- the presence of contraindications for patients with severe arterial hypertension and impaired renal function, as it contains low molecular weight proteins;

- the need for dynamic control of the immunogram, since the body's immunological system is included in the implementation of the effects;

- narrowly targeted use of the drug (only for endocrine ophthalmopathies).

The objective is to propose a method for the prevention of immunological deficiency in the tissues of the eye.

The technical result is the prevention of local immunosuppression in the tissues of the eye by local application of "Relic Gel 05".

The technical result is achieved by the fact that from the first day and throughout the entire period of prescribing corticosteroids locally, twice a day (morning and evening), patients apply and evenly distribute (without rubbing) Gel Relict 05 on the skin of the eyelids with a thin layer, not less than 2 mm, and left until completely absorbed. Full absorption of the gel in the tissues of the eyelids and conjunctiva occurs within 3-5 minutes. In this case, an additional skin toilet is not required, since after applying the gel there are no artifacts left on it. The duration of treatment is comparable with the duration of corticosteroid therapy. Treatment courses can be continued without side effects until corticosteroids are completely discontinued.

The advantages of the method:

- the external route of administration is technically simple, therefore treatment can be carried out in any conditions: in a hospital, on an outpatient basis, at home;

- the creation of a high concentration of the drug and therapeutic factors directly in the tissues of the anterior segment of the eye, since Gel Relikt 05 is applied locally;

- the absence of somatic contraindications and allergic reactions to the drug, since it does not contain proteins;

- dynamic control of the immunogram is not required, since the route of administration is local.

Thus, the method for the prevention of local immunosuppression in the local treatment with corticosteroids of postoperative, post-traumatic, infectious inflammation of the anterior segment of the eye by applying Gel Relict 05 is pathogenetic justified. It reduces by 4.4 times the number of complications, the occurrence of which in the treatment of ocular pathology is considered as clinical manifestations of the presence of signs of immunosuppression. The proposed method is simple to use and can be performed in a wide network of ophthalmological departments and even on an outpatient basis.

The table presents a comparative analysis of the frequency and complications of the anterior segment of the eye in the main group receiving Gel Relict 05 and the control group without it.

We observed 49 people with inflammation of the anterior segment of the eye receiving topical corticosteroids for this reason: 10 people - for postoperative cyclitis, 12 - exacerbation of recurrent uveitis, 8 - contusion of the 2nd degree of the eyeball, post-traumatic cyclitis, 11 - condition after penetrating scleral wound eyes, 8 - episcleritis.

The age of patients ranged from 15 to 72 years. Along with anti-inflammatory, absorbable, desensitizing, stimulating therapy, patients locally applied Gel Relic 05 to the skin of the eyelids.

For comparison, a retrospective analysis of 50 case histories of patients from the clinical database of HF FSI MNTK Eye Microsurgery treated for inflammation of the anterior segment of the eye, identical in pathogenesis and nosological forms, was performed. All of them received standard treatment with topical corticosteroids without Relic Gel 05. A comparative analysis of the frequency of complications, which are the clinical expression of immunosuppression, was carried out. In the main group of 49 people, complications arose in 5, in the control group of 50, in 22 people.

Example 1

Patient S., 48 years old, was treated for exacerbation of recurrent right eye uveitis, ankylosing spondylitis. On admission: vision of the right eye 0.6 n / a, left 1.0. The right eye is annoyed. The cornea is edematous, tender precipitates in the lower parts of the cornea, thin posterior synechiae. Vitreous body and fundus without pathology. Within 5 weeks he received anti-inflammatory, mydriatic, desensitizing immunocorrective therapy, corticosteroids and additionally “Gel Relikt 05”. Twice a day, he applied a uniform layer of at least 2 mm, distributed without rubbing the gel on the skin of the upper eyelid until corticosteroids were completely discontinued.

