RU2267979C1 - Method for determining pigmented retinitis development stages - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying electroretinography, visometry and perimetry techniques and evaluating dark adaptation disorders. Optical coherent retina tomography is applied for evaluating chorioretinal complex condition. The received data are studied for determining pigmented retinitis development stages like latent stage, the first clinical pigmented retinitis symptoms, disease manifestations and vision function depression.

EFFECT: high accuracy of early stage diagnosis.

5 dwg, 1 tbl

Description

The present invention relates to the field of medicine, namely to ophthalmology.

Retinitis pigmentosa is the most common inherited form of blindness and is found in all ethnic populations. Despite the significant prevalence and disabling severity of the process, the problem of retinitis pigmentosa is far from being resolved. There are many methods for determining dystrophic changes in the retina, which are based on the localization of the process, the form of inheritance, pathogenetic mechanisms that underlie degenerative processes in the retina.

There is a method by which three main criteria are determined: genetic type, anatomical type and functional symptoms (see Hereditary and congenital diseases of the retina and optic nerve. / Ed. By A.M. Shamshinova. - M .: Medicine, 1990. - C .47).

A known method, which includes the type of inheritance, the severity of the disease and the rate of disease progression (see Hereditary and congenital diseases of the retina and optic nerve / Edited by A.M.Shamshinova. M .: Medicine, 1990. - P. 49).

The closest is the method by which 4 stages of retinitis pigmentosa are determined:

Stage 1 - visual acuity of 0.5-0.9, the field of view is narrowed to 40 degrees, the ERG is sharply reduced, hemeralopathy;

Stage 2 - visual acuity of 0.4-0.5, the field of view is narrowed to 20-40 degrees from the center, there is no ERG or its amplitudes are sharply reduced, hemeralopathy;

Stage 3 - visual acuity of 0.1-0.3, field of view of 10-20 degrees, there is no ERG, color vision is impaired, atrophy of the optic nerve;

Stage 4 - visual acuity less than 0.1, field of view less than 10 degrees, ERG is absent, color vision, optic atrophy, optic atrophy of the choriocapillary layer are impaired (see Kantselson L.A., Farafonova T.I., Bunin A.Ya. Vascular diseases of the eye. - M .: Medicine, 1990. - 246 p.). However, the known methods determine the clinically pronounced form of retinitis, do not have high accuracy.

The technical result of the proposed method for determining the stages of development of retinitis pigmentosa is to increase the accuracy of determining the stage of development of the disease by determining the early signs of the disease, as well as determining the preclinical stage of the disease.

The technical result is achieved by conducting electroretinography, visometry, perimetry, assessment of the violation of dark adaptation.

New in achieving the technical result is that they perform optical coherence tomography of the retina, which assesses the state of the chorioretinal complex and by reducing the thickness of the photoreceptor layer and reducing its transparency, increasing the thickness of the pigment epithelium layer, narrowing the fields of view, increasing the threshold of dark adaptation, increasing the time period until the peak of the b-wave and a decrease in the amplitude of the a- and b-waves of electroretinography, the latent stage of the development of retinitis pigmentosa is determined.

Also new is the fact that with a thinning of the photoreceptor layer and a decrease in its transparency, the appearance of uneven thickness of the pigment epithelium layer with the appearance of defects in it, an increase in the dark adaptation threshold, an increase in the time period to the peak of the b-wave, an increase in the latency of the a wave, and a decrease in the amplitude of a- and b-waves of ERG, a progressive narrowing of the visual fields determine the stage of the first clinical signs of retinitis pigmentosa.

New is the fact that in the absence of signs of differentiation of the retinal layers, thinning of the nerve fiber layer, multiple defects of the pigment epithelium and redistribution of the pigment in the form of areas of its accumulation, sharp retinal thinning at the sites of pigment accumulation, thinning of the choriocapillary layer, significant narrowing of the visual fields, gross violations dark adaptation, a sharp drop in the amplitude of the waves of ERG, a decrease in visual acuity determine the stage of manifestation of the disease.

Also new is the fact that with retinal stratification at the level of the nerve fiber layer, a sharp thinning of the choriocapillary layer, extensive multiple defects of the pigment epithelium, detachment of the hyaloid membrane, the absence of dark adaptation and electrical activity of the cellular elements of the retina, as well as the narrowing of the visual fields to 5-10 degrees from the fixation point and a significant decrease in visual acuity determine the stage of inhibition of the function of the visual system.

