DE19910654C2 - Infusion solution for macular surgery - Google Patents
Infusion solution for macular surgeryInfo
- Publication number
- DE19910654C2 DE19910654C2 DE19910654A DE19910654A DE19910654C2 DE 19910654 C2 DE19910654 C2 DE 19910654C2 DE 19910654 A DE19910654 A DE 19910654A DE 19910654 A DE19910654 A DE 19910654A DE 19910654 C2 DE19910654 C2 DE 19910654C2
- Authority
- DE
- Germany
- Prior art keywords
- infusion solution
- retina
- surgery
- sodium
- macular
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
- 239000003978 infusion fluid Substances 0.000 title claims description 10
- 238000001356 surgical procedure Methods 0.000 title claims description 10
- WCUXLLCKKVVCTQ-UHFFFAOYSA-M Potassium chloride Chemical compound [Cl-].[K+] WCUXLLCKKVVCTQ-UHFFFAOYSA-M 0.000 claims description 6
- FAPWRFPIFSIZLT-UHFFFAOYSA-M sodium chloride Inorganic materials [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims description 5
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 claims description 3
- 239000001103 potassium chloride Substances 0.000 claims description 3
- 235000011164 potassium chloride Nutrition 0.000 claims description 3
- 239000011780 sodium chloride Substances 0.000 claims description 3
- VMHLLURERBWHNL-UHFFFAOYSA-M Sodium acetate Chemical compound [Na+].CC([O-])=O VMHLLURERBWHNL-UHFFFAOYSA-M 0.000 claims description 2
- -1 citrate ions Chemical class 0.000 claims description 2
- 239000001632 sodium acetate Substances 0.000 claims description 2
- 235000017281 sodium acetate Nutrition 0.000 claims description 2
- 239000001509 sodium citrate Substances 0.000 claims description 2
- NLJMYIDDQXHKNR-UHFFFAOYSA-K sodium citrate Chemical compound O.O.[Na+].[Na+].[Na+].[O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O NLJMYIDDQXHKNR-UHFFFAOYSA-K 0.000 claims description 2
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 claims description 2
- QTBSBXVTEAMEQO-UHFFFAOYSA-M Acetate Chemical compound CC([O-])=O QTBSBXVTEAMEQO-UHFFFAOYSA-M 0.000 claims 1
- 235000011056 potassium acetate Nutrition 0.000 claims 1
- 235000015424 sodium Nutrition 0.000 claims 1
- 230000005945 translocation Effects 0.000 claims 1
- 210000001525 retina Anatomy 0.000 description 15
- 238000000034 method Methods 0.000 description 8
- OYPRJOBELJOOCE-UHFFFAOYSA-N Calcium Chemical compound [Ca] OYPRJOBELJOOCE-UHFFFAOYSA-N 0.000 description 5
- 239000011575 calcium Substances 0.000 description 5
- 229910052791 calcium Inorganic materials 0.000 description 4
- 239000012530 fluid Substances 0.000 description 4
- 230000002262 irrigation Effects 0.000 description 4
- 238000003973 irrigation Methods 0.000 description 4
- 230000002207 retinal effect Effects 0.000 description 4
- FYYHWMGAXLPEAU-UHFFFAOYSA-N Magnesium Chemical compound [Mg] FYYHWMGAXLPEAU-UHFFFAOYSA-N 0.000 description 3
- 230000000694 effects Effects 0.000 description 3
- 210000000981 epithelium Anatomy 0.000 description 3
- 239000007788 liquid Substances 0.000 description 3
- 239000011777 magnesium Substances 0.000 description 3
- 229910052749 magnesium Inorganic materials 0.000 description 3
- 239000000203 mixture Substances 0.000 description 3
- 239000000049 pigment Substances 0.000 description 3
- 239000000243 solution Substances 0.000 description 3
- 239000003855 balanced salt solution Substances 0.000 description 2
- 229910001424 calcium ion Inorganic materials 0.000 description 2
- 210000003161 choroid Anatomy 0.000 description 2
- 238000001802 infusion Methods 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 239000003446 ligand Substances 0.000 description 2
- 239000011159 matrix material Substances 0.000 description 2
- 108091008695 photoreceptors Proteins 0.000 description 2
- 108020003175 receptors Proteins 0.000 description 2
- 239000011734 sodium Substances 0.000 description 2
