RU2425663C1 - Method of treating choroid tumours complicated by secondary retinal detachment (rd) - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for treatment of choroid tumours, complicated by secondary retinal detachment. For this purpose intravenous drop introduction of medication "Avastin" is carried out in dose 5 mg per 1 kg of patient's body weight. After that, limiting laser coagulation is performed. After two weeks transpupillar thermotherapy with infra-red laser is carried out. ^ EFFECT: method ensures efficient treatment of such pathology due to creation of favourable conditions for penetration of infra-red rays into tumour tissue as a result of preliminary elimination of screening retina action by introduction of medication "Avastatin" before carrying out laser treatment. ^ 1 ex

Description

The invention relates to medicine, namely to ophthalmic surgery, and can be used for the treatment of choroidal tumors complicated by secondary retinal detachment. One of the dangerous and widespread choroidal tumors is choroid melanoma (MX).

Choroid melanoma is a malignant tumor of the vascular tract. The prognosis for life, as with all malignant tumors, is unfavorable. Recently, there has been an increase in the frequency of MX by 16%. In the general structure of MX, its combination with secondary exudative retinal detachment is up to 70%.

The closest analogue, the prototype, is a method of treating MX using transpupillary exposure to its surface with an infrared laser - transpupillary thermotherapy (TTT) (abstract Bulgakova EV "Treatment of choroid melanomas using transpupillary diode-laser thermotherapy", Moscow, 2005, 2005, p. 26). But with secondary exudative detachment of the retina, treatment is impossible due to its screening, which significantly reduces the transmittance of the infrared laser rays to the tumor tissue. This makes it impossible to achieve its necrosis due to the lack of conditions for the necessary degree of heating of the tumor tissue. These patients undergo crippling surgery - enucleation of the eyeball.

The disadvantages of the analogue prototype are:

- the impossibility of sufficient tumor necrosis due to screening of laser radiation by secondary retinal detachment;

- the use of increased laser power, which leads to an increase in trauma to surrounding tissues;

- the possibility of developing secondary complications due to excessive laser exposure to nearby eye structures.

Objective: to propose a method for treating a tumor of the choroid, complicated by secondary retinal detachment.

The technical result of the invention: the creation of favorable conditions for the penetration of infrared rays into the tumor tissue of the choroid, complicated by secondary exudative retinal detachment, by preliminary inhibition of vasculogenesis.

The technical result is achieved by pre-intravenously administering the Avastin solution. Due to the fact that Avastin is an inhibitor of vasculogenesis, there is a decrease in the number of newly formed vessels, a decrease in the permeability of the vascular wall and further resorption of the transudate, due to which the retina is attached, its screening effect is eliminated. Optimum conditions are created for the subsequent TTT.

The first stage is a single intravenous drip of the Avastin preparation at the rate of 5 mg per 1 kg of the patient’s body weight and on the same day the first stage of laser treatment is performed - restrictive laser coagulation, after 2 weeks, the time of formation of the barrier from laser coagulates, when the maximum effect is achieved preparation and exudative detachment of the retina over the tumor becomes minimal, spend the second laser stage of treatment - TTT. At the same time, the required depth of tumor tissue necrosis is reached.

The advantages of the proposed method:

- the possibility of the maximum possible impact on the tumor tissue due to a decrease in exudative retinal detachment;

- a decrease in the used laser energy due to a decrease in the exudative detachment of the retina;

- reducing the morbidity of exposure due to a decrease in the used laser energy;

- an increase in the depth of penetration of the laser into the tumor tissue;

- a decrease in the number of stages of laser exposure due to an increase in the depth of penetration of infrared laser radiation into the tumor tissue;

- a decrease in the likelihood of metastasis due to the possibility of complete necrosis of the tumor.

Example: Patient K., aged 47, was admitted on 06/17/09 for surgical treatment with Ds: Choroid melanoma T ₂ M ₀ N ₀ , secondary local retinal detachment OD. 06/18/09 the first stage of treatment was carried out - intravenous administration of Avastin solution at the rate of 5 mg per 1 kg of the patient’s body weight and laser restrictive coagulation of the neoplasm.

The second tumor-destroying stage of laser treatment is scheduled after 2 weeks. 07/01/09 when examining the secondary detachment of the retina there is no barrier of laser coagulates formed well. 07/02/09 was successfully carried out the second stage of laser treatment using an infrared laser.

After 3 months, upon examination, it was revealed that a chorioretinal scar was formed at the site of the tumor.

Claims (1)

A method of treating choroidal tumors complicated by secondary retinal detachment, including transpupillary thermotherapy with an infrared laser, characterized in that Avastin is administered intravenously at a dose of 5 mg per 1 kg of patient’s body weight, then restrictive laser coagulation is performed, and two weeks after she is undergoing transpupillary therapy.