UA127694U - METHOD OF INTRAVITREAL IMPLEMENTATION OF DEXAMETHASONE IMPLANT IN COMBINATION WITH FACOEMULSIFICATION - Google Patents

Abstract

A method of intravitreal administration of a dexamethasone implant in combination with phacoemulsification, whereby phacoemulsification is performed and dexamethasone is administered in the form of an implant, wherein dexamethasone is administered intravitrally into the retrolent space during phacoemulsification.

Description

The utility model is in the field of medicine, namely, ophthalmology, and can be used for surgical treatment of eye diseases, including cataracts, diabetic retinopathy, proliferative diabetic retinopathy, diabetic macular edema, macular edema resulting from central vein occlusion retina or retinal vein branch occlusions, inflammation of the posterior segment of the eye in the form of non-infectious uveitis, other visual disturbances as a result of diabetic macular edema, in patients with pseudophakic eyes, and other diseases in which phacoemulsification is indicated, by performing intravitreal introduction of a dexamethasone implant in combination with fbracoemulsification .

Many methods of treatment for eye diseases are known from the state of the art. Yes, L.N.

Larionov |/Larionov L.N. About the possibility of conservative treatment of initial age-related cataracts / Herald of Ophthalmology. - 1980. - May 5. - Sat. 49-51. recommends prescribing methyluracil inside (0.25 95 solution 2 times a day for cortical and nuclear and 3 times a day for cup-shaped cataracts) for 3 months per course. Such courses are conducted with a one-month break. Instillations of this drug must be carried out constantly 2 times a day in combination with riboflavin, insulin and ATP. With progressive cataracts, methyluracil electrophoresis is performed 2 courses per year of 5 sessions each. As a result of treatment, with cortical cataracts, the stability of the pathological process was established in 86 95 cases, while in the control group of patients it was recorded in 31 95 cases.

A.M. Vodovozov, N.G. Glotova |(A.M. Vodovozov, N.M. Glotova. The result of the treatment of senile cataracts with taurine. Vestnyk othalmologii 1981, Mo 2, p. 44-45. for the treatment of senile cataracts, a 495 solution of taurine was used for 2 drops Z times day. At the same time, after 6 months, visual acuity increased in patients in 25 eyes out of 98 (25.5 95), did not change - in 54 eyes (55.1 Fo) and decreased in 19 eyes (19.3 95). In 2 patients had an allergic reaction.

H.S. Polunin, M.P. Ivanov (GS. Polunin, M.N. Ivanov. On the effect of lecozyme on the condition of the lens | studied the effect of lecozyme (in subconjunctival injections of 1-2 Rir of 5 injections every other day per course; the interval between courses of 2- 3 months) in 33 patients in 66 eyes. It was found that the visual acuity increased in 19 (28.8 95) eyes, remained the previous one in 37 (56.0 90) and decreased in 10 (15.2 9b) eyes.

G.D. Zhaboyedov and M.M. Sergienko (G.D. Zhaboyedov, M.M. Sergienko. "Eye diseases". K., 1999, p

From 158-160. emphasize that the treatment (Taufon, Smirnov drops, vitaiodurol, catachrome, sencatalin, etc.) is prescribed not so much to enlighten the lens as to prevent the further development of cataracts. Drops containing vitamins, trace elements, amino acids are intended for correction of metabolic processes in the lens. At the same time, the authors state that the effectiveness of installation therapy by the specified methods is doubtful.

As you can see, the effectiveness of the above medical methods of treating eye diseases is clearly insufficient.

From the state of the art, a method of phacoemulsification is known (Our experience in phacoemulsification of cataracts" by N. M. Sergienko - "Ophthalmological Journal", 1999, Moe1, p. 38), in which the fibrous membrane is cut, anterior capsulorhexis, hydrodissection and gyrodelineation are performed, and the phaco tip is inserted into the operating room incision, crushing and aspiration of the nucleus of the lens. However, the known method has a number of disadvantages. For example, there are high degrees of postoperative complications, damage and detachment of the iris with the subsequent danger of miosis bleeding.

The drug Ozurdex is known from the prior art, which contains dexamethasone in the form of an implant for intravitreal administration. Ozurdex is a monofluorinated synthetic glucocorticoid that has strong anti-inflammatory, anti-allergic properties and does not have a mineralocorticoid effect. Indications for administration are macular edema resulting from central retinal vein occlusion or branch retinal vein occlusion, inflammation of the posterior segment of the eye in the form of noninfectious uveitis, visual impairment resulting from diabetic macular edema, in patients with pseudophakic eyes or for whom noncorticosteroid therapy is ineffective or impractical The most frequent side effects associated with the technique of intravitreal administration of 700 mcg of dexamethasone in the form of an implant are herniation (prolapse) or detachment of the vitreous body, traction retinal detachment, increased intraocular pressure, endophthalmitis, intraocular inflammation, development of subcapsular cataract, secondary glaucoma due to lens swelling, conjunctival hemorrhages, vitreous hemorrhages, eye pain.

As can be seen, there is a need to create a new method of intravitreal introduction of the dexamethasone implant, which would ensure the reduction of side effects, allow obtaining a stable, long-lasting and reliable therapeutic effect, and would not cause relapses.

Thus, the task of the useful model is to improve the method of intravitreal introduction of the dexamethasone implant to achieve a high clinical effect.

The task is solved thanks to a new method of intravitreal introduction of a dexamethasone implant in combination with phacoemulsification, according to which phacoemulsification is carried out and dexamethasone is introduced in the form of an implant, and dexamethasone is introduced intravitreally into the retrolental space, during phacoemulsification, in a dose of 700 mg.

