Method for predicting primary open-angle glaucoma at early stages of disease

FIELD: medicine, ophthalmology.

SUBSTANCE: the diagnostics of primary open-angle glaucoma (POAG) should be carried out at fulfilling unloading diagnostic sample based upon evaluation of the dynamics of the data of computed static perimetry. At detecting alterations in the parts of vision field being characteristic for glaucomatous process it is necessary to conduct unloading sample: after preliminary control of intra-ocular pressure it is important to apply per 1 drop of ophthalmological preparation "Travatan" retroblepharally and in 24 h one should carry out control measurement of intra-ocular pressure and repeat computed static perimetry. In case of improved retinal sensitivity at the background of decreased intra-ocular pressure the sample should be considered to be positive and POAG diagnosis should be established. The innovation enables to prescribe selective hypotensive therapy in due time.

EFFECT: higher accuracy and efficiency of diagnostics.

3 ex

 

The invention relates to medicine, namely to ophthalmology, and is intended for the diagnosis of primary open-angle glaucoma (POAG) in the early stages of the disease.

So far not described any single, universal method, which gives the response of the patient the initial stages of primary open angle glaucoma, however, the success of medical and surgical treatment of patients with glaucoma depends on timely diagnosis, so the goal of improving the detection of the disease in the early stages of glaucoma process is very important.

There is a method of early diagnosis of primary open-angle glaucoma on the basis of a diagnostic unloading samples on Seasonally with canamericas control (Vol, sukhinina LB, Ustinov, H. Glaucoma, preleukemia, ocular hypertension. L., "Medicine". - 1985. - P.148). When setting the sample locally installerede 1% solution of pilocarpine.

The disadvantage of this method are frequent complaints in patients on eye redness, burning, pain in the head and eyeballs, blurred vision (due to the contraction of the pupil).

There is a method of fasting samples with oral administration of acetazolamide (diakarba) - carbonic anhydrase inhibitor (Flammer j, Drance S.M. Effect of acetazolamide on the differential threshold. - Arch. Ophtalm., 1983, vo.101, No. 9, p.1378-1380).

The disadvantage of this method is the possible systemic effect of diuretic, associated with changes in the level of electrolytes and alkaline reserve of the blood. In addition, the presence in most patients, concomitant General pathology (diseases with impaired renal function, prostatic hypertrophy, atrial fibrillation), there is no widely used diacarb. Reduction of circulating blood volume after diuretic effect paradoxically sometimes leads to spasm of peripheral vessels and the risk of elevated BP (Maren TH. The relation between enzyme inhibition and physiological response in the carbonic anhydrase system. //J. Pharmacol. Exp. Ther, 1963. - P.140-153).

The closest analogue of the proposed method is a method of determining the level of real tolerant of intraocular pressure with the study of the critical frequency of flicker fusion (Navratilova On the role of determining the level of true tolerance intraocular pressure in myopic patients with suspected glaucoma. // Glaucoma: problems and solutions: all-Russian scientific-practical conference: Sat. the scientific. senior - M., 2004. - S-110). This study used topically β-blocker (0.5% solution artiola) and carbonic anhydrase inhibitor dorzolamide (trusopta 2%).

The main drawback of all these methods of examination - impossibility (confirmation of diagnosis) based on the results of ASCS is adavani selectively assign effective antihypertensive treatment. Otherwise, antihypertensive therapy empirically selected drug can be not only ineffective but also harmful, because it can cause negative or paradoxical reaction to the drug.

Known methods of conducting drug tests in patients with primary open-angle glaucoma before assigning pilocarpine (Navratilova, Early diagnosis, peculiarities of clinical manifestations and treatment of open angle glaucoma in myopia: author. of thesis ... Dr. med. Sciences - M., 2004. - P.39).

However, given the often arise in the preparation of the above complaints and relatively low efficiency - pilocarpine today is not the drug of choice in the treatment of primary open-angle glaucoma.

Currently in ophthalmology for holding antihypertensive therapy uses synthetic analogue of prostaglandin - Travatan"reducing intraocular pressure at 30-35% of the original most physiological way - by increasing the outflow of aqueous humor within 24 hours after a single instillation (Netland, PA, Landry T, Sullivan EK, Andrew R, Silver L, Weiner A, Mallick S, Dickerson J, Bergamini MVW, Robertson SM, Davis AA, and the Travaprost Study Group. Am J Opthalmol 2001; 132:472-484). According to some researchers pronounced hypotensive effect was achieved more than 50% of patients with primary open-angle glauc is my using "Travatan" (Goldberg I., et al., J Glaucoma, 2001, 10, 414-422).

