RU2801496C1 - Method of the treatment of glaucoma optic neuropathy - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: retrobulbar sub-Tenon space is filled, an incision of the conjunctiva and Tenon's membrane is made 5 mm long, 10–12 mm from the limbus in the lower outer quadrant. Using a curved spatula, a tunnel is formed between the Tenon membrane and the sclera 6–8 mm long, a hydrogel drainage of size 2×2 mm impregnated with retinalamine, 5 mg of which is preliminarily dissolved for 10 seconds in 0.5 ml of saline NaCl solution is inserted through the incision into the formed tunnel to the posterior pole of the eye with a spatula. The surgery ends with the imposition of two interrupted sutures on the conjunctiva.

EFFECT: method allows to improve visual functions due to activation of regenerative-reparative processes and to stabilize metabolic disorders that occur during glaucoma in the optic nerve head.

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Description

The invention relates to medicine, in particular to ophthalmology, and can be used to treat glaucomatous optic neuropathy (GON).

Glaucoma occupies a leading place among the causes of visual impairment. Their gradual loss as a result of increased ophthalmotonus, local metabolic disorders, pathological apoptosis of retinal ganglion cells leads to the development of GON, and even after normalization of intraocular pressure (IOP), visual functions continue to deteriorate in 55% of patients, leading to blindness. (N.P. Pashtaev, T.G. Ivanova, N.Yu. Gorbunova, T.F. Artemyeva, A.A. Markova / Comprehensive treatment of patients with glaucoma optic neuropathy: a practical guide for doctors - Cheboksary: GOU IUV, 2008, - 4 s).

The rapid progression of the glaucoma process requires the use of neuroprotective therapy, which will protect the retina and optic nerve, as well as improve the microcirculation of already affected nerve fibers. For this, “targeted” drug delivery is more preferable (M.S. Pnyukhtina, D.A. Khvan, N.V. Filina - Neuroprotective treatment of glaucoma/TMJ, 2018, No. 2, p. 4).

A known method for the treatment of GON in the elderly (RF Patent No. RU 2411033), where the authors use betaxolol 0.5% in installations 1 drop 2 times a day constantly and a standardized extract of Gingko biloba EGb 761 - Tanakan according to the developed scheme. Tanakan is administered: 1 week - 1 tablet 1 time per day in the morning; 1 week - 1 tablet 2 times a day in the morning and in the afternoon; 2 months - 1 tablet 3 times a day; 1 week - 1 tablet 2 times a day in the morning and in the afternoon; 1 week - 1 tablet 1 time per day in the morning; 1 week - 1 tablet every other day in the morning (total - 3 months 1 week). The introduction according to the scheme is repeated 1 time in 6 months.

Significant disadvantages of the method are the possible short-term increase in IOP during the course of treatment, and the authors do not take into account the development of allergic reactions to the drugs used.

A complex method for the treatment of GON is known (RF Patent No. RU 2 577 763), where, after local antihypertensive therapy, transorbital low-frequency magnetic stimulation is performed on the closed eye for 5-7 minutes, courses every 3 months for 6-10 procedures.

The disadvantage of this method is the insufficient pathogenetic focus of the therapy, and, based on the comments of the authors, patients without severe somatic diseases were selected for the study, in the absence of contraindications to physiotherapy, which limits the widespread use of the technique.

The closest analogue is the method of combined treatment of glaucomatous optic neuropathy (RF Patent RU 2576785), which includes filling the retrobulbar sub-Tenon space with a long-term absorbable substance of a viscous consistency (Collastop or Healaflow), using parabulbar access in the lower outer quadrant of the conjunctival cavity, while applying a U-shaped suture on the micro-incision of the conjunctiva and Tenon's membrane, directing the free ends of the thread towards the outer corner of the eye, tie, without tightening, a single knot, a pharmacologically acceptable inert substance of a viscous consistency is introduced through the formed micro-incision, the introduction is carried out until the injected substance starts to exit the micro-incision, while tightening the P- a figurative suture, after the completion of the administration of the substance, a second knot is applied, from the next day after the operation, a complex of drugs that improve cerebral circulation, neurotrophics and antioxidants are taken for 10 days, while taking the drugs, they undergo a course of detensor therapy.

Significant disadvantages of the method are the impossibility of controlling the partial release of an inert substance of a viscous consistency through a micro-incision due to the lack of sufficient sealing of the operation area, the trauma and invasiveness of the method used, which requires a sufficiently high level of practical experience and skill of the operating surgeon.

The objective of the invention is to develop a new, effective method for the treatment of GON.

The technical result of the invention is the improvement of visual functions due to the activation of regenerative-reparative processes and the stabilization of metabolic disorders that occur during glaucoma in the head of the optic nerve.

The method is carried out as follows. After pre-treatment of the surgical field and local anesthesia, a micro incision of the conjunctiva and Tenon's membrane was performed 5 mm long, 10-12 mm from the limbus in the lower outer quadrant. Using a curved spatula, a tunnel was formed between the Tenon's membrane and the sclera, 6-8 mm long.

