RU2425660C1 - Method of treating people with primary open-angle glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology. Method includes exposure to magnetic field. Impact is performed with value of magnetic field induction on working surface of irradiator 30±5 mT, frequency 10 Hz. Impact is performed on region of cervical spine in projection of location of cervical sympathetic ganglia.

EFFECT: elaborated impact of magnetic field of said parameters only on said zones - regulating centres of sympathetic activity - ensures normalisation of intracranial blood flow, reduction of intraocular pressure, increase of bioelectric activity of visual cortex, increase of visual functions.

1 ex, 2 tbl

Description

The invention relates to medicine, ophthalmology and can be used to treat patients with primary open-angle glaucoma.

Existing treatments:

- Surgery;

- Conservative (drug) treatment;

- Physiotherapeutic treatment (carried out only after normalization of intraocular pressure):

1. Medicinal electrophoresis is a complex method of electrotherapy, in which drugs are introduced into the body through intact skin or mucous membrane by direct current (A.P. Nesterov, Primary open-angle glaucoma: pathogenesis and treatment principle, 2000, v. 1, No. 1, p. 4-5). The very active effect of small doses of injected medicinal substances (in milligrams), usually 2-6% of the amount on the pad or in the eye bath, is due to an increase in the body's sensitivity to them under the influence of the neuro-reflex action of direct current, which creates a certain background for the administered drug substances. Contraindications: hypersensitivity to current, malignant neoplasms, acute purulent-inflammatory processes, common dermatoses, severe atherosclerosis, tendency to bleeding, acute cardiovascular diseases, intolerance to the injected drug.

2. Electrical stimulation is an increase in the activity of organs or systems of the body by irritating them with electric current (Nesterov AP Glaucoma. 1995. - 281). In ophthalmology, it is used as a method of exposure to pulsed electric current, causing restoration of conduction in the nerve fiber in glaucoma. Contraindications: hypersensitivity to current, acute inflammatory diseases of the eye, intraocular hemorrhage, high myopia.

3. Ultra-high frequency electric field (UHF-therapy) - a method for the therapeutic use of an ultra-high frequency alternating electric field (40.68 MHz, 7.37 m wavelength), which has great penetrating power in tissue at a distance, without contact of electrodes with them (Nesterov A.P. Primary open-angle glaucoma: pathogenesis and treatment principle, 2000, v. 1, No. 1, pp. 4-5). Under the influence of moderate doses, the UHF field accelerates blood flow and the course of oxidative processes, enhances immunobiological processes, increases the permeability of the vascular walls, improves trophic and regenerative processes in the tissues, and activates the reticuloendothelial system. Contraindications: severe sclerotic changes in the vessels of the eye, fresh or recurrent hemorrhages, venous thrombosis of the eye, malignant tumors, various forms of hypertension, severe arterial hypotension, diabetes, cardiovascular insufficiency in the stage of decompensation.

4. The method of influence by pulses of electric current on the zones of the cervical ganglia on the apparatus "Sympatocor-01" (Libman E.S., Fedorov S.N. et al., 1990). The essence of the method: blocking the activity of the ganglia of the sympathetic nervous system by transdermally exposing them to a spatially distributed rotating field of electrical impulses). The disadvantages of the method of local exposure to pulses of electric current to the zones of the cervical ganglia has a number of side effects (hypotension, poor tolerance, pain).

Closest to the proposed method of treatment is magnetotherapy to the orbit. It is carried out only after normalization of intraocular pressure. The essence of the method: a local effect on the orbit of a magnetic field with a frequency of 10 Hz by the magnitude of the magnetic field induction on the working surface of the emitter is 30 ± 5 mT for 10 minutes with a course of 10 procedures.

The disadvantages of magnetotherapy to the orbit: this technique does not give a sufficiently pronounced increase in visual function in patients with glaucoma, because it does not allow to act directly on the regulatory centers of sympathetic activity and cause an increase in intracranial blood flow.

We first developed a method for treating patients with primary open-angle glaucoma, including exposure to a projection of the cervical sympathetic ganglia with a magnetic field of 10 Hz and a magnitude of magnetic field induction on the working surface of the emitter - 30 ± 5 mT.

