RU2367383C1 - Method for treating progressive myopia in infants - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, relates to the section "Ophthalmology" and can be used in eye hospitals and in the outpatient setting. A medicinal preparation Instenon is introduced in the form of endonasal electrophoresis to infants with progressive myopia.

EFFECT: method allows improving visual acuity.

2 tbl, 2 ex

Description

The invention relates to medicine, to the section "Ophthalmology" and can be used in eye hospitals and, most importantly, on an outpatient basis (in the eye offices of clinics).

Myopia often progresses in the school years, especially recently, when intense visual load in the educational process is combined with the widespread use of computers. A constant contraction of the ciliary muscle is accompanied by a lack of blood supply and, as a consequence, a deterioration in the trophism of the ciliary body and posterior part of the eye. Reduced blood flow leads to poor accommodation, chorioretinal dystrophies and in the optic nerve disc.

In the prevention of the progression of myopia, drugs are used that improve the hemodynamics of the eye, and drugs that enhance metabolic processes in the retina.

For chorioretinal complications, subconjunctival injections of 0.2% ATP solution are useful (Avetisov E.S. “Myopia”. M., 1986), 4% Taufon solution or 1% Emoxipine solution (Poveschenko Yu.L. “Ophthalmological Journal.” 1998, No. 1, pp. 27-31). However, Taufon and Emoxipin improve metabolic processes in cells and contribute to the normalization of cell membrane function, because have an antioxidant effect. These drugs are administered subconjunctively, although after the installation of anesthetics, pain remains and psychological trauma is present, with inappropriate behavior of the child, perforation of the eyeball is possible.

Closest to the proposed is a drug that improves regional hemodynamics, nicotinic acid. Apply nicotinic acid parenterally and in the form of electrophoresis (Avetisov ES "Myopia". M., 1986). However, intramuscular administration of nicotinic acid is painful, and after administration by electrophoresis, redness and tingling of the face, nettle rash also occur, which is very alarming for children and their parents.

In ophthalmology, Instenon is used in the treatment of patients with progressive primary glaucoma with normal intraocular pressure as a stimulant of neuronal metabolism and positive results have been obtained with parenteral administration (IL Bachaldin, “Clinical Ophthalmology. 2004, v.5, No. 1).

We first established that Instenon reduces the index of resistance of the vascular wall, resulting in an increase in the area of the exchange surface of microvessels, and hence the activity of diffusion of nutrients, resulting in improved metabolic processes in the retina, which are inhibited during myopia due to impaired blood flow. An improvement in retinal function is demonstrated by electrophysiological findings.

We first used Instenon in the form of endonasal electrophoresis (according to the generally accepted methodology in ophthalmology). The contents of the vial were diluted in 1 mm injection. Instenon was introduced from the anode (+) at a current strength of 0.5 mA by endonasal electrophoresis for 15 min. The effectiveness of the treatment was evaluated after 10 sessions of electrophoresis. Patients in the control groups received a course of endonasal electrophoresis with nicotinic acid.

We observed 78 patients (156 eyes) aged 8-13 years with acquired myopia. Of these, 41 children with moderate and high myopia, who made up the main group, and 37 patients, the control. Children of the main group were divided into subgroup I - children with moderate myopia (20 patients) and subgroup II - patients with high myopia (21 patients). Accordingly, patients in the control group comprised subgroups Ik and IIk (11 and 14 people). Before treatment, all children underwent a standard ophthalmological examination. According to electrophysiological indicators, the color index of the optic nerve disc was used to determine the state of the visual analyzer. According to dopplerography, blood flow velocity and resistance index in the intraorbital part of the orbital artery were evaluated.

Assessing the state of the myopic process, we noted that in patients I and Ic the spherical equivalent was 3.25-5.75 diopters, in groups II and IIk it was 6.5-11.5 diopters. The value of the front-rear axis (PZO), respectively: 25.20-26.13 mm, 26.73-29.59 mm. Visometry without correction in I and I to groups 0.1-0.09 with a maximum correction of 0.6-1.0; II and IIk groups - 0.09-0.03 with a maximum correction of 0.2-0.9.

In all children with myopia of various groups, the systolic blood flow velocity in the intraorbital part of a.ophthalmica was within the normal range (on average, in groups I and I 35.4 ± 3.2 mm / s, in groups II and II 36.1 ± 2, 1 mm / s). The resistance index differed: in the I and I groups it averaged 0.66 ± 0.05, in the II and II groups - 0.69 ± 0.03, which according to our data was the upper limit of the norm. In 6 patients of group II, the resistance index was higher than normal and amounted to 0.72-0.73. The color index, an indicator of decoloration of the optic nerve head, was significantly reduced in groups II and II and amounted to 1.37 ± 0.03, which is shown in table 1.

