RU2539161C2 - Method of treating herpes virus involvement of inner structures of eye - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and can be used for treating a herpes virus involvement of inner structures of an eye. The method involves a therapeutic retroscleral buckling with the biomaterial 'Alloplant Phagocytosis Stimulator' or the biomaterials 'Alloplant Phagocytosis Stimulator' and 'Alloplant Scleral Reinforcing Buckling'; that is followed by a choroid autolyphosorption with the biomaterial 'Alloplant for Autolyphosorption' and 'Alloplant Phagocytosis Stimulator' with the choroid autolyphosorption of one eye performed 2-6 months following the therapeutic retroscleral buckling, and of the second eye - 2-6 months following the choroid autolyphosorption of the first eye.

EFFECT: method provides the prolonged, and in some patients complete remission.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used for the treatment of chronic recurrent herpesviral lesions (inflammation) of the inner membranes of the eye (VOG). Depending on the location and depth of the lesion (different parts of the retina and / or choroid), chorioretinitis (central, peripheral), uveitis (central, peripheral), retinitis (central, peripheral), pars-planetitis, iridocyclitis and other VOG diseases are diagnosed ) The cause of herpesvirus infection of VOG is most often herpes simplex virus, cytomegalovirus and Epstein-Barr virus.

At present, VOG lesions of herpes virus etiology are quite widespread. Viruses enter the body through the skin and mucous membranes, including the eyes, and remain in a latent state throughout life, periodically causing an exacerbation of the disease of various localization.

Anatomical, morphological and physiological features of the vascular tract of the eye (multiple anastomoses, slowed blood flow) contribute to the delay of pathogens and their metabolic products. In addition, the presence of the blood-ophthalmic barrier and the delayed diffusion of antibodies through it lead to the creation of favorable conditions for the life of a number of pathogens. The choroid vasculature is the site of passage and deposition of a large number of infectious agents, toxic products and antigens. An important factor in the development of chronic VOG lesion is a violation of the permeability of the protective barriers of the eye and tissue sensitization, which is clinically manifested by the antigen-antibody reaction in the tissues of the eye and ends with edema and necrosis.

Consequently, the pathogenesis of herpesvirus infection of VOG is based on infectious-toxic and infectious-allergic processes, in which, along with retinal and choroid tissue infiltration, microcirculation disorders, arteriovenous occlusion, hypoxia, scarring, proliferation, vascular neoplasm, and retinal degeneration are observed.

With a recurrent lesion of VOG, exudative-transudative and gross degenerative-destructive changes in the eye occur. The reverse development of chorioretinal foci proceeds slowly and ends with rough scarring after 6-12 months.

The prognosis for herpesvirus infection of the eye is poor. Treatment is carried out for several years or even decades. Patients all the time need supportive therapy with virostatic drugs. Discontinuation of antiviral drugs leads to exacerbation (relapse). So, for example, in the absence of treatment, cytomegalovirus and herpetic retinitis end in blindness.

In some cases, progressive myopia is a consequence of chronic inflammation of the VOG, and the cause of accommodation spasm, deformation of the posterior segment of the eyeball (loosening of the sclera) is the toxic effect of the pathogen. In this case, myopia can be regarded as a complication of herpes virus infection of the inner membranes of the eye.

Herpesviral lesions of the inner membranes of the eye are difficult and long-term treatment, often recur (2-6 times a year), against their background there is a high probability of developing various complications - cataracts, secondary glaucoma, optic atrophy, exudative retinal detachment. During exacerbation, the patient is incapacitated, and the young working-age population is most often affected, therefore, the aspect under consideration has great social significance.

In addition, known methods of treatment relate to the treatment of a specific disease, for example, treatment of central chorioretinitis, peripheral chorioretinitis, central uveitis, peripheral uveitis, central retinitis, peripheral retinitis, etc. Moreover, these methods are not effective enough, they do not allow for a long, and in some patients complete remission, in addition, they have side effects and complications due to the duration and frequent repetition of the course of drug treatment. Therefore, the development of new and improvement of existing treatment methods remains an urgent task.

At present, no treatment method has been proposed that can be used for herpesvirus infection of the inner membranes of the eye, regardless of the location and depth of inflammation.

The goal is to develop a method for the treatment of herpes virus infection of the inner membranes of the eye, regardless of the location and depth of the lesion.

This goal is achieved in that the treatment of herpesviral lesion of VOG is carried out in three stages - conservative treatment (local and general) and two stages of surgical treatment - therapeutic retrosclerotherapy and autolymphosorption of the choroid. At the operational stages of treatment, three Alloplant biomaterials or combinations thereof are used. Manipulations are carried out according to a certain scheme with certain time intervals.

For the treatment of herpesvirus damage to the inner membranes of the eye, we did not use the step-by-step treatment we proposed, nor did we propose to use Alloplant data and their combination.

Thus, this technical solution meets the criteria of the invention of "novelty."

The authors did not find a method for the treatment of herpes virus infection of the inner membranes of the eye, which would include the proposed methods: conservative, and then two stages of surgical treatment and the use of various Alloplant biomaterials in the treatment. Namely, phased treatment, including conservative treatment, curative retroscleroplasty with Alloplant biomaterial and autolymphosorption of the choroid with Alloplant biomaterial, allows affecting all links of the pathogenesis of the disease (launch several mechanisms of action on the pathological focus), thereby achieving high treatment efficiency and increasing the duration of remission.

Our proposed method allows you to:

- reduce swelling of VOG,

- improve the permeability of the blood-ophthalmic barrier, activate the uveoscleral path of the outflow, enhance metabolic processes, provide detoxification of VOG,

- improve hemodynamics in the retina and choroid, due to the germination of full blood and lymph vessels, and this in turn leads to increased metabolic and regenerative processes,

- to prevent and eliminate complications such as the formation of neovascular (inferior) vessels in the retina, dystrophic changes (arising after the organization of exudate), the development of secondary glaucoma, complicated cataracts, retinal detachment, progressive myopia,

- normalize the cellular composition of suprachoroidal fluid.

The proposed manipulations, their sequence, the use of the proposed “Alloplant” and their form (“Alloplant-phagocytosis stimulator” in dispersed (powder) form, and “Alloplant for autolymphosorption” - in the form of a film) and the timing of the manipulations allow us to make the treatment according to the proposed method the most effective. Surgical intervention (medical retrosclerotomy) is carried out after drug treatment, on a favorable background, while creating, after a certain time, optimal conditions (no complications) for the third stage of treatment (autolymphosorption), and thereby ensures a long absence of recurrence of inflammation, normalization of local immunity, improvement and stabilization of visual functions.

The method can be used in the treatment of herpes virus infection of the inner membranes of the eye in eye clinics by doctors who own the technique of surgery.

Thus, the proposed method meets the criteria of the invention of "inventive step" and "industrial applicability".

The method is as follows:

before starting treatment according to the proposed method, the patient undergoes a complete ophthalmological examination, including determining visual acuity, assessing the state of the vitreous body (biomicroscopically and ophthalmoscopically), examining the fundus, measuring intraocular pressure, measuring the threshold of electrical sensitivity and electrolability, examining other visual functions, and also immunological examination, including enzyme immunoassay for herpes simplex virus, cytomegalovirus, Epstein-Barr virus and other infections (tuberculosis, toxoplasmosis) with the determination of the titer of immunoglobulin G to assess the activity of inflammation at present and evaluate the dynamics of treatment in the future. This analysis is repeated 6-12 months after the final treatment (stage 3), as well as in the process of dynamic observation of the patient after treatment (1 time per year).

If necessary, fluorescence angiography, ultrasound scanning of the eyes, optical coherence tomography of the eyes.

