RU2337656C1 - Method for thrombosis treatment in central vein of retina and its branches - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: under ophthalmoscope a single dose 500 IU of haemase is introduced into the eye epiretinal space, near thrombotic obturation zone of the vein. 14-16 days later, the retina coagulation by argon laser is carried out. Firstly, barrage of macular zone is implemented in horseshoe form, the fugure being opened towards disk of optic nerve. Coagulates are applied at the distance not less than 2500 mcm from the central pit in single flashes mode, rated 300 to 400 mW, exposition time 0.1-0.2 sec, and light beam diameter 50 mcm. Number of applications is 20 to 30. Then the laser is switched to automatic mode and coagulation of the rest retina parts is implemented, excluding the papillo-macular bundle. The same radiation parameters are used, except the light beam diameter is 100 mcm. Up to 500 application are made altogether, distanced to 2000 mcm one from another. In case of thrombosis of retina central vein branch, focal laser coagulation is carried out in the damaged branch quadrant only, by making up to 150 applications.

EFFECT: high and constant therapeutic effect under sparing laser therapy technique; complications diminishing during and after the treatment.

2 ex, 4 dwg, 6 tbl

Description

The invention relates to the field of clinical medicine, specifically to methods for treating central retinal vein thrombosis (CVC) and its branches.

Closest to the proposed method of treatment is a method for the treatment of CVT thrombosis by intravitreal administration of hemase [2, 3] at a dose of 500 ME. Manipulation is performed after local anesthesia by instillation of a 0.5% dicaine solution. After application of the vector expander, an insulin needle is injected into the sclera 5 mm from the limbus (mainly in one of the oblique meridians). Next, the needle is conducted to the central parts of the vitreous body and the drug is injected. If clinically necessary, the manipulation is repeated after a few days.

However, this method does not provide the necessary degree of bioavailability of the drug to the chorioretinal structures. The maximum concentration of the drug in the retina during intravitreal injection is only 12.4-13.2% of the administered dose [2, 3]. In connection with this circumstance, the need arises for repeated administration of the drug. The need to develop new methods for the treatment of thrombosis of CVC and its branches is due to the insufficient effectiveness of traditional pharmacotherapy and the high incidence of complications.

A new technical task is to obtain a more persistent therapeutic effect, reduce the treatment time for patients, reduce the number of relapses and complications, expand the scope.

To solve the problem in a method of treating thrombosis of CVC and its branches, which consists in conducting pharmacotherapy and administering a hemase at a dose of 500 ME, the hemase is injected once into the epiretinal space of the eye under ophthalmoscopic control closer to the site of obstruction of the vein with a thrombus, after which it is performed after 14-16 days “Gentle” retinal argon laser coagulation, for which, at the first stage, the macular zone is barraged in the form of a horseshoe, opened towards the optic nerve head (optic nerve head), the coagulates are applied at a distance of at least 2500 microns from the center the fossa fossa, with a power of 300-400 mW, an exposure time of 0.1-0.2 sec, a diameter of the light beam of 50 μm, the number of applications 20-30, and the barrage is performed in the mode of single flashes, then the laser is put into automatic mode and carried out coagulation of the remaining parts of the retina, with the exception of the papillomacular beam with the same radiation parameters, using a light beam diameter of up to 100 μm, up to 500 applications are applied, located at a distance of 2000 μm from each other, in the presence of thrombosis of the CVC branch, focal laser coagulation is performed to adranta branch retinal damaged, thus applied to 150 applications.

The method is as follows. Treatment is carried out in a treatment room under the control of a head-on binocular ophthalmoscope (HBO-2) with a lens of +20.0 D. The enzyme preparation of hemase is pre-diluted at a dose of 500 ME in 0.1 ml of isotonic sodium chloride solution. Next, the solution is collected in an insulin syringe, onto which a disposable needle from a two-milliliter syringe with a size of 0.6 mm × 30 mm is put on. After maximal mydriasis is reached, the patient is anesthetized three times (0.5% dicaine solution or 0.4% inocaine solution) with an interval of 3-5 minutes. The eye is fixed with an eyelid expander, then the conjunctival cavity is treated with a 0.02% aqueous solution of furacilin and 0.25% solution of chloramphenicol. The needle is injected through the sclera 5 mm from the limb in one of the oblique meridians (Figure 1). Then, under ophthalmoscopic control, the needle is passed into the epiretical space and the enzyme is injected as close to the place of venous obstruction as a thrombus.

