Oxygenated perfluorinated perfusion of the ocular globe to treat ischemic retinopathy

• US 4,795,423 A
• Filed: 08/28/1986
• Issued: 01/03/1989
• Est. Priority Date: 04/14/1980
• Status: Expired due to Term

• Current Assignee: Thomas Jefferson University (Main Line Health System)
• Original Assignee: Thomas Jefferson University (Main Line Health System)
• Inventors: Osterholm, Jewell L.
• Primary Examiner(s): NOT, DEFINED
• Assistant Examiner(s): Colosimo, Mark F.
• Application Number:
  US06/901,640
• Time in Patent Office: 859 Days
• Field of Search: 128/1 R, 604/20, 604/22-29, 604/51, 604/49
• US Class Current: 604/24
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61K 31/02 Halogenated hydrocarbons
• CPC Class Codes: A61K 31/34 having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide
• CPC Class Codes: A61K 9/0026 Blood substitute; Oxygen transporting formulations; Plasma extender
• CPC Class Codes: A61K 9/0029 Parenteral nutrition; Parenteral nutrition compositions as drug carriers
• CPC Class Codes: A61M 1/287 Dialysates therefor
• CPC Class Codes: A61M 1/32 Oxygenators without membranes
• CPC Class Codes: A61M 2025/0213 where the catheter is attached by means specifically adapted to a part of the human body
• CPC Class Codes: A61M 2025/028 having a mainly rigid support structure
• CPC Class Codes: A61M 2202/0464 Cerebrospinal fluid
• CPC Class Codes: A61M 2202/0476 Oxygenated solutions
• CPC Class Codes: A61M 2205/3653 by Joule effect, i.e. electric resistance
• CPC Class Codes: A61M 2210/0693 Brain, cerebrum
• CPC Class Codes: A61M 25/02 Holding devices, e.g. on the body
• CPC Class Codes: A61M 3/02 Enemata; Irrigators
• CPC Class Codes: A61M 3/0212 after use

Abstract

A novel method of treating ischemic retinopathy is disclosed. After diagnosis of ischemic retinopathy, as for example as a result of retinal infarction, the ocular globe is penetrated with two small cannulae. An inflow and outflow perfusion is then established with an oxygenated perfluorochemical emulsion or other physiologically compatible oxygenated liquid. A sufficient perfusion rate is established and maintained to provide the metabolic needs of the retina for the 3 to 5 day period necessary to permit the natural healing process to occur. The method comprises removing at least a portion of vitreous body to create an intraocular perfusion space and establishing a perfusion of physiologically compatible oxygenated fluid through that perfusion space at a rate and for a duration sufficient to permit the natural healing process to occur. Alternatively, a method of diagnosing the condition of retinal tissue suspected of being ischemic is disclosed.

Claims

1. A method of treating retinal ischemia, comprising the steps of:

a. removing at least a portion of the vitreous body to create an intra-ocular perfusion space; and

b. establising a circulation of a physiologically compatible oxygenated liquid through said perfusion space by injecting said liquid into and withdrawing said liquid from said space.

4. The method of claim 1 wherein step (b) further comprises inserting input and output cannulae through the irido-corneal region of the eye.

5. The method of claim 1 wherein said circulation is established at a rate of between about 0.25 to 10 ml/min.

6. The method of claim 5 wherein said circulation is conducted at a pressure of no greater than the normal vitreous pressure of said eye.

8. The method of claim 1 wherein said oxygenated liquid is circulated for a duration and at a rate sufficient to support the aerobic metabolism of the retina until healing occurs.

9. The method of claim 1 further comprising the step of periodically circulating through said perfusion space a transparent solution.

2. The method of claim I wherein said removing step comprises creating an incision at the limbus of the eye adjacent to the irido-corneal angle.

3. The method of claim 2 wherein said removing step comprises using an ultrasonic desecrator to remove a portion of the vitreous body.

7. The method of claim I wherein step (b) comprises inserting an 18 to 25 gauge cannulae into said intraocular perfusion space.

10. The method of claim I wherein said vitreous body is removed at least in the region adjacent to ischemic retinal tissue to be treated.

11. The method of claim 10 wherein said vitreous body is substantially completely removed.

12. A method of diagnosing the condition of retinal tissue suspected of being ischemic, comprising the steps of:

a. removing at least a portion of vitreous body to create an intracellular perfusion space adjacent to said retina;

b. establishing a circulation of a physiologically compatible liquid of known composition through said space by injecting said liquid into contact with said tissue and withdrawing said liquid from said space; and

c. analyzing said liquid withdrawn from said intraocular perfusion space to determine at least one characteristic of said withdrawn liquid which differs from said liquid as injected.

13. The method of claim 12 wherein said method further comprises comparing constituents of said liquid for at least a selected difference in the composition of said injected and withdrawn liquids.

14. The invention of claim 13 wherein said selected difference is a difference in oxygen content.

15. The invention of claim 13 wherein said selected difference is a difference in lactic acid concentration.

16. The invention of claim 13 wherein said selected difference is a difference in carbon dioxide concentration.

17. The invention of claim 13 wherein said selected difference is a difference in ammonia concentration.

18. The invention of claim 13 wherein said selected difference is a difference in enzyme content.

19. The invention of claim 13 wherein said difference is a difference in pH.

20. The invention of claim 13 wherein said difference is a difference in GABA.

21. The invention of claim 13 wherein said difference is a difference in microorganism contents.

22. The invention of claim 21 wherein said microorganism content is a bacterial content.

23. The invention of claim 13 wherein said difference is a difference in ion concentration.

24. The invention of claim 23 wherein said ion concentration difference is a sodium ion concentration difference.

25. The invention of claim 23 wherein said difference is the difference in concentration of potassium ions.

26. The invention of claim 13 wherein said difference is a difference in amino acid concentration.

27. The invention of claim 13 wherein said difference is a difference in concentration of myelin fragments.

28. The invention of claim 13 wherein said difference is a difference in identifiable cellular materials.

29. The invention of claim 13 wherein said difference is a difference in concentration of identifiable cellular organelles.

30. The invention of claim 13 wherein said difference is a difference in protein.

31. The invention of claim 13 wherein said difference is a difference in fats.

32. The invention of claim 13 wherein said difference is a difference in fat content.

33. The invention of claim 13 wherein said difference is a difference in RNA content.

34. The invention of claim 13 wherein said difference is a difference in DNA content.

35. The invention of claim 13 wherein said difference is a difference in cellular metabolic products.

36. The invention of claim 13 wherein said difference is a difference in metabolite content.

37. The invention of claim 13 wherein said difference is a difference in neurotransmitter content.