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Browsing by Subject "lasiaisinjektio"

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  • Diffusion of nanoparticles in the porcine vitreous 
    Turunen, Tiina (2016)
    Posterior eye segment diseases, such as age-related macular degeneration, are leading causes of preventable visual impairment in the developed countries. Direct intravitreal injections are currently routinely used to deliver therapeutic agents most efficiently to posterior eye segment. Regular injections can however cause ocular complications and some drugs may also be toxic to ocular tissues at high local concentrations of free drug. Different nano-sized particulate systems have been extensively studied as possible drug delivery systems for intravitreal administration offering sustained, local drug action with controlled release. The vitreous gel can form a barrier for diffusion of particles due to its macromolecular structure and composition. Furthermore, ageing and different disease states cause changes in the vitreous structure possibly resulting in shift in the intravitreal movement of particulate systems. In the literature part of this Master's thesis ocular drug delivery is reviewed with main focus on drug targeting in the posterior eye segment. In the experimental work liposomes with different lipid compositions and surface charges were prepared as model particulate systems to evaluate the intravitreal diffusion of nanoparticles with confocal microscope. Furthermore, the influence of aging on the intravitreal diffusion was modeled by enzymatic degradation of the vitreous gel structure. It is discovered that vitreous gel hinders the movement of nanoparticles. Level of hindrance depends on particle's characteristics. 100-200 nm anionic particles move quite freely in the negatively charged vitreous gel. Similarly sized cationic particles are immobile in the vitreous due to electrostatic interactions between surface of the cationic particle and anionic glycosaminoglycans in the vitreous. 1 µm anionic and cationic particles are sterically trapped inside the vitreous meshwork created by the 3-dimensional biopolymer network of the vitreal macromolecules. Vitreous liquefaction increases the diffusion rate of nanoparticles but the clinical impact on ocular pharmacokinetics needs further research.
  • Kustannusanalyysi kostean silmänpohjan ikärappeuman hoidossa käytettävien lasiaisinjektioiden vaihtoehtoisista toteutustavoista 
    Jakola, Janne (2017)
    The incidence of wet age-related macular degeneration (AMD) is increasing with ageing. AMD leads to blindness if it is not treated properly. Common treatment is to administrate intravitreal growth factor inhibitors. An ageing population increases the number of patients which overloads the public health services and expands costs. Traditionally, injections have been administered by physicians but because of the limited recourses nurses have been trained to administer injections. In addition, injections can be administered as physician's clinical extra work to alleviate the queue and as an outsourcing service from the private sector. As the resources of the public health service are limited, it is important to evaluate used methods reliably. The target of this research was to investigate the administration costs of intravitreal injections which are administered by physicians, nurses, a physician or a nurse working extra to alleviate the queue or by a private sector. The used method was cost analysis because the effectiveness of the care is the same regardless of the administer of the injection. The source of costs was Ecomed database of HUS, the data of cost accounting and catalogue of billing from the outsourcing service. The costs were examined in perspective of the producer of the service. Based on the cost analysis, the administration costs per injection are following: administered by physicians 51,39 €, nurse-administered 51,19 €, administered by a physician to alleviate the queue 100,46 €, nurse-administered to alleviate the queue 72,87 €, administered by a physician in outsourcing service 276,19 and nurse-administered in outsourcing service 269,85 €. The annual total costs of the producer of the service were 4 563 726 €. By increasing the number of injections administered by a nurse of HUS the need for an outsourcing service can be decreased which may decrease the annual total costs by two million euro. It is important to find cost-effective solutions because the number of patients are increasing. Based on this research it is more profitable to increase the number of injections administered by a nurse of HUS than to train more nurses to administrate injections to alleviate the queue or to work in outsourcing services. The result of this research can be adapted in planning of the public health services.

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