Treatment with the proposed method is carried out against the background of traditional pharmacotherapy of CVC thrombosis and its branches, including local (parabulbar) administration of fibrinolytics, anticoagulants, antiplatelet agents, angioprotectors and microcirculation correctors.

Figure 1 shows a diagram of the epiretinal administration of hemase.

14-16 days after epiretinal administration of hemase, after partial resorption of retinal hemorrhages and reduction of retinal edema, argon laser coagulation is performed using the green component of the emission spectrum of the VISUAL - 2 OPTON or COGERENT ophthalmic argon laser under drug mydriasis. The application of laser coagulates is carried out through a panfundus lens or a three-mirror Goldman lens after preliminary anesthesia with 0.5% dicaine solution.

At the first stage, the macular zone is barraged in the form of a horseshoe, opened to the side of the wound. Coagulates are applied at a distance of at least 2500 microns from the central fossa.

Work mode:

- power 300-400 mW - exposure time 0.1-0.2 sec - diameter of the light beam 50 microns - number of applications 20-30

The barrage is performed in a single flash mode. Then the laser is transferred to an automatic mode of operation and coagulation of the remaining parts of the retina, with the exception of the papillomacular beam. Use the above radiation parameters, changing only the diameter of the light beam to 100 microns. In total, up to 500 applications are applied, located at a distance of 2000 μm from each other (Figure 2, where 1 is the distance from the central fossa to the coagulate 2500 μm; 2 - coagulate with a diameter of 50 μm; 3 - the distance between coagulates 1500 μm, the diameter of coagulates 100 μm )

If there was thrombosis of the CVC branch, then focal laser coagulation of only the retinal quadrant of the damaged branch is performed, and up to 150 applications are applied.

The proposed mode of implementation of the method is selected based on the analysis of the results of clinical studies. Clinical studies were conducted in a group of 28 patients (28 eyes) with CVC thrombosis (32%) and its branches (68%). In this case, the initial visual acuity below 0.1 was in 17 patients (61%), 0.1 and above was in 11 patients (39%). The average circulation period did not exceed 30 days. All patients of this group, along with traditional treatment (fibrinolytics, anticoagulants, antiplatelet agents, angioprotectors and microcirculation correctors), underwent epiretinal administration of hemase in combination with argonlasercoagulation according to the proposed method.

The control group was represented by 62 patients (62 eyes) who received similar treatment without epiretinal administration of hemase.

Patients of both groups are comparable by sex, age and disease duration. Each group was divided into two subgroups: the first with an initial visual acuity below 0.1 and the second group - 0.1 and above.

All patients underwent general phthalmological examination, including visometry, perimetry, biomicroscopy, ophthalmoscopy, photographic recording, electrophysiological examination, as well as analysis of coagulation and anticoagulation systems, blood pressure control.

Table 1-6 shows a comparative analysis of the results of treatment of retinal vein thrombosis, which allowed us to identify the significant effectiveness of the proposed method of treatment.

For example, in patients of the main group, visual acuity on the 12th day of treatment was 1.5-2.5 times higher compared with the control group (Tables 1, 2). An increase in visual acuity was also more significant in the group with epiretinal administration of hemase. At the same time, visual acuity maximized in the first days after administration of the drug, while in the control group, visual acuity improved gradually throughout the treatment period (Figs. 3, 4). The results of electrophysiological studies (Tables 5, 6) before and after epiretinal administration of hemase indicate that epiretinal administration of this drug at the selected dosage does not have a toxic effect on the retina and optic nerve.

The fact of reducing the length of stay of patients of the main group from an average of 17.6 ± 0.98 bed days to 14.4 ± 0.1 is also important in the medical and social aspect.

Clinical example of the method

Example No. 1.

Patient J., 42 years old, complained of decreased vision in her right eye.

Anamnesis of the disease: vision decreases gradually over a period of 3 weeks. I have not received treatment before. Turned to the eye trauma center of the regional clinical hospital.

Objective inspection:

Visus OD = 0.06 is not adjusted;

OS = 1.0.

OD Biomicroscopy - anterior segment without features.

Ophthalmoscopy OD - DZN - pale pink, the borders are clear, the level is normal, the ratio of the width of the artery / vein = 1/3, the arteries are narrow, the veins are dilated, pathological crosses of the II degree. The inferior temporal vein is dilated, along the branch from the pathological arteriovenous intersection, multiple retinal hemorrhages. In the macular region of the retina: edema and pinpoint hemorrhages.

