Method for diagnosing optic nerve abnormality in the cases of endocrine ophthalmopathy

FIELD: medicine.

SUBSTANCE: method involves examining retina light sensitivity degree using computer-aided perimetry approach within 60° bandwidth from fixation point. Direct orbital muscle thickness and retrobulbar space volume is additionally determined by applying ultrasonic b-scanning method. Linear blood circulation speed and resistance index are also determined in the central retinal artery and posterior short ciliary arteries. Macular or general light sensitivity reduction 25% and more relative to age-specific norm being observed together with 50% growth and more in direct orbital muscle thickness, retrobulbar space volume growth by more than 35% in combination with linear blood circulation speed reduction in the central retinal artery and posterior short ciliary arteries by 40% and more and increasing resistance index by 20% and more relative to physiologic norm, optic nerve abnormality is diagnosed at early disease stages.

EFFECT: high reliability of diagnosis.

2 tbl

 

The invention relates to medicine, namely to ophthalmology, and is intended for early diagnosis of pathology of the optic nerve in endocrine ophthalmopathy.

The term ″endocrine ophthalmopathy((EA) is taken to determine eye damage, manifested by exophthalmos, orbital swelling of tissues, changes in the ocular muscles. According to the literature in 2/3 of patients with EE have disorders of visual function due to pathology of the optic nerve and retina (Approving et al. Swollen proptosis and optic neuropathy//Proc. ″Eroshevsky reading″, Samara-2002 - s-596).

The definition of the essential characteristics that allow to identify early signs of pathology of the optic nerve in endocrine ophthalmopathy, is of great medical and social importance, and, therefore, such a study is relevant and appropriate. There are several ways to diagnose pathology of the optic nerve on the basis of electrophysiological studies and comparative evaluation of different parameters of bioelectrical activity of the visual analyzer.

A known method for the diagnosis of pathology of the optic nerve (RF Patent No. 2134054, bull. Fig. No. 22, 1999), which provides a comparative assessment of the parameters of the optic disc (optic nerve disc) patients with available reference picture of the optic nerve disc in various diseases, and when the match is Denia most of the indicators diagnose the nature of the pathology. The disadvantage of this method is its low diagnostic value in the early stages of the disease, when visual function is reduced, and the objective changes in the optic nerve disc scarce.

A known method for the diagnosis of pathology of the optic nerve (RF Patent No. 1814536, bull. Fig. No. 17, 1993) based on the definition of the size of the blind spot, and when the increase of this indicator diagnose pathology of the optic nerve. The disadvantage of this method is the narrow range of its application, since it only shows the development of edema of the optic nerve disc, while the pathology of the optic nerve may develop without swelling of the optic nerve disc.

A known method for the diagnosis of pathology of the optic nerve (RF Patent No. 2098008, bull. Fig. No. 34, 1997), which is conducted in succession measurement threshold luminance sensitivity in the center of the field of view, and when the dispersion of responses at 0, 4 logarithmic units and more than diagnose a pathological condition of the optic nerve. The disadvantage of this method is the high probability of over diagnosis of pathology of the optic nerve in patients with ophthalmopathy, because in this disease, hormonal and vascular changes have a significant impact on the bioenergetics of the optic nerve, changing it to different degrees, but visual function over a long time, remain high.

There is a method of diagnosing patol the GII of the optic nerve and retina (RF Patent No. 2187238, Bull. Fig. No. 23, 2002), which provides a quantitative assessment of the electrophysiological parameters: threshold electrical sensitivity (EV) of the retina and electrical lability (EL) of the optic nerve in the initial state and after 1 hour after a single dose of the drug Wobenzym in the amount of 5-7 drops, while reducing the threshold EB 20 ľa and raise the threshold E 5 Hz conclude about reversible nature of the lesion of the optic nerve and retina. The disadvantage of this method is its low information content in endocrine ophthalmopathy, as it does not take into account changes in the orbit. In endocrine ophthalmopathy is an increase in the thickness extraocular muscles and seal retro-bulbar space. The changes in the orbit have a negative impact on orbital and retinal blood flow and on the functional state of the optic nerve.

