Diagnostic technique for glaucoma in patients with progressive myopia

FIELD: medicine.

SUBSTANCE: in patients with progressive myopia if glaucoma suspected, lachrymal fluid is examined for the concentration lactic (LA) and pyruvic (PA) acids for the right and left eyes. Then for each eye, hypoxia coefficients are calculated by formulae: HCOD=LAOS/PAOD, HCOS=LAOS/PAOS, where HCOD is the hypoxia coefficient of the right eye; LAOS is the LA concentration in the LF of the right eye, mmol/l; PAOD is the PA concentration in the LF of the right eye, mcmol/l; HCOS is the hypoxia coefficient of the left eye; LAOS is the LA concentration in the LF of the left eye, mmol/l; PAOS is the PA concentration in the LF of the left eye, mcmol/l. If the hypoxia coefficient HCOD exceeds 1.0, glaucoma on the corresponding eye is diagnosed.

EFFECT: use of the technique enables high reliable diagnosis of glaucoma in patients with progressive myopia.

2 ex

 

The invention relates to medicine, in particular to ophthalmology, and can be used for the diagnosis of glaucoma in individuals with progressive myopia.

Glaucoma is one of the major problems in ophthalmology, because for many years occupied a leading place in the structure of disability (Libman E.S., Shakhova E.V. Blindness and visual disability in the population of Russia // J. struct. Dokl. VIII Congress of ophthalmologists of Russia. M., 2005. - P.78-79).

When expressed forms of glaucoma clinical ophthalmic examination is enough for an accurate diagnosis. However, there is a category of patients whose diagnosis of glaucoma based on data from clinical and ophthalmologic examinations, difficult, and often impossible. This applies to patients with progressive myopia. Glaucoma occurring against the background of progressive myopia, hard to diagnose, because the relative increase of intraocular pressure leads to stretching of the outer capsule of the eye to increase its size, which in turn is accompanied by normalization of intraocular pressure (IOP) and the development of degenerative changes in the retina and the optic nerve (optic nerve disc) (Araie M, Arai M, Koseki, N. et al. Influence of myopic refraction on visual field defects in normal tension and primary open angle glaucoma // Jpn. J. Ophthalmol. - 1995. - Vol.9. No. .1. - P.60-64). Therefore, currently, the development of new methods for diagnosing glaucoma in individuals with progressive myopia remains one of the pressing problems in modern ophthalmology.

Conducted research on the medical-scientific and patent literature found various ways to diagnose glaucoma.

In the patent of Russian Federation №2166276 (2001, BIPM No. 13) diagnosis of glaucoma is carried out by research critical frequency of flicker fusion (ccsm) in zone Y. Increased intraocular pressure is produced using a blend of vacuum suction cups vacuum suction 1/4 periommatinae zone. At lower kcsm on the background compression is 20% or higher of initial value and increase the recovery time of this function for more than 5 minutes after removing the load diagnosed with glaucoma. The disadvantages of this method are its complexity of implementation, because it requires special equipment for carrying out the vacuum-diagnostic samples, and trauma to the myopic eye, which has a high probability of bleeding by compression of the choroidal or retinal vessels into force expressed the original chorioretinal dystrophy.

There is a way to diagnose glaucoma (Bunin YA, Yakovlev A.A. TO the problem of the pathogenesis and treatment of varieties of primary open-angle g is oucome. Glaucoma, 2003. No. 3. - P.3-5), which determined the content of total sulfated glycosaminoglycans and lipids. When those declines from 45% to 25% and improve elastane in lattice plates from 8% to 28% of the dry weight of the tissue to be diagnosed with glaucoma.

A known method for the diagnosis of glaucoma (RF patent No. 2207568, BIPM No. 18, 2003), lies in the microscopic examination of the lacrimal fluid (SG), which is in the amount of 0.01-0.02 ml put on a glass slide, dried at a temperature of 18-20°C for 10-12 hours. In the presence of a boundary of a protein and a narrow band with oriented crystals of salts on the edge of the Central salt zone diagnose the early stage of glaucoma, with equal width protein and regional bands with oriented crystals of salts on the edge of the Central salt zone - an advanced stage of glaucoma, with only the Central salt zone - severe stage, and in the presence of salt crystals in a protein the marginal zone of the terminal.

