The method of determining the mobility of the ocular prosthesis

 

(57) Abstract:

The invention relates to ophthalmology and is designed to determine the mobility of the ocular prosthesis in patients with anophthalmus at different times after surgery. The method is based on measuring the mobility of the ocular prosthesis on four main meridians. To measure, use the needle-pointer on the suction Cup, attached directly to the ocular prosthesis. First, determine the projection of the center of rotation of the eye prosthesis on the temporal area, then the length of the axis of rotation of the eye prosthesis. Then measured the maximum deviation of the ocular prosthesis in four major meridians. The angles of maximum deviation of the ocular prosthesis is calculated according to the calculation formula. After the measurement of the mobility of the ocular prosthesis in this way in 118 patients we can say that the results obtained are as accurate as possible, the assumption of error is minimized. The way is simple and affordable, does not require complex and expensive equipment, special training of the patient. 2 Il.

The invention relates to ophthalmology and is designed to determine the mobility of the ocular prosthesis in patients with anophthalmus.

In the application of crime, the emergence of "hot spots" in the country, an increase of technogenic and automobile injuries, severe gunshot injuries. After removal of the eyeball must correctly, the timing prosthesis patient. Ocular prosthesis does not only therapeutic, but also cosmetic features. Correctly performed enucleation, timely and careful selection of eye prosthesis allow you to obtain the best cosmetic result.

One of the indicators of cosmetic efficacy of eye prosthetics is the amount of movement of the ocular prosthesis. Currently, the publications on this issue are very few, and methods and devices for determining the mobility of the ocular prosthesis do not allow to accurately evaluate it.

The literature describes several ways to assess the mobility of the ocular prosthesis.

1. Indicative assessment of ocular motility of the prosthesis, which consists in the following. The patient is asked to keep a healthy eye with the object that the doctor moves in front of him in different directions (e.g., right-to-left, top-to-bottom). However, he observes, are the eyeball and the prosthesis synchronously or not and what the position housed in the housing. However, it can be used as approximate, since using them, we can only approximately be judged on the mobility of the artificial eye.

2. The method of measuring the mobility of the ocular prosthesis using tabletop (portable or projection of the perimeter. Table (portable) perimeter consists of a reinforced at the front of the arc black graduations from 0 to 90 degrees. after 5 deg.; chin with a rack; lock eyes with a white object; a light source (e.g., flashlight). Table perimeter is similar to the projection, but much smaller and light source is mounted directly on the device and associated with the arc. The measurement of mobility of the prosthesis is accomplished in the following way: the patient is seated so that the tested eye or ocular prosthesis were on the same line with the center of the arc of the perimeter. Then the doctor slowly moving the light source (e.g., flashlight) on the arc of the perimeter in one direction or another. The patient at this point ensures a healthy eye for a luminous object in the study eye, and in the study of ocular prosthesis moves it to the maximum deviation. The doctor monitors the position of the reflection reflex on the cornea of the eye, or about Lesnoe Apple examinee stops moving, image from a luminous object begins to "slip" from the center of the cornea as for healthy eye and the ocular prosthesis. It serves as a signal to stop the research and determine where the maximum displacement of the eyes or of the prosthesis on the arc of the perimeter in degrees. In exactly the same way determine the maximum deviation of the eyes or of the prosthesis in all other selected meridians (Kataev M. G., I. Filatova A. External methods study patients with anophthalmus, Moscow Scientific-practical conference, April 1998, S. 16-17).

However, this method is rather subjective, as well as glowing object is at a great distance from the patient, which leads to inaccuracy in the study. This method difficult to use in children, as it requires the patient's attention and perseverance. All the above leads to large errors in the study and does not allow to properly evaluate the results of treatment and prosthetics.

