RU2267339C1 - Method for treating children for strabismic amblyopia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves treating vision analyzer by applying physical factors like combined concurrent contact treatment with pulsating infrared laser radiation, pulsating incoherent radiation, pulsating red radiation and permanent magnetic field applied to occipitoparietal head and neck zone, carotid sinuses and biologically active points using magnetic infrared laser therapy apparatus having two radiator types and an optical acupuncture nozzle. The treatment course is 8-12 sessions long.

EFFECT: enhanced effectiveness of treatment; stable and high quality results; accelerated treatment course.

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Description

The invention relates to medicine and will find its application for the treatment of dysbinocular amblyopia in children.

In the structure of the formation of childhood blindness, low vision and disability, high amblyopia takes third place. The main form of prevention of blindness and disability is the timely elimination of removable visual disorders, effective rehabilitation treatment - the first stage of rehabilitation (ES Libman, materials of the Russian interregional symposium “Elimination of eliminated blindness: WHO Worldwide Initiative”, Moscow, 2003. P. 42).

In the pathogenesis of the development of dysbinocular amblyopia in children with friendly strabismus, special attention is paid to the functional state of the visual analyzer and its two ways of transmitting and processing visual information - retinocortical and encephaloretinal, as well as binocular vision disorder.

The main objective of the ortho-pleoptic methods of treating dysbinocular amblyopia with friendly strabismus is to obtain visual acuity of 0.4 and higher, which allows the normal joint work of both eyes, and the formation of the binocular nature of vision.

Conducted research on the medical-scientific and patent literature revealed various combined methods of hardware and physical effects on the visual system of the eye.

In the materials of the scientific-practical conference "Complex use of lasers in ophthalmology, new technologies, equipment." Kaluga, 1999, P.44-45, E.V. Tumennik in the article “Using the LOT-01 device for low-intensity laser therapy in ophthalmology” suggested using the LOT-01 device, which operates at a wavelength of 0.63 μm (He-Ne ), with a power range from 0.1 to 0.3 mW and a head nozzle NG-01 for the treatment of children with amblyopia. The anterior and posterior segments of the eye were treated with a laser spot with a spectrum structure of 4 minutes for each eye for 5 daily procedures. According to the author, in 84% of cases, an increase in visual acuity by 25-30% was noted. The therapeutic effect lasted on average up to 3 months. The disadvantage of this method is the instability of the treatment results.

Driga B.C. "Ophthalmoneurophysiological diagnosis and pathogenetically oriented treatment of amblyopia in children", author. diss ... cand. honey. sciences. - St. Petersburg, 2003. - 16 s., Proposed the use of a neuroprotector - cortexin - in the form of endonasal electrophoresis in the complex treatment of refractive-dysbinocular amblyopia. The disadvantages of the proposed method is the limitation of the contingent of patients with drug allergies, pathology of ENT organs.

In the patent literature there is information about methods of treating dysbinocular amblyopia.

Patent No. 2197199 (2003, Bull, No. 3) protected the "Method for the treatment of amblyopia", which consists in catering the tenon space with the introduction of cerebrolysin 0.6 ml, agapurin 0.5 ml, taufon 0.8 ml, dicinone 0.6 ml, emoxipin 0.5 ml 6 times a day sequentially in combination with a course of synchronous magnetic and light stimulation, video-computer auto-training and exercises with an accommodation line. Sessions are held for 10 days. The disadvantages of the method are the duration of each procedure, which is not acceptable for preschool children with a labile nervous system and poor perseverance, limiting the contingent of patients with drug allergies and the possibility of developing side effects from mask anesthesia during cationization of the tenon space of the eyeball.

Patents No. 2146910 (2000, Bull. No. 9), No. 2147424 (2000, Bull. No. 11), No. 2150253 (2000, Bull. No. 16), No. 2161939 (2001, Bull. No. 2) it is proposed, in combination with other hardware methods for the treatment of amblyopia, to use methods of laser stimulation of the macular region of the retina, which differ from each other in the localization of exposure, the range of wavelengths, pulse duration, and parts of the laser beam spectrum. A common drawback is the impact on the peripheral section of the visual analyzer and, therefore, the low efficiency and instability of the treatment results.

