RU2417803C1 - Method of physiotherapeutic correction of early post-operation complications of cataract extraction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and is intended for physiotherapeutic correction of early post-operation complications in patients who had undergone cataract extraction. Eye cornea is stimulated by laser irradiation with wavelength 633 nm, and structure of posterior eye segment - with laser irradiation 532 nm. Laser stimulation with irradiation of red and green colour is carried out alternately every second day with gradual increase of modulation frequency and procedure duration, treatment course constitutes 4-10 sessions, session duration is from 3 to 9 minutes, frequency of modulation of red and green laser irradiation constitutes 0.38-3.8 Hz, diametre of speckle-field spot is 45 mm.

EFFECT: method makes it possible to accelerate reparative processes.

3 cl, 4 tbl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended for physiotherapeutic correction of early postoperative complications in patients after cataract extraction: non-inflammatory corneal edema associated with a weakening of the barrier function of the corneal endothelium and postoperative deficiency of intraocular blood flow.

Many methods for cataract extraction are known, such as extracapsular, intracapsular, laser and ultrasonic cataract extraction.

However, all methods of cataract extraction can lead to low visual acuity as a result of the development of complications such as corneal edema, keratopathy, ischemic neuropathy, due to impaired hemodynamics in the posterior segment of the eye.

Closest to the proposed in its technical essence is a method of treating diseases of the posterior segment of the eye by conducting continuous laser radiation of the red range (with a wavelength of 633 mm) with an average power of 2.5 mW for 10 days for 1 session per day (Fabrikantov O.L. "Experimental and clinical principles of the use of pulsed infrared low-intensity laser radiation in ophthalmology." Abstract of dissertation for the degree of Doctor of Medical Sciences. - Obninsk, 2008, p.19).

But this method is not effective enough, since it practically does not affect the hemodynamics of the posterior segment of the eye, there is no significant increase in visual acuity.

The problem to which the claimed invention is directed is to increase the efficiency of treatment of patients in the early postoperative period after cataract extraction by reducing the period of postoperative rehabilitation, reducing the risk of developing keratopathy, and increasing visual functions.

The technical result consists in improving the functional results of cataract extraction, in increasing visual functions by improving hemodynamics of the eye and eliminating corneal edema.

The problem is solved in that in addition to the known method, laser radiation with a wavelength of 532 nm (green) is affected by the structures of the posterior segment of the eye. In this case, laser radiation with a wavelength of 633 nm (red) stimulate the cornea of the eye. Moreover, laser stimulation of both spectra is carried out alternately after 1 day with a gradual increase in the frequency of modulation and the duration of the procedure. The course of treatment is 4-10 sessions, the duration of the session is from 3 to 9 minutes, the modulation frequency is 0.38-3.8 Hz, the speckle field spot diameter is 45 mm.

We found for the first time that additional stimulation by green laser radiation (wavelength 532 nm) has a high activating effect on intraocular hemodynamics due to the activation of metabolism in the outer layers of the retina, choroid and increased arterial blood flow (data are shown in table 1).

Table 1 Average values of blood flow velocity in the central retinal artery and posterior short ciliary arteries depending on the type of radiation Type of radiation Blood flow rate in the central artery of the retina, cm / s in the posterior short ciliary arteries cm / s Red spectrum before treatment 16.56 + 5.7 22.6 ± 9.6 Red spectrum of radiation after treatment 19.85 ± 7.9 35.4 ± 7.5 Green spectrum before treatment 15.26 ± 3.7 23.21 ± 3.2 Green spectrum after treatment 22.40 ± 5.8 45.5 ± 4.7

Thus, stimulation by the laser radiation of 532 nm of the structure of the posterior segment of the eye, to a greater extent than stimulation by laser radiation of 633 nm, enhances blood flow.

And all this together increases the effectiveness of treatment by increasing hemodynamics and eliminating postoperative corneal edema.

The authors of the claimed method found that the stimulation of laser radiation of red and green, carried out alternately after 1 day with a gradual increase in the frequency of modulation and duration of the procedure, the treatment course of 4-10 sessions, the duration of the session from 3 to 9 minutes, with a frequency of modulation of red 0, 38-3.8 Hz and a speckle field spot diameter of 45 mm, increases visual functions and accelerates reparative processes by improving hemodynamics and reducing corneal edema, thereby improving the functional outcome of the surgical treatment.

The method is as follows.

In the first postoperative day (early postoperative period) after cataract extraction, in addition to standard antibiotherapy, they are exposed to low-intensity (2.5 mW) laser radiation with different wavelengths (633 and 532 nm) every other day using, for example, two Rubin attachments ( wavelength 633 nm) and Emerald (wavelength 532 nm) for speckle laser stimulation to the AMO-ATOS apparatus (manufacturer: TRIMA LLC, Saratov). It is preferable to begin treatment with exposure in red, since there is corneal edema in the postoperative period, and stimulation with laser radiation of this particular wavelength stops the edema.

