RU2336849C1 - Method for uveitis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: complex medicated therapy of patient is carried out. On the third day of treatment, additional metabolic plasma depletion is carried out by exfusion of 700 ml of blood with its further centrifugation at 3700 rpm at 20°C within 10 minutes and removal of supernatant plasm. The rest call mass is reconstituted in 100 ml of normal saline solution. Then 120 cm³ of ozonic-oxygenous mixture with 100 mcg/l ozone content is added to the containers with the cell mass. Obtained ozonised cell mass is reinfused intravenously with the rate of 30 drops per minute. Plasma depletion course consists of 5 sessions which are carried out with 3-day intervals.

EFFECT: increase of uveitis treatment efficiency.

2 tbl, 2 ex

Description

The invention relates to medicine, and more specifically to ophthalmology.

Uveitis attract special attention of ophthalmologists, since with this disease blindness in both eyes reaches 10%, and visual impairment is 30% (N.S. Zaitseva, L.A. Katsnelson, 1984). Anterior uveitis is more common, which is characterized by pain, ciliary soreness, corneal precipitates, exudative reaction in chamber moisture, synechia. Various treatments for uveitis are offered. This is intracorporal ultraviolet irradiation of blood (D.S. Krol, V.I. Baranov, 1995), low-intensity laser radiation for local exposure to the focus in the treatment of post-traumatic uveitis (G.A. Vinkova et al., 1999) and hemosorption (L . A. Katsnelson et al., 1991).

The proposed methods act on individual links in the pathogenesis of uveitis, are complex and require high-tech equipment.

It is known to wash the vitreous cavity with an ozonized physiological solution with an ozone concentration of 5.7 mg / l for at least 15 minutes during vitrectomy with especially severe forms of uveitis - endophthalmitis (V.P.Bykov et al. Materials of the 8th Congress of Ophthalmologists of Russia, M. , “House of the Press”, 2005, p.531).

The disadvantages of this method are as follows. Firstly, this method is used only in patients with an extremely severe form of uveitis - endophthalmitis, when it is necessary to excise the mooring lines, films in the vitreous body. Secondly, ozone is introduced only locally, into the cavity of the vitreous body and, accordingly, does not have a systemic bactericidal or virusocidal effect on the extraocular foci of infection. This circumstance is especially important for patients with uveitis, among which up to 50% of cases are infectious. Thirdly, the vitrectomy procedure is an invasive manipulation that has the potential risk of developing severe iatrogenic complications - hemophthalmia, damage and retinal detachment.

Closest to the claimed is a method of treating uveitis with the use of exchange plasmapheresis (L. A. Katsnelson, V. E. Tankovsky. Uveitis (clinic, treatment). M., 4th branch of the Military Publishing House. 1998, p.198.). Exchange plasmapheresis was carried out as follows: 500 ml of blood was exfused into a polymer container, then the container was placed in a refrigerator centrifuge, where the blood was centrifuged at 2000 rpm for 10 minutes. Plasma was removed, and the cell suspension was resuspended in 50 ml of physiological saline and reinfused to the patient. This procedure was repeated 4-5 times daily.

This method has the following disadvantages. Exchange plasmapheresis does not affect the etiological factor in the development of uveitis. The exchange plasmapheresis procedure has neither bactericidal nor virucidal action. This is especially unfavorable in the treatment of uveitis, since up to 50% of all cases of inflammation of the uveal tract are of an infectious nature (L.E. Teplinskaya et al. Materials of the 7th Congress of Russian Ophthalmologists, 2000, pp. 161-162).

The objective of the invention is to increase the effectiveness of the treatment of uveitis due to the simultaneous impact on the pathogenesis and etiological factor of the disease.

The problem is achieved by the method of treatment of uveitis, including the exchange of plasmapheresis. Complex drug therapy is carried out and, from the third day, plasmapheresis is performed with exfusion of 700 ml of blood, which is centrifuged at 3700 rpm at a temperature of 20 ° C for 10 min to remove the supernatant plasma. The cell mass is resuspended in 100 ml of physiological saline. Then, 120 cm ^{3 of an} ozone-oxygen mixture with an ozone concentration of 10,000 μg / L is introduced into containers with a cell mass and the ozonated cell mass is reinfused intravenously at a rate of 30 drops per minute. The course is performed 5 sessions of plasmapheresis after 3 days.

Novelty of invention

Conduct complex drug therapy. Therapy includes etiotropic (antibacterial, antiviral, etc.) and non-specific anti-inflammatory therapy with non-steroidal anti-inflammatory drugs, antihistamines, steroids, mydriatics, and other drugs as indicated.

Additionally, from the third day, plasmapheresis is performed with exfusion of 700 ml of blood, which is centrifuged at 3700 rpm at a temperature of 20 ° C for 10 min with removal of the supernatant plasma. The cell mass is resuspended in 100 ml of physiological saline.