Retinitis pigmentosa is a serious hereditary progressive disease of the organ of vision with a primary genetically determined lesion of the photoreceptor layer and retinal pigment epithelium. Pigmented epithelium and photoreceptors form a single functional system. A special role in the normal functioning of the retina is assigned to pigment epithelium. It carries a large functional load in the visual process. Pigmented epithelium not only produces phagocytosis of the spent external segments of the rods and cones, but also delivers the enzymes and substances necessary for their renewal. The membranes of his cells have electrical and transport properties that affect the electrical and photochemical activity of the outer segments of the photoreceptors, and this allows the pigment epithelium to quickly respond to light. Melanin, located inside the cells of the pigment epithelium, serves to protect the outer segments of the photoreceptors from the damaging effects of light, absorbing and reducing its scattering. With pigmentary dystrophy, the pigment epithelium loses its transport functions in the presence of simultaneously increased activity. The basal layer of the pigment epithelium is depleted, its cells are gradually destroyed, involving photoreceptors in the process. The cells of the pigment epithelium, when they are damaged, are capable of migration and the production of fibroblasts and, consequently, scar tissue. The degree of destruction of photoreceptors correlates with the degree of proliferation of the pigment epithelium. Gradually, the cells of the pigment epithelium are completely destroyed. There is an accumulation of pigment epithelium in perivascular spaces. Photoreceptors disappear. Muller cells form a fibrous layer. Later, hemodynamic disturbances in the choriocapillary layer, as well as retinal vessels, join. The dystrophic process is not limited to the retina, but extends to all tissues and structures of the eye.

The use of optical coherence tomography of the retina (OCT) allows you to consider and evaluate the state of all layers of the retina. Information on tissue obtained using OCT is intravital, i.e. reflects not only the structure, but also the features of the functional state of the tissues. OST is non-invasive, eliminates injury. The ability to repeatedly study and save the results in computer memory allows us to trace the dynamics of the pathological process, including in children, when, due to the age of the child and his inadequate behavior, electrophysiological studies are difficult. The use of optical coherence tomography in combination with other studies makes it possible to diagnose a non-pigmented form of the disease with minimal ophthalmological changes in the fundus, to reveal retinitis pigmentosa at the preclinical stage, and to objectively determine and classify the stages of the development of the disease.

Normally, with OST, the correct profile of the macula with a depression in the center is determined. The layers of the retina are differentiated according to their reflective ability, uniform in thickness, without focal changes. The outer edge of the retina with OCT is bounded by a highly photoreflective bright red layer about 70 microns thick. It is a single complex of retinal pigment epithelium and the layer of choriocapillaries. The darker band, which is determined on the tomogram immediately before the complex "pigment epithelium-choriocapillaries", is represented by photoreceptors. The sharp contrast between them allows you to measure the thickness of the retinal tissue. In the center of the macula, it averages 156 microns, at the edge of the macula - 259 microns. The bright red line on the inner surface of the retina corresponds to a layer of nerve fibers. The vitreous is normally optically transparent and has a black color on the tomogram.

The latent stage of retinitis pigmentosa determines the presence of destructive changes not only on the periphery of the retina, but also in the central parts of the retina and is characterized by a decrease in the thickness of the photoreceptor layer, an increase in the thickness of the pigment epithelium layer, and a decrease in the transparency of the photoreceptor layer, which is reflected in a change in the color palette of the photoreceptor layer towards white , the functional parameters of the visual system also change - an insignificant, but statistically significant narrowing of the visual field, the increase in the threshold is dark th adaptation, an increase in the latency of wave b and a decrease in the amplitude of waves a and b (see table).

The stage of the first clinical signs is characterized by the progression of dystrophic processes in the chorioretinal complex. Patients complain of decreased vision at dusk, difficulties in adaptation when moving from a bright room to a dark one. Changes in the field of view and dark adaptation reflect a progressive violation of the metabolic processes of the retina. The increase in the latency of wave "a" is due to a decrease in the absorption of light quanta due to changes in visual pigment and degeneration of photoreceptors. The decrease in the amplitude of the waves "a" and "b" is a criterion for assessing the degree of involvement of photoreceptors in the pathological process. There is an appearance of unevenness of the pigment epithelium layer (see table).

