RU2150235C1 - Method for diagnosing the cases of chronic posttraumatic uveitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying Doppler ultrasound examination of ophthalmic and supratrochlear artery detecting increased blood circulation flow rate on both sides, when inflammatory process takes place. The increase is marked to a greater extent on the side of the injured eye. Maximum systolic flow rate is > 31.5 ± 2.6 cm/s, 14.4 ± 1.13 cm/s, diastolic flow rate is > 8.6 ± 0.5 cm/s, 5.9 ± 0.6 cm/s, pulse index is 1.3 ± 0.1, 5.9 ± 0.03 in this case. EFFECT: accelerated diagnosis method; prevented progressive development of eye ball subatrophy and sympathetic ophthalmia.

Description

 The invention relates to medicine, in particular to ophthalmology, and can be used in the diagnosis of post-traumatic uveitis.

 It is known that the diagnosis of post-traumatic uveitis (PTU) is made on the basis of the presence of clinical symptoms of inflammation: photophobia, (lacrimation, cyclical pain, pericorneal injection, precipitation and exudation in the eye cavity. However, in chronic, sluggish forms of the disease, these symptoms are mild or even absent. At the same time, a moderate injection of the eyeball, as is known, can persist for a long time or appear when examining an eye that has suffered a serious injury, even with a favorable and during the process, and there is no need to prescribe intensive anti-inflammatory therapy.In connection with the foregoing, in the course of dispensary observation of the condition of the injured eye, difficulties may arise in the diagnosis of vocational schools, which complicates the doctor’s decision regarding therapeutic tactics (Yakhnitskaya L.K., 1992, Gyurjyan T.A., 1988-, Cherikchi L.E., 1977, Shevalev V.S. et al., 1978).

 The closest way to the claimed invention in terms of features is a method for diagnosing an inflammatory process in the eye after perforated wounds, in which ultrasound dopplerography revealed acceleration of blood flow in the orbital artery in 6 cases (Vinkova G.A., Gogolevskaya A.V., "Materials 4 scientific-practical conference of the Ekaterinburg Center MNTK MX eyes ", Ekaterinburg, 1997, p.3-5).

 The reasons that impede the achievement of the technical result indicated below include the fact that the known method does not provide for the diagnosis of chronic, sluggish, post-traumatic uveitis by hemodynamics in the supra-lateral artery on the side of the diseased eye, as well as in the orbital and supra-lateral arteries on the side of a paired healthy eyeball .

 The problem to which the invention is directed, is to enable the diagnosis of chronic vocational schools in the eye, suffered a perforated wound.

 The technical result is the timely diagnosis of vocational schools using the proposed method, the appointment of anti-inflammatory therapy and thereby preventing such serious complications as sympathetic ophthalmia and post-traumatic subatrophy of the eye.

 This problem is solved due to the fact that in the claimed method for the diagnosis of chronic technical colleges using ultrasound dopplerography (Doppler ultrasound), the blood flow velocity in the orbital and suprablock arteries is examined from both the injured and paired eyes, comparing the data obtained between themselves and with the standards, and with maximum systolic velocity> 31.5 ± 2.6 cm / s and 14.4 ± 1.3 cm / s, diastolic velocity> 8.6 ± 0.5 cm / s and 5.9 ± 0.6 cm / s a pulsatile index <1.3 ± 0.11 and 1.07 ± 0.03 diagnose the disease.

 The authors first proposed the use of ultrasound dopplerography of the orbital and supra-lateral arteries from the injured and healthy eye for the diagnosis of chronic post-traumatic uveitis.

 Studies on patent and scientific and technical sources of information have shown that the proposed method for the diagnosis of post-traumatic uveitis is not known and does not follow explicitly from the studied prior art, i.e. meets the criteria of "novelty" and "inventive step".

 The proposed diagnostic method is carried out on a multidisciplinary apparatus "Ultramark-9" company ATL (USA).

 The study of blood circulation in the orbital artery is carried out using a probe with an emissivity equal to 2 MHz, and consists in the fact that this probe is installed on the lowered upper eyelid in the medial corner of the eye socket, and the ultrasound beam is directed up and inward until a clear ultrasound signal appears.

 The blood flow in the supra-lateral artery is determined using an ultrasound transducer with an emitting power of 8 MHz, which is located in the medial corner of the orbit with closed eyelids in the direction of the medial and upper walls of the orbit. The device automatically calculates the main hemodynamic parameters in the studied arteries.

 Previously, in 28 healthy young people aged 17-39 years, blood flow indices in the orbital and suprablock arteries were studied; maximum systolic speed (MSS), diastolic speed (DS), pulsatile index (PI). They amounted respectively: MSS-31.5 ± 2.6 cm / s and 14.4 ± 1.13 cm / s; DS-8.6 ± 0.5 cm / s, 5.92 ± 0.6 cm / s; PI-13 ± 0.11 and 1.07 ± 0.03.

