RU2730975C1 - Method of treating endothelial-epithelial dystrophy of cornea - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology, and concerns treating endothelial-epithelial corneal dystrophy. That is ensured by complex treatment involving local application of taurine and dexpanthenol, systemic introduction of ascorbic acid, thiamine and pyridoxine, as well as introduction of autoplasma under eye conjunctiva in empirically designed mode.

EFFECT: it provides intensification of regeneration and improvement of water-salt metabolism in cornea due to complex action of used medicinal agents.

1 cl, 4 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used for the treatment of acquired degenerative processes of the anterior part of the eyeball, in particular the cornea, including postoperative dystrophies.

Endothelial-epithelial dystrophy of the cornea of the eye is a serious and, as a rule, a secondary disease that develops as a result of injuries, surgical interventions, and previous inflammatory diseases of the cornea, occupies one of the leading positions among the causes of corneal diseases in the Russian Federation. The cause of this chronic disease, which is difficult to treat, is associated with a violation of water-salt metabolism due to damage to the corneal endothelium. The resulting edema causes stratification of its tissues, a violation of transparency, which is accompanied by a decrease in visual acuity and persistent pain syndrome. Drug treatment of keratopathy is not very effective. Symptomatic remedies are used. There are also methods for the treatment of keratopathy, such as phototherapeutic keratostromectomy, the introduction of the patient's autologous blood with a suspension of hydrocortisone into the corneal stroma, the introduction into the anterior chamber of autoplasma activated by poludane, the technique of cross-linking corneal collagen. / Bikbova G. M, Bikbov M. M., Ophthalmosurgery No. 2, 2009, Corneal diseases /.

According to modern concepts, a significant role in the development of endothelial-epithelial dystrophy of the cornea is played by primary and secondary processes of a dystrophic and infectious nature, leading to the death of endothelial cells, which leads to dysfunction of the endothelial layer of the cornea. With the loss of endothelial cells (less than 500 cells per 1 mm), the permeability of the cornea increases, the fluid diffuses into the stroma, chronic edema develops and bullae are formed on the surface of the cornea. The failure of the barrier function of the endothelial layer of the cornea, according to a number of authors, occurs in most cases as a result of surgical interventions in the anterior segment of the eye: in 1.2-14% after cataract removal with implantation, more often than an anterior chamber intraocular lens (IOL) and in 5.8% - after antiglaucoma operations. Phacoemulsification contributes to the loss of up to 10% of endothelial cells. The volume of endothelial cell loss correlates with the size of the corneal incision, its location, the degree of cataract density, the parameters of the ultrasound used and the volume of irrigation fluid, and also depends on the specific clinical situation. The choice of therapeutic measures for endothelial-epithelial corneal dystrophy is determined by the stage of the pathological process and is currently carried out in two directions: conservative and surgical.

The task of pharmacotherapy of endothelial-epithelial corneal dystrophy is to reduce chronic corneal edema, relieve symptoms of discomfort and improve visual functions. In the conservative treatment of endothelial-epithelial corneal dystrophy, the use of various keratoprotective, hyperosmotic, tear substitutes, antioxidant, antibacterial agents, as well as therapeutic soft contact lenses and laser radiation is provided. / Filippova E.O., Krivosheina O.I. Point of view. East - West. No. 1 2017. Literature reviews /. It is not always possible to stabilize the process and enhance the regeneration of endotheliocytes only by conservative methods.

The technical problem solved by the present invention consists in creating a method that makes it possible to enhance the regeneration of corneal endothelial cells, improve water-salt metabolism in the cornea, prolong the period of remission, and improve visual functions.

A variant of a therapeutic procedure using a medicinal preparation of aminobenzoic acid and the patient's autoblood plasma is proposed.

The method is carried out as follows. At the first stage of treatment, the patient receives a comprehensive general and local antioxidant, metabolic, vascular, keratoprotective, antibacterial treatment, vitamin therapy. To do this, use drugs i / v ethylmethylhydroxypyridine succinate 5%, i / v ascorbic acid 5%, s / c vitamins of group B thiamine 5% - 1.0 ml, pyridoxine 5% - 1.0 ml, topical installation of solutions taurine 4%, dexpanthenol 5% ...