The closest in technical essence is the "Method for the treatment of amblyopia" patent No. 2128029 (1999, Bull. No. 9), providing a comprehensive (electromagnetic, infrared and laser) effects on the posterior parts of the eyeball and intracranial sections of the visual analyzer. The technique is carried out by exposure to the orbital part of the circular muscle of the eye with incoherent radiation with a wavelength of 860-930 nm and a power of 120 mW, a magnetic field of 20-45 mT, with a laser wavelength of 890 nm with a radiation power of 2-10 mW. Significant disadvantages of the proposed method are:

- the impact only on the peripheral section of the visual analyzer;

- lack of stimulation of the cortical section of the visual analyzer as the main determining factor in the pathogenesis of dysbinocular amblyopia;

- lack of a differentiated approach to restoring the physiological tone of the oculomotor muscles;

- low therapeutic efficacy and instability of treatment results.

The aim of the present invention is to increase the effectiveness of treatment: by obtaining more stable and higher therapeutic results, no risk of complications and side effects, reducing treatment time,

This goal is achieved through physical action using quantum therapy with percutaneous contact technique on the occipital-parietal region of the head, neck, carotid sinuses and stimulation of biologically active points (BAP).

The claimed method is as follows.

The treatment is carried out using the RIKTA-04/4 magneto-infrared laser therapeutic apparatus (M2D, M22D) (passport with the technical description and operating instructions, 2002; registered certificate No. 29/06010201 / 2053-01; MILTA-PKP GIT ) They use emitters “Shower 1” (having 10 laser diodes with a power of up to 4 W each) and “Main” (pulsed power of infrared (IR) laser radiation of at least 8 W) with λ = 890 nm, with pulsed incoherent IR radiation with λ = 860 -960 nm and an average power of 60 ± 30 mW, pulsed red radiation with λ = 600-700 nm and a frequency of 2 Hz and a constant magnetic field with magnetic induction of 35 ± 10 mT, as well as the KON-1 acupuncture optical nozzle to the Main »Emitter.

The patient is placed on the couch horizontally upside down. First, a scan is performed, acting on the occipital-parietal region of the scalp from the coronary suture of the parietal bone to the occipital foramen along the midline of the aponeurosis and on the parietal region from the upper temporal line to the mastoid process from top to bottom on both sides of the Soul 1 emitter with laser pulse power IR radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation and a constant magnetic field lasting 2-4 minutes.

Then, without changing the patient’s position, they act on the neck area with a “Shower 1” emitter with a pulse power of laser IR radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz, with pulsed red radiation and a constant magnetic field, scanning movement is laravertebral from top to bottom long extensor muscles of the back from the occipital foramen to C ₆ -Th ₂ lasting 2-4 minutes.

Then the patient is seated facing the doctor, the “Main” emitter is installed on the carotid sinuses on both sides and treated with this emitter with a pulse power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz, with pulsed red radiation and constant magnetic field exposure for 2 minutes.

The next stage of exposure is laser reflexology. Set the acupuncture optical nozzle "KON-1" on the "Main" emitter with an output power of laser IR radiation of 8 watts. The doctor acts on symmetrical points of general action and local action points in the upper inner part of the eye’s orbit (using the braking technique) with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation, a constant magnetic field and exposure of 20-30 seconds for each point, and on the local action points in the lower outer part of the orbit of the patient’s eyes and auricular points (according to a stimulating technique) with a frequency of pulsed laser and incoherent IR radiation of 5 Hz, with pulsed red radiation, a constant magnetic field and an exposure of 20-30 seconds per point. Initially affect the points of general action: F ₂ , F ₃ , E ₃₆ , Ci ₄ , IG ₃ , TR ₁₀ , V ₆₂ , then the points of local action around the eyes: V ₁ , V ₂ , BT ₆ , BT ₃ , VB ₁₄ , E ₁ , E ₂ , TR ₂₃ , VB ₁ , BT ₉ and auricular points: AT ₈ , AT ₉₅ , AT ₉₇ . The duration of exposure is 8-10 minutes, the course of treatment consists of 8-12 sessions.

