Method for determining intraocular pressure tolerance (intolerance) of a patient

FIELD: medicine.

SUBSTANCE: method involves measuring intraocular pressure. Static computer-assisted perimetry method is used in a way that luminous spot serves as test object. The spot acts upon eye in various vision field points with threshold brightness and then in growing sequence. Eye retina light-sensitivity is measured in vision field points under study. The number of points is set with patient examination program. Total light-sensitivity is measured in decibels. Medicamentous reduction of intraocular pressure is achieved with 0.5% Ocupress solution introduced as drops twice with 5-6 min long interval. The intraocular pressure being reduced at least by 4 mm of mercury column, repeated static perimetry examination is carried out. Total light-sensitivity being increased less than by 50 dB, individual initial intraocular pressure tolerance conclusion is drawn. Total light-sensitivity being increased by 50 dB or more, individual initial intraocular pressure intolerance conclusion is drawn.

EFFECT: enhanced effectiveness in determining intraocular pressure tolerance/intolerance.

 

The invention relates to medicine, namely to ophthalmology, and can be applied in the study eye, diagnosis of disease, as well as to the choice of methods of their treatment.

Tolerance - individual portability of intraocular pressure (IOP).

Intolerance - intolerance IOP.

The level of intraocular pressure is one of the significant indicators of the state of the organ of vision, the average rate of which is in the range of 16.0-26.0 mm Hg

However, there is individual variability is the norm, and the same level of IOP can be detrimental in terms of optic nerve injury, and for another - well-tolerated.

There are a number of prognostic tests based on detection of dynamic visual field defects when modifying IOP. In fact determined by the maximum IOP, where preserved, but inhibited nervous elements again begin to function. In some cases, tolerant pressure may exceed the accepted norms of IOP, others have to be lower than normal.

The basic principle of the methodology for determining the tolerance of IOP is the monitoring function of the eye with medication lowering IOP. Depending on which function is being monitored, there are compilations (blind spot), parametrizes the th (on the borders of the visual field), isometrically (visual acuity) and others.

Known isometrically method of determining tolerant (intolerant) intraocular pressure, when watching this feature eye as visual acuity. At the same time. first, measure the initial IOP and record the visual acuity of the patient for a certain TestObject. Then medication reduce IOP and after some time again measure visual acuity. And so to achieve the best studied function of view. Then compare the visual acuity obtained at the baseline IOP, and IOP when was achieved with the highest visual acuity, and then make a conclusion about the level of tolerance of individual IOP (see Republican proceedings of the second Moscow state medical Institute and the all-Russian scientific-methodical glaucoma center. Under the editorship of Professor Aeaster, M., 1983).

Closest to the claimed is Kamenetskii method of determining tolerant IOP (blind spot) (see Physiology and pathology of intraocular pressure. Republican proceedings of the second Moscow state medical Institute and the all-Russian scientific-methodical glaucoma center. Under the editorship of Professor Apostolova, M., 1983).

This method is glycaemia in the following. Measured initial IOP and recorded the status of the function. Then the patient is to reduce the IOP receives 0.25 g diakarba, and after an hour and a 50% aqueous glycerin solution with ascorbic acid. IOP and state-controlled functions are explored in an hour after taking glycerokinase, and then every 30 minutes until then, until it is fixed minimum spot size. Thus, accurate dynamics of the vertical size of the blind spot is reduced to not less than 3, see

After receiving the maximum lifting functions it is necessary to achieve a further reduction in IOP. It is proof that the IOP obtained at the previous measurement, is tolerant, because when it was registered the highest function.

The disadvantages of this method, like the previous one, is its complexity, high cost of time (minimum 4 hours); application of medicines General steps for unloading the eye that gives side effects, imperfect method, as there is a subjective factor, the giver, usually some errors.

The claimed invention is directed to solving the problem of reducing time determine tolerant IOP, as well as the exclusion of the subjective factor, due to the use of computer static perimetric studies, to decrease the possible complexity of the process more than 2 hours, and through the use of topical medications that are designed solely to drip into his eyes.

The invention consists in that the known method of determining the tolerance (intolerance) intraocular pressure of the patient, including the measurement of initial intraocular pressure (IOP), unloading eyes (medical reduction of intraocular pressure) and the influence of testobjects, after measuring the initial IOP use the computer a static perimetric studies, in which TestObject serves as the light spot impinging on the eye in different points of the field of view with a threshold brightness, and increasingly, this measures the level of light sensitivity of the retina in the surveyed points in the field of view, and then determine the total sensitivity in decibels (dB), this drug-induced IOP reduction exercise drip into the eyes of 0.5% solution of ocupress twice with an interval of 5-6 min, with a decrease of intraocular pressure is not less than 4 mm Hg re-produce static perimetry with increasing total sensitivity to below 50 dB conclude about individual tolerance (tolerance) initial intraocular pressure, i.e. resistance to him the optic nerve, and Vice versa, with increasing sum is ary sensitivity 50 dB or more is judged on individual intolerance (intolerance) initial intraocular pressure.

