RU2460501C1 - Method of endophthalmitis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to ophthalmology, and is intended for treatment of endophthalmitis. Method includes intravenous introduction of antibiotic of broad spectrum of action in single dose, for example, gentamicin. When maximal level of antibiotic concentration in blood is reached, autoserum is obtained. Vitrectomy is performed to patient. Operation is carried out with application of ozonised physiological solution for irrigation twice during 10 minutes. Then, eye cavity is washed with physiological solution during 2-3 minutes. Operation is finished by introduction into eye cavity of obtained autoserum until cavity volume is restored.

EFFECT: method ensures complete suppression of infectious process in eye cavity with preservation of eye as organ, with prospective of preservation of visual function as a result of reduction of toxic effect of antibiotic on retina.

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Description

The present invention relates to ophthalmology and is intended for the treatment of endophthalmitis.

Endophthalmitis is a serious complication of penetrating eye wounds, intraocular operations and systemic infections. Endophthalmitis often leads not only to the loss of visual functions, but also to the loss of the eye itself as an anatomical organ.

An effective way to treat endophthalmitis is vitrectomy, which significantly reduces the number of microorganisms and toxins in the eye cavity. Vitrectomy makes it possible to remove the affected vitreous body and exudate, prevents the development of inflammatory membranes, which can lead to detachment of the ciliary body and retina with all the ensuing adverse consequences.

The method of closed subtotal vitrectomy with the introduction of antibiotics into the eye cavity is widely known. However, not a single antibacterial drug covers the entire spectrum of microorganisms. The toxic effect of antibiotics on the retina is also known, and the concentration of antibiotics necessary to suppress the pathogenic flora is often fatal to the retina (Gundorova R.A., Bykov V.P., Velichko V.A. // Treatment of endophthalmitis using autoserum of blood. // Ophthalmosurgery and therapy. // 2004 - N 3 - S.27-29).

A known method of vitrectomy, in which an antibiotic is injected into the eye cavity, and during the operation, the eye cavity is constantly irrigated with physiological saline saturated with ozone. This option of vitrectomy increases the effectiveness of antibacterial action, and therefore, increases the percentage of positive outcome of the operation. But in this embodiment, the danger of toxic effects of the antibiotic on the retina remains, since the difference between the necessary therapeutic concentration and toxic is very small.

There is a known method of vitrectomy, in which intravitreal administration of an antibiotic is not used, and after the operation is completed, autoserum obtained from the blood of the operated patient after parenteral administration of antibacterial drugs is introduced into the eye cavity (Gundorova R.A., Bykov V.P., Velichko V.A. // Treatment of endophthalmitis using autoserum of blood. // Ophthalmosurgery and therapy. // 2004 - N 3 - P.27-29). A more effective effect of autoserum is explained by an increased content of bactericidal factors in it. Also a positive point is the fact that autoserum can serve as a complete substitute for the vitreous body. However, in this embodiment, the antibacterial effect is insufficient. This method is taken as the closest analogue.

The task of the invention is to develop a combined method for the treatment of endophthalmitis of various origins.

The technical result of the invention is the complete suppression of the infectious process in the cavity of the eye with preservation of the eye as an organ and at the same time with the prospect of maintaining visual function due to a decrease in the toxic effect of the antibiotic on the retina.

The technical result is achieved by combining irrigation during vitrectomy with a twofold administration of an ozonated physiological solution for 10 minutes, followed by washing it out for 2-3 minutes with physiological saline and introducing an auto-serum saturated with an antibiotic into the eye cavity through an irrigation system.

We have developed the most effective combination of antibacterial techniques against the background of maximum retina preservation, including vitrectomy, first with sanitation of the eye cavity with ozonized physiological saline, then supplemented with a longer antibacterial action of autoserum saturated with antibiotic, which is also a substitute for the vitreous body, which allows to obtain an adequate antibacterial effect with minimal exposure to the retina.

It is known that ozonized physiological solution effectively inhibits the growth of various microorganisms, including fungal, which allows for adequate sanitation of the eye cavity during vitrectomy (Godogze M.G. The use of ozone in the treatment of post-traumatic and postoperative endophthalmitis. // Diss. Cand. Honey. Sciences. // Moscow, 2000 - 123 pp.). However, the ozonized saline solution is quickly inactivated, and to maximize the effect, an additional effect on the pathogenic flora is necessary. Therefore, it seems appropriate to increase the antibacterial effect of ozonized physiological saline to replace it 10 minutes after administration with a repeat of its administration.