3. The method of determining the mobility of the artificial eye with a light source, a flat mirror attached with suction cups type A. L. Yarbus to the prosthesis, and the cartridge with the photosensitive material, on which is projected beam is authorized in the form of geometric shapes (square), the contour of which are mounted red light brand, consistently included walking through the finder for a given program (around the entire outline of the shape) and with a given constant velocity (given interval specified exposure time). Each subsequent light turns on after turning off the previous one. Research starts in polystannanes room. On ocular prosthesis, located in the conjunctival cavity of the patient, put the suction Cup with a mirror. Studied captures second healthy eye red light mark in the center of the square, the light beam from the illuminator is directed to the mirror of the prosthesis at such an angle that reflected from the mirror, the projected light spot in the center of the cartridge with the photosensitive material. Completely turning off the light in the room. Opens the cassette. The patient, in turn locking the second healthy eye briefly lit light brand, leads the eye contours geometric figures (squares), stimulating a similar movement of the prosthetic stump enucleating eyes and, therefore, of the prosthesis. Movement of the prosthesis are recorded on a photosensitive material using a light beam reflected from the mirror prosthetic denture in orbit, I. N. Shevelev, B. C. beisenbaeva journal of ophthalmology, 1977, No. 1, S. 26-27).

This method is quite complicated and time consuming to implement, requires certain equipment, increased attention and intelligence from the patient. It is difficult to use in children. Also used light object at a great distance from the patient, which leads to inaccuracies in the study. All the above makes it possible to reliably estimate the mobility of the artificial eye.

4. The method of measuring the mobility of the ocular prosthesis using a device consisting of two parts: needle-pointer, attached to the suction Cup directly to the prosthesis and a separate semi-circular measurement scale with graduations from 0 to 90 degrees. after 5 deg. Method of measurement with this device (meter) is the following: in the centre of the prosthesis in the area of the pupil is fixed with a rubber sucker, centruy scale, moving it so that in the extreme deviations of the needle pointer is parallel bars. Then when the maximum deviation of the prosthesis in the four main meridians in the direction of the needle-pointers mark the maximum angle of deflection on the scale in the form of a protractor. Received Rasula, Scientific-practical conference, April 1998, S. 16-17). The method is sufficiently informative, the use of needle-pointers in length up to several centimeters, attached directly to the prosthesis, moving on the scale, improves the accuracy of the measurement of mobility of the prosthesis, the technique is simple and easy to use.

This method and apparatus adopted for the nearest equivalent. However, it has disadvantages: the center of rotation of the prosthesis is not in the place of fastening of a needle-suckers, and then for prosthesis, which leads to some inaccuracy of the result.

The technical result of the proposed method is the possibility to determine the mobility of the ocular prosthesis in patients with anophthalmus at different times after surgery with maximum accuracy relative to the center of rotation of the eye prosthesis and more correctly.

The technical result is achieved by determining the mobility of the ocular prosthesis, by determining the maximum deviation of the ocular prosthesis on four main meridians using the measuring pointer, attached directly to the ocular prosthesis, characterized in that you first determine the projection of the center of rotation of the eye pratolina Meridian, then from the center of rotation of eye prosthesis, point M, determine the distance d to the selected point C lying on the axis of the prosthesis and combined with the end of the pointer, and then from the selected point C produces a linear measure of the maximum deviation of the end pointer for the four main meridians a1, a2, a3, a4and the angles of maximum deviation of the ocular prosthesis1,2,3,4each Meridian is calculated by the following formula:

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The method of determining the mobility of the ocular prosthesis is as follows: needle-pointer on the suction Cup is attached directly to the ocular prosthesis, then ocular prosthesis is placed in the conjunctival cavity of the patient. The patient is asked to look upwards and parallel to the needle-pointer put the line in the projection of the temple, then ask the patient to look down and also parallel to the needle-pointer put the second line in the projection of the temple. The intersection of two lines determine a point on the temple, which is the projection of the center of rotation of the eye prosthesis on the temporal area (M). The second stage determines the distance (d) from the center of rotation of eye prosthesis until the end of the needle pointer (C) is the length of the axis of rotation of the eye prosthesis, vyrazhennaya, then ask the patient to look up and the second line, perpendicular to the first, record the deviation of the needle-pointers in millimeters, also measure at the sight of the patient down (Fig. 1). The data obtained are linear deviations of the ocular prosthesis in the vertical Meridian. The deviation of the ocular prosthesis produce right and left in the horizontal Meridian in the following way: by the end of the needle-pointers put the line and ask the patient to look to the right, record the deviation of the needle-pointers in millimeters also to the left (Fig. 2).

