SU1683740A1 - Method for administering drugs to treat the eye diseases - Google Patents

Abstract

The invention relates to medicine, namely to ophthalmology. The aim of the invention is to improve the functional results and shorten the treatment time. In the method of administering medicinal substances for treating diseases of the eye, including the puncture of the pterygium, the puncture needle is further advanced into the lower orbital fissure prior to entering the orbit and the catheter is inserted into the retrobulbar space through the needle.

Description

The invention relates to medicine, namely to ophthalmology, and is intended for the introduction of medicinal substances into the retulbulbar space.

The purpose of the invention is to improve the functional results and shorten the treatment time.

The method is carried out as follows.

The position of the patient on the back. Head retracted to the opposite side of the puncture. Blood pressure, pulse, respiratory rate are measured. A 10 ml syringe is filled with 6-8 ml of a 2% lidocaine solution, and the syringe is connected to a standard needle 6 cm long and 0.7 mm in diameter. Treat the skin at the puncture site twice with alcohol and produce a shot. The point of injection is in the middle of the distance from the external auditory canal to the lateral angle of the eye immediately below the zygomatic arch. Push the needle deep into the center of the lower edge of the orbit to a depth of 3-4 cm, continuously entering lidocaine.

Penetration of the tip of the needle into the wing-palatal membrane is felt by a sudden loss of resistance. In this case, the patient notes painful chamber in the teeth of the upper jaw. Inject 3-4 ml of anesthetic. Then the needle slightly tilts toward itself, and the needle is further advanced towards the inner corner of the eye. At a depth of 5-6 cm, a loss of resistance (needle failure) is again felt, which indicates its presence in the lower orbital fissure. Inject 2-3 ml of anesthetic. Blood pressure, pulse, and number of breaths are measured. Without removing the needle, a plastic catheter with a diameter of 0.5 mm to a depth of 5-6 cm is inserted through its lumen into the retro-bulbar space. While holding the catheter, the needle is removed. Fix the catheter to the skin with adhesive tape. A needle is inserted into the lumen of its distal end, corresponding to

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ABOUT

internal diameter of the catheter. The needle is put on a sterile cap. Micro-infusion of medicinal substances is carried out through the catheter daily, and, if necessary, repeatedly.

The method is based on the obligatory insertion of a needle into the lower orbital fissure, after which the solution and the catheter are introduced into the retro-bulbar space. The computed tomography data shows that the retulbular space is catheterized, and the histograms confirm the uniform distribution of the treatment mixture in the orbit. Only by such a uniform distribution of medicinal substances can the desired therapeutic effect be achieved, which is not achieved by introducing the medicinal substances into the pterygoidal cyst.

Example 1. Patient D., 62 years old, diagnosed with artifacts, purulent uveitis. Ophthalmo-status: eye irritated, Edema of the corneal epithelium 2 tbsp., Desmentum membrane. The front camera is 2.5 mm deep and uniform. The pupil is in the center, there is no reaction to light. 1.5 mm. In the area of the pupil exudate. The fundus of the eye is not ophthalmoscopically. Severe pain syndrome.

At admission the patient was prescribed: dexazone - 0.5 mg. gengamycin - 0.4 mg, atropine 0.1 ml under the conjunctiva, sciolamine 0.25% solution in drops, dicinone - 2 ml intramuscularly. Anapis of blood, you saw leukositosis 7,500, a payuch nuclear shift.

After 2 hours of intake, the dynamics are sharply negative. Strengthened corneal edema, hypopion 2 cm, Significantly increased the amount of exudate. The reflex from the fundus is absent, the pain intensified, the patient is restless. HELL 170/100 mm Hg, pulse - 86 beats per minute. In addition to the prescriptions: hemodez 200 ml, kefzol - 1 g, dexazone - 4 mg, gentamicin - 80 mg, atropine - 1 ml intravenously, drip. When viewed in the morning, the condition of the eye deteriorated. Diagnosis: purulent uveitis. In the complex treatment, puncture catheterization of the retrobulbar space is recommended, followed by the introduction of a therapeutic mixture.