The method consists in the following: magnetotherapy is carried out by the emitter of a low-frequency traveling magnetic field at a frequency of 10 Hz and the magnitude of the magnetic field induction on the working surface of the emitter is 30 ± 5 mT. During magnetic therapy, the magnetic field emitter is fixed on the patient’s neck with the emitters located paravertebral on the cervical spine (C _III- C _VII ).

We observed 60 patients (116 eyes) aged 50 to 75 years, of whom 36 (60%) were women, 24 (40%) were men with a diagnosis of primary open-angle glaucoma (POAG) of stage I, II or III and the achieved level of target intraocular pressure (IOP). The duration of the disease in patients ranged from 6 months to 10 years.

Before and after treatment, all patients underwent clinical studies: visometry, ophthalmobiomicroscopy, Maklakov tonometry; study of the peripheral field of view (computer static perimetry on the device "PERISCAN", LLC "TRIMA"); electrophysiological study - cortical visual evoked potentials (VEP) with abduction of potential from the occipital region to the flash. The study of intraocular blood flow using ultrasound color Doppler mapping was performed on a multifunctional ultrasound system Voluson 730 Pro, while spectral velocity hemodynamics were evaluated: maximum systolic velocity (Vmax), final diastolic velocity (Vmin) and peripheral resistance index (Ri). Indices of intraocular blood flow of each patient were determined three times during the day, the data were averaged. The examination was carried out before and after treatment, as well as 1 and 3 months after the therapy.

The criteria for evaluating the effectiveness of therapy were: visual acuity, a total of 8 meridians of the border of the visual fields, the amplitude of the VEP, blood flow velocity in the vertebral, posterior short ciliary arteries (CCCA) and central retinal artery (CAC).

Statistical data processing was performed using standard methods of parametric and nonparametric statistics in the framework of the Statistica program, version 7.0.

In all patients under observation (60 patients, 116 eyes) with I, II, and III stages of POAG, intraocular pressure was normalized medically using a laser or surgical operation. The level of tonometric pressure was 18-22 mm Hg.

Depending on the treatment received, the patients were divided into 2 groups: group 1 (patients receiving magnetotherapy with exposure to the cervical sympathetic ganglia (32 patients, 62 eyes)); and group 2 (patients receiving magnetotherapy in the orbit (28 patients, 54 eyes)). Both groups of patients were representative by main clinical indicators.

In most patients, hemodynamic disturbances were observed in the basin of aa.ophthalmica et vertebralis. In 26 patients (43%) there were moderate changes in hemodynamic parameters, in 34 patients (57% - mainly patients with stage II and III glaucoma) - pronounced. In the group of patients with significant hemodynamic impairments, an insufficient effect of the traditional treatment was observed, in some cases even the negative dynamics of visual functions. A decrease in the maximum systolic and final diastolic blood flow velocity and an increase in the peripheral resistance index were observed in all subgroups, but were more pronounced in patients with stage III glaucoma.

Before treatment, the average value of visual acuity in patients with glaucoma was 0.5 ± 0.06; the average value of the total field of view for white for the 8 main meridians is -343.3 ° ± 20 °, for red - 80.6 ° ± 10 °. The amplitude of VIZ was reduced in all patients, on average, to 7.4 ± 0.6 μV. Patients of these subgroups showed a moderate circulatory deficiency in the studied vessels. A decrease in the maximum systolic blood flow velocity in the vertebral artery, SSCA and CAC was revealed; as well as diastolic velocity in the vertebral artery and SCCA. The peripheral resistance index in these vessels also exceeded the age norm.

After the treatment, positive dynamics were observed in all groups of patients (table 1). In the group of patients receiving magnetotherapy in the projection of the cervical sympathetic ganglia, after the course of treatment, the average visual acuity increased by 0.07; the total field of view along the 8 main meridians expanded to an average of 58 ° on white, and by 29 ° on red. Patients showed an increase in the maximum systolic blood flow velocity in the vertebral artery (by 13.26%), ZKCA (by 23.2%) and CAC (by 19.1%). Diastolic blood flow velocity in the posterior short ciliary arteries increased by 52.3%, in the CAC - by 9.9%, in the vertebral artery - by 29.9%. There was a decrease in the index of peripheral resistance in SSCA by 22%, in the vertebral artery - by 12%, in the CAC - by 15.3%. The amplitude of the VIZ increased by an average of 11.13%.