At the second stage of treatment, the patient receives an injection under the conjunctiva of autoplasma, which includes aminobenzoic acid and the patient's autoblood plasma, which is prepared immediately before use. The method for preparing autoplasma includes: taking the patient's blood from the cubital vein, with a volume of 4 ml into a test tube, with the addition of 1 ml of a solution of aminobenzoic acid 0.0007%, then one-stage centrifugation of the mixture at a speed of 3000 rpm on the ELMICM-6MT apparatus, for 15 minutes. The resulting autoplasma is injected subconjunctivally in an amount of 1.5 ml. The patient digs out the remaining solution independently into the conjunctival cavity 1-2 drops 6-8 times a day during the day. The interval between injections of the patient's autoplasma is 7 days, the course of treatment is general 5-7 weeks (i.e., once a week). Control examination is carried out weekly throughout the course of treatment, then after 3 and 6 and 12 months, then as needed. As a concomitant long-term therapy, the installation of reparative drugs is taurine 4%, dexpanthenol 5%, bromfenac 0.09% for 14 days.

The method allows to stimulate the processes of regeneration of the corneal epithelium, enhance the reparative properties of endothelial cells, normalize the water-salt balance, improve the quality of life of patients and achieve a lasting result from the treatment.

The method is confirmed by the following clinical example:

Example 1. Patient G., 78 years old, was referred for treatment to the ophthalmological department of GAUZ JSC AOKB with complaints of pain, lacrimation, photophobia, foreign body sensation and redness of the right eye. Considers himself a patient for 4 years.

Anamnesis: In 2015, the operation FEC + IOL in both eyes was performed. Is registered with a diagnosis of Glaucoma, installs Betoptic solution 2 times a day in both eyes.

Objectively: Visus OD = hand movement near the face

With biomicroscopy: OD- normotonic (IOP according to Maklakov 20 mm Hg). The cornea is diffusely edematous, descemetitis, more in the optical zone. The moisture of the anterior chamber is transparent. The anterior chamber is of medium depth. The iris is atrophic, the pupil is in the center, there is no reaction to light. IOL ZK is centered, Fundus reflex is weakened due to corneal changes. The fundus of the eye behind the fleur is not clearly detailed.

Was diagnosed with Endothelial-epithelial corneal dystrophy 3 tbsp. right eye. Artifakia in both eyes. OUG2 "a" of both eyes. The patient was prescribed the following treatment: Stage 1 - installation of Taurine solution 4% 6 r / d, Dexpanthenol 5% 3 r / d, IV solution of ethylmethylhydroxypyridine succinate 5% 4.0 ml in saline solution No. 7, IV solution Ascorbic acid 5% 4.0 ml in saline solution No. 7, n / a thiamine 5% -1.0 ml, pyridoxine 5% 1.0 ml. This therapy showed a weakly positive dynamics, a decrease in the patient's complaints, but the manifestations of descemetitis and keratopathy persisted.

At the 2nd stage, the patient underwent an injection of an autoplasma solution containing 0.0007% aminobenzoic acid and autoblood plasma under the conjunctiva. With dynamic observation, already on the 3rd day after the injection, there was a decrease in corneal edema, descemetitis, an increase in corneal transparency. Inpatient treatment lasted 7 days, with the discharge of Visus OD = 0.03 n / a, a persistent positive effect of the treatment remained. Subsequently, this patient underwent outpatient 5 injections of autoplasma solution, including aminobenzoic acid 0.0007% and autoblood plasma, under the conjunctiva with an interval of 7 days.

3 months after applying the method: with biomicroscopy, the eye is calm, the cornea is mild edema in the optical zone, minor phenomena of descemetitis in the central zone, visual acuity increased to Visus OD = 0.06 n / a. Control examination was carried out after 3, 6, 12 months, the stabilization of the disease is noted.

Example 2. Patient L., 59 years old, was referred for treatment to the ophthalmology department of GAUZ JSC AOKB with complaints of pain, periodic lacrimation, photophobia, feeling of foreign bodies in the right eye. Considers himself sick for 5 years.

From the anamnesis it is known what is observed in an ophthalmologist at the place of residence with a diagnosis of angle-closure glaucoma, in the anamnesis - operations STE + ZTS + ICR of the right eye in 2017 FEC + IOL of the right eye, explantation of the IOL of the right eye, CPK on the right eye in the MNTK "Eye Microsurgery" them. Acad. S.N. Fedorov, Khabarovsk.