The final diagnosis was made on the basis of the anamnesis, clinical picture, immunological examination data and the results of additional research methods: general blood test, general urine test, blood for sugar, Wasserman reaction, blood for rheumatic tests (CRP, sialic, seromucoid), immunogram, electrocardiogram, fluorography chest, abdominal ultrasound. Patients are consulted by a therapist, neurologist, infectious disease specialist, immunologist.

The proposed method includes three stages: conservative treatment and two stages of surgical treatment: therapeutic retrosclerotherapy and autolymphosorption of the choroid.

The first stage is conservative treatment: the patient is prescribed antiviral, immunomodulating, antioxidant, hormonal treatment. Topically (within two to three weeks) - Ophthalmoferon eye drops 1-2 drops 6-8 times a day, Aktipol 0.007% eye drops 1-2 drops 3-8 times a day, Oftanid eye drops 1-2 drops 5 times a day, Zovirax 3% ophthalmic ointment 3 times a day. 7 days after the start of treatment, Prenacid add eye drops 1-2 drops 3-4 times a day, Emoxipine 1% eye drops 1-2 drops. In addition, the patient is prescribed Acyclovir 200-400 mg 3-5 times a day or Valtrex, Famciclovir, Ganciclovir, Panavir (depending on the type of virus) - 5-10 days course, Imunofan 1.0 intramuscularly every other day, treatment 10 injections (tactivin, polyoxidonium), Cycloferon 2.0 intramuscularly every other day, course of treatment 10-30 injections, Lycopid 10 mg - 10 days; multivitamins with microelements, antioxidants - dikvertin, Oculist tablets, vitamin E for two to three weeks. In severe cases (pars-planetitis, acute retinal necrosis), add Half-Dan (0.2 g per 1 ml of sterile water for injection), 0.5 ml (100 μg) parabulbarno, daily or every other day, the course of treatment is 5-20 injections. The volume of treatment varies from the activity of the process.

For surgical treatment, Alloplant biomaterial is used (Registration Certificate No. 901 of 07/22/1987). Alloplant is included in the General Classification of Biological Products and is approved for wide clinical use. Specification No. 42-2-537-93 (Ministry of Health of Russia, registration number 056/003230 dated 05/17/1993).

After conservative treatment is completed, the second stage is carried out - therapeutic retrosclerotherapy of both eyes with Alloplant biomaterial. At this stage, the biomaterial "Alloplant-stimulator of phagocytosis" is used. If the patient has myopia, the biomaterial “Alloplant-sclero-reinforcing filling” is additionally used.

During medical retroscleroplasty, Alloplant biomaterial is injected between the sclera and tenon capsule into the posterior part of the eye. Through the use of a dispersed (powder) form, the area of contact with the tissue bed increases.

The need to complete this stage is to remove the inflammatory process of VOG, reduce edema, dryness of the suprachoroid space, and, in addition, this stage is preparatory for the third stage of treatment (autolymphosorption of the choroid by Alloplant biomaterial).

Technique for the operation of medical retrosclerotherapy with Alloplant biomaterial: the operation is performed under local anesthesia or general anesthesia (depending on age). The operation can be performed immediately on both eyes.

The operation is performed in the lower-inner and upper-outer sectors of the eyeball between the adjacent eye muscles. Conjunctiva and tenon capsule 1.5-2 mm long (subtenon space) are cut 6-10 mm from the limbus. Spatula create a move to the back pole. A blunt-pointed needle-cannula bent along the curvature of the eyeball is inserted into the hole formed, through which a suspension of 0.5 ml (25 mg) Alloplant-phagocytosis stimulant biomaterial is injected using a disposable syringe into the lower inner and 1.5 ml (75 mg) in the upper-outer sector. The needle is removed from the wound, the conjunctival incision is sutured with one interrupted suture in the upper and lower sectors.

To obtain dispersed Alloplant biomaterial, immediately prior to the operation, Alloplant powdered biomaterial - 100 mg is diluted in 2 ml of physiological saline and 0.5 ml of dexamethasone (the powdered biomaterial absorbs liquid upon dilution and 2.0 ml of suspension is obtained after dilution).

If the patient has any degree of myopia, 2 dispersed Alloplants are mixed in a syringe: Alloplant-stimulator of phagocytosis and Alloplant-sclero-strengthening filling, 100 mg each (100 mg of Alloplant is diluted in 2 ml of physiological saline and 0.5 ml dexamethasone). A total of 4 ml of suspension is obtained. The introduction is carried out as described above (0.5 ml of suspension in the lower internal and 1.5 ml of suspension in the upper external sector of each eye).

After the operation, the usual anti-inflammatory treatment is carried out (instill disinfectant drops, put ointment), dynamic outpatient monitoring for 10-14 days.

2-6 months after therapeutic retrosclerotherapy, the third stage of treatment is carried out - autolymphosorption of the choroid by Alloplant biomaterial of the right or left eye. At this stage, 2 types of Alloplant are used - for autolymphosorption and for stimulating phagocytosis. Autolymphosorption of the choroid by Alloplant biomaterial of the second eye is carried out 2-6 months after autolymphosorption of the choroid of the first eye.

Technique of autolymphosorption of the choroid by Alloplant biomaterial.

Under local anesthesia or general anesthesia, after applying blepharostat, in the lower-outer or lower-inner quadrant of the eyeball at the level of attachment of the rectus muscles, an arcuate incision of the conjunctiva is made, then it is separated. The adjacent straight eye muscles and the conjunctiva of the eyeball are sutured and held for which the eyeball is fixed. On the surface of the sclera, a large vessel entering the flap is selected, the branch branches are coagulated in order to increase blood flow in the lead vessel. At 6-15 mm from the limb (depending on the location of the process), two scleral notches are produced between the muscles in mutually ascending directions, in the form of a triangle or rectangle, the width of the base (side) is 6-8 mm to a depth of 1/4 or 1/3 of the thickness sclera. A vascular-episcleral flap containing a large vessel entering the flap is cut out from these notches by a keratotomy blade of a special design, the branch branches are coagulated. The flap is folded back to the limb and a through linear incision of the deep layers of the sclera to the suprachoroidal space at an angle of 65-70 ° relative to the surface of the sclera is made through the flap width (obtuse angle towards the posterior pole). Then this flap is inserted through the sclera incision using a spatula into the suprachoroidal space, and the Alloplant for autolymphosorption biomaterial (a film) 7 × 8 mm in size is implanted over the filled flap. The incision is sutured with 2 interrupted sutures. A rectangular fragment “Alloplant for autolymphosorption”, 7 × 8 mm in size, is placed on the sclera’s wound and it is fixed at the corners with 4 nodal scleral sutures 8: 0 nylon. Stitching stitches are removed. Then the dispersed biomaterial “Alloplant-stimulator of phagocytosis” is poured into the subtenon space in the amount of 0.5 g with a special spoon and slightly tamped. The conjunctiva is sutured with a continuous suture of Vicryl 8: 0. The operation is completed by parabulbar injection of dexamethasone at a dose of 0.3 ml and gentamicin 20 mg.

Treatment and management of the postoperative period.

All operated patients are examined on the day after surgery. An anti-inflammatory treatment is carried out - disinfectant drops are instilled into the eye, an ointment is placed. Discharge patients from the hospital for 2-3 days after surgery. Anti-inflammatory treatment is recommended to continue for 10-14 days after surgery.

2-6 months after surgery on the first eye, a similar operation is performed on the second eye (autolymphosorption of the choroid by Alloplant biomaterial).

Example 1

Patient K., 40 years old, turned 11.10.2004.

From the anamnesis: for 3 years he has been disturbed by a decrease in vision, more on the right eye, redness of the eyes, photophobia, floating "flies" in front of the eyes. Exacerbation 2-3 times a year. I went to the clinic, anti-inflammatory treatment was carried out 2-3 times a year. The effect of treatment is negligible, there is no improvement in vision. Remission (incomplete) 3-4 months and relapse again.