Table 1 Indicators of the functional state of the eyes in children with acquired progressive myopia Options I gr myopia avg. Art. (n = 40 eyes) Ik gr. myopia avg. Art. (n = 32 eyes) II gr. myopia is high. Art. (n = 42 eyes) IIc gr. myopia is high. Art. (n = 42 eyes) before treatment after treatment before treatment after treatment before treatment after treatment before treatment after treatment Resistance index 0.66 ± 0.05 0.59 ± 0.05 0.66 ± 0.04 0.64 ± 0.04 0.7 ± 0.03 0.59 ± 0.03 0.69 ± 0.02 0.69 ± 0.02 Blood flow velocity in the intraorbital part of A.ophthalmica, mm / s 35.4 ± 3.2 35.2 ± 3.0 35.3 ± 3.3 35.3 ± 3.2 36.1 ± 2.1 35.8 ± 1.9 36.1 ± 2.2 36.1 ± 2.1 DZN color index 1.45 ± 0.03 1.5 ± 0.03 1.46 ± 0.03 1.47 ± 0.02 1.37 ± 0.03 1.44 ± 0.03 1.37 ± 0.04 1.4 ± 0.04 Amplitude of rhythm-ERG, 30 Hz, μV 28 ± 1.6 32 ± 1.7 28 ± 1.6 29 ± 1,5 24 ± 1,6 28 ± 1,5 24 ± 1,6 25 ± 1.5 The amplitude of the total ERG, 30 Hz, μV 89 ± 1.8 94 ± 1.5 89 ± 1.8 90 ± 1,5 81 ± 2.0 88 ± 1.9 80 ± 2.0 83 ± 1.8 Visual acuity without correction 0.1 ± 0.01 0.2 ± 0.01 0.1 ± 0.03 0.15 ± 0.02 0.06 ± 0.02 0.08 ± 0.01 0.06 ± 0.01 0.07 ± 0.01 Visual acuity with correction 0.7 ± 0.2 0.8 ± 0.1 0.7 ± 0.2 0.7 ± 0.1 0.5 ± 0.3 0.7 ± 0.2 0.5 ± 0.3 0.55 ± 0.2

After the treatment, we noted a decrease in the resistance index in groups I and II to 0.59 ± 0.05, which most likely did not contribute to an increase in blood flow in a.ophthalmica, but significantly improved visual function: in group I myopes from 0, 7 ± 0.2 to 0.8 ± 0.1 (with correction), and in patients of group II a more pronounced effect was noted - from 0.5 ± 0.3 to 0.7 ± 0.2 (with correction). In control group patients, resistance index values were less dynamic. The value of the color index of the optic nerve disk significantly increased to normal numbers, especially significant in patients of group II (from 1.37 ± 0.03 to 1.44 ± 0.03), while a slight variation in the color index was observed among children in the control groups . Analyzing the results of electrophysiological studies, we noted the greatest increase in the amplitude of rhythmic ERG in patients who used instenon, especially in children with high myopia (from 24 ± 1.6 to 28 ± 1.5). All patients easily tolerated electrophoresis with instenon, subjectively noted an increase in visual acuity (objects are more clearly visible, sharper), asthenopic complaints disappeared when looking from distant objects to near ones and vice versa, no side effects were detected.

table 2 Examples of treatment for children with advanced myopia Patient I.M., 11 years old. Ds: Moderate progressive myopia in both eyes Patient A.A., 14 years old. Ds: Progressive myopia of moderate degree OD, progressive myopia of high degree OS Options before treatment after treatment before treatment after treatment Resistance index OD 0.68 0.57 0.69 0.57 OS 0.67 0.58 0.7 0.61 Blood flow velocity in the intraorbital part of A.ophthalmica, mm / s OD 37 34 39 34 OS 32 thirty 40 36 Color index OD 1.46 1,50 1.45 1.54 OS 1.44 1.48 1.40 1,50 Amplitude rhythm - ERG, 30 Hz, μV OD 39.5 46.3 42.5 46.3 OS 47.5 50.9 45.3 48,2 The amplitude of the total ERG, 30 Hz, μV OD 69.5 112 82.5 149 OS 70.5 103 78.7 137 Visual evoked potentials OD 16.3 18.7 12.9 15.1 OS 18.2 21.0 10.8 14.6 Visual acuity without correction OD 0.1 0.3 0.1 0.3 OS 0.1 0.3 0.1 0.2 Visual acuity with correction OD 1,0 1,0 1,0 1,0 OS 1,0 1,0 1,0 1,0

As can be seen from the data presented, the proposed method for the treatment of progressive myopia is clinically effective, economical and non-traumatic, which is especially important in children's practice.

Claims (1)

A method of treating progressive myopia in children, including endonasal administration of a drug, characterized in that instenon is used as the drug.