RU2494775C1 - Method of treating luetic optic neuropathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for treating luetic optic neuropathy. That is ensured by subconjunctival administration of Cefazolin 0.3-0.5 mg. That is combined with intramuscular injection of Gliatilin 2.0-4.9 ml, 1-3% Glutoxim 2.0 ml and Milgamma 1.0-2.0 ml. Dexazon 0.5 ml is introduced parabulbarly. The preparations are introduced once a day for 10 days. Additionally, starting with the first therapeutic day, 10 sessions of percutaneous transcranial magnetic stimulation of the optic nerves are conducted daily.

EFFECT: method provides improving the visual functions and eliminating the complications of the central nervous system due to the integrated treatment developed with the severity of the pathological process in these patients.

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Description

The invention relates to medicine, in particular to ophthalmology, and can be used in the treatment of luetic optical neuropathy.

Neurolues (neurosyphilis), affecting the nervous structures of the organ of vision, causes irreversible blindness, despite the specific treatment.

Clinically, luetic optic neuropathy is manifested by a gradual decrease in visual acuity. At first, a slight fogging appears, which gradually turns into a progressive decline in vision, up to light perception. There is a change in the visual field in the form of a central scotoma, a narrowing of the visual field is observed. The clinical picture is due to the appearance in the optic nerves, chiasm and tracts, respectively, of the location of the papillomacular bundle of foci of demyelination, atrophy of nerve fibers, proliferation of neuroglia and connective tissue. In cases of inadequate or late treatment, a sharp and irreversible decrease in visual function is possible.

The closest analogue is a method of treating optical neuropathy, including the use of iodine and strychnine nitrate, caffeine, insulin and intravenous glucose infusions with vitamin B1 for 2 weeks, oral administration of ascorbic and nicotinic acids. After 2 weeks, intravenous penicillin and bismuth preparations with iodine were prescribed (Therapeutic Ophthalmology, edited by M.L. Krasnov, Moscow: Medicine, 1985, p. 186).

However, the use of this therapy does not allow to fully enhance visual function, since antibacterial drugs poorly penetrate the blood-brain barrier and do not allow creating a therapeutic concentration in the affected area. Moreover, many antibacterial drugs used for luetic infection cause allergic reactions. Previously used preparations of iodine and bismuth have lost their importance due to their high toxicity and poor tolerance by patients.

The objective of the invention is to provide an effective method for the treatment of luetic optical neuropathy.

The technical result of the invention is to increase visual functions in this category of patients due to complex fractional therapy and transcutaneous transcranial magnetostimulation of the optic nerves, as well as the elimination of complications from the central nervous system.

The technical result, according to the invention, is achieved by the fact that in the method of treatment of luetic optical neuropathy, including the use of drugs, according to the invention, they are administered as drugs once a day for 10 days: cefazolin 0.3-0.5 mg under the conjunctiva ; intramuscularly: gliatilin 2.0-4.0 ml, glutoxim 1-3% 2.0 ml and milgamma 1.0-2.0 ml, parabulbar dexazone 0.5 ml, and also conduct 10 sessions of percutaneous transcranial magnetostimulation of the optic nerves daily starting from the first day.

The authors empirically, based on extensive clinical experience, selected drug doses and duration of treatment. According to the invention, the drug administration scheme is developed taking into account the severity and dynamics of the pathological process in case of luetic optical neuropathy with loss of visual functions until light perception. The advantage of the proposed treatment is good tolerance, ease of implementation, rarity of side effects, the possibility of its termination after achieving positive dynamics, excluding general complications from the central nervous system in this group of patients.

According to the invention, the administration of a complex of drugs intramuscularly allows them to be deposited for 4-6 hours, which potentiates the pharmacodynamics of the drugs.

The drug cefazolin, administered under the conjunctiva, has a powerful antibacterial effect. The mechanism of this effect is associated with damage to the cell membrane of dividing bacteria due to the specific inhibition of its enzymes. Gliatilin stimulates the central nervous system metabolism and the reticular formation. It improves mood, improves mental activity, concentration, remembering and the ability to reproduce the information received, optimizes cognitive and behavioral reactions, eliminates emotional instability, apathy. The drug glutoxim has a modulating effect on the intracellular processes of thiol metabolism, which plays an important role in the regulation of genetic and metabolic processes in cells and tissues, has a hepatoprotective effect, increases the body's resistance to intoxication, has a regulatory effect on redox processes, and also has a differentiated effect on normal (stimulation of proliferation and differentiation) and transformed (induction of apoptosis) cells. Milgamma is a combined preparation containing vitamins of group B. It has an analgesic effect, a stimulating effect on the regeneration of nerve tissue. Dexazone, administered parabulbarly, has an anti-edematous effect due to the vasoconstrictor effect. The magnetic field helps to improve the conductivity of optic neurons by accelerating axonal transport, as well as enhancing microcirculation in the vessels of the optic nerve, which activates its metabolism and helps to reduce swelling.

The method is as follows: daily after the administration of drugs transcranial magnetostimulation is performed - exposure to pulsed fields on the visual analyzer at the projection points of the optic nerve. The device is exposed to 4 points sequentially (eyes, temporal region, region behind the ear, occipital tubercles) for 5 minutes each. The device is a Bio MPG (MIKOF). Magnetic field parameters: intensity 2 T, modulation frequency 1 Hz. The described treatment regimen is shown in the table.