Objectively: The patient has photophobia, lacrimation, conjunctival hyperemia, mixed injection.

Visual acuity: right eye - 0.6 NK; left eye - 0.9 n.k.

IOP right eye - 18 mm Hg

IOP left eye - 17 mm Hg

Fields of vision (totaling 8 meridians): right eye - 460 °

 left eye - 480 °

The threshold of electrical sensitivity: right eye - 80 μA,

left eye - 70 μA (the norm for a given age is 15-65 μA)

Fundus: OD - in the paramacular region there is a loose chorioretinal lesion, 1/6 DD, with the inclusion of pigment, with perifocal edema that streams into the vitreous body, intraretinal hemorrhages around the focus. DZN is pale pink, the borders are blurry. Arteries are narrowed, veins are slightly dilated, full-blooded. OS: in the paramacular region - the chorioretinal lesion, 1/6 DD, with the inclusion of pigment, with perifocal edema, which mediates into the vitreous, around the lesion, intraretinal; hemorrhage. DZN is pale pink, the borders are blurry. Arteries are narrowed, veins are slightly dilated.

An ELISA blood test for cytomegalovirus positive - 72%, herpes simplex virus - 70%.

Based on the examination and examination, the patient was diagnosed with herpesvirus lesion of VOG. Herpes virus, chronic recurrent, central chorioretinitis of both eyes, subactive phase.

The patient is treated according to the proposed method.

At the first stage, conservative treatment was carried out for 3 weeks: topically (within three weeks) - Ophthalmoferon eye drops 1-2 drops 6-8 times a day, Actipol 0.007% eye drops 1-2 drops 3-8 times a day , Oftanid eye drops 1-2 drops 5 times a day, Zovirax 3% eye ointment 3 times a day. 7 days after the start of treatment - Prenacid eye drops 1-2 drops 3-4 times a day, Emoxipine 1% eye drops 1-2 drops. Acyclovir 400 mg 5 times a day for 5 days; Imunofan 1.0 intramuscularly every other day, a course of treatment of 10 injections (polyoxidonium); Lycopid 10 mg - 10 days; multivitamins with minerals, antioxidant - "Optometrist" 1 t. 2 times a day for three weeks.

At the end of conservative treatment, retro retrosclerotherapy of both eyes with Alloplant-phagocytosis stimulator biomaterial was performed. At the same time, 6 mm from the limbus in the lower-inner and upper-outer sectors, the conjunctiva and tenon capsule were cut 1.5 mm long. A spatula created a move to the back pole. A needle-cannula was inserted into the formed hole, to the posterior pole of the eye, through which a suspension of 0.5 ml (25 mg) of the dispersed Alloplant-phagocytosis stimulant biomaterial was introduced into the lower inner and 1.5 ml (75 mg) upper outer sector. The needle was removed from the wound, the conjunctival incision was sutured with one interrupted suture in the upper and lower sectors.

The postoperative period was uneventful.

1 month after surgery:

Visual acuity: right eye - 0.7 NK; left eye - 0.9-1.0

After 2 months, surgical treatment was performed - Autolymphosorption of the choroid of the right eye, in which 2 Alloplant biomaterials — Alloplant for autolymphosorption and Alloplant-phagocytosis stimulator — were used. Autolymphosorption was performed under local anesthesia in the lower-outer quadrant of the eyeball at the level of attachment of the rectus muscles produced an arcuate incision of the conjunctiva. The adjacent straight eye muscles and the conjunctiva of the eyeball were sutured, for which the eyeball was fixed. On the surface of the sclera, a large vessel entering the flap was selected and the branch branches were coagulated. 10 mm from the limb between the muscles produced two scleral notches in mutually ascending directions in the form of a triangle with a base width of 6 mm to a depth of 1/4 of the sclera thickness. A vascular-episcleral flap containing a large vessel entering the flap was cut out from these incisions with a keratotomy blade, and the branch branches were coagulated. The flap was folded to the side of the limbus and a through linear incision was made of the deep layers of the sclera to the suprachoroidal space at an angle of 65 ° relative to the sclera's surface. Then this flap, through the sclera incision, was tucked into the suprachoroidal space with a spatula, 7x8 mm in size Alloplant for autolymphosorption was implanted on top of the flap. The incision was sutured with 2 interrupted sutures. A rectangular fragment “Alloplant for autolymphosorption” of 7 × 8 mm in size was placed on the scleral wound and fixed at the corners with 4 interrupted scleral sutures. Suture-holders were removed. Dispersed biomaterial "Alloplant-stimulator of phagocytosis" was poured into the subtenon space in the amount of 0.5 g and slightly tamped. The conjunctiva was sutured with a continuous suture. The operation was completed by parabulbar injection of dexamethasone at a dose of 0.3 ml, gentamicin 20 mg.

The postoperative period was uneventful.

One month after surgery:

Visual acuity: right eye - 0.9 NK .; left eye - 1.0

The threshold of electrical sensitivity: right eye - 60 μa,

the left eye is 40 μA (the norm for a given age is 15-65 μA).

2 months after the autolymphosorption operation on the right eye, surgical treatment was performed - autolymphosorption of the choroid of the left eye, using the Alloplant for autolymphosorption and Alloplant-phagocytosis stimulator biomaterials. The operation was performed as described above.

The postoperative period without complications.

1 month after surgery:

Visual acuity: right eye - 1.0; left eye - 1.0

The threshold of electrical sensitivity: right eye - 45 μA,

the left eye is 30 μA (the norm for a given age is 15-65 μA).

Fundus: OD, OS - in the paramacular region, the chorioretinal lesion 1/8 DD with pigment deposition in the center, optic nerve disc pale pink with clear boundaries, medium-sized arteries, good filling, veins are not changed.

ELISA for cytomegalovirus positive 12%, herpes simplex virus 10%.

After 6 months at the control examination: no complaints.

Visual acuity: right eye - 1.0; left eye - 1.0.

IOP right eye - 17 mm Hg

IOP left eye - 17 mm Hg

The threshold of electrical sensitivity: right eye - 45 μA,

left eye - 30 μA.

Fields of vision (totaling 8 meridians): right eye - 515 °

 left eye - 520 °

The fundus: OD, OS - in the paramacular region - 1/8 DD chorioretinal lesion with pigment deposition in the center, optic nerve disc pale pink with clear boundaries, medium-sized arteries, good filling, veins are not changed.

The patient is observed annually for 7.5 years: 2005-2012.

Visual acuity and visual functions are stable, there were no visual impairments during the observation period (7 years).

There were no relapses.

ELISA for cytomegalovirus, herpes simplex virus - positive at low numbers - 10-12% (2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012)

Example 2

Patient N., 37 years old, came on October 30, 2006.

From the anamnesis: for 5 years, constant redness of the eyes, photophobia, to a greater or lesser extent, have been disturbing. Exacerbation 4-6 times a year. He went to the clinic, anti-inflammatory treatment was carried out 4-6 times a year. The effect of the treatment is negligible. Remission (incomplete) 2-3 months.

On examination:

redness of both eyes, moderate photophobia.

Visual acuity: right eye - 0.6 (-) 0.5 D = 0.9; left eye - 0.9 (-) 0.5 D = 1.0

IOP right eye - 14 mm Hg

IOP left eye - 15 mm Hg

The threshold of electrical sensitivity: right eye - 80 μA,

the left eye is 90 μA (the norm for a given age is 15-65 μA).

Fields of vision (totaling 8 meridians): right eye - 380 °,

 left eye - 390 °.

