RU2354335C1 - Method of anterior uveitis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be used for treatment of anterior uveitis. Subconjunctival injection of medication is made above one of main anterior ciliar arteries. Above said artery active electrode is installed for performing electrophoresis. Before injection sodium fluorescein is added to medication in order to give solution ellowish-brown colour. Control of medication inflow into blood stream is realised by means of performed during electrophoresis biomicroscopy with installed on slit lamp light filters for fluorescent angiography.

EFFECT: directed inflow of medication into blood stream as well as maximal saturation of iris with medication.

3 dwg

Description

The invention relates to medicine, namely to ophthalmology.

In the treatment of anterior uveitis - iridocyclitis - injection of drugs (antibiotics, mydriatics, corticosteroids, proteolytic enzymes) under the conjunctiva of the eyeball is widely used. Electrophoresis, in particular a bath, is an even more effective way of administering drugs to the eye (V. Okovitov, 1999). However, the insufficient therapeutic activity of this method is due to the loss of a medicinal substance that does not enter the eye due to the fact that when passing through the conjunctiva a significant part of it is lost, falling into the outlet conjunctival vessels (Polunin G.S., 1983).

The closest analogue to the claimed invention (prototype method) is a method for the treatment of hemophthalmia, in the technical solution of which there are two essential signs: a drug (proteolytic enzyme) is administered by injection under the conjunctiva of the eyeball, and then from the created episcleral depot into the eye (in vitreous body) by local electrophoresis (Polunin G.S. A method for the treatment of hemophthalmia. Authors certificate of the USSR No. 997678 of 02.23.1983).

It is obvious that not only proteolytic enzymes, but also many other drugs used in ophthalmology can be introduced into the eye by the prototype method. In particular, with anterior uveitis, the use of the above medicinal groups is possible. However, the necessary "point of application" of these drugs is not the vitreous, as in the prototype method, but the iris and ciliary body, in which the inflammatory process is localized.

Thus, the technical result of the claimed invention is the maximum saturation with the drug of the iris and ciliary body in patients with anterior uveitis.

The essential features of the prototype method do not make it possible to achieve the above technical result, since the bulk of the drug during the implementation of the prototype method penetrates the vitreous body, bypassing the iris and ciliary body.

It is well known that medicinal substances introduced into the bloodstream reach the individual organs and even their fragments most quickly and in sufficient quantities. In this case, the introduction of the drug into arteries, which are the main arteries for the organ as a whole or its fragment, would be optimal. For the anterior segment of the eye (iris, ciliary body), one of the leading great vessels is the anterior ciliary arteries, which is clinically and experimentally confirmed (Hayreh S.S., Scott W.E., 1978). These vessels are located episclerally, clearly visualized by biomicroscopy and are accessible to various kinds of influences.

Thus, the objective of the invention is the introduction of a drug directly into the bloodstream of the anterior ciliary artery. This is supposed to achieve the above technical result - the maximum saturation with the drug of the iris and ciliary body in patients with anterior uveitis.

In solving this problem, the following essential features are used, which are distinguishing from the closest analogue (prototype method).

The first of them is that the injection of the drug under the conjunctiva is done directly above one of the main anterior ciliary arteries, creating a depot of the drug just above it.

The second significant sign is that the local active electrode, from which electrophoresis is conducted, is also placed directly above this anterior ciliary artery in the area of the created drug depot. This is necessary for the subsequent directed intake of the drug into the bloodstream of this artery.

The third essential feature of the claimed invention is that a solution of sodium fluorescein is added to the drug before its injection subconjunctival administration, which stains the drug and thereby visualizes all stages of its further distribution. Thereby, the correctness of the solution of the problem of the claimed invention is controlled, since with the slightest change in the direction of the local electrode with respect to the anterior ciliary artery selected as an object, the drug ceases to enter the arterial bed. Fluorescein sodium, being a dye used for intravascular administration in ophthalmic diagnostics, acts in this case as a marker showing the direction of drug movement along the structures of the eyeball, in particular its blood vessels.

For the successful implementation of the above, certain actions are required, which are reflected in the following essential feature of the claimed invention. This fourth symptom is that, simultaneously with local electrophoresis of the drug with sodium fluorescein added to it, biomicroscopy of the eye is performed on a slit lamp with light filters installed on it for fluorescence angiography. This makes it possible to control the flow of the drug into the vessels of the anterior segment of the eye, in particular the iris, by their characteristic bright yellow-green fluorescence.

We give an example implementation of the claimed invention.

