RU2676248C1 - Method of diode-laser transpupillary thermotherapy of intra-ocular tumors under the conditions of increased intra-ocular pressure - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for the treatment of intraocular neoplasms (IN). Intraocular neoplasm (IN) is affected by laser radiation with a wavelength of 810 nm. Before and during treatment, the eyeball is compressed until achieving the moment of ophthalmoscopically controlled cessation of the pulsation of the central retinal artery. Diode-laser transpupillary thermotherapy is carried out in a continuous scanning mode with the laser beam moving along the IN surface until the effect appears in the form of the formation of a coagulant of the first degree according to the classification L'Esperance on the IN surface under the conditions of increased intraocular pressure. Radiation power 300–600 mW, spot diameter 1,000–3,000 microns.EFFECT: method reduces the risk of operative and postoperative complications by using low power laser radiation.1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used to treat intraocular neoplasms (BH).

There are many ways to treat VL: laser coagulation, diode-laser transpupillary thermotherapy (TTT), photodynamic therapy (PDT), brachytherapy (BT), cryodestruction, proton beam irradiation, stereotactic irradiation at gamma knife and cyber knife, surgical resection and enucleation of the eye.

The closest analogue is the method of laser treatment of VL, in which the VN is exposed to a laser beam with a wavelength of 810 nm at an exposure of 60 seconds, an average power of 729 mW, with a local temperature increase to 45-60 ° C, which leads to protein denaturation and, as consequence, to the destruction of tumor cells. (Shields CL, Shields JA, Cater J, et al. Transpupillary thermotherapy for choroidal melanoma: tumor control and visual results in 100 consecutive cases. Ophthalmology 1998; 105: 581-90)

The disadvantage of the described method is that when laser exposure to VL is not taken into account the effect of heat removal by blood flow in the vessels of VN and, as a result, there is a need to increase the power of laser radiation, which, in turn, increases the risk of damage to functionally significant structures of the eye. In addition, the high power of laser radiation contributes to excessive heating of the retina, causing damage to the eye, which reduces the depth of propagation of laser energy.

The objective of the invention is to develop a method of diode laser TTT VN while reducing tumor blood flow.

The technical result of the invention is to reduce the risk of surgical and postoperative complications, such as the formation of gross cicatricial changes in the retina in the treatment area, retinal traction in the macular zone.

) поверхности ВН, при этом мощность лазерного излучения составляет 40-80% от показателей мощности при проведении стандартной процедуры без компрессии и составляет в среднем 300-600 мВт.The technical result is achieved by the fact that in the method of transpupillary thermotherapy of intraocular tumors, under conditions of increased intraocular pressure, the eyeball is compressed until the ophthalmoscopically controlled cessation of pulsation of the central retinal artery (NAS), in which the intraocular pressure (IOP) is equalized with systolic pressure in VAT. When pulsation ceases, a TTT 810 nm diode-laser is carried out in a “scanning” continuous mode with the laser beam moving along the neoplasm surface until the effect manifests itself as the formation of a grade I coagulant (according to classification

) of the HV surface, while the laser radiation power is 40-80% of the power indicators during the standard procedure without compression and averages 300-600 mW.

).The method is as follows: With the help of mydriatics achieve maximum expansion of the pupil. After local anesthesia with a 0.5% alkaine solution, compression is performed on the patient's eye until the ophthalmoscopically controlled cessation of pulsation of the CAC is terminated. Next, laser irradiation is performed in the form of a TTT, radiation of a diode laser with a wavelength of 810 nm, a radiation power of 300-600 mW, a spot diameter of 1000-3000 μm, in "scanning", continuous mode with the laser beam moving along the surface of the HV until the effect in the form of formation coagulant I degree (classification

)

The effectiveness of TTT with compression was studied in the treatment of 120 patients (124 eyes), of which 25 were children aged 1 to 14 years. Among patients of the study group, the diagnosis of limited choroid hemangioma was noted in 76 patients, the diagnosis of retinoblastoma in 21 children, choroid melanoma in 17 patients and retinal capillary angioma, which is a manifestation of Hippel-Lindau syndrome, in 6 patients. For an accurate diagnosis, the patients underwent studies: visometry, biomicroscopy, ophthalmoscopy using non-contact and contact lenses, ultrasound B-scanning. The invention is illustrated by the following examples:

Example 1

на поверхности ВН.In patient B., aged 4.5 months, an examination by an ophthalmologist at the place of residence suspected a retinoblastoma of the left eye. The child was sent to the FSAI MNTK "MG" in Moscow. When conducting a B-scan, the presence of a lesion with a maximum prominence of 2.3 mm and a length of 5 mm located downward from the optic nerve disk (optic nerve disc) was detected. Visometry is difficult because of the age of the child. According to biomicroscopy, the cornea is transparent, the anterior chamber is of medium depth, the iris is structural, the pupil is round in shape with a diameter of 3 mm, the crystalline lens is transparent. Ophthalmoscopically, in conditions of medical sleep, there is a focus of the newly formed tissue of light gray color, located downward from the optic nerve disc, with sizes 2-2.5 of the diameter of the optic disc. The revealed clinical picture corresponds to the diagnosis of retinoblastoma. Without interrupting drug sleep, a TTT diode-laser was performed using a forehead ophthalmoscope, with compression until the pulsation of the CAC was stopped, in the "scanning" continuous mode, with a power of 600 mW, a spot diameter of 1000 μm until the formation of coagulant I degree according to classification

on the surface of VN.

After 1 month at the control examination, there was a lack of prominence during the B-scan. When examining the fundus in the conditions of medical sleep, the presence of a chorioretinal zone, surrounded by a corolla of hyperpigmentation, was revealed at the site of VL, which indicates the achievement of complete regression. Dynamic observation is recommended for the patient.

Example 2

на поверхности ВН.Patient S. 45 years, 3 months ago, when accidentally closing the left eye, found a change in the shape and color of objects when viewed with the right eye. When contacting an ophthalmologist at the place of residence, a neoplasm of the choroid of the right eye was diagnosed. The patient was referred to the FSAI MNTK "MG" in Moscow to verify the diagnosis and determine treatment tactics. During the examination, according to the B-scan, a volumetric neoplasm of the right eye, which is promising into the vitreous body, was detected, 2.8 mm high, 10.4 mm long, secondary retinal detachment 0.6 mm above the apex of the formation. Visometry - 0.2 with a correction of +1.0 D = 0.3. When conducting an ophthalmoscopy on the fundus of the right eye, near the upper inner edge of the optic nerve disc, juxtapapillary, involving the macular zone, a rounded scarlet formation of 4-5 diameter diameter optic nerve disc is visualized. Above the formation, secondary retinal detachment is determined. The patient was diagnosed with a hemangioma of the choroid of the right eye, it was recommended to conduct a diode laser TTT with simultaneous compression of the eyeball. With the help of mydriatics, maximum pupil expansion was achieved. After local anesthesia with 0.5% alkaine solution, a Reichel-Mainster 1x contact lens (0.95x) was installed on the patient's eye. Using coaxial illumination, the eye was compressed with a contact lens until the pulsation of the CAC ceased. Next, the tumor tissue was exposed to laser radiation with a long wavelength of 810 nm, a spot diameter of 3000 μm, with an exposure of 1 min, a power of 300 mW until the formation of coagulant 1 degree according to classification

on the surface of VN.

After 3 months at the control examination, an improvement in vision according to visometry to 0.7 with a correction of 0.5 D = 0.9 was noted. A decrease in the prominence according to the B-scan to 1.5 mm and reposition of the exfoliated retina were noted. Ophthalmoscopically recorded tumor regression with the formation of a zone of chorioretinal atrophy, elimination of retinal detachment, preservation of the macular region and the preservation of an insignificant amount of residual tumor tissue nearby.

Claims (1)

A method of transpupillary thermotherapy of intraocular tumors, including exposure to intraocular neoplasm (VN) with laser radiation with a wavelength of 810 nm, characterized in that before the treatment and during it, the eyeball is compressed until the ophthalmoscopically controlled pulsation of the central retinal artery is stopped, then a diode is performed laser transpupillary thermotherapy in continuous scanning mode with the laser beam moving along the HF surface until the effect in the form of coagulant I degree according to the classification of L'Esperance on the surface of VN under conditions of increased intraocular pressure with a radiation power of 300-600 mW, spot diameter 1000-3000 microns.