The fundus: OD - on the periphery in the lower-outer and upper-outer quadrants of greenish-gray color, two loose chorioretinal lesions 1-1 / 2 DD, with the inclusion of pigment, with perifocal edema, will be exchanged for intrathinal hemorrhages in the vitreous, with macular edema. DZN pale pink, easy fading. Arteries and veins are narrowed. OS - on the periphery in the lower-outer quadrant of greenish-gray color, one loose chorioretinal lesion 1/2 DD, with the inclusion of pigment, with perifocal edema, intraretinal hemorrhages around the lesion. DZN pale pink, easy fading. Arteries and veins are narrowed.

An ELISA blood test for cytomegalovirus positive - 83%, herpes simplex virus - 30%.

Based on the examination and examination, the patient was diagnosed with herpesvirus lesion of VOG. Herpes virus, chronic recurrent, peripheral chorioretinitis, neurochorioretinitis, subactive phase of both eyes, vitreous destruction, filamentous, granular myopia of both eyes.

Conservative treatment was carried out according to the scheme as described above: topically (within three weeks) - Ophthalmoferon eye drops 1-2 drops 6-8 times a day, Actipol 0.007% eye drops 1-2 drops 3-8 times a day, Zovirax 3 % eye ointment 3 times a day. After 7 days added: Prenacid eye drops 1-2 drops 3-4 times a day, Emoxipine 1% eye drops 1-2 drops.

Acyclovir 200 5 times a day or course of 10 days; Half-year (0.2 g in 1 ml dissolved with sterile water for injection) 0.5 ml (100 μg) parabulbarno, every other day, 5 injections, Imunofan 1.0 intramuscularly every other day, 10 injections (polyoxidonium); Lycopid 10 mg - 10 days; Multivitamins with microelements, Antioxidants - Vitamin E 100 Units. 2 times a day for three weeks.

After treatment, vision did not improve.

At the end of the conservative treatment, surgical treatment was performed - medical retroscleroplasty of both eyes with the biomaterials Alloplant-stimulator of phagocytosis and Alloplant-sclero-reinforcing filling, as described above: at the same time, the conjunctiva was cut 8 mm from the limbus in the lower-inner and upper-outer sectors and tenon capsules 2 mm long. A spatula created a move to the back pole. A needle-cannula was inserted into the hole formed, to the posterior pole of the eye, through which a suspension of 0.5 ml Alloplant dispersed biomaterials was introduced into the lower inner sector using a disposable syringe, while the suspension contained 12.5 mg Alloplant- phagocytosis stimulator ”and 12.5 mg“ Alloplant-sclero-reinforcing filling ”, and 1.5 ml of a suspension containing 37.5 mg“ Alloplant for phagocytosis stimulation ”and 37.5 mg“ Alloplant sclero-reinforcing filling ”were introduced into the upper-outer sector. The needle was removed from the wound, the conjunctival incision was sutured with one interrupted suture in the upper and lower sectors.

The postoperative period without complications.

1 month after surgery:

Visual acuity improved slightly:

right eye - 0.7 (-) 0.5 D = 0.9-1.0; left eye - 0.9 (-) 0.25 D = 1.0

After 3 months, surgical treatment was performed - autolymphosorption of the choroid of the right eye, as described above. The operation was performed under local anesthesia. In the lower inner quadrant of the eyeball at the level of attachment of the rectus muscles, an arched conjunctiva incision was made. The adjacent straight eye muscles and the conjunctiva of the eyeball were sutured, for which the eyeball was fixed. On the surface of the sclera, a large vessel entering the flap was selected and the branch branches were coagulated. 15 mm from the limb between the muscles, two scleral notches were made in mutually ascending directions (in the form of a triangle) with a base width of 8 mm to a depth of 1/3 of the sclera thickness. A vascular-episcleral flap containing a large vessel entering the flap was cut out along these notches with a keratotomy blade, and the branch branches were coagulated. The flap was thrown back towards the limb and a through linear incision was made of the deep layers of the sclera to the suprachoroidal space at an angle of 70 ° relative to the surface of the sclera. Then this flap was inserted through the sclera incision using a spatula into the suprachoroidal space, and the Alloplant for autolymphosorption 7 × 8 mm biomaterial was implanted over the filled flap. The incision was sutured with 2 interrupted sutures. A rectangular fragment of “Alloplant for autolymphosorption” 7 × 8 mm in size was placed on the sclera’s wound and fixed at the corners with 4 8: 0 nodal scleral sutures. Suture-holders were removed. Dispersed biomaterial "Alloplant-stimulator of phagocytosis" was poured into the subtenon space in the amount of 0.5 g and slightly tamped. The conjunctiva was sutured with a continuous suture. The operation was completed by parabulbar injection of dexamethasone at a dose of 0.3 ml, gentamicin 20 mg.

The postoperative period was uneventful.

1 month after surgery:

Visual acuity: right eye - 0.8 (-) 0.25 D = 1.0; left eye - 1.0.

The threshold of electrical sensitivity: right eye - 65 μa,

left eye - 70 μA (the norm for a given age is 15-65 μA)

After 4 months, surgical treatment was performed - autolymphosorption of the left eye choroid, as described above. During the treatment, the Alloplant for autolymphosorption biomaterial and the Alloplant-phagocytosis stimulator biomaterial were used.

The postoperative period was uneventful.

1 month after surgery:

Visual acuity: right eye - 1.0; left eye - 1.0.

The threshold of electrical sensitivity: right eye - 40 μA,

the left eye is 50 μA (the norm for a given age is 15-65 μA).

The fundus: OD - on the periphery in the lower-outer and upper-outer quadrant, the retinal folding is smoothed, two foci with the inclusion of pigment with clear boundaries 1/2 DD. There is no swelling of the macula, the macular reflex is expressed, there is mottling. The optic nerve disc is pale, the boundaries are clear. Arteries and veins are not changed. OS - on the periphery in the lower-outer quadrant there is a focus with the inclusion of pigment with clear 1/4 DD boundaries. There is no swelling of the macula, the macular reflex is expressed, there is mottling. The optic nerve disc is pale, the boundaries are clear. Arteries and veins are not changed.

ELISA for cytomegalovirus - positive 15%, herpes simplex virus - negative.

After 6 months at the control examination:

There are no complaints.

Visual acuity: right eye - 1.0; left eye - 1.0.

IOP right eye - 14 mm Hg

IOP left eye - 13 mm Hg

Fields of vision (totaling 8 meridians): right eye - 430 °,

 left eye - 430 °.

The threshold of electrical sensitivity: the right eye is 45 μA, the left eye is 55 μA.

The fundus: OD - on the periphery in the lower-outer and upper-outer stradder, the folding of the retina is smoothed out, two foci with the inclusion of pigment with clear 1/4 DD borders. There is no edema of the macula, the macular reflex is pronounced. The optic nerve disc is pale pink, the borders are clear. Arteries and veins are not changed. OS - on the periphery in the lower-outer quadrant there is a focus with the inclusion of pigment with clear 1/4 DD boundaries. There is no swelling of the macula, the macular reflex is expressed, there is mottling. The optic nerve disc is pale, the boundaries are clear. Arteries and veins are not changed.

The patient is observed annually: 2007, 2008, 2009, 2010, 2011, 2012. Visual acuity and other visual functions are stable, there were no visual impairments during the observation period (5.5 years). Visual acuity: right eye - 1.0; left eye - 1.0

There was no relapse.

ELISA for cytomegalovirus positive 10-15%, herpes simplex virus negative (2007, 2008, 2009, 2010)

Example 3

Patient K., 21 years old, came on 04.03.2003.

From the anamnesis: for 6 years, constant redness of the eyes, photophobia, to a greater or lesser extent, have been disturbing. Exacerbation 5-6 times a year. He went to the clinic, anti-inflammatory treatment was carried out 5-6 times a year. The effect of the treatment is negligible. Remission (incomplete) 1-2 months.

During the examination: redness of both eyes, photophobia.