Through a micro-incision, a hydrogel drainage 2 × 2 mm in size was introduced with a spatula into the formed tunnel to the posterior pole of the eye (5 mg of retinalamine was dissolved in 0.5 ml of saline NaCl 0.9%, exposure time 10 sec), which increased after impregnation with retinalamine. up to 4×4 mm. The operation ended with the imposition of two interrupted sutures on the conjunctiva.

There is a causal relationship between the set of essential features and the achieved technical result.

The proposed method includes several distinctive mechanisms. As an inert substance, the use of hydrogel drainage in the posterior pole of the eye triggers local aseptic inflammation, which in turn leads to activation of blood flow in the retrobulbar space and improved nutrition of the optic nerve. Cumulation of retinalamin in drainage ensures its long-term neuroprotective effect, which contributes to the survival of neurons under hypoxic conditions by improving tissue metabolism, optimizing energy processes, and regulating lipid peroxidation.

As a peptide bioregulator, retinalamine interrupts the delayed mechanisms of neuronal death, has a stimulating effect on photoreceptors, activates reparative processes, enhances contrast sensitivity and improves visual functions.

The invention is confirmed by the following examples.

Example 1

Patient B., 65 years old. Hospitalized with DS: OD - Primary open-angle glaucoma III A, operated Artifakia. Glaucoma optic neuropathy. Visual acuity before treatment: Vis OD = 0.1 sph-1.75 D = 0.6 n / k IOP OD (according to Maklakov) = 15 mm Hg. Computer perimetry OD: narrowing of the visual field is concentric, by 25-40 degrees along different meridians (more on the nasal side). In the central zone - a decrease in contrast sensitivity.

Treatment was carried out according to the proposed method, where a micro-incision was made 10 mm from the limbus, using a curved spatula, a tunnel was formed between the Tenon's membrane and the sclera with a length of 6 mm. 14 days after the start of treatment, the patient noted an improvement in distance vision in both eyes, an increase in brightness. Visual acuity after treatment was:

Vis OD = 0.2 sph-1.75 D = 0.7 n / c IOP OD (according to Maklakov) = 16 mm Hg. Computer perimetry OD: in the central zone - increased contrast sensitivity.

Example 2

Patient R., 69 years old. Hospitalized with DS: OD - Primary open-angle glaucoma II A, operated, complicated cataract. Glaucoma optic neuropathy.

Visual acuity before treatment: Vis OD = 0.2 sph-1.75 D = 0.4 n / k IOP OD (according to Maklakov) = 18 mm Hg. Computer perimetry - OD: narrowing of the visual field from the nasal side by 20 degrees. Decreased contrast sensitivity on the temporal side by 20 degrees. Treatment was carried out according to the proposed method, while a micro-incision was made 12 mm from the limbus, using a curved spatula, a tunnel was formed between the Tenon's membrane and the sclera with a length of 8 mm. 10 days after the start of treatment, the patient noted an improvement in distance vision, an increase in brightness. He also noted an improvement in his general condition - the absence of headaches, dizziness, improved memory. Visual acuity after treatment was:

Vis OD=0.3 sph-1.75 D=0.5 n/c IOP OD (according to Maklakov) = 13 mm Hg. Computerized Perimetry - OD: expansion of the visual field from the nasal side by 5 degrees.

Example 3

Patient H., 76 years old. Hospitalized with DS: OS - Primary open-angle glaucoma III A, operated Artifakia. Glaucoma optic neuropathy. Visual acuity before treatment:

Vis OS=0.2 sph-0.75 D=0.4 n/c IOP OS (according to Maklakov) = 19 mm Hg. Computer perimetry - OD: narrowing of the visual fields is concentric, by 20-40 degrees along different meridians (more on the nasal side). In the central zone - a decrease in contrast sensitivity.

Treatment was carried out according to the proposed method, while a micro-incision was made 12 mm from the limbus, using a curved spatula, a tunnel was formed between the Tenon's membrane and the sclera with a length of 6 mm. 14 days after the start of treatment, the patient noted an improvement in distance vision in both eyes, an increase in brightness. Visual acuity after treatment was: Vis OS=0.3 sph-0.5 D=0.5 n/a IOP OS (according to Maklakov) = 17 mm Hg.

Computer perimetry - expansion of the fields of view by 5-10 degrees along different meridians, in the central zone - increased contrast sensitivity.

According to the proposed method, 20 patients with glaucomatous optic neuropathy were treated. In all cases, improvement in visual functions, increased contrast sensitivity and expansion of peripheral visual fields were achieved; no surgical and postoperative complications were observed. Healing processes took place within 2 weeks. The remote observation period was 12 months.

Claims (1)

A method for the treatment of glaucomatous optic neuropathy, including filling the retrobulbar sub-Tenon's space, characterized in that an incision of the conjunctiva and Tenon's membrane 5 mm long is made 10-12 mm from the limbus in the lower outer quadrant, using a curved spatula, a tunnel is formed between the Tenon's membrane and the sclera 6-8 mm, through the incision into the formed tunnel to the posterior pole of the eye, a hydrogel drainage 2 × 2 mm in size, impregnated with retinalamine, 5 mg of which is preliminarily dissolved for 10 seconds in 0.5 ml of physiological NaCl solution, is introduced with a spatula; The operation ends with the imposition of two interrupted sutures on the conjunctiva.