RU2477628C2 - Method of treating ulcerative keratites - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology, and may be used for treating ulcerative keratites. A method consists in the fact that an etiotropic therapy is added by magnetophoresis of two drug preparations: cudesan and 0.25% derinat taken 1:1 dissolved in distilled water 5 ml. The magnetophoresis sessions involve the use of Gradient-1 apparatus of magnetic induction 10 to 15 mT for 10 minutes daily; the therapeutic course of 10 procedures.

EFFECT: method enables reducing the length of inflammatory process management, preventing development of such complications as leukoma, perforation, re-infection, epithelial-endothelial dystrophy, dry eye syndrome.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in the treatment of ulcerative keratitis of various origins - bacterial, herpetic, burn and autoimmune.

The leading pathogenetic mechanisms contributing to the formation of difficult to heal ulcerative defects of the cornea with purulent, herpetic, autoimmune and burn lesions include: overproduction of free radicals against a background of a decrease in antioxidant defense mechanisms, impaired energy metabolism with a decrease in ATP formation, and nucleic acid deficiency. The consequence of these processes is a decrease in the regenerative potential of the corneal tissue with the formation of gross vascularized clouding of the cornea, secondary dystrophies, which significantly reduce vision, at the end of the process.

There are methods of treating ulcerative keratitis in which, in addition to etiotropic - antibacterial and antiviral therapy, vitamins and vitamin-like substances, antioxidants, both in pure form and in the composition of sea buckthorn, rosehip, palm, proteolytic enzymes and their inhibitors are used (Pankov O .P. The use of antioxidants in the treatment of eye diseases. - M., 2000; Y. Maychuk. Corneal ulcers. - “Okulist” newspaper. 1999, No. 4; Puchkovskaya AA et al. Eye burns. - M.: Moscow, 2001).

The disadvantage of the applied methods is:

- low concentration in the cornea of the drugs used in the installation, oral methods of administration, since most of the drug enters the general bloodstream and is carried throughout the body;

- insufficient effectiveness of the therapy;

- long periods of medical rehabilitation.

The closest analogue - the prototype of the local treatment of ulcerative keratitis of various origins - is magnetophoresis of a 30% oil solution of tocopherol acetate - vitamin E (Sosin I.N., Buyavykh A.G. Physical therapy of eye diseases. - Simferopol, Tavria. - 1998, p. 71 -72, 145: Maichuk Yu.F., Rykun BC Antioxidants, proteinase inhibitors, and regeneration stimulants in the treatment of herpetic lesions of the cornea (copy of the report on SRI) - Chelyabinsk, 1988.

The disadvantages of this method are:

- long healing periods, corneal ulcer defects / since vitamin E does not control the spectrum of conjunctival microflora, does not exclude the risk of superinfection;

- does not prevent the development of gross vascularized clouding of the cornea;

- does not contain nucleic acids used for intracellular synthesis of protein and collagen, as well as enzymes involved in energy production and necessary for regeneration.

The objective of the invention is to propose a method for the treatment of ulcerative keratitis.

The technical result is to improve the quality of healing of the cornea in patients with ulcerative keratitis of bacterial, herpetic, autoimmune and burn origin.

The technical result is achieved by the fact that in patients with ulcerative lesions of the cornea, a combination of two drugs is used simultaneously: Kudesan and 0.25% derinat, which fill the bath for magnetophoresis in a 1: 1 ratio by adding 5 ml of distilled water, and treat on the apparatus magnetotherapy "Gradient - 1" with magnetic induction from 10 to 15 MT for 10 minutes daily. The course of treatment is 10 procedures.

Kudesan contains ubiquinone - coenzyme Q10 - a natural antioxidant that is formed in the human body, and vitamin E. (Difficult Patient Magazine, No. 3, 2010. “Use of antioxidant drugs in pediatric practice.” I.N. Zakharova, T.M. .Tvorogova, E.V. Skorobogatova). Coenzyme Q10 is present in all living cells of the body, participates in the production of energy that is necessary to fight infection, the process of respiration, growth and reproduction of cells (Tvorogova T.M., Zakharova I.H., Korovina N.A., Tarasova A. A., Khrunova KM, Popandupolo GG Therapy with coenzyme Q10 (Kudesan): focus on cardinal changes in autonomic dystonia in children and adolescents. // Pediatrics. - 2009. - T. 87. - No. 2. - p. 86-91).

