RU2291433C1 - Method for predicting clinical macular degeneration course - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining thiobarbituric acid-reactive substances concentration in lacrimal fluid of a patient. Coefficient value is calculated for showing relationship between thiobarbituric acid-reactive substances concentration inherent in macular degeneration patients to the value in healthy people. The value being greater than 2,0, progressive exudative hemorrhagic processes are predicted to take place in macular region.

EFFECT: high accuracy of prognosis.

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Description

The invention relates to medicine, namely to ophthalmology. It can be used to predict the course of macular degeneration and conduct therapy at the optimal time in this category of patients.

Dystrophic changes in the retina include macular lesions called macular degeneration (MD). According to the National Eye Institute (USA), among the causes of blindness, MD is second only to diabetic retinopathy. In the pathogenesis of MD, a marked effect has a change in redox processes [1, 2]. In recent years, this disease is diagnosed not only in the elderly, but also at a young age, which leads to primary disability in 11% of patients of working age, and among the elderly - 28%. In young people in the diagnosis of macular degeneration, it is necessary to solve the following problems: first - the selection of adequate therapy; the second is the refinement of the criteria for stabilizing the pathological process in the retina and the third is the timing of conservative therapy.

A known method for predicting by determining the concentration of serotonin in plasma of crozia in patients with macular degeneration [3]. With a non-exudative form of macular degeneration, the content of serotonin is determined within 0.2 μmol / L. A decrease in the concentration of serotonin to 0.16 μmol / L is recorded with exudative-hemorrhagic form of MD [3, 4].

In this case, the patient’s blood serves as the material for research, but the biochemical composition of the blood can significantly change with the development of a number of general diseases of the body. In particular, the content of serotonin can vary with diabetes. In diseases of the organ of vision, the biochemical composition of blood in patients under 40 years of age does not practically change. The main shifts occur in these cases directly in the environments of the eye, as well as in the lacrimal fluid [5].

To improve the accuracy of predicting the course of MD (the transition of the nonexudative phase to the exudative), the level of TAC-active products in the tear fluid is determined, the ratio of the content of TAC-active products in a patient with MD to the indicators of TAC-active products in healthy people and when the coefficient value is more than 2 0 predict disease progression.

The method is as follows: the tear fluid is taken with a micropipette without additional stimulation of tear secretion.

The content of TBA-active products is determined according to the generally accepted method [6]. In the determination of TBA-active tear products, 3 ml of a 3% solution of trichloroacetic acid and 1 ml of a 0.6% solution of thiobarbituric acid are added to 0.310 ml aliquots of lipids extracted with physiological saline (prepared with ex tempore). In the rest, the technique does not differ from the generally accepted one. Values of the criterion are calculated from the difference between the fluorescence values of the experimental and control samples and expressed in relative units.

The ratio of the content of TBA-active products in patients with macular degeneration to the content of TBA-active products of healthy people is calculated. Given the possible influence of various factors (primarily geoclimatic and environmental), reference levels were determined for TAC-active products in the tear fluid in healthy residents of Transbaikalia.

With an increase in the ratio index of more than 2.0, patients predict the progression of dystrophic processes in the macular region of the retina, and an increase in exudative-hemorrhagic manifestations. This group of patients is prescribed complex therapy with antioxidant and retinoprotective drugs. After treatment, the level of TBA-active products decreased by 40%. To monitor the effectiveness of treatment, the study of TBA-active products was carried out after 3-6 months.

This method improves the accuracy of predicting the course of macular degeneration, as well as timely prescribe courses of preventive treatment, which is especially important for young patients with high visual functions. The technique is highly informative and minimally invasive. The performed technique does not require exceptional funds, expensive drugs. The materials and methods used to set the methodology are publicly available. The method is used in patients with MD. Prediction accuracy is 72%.

The level of TBA-active products in the tear fluid in patients with macular degeneration. Tear fluid Control (n = 18) Patients with progression of the process (n = 38) Patients without process progression (n = 20) TBA-active products, UE / mg protein 2.73 ± 0.22 7.97 ± 0.63 p <0.001 4.01 ± 0.83 Note: n is the number of eyes examined;
p is the level of significant differences compared with the control.