 We examined 50 patients with sluggish uveitis at the age of 16-35 years old who suffered a severe perforated wound of the eyeball using the ultrasound scan method. The reliability of the diagnosis was monitored by biochemical studies of lipid peroxidation (LPO) and the activity of antioxidant enzymes catalase and superoxide dismutase in a patient’s tear. Previously, each patient underwent two-dimensional ultrasound of the common and internal carotid arteries to exclude narrowing of the lumen of these great vessels. In the inflammatory process in the eye, acceleration of blood flow in the orbital and suprablock arteries was noted in 100% of cases, and a pulsative index decreased in 94% compared with the control group. On the side of the paired eye in the orbital and suprablock arteries, acceleration of blood flow was noted in 96% of patients, a decrease in the pulsative index in 86% of cases, and these changes were less pronounced compared to those on the side of the injured eyeball. As the post-traumatic inflammatory process was stopped in the uveal tract of the injured eye, normalization of the hydrodynamic indices in the orbital and supra-lateral arteries was observed on both sides, and the normalization of the contents of lipid peroxidation products and antioxidant activity was recorded in parallel. Of the 50 patients observed in the late post-traumatic period, 13 patients with a diagnosis of sluggish uveitis did not have an acceleration of blood flow in the test vessels, the absence of an inflammatory process was confirmed by biochemical studies of lacrimal fluid. The studies performed allowed us to establish the diagnostic role of the method of bilateral ultrasound dopplerography of the ophthalmic and supra-lateral arteries in the detection of technical colleges for accelerating blood flow in them, which indirectly indicates intensive blood circulation in the vessels of the eyeball.

Examples
1. Patient K., 30 years old. He suffered a perforated wound of the corneoscleral region of the right eye 5 months ago. During this time, twice operated on for traumatic cataracts and the remains of the lens masses. It was observed at the ophthalmologist in connection with the prolonged course of vocational schools. On examination, a slight injection is noted, which slightly increases during the examination of the eye. According to the patient, the eye turns red after overheating and physical exertion. With USDG on the right, the MSS of the ophthalmic artery was 30.9 cm / s, the DS was 8.8 cm / s, the PI was 1.3, and in the study of hemodynamics in the suprablock artery, the MSS was 14.0 cm / s, and the DS was 6.2 cm / s, PI - 1.02. On the left, the MSS in the orbital artery was 30.4 cm / s, in the supralateral artery - 14.8 cm / s, DS respectively - 8.6 cm / s, 5.7 cm / s, PI - 1.4 and 1.1. Biochemical studies indicated normalization of lipid peroxidation and the antioxidant system. Conclusion: the phenomena of vocational schools are absent. Recommended observation, restriction of heavy physical labor.

 2. Patient B., 24 years old. 4 months ago, he was treated in the clinic for a severe perforated wound of the cornea, traumatic cataract, hemorrhage in the vitreous body of the right eye. 2 weeks after the injury, he was operated on at the height of traumatic uveitis due to cataracts due to the loss of lens masses. After the operation, a severe inflammatory process was observed. After 1.5 months, subatrophy developed against the background of sluggish uveitis. On examination, 4 months after the wound, the patient did not show complaints, a slight injection of the eyeball was noted. When ultrasound scan showed an acceleration of blood flow in the orbital and suprablock arteries compared with the standards and hemodynamic parameters of control vessels: in the right eye, respectively, the MSS was 39 cm / s and 20 cm / s, DS - 13.9 cm / s and 9.2 cm / s, PI - 1.0 and 0.09; on the left eye - MSS - 35.5 cm / s, 17.4 cm / s, DS - 9.4 cm / s and 6.9 cm / s, PI - 1.2 and 0.95. Biochemical control showed the activation of lipid peroxidation and antioxidant enzymes. Conclusion: Phenomenon of vocational schools, subatrophy of the eye (stage I). Prescribed treatment. With a second study after 1 month, normalization of hemodynamic parameters on both sides was noted.

 Thus, the proposed method is atraumatic, non-invasive, safe, highly reliable, simple, affordable. The method of ultrasonic dopplerography is very common in the country, and therefore, the proposed method can be applied in any ophthalmology department or hospital equipped with appropriate equipment, so the method is affordable, and therefore, "practically applicable".

Claims (1)

 A method for diagnosing chronic post-traumatic uveitis by ultrasound dopplerography, characterized in that the blood flow velocity in the orbital and suprablock arteries is examined from both the injured and the paired eye, and indicators are also compared at a maximum systolic speed> 31.5 ± 2.6 cm / s, 14.4 ± 1.13 cm / s, diastolic velocity> 8.6 ± 0.5 cm / s, 5.9 ± 0.6 cm / s, pulsatile index <1.3 ± 0.11 and 1.07 ± 0.03 diagnose the disease.