RU2272642C1 - Method for treatment of amblyopia in children with delayed intellectual development - Google Patents

Abstract

FIELD: medicine, ophthalmology, pediatrics.

SUBSTANCE: method involves apparatus treatment for 10 days with preliminary intramuscular administration of neuropeptide cortexin in the dose 5-10 mg, 10 injections. During apparatus treatment nootropic agent semax is administrated by intranasal route as instillations in the dose 1-2 drops, 2-3 times per 24 h for 10 days. Method provides improving eye memory, increasing rate in delivery and processing the eye information and the prolonged memory concentration necessary for effective apparatus method of treatment. Invention can be used in treatment of amblyopia in children with delayed intellectual development.

EFFECT: improved treatment method.

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Description

The invention relates to medicine, namely to ophthalmology, and is used in the treatment of amblyopia to increase the degree of restoration of visual functions in children with intellectual retardation.

It is known that amblyopia is a decrease in visual acuity without organic lesions of the optic-nervous apparatus of the eye (Avetisov ES, Dysbinocular amblyopia and its treatment. - M .: Medicine, 1968).

There are various types of amblyopia (refractive, anisometropic, obscuration, dysbinocular, mixed, etc.). In their origin, irrespective of the causes of the occurrence, disturbances are distinguished by the three main functionally interconnected links of the visual analyzer: retinal, genicular, cortical.

The existing methods for treating amblyopia are occlusion and a complex of various types of hardware methods, including computer programs, Avetisov macular area illumination, maculotester, amblyocor, etc. In recent years, occlusion and hardware treatment have been supplemented with phosphene-stimulation, magnetostimulation, reflexotherapy (Avetisov E.S. Dysbinocular amblyopia and its treatment. - M .: Medicine, 1968; L. Venger. Methods of treatment of amblyopia and their effectiveness. // Ophthalmol. Journal. - 2000. - No. 4. - P.74-79).

The disadvantages of these methods of treatment of amblyopia are:

- the long duration of the course hardware treatment (at least 20 sessions per 1 course, 3-4 courses per year);

- low effectiveness of the functional results of treatment (30 - 60%) (L. Venger. Methods for the treatment of amblyopia and their effectiveness. // Ophthalmol. Journal. - 2000. - No. 4. - P.74-79) even with normal intellectual development. ;

- the lack of the necessary stimulating effect on the mechanisms of visual memory, the speed of information processing and processing, the violation of which is characteristic of children with amblyopia, especially against the background of a delay in intellectual development, is one of the main reasons that reduce the effectiveness of hardware treatment.

Object of the invention: improving the effectiveness of hardware treatment by improving visual memory, increasing attention, speed of processing and processing of visual information.

The task is achieved by the fact that 10 days before the hardware treatment, a neuropeptide, for example cortexin, is prescribed in the form of intramuscular injections (5-10 mg in a course of 10 procedures), which increases the bioelectric activity of the brain, including the visual cortex, improves visual memory and speed processing visual information. During the hardware treatment, a nootropic agent is used, for example, 0.1% semax solution, in the form of intranasal instillations 1-2 drops 2-3 times a day for 10 days to increase the speed of nerve impulses.

This method treated 30 patients aged 4 to 7 years with amblyopia of various origins (20 people - high degree, 10 - medium degree) and intellectual development retardation (main group). As a comparison, we consider the results of hardware treatment in 30 children of the same age with amblyopia (10 - high and 20 - moderate), who, as in the main group, had a delay in intellectual development (control group). The duration of the hardware treatment course in children in the control group was 20 days.

Indicators The main group, n = 30 The control group, n = 30 Initial data After the 1st year of treatment Initial data After the 1st year of treatment Visual acuity 0.05-0.2 0.2-0.4 0.06-0.2 0.08-0.3 Course Duration (days) 10 twenty Multiplicity of repeated courses 1 time in 5-6 months 1 time in 3-4 months

From the table it follows that in the main group (patients received cortexin and semax in addition to hardware treatment), visual acuity after 1 year of observation in 64.2% increased by 0.1-0.2, and in 35.8% - by 0 , 3-0.4. The duration of one course of hardware treatment was 10 sessions, and the achieved positive effect lasted up to 5-6 months. In the control group, where children received only hardware treatment, in most cases (82.4%) the increase in visual acuity was 0.05-0.1, and only 11.6% - 0.2. At the same time, the duration of hardware treatment was 2 times longer. Characteristic for children of the main group was an increase in stability and concentration of attention, the speed of processing of visual information and accuracy of perception. The obtained effect was quite stable and lasted up to 5-6 months after the end of treatment.