The stage of manifestation of clinical manifestations is characterized by a generalization of dystrophic changes in the chorioretinal complex. In this case, further suppression of the functions of the scotopic system occurs. A characteristic feature for this stage of the development of the pathological process is the absence of signs of differentiation of the retinal layers both on the middle periphery and in the central departments. Thinning of the layer of nerve fibers is determined by the defeat of photoreceptors along with other retinal neurons. Defects of the pigment epithelium, the redistribution of the pigment in the form of areas of its accumulation.

The stage of oppression of the functions of the visual system is characterized by total destruction of the chorioretinal complex. There is a significant decrease in visual acuity, a narrowing of the visual fields, a violation of the dark adaptation is progressing, there is no electrical activity of the cellular elements of the retina. All patients showed complicated cataracts and gross destruction of the vitreous body. Retinal stratification occurs at the level of the nerve fiber layer, the remaining layers of the retina do not differentiate (see table).

Comparative analysis with the prototype shows that the claimed method is characterized in that they perform optical coherence tomography of the retina, which assesses the state of the chorioretinal complex and with a decrease in the thickness of the photoreceptor layer and a decrease in its transparency, an increase in the thickness of the pigment epithelium layer, narrowing of the visual fields, and an increase in the dark adaptation threshold , increasing the time period to the peak of the b-wave and decreasing the amplitude of the a- and b-waves of electroretinography determine the latent stage of development of retinitis pigmentosa this, with a thinning of the photoreceptor layer and a decrease in its transparency, the appearance of uneven thickness of the pigment epithelium layer with the appearance of defects in it, an increase in the dark adaptation threshold, an increase in the time period to the peak of the b wave, an increase in the latency of the a wave and a decrease in the amplitude of the a and b waves ERG, a progressive narrowing of the visual fields determine the stage of the first clinical signs of retinitis pigmentosa, in the absence of signs of differentiation of the retinal layers, thinning of the nerve fiber layer, multiple defects of the pigment ep telium and redistribution of the pigment in the form of areas of its accumulation, a sharp thinning of the retina at the places of accumulation of the pigment, a thinning of the layer of choriocapillaries, a significant narrowing of the visual fields, gross disturbances in dark adaptation, a sharp drop in the amplitude of the ERG waves, and a decrease in visual acuity determine the stage of manifestation of the disease, and when the retina is stratified at the level of nerve fibers, a sharp thinning of the layer of choriocapillaries, extensive multiple defects of the pigment epithelium, detachment of the hyaloid membrane, lack of dark adaptation and electrical activity and cellular elements of the retina, as well as narrowing the field of view of 5-10 degrees from the fixation point and a significant decrease in visual acuity determined step depression function of the visual system that meets the criterion of the invention of "novelty".

A new set of features allows to increase the accuracy of determining the stages of development of retinitis pigmentosa, conduct early diagnosis to clinical manifestations and complaints, diagnose a non-pigmented form of the disease when there are no characteristic changes in the fundus, and provide the possibility of using the method in young children. The method is non-contact and painless, allows an objective and accurate assessment of the state of structures, which allows a high degree of accuracy to monitor the pathological process. All this meets the criterion of "industrial applicability".

The method is illustrated by OST tomograms, where Fig. 1 shows the latent stage of the disease: 1 - layer of photoreceptors, 2 - layer of pigment epithelium; figure 2 - stage of the first clinical signs of the disease: 1 - a layer of photoreceptors, 2 - a layer of pigment epithelium, 3 - a layer of choriocapillaries; figure 3 - stage of the manifestation of the disease: 1 - pigment epithelium, 2 - layer of choriocapillaries; figure 4 - stage manifestation of retinitis pigmentosa - cystic edema of the macular region; figure 5 - stage of inhibition of the functions of the visual system - pronounced fibrosis of the retina.

The method is as follows. The study was performed on an OST-2000 apparatus manufactured by Carl Zeiss Meditec (Humphrey division). The scan length is set to 3 mm. The radiation power is 750 uW and 500 uW. Scan the central parts of the retina within 30 degrees from the fixation point. The obtained tomograms evaluate the thickness of the layer of photoreceptors, nerve fibers and retinal neuroglia. In addition, assess the transparency of the layers of the retina relative to the standard color scale of the device, the condition of the pigment epithelium and the layer of choriocapillaries. The following ophthalmological examination is performed for all patients except OST: refractometry, keratometry, echobiometry, anterior segment biomicroscopy, ophthalmoscopy, visometry, tonometry, dark adaptation research, perimetry, general electroretinography (ERG) and visually evoked potentials. According to the study, the following developmental stages inherent in pigment retinitis are determined:

1. latent stage;

2. stage of the first clinical signs;

3. stage of manifestation;

4. stage of oppression of the functions of the visual system.