However, for the production of diagnostic tests this drug was not used.

The most widespread diagnostic specimens, where as the evaluation criterion was studied the dynamics of the field of view. In full and with a high degree of accuracy static perimetry can only be performed on modern computerized analyzers, field of view, ensuring the standardization of all variables of the study (Balashevich L.I. research Methods of the field of view. SPb.: Publishing house of St. Petersburg maps., 2004. - P.9).

The technical result is to increase the accuracy of diagnosis of primary open-angle glaucoma in the early stages.

The technical result is achieved by the fact that a diagnosis of primary open-angle glaucoma is carried out with setting the discharge diagnostic tests based on the evaluation of the dynamics data computer static perimetric studies computer perimeter "Medmont M700" company "Medmont Pty Ltd (Australia). When detecting changes in the characteristic glaucomatous process areas of the field of view was done unloading the sample: after the preliminary control of intraocular pressure, the eyelids of both eyes once instilled 1 drop of ophthalmic drug "Travatan". After 24 hours, conducted the completed measurement of intraocular pressure and repeated computerized static perimetry. While improving the sensitivity of the retina on the background of reduction of intraocular pressure, a sample is positive, diagnosed with primary open-angle glaucoma.

The method was carried out as follows. Conducted static perimetry computer perimeter "Medmont M700" company "Medmont Pty Ltd (Australia). To determine the sensitivity of the retina was used a template system test for glaucoma by 104 points with a threshold strategy of the research. The brightness of the surface of the hemisphere, which serves as the backdrop for demonstrations of test objects was 31.5 apostilb. Exposure time of presentation of each stimulus was 0.2 with (according to the recommendations of the International perimetric society, 1979). Control fixation technique is Heijl-Krakau with randomized presentation of stimuli in the field of the blind spot. Registration and processing of data the study was carried Russified standard software Medmont Studio, version 3.5.9. Estimated total change of sensitivity in each of the four quadrants of the visual field.

When detecting changes in the characteristic glaucomatous process areas of the field of view was done unloading the sample. After preliminary measurements of intraocular pressure, konyunktivalny cavity instilled 1 drop of ophthalmic drug is "Travatan". Control measurement of intraocular pressure and computerized static perimetry was performed 24 hours after instillation of the drug. While improving the sensitivity of the retina on the background of reduction of intraocular pressure, a sample is positive, sets the diagnosis of glaucoma.

Clinical examples.

Example 1. Patient W., 77 years. Outpatient map No. 13785. Directed by the district ophthalmologist for further examination with a diagnosis of both eyes: initial age-related cataract, suspected glaucoma. Complaints: the sense of "seriousness" in the eyes of periodic worsening of vision - foggy image. Visual acuity of the right eye with correction = 1.0 in the left eye with correction = 0,8. Tonometry on Maklakova right eye = 23 mm Hg, left eye = 25 mm Hg When conducting kinetic perimetric studies of visual field defects not detected. On the map computer static perimetric studies (glaucoma test) sites have been identified depression in typical for glaucoma areas. Spent unloading the sample: for the eyelids of both eyes once poured 1 drop of ophthalmic drug "Travatan". At the control measurement after 24 hours of intraocular pressure (Maklakov): right eye = 15 mm Hg, left eye = 17 mm Hg In all four zones marked improvement in the sensitivity of the retina. Right eye: Verninskoe quadrant +31 dB, dims the nasal quadrant +15 dB verkhneisetsky quadrant +16 dB, negnevitsky quadrant +4 dB. Left eye: Verninskoe quadrant +77 dB, niinamesai quadrant +7 dB, verkhneisetsky quadrant +14 dB, negnevitsky quadrant +9 dB. Thus, on the background of lowering intraocular pressure of 8 mm Hg was observed an improvement of visual functions, in particular an increase in the sensitivity zone Y and medial areas of the nasal halves. Improvement of visual functions associated with the restoration of conductivity arcuate bundle of nerve fibers against lowering IOP, i.e. improvement of the axons of the ganglion cells and explanationsthe current in them. Diagnosed with primary open-angle glaucoma, taking into account the results of the sample treatment: the eyelids of both eyes "Travatan" 1 drop at night, every day, constantly. At the control examinations during the month of intraocular pressure stably compensated (16-18 mm Hg in both eyes), the negative dynamics of visual functions is missing.