The main diagnosis: Thrombosis of the inferior temporal branch of the central retinal vein of the right eye.

Background disease: hypertension II stage, II degree, risk 1 low).

Treatment was prescribed: intravenously - pentoxifylline 5.0 ml, physiological 0.9% NaCl solution, reopoliglyukin 400.0; inside cinnarizine, piracetam, aspirin 0.2 mg; local - parabulbar trental 0.3 ml, heparin 750 ME, dexazone 0.2 ml, emoxipin 0.4 ml, installations - dexamethasone 0.1%, potassium iodide 3%, aloe, emoxipin.

Additionally, epiretinal administration of hemase at a dose of 500 ME was performed

On the 14th day after the epiretinal administration of hemase, “sparing” argon laser coagulation was performed on a COGERENT ophthalmic laser under conditions of drug mydriasis. Laser coagulation was applied through a three-mirror Goldman lens after preliminary anesthesia with 0.5% dicaine solution. At the first stage, the macular zone was barraged in the form of a horseshoe, opened to the side of the wound. Coagulates were applied at a distance of at least 2500 microns from the central fossa. Operating mode: power 300 mW; exposure time 0.1 sec; diameter of a light beam of 50 microns; number of applications 20. Barrage was performed in single flash mode. Then the laser was switched to automatic mode and focal coagulation of the affected area — the inferior temporal quadrant of the retina — was performed. The following radiation parameters were used: power 300 mW; exposure time 0.15 sec; diameter of a light beam of 100 microns; number of applications 150.

Dynamics of visual acuity with correction Before treatment The day after the introduction of hemase one 2 3 5 8 eleven fourteen 16 1 month 3 months 0.06 0.2 0.3 0.3 0.5 0.5 0.5 0.5 0.5 0.6 0.6

Status localis: on day 16 of treatment OD: DZN - pale pink, clear borders, hemorrhages significantly resolved, edema in the macular region of the retina decreased, macular hemorrhages resorbed, the diameter of the inferior temporal branch of CVS decreased. Laser coagulation is paramacular and paravasal along the vein in the hemorrhage area.

Example No. 2.

Patient T., 56 years old, complained of an almost complete decrease in vision of the right eye.

Medical history: Vision decreased 10 days ago. Against the background of an increase in blood pressure, severe headaches appeared and vision of the right eye decreased. Over the next 3 days, the eye was practically blinded. I did not receive treatment. Turned to the eye trauma center of the regional clinical hospital.

Objective inspection:

Visus OD = 0.04 with correction (sph. Convex + 0.5D) = 0.05;

OS = 1.0.

OD Biomicroscopy - anterior segment without features.

Ophthalmoscopy OD - DZN is hyperemic, borders are not determined, it mediates into the vitreous body, veins are sharply dilated, full-blooded, convoluted, and arteries are practically invisible. The retina is sharply edematous, multiple retinal hemorrhages (a symptom of "crushed tomato). In the macular region of the retina: edema and hemorrhage.

The main diagnosis: Thrombosis of the central retinal vein of the right eye.

Background disease: hypertension of the III stage, III degree, risk 3 (high).

Treatment was prescribed: intravenously - pentoxifylline 5.0 ml, physiological 0.9% NaCl solution, reopoliglyukin 400.0; inside cinnarizine, piracetam, aspirin 0.2 mg; local - parabulbar trental 0.3 ml, heparin 750 ME, dexazone 0.2 ml, emoxipin 0.4 ml, installations - dexamethasone 0.1%, potassium iodide 3%, aloe, emoxipin.

Additionally, epiretinal administration of hemase at a dose of 500 ME was performed.

On the 16th day after the epiretinal administration of hemase, “sparing” argon laser coagulation was performed on a COGERENT ophthalmic laser under conditions of drug mydriasis. Laser coagulation was applied through a three-mirror Goldman lens after preliminary anesthesia with 0.5% dicaine solution. At the first stage, the macular zone was barraged in the form of a horseshoe, opened to the side of the wound. Coagulates were applied at a distance of at least 2500 microns from the central fossa. Operating mode: power 400 mW; exposure time 0.15 sec; diameter of a light beam of 50 microns; number of applications 30. Barrage was performed in single flash mode. Then the laser was switched to automatic mode and the remaining parts of the retina were coagulated, with the exception of the papillomacular beam. The following radiation parameters were used: power 400 mW; exposure time 0.2 sec; diameter of a light beam of 100 microns; the number of applications 500, located at a distance from each other of 2000 microns.