Derinat, a sodium salt of native ribonucleic acid, penetrates cells without structural changes, participates in protein synthesis and is a highly active stimulator of regenerative and protector intracellular structures, delaying the flow of substances that cause dystrophic changes in the main energy center of mitochondrial cells and DNA destruction (Vidal Handbook, 2006 g.).

The advantages of the proposed method:

- reduces the healing time of corneal ulcer defects;

- reduces the incidence of epithelial-endothelial dystrophies, perforations, gross opacities of the cornea, requiring keratoplasty to restore visual acuity;

- increases the effectiveness of visual rehabilitation for visual acuity.

For a comparative assessment of the effectiveness of treatment, 2 groups of subjects were formed.

Comparison group 1 (10 people) with ulcerative keratitis, who received, in addition to etiotropic (antibacterial and antiviral) therapy, daily magnetophoresis of a 30% oil solution of tocopherol acetate - vitamin E; in the 2nd main group (14 people), etiotropic therapy was supplemented with daily magnetophoresis from a combination of 2 drugs: Kudesan and Derinat 0.25% in a 1: 1 ratio.

Table No. 1 summarizes the treatment results obtained.

Table number 1 Treatment results Survey groups 1st comparison (n = 10) min-max 2nd main (n = 14) min-max Terms of stopping signs of inflammation (days) 12-19 9-14 Dates of complete corneal epithelization (days) 14-22 10-15 Categories of corneal opacities in the outcome (abs. H): thorn 3 2 spot 8 8 cloud one four Complications (abs. Parts): 8 5 corneal perforation 2 - reinfection 2 - epithelial-endothelial dystrophy 3 one dry eye syndrome 2 2 Visual acuity at discharge: 0.05-0.09 5 2 0.1-0.4 5 7 0.5-0.7 - four more than 0.7 - one

An analysis of the data obtained showed that as a result of the use of magnetophoresis from a combination of Kudesan and Derinat, 0.25% shorten the duration of the relief of inflammation by 3-5 days, and complete corneal epithelization by 4-7 days. The complication rate decreased by more than 3.5 times, in 35.7% of patients high visual acuity was obtained (0.5 or more) in the absence of such in the comparison group.

Example No. 1. Patient B., 44 years old, due to herpetic ulcer of the cornea of the right eye on the background of antiviral therapy (topically and systemically acyclovir, interferons and inducers of interferons) was prescribed daily bath magnetophoresis from a combination of Kudesan and Derinat 0.25%. After 10 days from the start of treatment, signs of inflammation were completely stopped, and a full corneal epithelial coating was restored. Visual acuity increased to 0.7 against 0.09 before treatment. The achieved therapeutic effect remained stable throughout the entire period of further observation of 8 months from the moment of discharge from the eye hospital.

Example No. 2. Patient K., 34 years old, was hospitalized with a diagnosis of “Autoimmune corneal ulcer of the left eye,” which arose against the background of concomitant rheumatoid arthritis. The outpatient treatment for 2 weeks, including local and systemic administration of actovegin, baralgin, cornegel, and immunotropic regeneration stimulants, was not effective. The patient is prescribed daily bath magnetophoresis in the left eye from a combination of Kudesan and Derinat 0.25% in a ratio of 1: 1. After 10 sessions, signs of inflammation stopped and complete healing of the corneal ulcer occurred with the restoration of a full epithelial coating. Visual acuity of the left eye increased to 0.6 against 0.05 before magnetophoresis. The achieved result remained stable throughout the observation period, namely 10 months from the date of discharge.

Claims (1)

A method of treating ulcerative keratitis of the eyes, consisting in etiotropic treatment, characterized in that antioxidants and stimulators of regenerative processes are additionally used, moreover, Kudesan drugs are used as antioxidants, and derinat 0.25% in a ratio of 1: 1 as stimulants of regeneration of the process, which diluted in 5 ml of distilled water and injected daily by magnetophoresis on a Gradient-1 apparatus for magnetic therapy with magnetic induction 10-15 mT, the procedure lasts 10 minutes, the course of treatment Ia 10 procedures.