RU2198631C2 - Method for treating chronic recurrent forms of herpetic eye lesions - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering Roncoleukine in 2-4-fold application as drops into injured eye during 2 h at a dose of 100000 MU in 100 ml of physiological salt solution with 1 ml of 10% albumin solution added, and as intravenous infusions in dripping 400000 MU in 200 ml of physiological salt solution with 4-5 ml of 10% albumin solution added keeping the same rate of application. EFFECT: enhanced effectiveness of immunomodulation as local immunity repair; prevented disease recurrence.

Description

 The present invention relates to medicine, namely to ophthalmology, can be used in the treatment of herpetic keratoconjunctivitis.

 Herpetic infection, according to WHO, ranks second among human infectious diseases and combines 70 viruses. Among viruses, a special role belongs to the herpes simplex virus (HSV-1 type). Moreover, the virus quite often infects almost all organs and systems of a person, transforms into a chronic recurring form or latently persists, is accompanied by treatment failures, the severity of complications, and temporary disability. One of the private clinical manifestations is the defeat of the herpes virus of the conjunctiva of the eyeball and cornea (ophthalmic herpes).

 Ophthalmic herpes treatment is accompanied by the same problems. Over the past decades, the disease has a pronounced upward trend, which is especially characteristic of urbanized regions with a high population density. The disease is closely associated with the immunodeficiency state of the body and in this regard, it is recommended that the complex treatment include, with recurrent forms of ophthalmic herpes, immunocorrective effects.

 A known method of treating chronic recurrent forms of herpetic eye lesions (HRFG PG, ophthalmic herpes) with antiviral drugs (caricide, ophtanid, zavirax). At the same time, the patient is prescribed desensitizing drugs (diphenhydramine, pipolfen, fenkarol) and stimulant (normal human immunoglobulin, autohemotherapy, FIBS, aloe, peat, peloid distillate).

 In this case, the drugs are used in therapeutic doses, the course of treatment depends on the indications (Ophthalmic Journal., 1997, 1, p. 28-30).

 Disadvantages: recurrence of the pathological process, duration of treatment, insufficient treatment effectiveness, despite the use of a large number of medications, many of which have side effects. Treatment cannot be considered adequate.

 For the prototype, we adopted a method for the treatment of viral diseases of keratoconjunctiva of the anterior eye (Ophthalmic Journal., Odessa, 1996, 4, p. 199), including herpes.

 The method involves creating a barrier of nonspecific cells around the site of virus introduction in order to limit the spread of infection. For this, an immunocorregurative preparation of recombinant interferon (Laferon) was used. At the 1st stage of treatment, patients receive antiviral, anti-inflammatory, desensitizing drugs for 30-35 days.

 Laferon is administered in a hospital in parabulbar or subconjunctival doses of 0.25-0.5 million from 3 to 10 injections and at the same time as instillations of 250-500 thousand units / 1 ml, 4-8 times a day. In this case, the patient continues to use disinfectant, anti-inflammatory, antiviral drugs. The complex stage - the treatment stage with the inclusion of Laferon is about 20 days. In general, a positive effect in the treatment was noted, however, in some cases, conjunctival hyperemia, edema and hyperemia of the skin of the lower eyelid, an increase in body temperature were observed, the antiproliferative effect of interferon (laferon) was noted. In more severe forms of the disease, Laferon is ineffective. In general, the inclusion of Laferon in treatment, as the authors note, only slightly reduces the severity of immunopathological changes in the patient’s body.

Tasks:
- increase the therapeutic effect of treatment;
- reduce the duration of treatment of fresh and chronically recurring forms of ophthalmic herpes;
- lengthen the period of remission;
- improve the quality of human life.

 The essence of the novelty of the invention is monotherapy with an immunomodulating drug "roncoleukin", which is administered 2-4 times drip into the affected eye at a dilution of 100 mU in 100 ml of saline and also 2-4 times every 2 days - infusion, at a dilution of 400 mU in 200 ml saline and 4-5 ml of 10% albumin.

 The technical result of the method is to increase the effectiveness of treatment of HRFG GHG. Moreover, the method creates the possibility of normalizing local and systemic immunity by regulating the level and activity of the most important pro-inflammatory cytokines (IL-1.10, tumor necrosis factor (TNF) - interferon (IFN).

 The method creates the possibility of treating keratoconjunctivitis not only in the form of monoinfection, but also in associations with other pathogens of keratoconjunctivitis (chlamydia, streptococcus and staphylococcus, cytomegoloviruses). Compared with the prototype, the method is much cheaper, gives an earlier positive result, lengthens the period of remission, significantly reduces the quality of the drugs used, because is monotherapy.

 The inventive step of the proposal is confirmed by its non-obviousness.

 The reproducibility of the method is not in doubt and, in our opinion, does not require additional evidence.

 The method was tested on 64 patients with herpetic keratitis aged 16 to 60 years, people of working age prevailed. In the group of patients, rare relapses were noted in 21.7%, in 58.3%, frequent relapses, the first attack of ophthalmic herpes was noted in 20% of patients, the consequences of previous attacks were noted in 71%, including ulceration of the superficial and deep layers of the cornea, 39.2% had various complications; 60.8% have uncomplicated forms of kerato herpes.