The claimed method is as follows.

First, measure the initial IOP studied his eyes, then the patient is seated firmly against the hemispherical screen computer perimeter, a pair of eyes close and start the measurement sensitivity of the retina. This happens as follows. On the screen at a certain point appears TestObject (light spot) and begins to affect the eye with increasing brightness. Determining the magnitude of the sensitivity of the eye at a given point on minimum brightness, which sees the patient at this point. A similar measurement of the light produced in the points, the number and location of which is given by the programme examination of the patient. The test duration for all points is not more than 6-9 minutes. Then determine the total sensitivity of the eye in decibels when the initial intraocular pressure. After that make unloading eyes (decrease IOP) method drip 0.5% solution of ocupress eyes twice after 5-6 minutes. There is still a 0.2% solution of ocupress, but in our case it is not suitable as it does not unload the eyes of most.

Intervals 5-6 minutes required for full suction drops of ocupress.

The maximum exposure ocupress occurs after 1 hour, i.e. achieved a specified reduction in the DG is not less than 4 mm Hg After that make repeated static perimetry (described above). Then compare the digital level of sensitivity of the retina to discharge his eyes and after discharge from the eye.

And when you increase the overall speed to below 50 dB conclude about individual tolerance (tolerance) source IOP, i.e. resistance to him the optic nerve and Vice versa, when the increase of the overall sensitivity 50 dB or more is judged on individual intolerance (intolerance) initial intraocular pressure. Then, if necessary, all the operations and modes of way make with the other eye of the patient.

And then make conclusions about the feasibility of anti-hypertensive treatment.

Example No. 1.

Patient Kuznetsov A.V., 68 years. The initial intraocular pressure was 24 mm RT. Art. the total sensitivity of the retina amounted to 1,125 dB. One hour after the introduction of ocupress IOP decreased to 19 mm RT. senior and total sensitivity increased to 1.223 dB, an increase of 98 dB, including 57 dB in the upper nasal quadrant. Thus, the initial pressure of 24 mm RT. Art. should be considered intolerant (unbearable) to the eye of the patient, although it is within statistical norms. Patient assigned to antihypertensive therapy ocupress.

Example 2.

Patient Medvedev M.I., 74 years. The initial intraocular pressure was 22 mm RT. Art., the total sensitivity of the retina at a given IOP 912 dB. After unloading eye pressure decreased to 17 mm RT. Art., the total sensitivity increased to 104 dB. Therefore, the initial pressure is intolerant. Assigned to laser treatment. The disease process is stable.

Example No. 3.

Patient bakhtiyarova A.P., 56 years. The initial intraocular pressure was 21 mm RT. tbsp. At a given level of IOP, the total sensitivity of the retina amounted to 850 dB. After unloading eye pressure decreased to 15 mm RT. Art., the total density increased by 48 dB. Therefore, the initial intraocular pressure is tolerant, and therefore we can talk about sustainability to him the optic nerve. The need to apply anti-hypertensive drugs not.

Based on the above we can conclude that the advantage of the proposed method (computer static perimetric studies) before known canamericas.

First, it significantly reduces the time of the study; secondly, very informative, third, excludes the presence of the subjective factor in obtaining diagnostic data. Practical application of this method is especially effective when establishing tacos what about the diseases of the eye, as glaucoma. First to characterize the IOP in patients with glaucoma have used the terms “offset”, “uncompensated” glaucoma, realizing the first intraocular pressure corresponding to the average rate (of 16.0-26.0 mm Hg), under the last - varying degree of its increase. However, it was found that when compensated glaucoma visual function in patients continued to fall as tolerant pressure they were below accepted norms.

In the study eye by the claimed method can certainly diagnose glaucoma even with normal intraocular pressure, determine the indications for antihypertensive therapy, and also to put indications to operative treatment.

How to determine the tolerance (intolerance) vnutriglaznogo pressure (IOP) of the patient, including the measurement of initial IOP, unloading eyes, medical reduction of intraocular pressure, check best eye function by reducing intraocular pressure and the influence of testobjects, wherein after measuring the initial IOP use the computer a static perimetric studies, in which TestObject serves as the light spot impinging on the eye in different points of the field of view with a threshold brightness, and then ascending, while metering the individual level of sensitivity of the retina in the surveyed points in the field of view, the number which is given by the programme examination of the patient, and then determine the total sensitivity in decibels, with medical reduction of intraocular pressure exercise drip into the eyes of a 0.5%solution of ocupress twice with an interval of 5-6 min, with a decrease of intraocular pressure is not less than 4 mm RT. senior re-produce static perimetry with increasing total sensitivity to below 50d make a conclusion about individual tolerance (tolerance) initial intraocular pressure, i.e., resistance to him the optic nerve, and Vice versa, when the increase of the overall sensitivity 50 dB or more is judged on individual intolerance (intolerance) initial intraocular pressure.



 

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