- 229910052708 sodium Inorganic materials 0.000 description 2
- 210000001519 tissue Anatomy 0.000 description 2
- 230000008733 trauma Effects 0.000 description 2
- 201000004569 Blindness Diseases 0.000 description 1
- BHPQYMZQTOCNFJ-UHFFFAOYSA-N Calcium cation Chemical compound [Ca+2] BHPQYMZQTOCNFJ-UHFFFAOYSA-N 0.000 description 1
- VEXZGXHMUGYJMC-UHFFFAOYSA-M Chloride anion Chemical compound [Cl-] VEXZGXHMUGYJMC-UHFFFAOYSA-M 0.000 description 1
- JLVVSXFLKOJNIY-UHFFFAOYSA-N Magnesium ion Chemical compound [Mg+2] JLVVSXFLKOJNIY-UHFFFAOYSA-N 0.000 description 1
- 229910019142 PO4 Inorganic materials 0.000 description 1
- ZLMJMSJWJFRBEC-UHFFFAOYSA-N Potassium Chemical compound [K] ZLMJMSJWJFRBEC-UHFFFAOYSA-N 0.000 description 1
- 206010038934 Retinopathy proliferative Diseases 0.000 description 1
- 206010064930 age-related macular degeneration Diseases 0.000 description 1
- 230000032683 aging Effects 0.000 description 1
- 239000007864 aqueous solution Substances 0.000 description 1
- 238000002306 biochemical method Methods 0.000 description 1
- 230000015556 catabolic process Effects 0.000 description 1
- 230000003197 catalytic effect Effects 0.000 description 1
- 150000001768 cations Chemical class 0.000 description 1
- 239000000470 constituent Substances 0.000 description 1
- 238000011010 flushing procedure Methods 0.000 description 1
- 230000003993 interaction Effects 0.000 description 1
- 150000002500 ions Chemical class 0.000 description 1
- 208000002780 macular degeneration Diseases 0.000 description 1
- 229910001425 magnesium ion Inorganic materials 0.000 description 1
- NBIIXXVUZAFLBC-UHFFFAOYSA-K phosphate Chemical compound [O-]P([O-])([O-])=O NBIIXXVUZAFLBC-UHFFFAOYSA-K 0.000 description 1
- 239000010452 phosphate Substances 0.000 description 1
- 239000011591 potassium Substances 0.000 description 1
- 229910052700 potassium Inorganic materials 0.000 description 1
- XAEFZNCEHLXOMS-UHFFFAOYSA-M potassium benzoate Chemical compound [K+].[O-]C(=O)C1=CC=CC=C1 XAEFZNCEHLXOMS-UHFFFAOYSA-M 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
- 230000002062 proliferating effect Effects 0.000 description 1
- 108090000623 proteins and genes Proteins 0.000 description 1
- 239000000523 sample Substances 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 230000035807 sensation Effects 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 230000000472 traumatic effect Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
- A61K33/14—Alkali metal chlorides; Alkaline earth metal chlorides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P27/00—Drugs for disorders of the senses
- A61P27/02—Ophthalmic agents
- A61P27/04—Artificial tears; Irrigation solutions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P41/00—Drugs used in surgical methods, e.g. surgery adjuvants for preventing adhesion or for vitreum substitution
Landscapes
- Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Chemical & Material Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- General Health & Medical Sciences (AREA)
- Medicinal Chemistry (AREA)
- Pharmacology & Pharmacy (AREA)
- Organic Chemistry (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Bioinformatics & Cheminformatics (AREA)
- General Chemical & Material Sciences (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Engineering & Computer Science (AREA)
- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
- Surgery (AREA)
- Inorganic Chemistry (AREA)
- Epidemiology (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Ophthalmology & Optometry (AREA)
- Medicinal Preparation (AREA)
Description
Die Erfindung wird im medizinischen Bereich, insbesondere in der Ophthalmologie, angewendet.The invention is used in the medical field, in particular in ophthalmology, applied.
