RU2276579C1 - Method for diagnosing clinical uveitis course type - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying ultrasonic Doppler flowmetry techniques for determining blood circulation characteristics in orbital artery, central retinal artery and posterior short ciliary arteries. Their changes are recorded once. Injured eye is compared to intact eye or both injured eyes are compared to control group eyes. Changes in maximum systolic blood circulation flow rate Vs, minimum diastolic blood circulation flow rate Vd and peripheral resistance index Ri values are recorded. Vs threshold value dropping by 11%, Vd threshold value by 34.6%, Ri value growing by 11.8% in central retinal artery on the injured eye or on both eyes and Vs value dropping b y 25.4%, Vd by 42% and Ri value growing by 11% in the posterior short ciliary arteries being observed, chronic uveitis clinical course is diagnosed to be the case. Vs threshold value growing up by 11%, Vd threshold value by 12%, Ri value dropping by 9% in central retinal artery and Vs value growing by 25%, Vd by 29% and Ri value dropping by 10% in the posterior short ciliary arteries being observed, acute uveitis clinical course is to be diagnosed.

EFFECT: high accuracy of early stage diagnosis; accelerated treatment course.

Description

The invention relates to medicine, namely to ophthalmology, and can be used in the diagnosis of the type of uveitis.

Known division of uveitis into acute, subacute and chronic, taking into account the history and clinical picture of the disease (Ermakova N. A. Classification and clinical evaluation of uveitis / breast cancer. Clinical ophthalmology. - 2003. - Volume 4. - No. 4. - P.146 -149. Katargina LA, Arkhipova LT Uveitis: pathogenetic immunosuppressive therapy. - M., 2004. - 100 p.)

There is a method for the diagnosis of traumatic uveitis, which consists in determining the biochemical parameters of the tear fluid, in which the activity of antioxidant enzymes superoxide dismutase (SOD) and catalase is measured as biochemical parameters, the coefficient K = SOD / catalase is calculated by their ratio, and its value is diagnosed at K> 10 traumatic uveitis, and with a value of K <10 the absence of this disease (Patent No. 2108576, RF. Publ. 10.04.1998).

A known method for predicting the course of traumatic uveitis, which consists in determining the biochemical parameters of the tear fluid, in which the total activity of lactate dehydrogenase (OA LDH) is measured as biochemical indicators, the total activity of malate dehydrogenase (OA MDH) of the tear and the shape of the course of the traumatic prognosis is predicted by the value of the prognostic coefficient (PC). uveitis. With a PC from 4.17 + 0.15 to 5.7 + 0.08, a favorable course of uveitis is predicted, a PC from 6.00 + 0.10 to 7.8 + 0.28 indicates a prolonged, unfavorable course of traumatic uveitis (Patent No. 2122737, Russian Federation, publ. 11/27/1998).

However, the known methods are not intended to diagnose the type of uveitis course by examining and comparing blood flow indices in the diseased and healthy eyes.

The objective of the present invention is to develop a method for the diagnosis of the type of uveitis, providing early diagnosis of the type of course of the disease, an adequate selection of the most effective therapy, which allows to reduce treatment time and accelerate recovery.

The problem is solved in that in a method for the diagnosis of the type of uveitis, including the use of ultrasound dopplerography to determine in the orbital artery (GA), central retinal artery (CAC) and posterior short ciliary arteries (CCCA) blood flow indicators, changes of which are recorded once in the patient’s comparison eyes with healthy or two diseased eyes with a control group, while recording changes in the maximum systolic blood flow velocity - Vs, the minimum diastolic blood flow velocity - Vd and peripheral resistance - Ri, and with a decrease in the threshold value of Vs by 11%, Vd by 34.6%, an increase in Ri - by 11.8% in the CAC on the sore eye (s), and also a decrease in Vs by 25, 4%, Vd by 42% and an increase in Ri by 11% in LSCC diagnose a chronic type of uveitis, with an increase in the threshold value of Vs by 15%, Vd by 12% and a decrease in Ri by 9% in CAC, as well as an increase in Vs by 25 %, Vd by 29% and a decrease in Ri by 10% in SSCA, diagnose acute type of uveitis.

The proposed method is illustrated by a detailed description and clinical examples.

The method is as follows.

Ultrasound examination of the orbit and the eyeball in two and three dimensions is carried out in the gray scale mode, color and energy Doppler mapping, working in real time. Scanning is performed avoiding excessive pressure of the sensor on the eyeball through the upper or lower eyelids of the closed eyeball in the standard horizontal position of the patient lying on his back or in an upright position, sitting, without special devices. Blood flow indices - the maximum systolic blood flow velocity - Vs (cm / sec), the minimum diastolic blood flow velocity - Vd (cm / sec) and the peripheral resistance index - Ri are recorded in GA, CAC and SSCA on a Medison 6000 instrument (ser. No. А34001642 ) broadband sensors of 7.5 and 10 MHz. Next, the values of blood flow parameters are recorded and correlated with the values recorded on the paired healthy eye in a unilateral inflammatory process and with the parameters registered in the control group for bilateral lesions, calculated on the basis of statistical processing of clinical trial data using the Statistica for Windows program version 5.1 company "StatSoft" based on parametric student criteria and nonparametric Wilcoxon criterion. A decrease in the threshold value of Vs by 11%, Vd by 34.6%, an increase in Ri by 11.8% in the CACs on the sore eye or in both eyes, as well as a decrease in Vs by 25.4%, Vd by 42% and an increase in Ri by 11% in WCCA testifies in 100% in favor of the chronic type of uveitis course. An increase in the threshold value of Vs by 15%, Vd by 12%, and a decrease in Ri by 9% in CAC, as well as an increase in Vs by 25%, Vd by 29%, and a decrease in Ri by 10% in CACA, are 100% in favor of the acute type course of uveitis.