The prefix “Rubin” (wavelength 633 nm) or “Emerald” (wavelength 532 nm) is set at eye level at a distance of 30 cm, setting the exposure power to 2.5 mW and the speckle field spot diameter equal to 45 mm. The duration of the first session is 3 minutes, while the frequency of the speckle field modulation is 0.38 Hz. But with severe edema, the duration of the first session is 5 minutes at the same speckle field modulation frequency. At each subsequent session, the exposure time is increased by 1 minute. The maximum duration of the procedure is 9 minutes. The modulation frequency is set every two days as follows: 1st and 2nd days of 0.38 Hz; 3rd and 4th days of 1.5 Hz; 5th and 6th days 2.25 Hz; 7th and 8th days 3.0 Hz; The 9th and 10th days of 3.8 Hz. The number of sessions (from 4 to 10) is set depending on the severity of corneal edema.

The authors of this method revealed that with a frequency of modulation of laser radiation equal to 1.5 Hz, there is a sharp increase in blood flow in the posterior segment of the eye. Therefore, in order to adapt the patient to low-intensity laser radiation of the speckle field, at the first sessions, the modulation frequency of the laser radiation is set to 0.38 Hz. Treatment regimens are illustrated in table 2.

table 2 Session No. Session Duration, min Modulation frequency, Hz Wavelength nm one 3 or 5 0.38 633 2 3 or 5 0.38 532 3 4 or 6 1,5 633 four 4 or 6 1,5 532 5 5 or 7 2.25 633 6 5 or 7 2.25 532 7 6 or 8 3.0 633 8 6 or 8 3.0 532 9 7 or 9 3.8 633 10 7 or 9 3.8 532

According to this technique, 40 patients were treated. As a result of treatment, a more rapid decrease in corneal edema, an increase in visual acuity, and increased blood flow in the posterior segment of the eye were noted. Bed day decreased by 2-3 days. Complications, such as keratopathy, ischemic neuropathy, were not detected in the long-term postoperative period.

Example 1

Patient P., 76 years old. Operated on cataracts of the left eye. Cataract extraction was performed with implantation of an intraocular lens (IOL). Visual acuity after surgery is 0.1-0.2, the blood flow velocity in the central retinal artery is 18.60 cm / s. In the first postoperative day, moderate corneal edema, single folds of the Descemet sheath were noted. According to the claimed method, 4 sessions of laser stimulation by speckle field were conducted every other day with a red emission spectrum of 633 nm, and a green emission spectrum of 532 nm (see table 3).

Table 3 Session No. Session Duration, min Modulation frequency, Hz Wavelength nm one 3 0.38 633 2 3 0.38 532 3 four 1,5 633 four four 1,5 532

Visual acuity became equal to 0.7. The cornea is transparent, increased blood flow in the central retinal artery (22.32 cm / s). There are no complications.

Example 2

Patient B., 70 years old. Operated on cataracts of the right eye. Cataract extraction was performed with IOL implantation. Visual acuity after surgery is 0.06, blood flow velocity of 16.48 cm / s. In the first postoperative day, moderate corneal edema, descemetitis of the membrane was noted. According to the claimed method, 10 sessions of laser stimulation by speckle field were conducted every other day with a red emission spectrum (633 nm) and a green emission spectrum - (532 nm) (see table 4).

Table 4 Session No. Session Duration, min Modulation frequency, Hz Wavelength nm one 5 0.38 633 2 5 0.38 532 3 6 1,5 633 four 6 1,5 532 5 7 2.25 633 6 7 2.25 532 7 8 3.0 633 8 8 3.0 532 9 9 3.8 633 10 9 3.8 532

Visual acuity became equal to 0.6. The cornea is transparent; the blood flow in the central retinal artery has increased (20.44). There are no complications after treatment.

Thus, the claimed method, enhancing the reparative processes of the cornea and hemodynamics of the posterior segment of the eye, increases the functional results of cataract extraction and eliminates complications such as keratopathy, ischemic neuropathy.

Claims (3)

1. The method of physiotherapeutic correction of early postoperative complications of cataract extraction by exposure to continuous red laser radiation with a wavelength of 633 nm, an average power of 2.5 mW, characterized in that it is additionally exposed to green laser radiation with a wavelength of 532 nm, an average power of 2, 5 mW, while laser stimulation with a red and green laser is carried out alternately after 1 day with a gradual increase in the frequency of modulation and the duration of the procedure, the course of treatment is 4-10 sessions, the duration of the session is from 3 to 9 minutes, the modulation frequency of the radiation of red and green lasers is 0.38-3.8 Hz, the speckle field spot diameter is 45 mm. 2. The method according to claim 1, characterized in that the modulation frequency is set every two days as follows: 1st and 2nd days - 0.38 Hz; 3rd and 4th days - 1.5 Hz; 5th and 6th days - 2.25 Hz; 7th and 8th days - 3.0 Hz; 9th and 10th days - 3.8 Hz. 3. The method according to claim 1, characterized in that the duration of the procedure is increased every two days by 1 min.