Method of recovering binocular functions in case of concomitant strabismus

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to ophthalmology. Laser stroboscopy is carried out during 5 days, 2 times a day with 1 hour interval. First 10 minutes each eye is influenced in turn, then for 5 minutes both eyes are influenced simultaneously. Distance to speckle is 1 m.

EFFECT: recovering binocular functions with elimination of anisoaccomodation, enhancing binocular interaction, increasing visual acuity.

3 cl, 2 ex

 

The present invention relates to ophthalmology and is intended for restoration of binocular function in concomitant strabismus.

Restoration of binocular functions, the elements of which are bitvalue merger, fusional reserves, relative accommodation, stereo, in-depth perception of space, by using orthoptic and diploptera. This Orthoptera - this treatment on devices with full artificial separation of the fields of vision of both eyes, diplopia - treatment in natural and related conditions [Avetisov AS, Kashchenko OTHER Way to restore binocular vision strabismus.//Discoveries, inventions, industrial designs, trademarks. Bulletin. - 1977. No. 8. - Ed. mon. 548274].

Orthoptic exercises are normally on devices with mechanical separation of fields of view, the most important of which is the synoptophore. The pair of test objects for both eyes is movable and can be positioned at any angle strabismus.

The aim of the exercise is to eliminate functional scotomas, development biovillage mergers and fusional reserves.

Orthoptic treatment limits in the future recoverability of binocular functions in vivo and provides recovery only 25-30% of patients. This is due to the artificial conditions of view on the quiet instruments. Therefore, after reaching the position symmetrical eye treatment to restore binocular functions without mechanical separation of the fields of view.

One of the diploptic treatment is a way of binocular consecutive images, developed Tpowell [Kashchenko OTHER Methods of research and restoration of binocular functions, system diploptera.//Proceedings of memory Averkieva. - M., 1999. - P.69-79]. The method helps to restore biovalley of fusion, to eliminate functional scotomas and to restore binocular vision.

There are a number diplomaticheskii ways in which diplopia is excited by different dissociable ("provocative") techniques: using prisms, color filters of increasing density. Use the computer program "EYE", "path", based on the color separation of fields of view. Method benimeli, when two pairs of the test have on the binarimeter in "free haploscope", diploptic exercises for creating an artificial aniseikonia by a smooth increase of the size of one of monocular images is not more than 5%, the method of phase haploscope using liquid crystal glasses [Avetisov AS, Kashchenko OTHER Way to restore binocular vision.//Discoveries, inventions, industrial is installed samples, trademarks. Bulletin. - 1977. No. 15. - Ed. mon. 554865],[Rabichev IE Methods benimeli in diploptic friendly treatment of strabismus. Abstract. dis.... Kida. the honey. Sciences. - Irkutsk, 1988. - 24 S.].

The present system restore binocular functions with friendly forms of strabismus mainly aimed at eliminating the phenomenon of suppression and recovery of fusional ability. Functional treatment of disorders of accommodation in patients with strabismus limited to the use of certain methods and not systematized.

The closest analogue of the present invention is a method of the same purposes, including reception of dissociation of accommodation and convergence (method "dissociation"), which "teaches" binocular fusion in terms of increasing the load on the adjustment apparatus a negative lens, and also the relaxation of positive spherical lenses under the control of binocular fusion in terms of color, raster and Polaroid separate the fields of view [Avetisov AS, Kashchenko OTHER Way to restore binocular vision. // Discoveries, inventions, industrial designs, trademarks. Bulletin. - 1977. No. 15. - Ed. mon. 554865]. The child overcomes excited when this vision and achieve binocular fusion of the four-point tests of the device, which he OBS the network during the exercise.

The method facilitates the development of bifixation, mergers, acquisitions and relative accommodative.

However, this method can be applied only after recovery of the reflex bifixation and in the presence of unstable binocular vision, which limits the application of this method in certain groups of patients with scotoma, monocular and simultaneous nature of the view.

Disclosure of the invention.

The objective of the invention is to develop a new method for the treatment of concomitant strabismus, based on direct impact on the accommodative apparatus.

The technical result of the invention is the elimination or reduction of the angle of strabismus, visual acuity improvement and restoration of binocular functions with the elimination of anisogametes, strengthening of binocular interaction.

The technical result is achieved due to the normalization of monocular and binocular tonocov accommodation squinting and locking eyes with the laser stroboscope developed in us mode.

Known methods of laser stroboscope that reduce visual fatigue aimed at relaxation excessive tone of the ciliary muscles, improvement in accommodative ability of the eye in people with actinomycetoma complaints.

Earlier studies of tone accommodation with friendly to the Soglasie was not carried out, although, there is information on the absolute decline of accommodative strabismus, especially monolateral type, as well as the presence of anisogametes (I. Smolyaninov, Aznauryan IE and others).

