RU2452436C1 - Method of treating optic nerve atrophy of vascular genesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology and is intended for treatment of optic nerve atrophy of vascular genesis. For this purpose pterygopalatine (PP) and submustoidal (SM) blockades are performed to patient with application of medicinal mixture, 7-9 blockades per course with time interval 22-24 hours. After that, discrete plasmapheresis in amount 3-5 procedures with time interval 48-72 hours is performed, with volume of exfusion for a procedure constituting 20-25% of circulating blood volume. Then extracorporal pharmacotherapy is carried out. Activation of cell mass, obtained in carrying out plasmapheresis, is performed with gliatilin in dose 500-1000 mg, with further reinfusion of activated cell mass intravenously, by drip infusion. To perform PP medicinal mixture, containing lidocaine 50-100 mg, gliatilin 250-500 mg, lidase 16-32 U, is used. To perform SM medicinal mixture, containing lidocaine 50-100 mg, cortexin 5-10 mg, lidase 16-32 U, is used.

EFFECT: invention ensures efficient treatment of disease with reduction of labour-consumption and simplification of method.

2 cl, 3 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended for the treatment of patients suffering from optic atrophy.

Atrophy of the optic nerve develops as a result of many diseases, when there is inflammation, swelling, damage, degeneration of the fibers of the optic nerve or vessels that feed it. Atrophy of the optic nerve often develops with damage to the central nervous system, tumors, syphilis, brain abscesses, encephalitis, multiple sclerosis, skull injuries, intoxication, alcohol poisoning with methyl alcohol, etc. Optic atrophy can be preceded by neuritis, congestive disk, atherosclerosis and hypertensive disease and vascular changes. Atrophy of the optic nerve can also develop in diseases such as obstruction of the central retinal artery and arteries that feed the optic nerve, with uveitis, retinal pigment degeneration.

The clinical picture consists of blanching of the optic disc and a sharp narrowing of the vessels. At the height of the development of atrophy, the disk becomes white, sometimes with a grayish or bluish tint, since there is a decrease in the number of small vessels.

Diagnosis of optic disk atrophy causes certain difficulties due to the fact that atrophy of the optic nerve is preceded initially by subtle changes in the form of a partial blanching of the disk, sometimes the temporal half, which indicates the involvement of the papillomacular bundle. In this case, the study of the field of vision and visual acuity is of particular importance.

For atrophy of the optic nerve, changes in the field of vision are most characteristic. The treatment of optic atrophy is a very complex and difficult problem due to the extremely limited ability to regenerate nerve tissue. It all depends on how widespread the degenerative process is in the nerve fibers and whether their viability is preserved.

There is a method of treating optic atrophy by transpupillary scanning irradiation of the optic disc region with low-intensity laser radiation (RF Patent No. 2375022, op. 10.12.2009). Immediately after completion of irradiation, a suspension of autologous cultured mesenchymal stem cells of the patient’s bone marrow in an amount of 1-2 × 10 ⁷ in 0.1 ml of physiological saline is intravitreal. The method provides an improvement or stabilization of visual functions.

A known method of treating optic atrophy is that a constant catheter is inserted into the retrobulbar space, through which electrostimulation is carried out once a day, and 40 ml before it, 1 ml of 10% piracetam solution is introduced into it, and subsequently - the necessary medications 4 times a day (RF Patent №2008859, on. 03/15/1994).

A known method of treating diseases of the optic nerve and retina, including daily administration to the patient for 10 days of the peptide bioregulators of retinalamine and cortexin in the following mode: 3 ml of a 0.1% solution of retinalamine is administered intramuscularly, and 2 ml is instilled into a quilted coat laid for the lower eyelid, then, for 7-10 minutes, magnetotherapy of the eyeballs is carried out, and then an additional 3 ml of a 0.2% solution of cortexin is administered intramuscularly, and 2 ml is used for endonasal phonophoresis with a special nasal probe (RF Patent No. 2373022 , Op. 27.11.2009).