Visual acuity: right eye - 0.08 (-) 1.5D + Cyl (-) 1.0Dax180 ° = 0.3; left eye - 0.05 (-) 1.5D + Cyl (-) 0.5Dax 150 ° = 0.5;

IOP right eye - 14 mm Hg

IOP left eye - 14 mm Hg

Fields of vision (totaling 8 meridians): right eye - 440 °,

 left eye - 460 °.

The threshold of electrical sensitivity: right eye - 100 μA,

the left eye is 90 μA (the norm for a given age is 10-50 μA).

Fundus: OD - on the periphery in the lower outer and lower inner quadrant of a grayish-white color, two loose chorioretinal lesions 1/2 DD, with the inclusion of pigment, with perifocal edema, will be exchanged for the vitreous body, intraretinal hemorrhages, with macular edema. DZN pale pink, easy fading. Arteries and veins are narrowed. OS - on the periphery in the lower-outer and upper-outer quadrants of greenish-gray color, two loose chorioretinal lesions 1-1 / 2 DD, with the inclusion of pigment, with perifocal edema, are exchanged for the vitreous body, intraretinal hemorrhages, with macular edema. DZN pale pink, easy fading. Arteries and veins are narrowed.

ELISA for cytomegalovirus positive - 75%, herpes simplex virus - 28%, Epstein-Barr virus 200 PIECES / ml (^ 40 positive).

The patient was diagnosed with herpesviral lesion of VOG. Herpes virus, chronic recurrent, peripheral chorioretinitis, subactive phase of both eyes, vitreous destruction, filamentous-granular, mild myopia of myopomyopathic astigmatism in both eyes.

Conservative treatment was carried out according to the scheme as described above: topically (within two weeks) - Ophthalmoferon eye drops 1-2 drops 6-8 times a day, Actipol 0.007% eye drops 1-2 drops 3-8 times a day, Oftanid eye drops 1-2 drops 5 times a day, Zovirax 3% ophthalmic ointment 3 times a day. After 7 days, Prenacid add eye drops 1-2 drops 3-4 times a day, Emoxipin 1% eye drops 1-2 drops. In addition, the patient is prescribed Panavir intravenously No. 3 with an interval of 72, then 36 hours; Half-year (0.2 g in 1 ml dissolved with sterile water for injection) 0.5 ml (100 μg) parabulbularly, daily, 10 injections, Imunofan 1.0 intramuscularly every other day, 10 injections (polyoxidonium); Lycopid 10 mg - 10 days; Multivitamins with minerals, antioxidant - "Optometrist" 1 t. 2 times a day for three weeks.

Vision has not improved.

At the end of the conservative treatment, surgical treatment was performed - medical retrosclerotherapy with biomaterials “Alloplant-stimulator of phagocytosis” and “Alloplant-sclero-reinforcing filling” of both eyes, while the conjunctiva and tenon capsule were cut 10 mm from the limbus in the lower-inner and upper-outer sectors 1.5 mm. A spatula created a move to the back pole. A cannula needle was inserted into the hole formed, to the posterior pole of the eye, through which a suspension of dispersed Alloplant for phagocytosis stimulation and Alloplant-sclero-reinforcing filling biomaterials was introduced into a quantity of 0.5 ml of a suspension containing 12.5 mg using a disposable syringe. “Alloplant to stimulate phagocytosis” and 12.5 mg of “Alloplant-sclero-strengthening filling”, in the lower inner sector and 1.5 ml of a suspension containing 37.5 mg of “Alloplant-stimulating phagocytosis” and 37.5 mg of “Alloplant-sclero-strengthening” seal "- in the upper-outer sec torus. The needle was removed from the wound, the conjunctival incision was sutured with one interrupted suture in the upper and lower sectors.

The postoperative period without complications.

1 month after surgery:

Visual acuity improved slightly:

right eye - 0.08 (-) 1.5D + Cyl (-) 1.0Dax180 ° = 0.3-0.4;

left eye - 0.07 (-) 1.5D + Cyl (-) 0.5Dax150 ° = 0.5-0.6;

After 6 months, surgical treatment was carried out - autolymphosorption of the choroid in biomaterials "Alloplant for autolymphosorption" and "Alloplant-phagocytosis stimulator" of the right eye as described above. The operation was performed under local anesthesia. In the lower-outer quadrant of the eyeball at the level of attachment of the rectus muscles, an arcuate incision of the conjunctiva was performed. The adjacent straight eye muscles and the conjunctiva of the eyeball were sutured, for which the eyeball was fixed. On the surface of the sclera, a large vessel entering the flap was selected and the branch branches were coagulated. 7 mm from the limb between the muscles, two scleral notches were made in mutually ascending directions (in the form of a rectangle) with a base width of 8 mm to a depth of 1/4 of the sclera thickness. A vascular-episcleral flap containing a large vessel entering the flap was cut out along these notches with a keratotomy blade, and the branch branches were coagulated. The flap was folded back towards the limb and a through linear incision was made of the deep layers of the sclera to the suprachoroidal space at an angle of 70 ° relative to the scleral surface. Then, this flap was inserted through the sclera incision using a spatula into the suprachoroidal space, and the Alloplant for autolymphosorption 7 × 8 mm biomaterial was implanted over the filled flap. The incision was sutured with 2 interrupted sutures. A rectangular fragment of “Alloplant for autolymphosorption” 7 × 8 mm in size was placed on the sclera’s wound and fixed at the corners with 4 8: 0 nodal scleral sutures. Suture-holders were removed. Dispersed (powder) Alloplant-phagocytosis stimulant biomaterial was poured into the subtenon space in an amount of 0.5 g and slightly tamped. The conjunctiva was sutured with a continuous suture. The operation was completed by parabulbar injection of dexamethasone at a dose of 0.3 ml, gentamicin 20 mg.

The postoperative period without complications.

1 month after surgery:

Visual acuity: right eye - 0.1 (-) 1.5D + Cyl (-) 0.5Dax 180 ° = 0.4;

left eye - 0.1 (-) 1.5D + Cyl (-) 0.5Dax180 ° = 0.6

The threshold of electrical sensitivity: right eye - 75 μa,

left eye - 60 μA (the norm for a given age is 10-50 μA)

After 2 months, surgical treatment of the left eye was performed, as described above, - autolymphosorption of the choroid with biomaterials “Alloplant for autolymphosorption” and “Alloplant-stimulator of phagocytosis”.

The postoperative period without complications.

1 month after surgery:

Visual acuity: right eye - 0.1 (-) 1.0D + Cyl (-) 0.5Dax180 ° = 0.5;

left eye - 0.1-0.2 (-) 1.0D + Cyl (-) 0.5Dax180 ° = 0.7.

The threshold of electrical sensitivity: right eye - 50 μA,

the left eye is 40 μA (the norm for a given age is 10-50 μA).

The fundus: OD - at the periphery in the lower-outer and lower-inner quadrants, the folding of the retina is smoothed, two foci with the inclusion of pigment with clear 1/4 DD borders. There is no swelling of the macula, the macular reflex is expressed, there is mottling. The optic nerve disc is pale, the boundaries are clear. Arteries and veins are not changed. OS - on the periphery in the lower-outer and upper-outer quadrant two foci with clear boundaries 1/2 DD. There is no edema of the macula, the macular reflex is pronounced. The optic nerve disc is pale, the boundaries are clear. Arteries and veins are not changed.

ELISA blood test for cytomegalovirus negative, herpes simplex virus negative, Epstein-Barr virus 60 PIECES / ml.

After 6 months at the control examination:

There are no complaints.

On the periphery in the lower-outer and lower-inner quadrants, the folding of the retina is smoothed out, two foci with the inclusion of pigment with clear 1/6 DD boundaries. There is no edema of the macula, the macular reflex is pronounced. The optic nerve disc is pale pink, the borders are clear. Arteries and veins are not changed. OS - on the periphery in the lower-outer and upper-outer quadrant two lesions with clear 1/4 DD boundaries. There is no edema of the macula, the macular reflex is pronounced. The optic nerve disc is pale, the boundaries are clear. Arteries and veins are not changed.