Dynamics of visual acuity with correction Before treatment The day after the introduction of hemase one 2 3 5 8 eleven fourteen eighteen 1 month 3 months 0.05 0.1 0.2 0.2 0.25 0.25 0.25 0.25 0.25 0.3 0.3

Status localis: on the 18th day of treatment OD: DZN - hyperemia slightly decreased, the borders are fuzzy, but determined, it will slightly mediate into the vitreous body. The diameter and tortuosity of the veins decreased, the arteries are narrow, convoluted. Hemorrhages significantly resolved, especially on the periphery, retinal edema decreased. Macular edema persists, but has become much smaller. Paramacular laser barrage along the entire fundus of the laser coagulate with the exception of the papillomacular bundle.

Thanks to the proposed method for the treatment of CVT thrombosis in patients, visual acuity significantly increased. In the long-term follow-up, visual acuity remained at a high level, which indicates a persistent therapeutic effect. During the entire observation period, the patients did not reveal any complications and they subjectively experienced epiretinal administration of hemase and argonlasercoagulation.

Through the use of the proposed method of treatment, the patient significantly increased visual acuity. In the long-term follow-up, visual acuity remained at a high level, which indicates a persistent therapeutic effect. During the entire observation period, the patient did not reveal any complications. Subjectively, the patient underwent epiretinal administration of hemase in combination with argon laser coagulation.

From literature it is known that the reason for a significant decrease in vision during CVC thrombosis is hemorrhagic retinal infarction [4, 8], which develops as a result of the formation of a thrombus, or at the junction of the upper and lower branches of the CVC (at this point there is a thickening of the smooth muscle cell layer and forms venous sphincter) at the level of the ethmoid plate, or in the area of pathological crosses. Such a localization of a thrombus is explained by the formation of turbulent blood flow in these places, which entails desquamation of the endothelium and the initiation of a cascade of biochemical reactions, as a result of which a thrombus forms.

According to the generally accepted opinion, the fundamental principle of pharmacotherapy of CVS and its branches is the use of a combination of fibrinolytic and anticoagulant drugs [1-3, 5, 6, 8, 9]. However, the use of indirect anticoagulants for thrombosis of retinal veins in recent years has been questioned, since with their systemic administration it is impossible to achieve the necessary concentration of the drug in the thrombus formation zone. In addition, there is a high risk of developing hemorrhagic complications due to the difficulty of maintaining the prothrombin index at an optimal level

Recently, enzyme therapy has become widespread. Various enzyme preparations are used to treat retinal vein thrombosis: thrombolitin, terrilithin, collalysin, plasmin, recombinant prourokinase, streptokinase, wobenzym, etc. Various administration methods are used, however, the maximum concentration of the drug in the retina with extrabulbar methods of administration is only 1.2-9, 3% of the administered dose.

Intravitreal administration of drugs at the present stage is widely used in the treatment of various pathologies of the organ of vision [2].

With this method of administration, various proteolytic enzymes are also used: collalysine, streptodecase, urokinase, fibrinolysin, etc. [2, 3, 6]. Currently, recombinant prourokinase, which has the ability to lyse a blood clot, is widely used. This enzyme is known in domestic production under the name of hemase and was studied with subconjunctival, parabulbar, retrobulbar, intravitreal methods of administration [1-3].

The proposed method for the treatment of thrombosis of CVC and its branches allows to obtain the maximum concentration of the enzyme preparation at the site of the formation of the thrombus and thereby accelerate its dissolution, contributes to a more rapid resorption of retinal hemorrhages, and reduction of edema in the macular region of the retina.

The applicants chose the anatomical region of the eye, the epiretinal space, which contains a liquid volume of up to 0.1 ml, as the site of drug administration. When introduced into the epiretinal space, hemase is delivered directly to the posterior segment of the eye, which helps to increase its bioavailability due to the maximum approximation of the drug to pathologically altered structures, while the vitreous remains practically intact.

Hemase dosage (500 ME) was selected based on the recommended dose for intravitreal administration in the annotation [1]. As shown by clinical trials, the proposed method allows to obtain a stable therapeutic effect with a single injection of the drug into the epiretinal space, which contributes to a significant reduction in the morbidity of the method.

Laser coagulation of retinal vein thrombosis is an important step in the system of their complex treatment. As is known, macular edema occurs due to transudation through the wall of parafoveal capillaries. The task of laser coagulation is to block the paramacular capillary network and thereby stop the release of the liquid composition of the blood into the macular zone. The use of a green argon laser and a red krypton laser for coagulation of the paramacular region has an advantage over other sources. Coagulation at argon and krypton sources promotes obliteration of “leaking” vessels and at the same time reduces the risk of macular folds [5, 9].

