RU2283035C1 - Method for evaluating therapeutic efficiency of endocrine ophthalmopathy - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: before the onset of therapy, on the 10^th - 14^th d, 1 mo after therapy and then according to values it is necessary to carry out complex ultrasound orbital investigation that includes B-scanning, the study of circulation in orbital vessels due to energetic and chromatic Doppler mapping of orbital artery and the upper orbital vein. Before therapy one should detect the following dysfunctions: edema of retrobulbar fiber, increased length of retrobulbar area being above 15 mm, thickness of orbital muscles being above 5.5 mm, muscular coefficient being above 60%, thickness of optic nerve being above 4.5 mm, increased maximal systolic rate of circulation up to 45 cm/sec, systolo-diastolic rate being above 5.5, values of hemodynamic ratio indices - resistance one being above 0.75 and pulsation index being above 1.5 of orbital artery, decreased linear rate of circulation in orbital vein being below 5.8 cm/sec. If during repeated trials one can observe decreased edema of retrobulbar fiber, decreased thickness of orbital muscles and other above-mentioned parameters one should state upon positive dynamics after efficient therapy conducted. The innovation enables to perform monitoring of therapy flow and evaluating therapeutic efficiency in case of endocrine ophthalmopathy due to applying complex echography - B-scanning and testing alterations of orbital vascular hemodynamics with techniques of chromatic and energetic Doppler mapping.

EFFECT: higher accuracy of evaluation.

Description

The invention relates to medicine, in particular to ophthalmology, and can be used to evaluate the effectiveness of the treatment of endocrine ophthalmopathy.

It is known to use ultrasonic B-scanning for the diagnosis of endocrine ophthalmopathy, in which the expansion of the retrobulbar space, the increase in the thickness of extraocular muscles and the optic nerve are determined (Fishkin Yu.G., 1985, Fridman F.E., 1987, Brovkina AF, 1993, 2004, Fledelius H., 1997, Kahaly G., 2001).

Known methods for studying the characteristics of blood flow in arterial and venous vessels of the orbit by color Doppler mapping indicate an increase in speed indicators of blood flow in orbital vessels in patients with Graves disease (Williamson, T.C. et al., 1996, Alp N.M. et al., 2000).

However, the known methods do not reflect the dynamics revealed by ultrasound examination of the pathology in the treatment process.

The aim of the invention is to monitor the course and evaluate the effectiveness of the treatment of endocrine ophthalmopathy using integrated ultrasound imaging - B-scan, the study of changes in the hemodynamics of the vessels of the orbit by color and energy Doppler mapping.

The method is as follows.

Complex sonography is performed on multifunctional ultrasound diagnostic devices HDI 5000 Philips or Voluson 730 equipped with power and color Doppler imaging modes, transpalpebral method with a multi-frequency linear sensor or an electronic convex scanning sensor with a frequency of 7.5-12 MHz.

The first comprehensive ultrasound examination of the orbit for patients with endocrine ophthalmopathy is carried out before the appointment of therapy. As you know, with ultrasound, the normal retrobulbar zone does not exceed 12-15 mm, the thickness of the muscles of the orbit is 4.0-4.5 mm, the optic nerve is 3.5-4.5 mm, the muscle coefficient is 50%. With endocrine ophthalmopathy, there is an increase in the length of the retrobulbar zone above 15 mm due to edema of the retrobulbar fiber, an increase in the thickness of the muscles of the orbit above 5.0 mm, the muscle coefficient above 60%, the thickness of the optic nerve above 4.5 mm.

Further, in the modes of color and energy Doppler mapping, the orbital vessels are visualized according to their topography, the maximum systolic, minimum diastolic and average blood flow velocities for the cardiac cycle, pulsation and resistance indices, the ratio of systolic to diastolic blood flow velocities in the orbital artery, its branches and the maximum speed are determined blood flow in the superior orbital vein.

With endocrine ophthalmopathy, an increase in the maximum systolic blood flow velocity exceeds 45 cm / sec (at normal values of 33.2-44.3 cm / sec), the ratio of systolic to diastolic blood flow velocities exceeds 5.5 (normal 4-5.5), indicators hemodynamic resistance indices - resistance above 0.75 (normal 0.6-0.72) and a pulsation index above 1.5 (normal 1.0-1.4) of the orbital artery, a decrease in the linear blood flow velocity in the orbital vein of less than 5 , 8 cm / sec (at normal values - 6.6-10 cm / sec).