As shown by our studies, conducted in different groups of patients with strabismus (accommodative, partially accommodative, reaccomodation), accommodation suffers for all types of strabismus. The data obtained using laser stroboscope (laser stroboscope is also used for diagnostic purposes to determine the tone of accommodation with 1 m and 0.33 m), testified to the violation of the tone of accommodation: when accommodative strabismus - decline (often retaining an eye, with partially accommodative strabismus - in both eyes and in case of nonaccommodative strabismus is on more squinting eye. Revealed the presence of anisogametes. The change in the tone of accommodation more expressed than 1 m, from 0.33 m Data accomodate on AK/01 And showed a decrease of this indicator in more squinting eye for all types of strabismus. It was also revealed abnormal increase of the ratio of accommodative convergence to accommodation in accommodative forms of strabismus. Based on the above, it was decided to act on the accommodative apparatus using laser stroboscope to restore narushin the th accommodative ability. Laser stroboscopy in the developed mode, as shown by our research, directly acts on the accommodative apparatus:

increases tone of accommodation, eliminates anisogametes, enhances binocular interaction, which leads to the reduction or disappearance of the angle of strabismus, visual acuity improvement (due to the normalization of accommodative ability and simultaneous stimulation of the photoreceptors of the retina) and the restoration of binocular functions.

The implementation of the invention.

To determine the capabilities of laser stroboscope when restoring visual function in patients with friendly strabismus were selected 15 people with accommodative and partially accommodative strabismus (after surgical repair of strabismus).

The method is as follows: the device is laser stroboscope consists of a rotating cylinder and a helium-neon laser, located at a distance of 5 m from it. Laser light upon reflection from a matte surface of the cylinder interferes and is perceived as a luminous point (speckle). The patient is shown diffuse horizontal dynamic laser speckle from a distance of 1 m In the first 10 minutes of act one to each eye, and then 5 minutes for both eyes. In the trial frame is placed corrective lens forces the th, necessary to stop the movement of grain. Then depending on the state of the tone of accommodation, the strength of the lenses is reduced by 0.25 to 0.5 diopters when geodinamicheskoi form of accommodative dysfunction and the patient is instructed to fix laser speckle for 5 minutes With repeated cycles of changing lenses with the gradual Menshenin 0.25-0.5 diopters was carried out in the case of stop motion "graininess". The positive effect will be when the value of the corrective lenses will tend to zero. Laser stroboscope is carried out in 5 days, 2 times a day with an interval of 1 hour.

The patient sits at a distance of 1 m from the cylinder with speckle. This mode is selected by a violation of the tone of accommodation for a distance of 1 m than for distances from 0.33 m In contrast to the known methods of treatment is the training and strengthening of the weakened ciliary muscle. In the first 10 minutes of act alternately on each eye for the normalization of monocular tonocov accommodation, and then 5 minutes on both eyes at the same time to enhance binocular interaction 2 times a day with an interval of 1 hour to enhance the effect, within 5 days by the day. Only the duration of one session is 15 minutes. A survey of patients conducted one week after treatment, after 3 months the effect was preserved, and in 6 months have noticed a decrease in tone is. It is preferable to repeat the treatment every 6 months.

As shown by our data, treatment with laser stroboscope resulted in normalization of monocular and binocular tonocov accommodation, and to reduce accommodative anisometropia. Were observed normalization of volumes absolute accommodation often squinting eyes in 76% of cases. Research conducted with correction, showed that 8 patients after treatment of strabismus angle disappeared, and the remaining 7 people it was less than 10°.

Effect on accommodative apparatus has improved the visual acuity of 0.1 to 0.4 (in 27% of cases).

Normalizing the tone of accommodation, accompanied by a decrease in the angle of strabismus, as well as increased visual acuity changed the nature of the vision of the patients. After treatment the number of patients with binocular vision increased from 26% to 60%.

The treatment had a positive effect on the value of fusional reserves. In 20% of patients showed normalization of both positive and negative fusional reserves, one patient reserves appeared for the first time.

Thus, if the inclination angles up to 10°), it is advisable to start treatment with laser strobe, and at large angles, the first step should be to carry out surgery with subsequent inclusion laser strobe.

Proposed ways which improves visual acuity, eliminates or reduces the angle of strabismus, restores visual function by eliminating anisogametes and strengthening of binocular interaction.

Clinical example 1. Patient O., age 10. Before treatment. Diagnosis: friendly, accommodative, alternating (often OD) strabismus. Hm medium.

Before treatment Vis OU 0,8 b/K and C/K. refraction Hm +to 3.5 diopters deviation alternive 8-10° without correction, 0° C correction. The amount of absolute accommodation often squinting eye to 3.0 diopters, often locking eyes of 7.0 diopters. The ratio AK/And 5.7 pdptr/diopters. The tone of accommodation with 1 m more squinting eyes a-0.7 diopters, often locking eyes -0,4 diopters, "binocular" tone of accommodation will be 0,55 diopters. With 0,33 meter tone of accommodation often squinting eye -2,0 diopters, often locking eyes -1,9 diopters, "binocular" tonus of-2.1 diopters. The nature of the view with 1 meter binocular with 2.5 and 5 meters simultaneously. OY=SY=7° C correction. Fusional reserves not.

