Method for predicting complications occurrence after lasik operations

FIELD: medicine.

SUBSTANCE: method involves carrying out ophthalmic examination. Posteroanterior axis is determined by applying ultrasonic echobiometry method. Availability and spread of peripheral chorioretinal dystrophy is ophthalmologically estimated in grades with Goldman lens as total over the whole eyeball perimeter. Immunoregulation index ratio (IRI=CD4 count/CD8 count), circulating immune complex content, and immunoglobulin IgA content are determined in blood. Posteroanterior axis being equal to or greater than 26.0 mm, peripheral chorioretinal dystrophy spread being greater than 180° and greater than eye ball perimeter, IRI being reduced 1.3 times as small and more, circulating immune complex content being increased by 60% and more and IgA being 1.5 times as high and more, complications development risk is considered to be high after Lasik operation.

EFFECT: high accuracy of prognosis.

2 tbl

 

The invention relates to medicine, namely to ophthalmology, and can be used in excimer-laser correction of myopia.

Myopia is the most common cause of vision loss among young people. In this regard, the problem of myopia is of great medical and social importance, because it limits the possibilities of choice of profession, military service in a significant number of people with myopia of high to medium (Escavation. Myopia - M., 1996).

In recent years, in practice implemented method of surgical excimer laser correction of myopia LASIK, which can improve visual acuity and to expand opportunities for professional integration of persons with low vision.

Despite the high-tech characteristics of the equipment and the highest professionalism of surgeons, LASIK surgery causes a number of complications in the postoperative period.

A number of authors have noted that in the postoperative period, different types of dystrophy of the corneal flap meet from 1.27% to 3.6% (A.D. Semenov and other Clinical forms of corneal syndrome and subepithelial fibroplasia after refractive excimer laser keratectomy". Ophthalmic surgery. 1994, No. 4, p.35-41; drones M.M. and other "complications of LASIK. Analysis of 7000 operations," proc. Dokl. VII Congress of ophthalmologists of Russia. M, 2000, V.1, s-245).

To improve the surveillance of the effectiveness of surgical rehabilitation of patients with myopia important and relevant is the prediction and prevention of complications of LASIK. There is a method of treatment of traumatic lesions of the cornea (RF Patent 2039540, B 1995, No. 21), wherein after surgery on the cornea is affected by electromagnetic radiation with a wavelength of 0.96 μm, when the energy of light the surface of the cornea of 0.34 mW/cm2in continuous mode with an exposure time of 2.5 minutes each day to complete the process of epithelialization.

Similar way, using physical effects on the cornea after surgery, prevention of dystrophic changes in it is a way to "Use of ubiquinone Q-10 for a local treatment and prevention of ophthalmologic pathologies following photorefractive therapy, refractive surgery and exposure to ultraviolet radiation" - (U.S. Patent W00137851, 2001, - 05-31). The method consists in the use of ultraviolet irradiation of the cornea after excimer-laser correction in combination with other drugs. The disadvantage of these 2 methods is the reduction of already formed complications such as corneal edema, presence of cellular elements under the corneal flap.

There is a method of treatment of complications after surgery, photorefractive keratectomy (RF Patent No. 2121826, 1998, bull. Fig. No. 33), where on the 4th day after the operation, determine the distance between the edges of the growing epithelial layer and, if the distance corresponds 1-9 mm and in the presence of fibrous exudate on the surface of the stroma rogove is s, treatment of fibrinolytic drugs and interferon inducer. The disadvantage of this method is the effect on cell proliferation in the cornea without regard to pathogenic factors causing complications, such as indicators of local immunity.

The known method of increasing the efficiency of the use of eye drops after excimer laser surgery (Patent RF №2000120701, 2001, bull. Fig. No. 19), which includes installation solutions, eye drops (tobrex, maxidex, naclof, diclof, betoptic), cooled to a temperature of 8°With not less than 20-25 minutes prior to instillation. The disadvantage of this method is its low efficiency in the relief of the inflammatory response of the cornea in persons with immunological failure.

A known method for predicting the possibility of complications after surgery, photorefractive keratectomy (RF Patent No. 2138191, 1999, bull. Fig. No. 27), which is used as a prototype. The method consists in the fact that after decapitalization cornea to photorefractive keratectomy spend biomicroscopy of Bowman's membrane of the cornea. If the surface of Bowman's membrane takes the form of a fine grit, then predict complications such as delayed epithelialization and development of flair. The disadvantage of this method is the operating rating of the layers of the cornea, not the OED is arziona. In addition, the disadvantages of the method include a technical difficulty, because the patient in the operating room under sterile conditions are deepithelization of the cornea, then the patient is carried out in a consultation room where you biomicroscopy, then the patient goes to the operating room for performing the following steps of operation. A significant drawback of this method is the lack of data on the pathogenetic mechanisms of the possibility of complications from the side of the cornea after excimer laser exposure.