The advantages of introducing a dexamethasone implant in a dose of 700 mg into the retrolental space are as follows: there is no puncture of the sclera of the eyeball, which is a prevention of the occurrence of endophthalmitis or intraocular inflammation; there is no injury to the vitreous body, which is a prevention of such complications as hernias (prolapse) or detachment of the vitreous body; the process is controlled, which is the prevention of traction retinal detachment; during the introduction of the drug into the retrolental space, a combined operation is performed (simultaneous cataract removal and insertion of an implant into the retrolental space), which is a prevention of the occurrence of subcapsular cataracts and secondary glaucoma.

The technical result according to the proposed technical solution is achieved due to a set of new essential features.

Thanks to the proposed new method of administration of the drug in combination with phacoemulsification, the duration and effectiveness of the therapeutic effect are significantly increased.

The claimed method, in comparison with the known ones, has such advantages as: stable, long-lasting and reliable therapeutic effect, the claimed method does not cause relapses. The proposed method is sufficiently adequate anatomically and clinically, gives good functional results.

The proposed new method provides a therapeutic effect due to a new sequence of actions. In addition, the proposed method does not cause unexpected side effects.

The claimed method is implemented as follows.

Operation protocol. Treatment of the operative field with antiseptic twice. The operating field is covered with an ophthalmic sterile disposable sheet. Treatment of the edges of the eyelids with 1 95 diamond green. Blepharostat. Washing the conjunctival cavity with an antiseptic.

From Paracentesis with a 20 b blade at 11 o'clock. A mydriatic and anesthetic solution was injected into the anterior chamber. Viscoelastic is inserted into the front chamber. Capsulorhexis of the anterior lens capsule was performed through paracentesis. Paracentesis with a blade at 20 o'clock at 1 p.m. Through paracentesis, hydrodissection and hydrodelineation of the lens nucleus with B55 kt solution was performed. Viscoelastic is inserted into the front chamber. A corneal tunnel was made with a 2.65 mm blade. Viscoelastic is inserted into the front chamber. With the help of a FAKO needle, a cross-shaped groove of the lens nucleus was made by the "demide apa sopseg" method. A lens is inserted into the cavity of the capsule.

The fracture of the nucleus of the lens along the furrows was performed. Viscoelastic is inserted into the front chamber.

FAKO-aspiration of the lens nucleus on the device. The aspiration-irrigation system washed out the cortical masses of the lens with B55 solution. Viscoelastic is inserted into the capsule bag. Polishing of the capsule bag. Viscoelastic is inserted into the capsule bag. A posterior capsulorhexis was performed.

An Ozurdex dexamethasone implant was inserted into the anterior chamber through the applicator pen. With a spatula, the implant is inserted between the anterior hyaloid membrane and the posterior capsule of the lens (into the retrolental space). With the help of cartridge C, an intraocular lens is implanted in the capsular bag. The viscoelastic was washed from the front chamber with a solution of B55 "t. Hydroadaptation of paracentesis. Subconjunctival injection of corticosteroid and antibiotic solution. Ointment with an antibiotic in the conjunctival vault. Monocular aseptic bandage.

A clinical example

Patient P., born in 1959.

Diagnosis: Complicated cataract, diabetic retinopathy (proliferative form), diabetic macular edema of both eyes.

Visual acuity of the right eye (September 7, 2017) 0.01 5rp-1.0 0-0.05

Visual acuity of the left eye (September 7, 2017) 0.05 n/c

Intraocular pressure (pneumotonometry) of the right eye - 13 mm Hg. Art.

Intraocular pressure (pneumotonometry) of the left eye - 12 mm Hg. Art.

The thickness of the retina according to the results of optical coherence tomography (September 7, 2017) was 597 rt in the right eye, 587 nt in the left eye. On September 7, 2017, operative treatment was performed on the right eye: phacoemulsification of cataract with implantation of a posterior chamber intraocular lens and retrolental introduction of Ozurdex dexamethasone implant. The postoperative period was uneventful

Gs10) complications.

Visual acuity of the right eye (December 5, 2017) 0.1 n/c

Intraocular pressure (pneumotonometry) of the right eye - 13 mm Hg. Art.

The thickness of the retina of the right eye in dynamics (05.12.2017) was 408 ut. On December 5, 2017, surgical treatment was performed on the left eye: phacoemulsification of cataract with implantation of a posterior chamber intraocular lens and retrolental introduction of Ozurdex dexamethasone implant. The postoperative period was uneventful and without complications.

Visual acuity of the right eye (February 15, 2018) 0.2 n/c

Visual acuity of the left eye (February 15, 2018) 0.3 5рp-1.0 0-04

Intraocular pressure (pneumotonometry) of the right eye - 12 mm Hg. Art.

Intraocular pressure (pneumotonometry) of the left eye - 13 mm Hg. Art.

The thickness of the retina of the left eye in dynamics (February 15, 2018) was 301 μm.

It should be understood that the example and embodiment described above are illustrative only and various modifications and changes are suggested to those skilled in the art, which are covered by the essence of this application and the scope of the technical solution formula. It should be understood that the above information in no way limits the scope of the rights under the application.

Claims (1)

USEFUL MODEL FORMULA The method of intravitreal introduction of a dexamethasone implant in combination with phacoemulsification, according to which phacoemulsification is carried out and dexamethasone is introduced in the form of an implant, and dexamethasone is introduced intravitreally into the retrolental space, during phacoemulsification, in a dose of 700 mg.