RU2520834C2 - Method for preventing and treating dry eye syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology. A method consists in using a portable dispensing apparatus with an automatically controlled spray dose number, comprising an electronic unit and a hydraulic unit. In the electronic unit, a piezoelectric detector fixed on an orbital bone, a clipping amplifier, a standard pulse shaper, an integrator, a threshold circuit with two thresholds, a feedback is established of a blink rate and the dose number of a medicated mixture injected into conjunctival cavities by means of microcatheters.

EFFECT: using the invention provides regular dosing artificial eye moistening in dry eye syndrome for preventive and therapeutic purposes.

3 dwg

Description

The invention relates to medicine, namely to ophthalmology. The method is based on the use of a special dispenser with feedback for the systematic dosed artificial moistening of eyeballs with a medicinal mixture. The method provides an increase in the effectiveness of the prevention and treatment of dry eye syndrome.

Dry eye syndrome, or dry keratoconjunctivitis, is a condition in which the lacrimal film on the cornea is insufficient for normal hydration of the anterior surface of the cornea. The resulting changes in the state of the surface of the eye are accompanied by uncomfortable sensations and, in severe cases, loss of vision. So in patients with dry keratoconjunctivitis with poor reparative ability, secondary damage to the surface of the corneal and conjunctival epithelium occurs. In turn, corneal epitheliopathy adversely affects the stability of the tear film. Klaassen-Broekema N., Mackor A.J., Bijsterveld O.P. The diagnosis power of the tests for tear gland related keratoconjuctivitis sicca // Neth. J. Med. - 1992. - Vol.40, N3 / 4. - P.113-116 [7].

A known method of treating dry eye syndrome with epithelial stimulants, which include fibronectin, growth factors, etc. Friedlaender M.H. Ocular manifestations of Sjogren's syndrome: keratoconjunctivitis sicca // Rheum. Dis. Clm. North Amer. - 1992. - Vol. 18. - P.591-608. In existing ophthalmic practice, relief of symptoms of dry eye can be achieved by two methods:

1) instilling a drop of epithelial stimulator regularly into the eyes;

2) by closing the opening of the lacrimal tubule with a special stopper. In this case, the loss of tear fluid is reduced by reducing its natural outflow [5, 6].

These methods, however, have a number of disadvantages, the main of which are:

a) the difficulties associated with prolonged multiple and dosed administration of drugs throughout the day;

b) the impossibility of the second method of completely eliminating this syndrome;

c) the need for frequent conducting of unpleasant for the patient eye manipulations.

Known methods for the systematic dosed administration of drugs in the eyeball. So, a portable dispenser of medicinal substances NDL-3 [Certificate on rat. Proposal No. 1141 dated 05/16/97., MNTK “Eye Microsurgery”], is intended for long-term round-the-clock administration of dosed volumes of various liquid drugs according to a given program to a patient in hospital or on an outpatient basis. Close to this is the method of catheterization and permanent perfusion of the conjunctival cavity (conjunctival douche) [Certificate on rat. proposal No. 1142 dated 05/16/97., MNTK “Eye microsurgery”] - for the treatment of purulent keratouveitis [2, 3].

Another method for the systematic administration of a drug mixture in the eyeball region is the method of rational use of drugs when delivering drugs to the subthenon space using a dispenser [RF Patent No. 2335271 of 03.14.07, IPC A61F 9/007, A61M 5/172], which is the closest analogue of the method for the systematic dosed irrigation of eyeballs with a medicinal mixture. Here, for a rational supply of the drug mixture into the subtenon space of the eye, a biotechnological system (BPS MN) with feedback is used [1].

The disadvantage of the analogue is that the feedback system used in it does not provide the necessary effectiveness of the proposed method. Here, firstly, it is difficult to install and fix the electrodes in the area of the conjunctival cavity, secondly, the installation of electrodes in the eye can injure the eye, and thirdly, the patient feels discomfort from a foreign body (electrodes) in the eye.

The aim of the invention is to provide a systematic dosed irrigation of eyeballs with a medicinal mixture, using a special dispenser with automatic control of the number of doses of a drug mixture injected in the area of the conjunctival cavities of the eyes.

The method according to the invention is implemented as follows.

Figure 1 and figure 2 presents the structural diagram of our proposed biotechnological medical system with feedback for the artificial systematic hydration of the eyeballs (BTS-IUG) and a general view of the BTS-IUG. Figure 3 presents time charts explaining the operation of the BTS-YUG. The use of BTS-IUG allows for prophylaxis and treatment both while the patient is working, for example, at a computer, and when he is at rest or watching TV, automatically injecting a dose of the drug mixture into the area of the conjunctival cavities with a decrease in the frequency of eye blinking below the threshold (threshold is set manually).

The principle of operation of the BTS-YUG presented in figure 1, is as follows.

Microcatheters are brought to the conjunctival cavities of the eyes, a piezosensor 2 is attached to the orbital bone, which generates an electric impulse U _d for each blinking act (Figure 3). The signal U _d coming from the output of the piezoelectric sensor (2) is amplified in an amplifier-limiter (3) and fed to a standard pulse shaper (4), which generates standard rectangular pulses U _d supplied to an integrator (5), the output of which is more intense U _and , and further to the two-threshold device (6) for comparison with predetermined thresholds.

