Method for the diagnosis of clinical variants of glaucoma in individuals with myopic refraction

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and can find application in the diagnosis of clinical variants of glaucoma that develops on the eyes with myopia. The diagnostic method is based on a comparative assessment of the degree of narrowing of the boundaries of the field of vision in the nasal and temporal half, the definition of linear blood flow velocity (BFV) in the Central retinal artery (CAC), the posterior short ciliary arteries (SCCA), ophthalmic Vienna (HS), and differentiate the prevalence of pathology in the arterial or venous link orbital blood flow in conjunction with hydrodynamic performance, while increasing the intraocular pressure (IOP) (Ro) to 19,0 mm RT.article and above, the reduction factor ease of movement (KLO) below 0.15 mm3/mm RT.article min and minute volume of liquid (WMS) below 0.9 mm3/min, with a predominance of the degree of narrowing of the boundaries of the field of vision in the nasal half compared with the degree of narrowing the field of vision in the temporal half, the expansion of the excavation of the optic nerve disc>0.6 and the decrease in BFV in SCCA 40% or more with normal venous outflow, diagnose ischemic variant of primary open angle glaucoma (POAG) in individuals with miopiceski values: Ro>17.0 mm RT.art., KLO-0.18 mm3/mm RT.article min and above, CAN be more than 1.5 mm3/min and the decrease in BFV in SCCA and CAC no more than 20%, combined with a slowdown in BFV in GW 25% or more, diagnose dyscirculatory variant of POAG in individuals with myopic refraction. The method allows to determine the hemodynamic link in the pathogenesis of glaucoma myopia medium and high, which in turn allows you to make the right choice in the treatment of patients.

The invention relates to medicine, namely to ophthalmology, and can find application in the diagnosis of clinical variants of glaucoma that develops on the eyes with myopia.

Glaucoma is one of the major problems in ophthalmology, because for many years occupied a leading place in the structure of disability. Every year again ill glaucoma 1 out of 1000 people over the age of 40 years. Among the clinical forms of the disease the most important primary open-angle glaucoma (POAG), which is 70% among all glaucomatous eye lesions (Smith E. A., et al. Pathogenetic aspects of treatment of primary open-angle glaucoma. M., 2001, S. 3-4).

The problem of early diagnosis of glaucoma is of great medical and social importance, so is assification glaucoma, which provides for the allocation of open-angle, angle-closure, and mixed forms. The basis of this division, the supposed structure of the anterior chamber angle and comparative evaluation with normal anatomic-topographic parameters (Nesterov A. P. Glaucoma. M., 1995, S. 76-83).

Glaucoma in individuals with myopic refraction on the classification of the loop is to open the form, but many clinical and physiological parameters are fundamentally different from the so-called “classic” POAG. The distinctive anatomical characteristics of glaucoma in individuals with myopia include the following: increase in the size of the eyeball, stretching scleral ring and physiological excavation of the optic disc (optic nerve disc). Due to the presence of the specific structure of the eyeball with myopia have difficulty early detection of glaucoma, since the known methods of diagnosis of POAG be not very informative in this category of patients.

There is a method for early diagnosis of POAG (A. S. No. 492280, 1975) by the comparative determination of the area of the blind spot before and after periommatinae compression. By increasing the area of the blind spot with respect to the norm diagnose glaucoma. The disadvantage of this is ikenye the blind spot.

A known method for the diagnosis of glaucoma and evaluation of treatment effectiveness (A. S. No. 812289, 1981) dosed by increasing IOP, determine the threshold static perimetric studies after vacuum compression and the presence of defects in the field of view establish the diagnosis of glaucoma. The disadvantage of this method is its invasiveness for the myopic eye, the likelihood of bleeding by compression of the choroidal or retinal vessels into force expressed the original chorioretinal dystrophy.

In the diagnosis of POAG emphasizes the totality of symptoms: increased intraocular pressure, narrowing of the field of vision in the nasal half of the increase in excavation of the optic nerve disc (Nesterov A. P. Glaucoma. M., 1995, S. 165-170). These parameters are very variable in patients with glaucoma with myopic refraction due to various changes in orbital blood flow and anatomical-topographical relationships. In POAG pathogenesis its development note is the deterioration of the arterial link, mainly in the ophthalmic artery (HA) (I. Loskutov A. Medical treatment of primary open-angle glaucoma. M., 2001, S. 60-70.)