Visual acuity: right eye - 0.1 (-) 1.0D + Cyl (-) 0.5Dax180 ° = 0.5;

left eye - 0.1-0.2 (-) 1.0D + Cyl (-) 0.5Dax180 ° = 0.7.

IOP right eye - 14 mm Hg

IOP left eye - 13 mm Hg

Fields of vision (totaling 8 meridians): right eye - 500 °

 left eye - 490 °.

The threshold of electrical sensitivity: right eye - 45 μA,

 left eye - 40 μA.

The patient is observed annually: 2003-2012.

There was no relapse.

Control examination in February 2012 - the result obtained after treatment by the proposed method, saved:

visual acuity is stable: right eye - 0.1 (-) 1.0D + Cyl (-) 0.5Dax180 ° = 0.5; left eye - 0.1-0.2 (-) 1.0D + Cyl (-) 0.5Dax180 ° = 0.7.

Other visual functions are also stable; there were no visual impairments during the observation period (9 years). There was no relapse.

ELISA blood test for cytomegalovirus negative, herpes simplex virus negative, Epstein-Barr virus negative (2008, 2009, 2010, 2011, 2012)

Example 4

Patient A., 31 years old, came 2.01.2009

From the anamnesis: About two weeks notes a deterioration in vision in the right eye, letters blur in the morning, a dark spot in front of the right eye, sometimes “rhombuses”, in the evenings there were disturbances in dark adaptation. Since childhood, wears glasses (-) 1.0 D, vision gradually worsened, to (-) 3.0-4.0 D. Earlier in 2008, herpes was detected in the blood.

Objectively: In a patient with conjunctival hyperemia, mixed injection, corneal endothelial sweating, the pupil of the right eye is slightly larger than the left.

Visual acuity: right eye - 0.04 (-) 4.5 D = 0.8,

left eye - 0.04 (-) 3.5 D + Cyl (-) 0.5 D ax 185 ° = 1.0

IOP right eye - 7 mm Hg. 1

left eye - 9 mm Hg

Fields of vision (totaling 8 meridians): right eye - 450 ° (in the center of the scotoma); left eye - 470 °.

The threshold of electrical sensitivity: the right eye is 80 μA, the left eye is 50 μA (the norm for this age is 15-65 μA).

Fundus: OD - the macula is hyperemic, in the paramacular region a grayish lesion, 1 DD, mediates into the vitreous body, single microbleeds, optic nerve discs are pale pink, the borders are slightly smeared, edema, arteries and veins are slightly dilated on the periphery of the retina. OS - in the macular region, mottling, DZN is pale pink, the borders are slightly smeared, edema, arteries and veins on the periphery of the retina are slightly dilated.

USG of the eyes: PZO OD - 2.39 cm, OS - 2.39 cm.

The vitreous is transparent. The retina is without features.

ELISA for cytomegalovirus - 220.5 U / ml (≥6 positive), herpes simplex virus - 30 ind.pos. (≥1 positive).

Based on the examination and examination, herpesvirus infection of VOG was diagnosed. Central serous retinitis (retinopathy) of herpes virus etiology, active phase, moderate myopia of the right eye. Myopo-myopic astigmatism of the left eye.

A general examination was carried out: a general blood test, a general urinalysis, blood for sugar, Wasserman reaction, blood for rheumatoid tests (CRP, sialic, seromucoid), a blood test for tuberculosis, toxoplasmosis, an immunogram, an electrocardiogram, chest fluorography, and ultrasound scan of the abdominal cavity were made. The patient was consulted by a therapist, neurologist, infectious disease specialist, immunologist.

OCT diagnostics: OD of the eye: separation of the sensory retina from the pigment epithelium. The diagnosis is confirmed.

The patient is treated according to the proposed method:

At the first stage, conservative treatment was carried out for 3 weeks: topically (within three weeks) - Ophthalmoferon eye drops 1-2 drops 6-8 times a day, Actipol 0.007% eye drops 1-2 drops 3-8 times a day , Oftanid eye drops 1-2 drops 5 times a day, Zovirax 3% eye ointment 3 times a day. 7 days after the start of treatment - Prenacid eye drops 1-2 drops 3-4 times a day, Emoxipine 1% eye drops 1-2 drops. Valtrex 1 g 3 times a day for 7 days; Taktivin 1.0 subcutaneously every other day, a course of treatment of 10 injections; Lycopid 10 mg - 10 days; multivitamins with minerals, antioxidant - "Optometrist" 1 t. 2 times a day for three weeks.

After treatment, vision did not improve.

At the end of conservative treatment, surgical treatment was performed - medical retrosclerotherapy with biomaterials “Alloplant-stimulator of phagocytosis” and “Alloplant-sclero-reinforcing filling” of both eyes, while a conjunctiva and tenon capsule were cut 10 mm from the limbus in the lower-inner and upper-outer sectors 1.5 mm. A spatula created a move to the back pole. A cannula needle was inserted into the hole formed, to the posterior pole of the eye, through which a suspension of dispersed Alloplant for phagocytosis stimulation and Alloplant-sclero-reinforcing filling biomaterials was introduced into a quantity of 0.5 ml of a suspension containing 12.5 mg using a disposable syringe. “Alloplant for stimulating phagocytosis” and 12.5 mg of “Alloplant-sclero-strengthening filling” in the lower inner sector and 1.5 ml of a suspension containing 37.5 mg of “Alloplant for stimulating phagocytosis” and 37.5 mg of “Alloplant-sclero-strengthening” seal "in the upper outer sect R. The needle was removed from the wound, the conjunctival incision was sutured with one interrupted suture in the upper and lower sectors.

The postoperative period was uneventful.

1 month after surgery:

Visual acuity: right eye - 0.08 (-) 4.5D = 0.9

 left eye - 0.04 (-) 3.5D = 1.0

IOP right eye - 11 mm Hg

 left eye - 12 mm Hg

Fields of vision (totaling 8 meridians): right eye - 470 ° (scotoma decreased), left eye - 480 °.

The threshold of electrical sensitivity: the right eye is 70 μA, the left eye is 40 μA (the norm for this age is 15-65 μA).

Eye fundus: OD - in the macular region, mottling, in the paramacular region, the grayish lesion decreased in size, there were no microbleeds, optic nerve disc disease, the borders were clear, the edema was slight along the periphery of the retina, the arteries and veins were slightly dilated. OS - a healthy reflex in the macular region, optic nerve disc disease is pale pink, the borders are clear, the edema is slight along the periphery of the retina, the arteries and veins are slightly dilated. After 2 months, surgical treatment was performed - autolymphosorption of the choroid of the right eye, in which 2 Alloplant biomaterials, Alloplant for autolymphosorption and Alloplant-phagocytosis stimulator, were used. Autolymphosorption was performed under local anesthesia in the lower-outer quadrant of the eyeball at the level of attachment of the rectus muscles produced an arcuate incision of the conjunctiva. The adjacent straight eye muscles and the conjunctiva of the eyeball were sutured, for which the eyeball was fixed. On the surface of the sclera, a large vessel entering the flap was selected and the branch branches were coagulated. 10 mm from the limb between the muscles produced two scleral notches in mutually ascending directions in the form of a triangle with a base width of 6 mm to a depth of 1/4 of the sclera thickness. A vascular-episcleral flap containing a large vessel entering the flap was cut out from these incisions with a keratotomy blade, and the branch branches were coagulated. The flap was folded to the side of the limbus and a through linear incision was made of the deep layers of the sclera to the suprachoroidal space at an angle of 65 ° relative to the sclera's surface. Then this flap, through the sclera incision, was tucked into the suprachoroidal space with a spatula, 7x8 mm in size Alloplant for autolymphosorption was implanted on top of the flap. The incision was sutured with 2 interrupted sutures. A rectangular fragment of "Alloplant for autolymphosorption" of 7x8 mm in size was placed on the sclera wound and fixed at the corners with 4 nodular scleral sutures. Suture-holders were removed. Dispersed biomaterial "Alloplant-stimulator of phagocytosis" was poured into the subtenon space in the amount of 0.5 g and slightly tamped. The conjunctiva was sutured with a continuous suture. The operation was completed by parabulbar injection of dexamethasone at a dose of 0.3 ml, gentamicin 20 mg.

