RU2315546C1 - Differential diagnosis method for setting optic nerve disk atrophy diagnosis accompanied by transitory intracranial blood pressure rise and that of congenital genesis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out ophthalmoscopic examination. Optic nerve disk image is built with fundus camera. Basic color component parameters are measured. Color distribution diagrams are built on patient eye fundus image in 256 color gradation scale. The obtained basic color brightness distribution diagrams are compared to reference diagrams using maximum likelihood criterion. Blue color maximum being from 90 to 184, blue color percent being from 2 to 15; green color maximum being from 207 to 232 and green color mode from 170 to 211, partial optic nerve disk atrophy accompanied by transitory intracranial blood pressure rise is diagnosed. Blue color maximum being less than 90 and greater than 184, blue color percent being less than 2 and greater than 15; green color maximum being less than 207 and greater than 232 and green color mode less than 170 and greater than 211, partial optic nerve disk atrophy of congenital genesis is diagnosed.

EFFECT: high reliability of differential diagnosis.

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Description

The invention relates to medicine, and is intended for the differential diagnosis of partial atrophy of the optic disc with a transient increase in intracranial pressure and congenital genesis in children.

According to the WHO, in the world there are about 42 million blind and visually impaired. 2/3 lost sight until 15 years of age due to partial atrophy of the optic nerve. The largest group of them are children with congenital partial atrophy of the optic nerve (ChASN) of hypoxic origin. As a rule, the pathological course of pregnancy led to early childbirth and fetal asphyxia of the 1-3 degree, which in most cases causes an increase in intracranial pressure and the development of perinatal posthypoxic encephalopathy with hypertension syndrome. With an increase in intracranial pressure (ICP), the outflow of tissue fluid through the optic nerve into the cranial cavity is difficult. The intracranial part of the optic nerve at the site of exit from the optic canal with an increase in ICP is pressed against the bones of the base of the skull by the substance of the frontal lobe. Tissue fluid flowing from the eye along the optic nerve is retained in the orbital and intracanal portions of the optic nerve. This leads to edema that extends to the optic nerve head. Edema of the optic nerve is enhanced by the development of venous stasis. Edema is more pronounced in the peripheral bundles of nerve fibers, then it spreads to the central bundles, which leads to a rapid and sharp decrease in visual acuity and the development of partial atrophy of the optic nerve. The disease is an important problem for pediatric neurologists and ophthalmologists, since in the absence of adequate treatment leads to blindness.

Congenital partial atrophy of the optic nerve together with optic disc hypoplasia (optic nerve disc), megalopapilla, coloboma of optic nerve disc, etc. refers to malformations or congenital anomalies of the development of optic disc disease due to deviations in the process of embryonic development of the primordium of the optic nerve. They are often combined with other anomalies in the development of the eye and are usually accompanied by an indistinguishable decrease in vision of varying degrees. Their characteristic feature is the stationarity of the process. Any dynamics in the state of visual functions and an ophthalmoscopic picture with anomalies is always absent.

A known method for the differential diagnosis of partial atrophy of the optic disk with a transient increase in intracranial pressure and congenital genesis, including the taking of anamnesis, ophthalmoscopy, the study of visual functions and their dynamics [A.V. Gustov, K.I. Sigriansky, J.P. Stolyarova. "Practical Neuroophthalmology", NGMA, Nizhny Novgorod, 2003, pp. 147-150). However, this method is subjective, in each case, an analysis of individual nonspecific symptoms is carried out, histological verification cannot be carried out and there are no objective criteria to accurately and reliably differentiate these diseases. In addition, the rapid progression of amblyopia against the background of the underlying disease in this severe category of children requires an accurate forecast of the appropriateness of the forthcoming adequate treatment.

The objective of the invention is the creation of an objective reliable method for differential diagnosis of partial atrophy of the optic nerve disc with a transient increase in intracranial pressure and congenital genesis in children with the aim of timely pathogenetically directed treatment to preserve visual functions.

The technical result is to increase the reliability of the method of differential diagnosis of partial atrophy of the optic disc with a transient increase in intracranial pressure and congenital origin.

The technical result according to the invention is achieved by the fact that in the method an image of the optic nerve disk is additionally carried out by means of a fundus camera, the parameters of the primary colors are measured, distribution diagrams of the indicated colors are constructed in the fundus image of the patient under examination in 256 gradations of brightness, while the red color range is determined , the minimum is blue, the median is green, the mode is green, then the resulting distribution diagrams of the primary colors are compared with the reference dia grams according to the maximum of similarity criteria and, if the maximum is blue from 90 to 184, the percentage of blue is from 2 to 15, the maximum is green from 207 to 232 and the green mode is from 170 to 211, then partial optic disk atrophy is diagnosed with a transient increase intracranial pressure, and if the blue maximum is less than 90 and more than 184, the blue color is less than 2 and more than 15, the green maximum is less than 207 and more than 232 and the green mode is less than 170 and more than 211, then partial atrophy of the optic nerve disc of congenital genesis is diagnosed in children.

The method is as follows. Fundus photography with a Topkon fundus camera, Japan, equipped with a Polaroid-type camera. Shooting takes place in a darkened room. The patient is examined sitting, chin and forehead leaning on the headrest. The patient's gaze is directed to a special flashing point, the position of which is controlled by the operator to obtain an image of the optic disc on the monitor screen. To capture and record the fundus of the eye, approximately 3-5 minutes are required, after which the patient is not required.