The advantages of the proposed method:

- an increase in the effect of visual rehabilitation in children with amblyopia and a delay in intellectual development;

- reducing the duration of the course of hardware treatment in 1.5 -2 times;

- reducing the frequency of repeated courses up to two times a year due to prolongation of the retention period of the achieved optical result;

- improving the quality of visual development by optimizing the mechanisms of short-term and long-term visual memory, functional activity of proprioceptive zones of the cerebral cortex.

Example 1

Girl M., 6 years old, over the past two years, regularly underwent courses of hardware treatment for high-grade refractive amblyopia, developed on the basis of high-level hyperopia with the phenomena of complex hyperopic astigmatism in both eyes.

Baseline:

vis OD = 0.01 sph + 5.0 ^D cyl +, 5 ^D ax180 ° = 0.05

vis OS = 0.01 sph + 5.0 ^D cyl + 1.0 ^D ax0 ° = 0.05

Refraction in a state of cycloplegia:

After 1 year of regular hardware treatment, including electrical stimulation, visual acuity with correction reached 0.1 in both eyes, and as a result of further treatment, an increase in visual acuity no longer occurred. Studies during this period of observing the functions of memory and thinking made it possible to identify low indicators of stability and concentration of attention, the speed of mental operations, and the amount of visual memory in a child according to a corrective test with Landolt rings.

In December 2003, the girl was treated according to the proposed method: 10 days before the hardware treatment, cortexin 10 mg was prescribed intramuscularly with a course of 10 procedures, and during the hardware treatment - 0.1% semax solution in the form of intranasal instillations 1-2 drops 2 times a day 10 days. After 10 treatment sessions, visual acuity increased with correction to 0.3 in both eyes. After 5 months, the course of treatment was repeated: visual acuity increased with correction to 0.5 in both eyes. The improvement of visual acuity was facilitated by the improvement of the child's intellectual functions: restoration of the normal volume and stability of long-term memory, a 1.5-fold increase in the speed of processing information, and stability of attention.

Example 2

Boy K., 7 years old, for 3 years (2001-2003) regularly received courses of hardware treatment for high degree obscurant amblyopia, artifact on the right eye.

Baseline:

vis OD = 0.05 n / a

vis OS = 1.0

Refraction in a state of cycloplegia:

From the anamnesis: at the age of 3 he was operated on for congenital cataract of the right eye with implantation of IOL T-26 (fundus without pathology).

After each course of hardware treatment, the visual acuity of the right eye increased from 0.05 to 0.1, but the achieved functional effect was unstable, and after 3-4 months, visual acuity decreased again to 0.05.

In the study of intellectual functions, their decrease was revealed. In this regard, in November 2003, a course of hardware treatment was carried out, supplemented by the use of 10 mg of cortexin 10 injections intramuscularly before the start of the course of treatment and the appointment of 0.1% semax solution intranasally during the treatment with 1-2 drops 1-2 times a day 10 days.

Against the background of treatment (10 procedures), visual acuity increased in the right eye to 0.3 and remained so for 5 months. The next course of treatment according to the proposed method was carried out in April 2004. Visual acuity of the right eye increased to 0.4, which correlated with an increase in the volume of short-term and long-term visual memory, and the speed of conducting and processing visual information.

Claims (1)

A method for the treatment of amblyopia in children with intellectual development retardation, consisting in the use of hardware treatment, characterized in that 10 days before it is additionally prescribed neuropeptide Cortexin 5-10 mg in a course of 10 procedures intramuscularly, and during hardware treatment, a nootropic agent is used - 0 , 1% solution of semax intranasally in the form of instillations 1-2 drops 2-3 times a day for 10 days.