RU2484795C2 - Method of inducing posterior detachment of vitreous body with miniplasmin - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for inducing posterior detachment of vitreous body. For this purpose 0.1 ml of miniplasmin solution is introduced endovitreally in 4 mm from limb. Preliminarily before introduction, solution of buffer salts up to pH values of 6.8-8.0 with osmolarity 280-320 mOsm to concentration of miniplasmin in solution 1 mg/ml is added into miniplasmin, mixed, heated to temperature 37°C and kept at said temperature for from 5 to 15 minutes.

EFFECT: method ensures reduction of toxic impact on retina and vitreous body, improvement of proteolytic properties of miniplasmin and, therefore, more complete detachment of vitreous body with reduction of interference trauma.

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Description

The invention relates to medicine, namely to ophthalmology.

In various diseases of the posterior segment of the eye, pathological processes developing in the area of the vitreoretinal connection are of great importance. According to modern data, the vitreoretinal compound is formed by the posterior hyaloid layer of the vitreous body (CHS ST) and the inner border membrane of the retina (VPM).

ZGS ST is the outer layer of vitreum with a thickness of 100-200 microns, having a higher density of collagen fibers and a higher concentration of hyaluronic acid, compared with the central part of the vitreous cavity.

VPM is the basement membrane of the internal processes of the Muller retinal cells. Morphologically, these are randomly interwoven fibers of type 4 collagen associated with glycoproteins. The thickness of the VPM depends on the location and varies with age. On the extreme periphery of the retina, it is thin - 50 nm. In the center of the retina, it thickens - 360 nm in the equator.

Of particular importance for understanding the importance of vitreoretinal relationships in the pathogenesis of diseases of the posterior segment of the eye is the fact that in the eyes with existing posterior vitreous detachment (ZOS), proliferative diabetic retinopathy does not develop, in addition, in patients with edematous-hemorrhagic form of diabetic retinopathy after the occurrence of spontaneous ZOST there is no progression of edematous-hemorrhagic changes in the retina, neovascularization does not develop, and even a decrease in edema of the set is noted atki with improvement of visual functions.

With such a serious disease of the posterior segment of the eye, as idiopathic macular tears (IIR), the adjacent CGS ST is assigned a leading role in the pathogenesis of the formation of a through macular defect. An interesting fact is that the risk of macular rupture in the presence of an SCH is less than 1%.

A known method of inducing ZOST using miniplasmin (US patent 7914783).

The method consists in endovitreal injection of 4 ml of limb 0.1 ml of miniplasmin solution at a concentration of 1.25 mg / ml using an insulin syringe with a 27 g needle.

However, this method has several disadvantages due to the use of high concentrations of miniplasmin, which can have a toxic effect on the retina and vitreous humor, which may cause an exudative reaction, as well as the death of nerve fibers in the retina, which leads to low visual functions after administration of miniplasmin , and also increases the patient's rehabilitation period after drug administration.

The objective of the invention is the development of a less traumatic method of inducing ZOST using miniplasmin and the prevention of postoperative complications.

The technical result achieved by using the present invention is the induction of a more complete ZOS, reducing toxic effects on the retina and vitreous body, accelerating the rehabilitation period by improving the proteolytic properties of miniplasmin.

The technical result is achieved by the fact that in the method for inducing posterior vitreous detachment, which includes endovitreal administration of 0.1 ml of miniplasmin solution in 4 mm from the limb according to the invention, a solution of buffer salts is added to miniplasmin prior to administration to pH values of 6.8-8 , 0 with an osmolarity of 280-320 mOsm to a concentration of miniplasmin in a solution of 1 mg / ml, stirred, heated to a temperature of 37 ° C and kept at this temperature for 5 to 15 minutes.

Complete the manipulation of instillations of corticosteroids.