Upon repeated examination after 1 month, there was a slight decrease in the index of peripheral resistance in the vertebral artery and CAC (by 5.3%). When examined after 3 months, the patients maintained the achieved level of hemodynamic parameters.

Dynamics of indicators in patients receiving magnetotherapy in the orbit was less pronounced. Visual acuity increased by an average of 0.06. The total expansion of the field of view along the 8 main meridians for white amounted to an average of 44.6 °, for red - 18.6 °. In this group of patients, an increase in the maximum systolic blood flow velocity was observed in the SCCA by 2.5% and in the CAC by 11.9%. The diastolic blood flow velocity in the CACs remained the same; in the SCCA and vertebral arteries it increased by 25.8% and 4%, respectively. In CCLC and vertebral artery, a decrease in the index of peripheral resistance by 10% and 3%, respectively, was observed, however, in the CAC an increase in the index by 13% was noted. In these patients, a moderate increase in the amplitude of VIZ was noted (on average by 5.8%).

A repeat examination after 1 month showed moderate negative dynamics, in most patients the hemodynamic parameters were slightly higher than the initial level. After 3 months, in most patients, the indicators were at baseline or lower.

Table 1 Dynamics of mean hemodynamic values in patients with POAG Test vessels Hemodynamic indicators Before treatment After treatment with the proposed method After treatment with the prototype method WCCA Vmax, cm / sec 12.09 ± 0.03 14.9 ± 0.05 * 12.4 ± 0.06 * Vmin, cm / sec 3.36 ± 0.1 5.12 ± 0.09 * 4.23 ± 0.07 * Ri 0.77 ± 0.02 0.6 ± 0.04 0.69 ± 0.05 * CAC Vmax, cm / sec 11.59 ± 0.05 13.8 ± 0.07 * 12.97 ± 0.06 Vmin, cm / sec 5.21 ± 0.03 5.73 ± 0.04 * 5.22 ± 0.04 * Ri 0.65 ± 0.04 0.55 ± 0.03 * 0.74 ± 0.02 * Spine art. Vmax, cm / sec 35.27 ± 0.02 39.95 ± 0.04 * 35.31 ± 0.03 * Vmin, cm / sec 14.85 ± 0.03 19.3 ± 0.02 * 15.45 ± 0.06 Ri 0.58 ± 0.05 0.51 ± 0.04 * 0.56 ± 0.02 * * - Differences between groups are significant, p <0.05

All patients who received magnetotherapy with an effect on the cervical ganglia showed good tolerance of treatment, a slight feeling of euphoria after 6-7 minutes of the procedure (in 18 patients); slight discomfort after 8 minutes of the procedure (in 6 people), disappearing after 5 procedures; 6 patients did not notice any subjective sensations.

Thus, as a result of the impact of a traveling magnetic field on the cervical ganglia of patients with primary open-angle glaucoma, when reaching the target intraocular pressure, an increase in visual functions was noted due to increased intracranial blood flow when acting directly on the regulatory centers of sympathetic activity. It should be noted an increase in the bioelectric activity of the visual cortex, which indicates a systemic effect of therapy. These effects are based on the high sensitivity of the nervous tissue to the magnetic field, which acts as a threshold stimulator on the limbic-reticular complex and hypothalamic-pituitary system. The technique of exposure to a region of the cervical sympathetic ganglia with a running magnetic field seems to be pathogenetically justified, given the vasodilating, antispasmodic, antihypertensive and neurotropic effects of the magnetic field.

An example, patient M, 67 years old, was treated at the Clinic of Eye Diseases of SSMU from 12/14/09 to 12/22/09 with a diagnosis of primary open-angle Ia glaucoma of the right eye, IIa glaucoma of the left eye. The duration of the disease is 2 years. The patient underwent a complete ophthalmological examination (the results are presented in table 2) and treatment was prescribed (table 2).

In this patient, intraocular pressure was normalized by surgery (left eye, the duration of the operation is 1.5 years) and medication (installation of the drug is 0.5% ocupress in both eyes twice a day). The level of tonometric pressure was 17-20 mm Hg. (right eye) and 18-21 mmHg (left eye). Subjectively, the patient complained of decreased vision in both eyes and recurring headaches.

