RU2330633C1 - Method of treatment of cornea ulcers of pseudomonas and gonococcal aetiology - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: conjunctival cavity is instilled with 0.3% Ciprofloxacinum solution. Ciprofloxacinum is instilled within 2 days with ten-hour night interval. Thus within the first hour - every 5 minutes, starting from the second hour - every two hours, within the second day - every three hours.

EFFECT: method enables to prevent rough destruction of cornea within all layers by propagative agents within the first day from treatment beginning; to prevent cornea perforation; to provide early infiltrate resorption and cornea ulcer epithelisation and to keep and restore visual functions in a short space of time.

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Description

The present invention relates to ophthalmology and is intended for the treatment of corneal ulcers of Pseudomonas aeruginosa and gonococcal etiology.

Among inflammatory eye diseases, keratitis and corneal ulcers of bacterial etiology present the greatest difficulties in treatment, accounting for 33.2% as primary and 37.3% as secondary infection among patients with corneal pathology who were admitted for inpatient treatment to the Department of Infectious and Allergic Eye Diseases (Maychuk Yu.F. Bulletin of Ophthalmology. M. - 2000. - No. 3. - S.35-37].

Corneal ulcers are considered serious eye diseases that are difficult to treat and almost always end in some degree of visual impairment, up to blindness. Severe cases of bacterial keratitis can lead to endophthalmitis, corneal perforation and loss of eye.

Bacterial ulcers can be localized in any part of the cornea, but with damage to the central zone, the disease is more difficult, more difficult to treat, and scarring in this area always leads to loss of vision [Kononenko L.A., Maychuk Yu.F. New drugs. M. - 2002. - No. 11. - S.15-19].

The following pathogenetic scheme for the development of corneal ulcers [Terry A.S., Lemp M.A., et al. // Bacterial keratitis. American Academy of Ophthalmology. San Francisco - 1995. - p.1-19].

Table 1. Violation of the integrity of the cornea ↓ Adhesion of bacteria to the cornea ↓ Invasion of the stroma through the epithelium or defect of the epithelial cover ↓ Propagation of pathogens ↓ Enzyme and / or Toxin Release ↓ Inflammatory cell migration ↓ Enzyme and / or Toxin Release ↓ Stroma destruction ↓ Perforation

Analysis of the patients observed by us allows us to identify the most common causative agents of bacterial corneal ulcers (more than 80% of all cases): Staphylococcae epidermidis, Staphylococcae aureus, Streptococcae spp., S. pneumoniae, Pseudomonas aeruginosa, Echerichia coli, Neisseria Proteus vulgarella are less common. In recent years, there has been a tendency to increase the frequency of keratitis caused by gram-negative microflora, in particular Pseudomonas aeruginosae. Among bacterial lesions of the cornea, ulcerative keratitis caused by Pseudomonas aeruginosa presents the greatest risk of vision loss [Maychuk Yu.F. The therapeutic algorithm for infectious corneal ulcers. Bulletin of ophthalmology. M. - 2000. - No. 3. - S.35-37].

The ratio of causative agents of bacterial corneal ulcers is most reliably expressed by the following figures: staphylococcus - 45%, streptococcus - 12%, Pseudomonas aeruginosa - 10%, mushrooms - 7%, acantameba - 1.6% [Rowsly J.J. et al. Cornea 2-nd Int. Conffer. Prague. 1996; 77].

In general, recently the ratio of gram-positive and gram-negative pathogens of bacterial keratitis has been noticeably changing, there is a shift towards an increase in the specific gravity of gram-negative pathogens [Maychuk Yu.F. Clinical Ophthalmology. M. - 2000.v.1. - No. 2. - S. 48-51].

The progression of the disease depends on the virulence of the pathogen and the protective capabilities of the body. So, Pseudomonas aeroginosa (Pseudomonas aeruginosa) and Neisseria gonorrhoeae (gonococcus) cause rapid destruction of the corneal stroma. Bacterial corneal ulcers of Pseudomonas aeruginosa and gonococcal etiology are less common than ulcers caused by staphylococcus and streptococcus, but have the most severe and fulminant course, often leading to perforation of the cornea. Other pathogens, such as staphylococcus and streptococcus, lead to a slowly developing limited focus of inflammation. The choice of medicines and possibly the early start of rational therapy are important in the outcome of the disease.

