RU2388438C1 - Method of introducing medical product in sub tenon's space in patients with operated refractory glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and is intended for introduction of medical products in sub Tenon's space in patients with operated refractory glaucoma with implanted valve Ahmed's drainage. From opposite side from place of drainage tube placing realised is translumbal puncture of anterior chamber with needle, whose external diametre corresponds to internal diametre of tube opening. Needle is passed along surface of iris and introduced in drainage tube. Through needle solution of necessary medicinal product is injected, and after that physiologic balanced solution in volume, corresponding to volume of tube and valve chamber.

EFFECT: method ensures reduction of trauma when medicinal products are introduced in sub Tenon's space and creation of high concentration of medicinal product in zone of posterior pole of eyeball simultaneously with preservation of IOP compensation.

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Description

The present invention relates to ophthalmology and is intended for the introduction of drugs into the subthenon space in patients with operated glaucoma with implanted Ahmed valve drainage.

Recently, the use of valve drainage devices, one of which is Ahmed's valve drainage (Huang M., Netland P. et al. Intermediate term Experience with the Ahmed Glaucoma Valve Implant. // Am. J., has been increasingly used for anti-glaucoma surgery. Ophthalm. 1999 .-- 127. - P.27-33). The valve drainage platform is installed and fixed in the subtenon space between the two direct oculomotor muscles, while the edge of the platform of the drainage device is at the posterior pole of the eye directly near the exit point of the optic nerve. Drainage of fluid from the front chamber through the valve device is carried out through the tube and valve chamber under the Ahmed valve drainage platform, after which the fluid is discharged into the subtenon space.

Currently, there are various methods of administering drugs aimed at their penetration into the eyeball to achieve various therapeutic effects. In addition to taking drugs inside and general therapeutic methods of injection, subconjunctival, parabulbar and retrobulbar injections are widely used, as well as various methods of physiotherapeutic drug administration (Mashkovsky M.D. Medicines. Pharmacotherapy manual for doctors. // Tenth edition. - 2 vol. - M .: Medicine. - 1986, 575 p.). Less commonly used is the introduction of the drug into the subtenon space, including the use of special infusomats (Bayandin D.L. Tactics of choosing a vascular collector and a method for introducing artificial substances during infusion therapy of ischemic conditions of the retina and optic nerve. // Abstract of Ph.D. - M. - 1994 - 28 p.) The introduction of drugs into the subtenon space is highly therapeutic, but rarely used due to the need for preliminary minor surgical intervention

Implantation into the subtenon space of a special tube leading out for drug administration is associated with a constant risk of infection along the tube, as well as the possibility of retrograde expiration of the drug and requires obstruction of its lumen with a special plug or connecting it to an infusion device, which is associated with serious discomfort for the patient.

A known method of introducing a drug into the subtenon space, in which the first step is a small incision of the bulbar conjunctiva, and then the bulbar part of the tenon capsule, after which a curved cannula is inserted into the subtenon space, through which the necessary drug is introduced into the posterior pole of the eye, after which applying a sealing seam to the cut. After the expiration of the drug, its administration can be repeated (Maksimov IB, Anisimova GV Involutional central chorioretinal dystrophies: the use of peptide bioregulators in complex treatment. // St. Petersburg: IPK Biont LLC. - 2004. - 88. from.). The disadvantage of this method is that as a result of each introduction of the drug into the subtenon space, it is necessary to re-cut the conjunctiva and the bulbar part of the tenon capsule, which can lead to its weakening in some areas and the formation of sclero-conjunctival scars in other areas. As a result, each subsequent administration of the drug may be more difficult than the previous one, which is associated with the difficulties encountered in getting the cannula into the subtenon space.

The objective of the invention is to develop an improved method of administering drugs with subtenon space in patients with operated glaucoma with previously implanted Ahmed valve drainage. The technical result of the proposed method is to reduce the morbidity with the introduction of drugs and the creation of a high concentration of the drug in the area of the posterior pole of the eyeball while maintaining compensation for IOP.

