RU2796183C1 - Method of intravitreal administration of drugs in the presence of senile scleral plaque - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: invention can be used for intravitreal administration of drugs in the presence of senile scleral plaque. To do this, the patient is prepared. The operating field is treated. Local anesthesia is performed. An eyelid expander is put on. The patient's gaze is directed. The eyeball is fixed behind the episclera. The sclera is examined for the presence of senile scleral plaque. The scleropuncture site is marked with a sclerometer. After that, scleropuncture is performed at a distance of at least 4 mm from the edge of the senile scleral plaque and the drug is injected.

EFFECT: invention reduces the risk of adverse outcomes of intravitreal administration of drugs by determining the safe localization of scleropuncture in this category of patients.

1 cl, 2 ex

Description

The invention relates to medicine, in particular to ophthalmology, and relates to the intravitreal administration of drugs.

The problem of the development of complications associated with the intravitreal administration of drugs determines the relevance of developing new safe methods for delivering drugs to the vitreous body. Known complications of intravitreal injections include endophthalmitis, uveitis, retinal rupture and detachment, retinal and vitreous hemorrhages, lens opacity, and vitreous prolapse.

To reduce the risk of vitreous prolapse and retinal detachment, a number of methods have been developed for intravitreal administration of drugs aimed at improving the safety of the procedure.

Thus, the instructions for the medical use of the drug "Lucentis" includes a description of the method of introducing the drug into the vitreous body (Instructions for the medical use of the drug "Lucentis". Registration number: LSR-004567/08). The known method is carried out as follows. Before intravitreal injection, anesthesia is provided, the surgical field is disinfected, the needle is inserted 3.5-4 mm posterior to the limbus, avoiding the horizontal meridian and directing the needle to the center of the eyeball.

Also known is the method of administration described in the instructions for the medical use of the drug "Eilea" (Instructions for the medical use of the drug "Eylea". Registration number: LP-003544). The known method is carried out similarly to the previous one, the difference lies in the fact that the next injection is carried out in a different part of the sclera.

The closest in terms of essential features is the method of intravitreal administration of drugs in ophthalmology (Patent RU No. 2581219 C1, IPC A61F 9/00, publ. 04/20/2016), including patient preparation, processing of the surgical field and local anesthesia, application of an eyelid dilator, direction of gaze patient, fixation of the eyeball for the episclera, marking the site of scleropuncture with a sclerometer, scleropuncture, the introduction of the drug, taken as the closest analogue (prototype).

A well-known method for performing an intravitreal injection includes preparing the patient, processing the surgical field and local anesthesia, applying an eyelid expander, directing the patient's gaze, fixing the eyeball behind the episclera, marking the scleropuncture site with a sclerometer, avoiding the horizontal - 3 and 9 hours - meridians, scleropuncture, drug administration, where fixation scleral tweezers with straight working ends are used, with the help of which the eyeball is fixed by the conjunctiva and episclera, after the injection of the drug, the syringe needle is left immersed in the eye cavity, then the ends of the indicated tweezers fixing the eyeball are unclenched, transferred to the site of scleropuncture and grasped without pressure the syringe needle at the surface of the conjunctiva, then the needle is removed, immediately after the removal of the needle tip from the wound, scleropressure is performed - the working ends of the tweezers are closed to form a flat surface about 1.5 mm wide, which is pressed against the conjunctiva above the scleral wound with slight pressure for 30-60 seconds .

This method of intravitreal administration of drugs in ophthalmology using fixation scleral tweezers with straight working ends sequentially for fixing the eyeball and scleropressure allows minimizing the time between removing the needle and pressing the wound, which is important to reduce the likelihood of liquid (drug or vitreous body) falling into it .

The disadvantage of the method according to the prototype is that it does not provide sufficient security, since when choosing an injection site - marking the scleropuncture site with a sclerometer, it suggests avoiding only the 3 and 9 o'clock meridians. At the same time, a number of elderly patients, who make up the vast majority of patients receiving intravitreal injections, have degenerative changes in the sclera in the form of an intrascleral cavity reaching 5.5 mm in length parallel to the limbus, going far beyond the 3 and 9 o'clock meridians. Similar changes, outwardly defined as spots of gray sclera, are called senile scleral plaque. When performing injections in the area of the senile scleral plaque, where up to ¾ of the scleral tissue is missing, there is a high risk of loss of the frame function of the sclera, vitreous prolapse, and retinal detachment.

The technical problem solved by the present invention is the creation of a method for intravitreal administration of drugs that effectively reduces the risk of adverse outcomes of intravitreal administration of drugs.

The technical result of using the invention is to reduce the risk of adverse outcomes of intravitreal administration of drugs by determining the safe localization of scleropuncture.