The classical parameters of argon laser coagulation are defined as follows (Saprykin, 1982): power 175-600 mW; exposure time 0.2-0.3 sec; the diameter of the light beam 50-200 microns; the number of applications is 800-1000 in 4-5 sessions, if one branch of the CVC is affected, then only the retinal quadrant is laser coagulated, drained by this branch, and the number of coagulates is 200-300 [7].

The argonlasercoagulation parameters of the proposed method are adapted for therapy in combination with epiretinal administration of hemase and are optimal for the combined treatment of retinal vein thrombosis. The exposure time and laser radiation power during treatment by the proposed method is reduced in comparison with the generally accepted one, the number of laser applications is also reduced to 500, and with branch thrombosis to 150, which allows for argon laser coagulation in 1 session. Such laser coagulation is "gentle" and allows you to get a persistent therapeutic effect in combination with epiretinal administration of hemase.

There is no consensus in the literature regarding the timing of laser coagulation. A number of authors recommend coagulation in the early stages after thrombosis, while others believe that the timing should be decided in each case in accordance with the clinical course and fluorescence angiography data. The early laser coagulation, according to the experience of some authors, is inappropriate, since an intensive pathogenetically oriented treatment, if started on time, restores the circulation in a thrombosed vessel [5, 7].

The timing of laser coagulation in the proposed method was determined on the basis of clinical experience, and it is optimal to carry out laser coagulation 14-16 days after epiretinal administration of hemase. By this time, retinal hemorrhages are partially resorbed, retinal edema is reduced, this allows the use of "gentle" laser coagulation with the least traumatic effect on the retina in comparison with classical methods.

Thus, the application of the proposed method allows to obtain a high and lasting therapeutic effect, reduce the treatment time of patients, reduce the number of complications during and after injection of enzyme preparations.

Table 1
The dynamics of visual acuity indicators (in medians) in patients of the main and control groups with initial visual acuity below 0.1. Group of patients Before treatment Duration of treatment, DNA one 3 5 8 12 thirty 90 180 Main 0.02 0.06 0.08 0.08 0.1 0.1 0.1 0.2 0.25 Control 0.02 0.02 0.02 0,03 0,03 0.04 0.04 0.05 0.05 p <0.01 p <0.001 p <0.0001 P <0.001 P <0.001 p <0.001 p <0.001 P <0.001 P <0.001

table 2
Dynamics of visual acuity indicators (in medians) in patients of the main and control groups with initial visual acuity of 0.1 and higher. Group of patients Before treatment Duration of treatment, days one 3 5 8 12 thirty 90 180 Main 0.2 0.4 0.4 0.4 0.45 0.5 0.5 0.6 0.6 Control 0.2 0.2 0.2 0.25 0.3 0.3 0.4 0.4 0.4 p <0.01 p0.01 p <0.01 p <0.01 p <0.01 P <0.01 1 p <0.01 p <0.01 p <0.01

Table 3.
The dynamics of perimetric indicators (the total value of the visual field indicator for 8 meridians) in patients of the main and control groups with initial visual acuity below 0.1. Patient group: Before treatment Duration of treatment, days 5 fifteen thirty Main line of sight 199 ± 41.9 352 ± 19.7 383 ± 17.8 412 ± 17.6 Scotomas 64.4 ± 3.06 40.2 ± 4.02 34.8 ± 4.47 30.2 ± 4.37 Control line of sight 262 ± 31.7 280 ± 29.0 308 ± 31.5 313 ± 28.7 Scotomas 76.5 ± 1.68 71.3 ± 3.1 56.6 ± 2.18 55.6 ± 2.56

Table 4
The dynamics of perimetric indicators (the total value of the visual field indicator for 8 meridians) in patients of the main and control groups with an initial visual acuity of 0.1 and higher Group of patients Before treatment Duration of treatment, days 5 fifteen thirty Main line of sight 397 ± 21.1 423 ± 15.4 466 ± 10.3 480 ± 12.4 Scotomas 64 ± 7.6 25 ± 1.2 4.6 ± 1.5 4 ± 0.01 Control line of sight 426 ± 23.2 432 ± 24.7 438 ± 23.6 438 ± 25.1 Scotomas 58 ± 1.8 45 ± 0.09 l2 ± 0.7 10 ± 1,07