The quantum therapy used is multifactorial (combined), simultaneous exposure to pulsed infrared laser radiation, pulsed broadband infrared radiation, pulsating red radiation and a constant magnetic field. It is known that the main therapeutic factor in quantum therapy is pulsed infrared laser radiation from a semiconductor gallium arsenide laser diode.

Laser radiation has monochromaticity (narrowband), spatial and temporal coherence and polarization and, thanks to these properties, has a powerful stimulating effect on blood circulation, membrane cell metabolism, activates neurohumoral factors, immunocompetent systems, harmonizes hormonal metabolic factors.

The simultaneous use of pulsating broadband infrared radiation from semiconductor LEDs has less biological efficiency than laser due to the greater spectral breadth, incoherence and non-polarization, but its distinctive advantage is the penetration to greater depth and a harmonizing effect on the tone of the central and autonomic nervous system.

The pulsating broadband red radiation in the composition of this exposure visualizes the treatment area, has a weak warming and beneficial psychotherapeutic effect.

Finally, a constant magnetic field rotates the axes of molecular magnetic dipoles, increasing the internal energy of the molecules, thereby exerting a noticeable potentiating effect on all the components of multifactor quantum therapy.

All of the above therapeutic factors, acting simultaneously (synergistically), mutually reinforce each other and thereby determine the unique physiotherapeutic therapeutic and energy-harmonizing, prophylactic effects of multifactorial effects.

The device "RIKTA-04/4" allows for blood processing non-invasively (ie without damaging the skin). Blood is an active photoreceptor for the near infrared range, therefore, with a low power flux density, high therapy efficiency is achieved. On the other hand, low quantum energy (1.5 eV) makes the procedure practically safe, and a large emitter area (20 cm ² ) allows for more than 1 BCC (circulating blood volume) to be activated in a short time (about 10 minutes) (Methodological recommendations for use apparatus of quantum therapy "RIKTA" // Edited by Yu.B. Kheyfets, Moscow, 2002 - P.16, 235-237).

Thus, the proposed method allows to increase the threshold of perception of the cortical part of the visual analyzer, the balance of the processes of excitation and inhibition in the cerebral cortex, improves blood circulation in the vertebrobasilar pool and blood supply to the eyeball, has an antispasmodic effect and restores binocular function of the eyes.

Clinical example 1.

Patient K., 3 years old (individual outpatient card No. 8/03). Diagnosis: Converging friendly accommodative strabismus. Hyperopia of a weak degree of the right eye, a high degree of the left eye. High left dysbinocular amblyopia.

At the initial treatment, according to the words of the parents, he does not tolerate the prescribed spectacle correction, makes complaints about hypersensitivity to bright light, is inhibited and tearful.

From the anamnesis of life, it was found that during the neonatal period, the diagnosis was made: natal injury of the cervical spine. The patient is registered with a neuropathologist regarding minimal cerebral dysfunction (MMD) with peripheral cervical insufficiency syndrome (CTC).

From the anamnesis of the disease, it was revealed that the patient has been using glasses for constant wear for 3 months, received a two-week course of photostimulation on the BWO (large reflexless ophthalmoscope) and percutaneous electrical stimulation of the peripheral section of the visual analyzer. However, no increase in visual function was noted.

On examination, it was found:

Visual acuity (OD) = 0.08 with sph (+) 1.0 D = 0.6

Visual acuity (OS) = 0.02 with sph (+) 4.5 D = 0.06

The left eye deviates to the nose to 15 ° according to Hirschberg without glasses, in glasses the angle of deviation of the left eye is 0 °. The mobility of the eyeballs is complete. The nature of vision was not subjectively determined. The fundus of both eyes without pathology.