The rationale for the proposed method is that the Ahmed valve drainage platform after implantation is located in the subtenon space in such a way that its edge is located in close proximity to the posterior pole of the eye, which allows drugs introduced through the Ahmed valve drainage tube to enter the zone of the posterior pole of the eye apples in close proximity to the exit of the optic nerve, which will provide a more effective target hit neuroprotective, anti-inflammatory, proteo lytic and other drugs.

The technical result is achieved through the use of previously implanted Ahmed valve drainage at the same time to reduce IOP and to administer the drug to form a drug depot in the subtenon space in the posterior region of the eyeball.

The introduction of the drug into the subthenon space is carried out in patients with Ahmed's model valve drainage previously implanted during anti-glaucoma surgery. In this case, the valve drainage platform is localized so that the edge of the valve drainage platform is in the area close to the posterior pole of the eye and the optic nerve exit zone, which allows the drug to enter through the valve drainage tube to expire under the valve drainage platform and thus create subtenon space, in the immediate vicinity of the optic nerve, the depot of the necessary drug.

The method is as follows.

After instillation anesthesia in patients with operated glaucoma with previously implanted Ahmed valve drainage, translimbal puncture of the anterior chamber with a needle, the outer diameter of which corresponds to the inner diameter of the lumen of the drainage tube, is performed on the opposite side from the location of the drainage tube. Under optical control, the needle is passed through the anterior chamber of the eye along the surface of the iris, inserted into the drainage tube, reaching tight contact, and then the necessary drug is injected into Ahmed's valve drainage tube. Then, without removing the needle from the lumen of the tube, the syringe on the needle is replaced with a syringe with balanced saline and injected into the tube in a volume corresponding to the volume of the tube and valve chamber, after which the needle is removed and removed from the anterior chamber, and the outer sheath puncture zone the eyes are sealed if necessary. The presence of a valve mechanism in this case prevents the possible reflux outflow of the drug into the anterior chamber.

Using this technique allows you to form a depot of a drug in the subtenon space in the posterior pole of the eyeball that provides the planned therapeutic effect.

Example: Patient S., age 69 years. Diagnosis: OS - previously operated on glaucoma in a far advanced stage with compensated IOP, glaucoma optical neuropathy. The field of view of the OS was 8 ° meridians 58 °. Ahmed valve drainage was implanted in the upper external quadrant with the outlet of the drainage tube into the anterior chamber for 1.30 hours. In order to treat glaucoma ischemic neuropathy, the indications for the introduction of a neuroprotective drug into the subtenon space to the posterior pole of the eye were determined. After instillation anesthesia, translimbal puncture of the anterior chamber was performed with a needle placed on a syringe with a neuroprotective drug (outer diameter of the needle is 0.305 mm) for 5 hours. Under optical control, the needle was passed through the anterior chamber and inserted into the lumen of the drainage tube through the valve drainage device into the subtenon space 0.5 ml of a neuroprotective drug was injected without removing the needle from the lumen of the tube, the syringe was replaced with a syringe with a balanced saline solution, which was introduced into the lumen of the tube. After removing the needle from the anterior chamber, a test was carried out for the tightness of the injection hole. Additional sealing was not required; grinding of the anterior chamber did not occur. The postoperative period was calm, without any complications. In the postoperative period, against the background of normal IOP on the OS, the patient subjectively noted an improvement in vision, an extension of the field of view of 8 meridians by 21 ° was recorded. Achieving a positive result became possible due to the achievement of a high concentration of the drug in the subtenon space.

Claims (1)

A method for administering drugs in patients with operated glaucoma with implanted Ahmed valve drainage, including translimbal puncturing of the anterior chamber from the opposite side of the location of the drainage tube with a needle whose outer diameter corresponds to the inner diameter of the tube’s lumen, while the needle is carried along the surface of the iris, is inserted into a drainage tube, a solution of the necessary preparation is injected, and then a physiological balanced solution in a volume corresponding to emu tube and the valve chamber.