The disadvantage of the above two methods is their adaptation to the elderly, when age-related changes in metabolic processes combined with pathological, so the criteria for diagnosis of glaucoma is not reliable for persons with progressive myopia.

In the patent of Russian Federation №2230478 (2004, BIPM No. 17) described a method for the diagnosis of Glauco the s in individuals with progressive myopia, which is by defining thresholds static perimetric studies, the values of intraocular pressure and determine the total level of light sensitivity in Verninskoe and weretemporarily the boundaries of the field of view of 30° from the fixation point. Intraocular pressure is measured consistently Maklakov tonometer 5-7,5-10-15, While reducing the total value of the light sensitivity Verninskoe border by 15% or more compared with the sensitivity weretemporarily border, with increasing IOP 20.0 mm Hg or higher, when measured 5 g tonometer with scale elastocrepe 10 mm and more are diagnosed with glaucoma in myopic eye. The disadvantage of this method is its lack of reliability of the diagnosis of glaucoma, since the increase in lens thickness, vitreous length of the body, the anterior-posterior axis of the eyeball and the zone of the optic nerve disc in progressive myopia leads to the development of glaucoma normal IOP more than 53% of cases (Grodun K., Heijl a, Bengtsson C. Refractive error and glaucoma // Acta. Ophthalmol. Scand. - 2001.- Vol.79.- No. 6. - P.560-566).

In the patent of Russian Federation №2297171 (2007, BIPM No. 11) described a method for the diagnosis of primary open-angle glaucoma in the early stages of the disease by fasting samples and assessment of data computer static perimetric studies. When detecting changes in the characteristic is for glaucomatous process areas of the field of view of the conduct discharge test: after the preliminary control of intraocular pressure once instilled 1 drop of ophthalmic drug "Travatan". After 24 hours, carry out control and measurement of intraocular pressure and repeat computerized static perimetry. While improving the sensitivity of the retina on the background of reduction of intraocular pressure, the sample is considered positive and diagnosed with primary open-angle glaucoma, early stage. The disadvantage of this method is the low reliability of the diagnosis of glaucoma in patients with progressive myopia, as Travatan" reduces intraocular pressure in these patients is not more than 60% of cases (Dolich P.P. Pathogenetic mechanisms of decline of visual functions in complicated myopia and combined with glaucoma, the development of a differentiated system of rehabilitation and follow up: author. of thesis ... Dr. med. Sciences. - Samara, 2006. - P.26).

RF patent №2314033 (2008, BIPM No. 1) a secure method for the diagnosis of early stages of primary open-angle glaucoma by determining the values of the ratios of the volumes of excavation of the optic disc as a whole and by sector to the respective amounts neuroretinal belt. In case of exceeding the maximum values of the norms of these relations at least one sector or the whole disk with the simultaneous presence in the fields of view of cattle diagnosed with early stage primary open-angle glaucoma.

In the patent of Russian Federation №2372018 (2009, BIP is No. 31) described a method for early diagnosis of glaucoma by determining the existence of an excavation of the optic nerve, the presence in the fields of view of the livestock, the availability of the closing angle of the anterior chamber and the presence of venous congestion. In the case of the simultaneous presence of all signs of glaucomatous changes diagnose glaucoma, if one of the signs to be diagnosed with early glaucomatous changes, in other cases the early stage of glaucoma.

The disadvantages of the above two methods is their lack of reliability and informative diagnosis of glaucoma in individuals with progressive myopia, because a significant increase in the size of the eyeball excavation of the optic disc (optic nerve disc) remains small due to high intraocular pressure and increase the boundaries of the blind spot caused by the development around the optic nerve disc chorioretinal dystrophy.

