RU2332171C1 - Method of forecasting infrared treatment efficiency for partial optic nerve atrophy - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: blood flow is located in ophthalmic artery, maximal systolic speed of blood flow (V_max) is measured with the help of transcranial dopplerography. Pathological activity (PA) of orbital zones is registered by the device of controlled reflexotherapy of acupuncture orbital spots. Forecast index (K_fore) is calculated by the formula: K_fore=PA/V_max. At the forecast index under 4.0 high efficiency of infrared effect is forecasted. At the forecast index over 10.0 low efficiency of infrared effect is forecasted.

EFFECT: possibility to forecast efficiency of infrared treatment of partial optic nerve atrophy.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used to determine the expected effect of the treatment of partial optic atrophy (ChASN).

A known method for assessing the responsiveness of cerebral vessels (Giller C. A. A bedside test for cerebral autoregulation using transcranial doppler ultrasound. Acta Neurochir. (Wien) 1991; 108: 7-14). When the blood flow was located in the cerebral arteries, the homolateral common carotid arteries were clamped around the neck, achieving a decrease in the blood flow velocity in the cerebral arteries by 30-50%; the compression duration was no more than 3 seconds. After the compression of the common carotid artery was stopped, a rapid increase in the blood flow velocity in the cerebral arteries was recorded, the value of which exceeded the initial rate by normal by at least 10%, and the duration was on average 1 cardiac cycle.

The disadvantages of this method are the short duration of compression and the empirical assessment of the response of blood flow, since within 3 seconds an adequate reaction does not develop from the side of the cerebral arteries.

A known method for assessing the current tone of resistive vessels in the middle cerebral artery basin using a compression test (Svistov DV, Parfenov VT, Khrapov KN The estimation of current tone of resistive vessels of middle cerebral artery with compression test. Int. Symp.on transcranial Doppler and intraoperative monitoring. St. Petersburg, 1995, 163), during which compression of the ipsilateral common carotid artery was performed for 5 seconds through transtemporal access, after which the linear velocity of blood flow in the middle cerebral artery was recorded for 15 seconds. We calculated the growth rate of the first peak of the average linear blood flow velocity upon termination of compression, the normalization time of the average linear blood flow velocity, and the autoregulation rate. The specified method was developed for the study of cerebral circulation in cerebrovascular pathology.

The authors in the scientific and medical and patent literature have not found a method for predicting the effectiveness of infrared exposure (IR) in ChASN.

The technical result of the invention is to obtain criteria for predicting the effectiveness of the treatment of prone infrared exposure.

The specified technical result is achieved by a method characterized in that the maximum systolic blood flow velocity in the orbital artery is measured, pathological activity of the orbital zones is recorded, and the prognosis coefficient (K _prog ) is calculated by the formula:

K _prog = PA / V _max ,

Where:

PA - pathological activity of the orbital zones,

V _max is the maximum systolic blood flow velocity in the orbital artery, and with a forecast coefficient of less than 4.0 predict high treatment effectiveness, more than 10.0 - low treatment efficiency.

The proposed method is as follows. Using transcranial dopplerography, the blood flow in the orbital artery (HA) is located; measure the maximum systolic blood flow velocity (V _max ) and with the help of the KROTA apparatus register the pathological activity (PA) of the orbital zones. Calculate the forecast coefficient (K _prog ) according to the formula: K _prog = PA / V _max . If the forecast coefficient value is less than 4.0, high treatment efficiency is predicted, more than 10.0 - low treatment efficiency.

Studies have been conducted in 54 patients with ChASN. The control group consisted of practically healthy individuals (n = 30). The age of the subjects is over 55 years. To study the results of treatment, patients were divided into 5 groups according to initial visual acuity (03): from “light perception” to 0.01-30 (27.7%) of the eyes, from 0.01 to 0.1-24 (22.2 %) eye, from 0.1 to 0.3-20 (18.5%) of the eye, from 0.3 to 0.5-18 (16.6%) of the eye, from 0.5 to 0.7-16 (14.8%) eye (Table 1).

The sensor was placed on the upper eyelid in the upper lateral corner of the orbit, the beam was directed to the projection point of its apex of the optic nerve channel, where HA was probed at a depth of 48 mm, and the ultrasound power was 7 mW / cm ² . At rest, a background recording of the maximum systolic blood flow velocity in GA was performed. For each group, the calculated percentage increase V _max for IV:

V _max gain = V _max after IV / V _max before IV × 100.