A corneal ulcer of Pseudomonas etiology develops rapidly, accompanied by severe cutting pain, lacrimation, photophobia. Purulent discharge is moderate, often as if fixed to an ulcer. Iritis develops rapidly, hypopion appears. An ulcer with a purulent crater-shaped bottom after 2-3 days can lead to perforation of the cornea.

Corneal ulcer of gonococcal etiology has a characteristic anamnesis, usually both eyes are affected, begins with profuse purulent discharge from the conjunctival cavity. The ulcer proceeds violently, accompanied by the rapid destruction of the stroma, which can lead to perforation in 1-2 days.

Given the severity and lightning speed of the course, as well as the increasing prevalence of Pseudomonas aeruginosa and gonococcal corneal ulcers, it is necessary to develop new rational chemotherapy methods, including drug selection, dosage form selection, dose selection and application regimens, except for eye drops instillations commonly accepted in ophthalmology [Maychuk Yu.F. Viral eye diseases. - M. - 1981. - P.272].

For a long time, the main means of combating pseudomonas and gonococcal infections were drugs from the aminoglycoside group.

In the course of choosing the dosage form, dose and regimen, we first developed a rational method of chemotherapy - a regimen of forced instillations of eye drops of a 0.3% Tobramycin solution belonging to the group of aminoglycosides [Kononenko L.A., Maychuk Yu.F. New drugs. M. - 2000. - No. 1. - S.41-45].

In the future, due to insufficient MIC (minimum inhibitory concentration) of Tobramycin, due to the constant increase in bacterial resistance, due to insufficient therapeutic effect, it became necessary to choose another antibacterial drug that is more effective in influencing gram-negative microorganisms, in particular Pseudomonas aeruginosa and Neisseria gonorrhoeae.

A feature of bacterial corneal ulcers is a large number of strains of pathogens resistant to aminoglycosides: for example, according to some reports, 63.6% of pathogens were resistant to gentamicin [Garg R., Sharma S., et al. // Ophthalmology. 1999; 106 (7): 1319-20].

Hence the main strategic direction of antibiotic therapy - new antibiotics, to which there are few resistant strains. Of the wide range of antibacterial drugs, the most promising are the antimicrobial agents of the fluoroquinolone group.

One of their representatives is Lomefloxacin, which we used according to the forced instillation regimen developed earlier using the 0.3% Tobramycin solution as an example.

The closest analogue of the present invention is a method of treating corneal ulcers of Pseudomonas aeruginosa and gonococcal etiology using eye drops of 0.3% Lomefloxacin solution in forced instillation mode. The method is as follows: instillations are carried out for four days, on the first day the first 2 hours of instillation were made every 15 minutes, starting from the third hour - every hour. Starting from the second day - every 2 hours. Against the background of the noted positive dynamics, for 3-4 days, instillations were carried out every 3 hours, followed by a decrease in their frequency to 4-6 times a day. Intensive antibacterial therapy was supplemented by generally accepted instillations of mydriatics, anti-inflammatory and antifungal drugs, epithelizing and regenerating drugs. Complex treatment also included intramuscular and parabulbar injections of antibiotics [Maychuk Yu.F., Kononenko L.A. Fluoroquinolones antibiotics in the treatment of corneal ulcers caused by Pseudomonas aeruginosa when wearing contact lenses // Refractive Surgery and Ophthalmology. - 2003. - t.3, No. 1. - S. 55-60].

The disadvantage of this method is the occurrence of a secondary fungal infection, respectively, increases the duration of treatment. This is due to the fact that this forced instillation scheme was calculated for Tobramycin, which belongs to the group of aminoglycosides. Replacing the antibacterial drug Tobramycin with a more promising antibiotic from the fluoroquinolone group, without changing the pattern of forced instillations, caused an increase in the number of complications in the form of a secondary fungal infection that develops against the background of prolonged intensive antibiotic therapy. As a result, there is a need for local and systemic antifungal therapy.

Based on the fact that fluoroquinolone antibiotics are a new generation of antibacterial drugs that are more active in influencing gram-negative and gram-positive microflora compared to aminoglycosides, it became necessary to develop a new, more effective treatment regimen for pseudomonas and gonococcal corneal ulcers.