Then the analysis by the operator follows (the boundaries of the optic nerve disc, large vessels and the rim zone were marked), computer processing was carried out on a general-purpose computer with a digital electronics system (at least 486/100/16 M with a hard drive of at least 1 GB), Windows 95. Required conditions for shooting: pupil width of at least 5 mm, transparency of the optical media of the eye. The examination results do not depend on the subjective influence of the patient or doctor.

Previously, for each pathology, an image of the fundus is selected with an established diagnosis, confirmed by other diagnostic methods. Based on these images, standards are formed for each type of pathology. The formation of standards is carried out according to the previously described methodology (patent RU No. 2134054, 2209581).

Next, an ophthalmoscopy of the fundus of the patient is performed, an additional measurement of the parameters of the constituent primary colors is performed, distribution diagrams of the indicated colors are constructed in the image of the fundus of the patient under study in 256 gradations of brightness, while the maximum is blue, the percentage of blue, the maximum and fashion are green, then obtained the primary color distribution diagrams are compared with the reference diagrams according to the maximum similarity criteria and, if the maximum blue color is from 90 to 184, the percentage of blue color is from 2 to 15 , the green maximum is from 207 to 232 and the green mode is from 170 to 211, then partial atrophy of the optic nerve disc is diagnosed with a transient increase in intracranial pressure, and if the maximum of blue is less than 90 and more than 184, the percentage of blue is less than 2 and more than 15, if the green color is less than 207 and more than 232, the green mode is less than 170 and more than 211, then partial atrophy of the optic disk of the optic nerve of congenital origin is diagnosed (see table).

Colorimetric parameters of the standards of partial atrophy of the optic disc with a transient increase in intracranial pressure and congenital genesis Options PRIV at transient increase in ICP Congenital Genesis blue percentage 2-5 less than 2 and more than 15 maximum blue 90-211 less than 90 and more than 211 maximum green 207-232 less than 207 and more than 232 fashion green 170-211 less than 170 and more than 211

The invention is illustrated by several clinical examples.

Example 1. Patient A., 5 years old. A history of low vision in both eyes. The visual acuity of both eyes is 0.01. Fundus: optic disc is pale, veins are dilated. The fundus image obtained using the fundus camera is scanned and analyzed. The following colorimetric parameters were obtained: blue maximum from 90 to 184, blue percentage from 2 to 15, green maximum from 207 to 232 and green mode from 170 to 211. The diagram corresponds to the standard: “Partial atrophy of the optic nerve with transient increase in intracranial pressure. " Clinical diagnosis was made: Partial atrophy of the optic nerve with a transient increase in intracranial pressure. Decongestants, a course of neurotrophic therapy by catheterization of retrobulbar space and sequential fractional administration of several drugs with nootropic, vasodilating effects and metabolic activators were prescribed. At the end of the course of treatment, visual acuity increased to 0.05.

Example 2. Patient N. 4 years. A history of low vision of the left eye. Visual acuity of the left eye is 0.02. Fundus: optic disc is pale, decolorized, clear boundaries. The fundus image obtained using the fundus camera is scanned and analyzed. The following colorimetric parameters were obtained: the maximum of blue is less than 90 and more than 184, the percentage of blue is less than 2 and more than 15, the maximum of green is less than 207 and more than 232, the green mode is less than 170 and more than 211. The diagram corresponds to the standard: "Partial atrophy of the optic nerve inborn genesis. " Clinical diagnosis made: Partial atrophy of the optic disc of congenital origin. The prognosis of treatment is poor.

According to the prototype method, 16 patients with suspected congenital partial atrophy of the optic nerve were examined. 8 patients were diagnosed with partial atrophy of the optic disc of congenital genesis, 3 patients with partial atrophy of the optic nerve with a transient increase in intracranial pressure. According to the proposed method, the same 16 patients were examined. Diagnosis: Partial atrophy of the optic nerve disk of congenital origin was made to 5 patients, Partial atrophy of the optic nerve with transient increase in intracranial pressure was delivered to 13 patients.

Thus, the technical result is an increase in the reliability of diagnosis - achieved in more cases.

Claims (1)

A method for differential diagnosis of partial atrophy of the optic disk with an increase in intracranial pressure and congenital genesis, including ophthalmoscopy, characterized in that the image of the optic disk is additionally carried out using a fundus camera, the parameters of the primary colors are measured, distribution diagrams of the indicated colors in the eye image are constructed the bottom of the studied patient in 256 gradations of brightness, while determining the maximum blue color, the percentage of blue color, ma the green maximum, the green mode, then the obtained distribution diagrams of the primary colors are compared with the reference diagrams according to the maximum similarity criteria, and if the maximum is blue from 90 to 184, the percentage of blue is from 2 to 15, the maximum is green from 207 to 232 and the mode of green color from 170 to 211, then partial optic disk atrophy is diagnosed with a transient increase in intracranial pressure, and if the maximum blue is less than 90 and more than 184, the percentage of blue is less than 2 or more than 15, the maximum green is less than 207 and more e 232 and the green mode is less than 170 and more than 211, then they are diagnosed with partial atrophy of the optic disk of the optic nerve of congenital origin.