Studies have been conducted in the frequency of complications after 290 operations LASIK in connection with the peculiarities of anatomical and topographical changes of the eyeball, the nature and severity of peripheral retinal dystrophy, its length, indicators of immune status of patients with myopia of high to medium. The results of the conducted research allowed to determine the prognostic criteria of complications after LASIK surgery.

Closest to the claimed method is a method of forecasting dystrophy corneal flap (RF Patent No. 2195234, 2002, bull. Fig. No. 36), which are biomicroscopy of the cornea on day 2 after excimer laser exposure, determine the size and localization of diffuse infiltration, if the square is diffuse infiltration is 3 mm 2then dystrophy develops with probability 1-2%, if the area is diffuse infiltration of less than 3 mm2the likelihood of malnutrition is 10-15%. The disadvantage of this method is its low predictive information content as diffuse infiltration of the cornea in the treatment of modern drugs, taking into account the immune status of patients, allows to quickly arrest the complications of excimer laser exposure, and if the drug is selected arbitrarily, dystrophy of the corneal flap are possible with different frequency.

Object of the invention is the justification criteria predict possible complications after excimer laser surgery - LASIK before the surgery.

The technical result of the proposed method is the combination of anatomical and topographical parameters of the eyeball, the length of the peripheral chorioretinal dystrophy (PRD) degree total perimeter of the eyeball and immunological parameters: immunoregulatory index (IRI), circulating immune complexes (CIC), immunoglobulin - Ig And in patients with myopia.

The technical result is achieved by the fact that prior to operative intervention in patients with myopia conduct ophthalmologic examination, method of U3-echobiometry define P Is O (anterior-posterior axis), ophthalmoscopically with lens Goldman assess the presence and extent of PRD in degree total perimeter of the eyeball is determined in the blood, the ratio of the immunoregulatory index (IRI=SD4/DM8), the content of the CEC and the level of immunoglobulin - Ig And, when PZO≥26.0 mm, length PRD 180° and more of the perimeter of the eyeball, reducing Iran to 1.3 and below, with the increase of the CEC by 60% or more, a Ig A - 1.5 times and more predict the possibility of complications after LASIK surgery.

The rationale of the proposed method was the research results of ophthalmologic status of patients with immunological indicators in relation to the number and severity of complications after LASIK surgery at 290 eyes with myopia of high to medium.

Depending on the eye and immunological changes in patients with myopia were divided into 2 groups.

The 1st group consisted of 55 patients (110 eyes) with myopia from 4.0 to 7.0 diopters, which PZO was less than 26 mm, the peripheral diffuse chorioretinal dystrophy distributed a total of less than 180° perimeter of the eyeball or absent.

In patients of the 2nd group (180 eyes) with myopia from 7,25 to 11.0 diopters PZO was from 26.0 to 28,4 mm, peripheral chorioretinal dystrophy (PRD) located at 180° and more of the perimeter of the eyeball and 172 eyes (95,5%) was previously completed argon laser coagulation of the retina.

Immunological parameters in patients with myopia of the 1st and 2nd groups differed from the data of the control group (table 1, 2).

Table No. 1
Immunological parameters of patients of the 1st group and the control.
IndicatorsPatient groupR, the coefficient of reliability% Change
1st groupControl
CEC $ 80,8±1,7153,3±3,3p<0,05↑51,6%
SD4(%)39,0±2,7545,5± and 4.9p>0,05↓14,3%
SD8(%)23,6±2,019,0±1,1p<0,05↑24,2%
IRI (SD4/DM8)1,652,4-↓31,3%
Ig A (g/l)1,49±0,121,08±0,17p<0,05↑38%
Ig M (g/l)1,17±0,09 1,0±0,10p>0,05↑17%
Ig G (g/l)9,73±0,249,56±0,91p>0,05↓2,7%

Data table No. 1 shows that patients with the size of the eyeball is not more than 26 mm, in the presence of a limited zone of retinal dystrophy (less than 180° perimeter of the eyeball) among immunological parameters significantly changed three: the CEC has increased by 51.6%; SD8- by 24.2% and immunoglobulin - Ig A - 38%.

This immunoregulatory index decreased by 31.3% compared to the data of the control group and was 1,65. In the postoperative period in 5 eyes of 110 (4,5%) after LASIK surgery was determined reactive moderate corneal edema, which on the background of adequate treatment was stopped after 3-4 days.

In patients of the 2nd group after LASIK surgery in 39 eyes of 180 (21,7%) developed corneal edema was determined cellular inclusion under the corneal flap. Mild signs of inflammation reached at 7-10 day on the background of intensive treatment. In this group of patients the main immunological parameters were increased compared to the 1st group in 1,5-2 times, CEC - 1.5 times, Ig A - 2 times.