In our opinion, the new treatment regimen should comply with the modern requirements of antibacterial therapy - the antibacterial drug used must be highly sensitive, primarily to gram-negative microflora. In addition, the new treatment regimen should be shorter in duration of use, but more effective in influencing gram-negative microflora, and also not cause complications.

The rapid course of Pseudomonas and gonococcal corneal ulcers leads to the fact that during the initial treatment of the patient, the corneal ulcer reaches a severe degree of severity, less often - moderate severity. Therefore, it is necessary to maintain the MIC of the drug, increasing the intensity of the forced instillation regimen in the first 1-2 days of treatment, while reducing the duration of their use. With a reduction in the duration of the forced instillation regimen, there is practically no risk of a secondary fungal infection that occurs against the background of prolonged intensive antibacterial therapy.

The task of the invention is to provide a method for the intensive treatment of corneal ulcers of Pseudomonas aeruginosa and etiopathogenetic etiology.

The technical result of the invention is the prevention of rapid destruction of all layers of the cornea by multiplying pathogens (Pseudomonas aeruginosa, Neisseria gonorrhoeae) on the first day from the start of treatment and the prevention of perforation of the cornea, followed by resorption of the infiltrate and epithelization of the corneal ulcer, as well as preservation and restoration of visual functions.

The technical result is achieved by constantly maintaining the minimum inhibitory concentration of the antibacterial drug Ciprofloxacin in the tear and cornea using forced instillations in a certain mode.

Ciprofloxacin is a broad-spectrum antibiotic that belongs to the antimicrobial drugs from the group of fluoroquinolones. The mechanism of action is associated with inhibition of the bacterial DNA gyrase enzyme and impaired DNA synthesis. The drug causes lysis of the bacterial cell wall. It has a bactericidal effect on bacteria that are both in the breeding phase and in the resting phase. With the use of Ciprofloxacin, there is no parallel development of resistance to other antibiotics that do not belong to the group of DNA gyrase inhibitors, which makes the drug highly effective against bacteria resistant, for example, to aminoglycosides (including Tobramycin), penicillins, cephalosporins, tetracyclines and many other antibiotics.

Compared with other drugs, ciprofloxacin is active primarily against gram-negative bacteria: Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Yersinia spp., Haemophilus spp., Pseudomonas aeruginosae, Moraxella catarrhalis, Neisseria spp. and others. Among gram-positive aerobic bacteria, Ciprofloxacin is susceptible to: Staphylococcus spp. (Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus), Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Enterococcus faecalis and others. Ciprofloxacin is also active against intracellular pathogens: Legionella pneumophila, Brucella spp., Chlamydia trachomatis, Mycobacterium tuberculosis, Corinebacterium diphtheriae and others.

Resistance of sensitive pathogens develops extremely slowly, because, on the one hand, after the action of Ciprofloxacin, there are practically no persistent microorganisms, and on the other hand, bacterial cells have no enzymes that inactivate it. According to research in the USA, the number of staphylococcus strains resistant to Ciprofloxacin increased from 5.8% in 1993 to 35% in 1997, and to Ofloxacin, respectively, from 4.7 to 35%. It is believed that the widespread use of Ciprofloxacin inside in general medical practice has led to a jump in the number of resistant pathogens to 76-82% in the United States. Moreover, in different countries these data differ significantly, this is due to the duration and intensity of the use of the antibacterial drug in each particular country [Goldstein M.N., Kowalski R.P. at al. // Ophthalmology. 1999; 106 (7): 1313-8].

In Russia, ciprofloxacin found its application later than in the United States, and the breadth of its use is much less. According to our studies, there is no resistance to gram-negative and gram-positive microflora to Ciprofloxacin, side effects and complications in the treatment of Ciprofloxacin are not observed.

Eye drops Ciprofloxacin - AKOS (Ciprofloxacin 0.3%) is the first domestic fluoroquinolone antibiotic. 1 ml of the instilled solution contains the active substance: ciprofloxacin hydrochloride - 3 mg and excipients: disodium ethylenediaminetetraacetic acid, mannitol or mannitol, anhydrous or 3-aqueous sodium acetate, glacial acetic acid, benzalkonium chloride, water for injection.