The disadvantages of the known methods are low efficiency due to the insufficient pathogenetic orientation of the therapy, since all therapeutic measures are carried out exclusively at the organ level, not taking into account the pathophysiological processes occurring at the organism level.

The closest to the claimed method, the prototype is a method of treating partial atrophy of the optic nerve, which consists in the fact that the patient is sequentially performed pterygopalatine-orbital blockade with a solution of lidocaine, xanthinol nicotinate and dexazone, after 5 minutes magnetostimulation with an alternating magnetic field of 0.15-0.25 T and after 20-30 min - a session of hyperoxybarotherapy in compression and decompression modes of 0.082-0.031 kPa / s for 10 minutes and isopression of 147-176 kPa for 40 minutes daily for 2 weeks (RF Patent No. 2192817, op. 20.11.2002 )

The disadvantages of this method are the high complexity and technical complexity of the method. The implementation of the wing-orbital blockade requires special training, highly qualified personnel, accompanied by a high percentage of complications, because bleeding, damage to the pterygopalatine ganglion is possible, and is quite difficult for patients to tolerate. For carrying out hyperoxybarotherapy, expensive equipment, serious engineering support, the need for the presence of an anesthesiologist and physiotherapist are necessary.

An object of the invention is to simplify the method, reduce its complexity and increase the effectiveness of treatment.

The goal is achieved by the proposed method, which consists in the following.

The patient is given complex treatment consisting of lymphotherapy by performing pterygopalatine and submastoid blockades using a drug mixture, discrete plasmapheresis and extracorporeal pharmacotherapy with activation of cell mass by gliatilin.

Pterygopalatine (CBN) and submastoid (SMB) blockades are performed alternately on the right or left side of the face, with a time interval of 22-24 hours, a course of 7-9 blocks, which ensures the rapid flow and accumulation of drugs in the lymphatic region. The CBN is performed as follows: directly under the zygomatic arch, retreating one third from the distance between the tragus of the ear and the edge of the orbit, inject with a needle with a diameter of 0.5-0.6 mm and a length of 3.5-4.0 mm, and introduce , 5-1.0 ml of the drug mixture in the projection of the anteroposterior lymph node, then change the needle direction angle by 30 degrees, advance the needle past the pterygoid processes of the main bone to a depth of 3.5-4.0 cm, falling into the pterygopalatine fossa. SMB is performed as follows: having retreated 1.5-2 cm from the submastoid process downward and laterally, they are injected with a needle and the drug mixture is injected into soft tissues.

The composition of the drug mixture for CBN includes the following drugs: lidocaine (50-100 mg), gliatilin (250-500 mg), lidase (16-32 units). The composition of the drug mixture for SMB includes the following drugs: lidocaine (50-100 mg), cortexin (5-10 mg), lidase (16-32 units).

Discrete plasmapheresis is carried out in the amount of 3-5 procedures with a time interval of 48-72 hours, for the exfusion procedure it makes up no more than 20-25% of the circulating blood volume, followed by extracorporeal pharmacotherapy with activation of cell mass with gliatilin in the amount of 500-1000 mg. Reinfusion is carried out intravenously.

The defining difference of the proposed method in comparison with the prototype is that they carry out complex treatment consisting of lymphotherapy by means of pterygopalatine and submastoid blockade, discrete plasmapheresis in combination with extracorporeal pharmacotherapy, which improves the efficiency of the method by improving cerebral blood flow, normalizing metabolic processes, activating the structure reticular formation of the brain.

A certain sequence of therapeutic measures of pterygopalatine and submastoid blockade, discrete plasmapheresis, extracorporeal pharmacotherapy was chosen because pterygopalatine and submastoid blockade allowed to create a depot of drugs near the optic nerve and improve eye hemodynamics; discrete plasmapheresis provides detoxification, hemorheological and immunotropic effects, and coupled with extracorporeal pharmacotherapy creates favorable conditions for the penetration of drugs into tissues, increases the microviscosity of the membrane structures of the nerve and the transport of calcium ions through the excitable membrane, increases the affinity of hemoglobin for oxygen and eliminates metabolic disorders.