The method is illustrated by clinical examples.

Example 1. Patient Ш, 38 years old, first visited an ophthalmologist in February 2010 with complaints of a sharp decrease in vision (according to the patient, for no apparent reason), decreased brightness of the visual picture, and the appearance of cloudy foci in the field of vision. Upon receipt from the anamnesis, it was revealed that since 2008, the patient has undergone treatment for latent syphilis twice in the Dermatovenerologic Dispensary (DIA), which was verified during the clinical examination (Wasserman reaction is positive, the microprecipitation reaction is positive; cerebrospinal fluid test for specific reactions: immunofluorescence reaction (RIF) +++ and pale treponemal immobilization reaction (RIBT) 52%; blood test for specific reactions: RIF 4.4; RIBT 70%).

In a neurological hospital, he received specific anti-syphilitic treatment in the form of intravenous administrations of ceftriaxone, non-specific detoxification and desensitization treatment). Patient weight 86 kg.

Upon admission to the ISTC "Eye Microsurgery" named after Acad. S.N. Fedorova: visual acuity - 0.01 is not corrected in both eyes. When computer perimetry revealed central deep scotoma. With ophthalmoscopy, the fundus of the eye: the optic nerve disk (optic disc) is dirty pink, the borders are fuzzy, the prominence of the optic disc into the vitreous body, the arteries are narrowed, the veins are dilated, convoluted, multiple inflammatory couplings along the vessels, diffuse atrophy of the choroid in the form of small foci throughout the eye bottom with pigment on and around them (a symptom of "salt and pepper").

The diagnosis was confirmed: luetic optical neuropathy of both eyes. The treatment was carried out in the hospital once a day for 10 days: subconjunctival cefazolin 0.5 mg diluted in 1 ml of water for injection (after anesthetizing the eye with 0.5% dicaine solution three times within 5 minutes); intramuscularly: gliatilin 4.0 ml, glutoxim 3% 2.0 ml, milgamma 2.0 ml and parabulbar dexazone 0.5 ml. Percutaneous transcranial magnetostimulation of both optic nerves was also performed for 10 days, daily, starting from the first day.

At the end of the course of treatment, visual acuity increased to 0.1 and 0.09 on the right and left eye, respectively, in the field of view, the depth of the central cattle decreased.

Example 2. Patient P., 49 years old, turned to the ISTC "Eye Microsurgery" named after Acad. S.N. Fedorov in March 2011 with complaints of a sharp decrease in vision and the appearance of cloudy foci in the projection of visual fields. In CVD, the diagnosis of neurosyphilis was confirmed (Blood on RW: positive, positive microprecipitation reaction; CSF test for specific reactions RIF ++++ and RIBT 49% blood test for specific reactions: RIF 4.2; RIBT 68%). In a neurological hospital, specific antibacterial and non-specific detoxification and desensitization treatments were performed). The patient's weight is 58 kg. Upon admission to the FGBI MNTK "Eye Microsurgery" the visual acuity of both eyes is 0.04-0.05, is not corrected. Central absolute scotomas were determined. Objective examination: fundus: optic nerve discs of a dirty pink color, fuzzy borders, optic nerve disc prominence to the vitreous body, arteries narrowed, veins dilated, convoluted, multiple inflammatory couplings along the vessels, diffuse atrophy of the choroid.

The diagnosis was confirmed: luetic optical neuropathy of both eyes.

The treatment was carried out in the hospital once a day for 10 days: subconjunctival cefazolin 0.3 mg diluted in 1 ml of water for injection (after anesthetizing the eye with 0.5% dicaine solution three times within 5 minutes); intramuscularly: gliatilin 2.0 ml, glutoxim 1% 2.0 ml, milgamma 1.0 ml and parabulbar dexazone 0.5 ml. Percutaneous transcranial magnetostimulation of both optic nerves was also performed for 10 days, daily, starting from the first day.

At the end of the inpatient treatment course, the patient’s visual acuity increased to 0.1, the edema and ischemia of the optic nerve disc significantly decreased, and the central scotoma disappeared into the field of view.

Table A method for the treatment of luetic optical neuropathy Days / Preparations 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th Cefazolin 0.3-0.5 mg under the conjunctiva + + + + + + + + + + Gliatilin 2.0-4.0 ml intramuscularly + + + + + + + + + + Glutoxim 1-3% 2.0 ml intramuscularly + + + + + + + + + + Milgamma 1.0-2.0 ml intramuscularly + + + + + + + + + + Dexazone 0.5 ml parabulbarno + + + + + + + + + + Percutaneous transcranial magnetostimulation + + + + + + + + + +

Claims (1)

A method for the treatment of luetic optical neuropathy, including the use of drugs, characterized in that the drugs are administered once a day for 10 days: cefazolin 0.3-0.5 mg under the conjunctiva; intramuscularly gliatilin 2.0-4.0 ml, glutoxim 1-3% 2.0 ml and milgamma 1.0-2.0 ml, parabulbar dexazone 0.5 ml, and also conduct 10 sessions of percutaneous transcranial magnetostimulation of the optic nerves daily, starting from the first day.