Eye drops Ciprofloxacin - AKOS (Ciprofloxacin 0.3%) are intended for topical treatment of bacterial diseases of the anterior segment of the eye. It is used in the form of instillations into the conjunctival cavity from 4 to 6 times a day, depending on the severity of the disease. In the intervals between instillations, the MIC (minimum inhibitory concentration) of the drug decreases, its therapeutic effect decreases, the pathogen continues to multiply and the corneal stroma is destroyed. Thus, there is no proper effect on the bacterial microflora (Pseudomonas aeruginosa and gonococcus), which is found in all patients with this pathology.

Given the rapid course of Pseudomonas and gonococcal corneal ulcers, it is necessary to maintain the MIC of the drug in order to avoid further corneal necrosis, leading to perforation after 1-2 days from the onset of the disease.

In connection with the foregoing, the idea of forced instillations of a promising domestic fluoroquinolone antibiotic - eye drops of a 0.3% solution of Ciprofloxacin. Clinical and laboratory observation was conducted to refine and improve the forced instillation regimen specifically for eye drops of a 0.3% solution of Ciprofloxacin.

Clinical and laboratory studies have shown that the use of the forced instillation regimen of antibacterial eye drops Ciprofloxacin leads to exposure of various pathogenesis of bacterial corneal ulcers of Pseudomonas aeruginosa and gonococcal etiology, maintains a minimum inhibitory concentration at a constant level. Thus, the therapeutic effect of the drug is enhanced, allowing you to stop the purulent-necrotic decay of the cornea in the first day from the start of treatment. This provides further unhindered access of drugs to a corneal ulcer, cleansed of purulent-necrotic masses. Therefore, the next stage of treatment is the generally accepted use of anti-inflammatory drugs, epithelizing and regenerating drugs.

Our further clinical and laboratory observations showed a high therapeutic effect of the proposed modified method for the treatment of bacterial corneal ulcers.

Analyzing the results of the treatment with eye drops of a 0.3% solution of Ciprofloxacin, introduced by the modified method of forced instillations, the timing of the disappearance of bacterial microflora from smears and crops was taken into account, attention was paid to the timing of the disappearance of clinical symptoms, and the treatment effectiveness, complications and side effects of the drug were taken into account.

With this in mind, the regimen of drug administration was selected that meets all the necessary requirements. In the selected regimen, the disappearance of microflora in smears and crops was observed a day after the start of treatment, regardless of the severity of the disease, while when using other schemes of Ciprofloxacin administration, as well as using the forced instillation schemes of Lomefloxacin and Tobramipine, these indicators ranged from 2 to 4 days depending on the drug used and the severity of the corneal ulcer. The above data indicate the effectiveness of the modified method of forced instillations, the increased effect of Ciprofloxacin on the bacterial flora, the early stages of the disappearance of pathogens in smears and crops, and the reduction in the recovery time.

Side effects and complications in the selected mode were not observed.

It should be noted that for severe corneal ulcers with descemetocele and the threat of corneal perforation, the modified method of forced instillations of Ciprofloxacin made it possible to maintain a constant high bactericidal concentration of the drug in the tear and the membranes of the eye without resorting to traumatic subconjunctival and parabulbic injections in the first days of treatment. Among the patients observed by us, perforation of the cornea was not noted.

Thus, the high efficiency of the treatment of bacterial corneal ulcers using the modified method of forced instillation of eye drops Ciprofloxacin allowed us to recommend this method as an etiopathogenetic treatment of corneal ulcers with severe fulminant course, namely, corneal ulcers of Pseudomonas aeruginosa and gonococcal etiology.

The method is as follows: 0.3% solution of Ciprofloxacin is instilled into the conjunctival cavity for two days with a ten-hour night break. On the first day of treatment, the first hour of instillation is carried out every 5 minutes, starting from the second hour - every two hours, on the second day - every three hours. Intensive antibacterial therapy is supplemented by generally accepted instillations of mydriatics, anti-inflammatory drugs, epithelizing and regenerating drugs.

Example 1

Patient S., born in 1987.

I was hospitalized in the Department of Infectious and Allergic Eye Diseases of the Moscow Scientific Research Institute of GB named after Helmholtz in 2006 with a diagnosis of OS - Pseudomonas corneal ulcer of mild severity (after contact lenses). OU - Myopia medium.

The patient turned to the SRI them. Helmholtz on the second day of the disease. On admission: complaints of pain in the OS, photophobia, lacrimation, purulent discharge from the OS, decreased visual acuity.