Objectively: Visus OD = 0.01 n / c

When biomicroscopy: The anterior segment and the accessory apparatus of the eye - the filtration cushion is flat. Cornea - edematous, bullous changes in the epithelium, descemetitis in the optical zone. Scleral autodrainages in the UPC at 10 and 14 hours, Anterior synechiae from 7 and 12 hours to the optical zone, The moisture of the anterior chamber is transparent. The anterior chamber is shallow. Afakia. Deep-lying environment, fundus is not clearly visualized.

Diagnosed with endothelial-epithelial dystrophy of the cornea, grade 3, operated on with ZUG 4 "a", aphakia, avitria of the right eye.

The patient was prescribed the following treatment: Stage 1 - installation of a solution of Taurine 4% 6 r / d, Dexpanthenol 5% 3 r / d, IV solution of ethylmethylhydroxypyridine succinate 5% 4.0 ml. in saline solution No. 7, i / v solution Ascorbic acid 5% 4.0 ml in saline solution No. 7, n \ c thiamine 5% -1.0 ml, pyridoxine 5% 1.0 ml. This therapy showed a weakly positive dynamics, a decrease in the patient's complaints, but bullous changes in the cornea persisted.

At the 2nd stage, the patient underwent an injection of an autoplasma solution containing 0.0007% aminobenzoic acid and autoblood plasma under the conjunctiva. With dynamic observation, already on the 2nd day after the manipulation, there was a decrease in corneal edema, a decrease in descemetitis, an increase in the transparency of the cornea, the bullae were opened and partially epithelized. Inpatient treatment lasted 7 days, with the discharge of Visus OD = 0.02 n / a, a persistent positive effect of the treatment remained. Subsequently, this patient underwent outpatient 6 injections of autoplasma solution, including aminobenzoic acid 0.0007% and autoblood plasma, under the conjunctiva with an interval of 7 days.

3 months after the application of the technique: with biomicroscopy, the eye is calm, with fluorescein staining, epithelial defects were not detected .. Control examination was carried out after 3, 6, 12 months, visual acuity recovered to Visus OD = 0.02 n / a, which proves the stabilization of dystrophic process in the cornea.

Example 3. Patient M., 62 g, was referred for treatment to the ophthalmology department of GAUZ JSC AOKB with complaints of pain, lacrimation, photophobia, feeling of a foreign body in the right eye. Considers himself ill for 3 months, when pain and decreased vision of the right eye appeared. Previously, she noted periodic cramps in the eyes, instilled preparations of artificial tears and the complaints subsided. From the anamnesis it is known what is observed in the optometrist at the place of residence with a diagnosis of Artifakia, in the anamnesis - EEC surgery of the right eye with IOL implantation about 15 years ago.

Objectively: Visus OD = 0.01n.k

When biomicroscopy: OD - Mixed injection of the eyeball. Ciliary soreness, corneoscleral scar from 10 am to 2 pm. Cornea - edematous, discemetitis. The moisture of the anterior chamber is transparent. P \ to medium depth. Iris: the drawing is shaded, the pupil is rounded, in the center, there is no reaction to light. IOL is centered. The fundus reflex is weakened. Deep-lying media are not clearly ophthalmoscopic. Was diagnosed with Acute uveitis, endothelial-epithelial corneal dystrophy 3 tbsp. right eye. Artifakia in both eyes.

The patient was prescribed the following treatment: in order to relieve uveal phenomena, general and local anti-inflammatory and antibacterial therapy was prescribed, on the 4th day of inpatient treatment, uveitis phenomena were completely stopped, Visus OD = 0.03 n / a. In order to improve visual acuity, the following technique was used: Stage 1 - instillation of a solution of Taurine 4% 6 r / d, Dexpanthenol 5% 3 r / d, IV solution of Ethylmethylhydroxypyridine succinate 5% 4.0 ml. on saline solution No. 7, in / in solution Ascorbic acid 5% 4.0 ml. on saline solution No. 7, n / a thiamine 5% 1.0 ml, pyridoxine 5% 1.0 ml. At the 2nd stage, the patient underwent an injection of an autoplasma solution containing 0.0007% aminobenzoic acid and autoblood plasma under the conjunctiva. With dynamic observation on the 4th day after the manipulation, there was a decrease in corneal edema, a decrease in descemetitis, an increase in the transparency of the cornea, with the discharge of Visus OD = 0.2 with core-1.0 = 0.5, a persistent positive effect of treatment remained. Subsequently, this patient underwent outpatient 5 injections of autoplasma solution, including aminobenzoic acid 0.0007% and autoblood plasma, under the conjunctiva with an interval of 7 days.