The drug miniplasmin before its endovitreal administration is prepared as follows. A frozen miniplasmin solution with a concentration of more than 1 mg / ml is thawed with a temperature control in a thermostat to a calculated value, a solution of buffer salts is added, bringing the miniplasmin concentration in the solution to 1 mg / ml, and then use.

The method differs from the closest analogue in that it allows you to induce a more complete ZOS, reduce toxic effects on the retina and vitreous humor, and accelerate the rehabilitation period due to the fact that miniplasmin is activated at the indicated temperature and time in an optimum state balanced by acidity and osmolarity. The activation of miniplasmin allowed to reduce its concentration, in the closest analogue miniplasmin is injected into the vitreous cavity at a concentration of 1.25 mg / ml, and in the proposed method miniplasmin is administered at a concentration of 1 mg / ml.

Example 1

Patient U., 73 years old. Diagnosis: right eye - artifact, vitreomacular traction syndrome, left eye - initial cataract.

Right eye:

Visual acuity - 0.1 does not correct

Tonometry - 18 mmHg

According to optical coherence tomography (OCT), vitreomacular traction syndrome in the right eye.

In order to eliminate this pathology, an induction of the posterior vitreous detachment according to the invention was performed on the right eye. Prior to surgery, miniplasmin was heated at a temperature of 37 ° C for 5 minutes, the pH of which was 7.0 with an osmolarity of 280 mOsm.

The operation and the postoperative period proceeded without complications. On the 2nd day, visual acuity - 0.2 does not correct.

Tonometry - 15 mmHg

After 3 months, visual acuity - 0.4 does not correct.

Tonometry - 16 mmHg

According to OCT, there is no vitreomacular traction in the right eye, ZOST.

Example 2

Patient B., 53 years old. Diagnosis: right eye - proliferative diabetic retinopathy, diabetic macular edema, left eye - proliferative diabetic retinopathy, condition after laser retinal coagulation.

According to OCT, the patient has a central retinal edema in his right eye.

Right eye:

Visual acuity - 0.05 does not correct.

Tonometry - 18 mmHg

In order to eliminate this pathology, an induction of the posterior vitreous detachment according to the invention was performed on the right eye. Prior to surgery, miniplasmin was heated at a temperature of 37 ° C for 10 minutes, whose pH was 7.5 with an osmolarity of 300 mOsm.

The operation and the postoperative period proceeded without complications. On the 5th day, visual acuity - 0.1 does not correct

Tonometry - 15 mmHg

After 3 months, visual acuity - 0.2 does not correct.

Tonometry - 16 mmHg

According to OCT on the right eye, retinal edema in the center is less, ZOS.

Example 3

Patient Sh., 60 years old. Diagnosis: the right eye is artifact, the left eye is epiretinal fibrosis, artifact.

According to OCT, the patient has central epiretinal fibrosis of the retina in the left eye.

Right eye:

Visual acuity - 0.2 does not correct.

Tonometry - 20 mmHg

In order to eliminate this pathology, induction of the posterior vitreous detachment according to the invention was performed on the left eye. Prior to surgery, miniplasmin was heated at a temperature of 37 ° C for 15 minutes, the pH of which was 8.0 with an osmolarity of 320 mOsm.

The operation and the postoperative period proceeded without complications. On the 10th day, visual acuity - 0.3 does not correct.

Tonometry - 20 mmHg

After 3 months, visual acuity - 0.4 does not correct.

Tonometry - 20 mmHg

According to OCT, there is no epiretinal fibrosis in the left eye, ZOS.

Claims (1)

Method for inducing posterior vitreous detachment, including endovitreal administration of 0.1 ml of miniplasmin solution in 4 mm from the limb, characterized in that a solution of buffer salts is added to miniplasmin prior to administration to pH 6.8-8.0 with an osmolarity of 280 -320 mOsm to a concentration of miniplasmin in a solution of 1 mg / ml, stirred, heated to a temperature of 37 ° C and kept at this temperature for 5 to 15 minutes.