The introduction of a therapeutic mixture of: lidocaine, gentamicin, dexazop and lidaza was carried out 3 times a day for 6 days. Pain syndrome was arrested after the first blockade. After 3 days, the patient's condition improved significantly: he slept well, there was no pain, IOP dropped to 26 mmHg. The exudate and hypopion, corneal chemosis decreased. Blood pressure stabilized at 140/85, temperature and leukocytosis are absent.

When examining a patient on the 6th day after 18 injections, the patient's condition is satisfactory. No complaints, active, hemodynamic stable. In the ophthalmostatus, the dynamics is significant: the injection of the eye block is absent, the cornea is transparent, there is no edema. Exudate and hyopion are absent. The folds of the cement sheath are not pronounced, front camera

0 3 mm deep, the pupil responds to light, IOP 24 mm Hg, IOL in the center, visual acuity of 0.2. The catheter is removed. Aseptic sticker. The patient was discharged on the 9th day for continuation of treatment in conditions of polikli5 peaks.

At the control examination after 2 months, objectively: the eye is calm, there is no corneal edema, the folds of the descement membrane disappeared, the anterior chamber is 3 mm deep. Vlada ha is transparent. Pupil rounded, reacts to light. IOL in the center. Visual acuity of 0.4.

Example 2. Patient 3, 29 years old, The diagnosis is complicated by an immature cataract, iri5 dotsiklit, artifak. Concomitant diseases of neurodermatitis with impaired regenerative abilities of the tissue. Allergic background.

From the anamnesis: operated 1 month ago.

0 Deterioration occurred suddenly. Complaints of severe pain in the right eye, do not stop analgesics. Ophthalmoscope: O - movement of the hand near the face, cornea - edema 2-3 tbsp. The eye is irritated, chemosis conjunctiva. IOL in the area of the pupil.

On admission, the patient is injected under the conjunctiva: gentamicin 0.5, dexazone 0.3, atropine 0.2. Intramuscularly: gentomycin 80 mg, suprastin 1 ml, dexazone

0 4 mg. When examined together after 3 hours, the patient is in a state without positive dynamics, with a tendency to worsening and progression of a purulent-inflammatory disease. The introduction of therapeutic

5 mixtures in the retrobulbar space. Has carried out the treatment of the proposed method. After treatment for 5 days (10 administrations), the catheter is removed. Aseptic sticker. The patient was discharged on the 8th day for

0 treatment in polyclinic conditions. At discharge: visual acuity of 0.5, the eye is calm, the cornea is transparent. The reaction is not light alive. Front camera depth 3.5. Reflex eye fundus pink. Under the influence of blockades, the appearance of neurodermatitis on the skin of the face disappeared - itching, no skin rashes, pastosity disappeared.

The effectiveness of the method was tested on 254 patients with inflammatory eye disease (uveitis-172, iridocyclitis82). The course of treatment required an average of 10-18 blockades. In all cases, after the first blockade, positive dynamics was observed: the pain syndrome was relieved, arterial pressure stabilized and the heart rate normalized, decreased by 4–5 mm Hg. intraocular pressure, normalized sleep and psychoemotional status. After 4-5 blockades, there was a significant positive dynamics on the part of the eye. The positive hemodynamic effect of the method should also be noted: according to the Doppler sonography, the blood flow in the supra-block artery increased almost 2 times, which, against the background of a decrease and stabilization of the systemic pressure, reflects an adequate state of microcirculation in the vascular eye pool.

The average duration of treatment was TO-12 days, which is almost 2 times lower in comparison with the known data. The analysis showed that the average duration of treatment for this pathology was

19-22 days The application of the proposed method allows the patient to stay in hospital in 2 times.

Using various combinations of medicinal substances and their combinations, this method allows the therapy of other diseases of the eye, such as optic neuritis and optic nerve atrophy, hypertensive pain syndrome, and latiology of vascular genesis.

Claims (1)

The method can be used as an independent method of treatment, and in the complex therapy of eye diseases. Invention Formula The method of administering drugs for the treatment of eye diseases, including puncture of the pterygopalatomy, is necessary in order to improve functional results and reduce of treatment periods, the puncture needle is further advanced into the lower orbital fissure before entering the orbit and a catheter is inserted into the retrobulbar space through the needle