The data of rheoencephalography (REG) indicated a deterioration in hemodynamics in the basin of vertebrobasilar (VBB) vessels - the volumetric blood flow of the vessels was 0.155 ohms on the right and 0.142 ohms on the left, the rheographic index was reduced to 0.5. Dopplerography data revealed a decrease in the linear velocity of blood flow (LSC) in the pool of vertebral arteries (PA) to 11.7 cm / s and in the pool of common carotid arteries to 20.1 cm / s. The data of the electroencephalogram (EEG) indicated asymmetry in the amplitude-frequency characteristics of the wave groups, which reached 35-55%, and the lack of localization of the maximum electrical activity in the occipital region.

The patient was treated according to the proposed method using a magnetic laser therapeutic apparatus "RIKTA-04/4":

- acted with a scanning movement from top to bottom on the occipital-parietal region of the scalp from the coronary suture of the parietal bone to the occipital foramen along the midline of the aponeurosis and on the parietal region from the upper temporal line to the mastoid process on both sides of the Soul 1 emitter with pulsed laser IR power radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation and a constant magnetic field lasting 3 minutes,

- acted on the neck area with the “Shower 1” emitter with a pulse power of laser IR radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz, with pulsed red radiation and a constant magnetic field scanning movement paravertebrally from top to bottom along the extensor muscles of the back from the occipital openings up to C ₆ -Th ₂ exposure duration 2 minutes,

- acted on the carotid sinuses on both sides of the "Main" emitter with a pulse power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz, with pulsed red radiation and a constant magnetic field, exposure time of 2 minutes,

- acted on a symmetric BAT “Primary” emitter with an acupuncture optical nozzle “KON-1”, with a pulsed power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation and a constant magnetic field, initially on general action points: F ₂ , F ₃ , E ₃₆ , Gi ₄ , IG ₃ , TR ₁₀ , V ₆₂ and local action points in the upper-inner part of the eye orbit V ₁ , V ₂ , BT ₆ , BT ₃ , VB ₁₄ , then local action in terms lower-external part of the eye orbits E _1, E _2, TR _23, VB _1, BT ₉ and auricular ₈ Glasses AT, AT _95, AT ₉₇ with laser pulse power 8W IR radiation, with a frequency of a pulse laser and incoherent IR radiation 5Hz, pulsed red radiation and the constant magnetic field, exposure of 20-30 seconds duration at each point of impact 9 minutes The treatment course was 12 sessions.

After treatment with this technique, the patient underwent asthenopic complaints. Visual acuity without correction increased to 0.5 in the right eye and to 0.1 in the left eye. Visual acuity with correction increased to 0.6 in the right eye and to 0.3 in the left eye.

Positive dynamics of visual functions correlated with hemodynamic parameters: on REG the rheographic index reached 0.8, the volumetric blood flow in the vessels (WB) increased to 0.172 ohms, and dopplerographic studies revealed an increase in BFV in the vertebral arteries to normal - 18.5 cm / s and in the pool common carotid arteries up to 21.4 cm / s, and on the EEG there was an alignment of the parameters of the amplitude-frequency characteristics of wave groups (asymmetry decreased to 20%), the maximum electrical activity appeared in the occipital region.

Clinical example 2.

Patient M., 5 years old (individual outpatient card No. 14/03). Diagnosis: Converging friendly accommodative strabismus. Farsightedness of an average degree of the right eye, a weak degree of the left eye. Dysbinocular amblyopia of an average degree of the right eye.

At the initial treatment, according to the words of the parents, he does not tolerate the prescribed spectacle correction, is distinguished by poor perseverance; shows no interest in reading and drawing.

From the anamnesis of life, it was found that during infancy the diagnosis was made: natal injury of the cervical spine (SHOP) and vertebral arteries (PA). The patient is registered with a neurologist about the consequences of the transferred natal injury (SHOP) and (PA) in the form of MMD with hyperdynamic syndrome and peripheral cervical insufficiency syndrome.

