The method of differential diagnosis and choice of method of surgical treatment of blepharoptosis

 

(57) Abstract:

The invention relates to ophthalmology and is designed for the differential diagnosis of blepharoptosis and choice of method of surgical treatment. The method of differential diagnosis and choice of method of surgical treatment of blepharoptosis, including the assessment of the functional state of the eye muscles and podnikatela of the upper eyelid. After conducting five daily sessions of electrical stimulation of the trigeminal nerve system blink reflex and the infrared laser stimulation in the area of projection of the lower third precentral gyrus of the cerebral cortex on both sides and in the absence of a difference in position age diagnosed blepharoptosia with functional failure of podnikatela of the upper eyelid. Then spend resection of levator of the upper eyelid. If there is a difference in position of the eyelids diagnose functional viability of podnikatela of the upper eyelid. This is followed by resection of the cartilage of the upper eyelid. The method allows to choose appropriate method of surgical treatment when blepharoptosia while reducing trauma intervention for neuromuscular apparatus of the eye. 2 C.p. f-crystals.

The invention relates to the OFTAL ' the tion.

There is a method of diagnosing blepharoptosia compared characteristics of the palpebral fissure on paired the eyes with the measurement in millimeters of otstoyniy century from the edge of the cornea, the contour of the eyelid margin and the location of the eyelashes, the provisions of the folds of the upper eyelid and others (Callahan A. Surgery of eye diseases. - M., 1963, S. 21 and 22).

The disadvantage of this method is the impossibility to determine the functional state of muscles - podnikatela upper eyelid and determining the activity of the trunk of the oculomotor nerve, which does not allow the selection of an appropriate method of surgical treatment.

The closest analogue of this method is the study of the motion of the century when its diagnostic eversion. The patient turn the upper eyelid and offer to look up. If the upper eyelid returns to its original position, consider its levator functionally wealthy.

To exclude the action of the frontal muscle as podnikatela upper eyelid press galea aponeurotica to the frontal bone and offer to look up (Callahan A. Surgery of eye diseases. - M., 1963, S. 21 and 22).

The described method allows to eliminate the influence of the frontal muscle to the movement of the upper eyelid, mistakenly taken for the function levator, and to determine eguie clear criteria for determining the functional state of muscles, that limits the choice of methods of treatment. According to the research results it is difficult to predict the postoperative effect of repair blepharoptosia.

We were set a task aimed at the creation of a method of differential diagnosis of various options blepharoptosia on the basis of application of electrical stimulation exit points of the branches of the trigeminal nerve system blink reflex and laterotemporal area projection of the lower third precentral gyrus on both sides.

This problem is solved by the fact that in the method of differential diagnosis and choice of method of surgical treatment of blepharoptosis, including the assessment of the functional state of the eye muscles, it is suggested to evaluate the functional viability of podnikatela upper eyelid after conducting five daily sessions of electrical stimulation of the trigeminal nerve system blink reflex and the infrared laser stimulation in the area of projection of the lower third precentral gyrus of the cerebral cortex on both sides and in the absence of a difference in position age diagnosed blepharoptosia with functional failure of podnikatela upper eyelid and hold resection of levator upper eyelid, and in the presence raznitsiy cartilage of the upper eyelid.

Thus, electrical stimulation spend a point electrode, the current exponential form with a frequency of 1 Hz, a pulse duration of 500 MS, 1 min on each point until the contraction of the circular muscles of the eye.

In addition, the IR-laser irradiation area projection of the lower third precentral gyrus of the cerebral cortex spend 5 min on each field, 2 fields per procedure when the power flux density of 2.4 mW/sq. see

theoretical idea underlying the proposed method is the concept of the effect of an increase in locomotor activity levator upper eyelid with laser and electrical stimulation through two components: one at the level of the oculomotor nerve, the stimulation of which is mediated through the brain stem, where the nuclei of all the motor nerves of the eye, under the influence of electric pulses recovering the conductivity of the nerve fibers; the other component - level projection of the lower third precentral gyrus of the cerebral cortex, where the rhythmic irritation occurs the area of hyperactivity that leads to a natural increase of blood flow to this area.

Chuvstvitelnosti impact directly on the exit point of the branches of the trigeminal nerve, that ensures the availability of treatment. Due to the transmission of nerve impulses at the level of the brain stem is mediated stimulation of motor nerves that Innervate levator upper eyelid.

Numerous clinical observations have shown that the use of electrical stimulation system blink reflex allowed to determine the performance of norm and pathology. Diagnostic conclusion can be made on the basis of studying the dynamics of changes of the width of the palpebral fissure, or based on a combination of indicators blink reflex and functional status of podnikatela upper eyelid.

Consideration of the relationship of the above methods allows you to more accurately and objectively assess the functional state of the motor apparatus of the eye.

The technical result of the proposed method is the selection of an appropriate method of surgical treatment when blepharoptosia while reducing trauma intervention for neuromuscular apparatus of the eye.

The technical result is achieved due to the preliminary objective assessment of the functional state of podnikatela upper eyelid.

Use the STV. After laterotemporal lower third precentral gyrus of the cerebral cortex and stimulation of the trigeminal nerve system blink reflex is an increase in the mobility of levator upper eyelid, resulting in changes or does not change the degree of blepharoptosia and increases or does not change the mobility of the upper eyelid, which determines the subsequent choice of surgical treatment method. If increasing the mobility of the upper eyelid, it is sufficient to perform the resection of cartilage. If no changes, it is necessary to perform the resection of levator of the upper eyelid. The proposed method suggests the possibility of influence on the processes of self-regulation and self-healing in the body.

