UA102957U - METHOD OF TREATMENT OF PRIMARY OPEN ANGLE GLAUCOMA - Google Patents

Abstract

A method of treating primary open-angle glaucoma involves antihypertensive therapy and the use of a drug with metabolic and antioxidant properties. As a drug with metabolic and antioxidant properties, appoint cerebrocurin 2 ml solution for injection intramuscularly 1 time a day for the first 5 days, and then - 0.5 ml parabulbar in each eye and 1 ml intramuscularly for 5 -15 days, the course to increase visual acuity and normalization of intraocular pressure.

Description

The useful model belongs to medicine, namely to ophthalmology and can be used for the treatment of primary open-angle glaucoma.

At present, more than 60 million people in the world suffer from glaucoma, and the prevalence of glaucoma has increased by an average of 36.7 96, while glaucoma remains one of the main causes of blindness and visual disability | Rkov S.A. Disease incidence, prevalence of ophthalmopathologists and disability due to it in Ukraine / S.A.

Riyikov, O.P. Vytovskaya, G.I. Stepaniuk // Glaucoma News! - 2009. - Mo 1 (9). - pp. 34-35; Ocidieu

N. Mopamliae eridethioiodu ip diashsota // Moga Siashisota Sopagev5 (AIS5) bipdaroge. - 2007. -

Arvigas's rook. - Schepema Medis! Rybiizpeg5, Sepema, Zm/i2epapa, 2007. - R. 11.

Even modern methods of treatment of primary open-angle glaucoma in many patients do not provide an opportunity to stabilize the pathological process and prevent disability, which makes it urgent to develop new treatment methods based on the definition of the main links of the pathogenesis of this disease. known methods of treatment of primary open-angle glaucoma, which are aimed at reducing elevated intraocular pressure, in a significant percentage of cases do not provide stabilization of glaucomatous optic neuropathy, which is explained by the lack of influence on the vascular and metabolic links of the pathogenesis of the disease (Nesterov A.P. Primary open-angle glaucoma: pathogenesis and principles of treatment / A.P. Nesterov // Klin, Ophthalmol. - 2000. - Vol. 1, Mo. 1. - pp. 4-5).

There is a way to treat primary open-angle glaucoma, which includes, in addition to hypotensive therapy, also the appointment of a drug with metabolic and antioxidant properties - lipoic acid | IFilina A.A. Lipoic acid as a means of metabolic therapy for open-angle glaucoma / A.A. Filina, N.G. Davydova // Vesty Ophthalmol. - 1999. - Mo. 1. - P. 6-8). However, this method does not always ensure the stabilization of visual field indicators and glaucomatous optic neuropathy, because it does not ensure the normalization of such an important link in the pathogenesis of primary open-angle glaucoma, as the metabolism of nitric oxide, which takes part in the regulation of hemo- and hydrodynamics, and the mechanisms of optic nerve apoptosis.

More effective is the method of treatment of primary open-angle glaucoma, which includes hypotensive therapy and the use of a drug with metabolic and antioxidant

Due to its properties, ascorbic acid is prescribed depending on the stage of glaucoma in the form of instillations of 0.02 95 solution into the conjunctival sac 1 drop 2-3 times a day and in the form of oral tablets of 500 mg 2-3 times a day for a month (Pat. Mo 3173 OO, SHA, MPK AbIK 31/375. Method of treatment of primary open-angle glaucoma / O.V. Petrenko, G.D. Zhaboyedov;

National Medical University named after O.O. Bogomolets - 3. Me 2004021347, Application. 25.02.2004;

Publ. 15.10.2004). The described method of treatment is pathogenetically justified, since ascorbic acid can affect the metabolism of nitric oxide, but it does not take into account the state of other factors involved in the autoregulation of hemodynamics of the optic nerve and outflow of intraocular fluid, in particular endothelin-1.

The most effective method of treatment of primary open-angle glaucoma, which includes hypotensive therapy and the use of a drug with metabolic and antioxidant properties, for which tivortin is prescribed for 100 ml of solution for injection intravenously by drip at a rate of 10 drops per minute 1 time per day for 3-5 days, and then 5 ml of the solution for oral use 3 times a day for 8-15 days (Pat. Mo 52177 |,

OA, IPC AbIE 9/00. Method of treatment of primary open-angle glaucoma / M.V. Panchenko,

Panchenko O.M., Samofalova M.M. etc.; Kharkiv National Medical University - 3. Mo. 201005224, Application. 29.04.2010; Publ. 10.08.2010).