Example 2. Patient M., 50 years. Outpatient map No. 14121. Directed by the district ophthalmologist for further diagnosis. Complaints: notes periodically sense of "pressure" in the eyeballs, and pain in the frontal region. The diagnosis at the direction of both eyes: presbyopia, suspected glaucoma; left eye: hypermetropia low degree of astigm what magnetism, amblyopia weak. Visual acuity of the right eye without correction = 1.0, the left eye with correction = 0,5. Tonometry on Maklakova right eye = 25 mm Hg, left eye = 25 mm Hg When conducting kinetic perimetric studies of visual field defects not detected. On the map computer static perimetric studies (glaucoma test) sites have been identified depression in typical for glaucoma areas. Spent unloading the sample: for the eyelids of both eyes once poured 1 drop of ophthalmic drug "Travatan". At the control measurement after 24 hours of intraocular pressure (Maklakov): right eye = 16 mm Hg, left eye = 17 mm Hg In all four zones marked improvement in the sensitivity of the retina. Right eye: Verninskoe quadrant + 52 dB, niinamesai quadrant +69 dB, verkhneisetsky quadrant +58 dB, negnevitsky quadrant +34 dB. Left eye: Verninskoe quadrant +6 dB, niinamesai quadrant +6 dB, verkhneisetsky quadrant +20 dB, negnevitsky quadrant +8 dB. A patient diagnosed with both eyes: primary open-angle glaucoma taking into account the result of the sample assigned to antihypertensive mode: behind the eyelids of both eyes "Travatan" 1 20.00 daily, constantly. At the control examination within 2 months of complaints on the eyes no registered stabilization of intraocular pressure level 16-19 mm Hg (both eyes), neg is supplemented flax dynamics of visual functions is missing.

Example 3. Patient M., 53. Outpatient map No. 13547. The complaint: frequent change of presbyopic correction, blurred vision after optic load near. The diagnosis of both eyes: presbyopia and suspected glaucoma. Visual acuity of the right eye without correction = 1.0 in the left eye without correction = 1,0.

Tonometry on Maklakova right eye = 24 mm Hg, left eye = 23 mm Hg When conducting kinetic perimetric studies of visual field defects not detected. On the map computer static perimetric studies (glaucoma test) sites have been identified depression in typical for glaucoma areas. Spent unloading the sample: for the eyelids of both eyes once poured 1 drop of ophthalmic drug "Travatan". At the control measurement after 24 hours of intraocular pressure (Maklakov): right eye - 6 mm Hg, left eye 4 mm Hg According to a computer perimetric studies in all four areas noted improvement in sensitivity. Right eye: Verninskoe quadrant +76 dB, niinamesai quadrant +46 dB, verkhneisetsky quadrant 18 dB, negnevitsky quadrant +41 dB. Left eye: Verninskoe quadrant +97 dB, niinamesai quadrant +89 dB, verkhneisetsky quadrant +21 dB, negnevitsky quadrant +9 dB. A patient diagnosed with both eyes: primary open-angle glaucoma taking into account the result of the sample assigned to antihypertensive treatment is: for the eyelids of both eyes "Travatan" 1 20.00 daily constantly. At the control examination within 2 months: complaints are not really marked stabilization of intraocular pressure at the level of 17-19 mm Hg (both eyes), the negative dynamics of visual functions is missing.

When the research was confirmed a pronounced hypotensive effect of ophthalmic drug "Travatan", which makes the test more reliable. In addition, the reduction of intraocular pressure by 1 mm Hg reduces the risk of progression of glaucomatous process by 10% (according to a multicenter clinical study of the Early Manifest Glaucoma Trial EMGT).

The mechanism of action of Travatan does not reduce the volume of produced intraocular fluid, therefore, have less of an impact on the trophism of the layers of the eyeball, which can reduce costs registrationthe treatment.

In the tests, the patient receives objective information about the reason for selecting the hypotensive drug.

To date in the evaluation of patients with suspected glaucoma was not included preliminary evaluation of the effectiveness of a drug for a follow up appointment antihypertensive therapy. The patient had about 30 days is appointed to resolve the question of the effectiveness of the drug and further tactics of treatment. Thus, IP is the use of the proposed method can improve the efficiency of detection of primary open-angle glaucoma in the early stages of the disease.

Method for the diagnosis of primary open-angle glaucoma in the early stages of the disease, including static perimetry, characterized in that in the presence plots depression in typical for glaucoma areas of the patient is carried out installation in konyunktivalny cavity 1 drops "Travatan and after 24 h is held control perimetry, while improving the sensitivity of the retina on the background of reduction of intraocular pressure, a sample is positive, diagnosed with primary open-angle glaucoma.



 

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