The method is as follows.

Initially conduct the measurement of the width of the palpebral fissure in three positions: 1 - when looking straight, 2 - when you look down and 3 - when you look up. The definition of indicators blink reflex modification M. Y. Gerasimenko (Gerasimenko M. Y. Ultrasound and sinusoidal modulated currents in the rehabilitation of patients after bone-reconstructive surgery in the maxillofacial region.//Dis....Kida.the honey.Sciences. -M., 1988, S. 75). Next Provo parties, point electrode (cathode) of the device, "Necropolis", the anode is located in the hand on the Palmar surface. Electrostimulation is carried out by the current exponential form, a pulse duration of 500 MS, with a frequency of 1 Hz, until the emergence of a visible reduction in the circular muscle of the eye on the side of the irritation. Each point was stimulated for 1 min On a course of treatment for at least 5 daily treatments. Infrared laser irradiation area projection of the lower third precentral gyrus of the cerebral cortex from the office of the Isel-2", 5 min on each field, 2 fields per procedure when the power flux density of 2.4 mW/square, see the end of the course be re-measurement of the width of the palpebral fissure in the three positions and measurement of indicators blink reflex. When positive trend with increasing size of the palpebral fissure in one of the positions and the improvement blink reflex it is concluded that functional conservation of podnikatela upper eyelid.

1. Patient S., 1994, p., was in the eye Department with a diagnosis of operated blepharoptosia left 2 degrees, hyperopic astigmatism in both eyes, amblyopia weak left eye.

From history: the child was in treatment is and the maximum resection of levator of the upper eyelid on the left. Postoperative partial effect.

Admission: visual acuity of the right eye of 0.8, with correction S.F.+1.0 and cyl.+0.5 axis 90 degrees. is 1.0. Visual acuity of the left eye of 0.7, with correction S.F.+1.0 and cyl.+1.0 axis 90 degrees. is 0.8.

Examination: the position of the upper eyelid of the right eye in all the correct positions, mobility in full. On the left is in the primary position, the width of the palpebral fissure already healthy side of 2 mm, when looking up to 3.5 mm and down by 1.5 mm At a calm closing century marked liftall left up to 1.5 mm

Regular planned intervention: re-resection Elevator, with additional resection of the cartilage of the upper eyelid on the left.

Before surgery, a course of 10 sessions was held electrostimulation of the first branch of the trigeminal nerve by the type of blink reflex point electrode (cathode) of the device, "Necropolis", current exponential form with a frequency of 1 Hz, a pulse duration of 500 MS and laterotemporal in the area of projection of the lower third precentral gyrus of the cerebral cortex IR laser apparatus of the "Isel-2", 5 minutes for each field, 2 fields per procedure when the power flux density of 2.4 mW/sq. see

After the sessions are different is in the lagophthalmos left decreased by 0.5 mm Visual acuity of the left eye with spectacle correction increased to 1.0.

Unlike previously planned intervention volume subsequent operations decreased to resection of cartilage of the upper eyelid on the left.

2. Patient S., R. 1993, was in the eye Department with a diagnosis of congenital blepharoptosia right 2 degrees, hyperopic astigmatism in both eyes.

Admission: visual acuity of the right eye of 0.8 with correction cyl.+0.75, axis 90 degrees. is 1.0. Visual acuity of the left eye of 0.8 with correction cyl.+0.75, axis 90 degrees. is 1.0.

Examination: the width of the palpebral fissure in the primary position different from the healthy side of 2 mm, when looking up to 3.5 mm and when looking down the upper eyelid below 1.5 mm of Lagophthalmos with quiet closing of the eyelids is not marked.

Regular planned surgery: resection of levator of the upper eyelid on the right.

Before surgery, a course of 10 sessions was held electrostimulation of the first branch of the trigeminal nerve by the type of blink reflex point electrode (cathode) of the device, "Necropolis", current exponential form with a frequency of 1 Hz, a pulse duration of 500 MS and laterotemporal in the area of the projection of the lower Olya for the procedure when the power flux density of 2.4 mW/sq. see

After the sessions the difference of the position of the eyelids healthy and operated sides were changed on average by 1.0 mm

The amount of subsequent operations decreased to resection of cartilage of the upper eyelid on the left.

Thus, the invention is intended to determine the functional state of the neuromuscular system, providing the effect of raising the upper eyelid with congenital blepharoptosia that can be used to select the most rational approach for surgical intervention and evaluation of its effectiveness.

1. The method of differential diagnosis and choice of method of surgical treatment of blepharoptosis, including the assessment of the functional state of the eye muscles, wherein assessing the functional viability of podnikatela upper eyelid after conducting five daily sessions of electrical stimulation of the trigeminal nerve system blink reflex and the infrared laser stimulation in the area of projection of the lower third precentral gyrus of the cerebral cortex on both sides and in the absence of a difference in position age diagnosed blepharoptosia with functional failure of podnikatela upper eyelid and hold resection of odnimatelna upper eyelid and hold resection of cartilage of the upper eyelid.

2. The method according to p. 1, characterized in that the stimulation spend a point electrode, the current exponential form with a frequency of 1 Hz, a pulse duration of 500 MS, 1 min on each point until the contraction of the circular muscles of the eye.

3. The method according to p. 1, characterized in that the IR-laser irradiation area projection of the lower third precentral gyrus of the cerebral cortex spend 5 min on each field, 2 fields per procedure when the power flux density of 2.4 mW/cm2.

 

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