From the anamnesis of the disease, it was revealed that the patient has been using glasses for constant wear for 2 years, regularly conducts classes on the synaptophore every 3-4 months to develop binocular vision, receives a two-week course of photostimulation on BWO (large reflexless ophthalmoscope) 2 times a year percutaneous electrical stimulation of the peripheral section of the visual analyzer. However, an increase in visual function and restoration of the binocular nature of vision was not noted.

On examination, it was found:

Visual acuity (OD) = 0.08 with sph (+) 4.0 D = 0.3

Visual acuity (OS) = 0.8 with sph (+) 1.5 D = 0.9

The right eye deviates to the nose up to 15 ° according to Hirschberg without glasses, in glasses the angle of deviation of the left eye is 0 °. The mobility of the eyeballs is complete. The nature of vision at a four-point color test is simultaneous in convergent type. The fundus of both eyes without pathology.

The data of rheoencephalography (REG) indicated a deterioration in hemodynamics in the basin of vertebrobasilar (VBB) vessels - the volumetric blood flow of the vessels was 0.165 ohms on the right and 0.172 ohms on the left, the reographic index was reduced to 0.6. Dopplerography data revealed a decrease in the linear velocity of blood flow (LSC) in the pool of vertebral arteries (PA) to 13.7 cm / s and in the pool of common carotid arteries to 20.2 cm / s. EEG data determined a sharp decrease in the amplitude and frequency of the alpha rhythm (2 times lower than age-related indicators).

The patient was treated according to the proposed method using a magnetic laser therapeutic apparatus "RIKTA-04/4":

- acted with a scanning movement from top to bottom on the occipital-parietal region of the scalp from the coronary suture of the parietal bone to the occipital foramen along the midline of the aponeurosis and on the parietal region from the upper temporal line to the mastoid process on both sides of the Soul 1 emitter with pulsed laser IR power radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation and a constant magnetic field lasting 4 minutes,

- acted on the neck area with the “Shower 1” emitter with a pulse power of laser IR radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz, with pulsed red radiation and a constant magnetic field scanning movement paravertebrally from top to bottom along the extensor muscles of the back from the occipital openings up to C ₆ -Th ₂ exposure duration 3 minutes,

- acted on the carotid sinuses on both sides of the "Main" emitter with a pulse power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz, with pulsed red radiation and a constant magnetic field, exposure time of 2 minutes,

- acted on a symmetric BAT “Primary” emitter with an acupuncture optical nozzle “KON-1”, with a pulsed power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation and a constant magnetic field, initially on general action points: F ₂ , F ₃ , E ₃₆ , Gi ₄ , IG ₃ , TR ₁₀ , V ₆₂ and local action points in the upper-inner part of the eye orbit V ₁ , V ₂ , BT ₆ , BT ₃ , VB ₁₄ , then to local action points in the lower-outer part of the eye orbit E ₁ , E ₂ , TR ₂₃ , VB ₁ , BT ₉ and auricular t glasses AT ₈ , AT ₉₅ , AT ₉₇ with a pulse power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 5 Hz, with pulsed red radiation and a constant magnetic field, exposure time of 20-30 seconds for each point lasting 10 minutes , the course of treatment was 10 sessions.

After treatment with this technique, the patient underwent asthenopic complaints. Visual acuity without correction increased to 0.5 in the right eye and to 0.9 in the left eye. Visual acuity with correction increased to 0.6 in the right eye and to 1.0 in the left eye. The nature of the vision went from a convergent type to an unstable binocular with a leading left eye.

Positive dynamics of visual functions correlated with hemodynamic parameters: on REG the rheographic index reached the norm (1.1), the volumetric blood flow in the vessels (WBB) increased to 0.189 ohms and dopplerographic studies revealed an increase in the BFV in the vertebral arteries to the norm - 18.9 cm / s and in the pool of common carotid arteries up to 22.4 cm / s, and on the EEG there was a recording of an α-organized alpha rhythm with equalization of amplitude and frequency to the age norm, the focus of maximum electrical activity was recorded in the occipital region.