Then, 120 cm ^{3 of an} ozone-oxygen mixture with an ozone concentration of 10,000 μg / L is introduced into containers with a cell mass.

Reinfuse the ozonated cell mass intravenously at a rate of 30 drops per minute. The course spend 5 sessions of plasmapheresis after 3 days.

The effectiveness of the method is explained by the fact that the removal of part of the plasma during exchange plasmapheresis helps to remove macroglobulins, antibodies, immune complexes, inflammatory mediators and other pathological components from the bloodstream. We performed the exfusion of 700 ml of blood, which to a greater extent facilitated the removal of the listed pathological components from the blood. Plasmapheresis improves microcirculation, eliminates the blockade of the macrophage system, which can significantly increase sensitivity to drugs and activate the body's own defenses.

Ozonation of the cell mass during plasmapheresis enhances microcirculation and trophism in the membranes of the eye, normalizes the rheological parameters of blood and immune status, and also enhances the detoxification system of the body. Ozone therapy also has bactericidal, fungicidal and antiviral effects. According to our data, the combination of plasmapheresis with ozonation of the cell mass contributes to the normalization of the most important indicator of homeostasis - neopterin. This protein reflects the combined effect of various cytokines on a population of monocytes / macrophages stimulated by interferon-g. Our analysis of the values of neopterin in the blood serum of patients with uveitis (15 patients) using nonparametric statistics proved that a course of plasmapheresis with ozonation causes a decrease in high protein levels from 7.54 ± 0.8 nmol / L to 4.71 ± 0.71 nmol / l (p <0.05).

The effectiveness of the method is also proven in clinical practice. Clinical observations are 55 patients (55 eyes), of which 15 patients (15 eyes) of the main group and 40 patients (40 eyes) of the control group. In the main group, patients along with traditional therapy received treatment according to the claimed method, 5 plasmapheresis sessions with ozonation of the cell mass per course. Compared to the control in the main group, the pain syndrome stopped 2.3 days earlier; inflammatory exudate and precipitates on the corneal endothelium resolved 4.2 days faster (p <0.05). Functional outcomes in the main group of patients were also preferable.

The essence of the method is as follows. The patient is given drug therapy, including non-specific anti-inflammatory therapy with non-steroidal anti-inflammatory drugs (inside indomethacin 150 mg / day), antihistamines (inside suprastin 100 mg / day), steroids (injection under the dexon conjunctiva 8 mg), mydriatics (instillation 1%) . The patient is injected intravenously with 200 ml of reopoliglyukin. Then, 700 ml of blood is exfused into standard Gemacon 500/300 plastic containers, which contain 100 ml of glugicir. Then another 200 ml of reopoliglyukin is entered. Blood is separated on a Kendro Heraeus refrigerator centrifuge (USA) at a temperature of 20 ° C with a rotor speed of 3700 rpm and a centrifugation time of 10 minutes. After centrifugation, the containers are placed in plasma extractors and the plasma is slowly squeezed out, and the cell mass is resuspended in 100 ml of physiological saline. Then, 120 cm ^{3 of an} ozone-oxygen mixture with an ozone concentration of 10,000 μg / L is collected from the Medozons BM apparatus and immediately introduced into a container with a cell mass, because ozone has the property of rapidly decaying. The resuspended cell mass is mixed with the ozone-oxygen mixture by shaking the container for 5 seconds, and the ozonated cell mass is reinfused intravenously at a rate of 30 drops per minute. The course of treatment is 5 procedures, performed 2 times a week.

Clinical example 1. Patient X., 49 years old, acute panuveitis on the left. Upon receipt of a complaint of intense pain, decreased vision on the left, photophobia, lacrimation. Visual acuity OS = 0.2, IOP = 19 mm Hg

Objectively the left eye: ciliary soreness from 10 to 2 hours, endothelial edema, many small precipitates on the corneal endothelium, iris stroma edema, fibrin effusion into the vitreous body. On the fundus: blurring of the borders of the optic nerve, swelling in the macular zone, two large and many small inflammatory chorioretinal foci on the middle periphery. After the first session of exchange plasmapheresis with ozonation of the cell mass, the patient noted relief of pain, photophobia and lacrimation. After the second session of exchange plasmapheresis, antibiotics that were prescribed systemically were canceled (v / m penicillin sodium salt 1 million - 4 times a day).