Visual acuity at admission: Vis OD = 0.2; (-) 4.0 = 1.0

OS = 0.02; (-) 4.0 = 0.1 does not correct

The treatment was performed with eye drops of 0.3% ciprofloxacin in forced instillation mode: a 0.3% ciprofloxacin solution was instilled into the conjunctival cavity for two days with a ten-hour night break. On the first day of treatment, the first hour of instillation was carried out every 5 minutes, starting from the second hour - every two hours, on the second day - every three hours. On the third day of treatment, they switched to generally accepted treatment regimens, since the corneal ulcer was cleansed of purulent-necrotic masses, and the destruction of the corneal stroma completely stopped. The disappearance of Pseudomonas aeruginosa in smears and crops was noted after the first day of treatment. In the future, the use of conventional anti-inflammatory drugs, drugs of epithelizing and regenerating action led to complete resorption of infiltrate and epithelization of corneal ulcers.

The patient was discharged on the 12th day of treatment with recovery.

Visual acuity at discharge: Vis OD = 0.2; (-) 4.0 = 1.0

OS = 0.1; (-) 4.0 = 1.0

Example 2

Patient S., born in 1987.

I was hospitalized in the Department of Infectious and Allergic Eye Diseases of the Moscow Scientific Research Institute of GB named after Helmholtz in 2005 with a diagnosis of OS - Pseudomonas corneal ulcer of moderate severity (after contact lenses). Uveitis with hypopion. OU - moderate myopia.

The patient turned to the SRI them. Helmholtz on the fifth day of the disease. Before contacting the Research Institute of GB them. Helmholtz was treated in the contact correction office at the place of purchase of contact lenses: albucid - eye drops, chloramphenicol - eye drops, tetracycline ointment. On admission: complaints of pain in the OS, photophobia, lacrimation, purulent discharge from the OS, decreased visual acuity.

Visual acuity at admission: OD = 0.1; (-) 5.0 = 0.9 does not correct

OS = correct light projection

The treatment was performed with eye drops of 0.3% ciprofloxacin in forced instillation mode: a 0.3% ciprofloxacin solution was instilled into the conjunctival cavity for two days with a ten-hour night break. On the first day of treatment, the first hour of instillation was carried out every 5 minutes, starting from the second hour - every two hours, on the second day - every three hours. The disappearance of Pseudomonas aeruginosa in smears and crops was noted after the first day of treatment. By the end of the second day of treatment, the surface of the ulcer was completely cleansed of purulent-necrotic masses, the process of destruction of the corneal stroma was completely stopped, the phenomena of uveitis and hypopion were partially stopped. From the third day of treatment, they switched to generally accepted treatment regimens. In the future, the use of generally accepted anti-inflammatory drugs, preparations of epithelizing and regenerating effects led to complete resorption of infiltrate, epithelialization of corneal ulcers, and relief of uveal phenomena.

The patient was discharged on the 17th day of treatment with recovery. At the site of the resorbed corneal ulcer, intense opacification formed in the central zone, reducing visual acuity.

Visual acuity at discharge: OD = 0.1; (-) 5.0 = 1.0

OS = 0.1 does not correct

Example 3. Patient K., born in 1967.

I was hospitalized in the Department of Infectious and Allergic Eye Diseases of the Moscow Scientific Research Institute of GB named after Helmholtz in 2005 with a diagnosis of: OD - Perforated Pseudomonas corneal ulcer severe. Endophthalmitis with hypopion. OU - Condition after keratotomy.

The patient turned to the SRI them. Helmholtz on the 30th day of the disease. Before contacting the Research Institute of GB them. Helmholtz was treated in the eye department of the district hospital at the place of residence, intensive systemic and local antibiotic therapy was carried out. Against the background of treatment at the place of residence, negative dynamics were noted: perforation of the cornea occurred during 2 keratotomy scars and endophthalmitis with hypopion developed. At the place of residence, the patient was offered enucleation, which she refused, and due to the extremely serious condition of the OD, the patient was sent to the MRI them. Helmholtz. On admission: complaints of severe pain in the OS, photophobia, lacrimation, purulent discharge from the OS, a sharp decrease in visual acuity.

Visual acuity at admission: OD = correct light projection.