Two weeks after the start of treatment, pericorneal injection and corneal endothelial edema decreased, the precepts resolved, and the effects of descemetitis remained. On examination, after another week, the right eye is calm, vision is 1.0, the cornea is not changed, the vitreous destruction of the filamentous.

Example 2

Patient K., 23 years old, was treated for post-traumatic iridocyclitis of the left eye after a penetrating scleral wound for 4 weeks. He received anti-inflammatory, absorbable, desensitizing treatment, corticosteroids locally and in tablets. From the first day of their administration, Gel Relikt 05 was prescribed in the form of a double overlay on the skin of the upper eyelid in the morning and evening with an even layer, at least 2 mm, without rubbing. On examination, after three weeks the injection of the eyeball decreased, corneal endothelial edema also decreased, precipitates began to dissolve. The pain syndrome disappeared, the cellular reaction in the vitreous body also decreased. A week later, the left eye is calm. There is a scar on the sclera. There are no precipitates and edema of the corneal endothelium. The iris in color is not changed. Single synechia at 3 o’clock. In the vitreous, filamentous destruction. The fundus is visible freely, there is no pathology.

Example No. 3.

Patient E., 69 years old, was operated on for cataracts of the left eye with implantation of an intraocular lens. Two days after the operation, chronic sinusitis worsened and, as a result of this, uveitis of the operated eye arose. Antibiotics, corticosteroids, mydriatics, absorbable and desensitizing agents were prescribed. "Relic Gel 05" the patient did not receive. The pain syndrome stopped after 7 days. Over a period of two weeks, pericorneal expressed injection, edema of the iris and endothelium of the cornea persisted, although the amount of precipitates gradually decreased, as did the cellular reaction of the vitreous body. Fibrin resolves in the anterior chamber.

A week later, again there was pain in the eye, photophobia. Vision of the left eye decreased. When viewed in the cornea, a few coin-like infiltrates in the epithelium and surface layers of the stroma. The diagnosis was made: herpetic keratitis, antiviral agents and Gel Relict 05 were added to the treatment. The patient applied 2 times a day with a uniform layer of at least 2 mm, distributed it, without rubbing, on the skin of the upper eyelid. When viewed after 2 weeks: the left eye is calm, the cornea is not changed. Postoperative sutures on it without signs of inflammation and swelling, the moisture of the anterior chamber is clean, there are no precepts, and the filamentous body has a light filamentous destruction.

Table A comparative analysis of the frequency and complications of the anterior segment of the eye in the main group receiving Gel Relikt 0.5 and in the control group without its purpose. The main group of 49 people received corticosteroids for a long time from 3 to 7 weeks (on average, 6.1 ± 1.1 weeks) The control group of 50 people who received corticosteroids on average from 3 to 6 weeks Nosological forms Number of persons Activation. viral infection Marginal keratitis Purulent keratitis Fungal corneal ulcer Dystrophic changes in the cornea Number of persons Activation. viral infection Marginal keratitis Purulent keratitis Fungal corneal ulcer Dystrophic changes in the cornea Postoperative iridocyclitis 10 one - - - - 10 one 2 - - one Exacerbation of recurrent uveitis 12 - one - - - 12 - - one 2 3 Post-traumatic iritis after contusion 8 - - - - - four one - - - - Post-traumatic iridocyclitis after penetrating wounds eleven - - one - 2 fifteen 3 - one one four Episiscleritis 8 - - - - - 9 one one - - - Total 49 one one one - 2 fifty 6 3 2 3 8

Claims (1)

The method of immunorehabilitation in the treatment of inflammation of the anterior segment of the eye with corticosteroids, which involves the use of biogenic stimulants, characterized in that Gel Relik 05, which is applied and evenly distributed with a layer of at least 2-3 mm thick, is used as a biogenic stimulator the skin of the upper and lower eyelids without rubbing twice a day, while the duration of treatment in each individual patient corresponds to the duration of the corticosteroid therapy.