Autoserum of blood can serve as a full substitute for the vitreous in view of its identity to the vitreous. It also takes into account its antibacterial effect after parenteral administration of antibacterial agents before receiving it.

Taking into account these facts, we decided to use when conducting vitrectomy and ozonized physiological saline for irrigation, and autoserum of patients after taking antibiotics. The proposed method is expected to increase the antibacterial effect of the treatment with the lowest possible toxic effect, which was confirmed in a clinical setting.

The method is as follows. In a patient with endophthalmitis receiving a systemically broad-spectrum antibiotic, 20 ml of blood is taken from the ulnar vein under aseptic conditions and placed in a glass flask with beads. Shaking the flask for 5-6 minutes, they achieve winding of fibrin filaments onto beads (the method of blood defibrinization), which prevents blood coagulation. The flask is placed in a refrigerator at a temperature of 5-6 ° C. After cooling the shaped elements, the serum is ready for use, and the required amount is placed in a disposable syringe.

Then proceed to the implementation of the surgical part. The conjunctiva is dissected on the patient’s eye at a distance of 5-6 mm from the limbus. Sclerotomy is carried out parallel to the limb at a distance of 3.5-4 mm in the region of the flat part of the ciliary body. Incisions are made in the meridian of 10 and 2 hours, respectively, for the introduction of the tips of the vitreophage and irrigation system. The third incision at 11 o'clock is carried out for the introduction of the fiber.

When conducting vitrectomy, an ozonized saline solution is used as an irrigation solution. Ozonation of a 0.9% saline solution is carried out, for example, using a domestic ozonizer - installation UOTA-60-01 "Medozon".

In the process of vitrectomy, as the vitreous body is removed, the state of the eye cavity is evaluated in relation to the clinical picture reflecting the stage of the disease (according to the classification of bacterial endophthalmitis A.M. Yuzhakov) and the possible nature of the pathogenic and conditionally pathogenic flora. The more pronounced clinical changes, the greater the volume and concentration of ozone in physiological saline are required for irrigation of the eye cavity.

During vitrectomy, the ozonized saline solution is replaced with fresh saline as it is inactivated, that is, after 23 minutes and the eye cavity is washed with saline for 2-3 minutes to completely remove the ozonized saline.

The operation is completed by introducing from the syringe a pre-prepared autoserum in the amount of 10 ml obtained from 20 ml of blood, and suturing the surgical incisions.

According to the proposed method, 20 patients with various types of endophthalmitis were operated on.

Clinical example.

Patient A., after receiving a penetrating wound with a metal object, was admitted with a diagnosis of Endophthalmitis of the right eye. The patient was prescribed systemic therapy, and surgical treatment was also offered. 1.5-2 hours after the first injection of gentamicin (by this time, the concentration of gentamicin in the blood reaches its maximum level), a blood sampling of 20 ml was performed to obtain serum. After deposition of blood cells and obtaining serum, the patient underwent closed vitrectomy using ozonized physiological saline as irrigation, as well as intracavitary administration of autoserum. During a vitrectomy, the ozonized saline solution was replaced with fresh after reaching its maximum therapeutic concentration, that is, after 10 minutes, and after another 10 minutes, the eye cavity was washed with saline for 2-3 minutes to completely remove the ozonized saline. The operation was completed by introducing a pre-prepared autoserum obtained from 20 ml of blood from the syringe until the volume of the cavity of the eye was replenished and the surgical incisions were sutured.

The postoperative period was uneventful with standard therapy. By 7 days after the operation, the inflammatory phenomena almost completely subsided. The conjunctiva was slightly irritated, the cornea was transparent, the moisture of the anterior chamber was transparent, the reflex from the fundus was pink. Ophthalmoscopically determined the normal state of the fundus. An increase in visual acuity was noted.

Thanks to the proposed method, it was possible to achieve a relief of the inflammatory process in the eye cavity and to obtain a satisfactory result.

Thus, the proposed method allows you to effectively suppress the causative agents of bacterial infections while reducing the undesirable toxic effects of drugs on intraocular structures.

Claims (1)

A method for the treatment of endophthalmitis, including the introduction of a broad-spectrum intravenous antibiotic in a single dose, obtaining autoserum and introducing it into the eye cavity after vitrectomy is completed, characterized in that ozonized saline solution is used twice for 10 minutes for irrigation, then the eye cavity is washed with saline solution for 2-3 minutes, and then serum is introduced into the cavity of the eye until the volume is replenished.