RU2402303C1 - Method of treating epithelial ingrowth - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and to ophthalmology, and can be used for treating the ingrowth of corneal epithelial cells under a corneal flap. When detecting the corneal epithelial cells in the intrastromal space, photographic recording is applied, and the offered therapy is administered when describing the growth of corneal epithelial cells. At first, beta-therapy sessions are conducted that implies the use of applicators on the eye cornea daily for four days at a single dose 5 Gy, total dose 20 Gy. Next day after the termination of beta-therapy sessions, Collalysinum electrophoresis bathes are applied daily for 10 days. The method enables the regression of the corneal epithelial cells in the intrastromal space. The combination of an epithelial cell destroying effect of beta-therapy and absorbability of Collalysinum electrophoresis bathes allows blocking the growth and promotes the resorption of the epithelial cells in the intrastromal space without mechanical scarification.

EFFECT: use of the offered method provides destruction of the epithelial cells under the corneal flap with no surgical intervention, prevents recurrence, progression of the ingrowth of the corneal epithelial cells under the corneal flap, development of irregular astigmatism.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used for treatment with ingrown corneal epithelial cells under a corneal flap.

One of the forms of epithelial ingrowth after laser keratomileusis in situ is the formation of isolated nests of epithelial cells under the flap, the appearance of which is the result of accidental implantation during surgery. Most often, they gradually resolve on their own over several months, but in some cases they tend to grow and are accompanied by a decrease in vision, a softened flap and the development of irregular astigmatism.

There is a method of treating epithelial ingrowth, which in the presence of progressive growth poses a threat to central vision (see Balashevich LI "Refractive Surgery." - St. Petersburg: Publishing House SPb MAPO, 2002, P.130), which consists in removing epithelial cells corneas from the intrastromal space. To do this, resort to separation of the flap and removal - washing the ingrown epithelium. The disadvantage of this method is the inefficiency of the known method due to relapse or progression of the growth of epithelial cells under the corneal flap. In addition, in the long term after laser keratomileusis, when the corneal flap is raised, the morbidity of the performed manipulation increases.

The objective of the invention is the creation of an effective method of treatment when growing cells of the corneal epithelium under the corneal flap after laser keratomileusis in situ. The technical result obtained in this case consists in the effectiveness of the proposed method, which provides regression of corneal epithelial cells in the intrastromal space. The combination of the effect of beta-therapy destroying the cells of the corneal epithelium and the resorbing ability of the bath electrophoresis with collalysine allows to stop the growth and promotes the resorption of epithelial cells in the intrastromal space without mechanical scarification. Using the proposed method provides the destruction of epithelial cells under the corneal flap without surgical intervention, prevents relapse, the progression of the process of ingrowth of corneal epithelial cells under the corneal flap, the development of irregular astigmatism, allows you to use the inventive method at different periods of the postoperative period, ensures the preservation of visual acuity, reduces the rehabilitation of patients .

The specified technical result is achieved by the fact that in the method of treating epithelial ingrowth, which consists in removing corneal epithelial cells from the intrastromal space, beta-therapy sessions are performed daily for four days on the cornea of the eye (single dose - 5 Gray; total dose - 20 Gray), then the day after the end of beta therapy, a bath electrophoresis with collalysine is performed daily for 10 days.

A method of treating epithelial ingrowth is as follows. In patients who underwent laser keratomileusis surgery, dynamic examinations are planned in the postoperative period, including visometry, keratorefractometry, biomicroscopy. When revealing corneal epithelial cells in the intrastromal space, photoregistration is performed, and when determining the growth of corneal epithelial cells, treatment is carried out according to the proposed method. First, beta therapy sessions are performed when applicators are applied daily to the cornea for four days (single dose - 5 Gray; total dose - 20 Gray). The selected dose does not have a damaging effect on healthy tissues of the eye, given the minimum dosage. For conducting beta-therapy sessions, closed-type ophthalmic applicators using strontium radionuclide - 90 + yttrium - 90 are used. The surface location of epithelial cells in the corneal stroma of 1-1.5 mm implies the maximum absorption of the total dose, while the harmful effect on the surrounding eye structures is minimal. The day after the completion of beta therapy, a bath electrophoresis with collalysine is performed daily for 10 days.

The method is illustrated by the following clinical examples.

1. Patient 3. DS: Myopia is a high degree of OU. Visual acuity upon admission to the right eye was 0.04 with a correction of 7.0 = 1.0; on the left eye was 0.04 with a correction of 6.5 = 1.0.

The patient underwent refractive surgery according to the LASIK technique in both eyes. The course of the early postoperative period is uncomplicated: on the first day after the operation, visual acuity in both eyes was 0.8, and by one month it increased to 1.0. In the interface of the right eye in the paraoptic zone, point inclusion was determined. Photo registration was carried out. Within three months after the operation, there were complaints of discomfort and dry eyes in the morning. Various tear substitutes have been prescribed. At six months after LASIK surgery, the acuity of both eyes is 1.0, there are no complaints, an epithelial cyst with a tendency to growth is determined in the intrastromal space in the paraoptic zone. A course of treatment was carried out eight months after the operation, including four daily beta-therapy sessions (single dose - 5 Gray; total dose - 20 Gray). The day after the completion of beta therapy, a 10-day electrophoresis with collalysin was performed daily. After 10 days, biomicroscopy and control photoregistration were performed and a decrease in the density of epithelial cells was determined. A month after the treatment, the epithelial cells resorbed with the formation of a slight cloud-like intrastromal opacification. Visual acuity throughout the observation period = 1.0.

Patient K. DS: Myopia of moderate degree OU.

12/05/05, Surgery was performed laser intrastromal keratomileusis OU without complications.

12/06/05. VIS OD = 1.0, VIS OS = 1.0. There are no complaints. OU calm. The flap is stable, the position is correct, the edges are adapted. OD in the interface are single inclusions in the paracentral region. OS interface is transparent.

03/13/06. VIS OD = 0.5, VIS OS = 1.0 - complaints of decreased vision OD.

OD is calm. At the interface in the paraoptic zone with the capture of the optical center, nests of epithelial cells are determined.

The patient underwent four beta therapy sessions (single dose - 5 Gray; total dose - 20 Gray), and the day after the completion of beta therapy sessions, they performed a bath electrophoresis with collalysine daily for 10 days.

04/14/06. VIS OD = 0.8-1.0, VIS OS = 1.0.

OU are calm, the flaps are stable, the cornea is transparent. There are no complaints.

The patient was discharged for outpatient monitoring.

Claims (1)

A method of treating epithelial ingrowth under a corneal flap, which consists in removing corneal epithelial cells from the intrastromal space, characterized in that when detecting the growth of corneal cells in the intrastromal space, beta-therapy sessions are performed daily for four days on the cornea with a single dose of 5 Gy; with a total dose of 20 Gy, after which the day after the end of beta therapy, a bath electrophoresis with collalysine is performed daily for 10 days.