In der Ophthalmologie, insbesondere in der Makulachirurgie, ist es in einer Reihe von Fällen erforderlich, die Netzhaut abzulösen, um den ca. 1 qmm großen hinteren Augenpol zu translozieren. Solche Fälle sind unter anderem subretinale Veränderun gen, insbesondere bei der altersbedingten Makuladegeneration, die etwa 30% der alternden Bevölkerung betreffen kann und unbehandelt in vielen Fällen zur Erblindung führt.In ophthalmology, particularly in macular surgery, it is in a number of In some cases it is necessary to detach the retina in order to remove the approximately 1 square mm large posterior To translocate eye pole. Such cases include subretinal changes genes, especially age-related macular degeneration, which accounts for about 30% of the aging populations can affect and, if left untreated, cause blindness in many cases leads.
Es gibt deshalb seit längerem Bestrebungen, Methoden zu entwickeln und aufzubau
en, um eine gesunde Netzhaut schonend abzulösen, um den Patienten im darunterlie
genden Gewebe operieren zu können. In die chirurgische Praxis haben vier Methoden
Eingang gefunden:
There have therefore been efforts for a long time to develop and build methods to gently detach a healthy retina in order to be able to operate on the patient in the underlying tissue. Four methods have found their way into surgical practice:
- - eine transsklerale Infusion mit intraokularer Spülflüssigkeit- a transscleral infusion with intraocular irrigation fluid
- - eine intraokulare Infusion unter die Netzhaut mit intraokularer Spülflüssigkeit- an intraocular infusion under the retina with intraocular irrigation fluid
- - eine Methode, bei der viele kleine Bläschen mit intraokularer Spülflüssigkeit unter der Netzhaut gesetzt werden, die dann zusammenfließend die Netzhaut ablösen- a method in which many small vesicles are covered with intraocular irrigation fluid the retina, which then merge and detach the retina
- - eine bimanuelle Anhebung der Netzhaut mit Zangen.- a bimanual lifting of the retina with forceps.
Diese Behandlungsmethoden sind traumatisch und haben den Nachteil, daß sie sehr lange dauern. Ein weiterer wesentlicher Nachteil besteht in der Schädigung der Photorezeptoren der Netzhaut und des Pigmentepithels. Diese Veränderungen führen dann auch häufig zu einer massiven Narbenreaktion der Netzhaut (proliferative Viotreoretinopathie) und zur Schädigung der Lichtempfindung des Auges.These treatment methods are traumatic and have the disadvantage that they are very take a long time. Another major disadvantage is the damage to the Photoreceptors of the retina and pigment epithelium. These changes lead then often to a massive scar reaction of the retina (proliferative Viotreoretinopathy) and damage to the eye's sensation of light.
Die letztgenannte Methode ist deshalb nachteilig, weil sie allein auf eine mechanische Arbeitsweise abstellt. Die lange Operationszeit führt zu einer gehäuften Rate der proliferativen Retinopathie, der schwersten Komplikation von Netzhautoperationen. Die anderen drei genannten Methoden arbeiten mit Spülflüssigkeit. Diese Verfahrens weisen sollen die Adhäsion der Netzhaut vermindern und Ablösung von der Aderhaut erleichtern. Das gelingt jedoch bisher nur unzureichend. The latter method is disadvantageous because it relies solely on a mechanical one Stops working. The long operation time leads to an increased rate of proliferative retinopathy, the most serious complication of retinal surgery. The other three methods mentioned work with flushing liquid. This procedure Ways are supposed to decrease the adhesion of the retina and detachment from the choroid facilitate. However, this has so far only been inadequate.
Die Ursachen der vorstehend geschilderten Nachteile bestehen darin, daß die einge setzten Spülflüssigkeiten die Netzhautadhäsion nicht ausreichend vermindern, weil sie von ihrer Zusammensetzung her dazu nicht geeignet sind.The causes of the disadvantages described above are that the irrigation fluids do not sufficiently reduce retinal adhesion because they are unsuitable for this in terms of their composition.
