Method for predicting corneal complications after photorefraction keratectomy

FIELD: medicine, ophthalmology.

SUBSTANCE: due to the method of immunoenzymatic assay one should detect the content of antiphlogistic IL-1 and TNF- and antiphlogistic IL-4 cytokins in lacrimal liquid and based upon the values obtained one should calculate the index of inflammatory activity (IIA) by the following formula: where CHR - a coefficient of homeostatic reserves of cornea which should be calculated by the following formula: where T0 - the data of corneal thermometry before loading vacuum sample; T1 - the data of corneal thermometry immediately after the sample; T2 - the data of corneal thermometry 30 min after loading vacuum sample and at IIA value ranged 0.9-1.0 one should predict uncomplicated adaptive flow of inflammatory-regenerator processes, at IIA>1.0 one should predict exudative character of inflammatory-regenerator processes at the development of early subepithelial corneal disorders, and at IIA<0.9 one should predict chronic proliferative flow of inflammatory-regenerator processes at developing late subepithelial corneal fibroplasias.

EFFECT: higher quality and accuracy of prediction.

3 ex, 1 tbl

 

The invention relates to ophthalmology, in particular for refractive surgery and can be used to predict the nature of corneal complications after photorefractive keratectomy (PRK).

There are ways of determining the presence of inflammation in the tissues of the cornea after PRK, but they do not allow to predict the nature of the flow of inflammation to the patient and, accordingly, to prescribe an adequate treatment. The closest analogue prototype is a method for predicting the inflammatory process in the cornea by defining plasminogen activity of the lacrimal fluid (SG). (Oaganca, the State of the lacrimal fluid and stabilizing the tear film in photorefractive surgery: abstract of thesis. Kida. the honey. Sciences: 14.00.08 / Medical research ophthalmic center "New look", the research Institute of eye diseases of the Russian Academy of medical Sciences.)

But the disadvantage of this method is the inability to predict the nature of the inflammatory-regenerative processes, depends on the adaptive response of tissue to injury. Inflammation and regeneration is inseparably connected components and the imbalance of cytokines leads to instead of adaptive - exudative or proliferative inflammatory response, which is manifested by a delay epit the implementation of the cornea and, as a result, her blushing. Plasminogen enzymes, not as a specific marker, only indicate the presence of an inflammatory reaction. The method does not provide an individualized approach to treatment after PRK.

The task of improving the quality of prediction by determining the nature of the inflammatory-regenerative processes after PRK.

The problem is solved as follows.

A day after holding PRK immunoassay method to determine the content in LF proinflammatory (IL-1, TNF-α) and anti-inflammatory (IL-4) cytokines. Based on the data obtained, calculate the index of inflammatory activity (IVA) of the cornea according to the formula obtained by experimental methods

where the WILLOW - index of inflammatory activity;

IL-1+TNF-α - proinflammatory cytokines;

IL-4 is an anti-inflammatory cytokine;

GSR - factor homeostatic reserves the cornea is determined before surgery by using the load vacuum-samples according to the formula derived by experimental

where T0data thermometry of the cornea to the sample;

T1data thermometry of the cornea immediately after sample;

T2data thermometry of the cornea after 30 minutes the sample.

When WILLOW is from 0.9 to 1.0 predict the adaptive nature of the inflammatory-regenerative processes.

When is WILLOW>1,0 predict exudative nature of the inflammatory-regenerative processes with the development of the early subepithelial flair of the cornea.

When is WILLOW<0.9 to predict the development of chronic proliferative inflammatory-regenerative processes with the formation of late subepithelial fibroplasia of the cornea (see table 1)

Table 1
YVESThe nature of the inflammatory-regenerative processes
AdaptiveExudativeProliferative
from 0.9 to 1.098,8%
>1,097,6%
<0,999,1%

The advantages of the proposed method:

Pro - and anti-inflammatory cytokines are specific marker of local inflammatory response;

- the ability to predict clinical varieties of local inflammatory response;

- the possibility of a differentiated approach to the appointment of local therapy after PRK.

The technical result of the invention is to improve the quality of the VA and prediction of corneal complications by identifying the nature of the inflammatory-regenerative processes, that allows you to assign adequate treatment.