This method of treating primary open-angle glaucoma is the closest to what is claimed, in terms of technical essence and the result that can be achieved, so it was chosen as a prototype.

Normalization of the disturbed metabolism of nitric oxide in the modern schemes of the pathogenesis of primary open-angle glaucoma occupy an important place. Since tivortin is a substrate for the enzyme MO-synthase, which catalyzes the synthesis of nitric oxide in endotheliocytes, inhibits the synthesis of endothelin-1, and also inhibits the synthesis of asymmetric dimethylarginine - a powerful endogenous stimulator of oxidative stress, thus exerting an antioxidant effect, the proposed method of treatment is pathogenetically justified in treatment of primary open-angle glaucoma, but has certain disadvantages, the main of which is that it does not take into account the state of other factors involved in the accelerated apoptosis of retinal ganglion cells.

In connection with the above, the basis of a useful model is the task of increasing the effectiveness of treatment of primary open-angle glaucoma.

The problem, which is the basis of a useful model, is solved by the fact that in the known method of treatment of primary open-angle glaucoma, which includes hypotensive therapy and the use of a drug with metabolic and antioxidant properties, according to the useful model, as a drug with metabolic and antioxidant properties, cerebrocurin is prescribed for 2 ml of solution for injections intramuscularly 1 time a day during the first 5 days, and then - 0.5 ml parabulbarally under each eye and 1 ml intramuscularly for 5-15 days, with a course of increasing visual acuity and normalization intraocular pressure.

The technical effect of the useful model, namely the increase in the effectiveness of the treatment of primary open-angle glaucoma, is due to the synergism of the proposed measures.

The method is performed as follows: For the treatment of primary open-angle glaucoma, as a drug with metabolic and antioxidant properties, cerebrocurin is prescribed in 2 ml of a solution for injections intramuscularly once a day for the first 5 days. Then 0.5 ml is prescribed parabulbar under each eye and 1 ml intramuscularly for 5-15 days. The course is carried out until visual acuity increases and intraocular pressure normalizes.

Cerebrocurin contains active neuropeptides obtained from the brain of bovine embryos, exhibits pronounced neurotrophic effects, optimizes energy metabolism, stimulates intracellular protein synthesis, inhibits the processes of the glutamate-calcium cascade and lipid peroxidation, thereby exerting an antioxidant effect, and normalizes the activity of glutathione transferase and glutathione peroxidase, reduces the concentration of stable metabolites of nitric oxide and the activity of MO synthase, reduces the death of neurons due to apoptosis.

The effectiveness of the method is illustrated by the following examples.

Example 1. Patient Zh., born in 1945, was being treated in the eye department with the diagnosis: primary open-angle glaucoma, advanced stage, compensated right eye, primary open-angle glaucoma, advanced stage, compensated left eye, partial complicated cataract, age-related macular degeneration both eyes

Glaucoma was first diagnosed about 4 years ago. He regularly underwent treatment courses in the eye department. During the last two months, he complains of worsening

From vision, which continues after the course of treatment. At home, I instilled Kombigan in both eyes - 1 drop 2 times a day.

Objectively: Right eye: visual acuity - 0.5-0.6 n/k.

The eye is calm, the cornea is transparent, the iris is subatrophic, the lens has initial darkening. Fundus - the optic disc is pale, partially discolored, glaucomatous excavation - 8/10; macular zone - slight edema. Intraocular pressure - 24 mm Hg. Art. (by

Maklakov).

Static computer perimetry before treatment - MO--14.47 dB.

Optical coherence tomography of the optic nerve before treatment: the average thickness of the layer of peripapillary nerve fibers - 69 mmcm; the thickness of the layer of peripapillary nerve fibers in the lower quadrant - 76 mmcm; the thickness of the layer of peripapillary nerve fibers in the sector of 19 h. - 58 mmkm.

Left eye: visual acuity - 0.9 n/c.

The eye is calm, the cornea is transparent, the iris is unchanged, the lens has initial darkening.

Fundus - optic disc is pale, discolored, glaucomatous excavation - 7/10; macular zone - pigment dissociation, not numerous drusen. Intraocular pressure - 24 mm Hg. Art. (according to Maklakov).

Static computer perimetry before treatment - MO--8.14 dB.

Optical coherence tomography of the optic nerve before treatment: the average thickness of the layer of peripapillary nerve fibers is 70 mmcm; the thickness of the layer of peripapillary nerve fibers in the lower quadrant - 76 mmcm; the thickness of the layer of peripapillary nerve fibers in the sector of 17 h. - 81 mmkm.