The specified technical result is achieved by the fact that in the method of intravitreal administration of drugs, including preparing the patient, processing the surgical field and local anesthesia, applying an eyelid expander, directing the patient's gaze, fixing the eyeball behind the episclera, marking the site of scleropuncture with a sclerometer, scleropuncture, administration of the drug, according to the invention , before marking the scleropuncture site, the sclera is examined and, if a senile scleral plaque is detected, the needle is inserted at a distance of at least 4 mm from the edge of the senile scleral plaque.

The distance of 4 mm from the edge of the senile scleral plaque was determined on the basis of our own tomographic studies, indicating the spread of a defect in the scleral fibers beyond the visible boundaries of the senile scleral plaque, and therefore a puncture at a closer distance can lead to a persistent violation of the tightness of the eyeball, prolapse of the vitreous body and the development of retinal detachment and choroid. Restriction on the greatest distance from the senile scleral plaque is not required, because the boundaries of the scleropuncture area are limited by the horizontal meridian or the location of the opposite scleral plaque, if present.

The proposed method of intravitreal administration of drugs is carried out as follows.

First, the patient is placed on the operating table in a horizontal position, the surgical field is treated, in particular with a 5% solution of povidone-iodine, local anesthesia is performed, in particular with a 0.4% solution of oxybuprocaine hydrochloride in the form of eye drops, then an eyelid dilator is applied, the patient's gaze is directed in the direction opposite to the supposed place of scleropuncture, the eyeball is fixed with tweezers behind the episclera, after which the sclera is examined and, if a senile scleral plaque is found, the scleropuncture site is marked with a sclerometer 3.5-4 mm posterior to the limbus and at a distance of at least 4 mm from the edge of the senile scleral plaque, avoiding the horizontal meridian, after which scleropuncture is performed according to the markup and the drug is injected into the vitreous body. After that, the needle is removed, short-term scleropressure is performed at the puncture site, the eyelid expander is removed and eye drops with an antibiotic are instilled.

The proposed method of intravitreal administration of drugs has been tested in clinical practice. Below is an example of a specific implementation of the proposed method.

Example 1

An 82-year-old female patient with a diagnosis of neovascular age-related macular degeneration was hospitalized for intravitreal administration of Lucentis. First, the patient was laid on the operating table in a horizontal position, the surgical field was treated with a 5% solution of povidone-iodine, local anesthesia was performed with a 0.4% solution of oxybuprocaine hydrochloride in the form of eye drops, then an eyelid dilator was applied, the patient's gaze was directed in the direction opposite to the intended site of scleropuncture, the eyeball was fixed behind the episclera with tweezers, after which the sclera was examined and a senile scleral plaque was found, the scleropuncture site was marked with a sclerometer 3.5 mm posterior to the limbus and at a distance of 4 mm from the edge of the senile scleral plaque, avoiding the horizontal meridian, after which scleropuncture was performed according to the marking and injected the drug into the vitreous body. After that, the needle was removed, a short-term scleropressure was performed at the puncture site, the eyelid expander was removed, and eye drops with an antibiotic were instilled. Complications from the operation were not registered.

Example 2

A 79-year-old female patient with a diagnosis of neovascular age-related macular degeneration was hospitalized for intravitreal administration of Lucentis. First, the patient was laid on the operating table in a horizontal position, the surgical field was treated with a 5% solution of povidone-iodine, local anesthesia was performed with a 0.4% solution of oxybuprocaine hydrochloride in the form of eye drops, then an eyelid dilator was applied, the patient's gaze was directed in the direction opposite to the intended site of scleropuncture, the eyeball was fixed behind the episclera with tweezers, after which the sclera was examined and a senile scleral plaque was found, the scleropuncture site was marked with a sclerometer 4 mm posterior to the limbus and at a distance of 5 mm from the edge of the senile scleral plaque, avoiding the horizontal meridian, after which scleropuncture was performed according to the marking and injected drug into the vitreous. After that, the needle was removed, a short-term scleropressure was performed at the puncture site, the eyelid expander was removed, and eye drops with an antibiotic were instilled. Complications from the operation were not registered.

As can be seen from the results obtained, the proposed method of intravitreal administration of drugs allows intravitreal administration of drugs with high safety, resulting in a reduced risk of adverse outcomes of intravitreal administration of drugs.

Claims (1)

A method for intravitreal administration of drugs in the presence of a senile scleral plaque, including preparation of the patient, treatment of the surgical field and local anesthesia, application of an eyelid expander, direction of the patient's gaze, fixation of the eyeball behind the episclera, marking the site of scleropuncture with a sclerometer, scleropuncture, administration of the drug, characterized in that before by marking the scleropuncture site, the sclera is examined and, if a senile scleral plaque is detected, the needle is inserted at a distance of at least 4 mm from the edge of the senile scleral plaque.