Table 1 The dynamics of immunological parameters of blood serum of patient X Indicators Before treatment After treatment White blood cells 3.5 × 10 ⁹ 14 × 10 ⁹ Lymphocytes 43% 1.5 × 10 ⁹ 25% 3.5 × 10 ⁹ Cd3 63% 0.94 × 10 ⁹ 32% 1.12 × 10 ⁹ Cd4 21% 0.31 × 10 ⁹ eleven% 0.38 × 10 ⁹ Cd8 29% 0.43 × 10 ⁹ 24% 0.84 × 10 ⁹ Cd95 13% 0.19 × 10 ⁹ 3% 0.1 × 10 ⁹ Cd20 four% 0.06 × 10 ⁹ 2% 0.07 × 10 ⁹ IRI 0.72 0.45 CEC 98 beats Units 55 units IgM 2.35 g / l 1.01 g / l IgG 17.8 g / l 7.9 g / l IgA 0.9 g / l 1.6 g / l C3 1.24 0.88 C4 0.23 0.13 Neopterin 8.98 4.0 General complement study for 50% hemolysis 25 51

After five sessions of plasmapheresis with ozonation of the cell mass on the background of traditional therapy (antibiotics: gentamicin solution 10 mg under the conjunctiva; instillation of a 0.25% solution of chloramphenicol 3 times a day; corticosteroids: iv 40 mg dexone 1 time per day, injections under dexamethasone conjunctiva 4 mg once a day, dexamethasone 4 times a day in instillations; inside the table indomethacin 0.25 mg 3 times a day; orthophene 3 ml i / m; 1% atropine solution in instillations 2 times a day; reopoliglukin 400 ml iv (drip) the phenomena of acute panuveitis and vision were stopped patient X. improved to 0.4. Plasmapheresis sessions were performed after 3 days.

Clinical example 2. Patient S., 56 years old. Recurrent uveitis of both eyes, exacerbation of serous-plastic iridocyclitis on the left, remission on the right. Ankylosing spondylitis.

Upon receipt of a complaint of decreased vision on the left, pain, photophobia, lacrimation. Visual acuity OS = 0.05, IOP = 16 mm Hg Objectively the left eye: a pronounced mixed injection, ciliary soreness, corneal endothelial edema, fibrinous effusion in the anterior chamber moisture, iris stroma edema and hyperemia of own vessels, circular synechia, gross destruction of the vitreous body. Treatment: corticosteroids (orally dexamethasone 25 mg / day, instillation of a solution of dexamethasone 4 times a day), cytostatics (orally methotrexate 10 mg per week), mydriatics (atropine solution 1% in instillations 2 times a day, Turunda according to Gredl with a solution of mesatone 1 %), enzyme therapy (injections of collalysine 60 KE under the conjunctiva), detoxification (reopoliglyukin 400 ml iv), a warming half-alcohol compress in the evening, a bath phonophoresis with a 3% solution of calcium chloride. After the first plasmapheresis session with ozonation of the cell mass, ciliary soreness, photophobia and lacrimation stopped, circular synechia completely broke, after 3 days the fibrinous effusion in the anterior chamber resolved. After five sessions of plasmapheresis, carried out after 3 days, with the ozonation of the cell mass, the phenomena of acute iridocyclitis stopped and the visual acuity improved to 0.6.

The dynamics of the immunological parameters of the blood of patient C. are presented in table 2.

table 2 The dynamics of immunological parameters of blood serum of patient C Indicators Before treatment After treatment White blood cells 9.2 × 10 ⁹ 4,5 × 10 ⁹ Lymphocytes 24% 2.2 × 10 ⁹ 21% 0.94 × 10 ⁹ Cd3 57% 1.25 × 10 ⁹ 71% 0.66 × 10 ⁹ Cd4 17% 0.37 × 10 ⁹ 49% 0.46 × 10 ⁹ Cd8 28% 0.61 × 10 ⁹ 17% 0.15 × 10 ⁹ Cd95 21% 0.46 × 10 ⁹ 7% 0.06 × 10 ⁹ Cd20 8% 0.17 × 10 ⁹ 5% 0.04 × 10 ⁹ IRI 0.6 2.88 CEC 89 beats Units 45 units IgM 3.11 g / l 0.49 g / l IgG 21.7 g / l 14.8 g / l IgA 3.94 g / l 1.6 g / l C3 1.31 1,04 C4 0.44 0.44 Neopterin 20.11 8,496 General complement study for 50% hemolysis 33 44

Thus, the anti-inflammatory and antibacterial effects of metabolic plasmapheresis with ozonation of the cell mass in the treatment of uveitis have been proven. The effect of treatment manifested itself earlier than with traditional therapy. Favorable dynamics of blood immunological parameters was noted in patients with uveitis who received combined treatment with exchange plasmapheresis with ozonation of the cell mass with ozone.

Claims (1)

A method for the treatment of uveitis, including exchange plasmapheresis, characterized in that they carry out complex drug therapy and, additionally, from the third day, plasmapheresis with exfusion of 700 ml of blood, which is centrifuged at 3700 rpm at a temperature of 20 ° C for 10 min with removal of the supernatant plasma, the cell mass is resuspended in 100 ml of physiological saline, then 120 cm ^{3 of an} ozone-oxygen mixture with an ozone concentration of 10,000 μg / l is introduced into containers with a cell mass and reinfusion of the ozonated cell mass inside at a rate of 30 drops per minute, per course of 5 plasmapheresis sessions after 3 days.