After 10-14 days, 1 month and further, according to indications, repeated complex ultrasound examinations are performed. With a tendency to decrease and (or) normalize the thickness of the rectus muscles of the orbit, optic nerve, the length of the retrobulbar space, the muscle coefficient, decrease the maximum systolic blood flow velocity, systolic-diastolic ratio, ophthalmic artery resistance indices, increase and (or) normalize the blood flow velocity in the orbit Vienna note a positive trend, indicating the effectiveness of the therapy. In the absence of the above changes, as well as with a tendency to decrease the minimum diastolic blood flow velocity, increase the resistance indices - pulsation more than 1.5, resistance more than 0.8 - chronic chronic course of the pathological process and the stage of transition to fibrosis are recorded, which requires treatment correction. The stage of fibrosis is characterized by a decrease in the minimum diastolic blood flow velocity below 5 cm / s, an increase in the systolic-diastolic ratio of more than 6, a pulsation index of more than 1.5, a resistance index of more than 0.8. Maintaining a high blood flow velocity in the orbital artery indicates the preservation of the activity of the process, which requires the appointment of adequate therapy. Maintaining a low blood flow velocity in the orbital vein below 5 cm / sec indicates difficulty in the venous outflow and the possible development of secondary ophthalmic hypertension, which requires the appointment of appropriate treatment.

We examined 127 patients with endocrine ophthalmopathy who are being treated in the endocrinology department of the Republican Clinical Hospital of the Ministry of Health of the Republic of Tajikistan.

Information sources

1. Aznabaev M.G., Gabdrakhmanova A.F., Zhumaniyazov A.Zh., Zotova L.T. A method for differential diagnosis of neoplasms of the orbit. RF patent №2213594 // Problems of ophthalmology. - 2004. - No. 1. - p. 94.

2. Aznabaev M.G., Gabdrakhmanova A.F., Safiullina Z.Kh., Zotova L.T. Duplex scanning in the diagnosis of retrobulbar neoplasms / Mater, scientific-practical. conf. New technologies in ophthalmology. - Ufa. - 2000 .-- p.307-309.

3. Aznabaev M.G., Gabdrakhmanova A.F., Safiullina Z.Kh., Zotova L.T., Zhumaniyazov A.Zh., Akhtyamov K.N. Complex ultrasound diagnostics of volumetric orbit formations. /Guidelines. - Ufa. - 2001. - 10 p.

4. Brovkina A.F. Endocrine ophthalmopathy. - M., GEOTAR-MED, - 2004 .-- 174 p.

5. Fishkin Yu.G. Acoustic studies in the diagnosis of endocrine ophthalmopathy. Abstract. dis. Cand. honey. sciences. - M. - 1985. - 25 p.

6. Friedman F.E. Gundorova R.A., Kodzov M.B. Ultrasound in ophthalmology. - M., 1989 .-- 256 s.

7. Alp MN; Ozgen A; Can i; Cakar P; Gunalp I. Color Doppler imaging of the orbital vasculature in Graves' disease with computed tomographic correlation // Br. J. Ophthalmol. - 2000. - Sep; 84 (9): p1027-30.

8. Fledelius H. Ultrasound in ophthalmology // Ultrasound-Med-Biol. - 1997., 23 (3). - P.365-375.

9. Kahaly G. Imaging in thyroid-assosiated orbitopaty // Eur. J. Endocrinol. - 2001 .-- Vol. 145. - P.112-113.

10. Williamson TH; Harris A. Color Doppler ultrasound imaging of the eye and orbit // Surv Ophthalmol 1996 Jan-Feb; 40 (4): p255-67.

Claims (1)

A method for evaluating the effectiveness of treatment of endocrine ophthalmopathy by conducting an ultrasound examination of the orbit, characterized in that before treatment, for 10-14 days, after 1 month of treatment and then, according to indications, a comprehensive ultrasound examination of the orbit, including a B-scan, a study of blood flow in orbital vessels with using energy and color Doppler mapping of the orbital artery and superior orbital vein, the following deviations are detected before treatment: edema of retrobulbar fiber, an increase in the retrobulbar zone is more than 15 mm thick, the orbit muscle thickness is greater than 5.5 mm, the muscle coefficient is more than 60%, the optic nerve thickness is more than 4.5 mm, the maximum systolic blood flow velocity is increased to 45 cm / s, the systolic-diastolic ratio is more than 5.5 , indicators of hemodynamic resistance indices - resistant above 0.75 and a pulsation index above 1.5 of the orbital artery, a decrease in the linear blood flow velocity in the orbital vein below 5.8 cm / s, and if repeated studies decrease edema of retrobulbar cell tissues, orbit muscle thickness, retrobulbar space length, muscle coefficient, optic nerve thickness, and also observe a decrease in the maximum systolic blood flow velocity, pulsation and resistive ophthalmic artery indices, an increase and / or normalization of blood flow velocity in the orbital vein, a decrease in systolic-diastolic ratio, they ascertain the positive dynamics of the ongoing effective treatment.