The latent stage of development of retinitis pigmentosa is determined by the following symptoms:

- reducing the thickness of the layer of photoreceptors;

- an increase in the thickness of the layer of pigment epithelium;

- reduced transparency of the photoreceptor layer;

- narrowing of the field of view;

- increase the threshold of dark adaptation;

- an increase in the time period to the peak of the b-wave and a decrease in the amplitude of the a- and b-waves of the ERG.

The stage of the first clinical signs of retinitis pigmentosa is determined by the following symptoms:

- thinning of the layer of photoreceptors;

- decrease in its transparency;

- uneven thickness of the layer of pigment epithelium;

- increase the threshold of dark adaptation;

- increase the latency of the wave "a";

- an increase in the time period to the peak of the b-wave and a decrease in the amplitude of the a- and b-waves of the ERG;

- progressive narrowing of the visual fields.

In addition, an increase in the anteroposterior axis of the eye, a change in refraction towards myopization, and destruction of the vitreous are noted.

Stage of manifestation is determined by:

- the absence of signs of differentiation of the layers of the retina;

- thinning of the layer of nerve fibers;

- multiple defects of the pigment epithelium;

- thinning of the layer of choriocapillaries;

- a significant narrowing of the fields of view;

- gross violations of dark adaptation;

- a sharp drop in the amplitude of the waves of the ERG;

- decrease in visual acuity.

The stage of oppression of the functions of the visual system is determined by:

- retinal stratification at the level of the layer of nerve fibers;

- sharp thinning of the layer of choriocapillaries;

- extensive multiple defects of the pigment epithelium;

- lack of dark adaptation;

- detachment of the hyaloid membrane;

- lack of electrical activity of cellular elements of the retina;

- narrowing of the visual fields to 5-10 degrees from the fixation point;

- a significant decrease in visual acuity.

The remaining layers of the retina do not differentiate. Given the hereditary nature of the disease, 45 people were examined - the closest relatives of patients aged 5 to 14 years who did not complain of vision.

The method is illustrated by the following clinical examples.

Example 1. Patient K., 11 years old. Deaf-mute child, referred to the IF MNTK "Eye Microsurgery" by an audiologist to exclude pathology from the visual system.

From the anamnesis it turned out that the patient's great-grandmother suffered from retinitis pigmentosa.

At the time of examination, the child does not complain. The visual acuity of both eyes is 1.0, the field of view is a total of 8 meridians: OD-523 degrees, OS-487 degrees. Biometrics data:

OD OS PZO - 22.28 mm 22.26 mm Depth of the anterior chamber - 3.2 mm 3.18 mm The thickness of the lens is 3.7 mm 3.71 mm

Refraction OD + 0.82D, OS + 0.80D.

On examination, the condition of the anterior segment of the eye without features. Optical media are transparent. Fundus: optic nerve disc not changed, central departments, visible periphery of the retina without features, pathological reflexes along the vessels are noted. Electrophysiological indicators (ERG, VEP) within the age norm. Dark adaptation is not broken (photo-stress test: OD - 48 sec, OS - 42 sec).

The OCT tomogram (Fig. 1) revealed a decrease in the transparency of photoreceptors, a decrease in the thickness of the photoreceptor layer along the edge of the macula: OD - 72 microns, OS - 65 microns, an increase in the thickness of the pigment epithelium: OD - 61 microns, OS - 63 microns.

Based on the examination and medical history, the child was diagnosed with retinitis pigmentosa (latent stage, autosomal recessive inheritance type). Gref-Usher syndrome.

Example 2. Patient A., 15 years old. He complained of decreased vision at dusk. Father has retinitis pigmentosa. Visual acuity OD - 0.8, OS - 1.0. Field of view: OD - 326 degrees, OS - 417 degrees.