The closest technical solution and taken for the prototype is the Way to diagnose the initial stage of open angle glaucoma", protected by the RF patent №2314535 (2008, BIPM No. 1), consisting in the study of the lacrimal fluid of the patient. In the tear fluid determine the levels of autoantibodies (AAB) to antigens (AG) of native and denatured DNA (h - and d-DNA) and the levels of circulating immune complexes (CIC) in the tear fluid of the patient. When the levels of autoantibodies to n - and d-DNA above 0.7 and 0.8 used, respectively, and mn is the significance level of the CEC above 33,0 used diagnose the early stage of FNH. The disadvantages of this method are the difficulty of performing immunological studies and the lack of reliability of the diagnosis of glaucoma with progressive myopia, due to the fact that detection of AAT to antigens of native and denatured DNA in the tear fluid of patients with glaucoma with progressive myopia are not more than in 42.8% of cases (Teplinskaya LE Authenticatorbase when eyes diseases // Optometrist - 2006. No. 4.- P.18).

The aim of the invention is to simplify the method, as well as increasing the reliability of the diagnosis of glaucoma in patients with progressive myopia.

This goal is achieved by the fact that patients with progressive myopia with suspected glaucoma explore tear fluid, which determine the concentration of milk (MK) and pyruvic (STC) acids for right and left eyes. Then for each eye compute the coefficients of hypoxia by the formulas:

KGOD=MCOD/STCOD,

KGOS=MCOS/STCOS,

where KGODfactor hypoxia of the right eye;

MCODthe concentration of MC in LF right eye, mmol/l;

STCODthe concentration of pyruvate in SG right eye, µmol/l;

KGOSfactor hypoxia left eye;

MCOS- conc the Oia MC in LF left eye, mmol/l;

STCOSthe concentration of PVA in LF left eye, umol/L.

When the value of the coefficient of hypoxia KGODmore than 1.0 diagnose glaucoma in my right eye, when the value of the coefficient of hypoxia KGOSmore than 1.0 diagnose glaucoma in his left eye, when the value of both coefficients more than 1.0 diagnose glaucoma in both eyes.

The method is as follows. In patients with progressive myopia from the lower conjunctival fornix of each eye, without anesthesia, microcannula taking lacrimal fluid in a volume of 0.2 ml in separate dry test tube. Stimulation of lesoproduktsii conduct mechanical irritation receptor endings of the trigeminal nerve in the mucous membrane of the eye. The concentration of lactic and pyruvic acids in the tear fluid of the right and left eyes is determined according to standard methods (Handbook of laboratory research methods / edited by L.A. Danilova. - SPb.: Peter, 2003.- S-370). Then calculate for each eye coefficients of hypoxia by the formulas:

KGOD=MCOD/STCOD,

KGOS=MCOS/STCOS,

where KGODfactor hypoxia of the right eye;

MCODthe concentration of MC in LF right eye, mmol/l;

STCODthe concentration of pyruvate in SG right eye, µmol/l;

KG factor hypoxia left eye;

MCOSthe concentration of MC in LF left eye, mmol/l;

STCOSthe concentration of PVA in LF left eye, umol/L.

When the value of the coefficient of hypoxia KGODmore than 1.0 diagnose glaucoma in my right eye, when the value of the coefficient of hypoxia KGOSmore than 1.0 diagnose glaucoma in his left eye, when the value of both coefficients more than 1.0 diagnose glaucoma in both eyes.

Practical feasibility of the proposed method is illustrated by clinical examples.

Example 1.

Patient K., aged 20, with progressive myopia of a high degree of both eyes has acted in a consultative polyclinic of the Regional clinical hospital of Rostov-on-don with a diagnosis of suspected glaucoma in both eyes. History of myopia appeared in 7 years. For the last 2 years the increase of myopia in both eyes was 2.0 diopters.

The results of the survey:

VOD=0,08 sph to 8.0 diopters=0,9; IOP=25,0 mm Hg

VOS=0,04 sph-9,0 diopters or=0.6; IOP=26.0 mm Hg

For diagnosis the patient study was conducted according to the claimed method. The patient K. from the lower conjunctival fornix of each eye, without anesthesia, microcannula collected the tear fluid in a volume of 0.2 ml in separate dry test tube. Stimulation of lesoproduktsii held fur the technical irritation receptor endings of the trigeminal nerve in the mucous membrane of the eye. The concentration of lactic and pyruvic acids in the tear fluid of the right and left eye were determined by standard methods (Handbook of laboratory methods of research. / Ed. by L.A. Danilova. - SPb.: Peter, 2003.- s-370). Were obtained the following values:

MCOD=0,49 mmol/l, MCOS=0.52 mmol/l;

STCOD=0,39 mmol/l, STCOS0.41 µmol/L.