In the pathogenesis of glaucoma, developing in patients with myopic refraction, changes occur in arterialized glaucoma, on the hydrodynamics of the eye and require different approaches to treatment. It should be emphasized that the linear blood flow velocity (BFV) in HA glaucoma in myopic eye can vary from 22 to 52 cm/S.

The closest analogue, taken as a prototype, is a method for early diagnosis of POAG (Nesterov A. P. Glaucoma. M., 1995, S. 172-173), providing for the diagnosis of glaucoma in the presence of the following symptoms: change the optic nerve disc in glaucoma type, visual field defects glaucoma nature, pathological indicators of aqueous outflow, the asymmetry of the IOP and the values of e/D, severe degeneration of iris and pigmentation trabeculae and asymmetry of these indicators. The disadvantage of this method is its low information content in patients with myopia of high to medium, so as myopia, by itself, is accompanied by the development of degenerative changes in the anterior and posterior segment of the eye. Due to the tension of the eyeball in myopia the IOP often does not exceed the average rate. In addition, the IOP and the degree of degeneration independent of changes in orbital blood flow.

The objective of the invention is to develop a method for the diagnosis of clinical Technical result is the selection of two variants of clinical course of glaucoma in individuals with myopia: open-angle glaucoma flowing through the ischemic type, and open-angle glaucoma, flowing through dyscirculatory type.

The technical result is achieved in that in the method for the diagnosis of clinical variants of glaucoma in individuals with myopic refraction, including defining the boundaries of the field of view, the parameters of the optic nerve, IOP and indicators of hydrodynamics, according to the invention, additionally determine BFV in the Central artery of the retina (CAC), the posterior short ciliary arteries (SCCA), ophthalmic Vienna (HS) and differentiate the prevalence of pathology in the arterial or venous link orbital blood flow in conjunction with hydrodynamic performance, while increasing the true IOP (Ro) to 19,0 mm RT.article and above, the reduction factor ease of movement (KLO) below 0.15 mm3/mm RT.article min and minute volume of liquid (WMS) below 0.9 mm3/min, with a predominance of the degree of narrowing of the boundaries of the field of vision in the nasal half compared with the degree of narrowing the field of vision in the temporal half, the expansion of the excavation of the optic nerve disc>0.6 and the decrease in BFV in SCCA 40% or more with normal venous outflow, diagnose ischemic variant of POAG in individuals with myopic refraction, and in similar settings SUP>3/min and the decrease in BFV in SCCA and CAC no more than 20%, combined with a slowdown in BFV in GW 25% or more, diagnose dyscirculatory variant of POAG in individuals with myopic refraction.

The proposed method allows to determine important hemodynamic link in the pathogenesis of glaucoma myopia medium and high, which in turn allows you to make the right choice in the treatment of patients.

Example 1.

B-Naya K., 48 years (East. bol. 24/2003)

VOD=0.1 sph-6.0 D=0.7

VOS-0.1 sph-8.0 D =0.4

These monografii: OD Ro=19.5, C=0.10, F=0.9, Rho=195

OS Po=19.5, C=0.07, F=0.67, Po/c=279

Gonioscopy - the anterior chamber Angle is open, wide profile, atrophy of the iris, moderate pigmentation trabeculae in both eyes.

The fundus of both eyes: the optic nerve disc pale pink around staphyloma, e/D=0.6 to the right, 0.7 - left, arteries are narrowed significantly, the ratio of the caliber of vessels 1:3.

Field of view

OD-narrowing of the boundaries in the nasal half to 35 degrees from the fixation point, in the temporal half to 70 degrees.

OS-narrowing of the boundaries in the nasal half to 20 degrees from the fixation point, in the temporal half to 70 degrees, i.e., in the nasal half of the field of vision narrowed to 25 degrees the whisker with respect to the norm.

Data ULTRASOUND scan of the orbital vessels (BFV (cm/s)

OD: CAC=7; SCCA=10; HS=9.