Eine aus der US 5770628 A bekannte ophthalmische Zusammensetzung enthält Natrium-, Kalium-, Calcium-, Magnesium-, Chlorid-, Phosphat- und Citrationen.An ophthalmic composition known from US 5770628 A contains sodium, potassium, calcium, magnesium, chloride, Phosphate and citrate ions.
Die Erfindung hat das Ziel, eine schonende Methode zur Netzhautablösung anzuge ben, durch deren Anwendung die Operationszeit verkürzt und die Sicherheit des Gelingens des chirurgischen Eingriffs erhöht werden kann.The aim of the invention is to provide a gentle method of detaching the retina practice, the use of which shortens the operating time and increases the safety of the The success of the surgical procedure can be increased.
Die Erfindung hat die Aufgabe, eine Infusionslösung anzugeben, welche die Ablösung der Netzhaut vom Trägergewebe erleichtert und damit eine deutliche Erleichterung der Makulachirurgie und eine Verbesserung ihrer Erfolgschancen ermöglicht.The invention has the task of specifying an infusion solution which enables the detachment the retina is relieved by the carrier tissue and thus a significant relief of macular surgery and an improvement in its chances of success.
Die Aufgabe wird erfindungsgemäß dadurch gelöst, daß eine strikt calcium- und magnesiumfreie Infusionslösung angewendet wird.The object is achieved in that a strictly calcium and magnesium-free infusion solution is used.
Der Erfolg dieser Infusionslösung ist eindeutig dem Fehlen der Ionen des Calciums und des Magnesiums geschuldet.The success of this infusion solution is clearly due to the lack of calcium ions and due to magnesium.
Dieser Effekt ist überraschend und kann nicht aus der allgemeinen Erfahrung oder aus üblichem fachgerechten Handeln abgeleitet werden. Im allgemeinen wird versucht, die Wirksamkeit einer Infusionslösung, einer Spülflüssigkeit oder allgemein einer wäßrigen oder auch nichtwäßrigen Lösung, die einen oder mehrere Bestandteile enthält, durch Zusatz weiterer Stoffe zu verbessern. Forscher streben durch Zusatz weiterer Mittel Synergieeffekte an, postulieren katalytische Wirksamkeit oder derglei chen. Es kommt nur in Ausnahmefällen vor, dass durch Reduzieren des Gehaltes einer Lösung um die Hälfte seiner Bestandteile und zwar nicht durch proportionales Reduzieren, sondern durch deren völliges Weglassen, im vorliegenden Beispielfall des Verringern des Kationengehaltes der Infusionslösung von vier auf zwei, eine so gravierende Verbesserung der Gebrauchsfähigkeit eintritt, dass eine Erfindung vor liegt.This effect is surprising and cannot be derived from general experience or from can be derived from the usual professional behavior. In general it is attempted the effectiveness of an infusion solution, a rinsing liquid or a general one aqueous or non-aqueous solution containing one or more components contains to be improved by adding other substances. Researchers aspire by addition further means suggest synergy effects, postulate catalytic effectiveness or the like chen. It only happens in exceptional cases that by reducing the salary a solution by half of its constituent parts, and not by proportional Reduce, but by omitting them completely, in the present example of reducing the cation content of the infusion solution from four to two, one like that Serious improvement in usability occurs that an invention before lies.
Die entwickelte pharmakologisch-biochemische Methode zur Verminderung der Netzhautadhäsion erleichtert deren operative Ablösung, verkürzt die Operationszeit und mindert die Traumatisierung der Netzhaut. The developed pharmacological-biochemical method to reduce the Retinal adhesion facilitates its operative detachment and shortens the operating time and reduces trauma to the retina.
Der Gehalt der erfindungsgemäßen Infusionslösung an Natrium- und Kaliumsalzen
kann variieren. Es zeigte sich, dass eine Lösung, bestehend aus
The sodium and potassium salt content of the infusion solution according to the invention can vary. It turned out that a solution consisting of
für den vorgesehenen Zweck gut geeignet ist.is well suited for the intended purpose.