The treatment was performed according to the above method. The patient was placed at a distance of 1 m from the screen with speckle. In a test frame was placed lens power +of 3.5 diopters in front of each eye. In the first 10 minutes worked alternately on each eye, and then 5 minutes on both eyes at the same time. The patient tried to stop the movement of the laser speckles. After reaching effect strength of the lenses was reduced by 0.25 diopters. The first session of 3.5 diopters, a second treatment +of 3.25 diopters, third session - +3,0 diopters, etc. came to +1.0. The reducing power of the positive lens leads to increased tone of accommodation. The treatment lasted for 5 days, 2 times a day with an interval of 1 hour.

After treatment: Vis OU 1,0 b/K and C/K. refraction Hm +to 3.5 diopters deviation in primary position 0° without correction, in dividing the installation of traffic by type of esotropia, 0° C correction. The amount of absolute accommodation often squinting eyes of 7.0 diopters, often fixing his eyes were 9.0 diopters. The ratio AK/As 4,9 Ave DP/DP. The tone of accommodation with 1 m more squinting eye -0,8 diopters, often locking eyes of-0.75 diopters, "binocular" tone of accommodation of-0.75 diopters from 0.33 meter tone of accommodation often squinting eyes and 2.5 diopters, often locking eyes -2,4 diopters, "binocular" tone -2,4 diopters. The nature of binocular vision throughout. OY=SY=0° C correction. Fusional reserves +4,0; -2,0.

Thus, the normalization of the accommodative apparatus resulted in the normalization of visual functions: to improve visual acuity, reduction of the angle of strabismus, restoration of binocular vision.

Clinical example 2. Patient A., aged 6. Before treatment. Diagnosis: friendly, partial accommodative, alternating (usually OS) strabismus. Amblyopia weak, OS Hm weak.

Before treatment Vis b/C OD 0,8; OS 0.6 and c/K OD of 1.0 OS 0,7, refraction Hm OD +2,5 OS +2,75 diopters, d is veazie alternive 25° without correction, 17-20° C correction. The amount of absolute accommodation often squinting eyes of 2.0 diopters, often locking eyes of 6.0 diopters. The ratio AK/And 5.5 pdptr/diopters. The tone of accommodation with 1 m more squinting eye -6,0 diopters, often locking eyes of-0.5 diopters, "binocular" tone of accommodation of-0.5 diopters. With 0,33 meter tone of accommodation often squinting eye -1,8 diopters, often locking eyes -1,7 diopters, "binocular" tone -1,8 diopters. Nature vision monocular throughout. OY=20° C correction SY - scotoma.

The surgery intervention: recession MRM of 4 mm, resection MRL 8 mm Deviation 0-7°. Without correction. 0°-3° C correction.

After 1 month completed the treatment on a laser strobe. After treatment, the tone of accommodation normalized and was with a distance of 1 m more squinting eye -0,8 diopters, often locking eyes of-0.75 diopters increased and "binocular" tone of accommodation to-0.8 diopters, which leads to increased binocular interaction. With 0,33 meter tone of accommodation often squinting eye -2,6 diopters, often locking eyes and 2.5 diopters, "binocular" tone -2,7 diopters. There was an increase of visual acuity without correction and with correction Vis b/C OD of 0.9; OS of 0.7-0.8 and c/K OD of 1.0 OS 1.0, the refraction Hm OD +2,5 OS+2,75 diopters decreased deviation without glasses and disappeared altogether in glasses: deviation 0-3° without correction alternive, 0° C correction. Increased volume of absolute accommodation h the school squinting eye to 5.0 diopters, often fixing his eyes to 8.0 diopters. The ratio AK/And decreased to 4.5 pdptr/diopters. The character of view simultaneously from 5 to 2.5 m and 1 m - unstable binocular. OY=5° C correction SY=OY. Fusional reserves not.

The proposed method can also be used after surgery to remove the residual angle of strabismus, improve visual acuity, binocular vision restoration by normalizing monocular and binocular tonocov accommodation more squinting and often locking eyes.

1. The method of restoration of binocular function in concomitant strabismus, characterized in that conduct laser stroboscope for 5 days 2 times a day with intervals of 1 h, during the first 10 min act alternately on each eye, and then 5 minutes on both eyes simultaneously with the distance to the speckle size 1 m

2. The method according to claim 1, characterized in that when the angle of strabismus is more than 10° previously conducted surgical strabismus.

3. The method according to claim 1, characterized in that the treatment should be repeated after 6 months.



 

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