 In patients, along with traditional general clinical laboratory methods of research in dynamics (visometry, biomicroscopy), studies of the immune status were carried out with computer-aided decoding of immunograms and the study of cytokine levels in the lacrimal fluid and blood, lipid peroxidation, the state of the cellular immunity (general population of T- lymphocytes, T-helpers / inducers, T-suppressors / killers, B-lymphocytes). From indicators of humoral immunity, the concentration of serum immunoglobulins and the level of CEC were determined.

 In all patients with herpes, immune disorders were detected. In this regard, the treatment of recurrent forms of herpes is carried out by immunocorrection. For this purpose, use the drug roncoleukin.

 Patients are prescribed simultaneously roncoleukin drip into the eyes (droppers) infusion at intervals every 2 days: drip in a dilution of 100 mU in 100 ml of saline and infusion 400 mU in 200 ml of saline and 4-5 ml of 10% albumin, respectively. When diluting roncoleukin for instillation into the eyes, 1 ml of 10% albumin can be added.

 Example 1. Patient Z., 48 years old, medical history 1159. From 01/17/2000 to 01/31/2000 she was hospitalized in the eye department of the Krasnodar Regional Clinical Hospital with a diagnosis of metagerpetic keratitis of the right eye. Received complaints of eye pain, photophobia, feeling of a "foreign body", lacrimation, decreased vision of the right eye.

 From the anamnesis: 20 years ago suffered a herpetic keratitis of the right eye. Relapse of herpes of the right eye after pneumonia.

 On examination: Vigus OD = 0.04, not corrected, Vigus OS = 1.0. Biomicroscopy: OD - severe blepharospasm, lacrimation, eyelids swollen, hyperemic. Conjunctiva of the eyelids, transitional folds, eyeball with mixed injection. The cornea is edematous, with extensive superficial ulceration covering the optical zone. The corneal stroma is involved in the process. The cornea is stained with fluorescein. Anterior chamber with pure moisture, a pupil with a lively response to light. The color and pattern of the iris is not changed.

 The patient was prescribed immunocorrecting monotherapy with a solution of roncoleukin by systemically administering the drug locally: a dropper on the right eye for 2 hours, 100 IU of roncoleukin in 100 ml of phys. solution and 1 ml of 10% albumin and intravenous infusion of the drug at 400 IU in 200.0 ml of physical. solution with the addition of 4 ml of 10% albumin solution. The procedures were performed 2 times, with an interval of 2 days.

 Follow-up examination after treatment: the patient does not complain; blepharospasm, edema and hyperemia of the eyelids, lacrimation disappeared. Visometry revealed an increase in vision of the right eye to 0.8. Biomicroscopy: the cornea is transparent, spherical, not stained with fluorescein. The anterior chamber is moderate, the moisture is clean, the pupil responds normally to light, the iris is unchanged, and a pink reflex from the fundus. Discharged in satisfactory condition, a follow-up examination after 0.5 years showed: no relapse, left and right eyesight - 1.0.

 Example 2. Patient A., 40 years old. I was in the hospital from 02.02.2000 to 02.14.2000. Diagnosis: disk-shaped keratitis - hypopion, with a transition to the corneal ulcer of the left eye, caused by the herpes simplex virus. Complaints: severe pain, loss of vision in the left eye. Associates his illness with severe nervous stress. Before hospitalization, treatment for 2 months was unsuccessful. On examination, the eyelids are swollen, hyperemic, there is a sharp photophobia, blepharospasm, lacrimation. Visometry: Vis OD = 0.1, Vis OS = 0.2. Biomicroscopy of the left eye: a mixed injection of the eyeball. On the cornea in the optic zone of yellow-white color, an infiltrate reaching the deep layers of the cornea, up to 4 diameters of the optic disc. The anterior chamber is of medium depth, hypopion up to 2.5 mm. The iris is swollen, with dilated vessels, the pupil does not respond to light. The fundus is not ophthalmoscopic.

 The patient was treated with roncoleukin solution. Drip into the left eye - 4 times, every 2 days at 100 IU in 100 ml of physical. solution and infusion, also 4 times, after 2 days, 400 IU in 200 ml of physical. solution, with the addition of 5 ml of 10% albumin.

 The result of treatment: improvement after 2 procedures, complaints disappeared, hypopion decreased to 0.5 ml, epithelization of the corneal defect began. After 4 procedures: the anterior chamber moisture is clean, there is no hypopion, the eye is calm, the cornea is not stained with fluorescein, and vision is up to 0.4.

 Discharged in satisfactory condition. Inspection after 0.5 years: no complaints, no relapses over the past period, vision remains stable, cannot be corrected due to the presence of an eyesore in the optical zone of the cornea.

 Thus, the proposed method when used allows to reduce treatment time, reduce labor costs and the number of drugs used, significantly more quickly obtain positive treatment results, eliminate or reduce relapses of the disease, reduce the time of disability, and achieve a high quality of life for the patient in a short time.

Claims (1)

 A method of treating chronic recurrent forms of herpetic eye lesions and the first attack of ophthalmic herpes using immunomodulators, characterized in that the therapy is carried out by 2-4 times administration of roncoleukin every 2 days drip into the affected eye for 2 hours, 100,000 ME in 100 ml of physiological saline solution the addition of 1 ml of a 10% solution of albumin and in the same multiplicity by intravenous infusion, drop by drop, every 2 days, 400,000 IU in 200 ml of physiological solution with the addition of 4-5 ml of a 10% solution of albumin.