Magnetotherapy was carried out on an AMO-ATOS device (TRIMA LLC, Saratov) with a low-frequency traveling magnetic field emitter at a frequency of 10 Hz and a magnetic field induction on the working surface of the emitter of 30 ± 5 mT. When conducting magnetic therapy, the magnetic field emitter was fixed on the patient’s neck with the emitters located paravertebral on the cervical spine (C _III- C _VII ). The course of therapy included 10 sessions of 10 minutes.

table 2 Functional indicators of patient M. before and after treatment Indicator Right eye, before treatment Right eye after treatment Left eye, before treatment Left eye after treatment Visual acuity 0.4 + 1.5D = 0.9 0.4 + 1.5D = 1.0 0.3 0.4 PZ on white 510 ° 520 ° 265 ° 290 ° PZ on red 130 ° 180 ° 40 ° 80 ° Amplitude of VIZ, μV 8.64 9.28 7.41 8.12 WCCA Vmax, cm / sec 14.61 15.91 13.96 10.06 Vmin, cm / sec 4.22 6.49 3.9 4.87 Ri 0.71 0.59 0.72 0.52 CAC Vmax, cm / sec 13.31 13.8 16.23 10.39 Vmin, cm / sec 5.19 4.06 3.9 4,54 Ri 0.61 0.71 0.64 0.56 Spine art. Vmax, cm / sec 37,2 35.42 25.39 41.33 Vmin, cm / sec 10.63 23.03 8.27 9.45 Ri 0.71 0.35 0.67 0.77

This patient showed good tolerance of treatment, a slight feeling of euphoria after 6-7 minutes of the procedure; subjectively, the patient noted an improvement in vision, especially in the left eye, and a decrease in headaches.

After the treatment with the proposed method, positive dynamics were noted. Visual acuity increased by 0.1 in both eyes. The increase in the field of view of the right eye for white was 10 °, for red - 60 °; left eye - 25 ° to white and 40 ° to red. The amplitude of VIZ of the right eye increased by 7.4%, the left - by 9.5%. The maximum systolic blood flow velocity increased in the SCCA and CAC of the right eye by 8.89% and 3.6%, respectively, and in the vertebral arteries on the left by 62.7%. Diastolic blood flow velocity increased in the SCCA of the right and left eye (by 53.7% and 24.8%, respectively), CAS of the left eye (by 16.4%) and vertebral arteries on both sides (by 116% on the right and 14.2% left). A decrease in the peripheral resistance index was observed in the SCCA of the right and left eye (by 16.9% and 27.7%, respectively), the CAC of the left eye (by 12.5%) and the vertebral arteries on the right (by 50.77%).

Upon repeated examination after 1 month, there was a slight decrease in the index of peripheral resistance in the vertebral artery and CAC (by 5.3%) of the right eye, a slight increase in the maximum systolic blood flow velocity of the left eye eye, the remaining parameters were insignificant. When examined after 3 months, the patient showed no negative dynamics.

As can be seen from the results of the study, as a result of the impact of a traveling magnetic field on the cervical ganglia of patients with primary open-angle glaucoma when the target intraocular pressure was achieved, an increase in visual functions was noted due to increased intracranial blood flow when acting directly on the regulatory centers of sympathetic activity. It should be noted an increase in the bioelectric activity of the visual cortex, which indicates a systemic effect of therapy. These effects are based on the high sensitivity of the nervous tissue to the magnetic field, which acts as a threshold stimulator on the limbic-reticular complex and hypothalamic-pituitary system. The technique of exposure to a region of the cervical sympathetic ganglia with a running magnetic field seems to be pathogenetically justified, given the vasodilating, antispasmodic, antihypertensive and neurotropic effects of the magnetic field. The effectiveness of magnetic sympathetic correction in patients with POAG allows recommending the inclusion of magnetotherapy with effects on the cervical ganglia in the complex treatment of glaucoma patients.

Claims (1)

A method of treating patients with primary open-angle glaucoma, including exposure to a magnetic field with a frequency of 10 Hz and the magnitude of the magnetic field induction on the working surface of the emitter 30 ± 5 mT, characterized in that the magnetic field is applied to the cervical spine in the projection of the location of the cervical sympathetic ganglia.