The closest analogue to the claimed method and taken for the prototype is "a Method for diagnosing pathology of the retina and optic nerve (RF Patent No. 2207039, bull. Fig. No. 18, 2003), the essence of which is the study of light sensitivity in the range of 60 degrees from the fixation point by calculating the probability functions the correspondence between the level of light sensitivity in the Central points on the periphery of the visual field. Pat is the logic diagnose, when the maximum probability of matching the compare function is achieved with the exception of the threshold contrast of the scope. The disadvantage of this method is the difficulty of assessing the type of pathology, limited in application, because there is no such computer programs in wide use.

The technical challenge is to develop a method for the diagnosis of pathology of the optic nerve in patients with ophthalmopathy in the early stages of the disease. The technical result is achieved by the fact that the patient with endocrine ophthalmopathy examine the level of light sensitivity of the retina by means of computer perimetric studies in the range of 60 degrees from the fixation point, additionally determine the thickness of the straight muscles of the eyeball and the amount of retro-bulbar space by ultrasonic b-scan and linear blood flow velocity (BFV) and the resistance index (IR) in the Central retinal artery (CAC) and posterior short ciliary arteries (SCCA) while reducing the level of macular and (or) the overall light sensitivity of the retina by 25% or more with respect to age norm, increasing the thickness of direct muscles on 50% or more, the increase in the volume of retro-bulbar space more than 35% in combination with a decrease in BFV in the cars, SCCA 40% and more, with increasing IR by more than 20% from what oseney to normal physiological diagnose pathology of the optic nerve in the early stages of the disease.

The rationale for the development of the proposed method for the diagnosis of pathology of the optic nerve in patients with ophthalmopathy was the results of a comprehensive study of 42 patients with a diagnosis of Diffuse goiter, ophthalmopathy. Dynamic observation over 2 years for clinical disease development and comparative evaluation of ophthalmologic parameters with a control group of healthy individuals of similar age (24-40 years) helped to identify the significant factors influencing the defeat of the optic nerve and to diagnose this pathology in the early stages of the EA 71,4%. Anatomical and physiological indicators of the orbit and the eyeball in the control group and patients with endocrine ophthalmopathy (EA) with long-term preservation of visual function and pathology of the optic nerve are presented in table 1.

The analysis of the results obtained in a comparative perspective as a percentage showed that under favorable clinical course EA with integrity high visual acuity and peripheral borders of the visual field changing anatomical indicators does not exceed 20% in relation to the physiological norm, and the dynamics of physiological parameters does not exceed 15%. With the development of pathology of the optic nerve atrophy in patients with EA anatomical indicators quickly Uhud which are stated more than 40%, and physiological - more than 25% compared to normal (table 2).

Table 2

The dynamics of changes in anatomical and physiological indicators (in %) at different conditions of visual analyzer
indicatorsVisual analyzer
stabledeterioration
Macular light sensitivityDecrease by 10-15%, for an average of 11.6%Reduction of 25-30%, with an average of 28.1%
General light sensitivityDecrease by 10-15%on average -14%A reduction of 25-30%, on average, at 27.1%
The thickness of direct eye musclesAn increase of 10-15%, with an average of 11.8%Increase by 50-70%, on average - 64,4%
The amount of retro-bulbar space (mm3)An increase of 10-15%, with an average of 14.8%An increase of 35-40%, on average -41,5%
HABFV

IR
CACBFV

IR
ZCCABFV

IR

The method is as follows

The patient with endocrine ophthalmopathy examine the level and total macular light sensitivity of the retina by the method of static computer perimetric studies on computer perimeter Torso (Japan), followed by ULTRASOUND scanning of the orbit Acuson determine BFV in SCCA and CAC, then method B-scan of the orbit determines the amount of retro-bulbar space and thickness of direct eye muscles, the obtained results are compared with the physiological norm of appropriate indicators. By reducing macular and (or) the overall light sensitivity of the retina by 25% or more, the increase in the volume of retro-bulbar space more than 35%, and the thickness of direct muscle by 50% or more in combination with a decrease in BFV in the cars, SCCA 40% or more, while increasing the resistance index (IR) in these vessels by 20% or more in relation to physiological norms of the diagnosed pathology of the optic nerve in the early stages of the disease.