The postoperative period was uneventful.

One month after surgery:

Visual acuity: right eye - 0.09 (-) 4.5D = 1.0

 left eye - 0.1 (-) 3.5D = 1.0

IOP right eye - 12 mm Hg

left eye - 12 mm Hg

Fields of vision (totaling 8 meridians): right eye - 480 ° (no scotoma); left eye - 480 °.

The threshold of electrical sensitivity: the right eye is 60 μA, the left eye is 35 μA (the norm for this age is 15-65 μA)

Fundus: OD - in the macular region without visible changes, in the paramacular region, the grayish lesion decreased in size, there were no microbleeds, optic nerve disc disease, the borders were clear, the edema on the periphery of the retina was slight, the arteries and veins were not changed. OS - in the macular region, a healthy reflex, optic nerve disc disease, pale pink borders are clear, swelling on the periphery of the retina is insignificant, arteries and veins are not changed.

The patient is observed for 3 years.

Visual acuity and visual function are stable. There were no visual impairments during the observation. There were no relapses.

ELISA blood test for cytomegalovirus, herpes simplex virus negative (January 2012).

Example 5

Patient E., 19 years old, came on November 26, 2008.

From the anamnesis: in the summer of 2008, blurred vision, sparks and asterisks in the eyes, eye pain, redness of the eyes, went to the clinic, was diagnosed with myopia, glasses were prescribed, drops were prescribed, no improvement came, redness of the eyes increased, there was an unstable headache.

Objectively: The patient has conjunctival hyperemia, tortuosity, bulbar vasodilation, mixed injection, corneal endothelial mucus, iris rubeosis.

Visual acuity: right eye - 0.5 (-) 1.0 D = 1.0; left eye - 1.0

IOP, right eye - 13 mmHg

 left eye - 14 mm Hg

Fields of vision (totaling 8 meridians): right eye - 475 °

 left eye - 470 °.

The threshold of electrical sensitivity: the right eye is 80 μA, the left eye is 50 μA (the norm for this age is 10-50 μA)

The fundus of the eye: OU of the optic nerve disc with clear boundaries, in the center extended physiological excavation, the vessels are narrowed, in the macular region hyperemia, more on the right, additional tricks on the periphery, yellowish, redistribution of pigment, swelling more on the right.

In the vitreous body, floating opacities in the form of threads and flakes.

USL of the eyes: PZO OD - 2.31 cm, OS - 2.31 cm.

Vitreous humor - floating echo inclusions. The retina is without features.

ELISA blood test for herpes simplex virus - 25 ind.pos. (≥1 positive).

Based on the examination and examination, herpesvirus infection of VOG was diagnosed. Peripheral uveitis of herpes virus etiology, subactive course, destruction of the vitreous body, filamentous-granular medium, medium intensity of inflammation of both eyes, mild myopia, spasm of accommodation of the right eye.

A general examination was carried out: a general blood test, a general urinalysis, blood for sugar, Wasserman reaction, blood for rheumatoid tests (CRP, sialic, seromucoid), a blood test for tuberculosis, toxoplasmosis, an immunogram, an electrocardiogram, chest fluorography, and ultrasound scan of the abdominal cavity were made. The patient was consulted by a therapist, neurologist, infectious disease specialist, immunologist.

The diagnosis is confirmed.

The patient is treated according to the proposed method:

At the first stage, conservative treatment was carried out for 3 weeks: topically (within three weeks) - Ophthalmoferon eye drops 1-2 drops 6-8 times a day, Actipol 0.007% eye drops 1-2 drops 3-8 times a day , Oftanid eye drops 1-2 drops 5 times a day, Zovirax 3% eye ointment 3 times a day. 7 days after the start of treatment - Prenacid eye drops 1-2 drops 3-4 times a day, Emoxipine 1% eye drops 1-2 drops. Acyclovir 200 5 times a day or course of 10 days; Taktivin 1.0 subcutaneously every other day, a course of treatment of 10 injections; Lycopid 10 mg - 10 days; multivitamins with minerals, antioxidant - "Optometrist" 1 t. 2 times a day for three weeks.

After treatment, vision did not improve.

At the end of the conservative treatment, surgical treatment was performed - medical retrosclerotherapy with biomaterials “Alloplant-stimulator of phagocytosis” and “Alloplant-sclero-reinforcing filling” of both eyes, while the conjunctiva and tenon capsule were cut 10 mm from the limbus in the lower-inner and upper-outer sectors 1.5 mm. A spatula created a move to the back pole. A cannula needle was inserted into the hole formed, to the posterior pole of the eye, through which a suspension of dispersed Alloplant for phagocytosis stimulation and Alloplant-sclero-reinforcing filling biomaterials was introduced into a quantity of 0.5 ml of a suspension containing 12.5 mg using a disposable syringe. “Alloplant for stimulating phagocytosis” and 12.5 mg of “Alloplant-sclero-strengthening filling” in the lower inner sector and 1.5 ml of a suspension containing 37.5 mg of “Alloplant for stimulating phagocytosis” and 37.5 mg of “Alloplant-sclero-strengthening” seal "in the upper outer sector . The needle was removed from the wound, the conjunctival incision was sutured with one interrupted suture in the upper and lower sectors.

The postoperative period was uneventful.

1 month after surgery:

Visual acuity: right eye - 0.6 (-) 0.75D = 1.0; left eye -1.0

IOP right eye - 14 mm Hg

left eye - 14 mm Hg

Fields of vision (totaling 8 meridians): right eye - 480 °

 left eye - 470 °.

The threshold of electrical sensitivity: the right eye is 70 μA, the left eye is 50 μA (the norm for this age is 10-50 μA)

The fundus of the eye: OU of the optic nerve disc with clear boundaries, in the center extended physiological excavation, the vessels are narrowed, mottling in the macular region, additional tricks on the periphery are minor, pigment redistribution, no edema.

In the vitreous body, floating opacities in the form of threads and flakes.

After 2 months, surgical treatment was performed - autolymphosorption of the choroid of the right eye, in which 2 Alloplant biomaterials, Alloplant for autolymphosorption and Alloplant-phagocytosis stimulator, were used. Autolymphosorption was performed under local anesthesia in the lower-outer quadrant of the eyeball at the level of attachment of the rectus muscles produced an arcuate incision of the conjunctiva. The adjacent straight eye muscles and the conjunctiva of the eyeball were sutured, for which the eyeball was fixed. On the surface of the sclera, a large vessel entering the flap was selected and the branch branches were coagulated. 10 mm from the limb between the muscles produced two scleral notches in mutually ascending directions in the form of a triangle with a base width of 6 mm to a depth of 1/4 of the sclera thickness. A vascular-episcleral flap containing a large vessel entering the flap was cut out from these incisions with a keratotomy blade, and the branch branches were coagulated. The flap was folded to the side of the limbus and a through linear incision was made of the deep layers of the sclera to the suprachoroidal space at an angle of 65 ° relative to the sclera's surface. Then this flap, through the sclera incision, was tucked into the suprachoroidal space with a spatula, and the Alloplant for autolymphosorption 7 × 8 mm biomaterial was implanted over the filled flap. The incision was sutured with 2 interrupted sutures. A rectangular fragment “Alloplant for autolymphosorption” of 7 × 8 mm in size was placed on the scleral wound and fixed at the corners with 4 interrupted scleral sutures. Suture-holders were removed. Dispersed biomaterial "Alloplant-stimulator of phagocytosis" was poured into the subtenon space in the amount of 0.5 g and slightly tamped. The conjunctiva was sutured with a continuous suture. The operation was completed by parabulbar injection of dexamethasone at a dose of 0.3 ml, gentamicin 20 mg.