In this case, as a medicinal mixture for pterygopalatine and submastoid blockades, optimally selected compositions are used, including a lymphostimulator - lidocaine, gliatilin, which increases the linear blood flow velocity in the cerebral arteries, cortexin, which has a tissue-specific multifunctional effect on the brain, and the lidase enzyme, which causes an increase in tissue permeability and facilitates the movement of fluids in interstitial spaces. Using these balanced medicinal mixtures allows you to quickly normalize the redox processes due to a wide range of anti-inflammatory, decongestant, lymphostimulating, hemoresorption and disaggregate effects of the mixture used and the topography of its introduction. With the introduction of the drug mixture into the lymphatic region of the orbit, its pharmacokinetics changes significantly, expressed in the selective accumulation of drugs in the focus of inflammation and the long-term maintenance of their high therapeutic concentration.

Gliatilin is a neuroprotector, improves the transmission of nerve impulses in cholinergic neurons, and positively affects the plasticity of neuronal membranes and the function of receptors. Improves cerebral blood flow, enhances metabolic processes in the brain, activates brain structures. Gliatilin increases the linear velocity of blood flow on the affected side, normalizes spontaneous bioelectric activity of the brain, and increases the tolerance of neurons to ischemic effects.

Cortexin - increases the efficiency of energy metabolism of brain cells, improves intracellular protein synthesis, regulates lipid peroxidation in brain cells, reduces the formation of free radicals, and blocks free radical oxidation.

Lidase is an enzyme preparation isolated from the testes of cattle. Breaks down the main component of the interstitial substance of connective tissue - hyaluronic acid, reduces its viscosity, increases tissue and vascular permeability, facilitates the movement of fluids in interstitial spaces; reduces swelling of the tissue.

Lidocaine - stabilizes cell membranes, blocks sodium channels, dilates blood vessels.

The invention is illustrated by the following examples of specific performance.

Example 1

Patient B., 56 years old, was admitted to the NF FSI MNTK "Eye Microsurgery" with a diagnosis of Atrophy of the optic nerve of the vascular origin of OU.

Screening before treatment:

VIS OD 0.03 sph + 1.5 cy1 0.00 ax 0 = 0.05 OS 0.1 sph + 1.5 cyl 0.00 ah 0 = 0.3

Sphere Perimetry:

OD 355 ° OS 345 °

During the course of treatment, lymphotropic therapy was carried out by performing block-winged (CBN) and submastoid (SMB) blocks on the right and left side of the face with an interval of 22 hours, a course of 9 procedures using the following medicinal mixtures:

The formulation of the drug mixture for CBN: lidocaine 50 mg, gliatilin 250 mg, lidase - 16 units.

The formulation of the drug mixture for SMB: lidocaine 50 mg, cortexin 5 mg, lidase - 16 units.

Discrete plasmapheresis was performed in an amount of 5 procedures with a time interval of 48 hours; for the exfusion procedure, it accounted for 25% of the circulating blood volume, followed by the extracorporeal pharmacotherapy technique with activation of the cell mass by gliatilin in the amount of 500 mg.

After the end of the course of treatment, an increase in visual acuity, an improvement in spheroperimetry, visual performance, and an improvement in general condition are noted.

Examination after treatment:

VTS OD 0.10 n / a OS 0.2 sph + 0.75 cyl + 0.5 ax 9 0 = 0.65

Sphere Perimetry:

OD 350 ° OS 390 °

Example 2

Patient S., 51 years old, was admitted to the NF FSI MNTK "Eye Microsurgery" with a diagnosis of Atrophy of the optic nerve OU, anterior ischemic neuropathy OU.