Then was calculated for each eye coefficients of hypoxia by the formulas:

KGOD=MCOD/STCOD,

KGOS=MCOS/STCOS,

where KGODfactor hypoxia of the right eye;

MCODthe concentration of MC in LF right eye, mmol/l;

STCODthe concentration of pyruvate in SG right eye, µmol/l;

KGOSfactor hypoxia left eye;

MCOSthe concentration of MC in LF left eye, mmol/l;

STCOSthe concentration of PVA in LF left eye, umol/L.

Were obtained the following values: KGOD=1,26 KGOS=1,27. Since KGOD=1,26>1,0 KGOS=1,27>1.0, the patient was diagnosed with glaucoma in both eyes. The patient was prescribed the appropriate medication, the results of which confirmed the reliability of the diagnosis.

Example 2.

Patient M., 22, with progressive myopia of a high degree right eye turned to the clinic Rostov-onDon, complaining of decreased vision in the right eye. From the history of the growth of myopia in the right eye for the last year amounted to 1.5 diopters. During examination:

VOD=0,05 sph-8,5 DP=1,0 IOP=24.0 mm Hg

VOS=0,08 sph-4,5 DP=1,0 IOP=18,0 mm Hg

Under normal perimetric studies of peripheral field of vision of both eyes was normal.

For a diagnosis to a patient, a study was conducted according to the claimed method. Patient M from the lower conjunctival fornix of each eye, without anesthesia, microcannula collected the tear fluid in a volume of 0.2 ml in separate dry test tube. Stimulation of lesoproduktsii conducted by mechanical irritation of the receptor endings of the trigeminal nerve in the mucous membrane of the eye. The concentration of lactic and pyruvic acids in the tear fluid of the right and left eye were determined by standard methods (Handbook of laboratory research methods / edited by L.A. Danilova. - SPb.: Peter, 2003.- s-370). Were obtained the following values:

MCODor =0.51 mmol/l, MCOS=0.29 mmol/l;

STCOD=0,40 çmol/l, STCOS=0.36 µmol/L.

Then was calculated for each eye coefficients of hypoxia by the formulas:

KGOD=MCOD/STCOD,

KGOS=MCOS/STCOS,

where KGODfactor hypoxia of the right eye;

MCODthe concentration of MC in LF right eye, mmol/l;

sup> ODthe concentration of pyruvate in SG right eye, µmol/l;

KGOSfactor hypoxia left eye;

MCOSthe concentration of MC in LF left eye, mmol/l;

STCOSthe concentration of PVA in LF left eye, umol/L.

Were obtained the following values: KG0D=1,27 KG0S=0,8. Since KG0D=1,27>1,0 KG0S=0,8<1.0, the patient was diagnosed with glaucoma of the right eye. Assigned adequate treatment, the results of which confirmed the reliability of the diagnosis.

According to the claimed method we examined 45 patients with progressive myopia of one or both eyes with suspected glaucoma; 43 patients were diagnosed with glaucoma. Clinical diagnosis of glaucoma is set according to the claimed method, in all cases was confirmed by additional examination using computer perimetric studies and retinal tomography of the optic nerve, the use of which little is available for mass screening.

Thus, the Method of diagnosing glaucoma in individuals with progressive myopia" is easy to implement and allows you to reliably diagnose glaucoma in individuals with progressive myopia.

A method for diagnosing glaucoma in individuals with progressive myopia, which consists in the study with the serious fluid (SG) of the patient, characterized in that the tear fluid of each eye to determine the concentration of milk (MK) and pyruvic (STC) acids, then for each eye compute the coefficients of hypoxia by the formula:
KGOD=MCOD/STCOD,
KGOS=MCOS/STCOS,
where KGODfactor hypoxia of the right eye;
MCODthe concentration of MC in LF right eye, mmol/l;
STCODthe concentration of pyruvate in SG right eye, µmol/l;
KGOSfactor hypoxia left eye;
MCOSthe concentration of MC in LF left eye, mmol/l;
STCOSthe concentration of PVA in LF left eye, umol/L.
and when you factor hypoxia more than 1.0 diagnose glaucoma at the appropriate eye.



 

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