3 months after the application of the technique: with biomicroscopy, the eye is calm, the cornea is transparent, slight descemetitis in the optics. Control examination was carried out after 3, 6, 12 months, visual acuity increased to Visus OD = 0.2 with short-1.0 = 0.7, no cuts and lacrimation, which proves the stabilization of the dystrophic process in the cornea.

Example 4. Patient K., 68 years old, was referred for treatment to the ophthalmology department of GAUZ JSC AOKB with complaints of pain, decreased vision, feeling of a foreign body in the right eye. Considers himself sick for 2 weeks.

From the anamnesis it is known, in the anamnesis FEC + IOL of the left eye in 17 g of the MNTK "Eye Microsurgery" them. Acad. S.N. Fedorov, Khabarovsk, FEC + IOL of the right eye in August 19, city clinical hospital.

Objectively: Visus OD = 0.01 n / c

When biomicroscopy: OD - light pericorneal injection, Cornea - edematous, single bullae in the optical area, descemetitis. The moisture of the anterior chamber is transparent. P \ to medium depth. Iris: dystrophy of the pigment leaf, the pupil is rounded, in the center, the reaction to light is lively. IOL ZK is centered. The fundus reflex is weakened. Deep-lying media are not clearly ophthalmoscopic.

Diagnosis: Endothelial-epithelial dystrophy of the cornea 3 tbsp of the right eye. Artifakia in both eyes.

The patient was prescribed the following treatment: Stage 1 - installation of Taurine solution 4% 6 r / d, Dexpanthenol 5% 3 r / d, IV solution of ethylmethylhydroxypyridine succinate 5% 4.0 ml in saline solution No. 7, IV solution Ascorbic acid 5% 4.0 ml in saline solution No. 7, n / a thiamine 5% 1.0 ml, pyridoxine 5% 1.0 ml. This therapy showed weakly positive dynamics, a decrease in the patient's complaints, however, isolated bullous changes in the cornea persisted. At the 2nd stage, the patient underwent an injection of an autoplasma solution containing 0.0007% aminobenzoic acid and autoblood plasma under the conjunctiva. With dynamic observation, already on the 2nd day after the manipulation, there was a decrease in corneal edema, a decrease in descemetitis, an increase in the transparency of the cornea, the bullae were opened, the cornea was partially epithelized. Inpatient treatment lasted 7 days, when Visus was discharged OD = 0.4 n / a, a persistent positive effect of treatment remained. Subsequently, this patient underwent outpatient 5 injections of an autoplasma solution, including aminobenzoic acid 0.0007% and autoblood plasma, under the conjunctiva with an interval of 7 days.

3 months after the application of the technique: with biomicroscopy, the eye is calm, when stained with fluorescein, no epithelial defects were detected, the cornea is transparent, single folds of the Descemet membrane in the area of the postoperative corneal scar. Control examination was carried out after 3, 6, 12 months, visual acuity recovered to Visus OD = 0.4s-1.0 = 0.7, cramps and a feeling of a foreign body did not bother.

Thus, the proposed method for treating endothelial-epithelial corneal dystrophy using a patient's autoplasma solution containing 0.0007% aminobenzoic acid and autoblood plasma makes it possible to improve visual functions, significantly improve the patient's quality of life, reliably stabilize the dystrophic process in the cornea for up to 1 year. In total, it was treated in this way for 2018-2019. 30 people. After treatment in a year up to 80% there is a stable stabilization of the process and improvement of visual functions.

Claims (1)

A method of treating endothelial-epithelial corneal dystrophy, including at 1 stage within 1-4 days the installation of solutions: taurine 4% - 6 times a day, dexpanthenol 5% - 3 times a day, intravenous solution of ethylmethylhydroxypyridine succinate 5% 4.0 ml in saline No. 7, intravenous solution of ascorbic acid 5% 4.0 ml in saline solution No. 7, subcutaneously: thiamine 5% 1.0 ml, pyridoxine 5% 1.0 ml, at the 2nd stage - injection of autoplasma under the conjunctiva in an amount of 1.5 ml, prepared before use from mixture 4 ml of blood from the patient's cubital vein and 1 ml of aminobenzoic acid 0.0007%, by centrifugation, at a speed of 3000 rpm, on the ELMI CM-6MT apparatus, for 15 minutes, in the amount of 5-7 procedures, with an interval of 7 days, simultaneously carrying out the accompanying therapy with installations of reparative drugs taurine 4%, dexpanthenol 5%, bromfenac 0.09%, for 14 days.