When the voltage at the output of the integrator 5 of the upper threshold level (Por.2) is reached, the threshold device 6, the control voltage driver (7) generates a signal to turn off the metering pump motor in the hydraulic unit (9) (via the electronic metering control unit (8)). When this voltage is reduced to the lower threshold (Por.1), the threshold device 6, the specified driver (7) generates a control signal to turn on the metering pump motor in the hydraulic unit (9), also through the electronic control unit (8), and injections occur doses of the drug mixture in the conjunctival cavity of both eyes.

Clinical examples

1. Patient Mirzoeva R., 45 years old. For 5 years suffering from Sjogren's syndrome. Complaints of intense burning in the eyes, photophobia, worse in the evening, when visual work becomes completely impossible. On the cornea, epithelial “threads” periodically form, upon self-removal of which the patient notes temporary relief. On examination, pronounced manifestations of "dry" keratoconjunctivitis were detected against the background of a complete absence of tear menisci. The tear film rupture time (Norn test) was 3 seconds, the amount of total tear production (Schirmer test) was 4 mm / 5 min, and the main secretion (Jones test) was 1 mm / 5 min. The data obtained together made it possible to diagnose: Severe syndromic (Sjogren) corneal conjunctival xerosis of both eyes with impaired tear production and stability of the tear film.

2. Patient G. Ramazanova, 53, suffers from climacteric syndrome (atypical form, postmenopausal period). Complaints of a feeling of a "foreign body" in both eyes, periodic lacrimation and photophobia. When instilling a 0.25% solution of chloramphenicol prescribed by an ophthalmologist at the clinic for chronic conjunctivitis, it burns, and the installation of a 20% solution of sodium sulfacyl does not tolerate due to severe pain. On examination, “flaccid” conjunctival hyperemia, the presence of microparticles in the thickness of the tear film were found. The height of the lacrimal menisci slightly exceeded the norm. The tear film rupture time (Norn test) was 7 seconds. Given the presence of lacrimation, the amount of tear production was not measured. Diagnosed with: “Light syndromic (climactric) corneal conjunctival xerosis with decreased stability of the tear film”.

3. Patient Magomedov X., 67 p. After damage to the facial nerve during neurosurgical surgery, left-sided lagophthalmus arose. He complained of a feeling of “dryness” and a feeling of a “foreign body” in his left eye, as well as its periodic redness. On examination, left-sided paralytic lagophthalmus with viscous mucous discharge from the conjunctival cavity, the absence of lacrimal menisci, microparticles floating in the lacrimal film are determined. The tear film rupture time (Norn test) was 6 seconds, the total tear production (Schirmer test) was 2 mm / 5 min, and the main (Jones test) was 1 mm / 5 min. Diagnosis: “Symptomatic corneal conjunctival xerosis of the left eye of moderate severity with a violation of tear production and stability of the tear film. Paralytic left-sided lagophthalmus "

In all cases, in the complex treatment, a biotechnical system of artificial dosed eye moisturization was used, which provided for the systematic irrigation of the bulbar conjunctiva with a medicinal mixture using a special dispenser with automatic adjustment of the dose of the injected mixture. As a result, stabilization of functional and clinical parameters was observed in all patients.

The proposed method for the prevention and treatment of dry eye syndrome can be widely implemented in ophthalmic practice, especially in day care and outpatient outpatient hospitals.

Literature

1. Patent No. 2335271 dated 03/14/07, IPC A61F 9/007, А61М 5/172 “Rational use of drugs when delivering drugs to the subtenon space using a dispenser”.

2. Certificate on rat. Proposal No. 1141 of 05.16.97, MNTK "Eye Microsurgery."

3. Certificate on rat. Proposal No. 1142 of 05.16.97, MNTK “Eye Microsurgery”.

4. Brzesky V.V., Somov E.E. Dry Eye Syndrome. St. Petersburg: Apollon, 1998 .-- 96 p.

5. Methodological recommendations of the Dry Eye Syndrome - RMAPO, Moscow 2002

6. Pirogov Yu.I., Brzhesky V.V., Davydov V.A., Paschina M.N. Immunological status of patients with dry eye syndrome of various origins // Combat damage to the organ of vision. - SPb., 1993 .-- 135 p.

7. Brzesky V.V., Somov E.E. Corneal conjunctival xerosis (diagnosis, clinic, treatment). St. Petersburg: Publishing House Levin St. Petersburg, 2003. - 120 p.

Claims (1)

A method for the prevention and treatment of dry eye syndrome, which consists in using a wearable dispenser with automatic control of the number of injected doses, consisting of an electronic unit and a hydraulic unit, characterized in that in the electronic unit using a piezoelectric sensor mounted on the orbital bone, an amplifier-limiter, a standard shaper pulses, an integrator, a threshold device with two thresholds, an automatic feedback is established between the frequency of eye blinks and the number of doses of drug Mesi injected into the area of their conjunctival cavities using microcatheters.

Images