Table 5
Change in electrophysiological parameters in patients of the main and control groups with visual acuity below 0.1 Group of patients Amplitude of wave a, microvolt Amplitude of wave in, mkv W / A ratio Fosphen, sec Lability, sec Before treatment On the 14th day Before treatment On the 14th day Before treatment On the 14th day Before treatment On the 14th day Before treatment On the 14th day Main group 8.82 ± 1.55 20.3 ± 1.38 90.6 ± 6.97 99.3 ± 6.36 3.33 ± 0.28 3.49 ± 0.25 33.3 ± 7 81.6 ± 14.36 30 ± 6.3 40 ± 2.1 Control group 11.6 ± 3.05 20.15 ± 2.4 40.4 ± 12.1 75.71 ± 16.78 2.59 ± 0.56 2.37 ± 0.22 23.75 ± 4.78 38.75 ± 2.5 30 ± 4,52 38.3 ± 20.01

Table 6
Change in electrophysiological parameters in patients of the main and control groups with visual acuity below 0.1 and above Group of patients Amplitude of wave a, microvolt Amplitude of wave in, mkv W / A ratio Fosphen, sec Lability, sec Before treatment On the 14th day Before treatment On the 14th day Before treatment On the 14th day Before treatment On the 14th day Before treatment On the 14th day Main group 12.8 ± 3.09 27.12 ± 2.2 69.5 ± 8.02 120.1 ± 16.0 3.58 ± 0.48 3.44 ± 0.4 46.25 ± 0.75 87.5 ± 14.43 47.5 ± 0.87 48.75 ± 0.75 Control group 15.57 ± 1.81 19.32 ± 1.24 77.52 ± 9.04 107.7 ± 12.16 2.5 ± 0.37 2.5 ± 0.16 48.75 ± 0.46 62.5 ± 4.64 45 ± 0.1 45 ± 0.07

Information sources

1. Alyabyeva J.Yu. The use of the hemase drug for the treatment of intraocular hemorrhage and postoperative fibrinoid syndrome // Clinical Ophthalmology. - 2002. - T.3, No. 3. - S.10-13.

2. Danilichev V.F., Knorring G.Yu. Proteolytic enzyme therapy for eye pathology. - Guidelines. - SPb. - 2005. - P.312.

3. Danilichev V.F. Ophthalmology. Enzymotherapy and extracorporeal hemocorrection. - A guide for doctors. - SPb. - 2002. - P.56.

4. Zapuskalov IV Krivosheina O.I. Blood circulation mechanics. - Tomsk: Siberian State Medical University, 2005. - P.91.

5. Katsnelson L.A., Forofonova T.I., Bunin A.Ya. Vascular diseases of the eye. - M.: Medicine. - 1990. - S. 126-150.

6. Polunin G.S. The main directions of enzyme therapy in ophthalmology. - Abstracts of the IV All-Russian Congress of Ophthalmologists. - M. - 1982. - S. 424-425.

7. Saprykin P.I., Shubochkin L.P., Sumarokova E.S. Lasers in ophthalmology. - Saratov. - 1982. - P.206.

8. Gass J.D. Stereoscopic atlas of macular diseases 4th Ed./ Mosby, 1997 .-- P.546.

9. Williamson T. Central retinal vein occlusion: what is the story? / T. Williamson // Br. J. Ophthalmol. - 1997. - Vol. 81. - P. 698-704.

Claims (1)

A method for the treatment of thrombosis of the central retinal vein (CVS) and its branches by conducting pharmacotherapy and introducing hemase into the eye area at a dose of 500 ME, characterized in that the hemase is administered once into the epiretinal space of the eye under ophthalmoscopic control closer to the site of obstruction of the vein with a thrombus, then after 14 -16 days carry out retinal argonlasercoagulation, for which, at the first stage, the macular zone is barraged in the form of a horseshoe, opened towards the optic disc, while the coagulates are applied at a distance of not less than 2500 microns fovea, at a power of 300-400 mW, the exposure time of 0.1-0.2 seconds; the diameter of the light beam 50 μm; the number of applications is 20-50, and the barrage is performed in a single flash mode, then the laser is switched to automatic mode and coagulation of the remaining parts of the retina, with the exception of the papillomacular beam, with the same radiation parameters, changing only the diameter of the light beam to 100 μm, total up to 500 applications located at a distance of 2000 μm from each other, in the presence of thrombosis of the CVC branch, focal laser coagulation is carried out only in the retinal quadrant of the damaged branch by applying up to 150 applications.

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