OS: CAC=6; SCCA=9; GW=9.

The results obtained show a decrease in BFV orbital arteries by 40-50% compared to normal at normal venous outflow. On the basis of data obtained diagnosed with POAG advanced stage, with moderately elevated intraocular pressure, ischemic option, high myopia in both eyes. Patient treatment: Betaxolol on 1 drop×2 times a day, INSTENON FORTE 1 tab.×3 times per day for 2 months, magnetotherapy on orbital and parietal-occipital region, No. 10.

When you examine the patient after 2 months of a positive dynamics: the IOP was normalized and improved hydrodynamics - Ro=15.4, C=0.19, F=1.3, Po/c=81, on both eyes. The field of vision has expanded to a total of 8 Meridiani 40 degrees in the right eye and the 35 - to-left.

Example 2.

B-Naya A., 40 East. bol. 43/2003)

VOD=0.08 sph-8.0 D=0.9

VOS=0.06 sph-9.0 D=0.6

These monografii: OD Po=17.3, c=0.18, F=1.5, Po/c=108

OS Po=22.3, c=0.20, F=2.46, Po/c=l 12

Gonioscopy - the anterior chamber Angle is open, wide profile, atrophy of the iris with obnagenniy caliber and high blood prelimarny vessels, atrophy of the iris.

The fundus of both eyes: the optic nerve disc pale pink around the myopic staphyloma, e/D=0.6 to the right, 0.7 - left artery of normal caliber, Vienna expanded twice, full-blooded.

Field of view

OD-narrowing of the boundaries in the nasal half of up to 40 degrees from the fixation point, in the temporal half to 75 degrees.

OS-narrowing of the boundaries in the nasal half to 35 degrees from the fixation point, in the temporal half to 70 degrees. Thus, on the background of concentric narrowing of the visual field characteristic of high myopia, is determined by the predominance of narrow borders in the nasal half.

Data ULTRASOUND scan of the orbital vessels (BFV (cm/s)

OD: CAC=14; SCCA=15; HS=5.

OS: CAC=12; SCCA=15; HS=4.

The results obtained show a decrease in BFV orbital arteries by 15-20% compared to the norm, with a significant slowing of the venous outflow by 40-45%. On the basis of data obtained diagnosed with POAG advanced stage, with moderately elevated IOP, dyscirculatory option. Patient treatment: ksalatan 1 K×1 p/day at night and the preparations improving venous outflow, GINKYO 1 tab.×3 R/day for 2 Me4, C=0.24, F=1.3, Po/c=64 for both eyes. The field of vision widened in his right eye at 55 degrees total 8 meridianum and 40 degrees in the left eye.

Thus, the application of the proposed method allows to evaluate the hemodynamics of the eye, which in turn allows you to assign adequate treatment that improves visual function in severely ill patients with combined pathology of glaucoma and myopia.

Method for the diagnosis of clinical variants of glaucoma in individuals with myopic refraction by defining the borders of the visual field, optic disc, IOP and indicators of hydrodynamics, characterized in that it further determine BFV in the Central artery of the retina (CAC), the posterior short ciliary arteries (SCCA), ophthalmic Vienna (HS) and differentiate the prevalence of pathology in the arterial or venous link orbital blood flow in conjunction with hydrodynamic performance, while increasing the true IOP (Ro) to 19,0 mm RT.article and above, the reduction factor ease of movement (KLO), below 0.15 mm3/mm RT.article min and minute volume of liquid (WMS) below 0.9 mm3/min, with a predominance of the degree of narrowing of the boundaries of the field of vision in the nasal half compared with the degree of suzani is e, with normal venous outflow, diagnose ischemic variant of POAG in individuals with myopic refraction, and in similar settings pathology of the optic nerve disc, boundaries of the field of view, but when values: Ro>17.0 mm RT.art., KLO-0.18 mm3/mm RT.article min and above, CAN be more than 1.5 mm3/min and the decrease in BFV in SCCA and CAC no more than 20%, combined with a slowdown in BFV in GW 25% or more, diagnose dyscirculatory variant of POAG in individuals with myopic refraction.



 

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