OS = 0.3; (+) 1.0 = 0.6-0.7 does not correct

The treatment was performed with eye drops of 0.3% ciprofloxacin in forced instillation mode: a 0.3% ciprofloxacin solution was instilled into the conjunctival cavity for two days with a ten-hour night break. On the first day of treatment, the first hour of instillation was carried out every 5 minutes, starting from the second hour - every two hours, on the second day - every three hours. The use of the forced instillation regimen for eye drops Ciprofloxacin made it possible to dispense with the use of traumatic parabulbar and subconjunctaval injections until the corneal perforation zone was completely scarred. The disappearance of Pseudomonas aeruginosa in smears and crops was noted after the first day of treatment. On the second day of treatment, the surface of the ulcer was completely cleansed of purulent-necrotic masses, the process of destruction of the corneal stroma completely stopped, the phenomena of endophthalmitis were partially stopped, the hypopion was completely resorbed. Thus, it became possible on the third day of treatment to switch to generally accepted treatment regimens. In the future, the use of conventional anti-inflammatory drugs, drugs of epithelizing and regenerating action led to complete resorption of infiltrate, epithelialization of corneal ulcers, relief of the phenomena of endophthalmitis.

The patient was discharged on the 27th day of treatment with recovery, clouding formed on the site of the perforated Pseudomonas corneal ulcer. Subsequently, in the process of resorption of clouding, visual acuity OD increased. A method of treating eye drops with 0.3% ciprofloxacin in the regime of forced instillations made it possible to achieve an accelerated therapeutic effect in a short time, complete resorption and epithelization of a corneal ulcer, scarring of the perforation zone, relief of the phenomena of endophthalmitis, preservation of the eye with restoration of visual functions.

Visual acuity at discharge: VIS OD = 0.02.

Visual acuity 1 month after discharge: VIS OD = 0.06.

Visual acuity 3 months after discharge: VIS OD = 0.1.

Example 4

Patient M., born in 1970.

He was hospitalized in the Department of Infectious and Allergic Eye Diseases of the Moscow Scientific Research Institute of GB named after Helmholtz in 2004 with a diagnosis of OU - Gonococcal corneal ulcer of mild severity.

The patient turned to the SRI them. Helmholtz on the 1st day of illness. Before contacting the Research Institute of GB them. Helmholtz did not receive treatment. On admission: complaints of pronounced swelling of the eyelids OU, profuse purulent discharge, severe pain in OU, photophobia, lacrimation, a sharp decrease in visual acuity.

Visual acuity at admission VIS OD = 0.02; OS = 0.02.

The treatment was performed with eye drops of 0.3% ciprofloxacin in forced instillation mode: a 0.3% ciprofloxacin solution was instilled into the conjunctival cavity for two days with a ten-hour night break. On the first day of treatment, the first hour of instillation was carried out every 5 minutes, starting from the second hour - every two hours, on the second day - every three hours. The course of antibiotic therapy in the regime of forced instillations made it possible to achieve in a short time an accelerated therapeutic effect, complete resorption of infiltrate and epithelialization of corneal ulcers. By the end of the first day of treatment, the surface of the ulcer was completely cleansed of purulent-necrotic masses, the infiltrate was completely resorbed, and the corneal ulcer was epithelized. The disappearance of Neisseria gonorrhoeae in smears and crops was observed after the first day of treatment. The additional use of conventional anti-inflammatory drugs, epithelizing and regenerating drugs led to the complete resorption of infiltrate and epithelialization of corneal ulcers.

Due to the use of Cilrofloxacin eye drop treatment regimen in the forced instillation regimen, a blurred surface was formed at the site of the resorbed corneal ulcer, which did not affect visual acuity in both eyes. The patient was discharged on the 3rd day of treatment with full recovery.

Visual acuity at discharge VIS OD = 1.0; OS = 1.0

Thus, the proposed method allows to prevent the rapid destruction of all layers of the cornea by multiplying pathogens (Pseudomonas aeruginosa, Neisseria gonorrhoeae) in the first days from the start of treatment, to prevent perforation of the cornea, to achieve early resorption of infiltrate and epithelialization of corneal ulcers, and also to preserve and restore visual functions.

Claims (1)

A method of treating corneal ulcers of Pseudomonas aeruginosa and gonococcal etiology, including instillation in the conjunctival cavity of a 0.3% ciprofloxacin solution, characterized in that ciprofloxacin is instilled for 2 days with a ten-hour night break, with every 5 minutes in the first hour, starting from the second hours - every two hours, on the second day - every three hours.