The postoperative period was uneventful.

One month after surgery:

Visual acuity: right eye - 0.7 (-) 0.5D = 1.0; left eye - 1.0

IOP right eye - 14 mm Hg

 left eye - 14 mm Hg

Fields of vision (totaling 8 meridians): right eye - 480 °

 left eye - 470 °

The threshold of electrical sensitivity: the right eye is 60 μA, the left eye is 45 μA (the norm for a given age is 10-50 μA).

The fundus of the eye: OU of the optic nerve disc with clear boundaries, in the center extended physiological excavation, the vessels are narrowed, mottling in the macular region, additional foci on the periphery are insignificant, pigment redistribution, edema persists. In the vitreous body, floating opacities in the form of threads and flakes, more to the left.

After 4 months, surgical treatment was performed - autolymphosorption of the left eye choroid, as described above. During the treatment, the Alloplant for autolymphosorption biomaterial and the Alloplant-phagocytosis stimulator biomaterial were used.

The postoperative period was uneventful

Visual acuity: right eye - 0.9 (-) 0.25 D = 1.0; left eye -1.0

IOP right eye - 14 mm Hg

 left eye - 13 mmHg

Fields of vision (totaling 8 meridians): right eye - 480 °

left eye - 480 °.

The threshold of electrical sensitivity: the right eye is 50 μA, the left eye is 40 μA (the norm for this age is 10-50 μA)

The fundus of the eye: OU of the optic nerve disc with clear boundaries, in the center extended physiological excavation, the vessels are narrowed, a healthy reflex in the macular area, peripheral extra tricks are single with clear boundaries, pigment redistribution, no retinal edema.

In the vitreous body, floating opacities in the form of single filaments.

The patient is observed for 3.5 years. There are no complaints.

Visual acuity and visual function are stable. There were no visual impairments during the observation.

There were no relapses.

An ELISA blood test for herpes simplex virus was carried out 2 times, the result is 4 times lower than before (from April 2012).

The proposed method of treatment was used in 596 patients with herpesvirus infection of VOG. VOG lesions had different localization and depth (peripheral chorioretinitis, central chorioretinitis, peripheral uveitis, central uveitis, central retinitis, peripheral rhinitis, pars-planite, iridocyclitis).

After treatment, all patients received a positive effect:

1. Visual acuity increased (without correction, with correction): in fresh processes, visual acuity was restored to physiological norm (up to 100%) in 82% of patients. In patients with old degenerative changes in the retina, visual acuity increased by 10-20% of the original. This treatment effect persists during the follow-up period (3–9 years).

2. After treatment, all patients disappeared clinical complaints. During the observation period (3–9 years), 1 patient repeatedly submitted complaints (after an injury).

3. Visual functions have improved: color perception, binocular and spatial vision, peripheral vision, dark and light adaptation, visual load tolerance.

4. Improved neurophysiological parameters of the eye (threshold of electrical sensitivity).

5. The duration of remission has increased. Patients did not have relapses during the entire observation period after treatment (3–9 years), if they were present 2 to 6 times a year before the treatment we proposed.

6. The titer of specific immunoglobulin G for the herpes simplex virus, cytomegalovirus, Epstein-Barr virus decreased to low or negative indicators and this effect persists for the duration of observation (3-9 years).

The proposed method allows to achieve good clinical results without complications associated with drug treatment. This is due to the fact that drug treatment is carried out once, the course is short (2-3 weeks) and after the end of treatment, supportive drug therapy with virostatic and other drugs is not required. Therefore, this method of treatment can reduce the drug burden on the body and avoid complications associated with taking the drugs.

Thus, our proposed method is a pathogenetically oriented treatment, has high efficiency and allows for long-term remission. The absence of relapse allows you to abandon maintenance therapy with virostatic drugs. High efficiency is associated with the fact that in the process of treatment, the main mechanisms of the pathogenesis of the disease are affected. As a result of treatment, there is an effect on the infectious-allergic inflammatory process, activation of local immunity, improvement of lymph and blood circulation of the inner membranes of the eye, vessels of the Zinn-Haller circle around the optic nerve, restoration of metabolic processes in the choroid and retina.

Claims (4)

1. A method of treating herpesvirus damage to the inner membranes of the eye, including drug treatment by taking antiviral, immunomodulating, hormonal, antioxidant drugs, after which therapeutic retrosclerotherapy of the eyes with Alloplant-phagocytosis stimulator biomaterial or Alloplant-phagocytosis-stimulator biomaterials sclerotherapy seal ", and then autolymphosorption of the choroid of the eye is carried out with biomaterials" Alloplant for autolymphosorption "and" Alloplant-stim phagocytosis enhancer ”, in this case autolymphosorption of the choroid of one eye is carried out 2-6 months after therapeutic retrosclerotherapy, and of the second eye 2-6 months after autolymphosorption of the choroid in the first eye. 2. The method according to claim 1, characterized in that the two biomaterials "Alloplant-stimulator of phagocytosis" and "Alloplant-sclero-reinforcing seal" during therapeutic retrosclerotherapy are used in patients with myopia. 3. The method according to claim 1, characterized in that the therapeutic retrosclerotherapy is carried out as follows: 6-10 mm from the limb, the conjunctiva and tenon capsule are cut 1.5-2 mm long, the trowel creates a stroke to the posterior pole, into the hole formed, to the posterior pole of the eye, a cannula needle is inserted through which a suspension of dispersed biomaterial Alloplant-phagocytosis stimulator or dispersed biomaterials Alloplant-phagocytosis stimulator and Alloplant-sclero-reinforcing seal is injected, while introducing into the lower inner sector 0.5 ml of the suspension, which contains 25 mg of the Alloplant-phagocytosis stimulator biomaterial or 12.5 mg of the Alloplant-phagocytosis stimulant and Alloplant-sclero-reinforcing seal biomaterials, and 1.5 ml of the suspension is injected into the upper-outer sector , which contains 75 mg of the Alloplant-phagocytosis stimulator biomaterial or 37.5 mg of the Alloplant-phagocytosis stimulator biomaterial and Alloplant-sclero-reinforcing seal, after which the needle is removed from the wound, the conjunctival incision is sutured. 4. The method according to claim 1, characterized in that the autolymphosorption of the choroid is carried out as follows: in the lower-outer quadrant of the eyeball at the level of attachment of the rectus muscles, a conjunctiva is cut, a large vessel entering the flap is selected on the sclera surface, the branch branches coagulate, in 6-15 mm from the limb between the muscles produce two scleral notches in mutually opposite directions, in the form of a triangle with a base of 7-8 mm to a depth of 1/4 or 1/3 of the sclera thickness, a vascular-episcleral flap containing large the udder included in the flap, the branch branches coagulate, the flap is folded towards the limbus and a through linear incision is made of the deep layers of the sclera to the suprachoroidal space at an angle of 65-70 ° relative to the sclera surface, then this flap is inserted through the sclera into the suprachoroidal the space, on top of the tucked flap, the Alloplant for autolymphosorption biomaterial of 7 × 8 mm size is implanted, the incision is sutured, the Alloplant for autolymphosorption 7 × 8 mm size is placed on the wound of the sclera and its fix angularly, then the dispersed biomaterial "Alloplant-phagocytosis stimulator" is poured into the subtenon space in the amount of 0.5 g, the conjunctiva is sutured.