The rationale for the claimed method is the data obtained from clinical trials when comparing two study groups. The main group included 115 patients with uveitis of various etiologies and localization (135 eyes). The control group included 65 people with no inflammation in the uveal tract.

In the main group, 83 patients showed a decrease in the threshold value of Vs by 11%, Vd by 34.6%, an increase in Ri by 11.8% in the CAC, as well as a decrease in Vs by 25.4%, Vd by 42%, an increase in Ri 11% in WCCA. In the remaining 32 patients of the main group, an increase in the threshold value of Vs by 15%, Vd by 12% and a decrease in Ri by 9% in CAC, as well as an increase in Vs by 25%, Vd by 29% and a decrease in Ri by 10% in WCC, were recorded.

The data obtained indicate a high diagnostic significance of the proposed indicators: their sensitivity and specificity when exceeding the threshold level are 94.8% and 95.3%, respectively.

Clinical example 1.

Patient R., medical history No. 22306, 38 years old, was admitted to the Department of Eye Microsurgery (OMHG) of the Kurgan Regional Hospital on November 15, 2004 due to peripheral uveitis of both eyes, visual acuity of the right eye was 1.0, and the left eye was 1.0. The main complaints of the patient were blurred vision, floating spots in front of the right eye. The field of vision of both eyes is not changed. Inflammatory cells were detected in the vitreous of both eyes. A focused examination of the peripheral parts of the retina and vitreous revealed exudative deposits over the area of the pars plan and the dentate line, the retina in the lower and nasal parts was swollen and infiltrated, these changes were more pronounced in the right eye. During A / B scanning, the thickness of the choroid on the right eye was 1.7 mm, on the left - 1.4 mm (normal 0.9-1.0 mm). Ultrasound dopplerography revealed a decrease in Vs, Vd, an increase in Ri in CAC, as well as a decrease in Vs and Vd and an increase in Ri in SCCA, reaching a threshold level.

Thus, in this patient, taking into account the characteristics of the clinical picture and changes in the threshold level of blood flow indices (in this case, a decrease), a chronic type of uveitis was established in both eyes compared to the control group.

Clinical example 2.

Patient E., medical history No. 3030, 46 years old, was admitted to the Department of Eye Microsurgery (OMHG) of the Kurgan Regional Hospital on January 28, 2005 due to anterior serous uveitis of the left eye. Visual acuity of the left eye of 0.5 is not corrected, the right eye of 1.0. Field of vision of both eyes without pathology. In the left eye, a weakly expressed mixed conjunctival injection was noted, multiple small and large single precipitates located throughout the area, multiple pigmented synechiae were detected on the corneal endothelium, inflammatory cell elements were detected in the anterior and middle layers of the vitreous (++). There was no focal pathology on the fundus. In the right eye, pathological changes are not registered. During the A / B scan, the thickness of the choroid on the left eye was 1.2 mm (normal 0.9-1.0 mm). During Dopplerography, there was an increase in Vs, Vd and a decrease in Ri in PAS, as well as an increase in Vs and Vd and a decrease in Ri in SSCA, which reached a threshold level.

Thus, on the basis of the ophthalmological picture and the registered increase in blood flow parameters by the threshold level, an acute type of uveitis was diagnosed in this patient.

The proposed method allows one to ascertain the type of uveitis course in the early stages, thereby playing an important role in differential diagnosis and choosing the most effective therapy, thereby reducing treatment time and accelerating recovery.

In addition, the proposed method is non-invasive and does not pose a threat of infection with serious diseases (hepatitis, AIDS).

The proposed method is simple to implement, has no contraindications for its use in patients of any age groups, including children, it can be used on an outpatient basis, even with opaque optical media, basic diagnostic equipment is used for its implementation.

Claims (1)

A method for diagnosing the type of uveitis course, including the use of ultrasound dopplerography for determining the orbital artery (GA), central retinal artery (CAC) and the posterior short ciliary arteries (CCCA) of blood flow indicators, the change of which is recorded once in the comparison of a sick eye with a healthy or two sick eyes with the control group, while recording changes in the maximum systolic blood flow velocity Vs, the minimum diastolic blood flow velocity Vd and the peripheral resistance index Ri, etc. a decrease in the threshold value of Vs by 11%, Vd by 34.6%, an increase in Ri by 11.8% in CACs on the sore eye or in both eyes, as well as a decrease in Vs by 25.4%, Vd by 42% and an increase in Ri by 11% in WCC diagnose a chronic type of uveitis, with an increase in the threshold value of Vs by 15%, Vd by 12% and a decrease in Ri by 9% in CAC, as well as an increase in Vs by 25%, Vd by 29% and a decrease in Ri by 10% in ZKCA diagnose an acute type of course of uveitis.