Orbital zones PA were recorded on the KROTA apparatus. The limits of normal fluctuations of the forecast coefficient in the control group were 1.30-1.60. In the main group, the fluctuations in the forecast coefficient were 4.0–6.0, 6.0–7.2, and 7.2–10.0; an indicator of the percentage increase in systolic velocity (Table 2). Thus, in patients with a prognosis coefficient of less than 4.0, the treatment of PRAS is highly effective, with a prognosis coefficient of more than 10.0, treatment is ineffective.

The above data indicate that the proposed method for predicting the effectiveness of the treatment of PRAS with infrared exposure can be used for sufficiently accurate and reliable prediction of the expected treatment effect.

The proposed method is illustrated by the following examples.

Example 1. Patient S., 47 years old, diagnosed with partial atrophy of the optic nerve of traumatic genesis 3 years ago.

Objectively: OD - visual acuity of 0.01 does not correct, OS - visual acuity of 0.01 does not correct. Biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, the reaction to light is preserved. The crystalline lens is transparent, the vitreous is transparent. The fundus of the eye: the optic disc is pale in color, the boundaries are clear. Macular reflexes preserved. The vessels are not changed.

HA hemodynamic parameters: OD - maximum systolic velocity of 20.94 cm / s, OS - 22.11 cm / s. The pathological activity of the orbital zones is 250 μA.

The patient calculated the forecast of effectiveness: OD - 11.93, OS - 11.3.

The prognosis coefficient was more than 10.0, they determined the low efficiency of the IV and the increase in systolic velocity in the GA by 1.51%. After treatment, the prognosis was confirmed: systolic velocity in the right eye was 21.87 cm / cm, and in the left eye - 23.04 cm / cm.

Example 2. Patient Yu., 55 years old, diagnosis: partial atrophy of the optic nerve of the right eye (due to circulatory disorders in the vascular pool of the eye). Hypertensive angiosclerosis of the retina of the left eye. Weak hypermetropia. Objectively: visual acuity OD - 0.7, does not correct; OS - 0.7 with sph + 0.75-0.9 correction. With biomicroscopy, the anterior and posterior segment of the eyeballs without pathological changes. Fundus: OD of the optic nerve is pale in color, the borders are clear, the arteries are slightly narrowed, the veins of medium caliber, the macular reflex is preserved, the periphery of the retina is without features. OS - DZN - pale pink in color, the boundaries are clear, the arteries are significantly narrowed, their tortuosity and uneven caliber are increased. The symptom of Salus-Hun is 1.2.

HA hemodynamic parameters - maximum systolic velocity 34.98 cm / s, pathological activity of orbital zones 130 μA.

The data are substituted into the formula and the forecast coefficient is calculated equal to (K _prog = 3.4). Predict the high efficiency of IV.

After treatment, the systolic velocity in GA was 36.55 cm / s, which confirmed the prognosis of an increase in velocity in GA by 3.56%.

From the studies it is clear that the proposed method is an effective, safe and generally available method for predicting the effectiveness of the treatment of ChASN, this technique can be carried out in any medical institution that has ultrasound diagnostic equipment.

Table 1
Distribution by initial visual acuity Group of patients Initial visual acuity The number of eyes (%) First group from "light perception" to 0,01 30 (27.7) Second group from 0.01 to 0.1 24 (22.2) Third group from 0.1 to 0.3 20 (18.5) Fourth group from 0.3 to 0.5 18 (16.6) Fifth group from 0.5 to 0.7 16 (14.8)

table 2
The distribution of indicators predicting the effectiveness of K _prog and V _max Group of patients Indicators K _prog Increase Vmax% First group More than 10.0 1.51% ± 0.37% Second group 7.2-10.0 2.12% ± 0.28% Third group 6.0-7.2 2.53% ± 0.31% Fourth group 4.0-6.0 3.04% ± 0.24% Fifth group Less than 4.0 3.56% ± 0.43%

Claims (1)

A method for predicting the effectiveness of the treatment of partial optic atrophy with infrared exposure, characterized in that the maximum systolic blood flow velocity in the orbital artery is measured, pathological activity of the orbital zones is recorded, the prognosis coefficient (K _prog ) is calculated by the formula K _prog = Pa / V _max , where PA is pathological activity of orbital zones, V _max. - the maximum systolic blood flow velocity in the orbital artery, and with a forecast coefficient of less than 4.0 predict high treatment effectiveness, more than 10.0 - low treatment effectiveness.