RU2375993C2 - Method and medication for treatment of retinal vien thrombosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particularl to ophthalmology, and can be intended for treatment of retinal vein thromboses. Simultaneously 0.1 ml of kenalog and 0.1 ml of gemaza 500U are introduced intravitreally by injection through flat part of ciliary body in 4 +/-1 mm from limb.

EFFECT: method allows in maximally short period to reduce ischemic retinal edema and squeezing of its morphological structures, as well as accelerate retinal hemorrhages resorption, improve rheology of retinal channel blood with following restoration of retina receptors functions, which results in essential increase of visual acuity, application of two medications of kenalog ad gemaza simultaneously is pathogenically conditioned, because together they potentiate treatment result.

2ex

Description

The invention relates to medicine, in particular to ophthalmology, and for the treatment of retinal vein thrombosis.

A known method of treating retinal vein thrombosis (2).

The method consists in the fact that a three-port closed vitrectomy is performed with the complete removal of the posterior hyaloid membrane, followed by laser coagulation of the retina and retinal veins in order to create retinochoroidal anastomoses.

This treatment method refers to a serious cavity intervention on the eyeball with the possible development of intra- and postoperative complications, leading in some cases, according to the literature, to complete loss of the eye. There are also contraindications to the implementation of this method according to the general condition of the patient in the presence of severe somatic pathology.

There is also a method of treating retinal vein thrombosis (1), which consists in introducing large doses (20 mg) of triamcinolone acetonide (Kenalog) into the vitreous cavity in order to reduce retinal edema.

The disadvantages of this method, taken as a prototype, is the introduction of large doses of Kenalog, which, in turn, can provoke the development of complications such as steroid cataracts, glaucoma, cause necrosis of the inner membranes of the eyeball.

The purpose of the present invention is to increase the effectiveness of complex treatment of retinal vein thrombosis.

This goal is achieved by the fact that in the method of treating retinal vein thrombosis, a means consisting of a hormone and an enzyme is introduced into the vitreous cavity: 0.1 ml (4 mg) of triamcinolone acetonide (kenalog preparation) and 0.1 ml (500 IU) of recombinant prourokenase ( hemase preparation). Injection of the substance is carried out under operating conditions with the obligatory observance of the rules of aseptic and antiseptic, with an insulin syringe diluted in physiological saline, in a cocktail, through the flat part of the ciliary body of the eyeball 4 ± 1 mm from the limbus. In the future, paracentesis is performed with the release of intraocular fluid to normalize intraocular pressure. In order to prevent infection, a subconjunctival injection of an antibiotic and dexamethasone is performed. In the postoperative period, antibiotics and non-steroidal anti-inflammatory drugs are prescribed.

The introduction of two drugs simultaneously is a pathogenetically determined method of treatment, since the mechanism of action of drugs is multidirectional, and together they potentiate the result of treatment. Kenalog has a pronounced anti-edematous and anti-angiogenic effect, which allows to reduce ischemic retinal edema and compression of its morphological structures as soon as possible, with subsequent restoration of the function of the retina receptors, transmission of impulses through nerve fibers, and rheology of blood through the capillaries. Hemase, a new generation of fibrinolytic, catalyzes the conversion of plasminogen to plasmin, thereby lysing fibrin clots. This, in turn, accelerates the resorption of retinal hemorrhages, restores the blood rheology of the retinal bed, reduces retinal ischemic edema, thereby contributing to the restoration of its functions.

Example 1. Patient S., 52 years old. Diagnosis: Partial thrombosis of the upper temporal branch of the central retinal vein with edema of the macular zone of the left eye.

Complaints of fog, a veil, a net in front of the left eye. The visual acuity of the right eye is 1.0, the left - 0.1 with a correction of up to 0.5. Against the background of the generally accepted ophthalmotherapeutic treatment of retinal vein thrombosis, the patient was administered intravitreal 0.1 ml of Kenalog and 0.1 ml of hemase. On the 3-5th day after the injection of drugs, a significant improvement in visual functions was noted, the disappearance of the shroud in front of the eye. Visual acuity increased to 0.5 with correction to 0.7, and after a month it was 0.8, while it persisted for 12 months.

Example 2. Patient Ch., 48 years old. Diagnosis: Partial thrombosis of the superior temporal branch of the central retinal vein with swelling of the macular zone of the right eye.

Complaints about a sharp decrease in visual acuity, fog is veiled in front of the right eye. Visual acuity of the right eye was 0.1, the left - 1.0. The patient also underwent therapy according to our proposed technique. On the 3rd day, visual acuity in the right eye increased to 0.5, and by the time of discharge it was restored to 1.0. Results remained stable throughout the year.

The proposed method treated 20 patients (20 eyes). None of the patients had complications during the procedure or in the subsequent observation period. The use of this method allowed to stop retinal edema in the macular zone in 92% of cases, to accelerate the resorption of retinal hemorrhages by 1.5 times, which significantly increased visual acuity in the observed patients by an average of 0.5 ± 0.2 (p> 0.01) , reduced the duration of inpatient treatment by an average of 3.1 ± 0.3 bed-days (p> 0.05).

Information sources

1. Efgrafov V.Yu., Ignatova N.A., Zalieva V.I. The results of endovitreal administration of high doses of Kenalog with venous thrombosis of the retina. On Sat scientific articles on the materials of the scientific and practical conference, ed. H.P. Tahchidi. - Moscow, March 23, 2007 .-- P.81-85.

2. Kashtan O. V., Timokhov V. P., Tillyahodjaev S. S., Ogorodnikova S. N. Surgical treatment of retinal vein thrombosis. On Sat scientific articles on the materials of the scientific and practical conference, ed. H.P. Tahchidi. - Moscow, March 23, 2007 .-- S.134-137.

Claims (2)

1. The method of treatment of retinal vein thrombosis, which consists in the intravitreal administration of drugs, characterized in that by injection through the flat part of the ciliary body 4 +/- 1 mm from the limbus, kenalog and hemase are simultaneously administered intravitreal. 2. A tool for the treatment of retinal vein thrombosis, consisting of 0.1 ml of Kenalog and 0.1 ml of hemase 500ED.