According to the data from the angles of maximum deviation of the ocular prosthesis rely on his arctan according to the above formula

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Presents way of the surveyed 118 patients with anophthalmus at different times after surgery, assessed the effectiveness of the formed stump, compared the mobility of the prosthesis depending on the method of filing of the eye muscles, as well as the mobility of the ocular prosthesis when measured in other ways.

Example 1. Patient Bulatseva K. I., 1984 R. Diagnosis: OD-slow traumatic uveitis, subatrophy 3 tbsp., amaurosis. OS-healthy. 29.12.98. OD-enucleation with the plastic stump carbon voennoi scale in the form of a protractor (nearest equivalent) the following data were obtained: the deviation of the ocular prosthesis up to 28 degrees, down to 20 degrees to the right 25 degrees left to 30 degrees.

When measuring needle pointer on a suction Cup mounted on an ocular prosthesis, and two standard lines of the following data were obtained: the length of the axis of rotation of the eye prosthesis (s) = 53 mm, the deviation of the ocular prosthesis up to 20 mm, that when calculating the tangent of 20 degrees, down to 13 mm, which is 13 degrees, right - 15 mm, which is 15 degrees, to the left is 18 mm, which is 18 degrees. The total amount of movement of the ocular prosthesis when measuring the first way was 103 degrees, and when measuring the second way is 66 degrees.

Example 2. Sick Azgaldyan A. O., 1978 R. Diagnosis: OS - consequences of blast injury, subatrophy 3 tbsp., low-grade uveitis, retinal detachment. OD - healthy. 25.06.99. OS - enucleation with the plastic stump carbon felt disk 4.

When measuring needle pointer mounted on an ocular prosthesis, and scales in the form of a protractor (nearest equivalent) the following data were obtained: the deviation of the ocular prosthesis up to -20 degrees, down to 25 degrees to the right 15 left to 20 degrees.

When measuring needle pointer mounted on an ocular prosthesis, and two standard lines were obtained from the following data: the gens is 14 degrees, the deviation of the ocular prosthesis to bottom - 20 mm, which is 20 degrees, right - 10 mm, which is 10 degrees, left - 12 mm, which is 12 degrees.

The total amount of movement of the ocular prosthesis when measuring in the first case was 80 degrees, and the second is 56 degrees.

From the examples above we can say that the measurements method using a needle-pointer, attached to the prosthesis by defining a length axis of the prosthesis and the maximum deviation of the last four major meridians that allow for the most accurate measurement of the mobility of the ocular prosthesis. Definition of the center of rotation of the eye prosthesis and the true length of the axis of rotation allows with mathematical precision to calculate the mobility of the artificial eye and to minimize the assumption of error. The way is simple and affordable, does not require sophisticated equipment and special training of the patient.

Thus, using the above-described method allows to determine the mobility of the ocular prosthesis accurately, simply and objectively.

The method of determining the mobility of the ocular prosthesis by determining the maximum deviation of the ocular prosthesis according to camerasize fact, first determine the projection of the center of rotation of the eye prosthesis on the temporal area (M) as the point of intersection of the projections of the axis of the prosthesis in the maximum deviations of the latter in the vertical Meridian, and then from the center of rotation of eye prosthesis point M determine the distance d from the selected point (S) lying on the axis of the prosthesis and combined with the end of the pointer, and then from the selected point To produce a linear measure of the maximum deviation of the end pointer for the four main meridians and1and2and3and4and the angles of maximum deviation of the ocular prosthesis 1,2,3,4each Meridian is calculated by the following formula:



 

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