A patient with anterior uveitis, depending on the stage of the disease and the desired effect of medication (relief of inflammation, dilated pupil, resorption of adhesions, etc.), is prescribed one or another drug that is supposed to be administered by the claimed method. Previously, in a 0.5-0.7 ml solution of this drug, a 10% injection solution of sodium fluorescein is added in a volume of 2 units of division of the insulin syringe. In this case, the drug should be painted in a uniform tan color. The patient is performed with any suitable anesthetic (dicain, lidocaine, inocaine, etc.), local instillation eye anesthesia, in which the drug is to be administered. After the onset of anesthesia, the patient is seated at the slit lamp and biomicroscopy is performed, choosing one of the main anterior ciliary arteries into which the drug is to be administered. After that, 0.1 ml of the drug mixed with sodium fluorescein is administered under the conjunctiva above the specified artery. After this, local electrophoresis is started. To do this, first on the table next to the slit lamp, an iontophoresis apparatus is placed. One electrode (plate) is fixed under the patient’s head. A second silver (needle, diameter about 0.8 mm) with a moistened cotton microtampon previously fixed on it is placed over the selected anterior ciliary artery and the episcleral depot created above it from a mixture of a drug with sodium fluorescein. The electrode is held by the hand of the doctor conducting the procedure, and is pressed tightly against the conjunctiva above the artery, without however causing blood flow disturbances in it. All this is carried out under biomicroscopic control. Having made sure that the position of the active electrode is correct, the assistant switches on the iontophoresis device at the doctor’s command and introduces the filters in it for fluorescence angiography into the optical system of the slit lamp. Exciting fluorescence (blue) is located in front of the illuminator, and barrier (orange) is located on the slit lamp lens. Further electrophoresis is carried out under constant biomicroscopic control. The criterion for stable entry into the vessels of the anterior segment is the fluorescence of the vessels of the anterior segment, primarily the iris, maintained during the entire electrophoresis. Electrophoresis is carried out at a current strength of 0.4-0.5 mA. Its average duration is 10 minutes. The accompanying drawings illustrate the foregoing. They are represented by photographs taken using a photo-slit lamp equipped with filters for fluorescence angiography.

39 s after the start of electrophoresis, a local (dark) electrode is visible, placed above the brightly fluorescent episcleral depot of the drug (Fig. 1). The electrode is located above the anterior ciliary artery, which is not visible in the photo due to bright background fluorescence. One can see fluorescein entering into separate episcleral vessels. He has not yet entered the vessels of the iris.

43 s after the start of electrophoresis, the appearance of fluorescein in the vessels of the iris is visible (Fig. 2).

47 seconds after the start of electrophoresis, the filling of the vessels of the iris with fluorescein up to its pupillary edge is visible (Fig. 3).

The inventive method was the treatment of 9 patients with anterior uveitis. Among them were patients with an acute inflammatory process (6 people), as well as residual effects of the process (3 people). Mydriatics (atropine, mesatone), enzymes (collalysin, lidase) were introduced. As a result, it was possible to achieve the elimination of posterior synechia in 4 people who did not succeed in achieving this by generally accepted methods of administration. When using the proposed method, the relief of such inflammatory phenomena as ciliary injection, opalescence of the anterior chamber moisture, iris edema, the presence of precipitates on the corneal endothelium, occurred after 7-10 days, with the usual administration of drugs (winnings and subconjunctival injections) - after 10-15 days.

References

1. Okovitov VV Physiotherapy methods in ophthalmology. - M., 1999 .-- 158 p.

2. Polunin G.S. A method for the treatment of hemophthalmus. USSR Authenticity Certificate No. 997678 of 02.23.1983.

3. Hayreh S.S., Scott W.E. Fluorescein iris angiography. I. Normal pattern // Arch. Ophthalmot. - 1978. - Vol. 96, No. 8. - P.1383-1389.

4. Hayreh S.S., Scott W.E. Fluorescein iris angiography. II Disturbances in Iris Circulation Following Strabismus Operation on Various Recti // Arch. Ophthalmol. - 1978. - Vol. 96, No. 8. - P.1390-1400.

Claims (1)

A method of treating anterior uveitis by injecting a drug under the conjunctiva of the eyeball and then introducing it into the eye by local electrophoresis, characterized in that the subconjunctival injection of the drug is performed on one of the main anterior ciliary arteries, with subsequent electrophoresis, an active electrode is placed over this artery, before injection a solution of sodium fluorescein is added to the drug before staining the solution in a tan color, control was received The drug is injected into the bloodstream of the anterior segment of the eye by biomicroscopy performed during electrophoresis with light filters mounted on a slit lamp for fluorescence angiography.

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