Jedoch sind auch allgemein intraokular angewendete Infusionslösungen geeignet, wenn sie nur frei sind von Calcium- und Magnesiumionen.However, infusion solutions that are generally used intraocularly are also suitable, if only they are free of calcium and magnesium ions.
Insoweit ist die vorstehend angegebene Lösungszusammensetzung lediglich ein Beispiel.To this extent, the above-mentioned solution composition is only a Example.
Im makulachirurgischen Eingriff wird die calcium- und magnesiumfreie Flüssigkeit anstelle des üblichen BSS (balanced salt solution) verwendet, bis die Netzhaut ablösung beginnt. Die Ablösung beginnt sofort nach Perforation der Retina durch eine Diathermiesonde von der Peripherie zum Zentrum. Dies geschieht wahrscheinlich aufgrund eines Zusammenbruchs der normalen Calciuminteraktionen mit der Inter photorezeptormatrix. Die Ionenbalance zwischen der Interphotorezeptormatrix, die kritisch ist für feste Rezeptorligandenkomplexe, ist gestört und damit verschwindet die starke retinale Adhäsion. Dies bedeutet ein geringes Trauma mit weniger Photorezep torschaden, verkürzte Dauer der Chirurgie, verringerte Ausstreuung von Pigmentepit hel und geringeren Verlust von Pigmentepithel. Magnesium wirkt in ganz ähnlicher Weise im Rezeptorligandkomplex, so dass sein Fehlen die Ablösung der Netzhaut von der Aderhaut zur Vorbereitung eines chirurgischen Eingriffs wesentlich erleichtert.In macular surgery, the calcium and magnesium-free liquid is removed used instead of the usual BSS (balanced salt solution) until the retina replacement begins. The detachment begins immediately after the retina is perforated by a Diathermy probe from the periphery to the center. This is likely to happen due to a breakdown in normal calcium interactions with the inter photoreceptor matrix. The ion balance between the interphotoreceptor matrix that is critical for solid receptor ligand complexes, is disturbed and thus disappears strong retinal adhesion. This means less trauma with less photo prescription gate damage, shortened duration of surgery, reduced spread of pigment epit helium and less loss of pigment epithelium. Magnesium has a very similar effect Way in the receptor ligand complex, so that its absence is the detachment of the retina from the choroid in preparation for a surgical procedure.
Claims (3)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE19910654A DE19910654C2 (en) | 1998-09-07 | 1999-03-10 | Infusion solution for macular surgery |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE19840559 | 1998-09-07 | ||
| DE19910654A DE19910654C2 (en) | 1998-09-07 | 1999-03-10 | Infusion solution for macular surgery |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| DE19910654A1 DE19910654A1 (en) | 2000-03-23 |
| DE19910654C2 true DE19910654C2 (en) | 2000-12-07 |
Family
ID=7879925
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| DE19910654A Expired - Fee Related DE19910654C2 (en) | 1998-09-07 | 1999-03-10 | Infusion solution for macular surgery |
Country Status (1)
| Country | Link |
|---|---|
| DE (1) | DE19910654C2 (en) |
Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5770628A (en) * | 1994-07-25 | 1998-06-23 | Laboratoire Medidom S.A. | Ophthalmic preparation for use as artificial tear |
-
1999
- 1999-03-10 DE DE19910654A patent/DE19910654C2/en not_active Expired - Fee Related
Patent Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5770628A (en) * | 1994-07-25 | 1998-06-23 | Laboratoire Medidom S.A. | Ophthalmic preparation for use as artificial tear |
Also Published As
| Publication number | Publication date |
|---|---|
| DE19910654A1 (en) | 2000-03-23 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| OP8 | Request for examination as to paragraph 44 patent law | ||
| D2 | Grant after examination | ||
| 8364 | No opposition during term of opposition | ||
| 8339 | Ceased/non-payment of the annual fee |