The proposed method was tested in the Regional Children's Hospital in 18 patients (36 clinical cases) with convergent friendly accommodative strabismus, farsightedness of varying degrees, with the presence of dysbinocular amblyopia of varying degrees, aged 3 to 7 years (preschool age). Previously, before the treatment, patients showed insignificant positive dynamics, unstable therapeutic results against the background of ongoing courses of ortho-pleoptic treatment of the visual analyzer (synaptophor, retinal photostimulation, laser stimulation of the macular region, optic nerve stimulation).

The table shows the treatment results for patients with dysbinocular amblyopia.

As can be seen from the table, the claimed method allows you to fully restore the work of the peripheral and cortical departments of the visual analyzer in 44.44% of cases and to conduct a sufficient and optimal correction of vertebrobasilar vascular insufficiency in 72.22% of cases.

Table Number of clinical cases Dysbinocular Amblyopia high average weak absent Before treatment. eighteen 10 8 - After treatment (according to the method) 2 8 10 16

Thus, the claimed method is safe, does not cause adverse and allergic reactions, allows to achieve high and stable treatment results, reduce treatment time.

Claims (1)

A method for the treatment of dysbinocular amblyopia in children, involving exposure to the visual analyzer with physical factors, characterized in that the patient is subjected to combined, simultaneous contact exposure with pulsed laser infrared (IR) radiation with λ = 890 nm and pulsed power from 8 to 20 W, pulsed incoherent infrared radiation with λ = 860–960 nm with an average power of 60 ± 39 mW, pulsed red radiation with λ = 600–700 nm with a frequency of 2 Hz and a constant magnetic field with magnetic induction of 35 ± 10 mT per occipital-dark the area of the head, neck, carotid sinuses and biologically active points (BAP) using the RIKTA-04/4 magneto-infrared laser therapeutic apparatus with two types of emitter - “Main” and “Shower 1”, as well as an acupuncture optical nozzle “KON- 1 ", initially they act with a scanning movement from top to bottom on the occipital-parietal region of the scalp from the coronary suture of the parietal bone to the occipital foramen along the midline of the aponeurosis and on the parietal region from the upper temporal line to the mastoid process on both sides emitter "Shower 1" with a pulsed power of laser IR radiation of 20 W, with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz, with pulsed red radiation and a constant magnetic field lasting 2-4 minutes, then they act on the neck area with a radiator "Shower 1" with a pulsed power of laser IR radiation of 20 W, with a frequency of pulsed laser and incoherent PC radiation of 50 Hz, with pulsed red radiation and a constant magnetic field, scanning movement is paravertebral from top to bottom along an extended muscle muscles of the back from the occipital foramen to C ₆ -Th ₂ lasting 2-4 minutes, then they are exposed to the carotid sinuses on both sides by the “Main” emitter with a pulse power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 50 Hz , with pulsed red radiation and a constant magnetic field with an exposure of 2 minutes each, then act on the symmetrical BAT "Main" emitter with an acupuncture optical nozzle "KON-1", with a pulse power of laser IR radiation of 8 W, with a pulse frequency th laser and noncoherent infrared radiation of 1000 Hz, a pulsed red radiation and the constant magnetic field, initially for common action point F _2, F _3, E _36, Gi _4, IG _3, TR _10, V ₆₂ and local action in terms verhne the inner part of the eye orbit V ₁ , V ₂ , BT ₆ , BT ₃ , VB ₁₄ , then to the local action points in the lower-outer part of the eye orbit E ₁ , E ₂ , TR ₂₃ , VB ₁ , BT ₉ and auricular points AT ₈ , AT ₉₅ , AT ₉₇ with a pulsed power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation of 5 Hz, with pulsed red radiation and a post with a magnetic field with an exposure of 20-30 s for each point with a duration of exposure of 8-10 minutes, the course of treatment is 8-12 sessions.