Biometrics: OD OS PZO 22.98 mm 23.06 mm Front camera depth 3.2 mm 3.28 mm Lens thickness 3.72 mm 3.71 mm Refraction -0.75D -0.80D

On examination, the condition of the anterior segment of the eye without features. The destruction of the vitreous body, the rest of the environment is transparent. Fundus: optic nerve disc not changed, pale pink, drusen (multiple rounded foci of 0.5-1.0 mm in diameter) grayish in color are defined peripapillary. The vessels of the retina are evenly narrowed. Along the vessels on the middle periphery, the accumulation of pigment in the form of "bone cells", the macula without features.

When registering an ERG, the latent time of the b - OD wave is elongated - 42 ms, OS - 41 ms and its amplitude decreases (OD - 98 μV, OS - 104 μV). An increase in the threshold of dark adaptation was also detected (OD photo-stress test - 8 sec, OS - 92 sec).

On the OST tomogram (figure 2) revealed: a decrease in the transparency of photoreceptors, a decrease in its thickness (right eye - 62 microns, left eye - 65 microns), uneven thickness of the pigment epithelium, the appearance of pigment epithelium defects. A fibrous layer is formed on the inner surface of the retina (red staining).

Based on the examination and medical history, the child was diagnosed with retinitis pigmentosa (stage of the first clinical signs, autosomal dominant type of inheritance). Myopia of the 1st degree of both eyes.

Example 3. Patient E., 23 years old. Observed by an ophthalmologist at the place of residence with a diagnosis of retinitis pigmentosa for 8 years. Concerned about the decline in vision at dusk, the narrowing of the fields of vision. Heredity is not traced.

Visual acuity of the right eye is 0.9, the left is 0.5. Line of sight:

OD-92 deg., OS-96 deg.

Biometrics: OD OS PZO 22.28 mm 22.2 mm Front camera depth 2.82 mm 3.04 mm Lens thickness 3.98 mm 3.77 mm Refraction -0.5 D -0.25 D

On examination, the condition of the anterior segment of both eyes is unremarkable. Gentle opacification under the posterior lens capsule. Rough destruction of the vitreous body. Fundus: optic nerve discs are waxy, monotonous, disc borders are shaded, physiological excavation is not expressed, its standing in the vitreous is noted. The number of vessels descending from the disk is reduced, arteries and veins are narrowed, vessels have atypical branching. In the macula, cystic edema of the retina is more pronounced on the right. The latent time of the ERG waves was increased (right eye: a-wave - 21 ms, b-wave - 44 ms, left eye: a-wave 20 ms, b-wave 42 ms), their amplitude was sharply reduced (right eye: a- wave - 6 μV, b-wave - 24 μV, left eye: a-wave - 11 μV, b-wave 18 μV). Violation of dark adaptation is noted (photo-stress test: OD - 220 sec, OS - 269 sec).

On the OCT tomogram (figure 3), retinal edema is visible, a cyst in the macular region is determined. Photoreceptors are absent. The thickness of the pigment epithelium is uneven. The areas of pigment accumulation are visible, gross defects of the pigment epithelium, thinning of the layer of choriocapillaries, fibrosis. A significant accumulation of pigment and a sharp thinning of the retina are visible on the middle periphery. Based on the survey data, the diagnosis was made: Retinitis pigmentosa (stage of manifestation). Complicated cataract of both eyes. Myopia of an average degree of both eyes.

Example 4. Patient G., 32 years old. Suffers from retinitis pigmentosa since 14 years. Retinitis pigmentosa in mother and grandmother. It was observed and treated at the place of residence. Directed to IF MNTK "Eye Microsurgery" for surgical treatment for cataracts of the left eye. Complaints about low vision of the right eye, lack of objective vision in the left eye. Visual acuity of the right eye - 0.1, left - 0.02. Field of view: the right eye - 45 degrees, the left eye - could not be verified (the patient does not fix the mark). Biometrics data:

Biometrics data: OD OS PZO 22.03 mm 21.5 mm Front camera depth 2.34 mm 2.37 mm Lens thickness 4.15 mm 4.76 mm Refraction +1.75 D -2.25 D

On examination, clouding under the posterior capsule of the lens on the right eye, gross destruction of the vitreous is noteworthy. DZN monotonous, waxy with clear boundaries. The disk promotes into the vitreous. The vessels are narrowed, their number and branching are reduced. There are desolate vessels. Across the retina, pigment deposition in the form of bone bodies. The left eye is a clouding in the cortex and under the posterior lens capsule. The fundus reflex is pink. Details of the fundus are not ophthalmoscopic. ERG is not recorded. On the OCT tomogram (figure 4), pronounced retinal fibrosis, the absence of photoreceptors, gross defects of the pigment epithelium, and retinal stratification are visible. Diagnosis: Retinitis pigmentosa (inhibition stage, autosomal dominant type of inheritance). Complicated cataract of both eyes.