Table No. 2
Immunological p is the indicators of the patients of the 2nd group and the control.
IndicatorsPatient groupR, the coefficient of reliability% Change
2nd groupControl
CEC $ 98,5±2,6253,3±3,3p<0,05↑84,8%
SD4(%)32,5±1,345,5± and 4.9p<0,05↓28,6%
SD8(%)24,8±1,619,0±1,1p<0,05↑30,5%
IRI (SD4/DM8)1,32,4-↓54,0%
Ig A(g/l)2,19±0,221,08±0,17p<0,05↑2 times
Ig M (g/l)1,09±0,061,0±0,10p>0,05↑1,3%
Ig G (g/l)10,07±0,329,56±0,91p>0,05↑5,3%

The results allowed us to justify the significant features of the forecasting inflammatory complications of LASIK: increase PZO≥26,0, the prevalence PRD≥180° perimeter eye is on Apple, reducing Iran to 1.3 and below, with the increase of the CEC by 60% or more, and Ig And 1.5 times or more relative to the physiological norm.

The proposed method allows you to choose pathogenetically reasonable treatment for the prevention of inflammatory autoimmune complications in the early postoperative period and to increase the efficiency of surgical rehabilitation of patients with myopia.

Example.

Patient, 28 years of age (AMB. East. bol. No. 4172/2005).

Ds: the Myopia of an average degree right eye, a high degree left eye, peripheral chorioretinal dystrophy.

Visual acuity:

OD=0,06 Sph - 6,5 L=1,0 IOP-18,0 mm Hg

OS=0,04 Sph - 7,5 D=0,9 IOP=19, mm Hg

Echo biometrics:

PZO - OD=26,8 mm

OS=27,4 mm

Pachymetry of the cornea:

OD 542 mcm

OS 539 mcm

Biomicroscopy: both eyes are calm, the cornea is transparent, the limb vascularization small - width of less than 1 mm, the Front camera is of medium depth, iris trabecular structure dystrophy no, lens, and vitreous body transparent.

The fundus of the eye: OD - optic nerve disc pale pink, myopic cone from the temporal side, the vessels are normal. Peripheral lattice dystrophy total of 180° perimeter of the fundus, centrally located lesions laser photocoagulation.

OS - the optic nerve disc pale pink, circular myopic staphyloma, 240° perimeter of the fundus of ODA, the process identifies areas of lattice degeneration, ubrication previously carried out by laser photocoagulation.

Immunological research:

CEC - 90 USD

SD4- 39%; SD8- 34%; IRI=1,14;

Ig A=2,43 (g/l), Ig M=0,73 (g/l); Ig G=9,9 (g/l)

Immunological parameters differ from the norm: the CEC increased 2.25 times; IRI decreased by 52.5% (IRI N=2,4).

Surgery LASIK performed on traditional technology without complications.

On the 2nd day after the operation is determined by the diffuse corneal edema in both eyes, optical slice is thickened.

VISUS OU=0,3 n/q.

Treatment:

- Maxitrol (as an anti-inflammatory drug) in instillations 6 times a day;

- Superlymph (as immunocorrector) 3 times a day;

- Wobenzym (as an antitumor drug) 5 table 3 times a day 30 minutes before meals.

After 7 days were stopped corneal edema, resorbed cellular inclusion under the corneal flap, the optical section of the cornea is normalized.

Visual acuity without correction:

VOD=1,0; VOS=0,85

This example confirms that to excimer intervention, the patient decided chorioretinal changes in combination with evidence of immunological failure. The operation caused the development of autoimmune inflammation of the cornea, the appointed immunomodulators Wobenzym and Superlymph resulted in complete relief of inflammation and restoration of corneal transparency./p>

A method for predicting the possibility of complications after LASIK surgery (excimer-laser correction of myopia) by ophthalmologic examination of the patient with myopia, characterized in that prior to operative intervention in patients with myopia conduct ophthalmologic examination method ULTRASONIC-echobiometry determine the anterior-posterior axis (PZO), ophthalmoscopically with lens Goldman assess the presence and extent of peripheral chorioretinal dystrophy (PRD) degree total perimeter of the eyeball is determined in the blood, the ratio of the immunoregulatory index (IRI): IRI=SD4/DM8the content of circulating immune complexes (CIC) and the level of immunoglobulin - Ig And, when PZO≥26.0 mm, length PRD 180° and more of the perimeter of the eyeball, reducing Iran to 1.3 and below, with the increase of the CEC by 60% or more, and Ig And 1.5 times and more predict the possibility of complications after LASIK surgery.



 

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