As confirm the data submitted clinical example:

Patient P.(AMB. East. disease 21/2003) 38 years appealed to the regional clinical hospital of Rostov-onDon for a consultation about exophthalmos, pain in the eyeball.

Vis OD=1.0 in IOP=18,0 mm Hg

Vis OS=1,0 IOP=20.0 mm Hg

Acsitlali - when basis 98 mm Vistana right eye is 23 mm

left eye - 25mm

The patient, according to the proposed method was investigated light sensitivity of the retina of both eyes. Data computer perimetric studies: level of macular light sensitivity of the right eye amounted to 214 dB (which is 27% below the physiological norm), the overall light sensitivity was 1637 dB (which is 26% below normal). Visual acuity of both eyes=1,0. Anterior segment without features, the fundus of the eye - the optic nerve disc pale pink, clear boundaries, artery evenly narrowed veins are enlarged, the ratio of the caliber of vessels a/b=1/3.

The data of ULTRASONIC scan of the orbital vessels (lbfv, IR)

Right - CAC - 9 cm/sec (IR-0,7)

SCCA - 10 cm/sec (IR-0,72)

Left - CAC - 8 cm/sec (IR-0,7)

SCCA - 9 cm/sec (IR-0,71).

The findings suggest that reduction of volume blood flow in the ophthalmic arteries (CAC, SCCA) at 45-50% compared to normal.

ULTRASONIC study of the orbit showed that the right thickness of direct muscle 6.7 mm, and the volume of retrobulbarnaya - 25,9 mm3. The obtained data testify to the increase in these indicators on 41-46% compared to normal.

On the basis of totality of symptoms was diagnosed with endocrine ophthalmopathy, descending partial atrophy of the optic nerve in both eyes.

Recommended medications ATP at 1.0 V/m N 20; the pharmacological 1 tab. 2 R in day 1 month.

When you re-inspection after 6 months the decrease of visual acuity to 0.8 in both eyes narrowing of the peripheral borders of 10-15 degrees in all meridians, the presence of a Central relative scotomas. In the fundus was determined by blanching the optic nerve disc, signs of venous dilatation. ULTRASOUND scan of the orbital vessels confirmed the same data as in the initial examination. BFV in CACO 9-8 cm/sec, IR a-0.7-0,73 respectively in the right and left eye. ULTRASONIC study of the orbit showed an increase in the thickness of the straight muscles of the eyeball up to 7 mm and retro-bulbar space to 26 mm3. Exophthalmos is also increased data acsitlali:

Vistanaright eye=24 mm
left eye=26 mm
base=98 mm

This example shows that after 6 months, the diagnosis of optic nerve atrophy was evident progressed the decline of visual functions, registered simpler diagnostic equipment. The findings confirmed the diagnosis of optic nerve atrophy at earlier stages of endocrine ophthalmopathy.

On the basis of the conducted research it can be concluded that in comparison with the prototype of the claimed "a method for diagnosing pathology of the optic nerve in endocrine ophthalmopathy allows early diagnosis of lesions of the optic nerve, depending on the essential distinguishing features.

A method for diagnosing pathology of the optic nerve in endocrine ophthalmopathy by determining the light sensitivity of the retina, characterized in that it further determine the thickness of the straight muscles of the eyeball, the volume of retro-bulbar space, linear blood flow velocity (BFV) and the resistance index (IR) of the Central artery of the retina (CAC) and posterior short ciliary arteries (SCCA) while reducing the level of macular and (or) the overall light sensitivity of the retina by 25% or more, increasing the thickness of direct muscle by 50% or more, the increase in the volume of retro-bulbar space more than 35% in combination with a decrease in BFV in the cars and SCCA 40% and more, with increasing IR by more than 20% compared to normal physiological diagnose pathology of the optic nerve in the early stages of illness is evania.



 

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