Screening before treatment:

VIS OD 0.05 sph + 3.0 cyl 0.00 ax 0 = 0.1 OS 0.2 sph + 1.5 cyl 0.00 ax 0 = 0.6

Sphere Perimetry:

OD 465 ° OS 302 °

During the course of treatment, lymphotropic therapy was carried out by performing block-winged (CBN) and submastoidal (SMB) blocks on the right and left side of the face with an interval of 24 hours, a course of 7 procedures using the following medicinal mixtures:

The formulation of the drug mixture for CBN: lidocaine 100 mg, gliatilin 500 mg, lidase - 32 units.

The formulation of the drug mixture for SMB: lidocaine 100 mg, cortexin 10 mg, lidase - 32 units.

Discrete plasmapheresis was performed in an amount of 5 procedures with a time interval of 72 hours, for the exfusion procedure amounted to 20% of the circulating blood volume, followed by extracorporeal pharmacotherapy with activation of the cell mass with gliatilin in the amount of 1000 mg.

After the end of the course of treatment, an increase in visual acuity, an improvement in spheroperimetry, visual performance, and an improvement in general condition are noted.

Examination after treatment:

VIS OD 0.10 sph + 2.0 cyl 0.00 ax 0 = 0.3 OS 0.3 sph + 1.0 cyl 0.00 ax 0 = 0.7

Sphere Perimetry:

OD 465 ° OS 465 °

Example 3

Patient T., 50 years old, was admitted to the NF FSI MNTK “Eye Microsurgery” with a diagnosis of Atrophy of the optic nerve OU, anterior ischemic neuropathy OU.

Screening before treatment:

VIS OD 0.20 n / a OS 0.20 sph-0.50 cyl 0.00 ax 0 = 0.30

Sphere Perimetry:

OD 435 ° OS 185 °

During the course of treatment, lymphotropic therapy was performed by performing on the right and left side of the face pterygopalatine (CBN) and submastoidal (SMB) blocks with an interval of 24 hours, a course of 8 procedures using the following medicinal mixtures:

The formulation of the drug mixture for CBN: lidocaine 75 mg, gliatilin 500 mg, lidase - 32 units.

The formulation of the drug mixture for SMB: lidocaine 75 mg, cortexin 10 mg, lidase - 32 units.

Discrete plasmapheresis was performed in an amount of 4 procedures with a time interval of 72 hours, for the exfusion procedure amounted to 25% of the circulating blood volume, followed by extracorporeal pharmacotherapy with activation of the cell mass with gliatilin in the amount of 1000 mg.

After the end of the course of treatment, an increase in visual acuity, an improvement in spheroperimetry, visual performance, and an improvement in general condition are noted.

Examination after treatment:

VIS OD 0.85 n / a OS 0.75 sph-0.50 cyl 0.00 ax 0 = 1.0

Sphere Perimetry:

OD 428 ° OS 474 °

Using the proposed method will improve the functional parameters of the organ of vision: to expand the field of view, increase visual acuity, improve spherometry, visual performance, improve the general condition of the body.

Claims (2)

1. A method of treating optic atrophy of vascular origin, comprising administering drugs to the lymphatic region of the orbit, characterized in that the patient undergoes pterygopalatine (CBF) and submastoid blockade (SMB) using the drug mixture, a course of 7-9 blockade with a time interval of 22 -24 hours, then discrete plasmapheresis is carried out in an amount of 3-5 procedures with a time interval of 48-72 hours, with an exfusion volume per procedure of 20-25% of the circulating blood volume, then extracorporeal pharmacotherapy with active 500-1000 mg gliatilin of the cell mass obtained by plasmapheresis, followed by reinfusion of the activated cell mass intravenously, drip, while using a treatment mixture containing 50-100 mg lidocaine, 250-500 mg gliatilin, lidase 16-32 Units., And for the implementation of SMB using a therapeutic mixture containing: lidocaine 50-100 mg, cortexin 5-10 mg, lidase 16-32 Units. 2. The method according to claim 1, characterized in that the blockades are performed alternately on the right or left side of the face.