Example 1. Patient Century Turned into the center with a diagnosis of myopia in both eyes. When viewed from the high myopia in both eyes sph - 8,0 D, visual acuity of 0.9. 11.10.04, surgery PRK on both eyes to correct myopia. Through the day according to the formula calculated WILLOW, he was found to be 0.96 - predicted adaptive nature of the inflammatory-regenerative processes. On the third day after surgery: eye serene, the cornea is transparent, complete epithelialization. In the postoperative period the patient received the standard treatment. After treatment, the visual acuity of both eyes 0,8-0,9 without correction, cornea transparent. After 3 months, visual acuity 0.9 to 1.0. After 6 months visual acuity is stable.

Example 2. The patient Was Asked 11.12.04, in the centre of myopia sph - 8,0 D, visual acuity of 0.9. Surgery PRK using standard technology. Through the day according to the formula calculated WILLOW, he was equal 1,12 - projected exudative nature of the inflammatory-regenerative processes. During the early postoperative period without features, on the 4th week of treatment on the cornea noted early subepithelial fibroplasia by 1-2 points. Accordingly, the treatment regimen was strengthened and further appointed antioxidant histogram 2 courses of 10 days with an interval of two weeks. After the end l of the treatment after 2 months, the visual acuity of both eyes of 0.7 and, on the cornea residual effects fibroplasia. Conducted one course resolving therapy with lidsay 10 sessions in a day. After 6 months, the visual acuity of 0.8 to 0.9, the cornea is transparent.

Example 3. Patient J. Applied 21.12.04, in the centre of myopia sph - 8,0 D visual acuity of 0.9. Surgery PRK using standard technology. Through the day according to the formula calculated WILLOW, he was equal to 0.8 - projected exudative nature of the inflammatory-regenerative processes. In the early postoperative period marked late epithelialization of the cornea (6 days), so from the very beginning was conducted intensive treatment using therapeutic Arsenal, and superlymph (which is a complex of natural cytokines). After the end of treatment, 3 months, visual acuity in both eyes of 0.4-0.5 n/a, corneal subepithelial fibroplasia 2-3 points. After 6 months, the visual acuity of 0.6-0.7, opacities in the cornea slightly decreased. In total, held on 3 course resolving therapy with lidsay 10 sessions in a day. Visual acuity through the year approached 0,8-0,9, on the cornea residual effects fibroplasia.

A method for predicting corneal complications after photorefractive keratectomy, exαcausesa that determine enzyme-linked immunosorbent assay content in the tear fluid Pro - IL-1 is TNF-α and anti-inflammatory IL-4 cytokines, on the basis of these indicators are calculated index of inflammatory activity (IVA) according to the formula:

where GSR - factor homeostatic reserves of the cornea, which is calculated by the formula:

where T0data thermometry of the cornea to load the vacuum samples; T1data thermometry of the cornea immediately after sample; T2data thermometry of the cornea for 30 minutes after the load vacuum samples and when WILLOW is from 0.9 to 1.0 predict uncomplicated adaptive inflammatory-regenerative processes, when WILLOW>1,0 predict exudative nature of the inflammatory-regenerative processes with the development of the early subepithelial flair of the cornea while WILLOW<0.9 to predict chronic proliferative inflammatory-regenerative processes with the formation of late subepithelial fibroplasia of the cornea.



 

Same patents:

FIELD: medicine, laboratory diagnostics.

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EFFECT: higher efficiency.

3 ex, 3 tbl

FIELD: immunology.

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8 ex, 1 tbl

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: the present innovation deals with detecting the concentration of antibodies to neurospecific enolase (NSE) and gliofibrillo-acid protein (GFAP) in blood serum of pregnant women. The development of gestosis should be predicted at the level of anti-NSE-antibodies being above 0.6 mcg/ml or anti-GFAP-antibodies being above 0.9 mcg/ml. The innovation provides high information value and specificity of the method suggested to predict the development of gestosis.

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3 ex, 1 tbl

FIELD: medicine, ophthalmology.

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3 ex, 2 tbl

FIELD: medicine, laboratory diagnostics.

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4 ex, 2 tbl

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1 tbl, 13 ex

FIELD: medicine, immunology.

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EFFECT: higher efficiency.

7 ex, 1 tbl

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38 cl, 92 dwg, 3 tbl, 8 ex

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2 ex, 1 tbl

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2 tbl

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3 ex

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2 tbl

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EFFECT: higher efficiency.

2 ex

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3 ex

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6 cl, 2 dwg

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4 dwg

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2 ex

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1 ex

FIELD: medicine.

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2 cl, 2 dwg

FIELD: medicine.

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EFFECT: high accuracy of study.

FIELD: medicine, neurophysiology.

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EFFECT: higher reliability of prediction.

2 ex

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