Examples: Patient K., 32 g., Diagnosis: pre-form stage of macular degeneration. Dystrophic foci are recorded symmetrically in both eyes. Visual acuity was OD = 0.9; OS = 1.0, reduced contrast sensitivity to gray in the high and low frequencies by 25%. The coefficient of TBA-active products was 3.0. When observed for six months, progression of dystrophic processes in the macular region was noted, visual acuity decreased by 20% in both eyes. Assigned to complex therapy, including retinalamine. Retinalamin, a complex of polypeptides with a macular mass of up to 10 kDa, isolated from the retina of the cattle. The drug is approved for medical use by order of the Ministry of Health of the Russian Federation No. 212 of June 1, 1999 (reg. No. 99.212.7). Retinalamin is administered parabulbarno, once, daily, 5.0 mg for 10 days (50.0 mg per course). The coefficient of TBA-active products was 1.9. Courses were repeated after 4-6 months. When observed for three years against the background of treatment courses, the progression of the pathological process was not recorded, visual functions remained at the same level (the coefficient was 1.8-1.9 in dynamics).

Patient D., 34 g., Diagnosis: predisformal stage of macular degeneration of the right eye. Visual acuity OD = 0.8, OS = 1.0. Reduced contrast sensitivity to gray in the high frequency region by 10%. The coefficient of TBA-active products was 1.7. Observation for three years did not reveal a deterioration in visual function. With ophthalmoscopy, dynamics from the macular region were not detected.

Patient M., 22 g., Diagnosis: predisformal stage of macular degeneration of both eyes. Visual acuity OU = 1.0. Reduced contrast sensitivity to gray in the high frequency region by 15%. The coefficient of TBA-active products was 2.8. He refused the proposed therapy. Two months later, he noted a sharp decrease in visual acuity in the left eye. When contacting an ophthalmologist after four months, visual acuity in the left eye was 0.04. On the fundus in the macular region, gray exudate, areas of hemorrhage, the coefficient of TBA-active products was 3.2.

Patient S., 68 L., diagnosis: pre-form stage of macular degeneration of both eyes, incomplete complicated cataract of both eyes. Visual acuity OD = 0.6, OS = 0.5, with a correction of + 0.1D was 0.7. Reduced contrast sensitivity to gray in high frequencies by 20%. The coefficient of TBA-active products was 1.4. Within three years, the visual acuity on OD decreased to 0.2 due to clouding in the lens, on OS the visual acuity did not change. After cataract extraction with IOL implantation, visual acuity in the right eye was 0.9. With ophthalmoscopy for three years, dynamics from the macular region were not detected.

Patient M., 56 years old, pre-form stage of macular degeneration of both eyes. Visual acuity OD = 0.8, OS = 0.7. Reduced contrast sensitivity to gray in high frequencies by 20%. The coefficient of TBA-active products was 2.6. Within six months, a decrease in visual functions was noted: the appearance of central relative cattle and a decrease in visual acuity by 30%. When ophthalmoscopy in the macular region revealed exudative hemorrhagic processes. Prescribed complex therapy, including retinalamin, histochrome. After a course of therapy, visual acuity increased to the original, scotomas in the field of vision were not detected. The coefficient of TBA-active products was 1.7. For three years, courses of therapy were carried out after 4-6 months. Progression of the pathological process has not been identified. The coefficient of TAC-active products in dynamics ranged from 1.6 to 1.8.

Bibliography

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3. The importance of serotonin in the pathogenesis of diabetic retinopathy and central chorioretinal dystrophy of the retina / A.I. Mukha, L. V. Korzenkova, N. V. Fedorova, E. D. Syromyatnikova // Vestn. ophthalmol. - 2002. - No. 4. - S. 31-33.

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Claims (1)

A method for predicting the course of macular degeneration, including a biochemical study of biological materials, characterized in that TAC-active products are determined in the tear fluid, the ratio of TAC-active products in a patient with macular degeneration to the level of this indicator in healthy individuals is calculated, with a coefficient value of more than 2 0 predict the progression of exudative hemorrhagic processes in the macular region.