Table
Anatomical and functional characteristics of the visual system in patients at various stages of retinitis pigmentosa Indicators The control
M ± m Latent stage M ± m Stage of the first clinics. signs of PM ± m Stage manifestation of clinics. manifestations of M ± m Stage of oppression of the functions of the visual system M ± m one 2 3 four 5 Anteroposterior 22.92 ± 0.1 22.3 ± 0.3 23.7 ± 0.4 23.7 ± 0.6 23.7 ± 0.4 axis (mm) P _2-3 <0.05 P _2-4 <0.05 P _2-5 <0.05 3.72 ± 0.1 3.75 ± 0.1 3.75 ± 0.2 4.22 ± 0.12 4.4 ± 0.11 Thickness P _1-4 <0.01 P _1-5 <0.01 lens P _2-4 <0.05 P _2-5 <0.01 (mm) P _3-5 <0.05 0.66 ± 0.1 0.82 ± 0.16 -3.42 ± 1.2 -3.4 ± 0.4 -3.28 ± 1.2 Refraction P _1-3 <0.05 P _1-4 <0.001 P _1-5 <0.05 (diopters) P _2-3 <0.05 P _2-4 <0.01 Thickness 249.4 ± 1.2 259.3 ± 5.2 256.1 ± 4.9 236.9 ± 5.4 229.4 ± 4.8 retina by P _1-4 <0.05 P _1-5 <0.001 the edge of the macula P _2-4 <0.05 P _2-5 <0.05  (microns) P _3-4 <0.05 P _3-5 <0.01 Thickness 149.9 ± 1.1 153.6 ± 8.4 146.0 ± 3.8 235.9 ± 4.8 129.2 ± 4.8 retina in P _1-4 <0.001 P _1-5 <0.01 center (μm) P _2-4 <0.001 P _2-5 <0.05 P _3-4 <0.001 P _3-5 <0.05 P _4-5 <0.001 89.9 ± 0.8 72.4 ± 2.6 60.9 ± 2.8 12.4 ± 3.7 5.0 ± 3.7 Thickness P _1-2 <0.001 P _1-3 <0.001 P _1-4 <0.001 P _1-5 <0.001 photoreceptors P _2-3 <0.05 P _2-4 <0.001 P _2-5 <0.001 paramacular P _3-4 <0.001 P _3-5 <0.001 (microns) P _4-5 <0.001 Minimum thickness 53.0 ± 0.6 62.4 ± 2.2 53.1 ± 1.9 50.1 ± 2.4 50.7 ± 2.41 pigment epithelium (μm) P _1-2 <0.001 P _2-3 <0.01 P _2-4 <0.01 Maximum 54.2 ± 0.5 64.3 ± 2.1 68.8 ± 3.0 99.3 ± 2.1 110.9 ± 2.06 thickness P _1-2 <0.001 P _1-3 <0.001 P _1-4 <0.001 P _1-5 <0.001 pigmented P _2-4 <0.001 P _2-5 <0.001 epithelium P _3-4 <0.001 P _3-5 <0.001 (microns) P _4-5 <0.001 50.7 ± 0.3 53.7 ± 2.1 41.7 ± 2.3 19.6 ± 1.53 17.1 ± 1.5 Layer thickness P _1-3 <0.01 P _1-4 <0.001 P _1-5 <0.001 choriocapillaro P _2-3 <0.05 P _2-4 <0.001 P _2-5 <0.001 in (microns) P _3-4 <0.001 P _3-5 <0.001 Nerve layer thickness 68.6 ± 1.3 66.6 ± 2.5 61.5 ± 1.8 - - fibers (μm) P _1-3 <0.01 Table (continued) 0.99 ± 0.01 0.98 ± 0.01 0.74 ± 0.04 0.54 ± 0.14 0.06 ± 0.04 P _1-3 <0.001 P _1-4 <0.001 P _1-5 <0.001 Sharpness P _2-3 0.001 P _2-4 <0.001 P _2-5 <0.001 of view P _3-5 <0.001 (unit) P _4-5 <0.001 Field 535.5 ± 1.5 483 ± 7.13 365.1 ± 13.2 111.4 ± 16.6 34.41 ± 6.6 view on P _1-2 <0.001 P _1-3 <0.001 P _1-4 <0.001 P _1-5 <0.001 8 meridians P _2-3 <0.001 P _2-4 <0.001 P _2-5 <0.001 (degrees) P _3-4 <0.001 P _3-5 <0.001 P _4-5 <0.001 Photostress 14.3 ± 0.6 48.36 ± 5.5 92.1 ± 1.9 260 ± 3.6 - test P _1-2 <0.001 P _1-3 <0.001 P _1-4 <0.001 (sec) P _2-3 <0.001 P _2-4 <0.001 P _3-4 <0.001 IOP (mmHg) 17.9 ± 0.3 18.0 ± 0.4 19.04 ± 0.2 20.18 ± 1.4 20.88 ± 1.4 Latent 19.1 ± 0.2 18.43 ± 0.62 21.2 ± 0.61 22.11 ± 0.4 - time P _1-3 <0.001 P _1-4 <0.001 a-waves (ms) P _2-3 <0.01 P _2-4 <0.001 Amplitude 83.5 ± 2.1 55.36 ± 3.5 38.57 ± 3.3 9.8 ± 7.1 - a waves P _1-2 <0.001 P _1-3 <0.001 P _1-4 <0.001 (μV) P _2-3 <0.001 P _2-4 <0.001 P _3-4 <0.05 Latent 37.3 ± 0.31 39.64 ± 0.34 42.0 ± 0.5 43.4 ± 0.42 - b-wave time P _1-2 <0.05 P _1-3 <0.01 P _1-4 <0.001 (ms) P _2-3 <0.01 P _2-4 <0.001 Amplitude 239.8 ± 6.1 148.4 ± 5.6 72.5 ± 7.6 10.32 ± 2.52 - b-waves P _1-2 <0.001 P _1-3 <0.001 P _1-4 <0.001 (μV) P _2-3 <0.001 P _2-4 <0.001 P _3-4 <0.001 Latent 97.6 ± 0.4 99.14 ± 1.4 106.4 ± 1.3 111.0 ± 0.84 - time P _1-3 <0.001 P _1-4 <0.001 VIZ P _2-3 <0.01 P _2-4 <0.001 (ms) P _3-4 <0.05 Amplitude 68.2 ± 1.6 62.14 ± 2.6 45.0 ± 1.7 25.12 ± 1.6 - VIZ P _1-3 <0.001 P _1-4 <0.001 (μV) P _2-3 <0.001 P _2-4 <0.001 P _3-4 <0.001