Treatment was carried out - instillations in both eyes: combigan - 1 drop 2 times a day, oftan - catachrome - 1 drop 3 times a day. Cerebrocurin 2 ml solution for injections intramuscularly once a day for the first 5 days, and then 0.5 ml - parabulbar under both eyes and 1 ml intramuscularly for 5 days.

The patient was re-examined six months after the treatment:

Visual acuity of the right eye: 0.7-0.8 n/c. Fundus - without dynamics. Intraocular pressure - 22 mm Hg. Art. (according to Maklakov).

Static computer perimetry - MO--12.72 dB.

Optical coherence tomography of the optic nerve: the average thickness of the layer of peripapillary nerve fibers - 80 mmcm; the thickness of the layer of peripapillary nerve fibers in the lower quadrant is 89 mmcm; the thickness of the layer of peripapillary nerve fibers in the sector of 19 h. - 72

MMmKM.

Left eye: visual acuity: 0.9-1.0. Fundus - without dynamics. Intraocular pressure - 20 mm Hg. (according to Maklakov).

Static computer perimetry - MO--6.25 dB.

Optical coherence tomography of the optic nerve: the average thickness of the layer of peripapillary nerve fibers - 90 mmcm; the thickness of the layer of peripapillary nerve fibers in the lower quadrant - 76 mmcm; the thickness of the layer of peripapillary nerve fibers in the sector of 17 h. - 72

MMmKM.

Thus, the treatment made it possible to improve visual functions and achieve stabilization of the structural indicators of the optic nerve in both eyes.

Example 2. Patient 0O., born in 1949, was being treated in the eye department with the diagnosis: primary open-angle glaucoma, advanced stage, compensated right eye, primary open-angle glaucoma, initial stage, compensated left eye, initial age-related cataract of both eyes.

She has been suffering from glaucoma for a year, instilled Arutimol in both eyes - 1 drop 2 times a day and Taflotan - 1 drop 1 time a day.

Objectively: Right eye: visual acuity - 0.1 n/c.

The eye is calm, the cornea is transparent, the iris is subatrophic, the lens has initial darkening. Fundus - optic disc is pale, discolored, glaucomatous excavation - 710; macular zone - unchanged. Intraocular pressure - 19-21 mm Hg. Art. (according to Maklakov).

Gonioscopy - the angle of the anterior chamber is open, of medium width, the degree of pigmentation is II.

Static computer perimetry before treatment - MO--4.01 db.

Left eye: visual acuity - 0.2 with sphere H 1.5 D-O.5.

The eye is calm, the cornea is transparent, the iris is subatrophic, the lens has initial darkening. Fundus - optic disc is discolored, glaucomatous excavation - 6/10; macular zone - unchanged. Intraocular pressure - 19 mm Hg. Art. (according to Maklakov). Gonioscopy -

From the angle of the anterior chamber is open, of medium width, the degree of pigmentation is I.

Static computer perimetry before treatment - MO--3.2 db.

Treatment was prescribed - instillation in both eyes: Arutimol - 1 drop 2 times a day and Taflotan - 1 drop 1 time a day, Oftan - Catachrome - 1 drop 3 times a day.

Cerebrocurin 2 ml solution for injections intramuscularly once a day for the first 5 days, and then 0.5 ml - parabulbar under both eyes and 1 ml intramuscularly for 5 days.

After the treatment:

Visual acuity of the right eye: - 0.2 with sphere H 2.0 D - 0.2. Fundus - without dynamics.

Intraocular pressure - 20 mm Hg. Art. (according to Maklakov).

Static computer perimetry - MO--0.95.

Visual acuity of the left eye: - 0.2-0.3 with sphere H 1.5 D - 0.6-0.7. Fundus - without dynamics.

Intraocular pressure - 20-21 mm Hg. Art. (according to Maklakov).

Static computer perimetry - MO--0.34.

Thus, the treatment made it possible to improve visual functions in both eyes.

Claims (1)

USEFUL MODEL FORMULA The method of treatment of primary open-angle glaucoma, which includes hypotensive therapy and the use of a drug with metabolic and antioxidant properties, which differs in that as a drug with metabolic and antioxidant properties, cerebrocurin is prescribed in 2 ml of a solution for injection intramuscularly 1 time per a day for the first 5 days, and then - 0.5 ml parabulbar under each eye and 1 ml intramuscularly for 5-15 days, with a course to improve visual acuity and normalize intraocular pressure.