Claims (1)

A method for determining the stages of development of retinitis pigmentosa, including electroretinography, visometry, perimetry, assessment of dark adaptation disorders, characterized in that they perform optical coherence tomography of the retina, which assesses the state of the chorioretinal complex, and with a decrease in the thickness of the photoreceptor layer and a decrease in its transparency, increase in thickness a layer of pigment epithelium, narrowing of the fields of vision, increasing the threshold of dark adaptation, increasing the time period to the peak of the b-wave and decreasing the amp the results of a- and b-waves of electroretinography determine the latent stage of development of retinitis pigmentosa, with a thinning of the photoreceptor layer and a decrease in its transparency, the appearance of uneven thickness of the pigment epithelium layer with the appearance of defects in it, an increase in the dark adaptation threshold, an increase in the time period to the peak of the b-wave, an increase in the latency of wave a, a decrease in the amplitude of the a and b waves of ERG, a progressive narrowing of the visual fields determine the stage of the first clinical signs of retinitis pigmentosa, in the absence of signs of differential retinal layers, thinning of the layer of nerve fibers, multiple defects of the pigment epithelium and redistribution of the pigment in the form of sections of its accumulation, sharp thinning of the retina in places of accumulation of the pigment, thinning of the choriocapillary layer, significant narrowing of the fields of view, gross disturbances in dark adaptation, a sharp drop in the amplitude of the ERG waves, a decrease in visual acuity determines the stage of the manifestation of the disease, and with retinal stratification at the level of the nerve fiber layer, a sharp thinning of the choriocapillary layer, extensive idents defects pigment epithelium detachment of the hyaloid membrane, the absence of dark adaptation and the electrical activity of the cellular elements of the retina, as well as narrowing the field of view of 5-10 degrees from the fixation point and a significant decrease in visual acuity determined step depression function of the visual system.

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