RU2342905C1 - Method for prognosis of result of optical neuritis - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: diameter of optic disc, peripapillary layer thickness of nerve fibers and thickness of perifovea are determined, and the result of optical neuritis is prognosed according to the thickness of peripapillary layer of nerve fibre, the thickness of perifoveolar zone in macula and the diameter of optic disc.

EFFECT: method allows prognosing a possible result of optical neuritis.

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Description

The invention relates to medicine, in particular to ophthalmology, and can be used to predict the outcome of optical neuritis (OH).

There are methods for assessing the degree of visual analyzer dysfunction in patients with OH by determining the threshold of electrical sensitivity, electrical lability, the critical frequency of flicker fusion, visually-induced potentials, and visual fields. etc. [Karlova I.Z. Spatial contrast sensitivity in the differential diagnosis of optical neuritis / I.Z. Karlova, A.M. Shamshinova, A.E. Belozerov, I.A. Loskutov // Bulletin of Ophthalmology. - 1996. - No. 3. - S.22-24]. But the disadvantage of these methods is the ability to determine only the functional state, to ascertain the presence of optic neuritis. The closest analogue to the prototype is ultrasonic B-scanning, in which the state of the optic nerve is determined, but the disadvantage of this method is the low resolution and the inability to layer-by-layer scanning of the optic nerve and retina [Neroev V.V. The role of ultrasound B-scanning in differential diagnosis and prediction of the course of optical neuritis / V.V. Neroev, I.Z. Karlova, O.V. Zaitseva, G.V. Kruzhkova, A.N. Smartly // Bulletin of Ophthalmology. - 2001. - No. 6. - S.25-29].

The objective is to propose a method for predicting the outcomes of optical neuritis (OH).

EFFECT: possibility of predicting the outcomes of optical neuritis (OH) by determining the diameter of the optic disc, the peripapillary thickness of the nerve fiber layer and the thickness of the perifove in patients with OH.

The technical result is achieved in that patients with optic neuritis determine the diameter of the optic disc, the peripapillary thickness of the nerve fiber layer and the thickness of the periphova using the method of optical coherence tomography (OCT), which allows you to study living tissue in a non-invasive manner and is based on a comprehensive analysis of reflections of low coherent radiation from test tissues. The resolution of this method is about 10 microns, which allows you to obtain a layered image of the layers of the retina and optic nerve, as well as to judge the presence and degree of tissue edema. Accordingly, the greater the swelling of the tissues of the optic nerve and retina, the greater the compression of the nerve fibers and the development of atrophy of the optic nerve. The outcome of OH can be judged by the degree of thickness of the peripapillary layer of nerve fibers, the perifovolar zone of the macula, and the diameter of the optic disc.

With an optic disc diameter of 1.37 to 2.17 mm, a peripapillary thickness of the nerve fiber layer of 99.7 to 124.9 μm, and a peripheral thickness of 190 to 231.2 μm, there is a chronic course of OH with a partial or complete outcome in atrophy optic nerve. With full recovery, the diameter of the optic nerve disk is from 2.18 mm and above, the peripapillary thickness of the nerve fiber layer is from 125 μm and above, and the thickness of the periphova is from 231.3 μm and above (see Table 1).

The main group was 70 people. The diameter of the optic disc, the peripapillary thickness of the layer of nerve fibers, and the thickness of the perifovea were determined for all patients upon admission. In retrospect, after 3 years, all patients were divided into 2 groups depending on OH outcomes.

The advantages of the proposed method:

- the analysis is atraumatic;

- the analysis is informative, since by its results it is possible to judge the condition (presence of edema) of the optic disc, the macular region;

- allows you to determine the severity of the clinical course of the disease, the presence of a hidden course of the disease, to prevent the development of complications of OH, due to the appointment of timely pathogenetic treatment.

Example No. 1.

Patient M., 29 years old, complained of pain during eye movement, fog before the eyes, a sharp decrease in vision in both eyes. From the anamnesis it is known that she fell ill 5 days ago, after suffering an acute respiratory viral infection with an increase in temperature to 37.4 ° C. In ophthalmostatus: visual acuity of the right eye - 0.2 n / a, left - 0.4 n / a. The central scotoma is in sight. OCT indices were as follows: optic disc diameter 2.2 mm, peripapillary thickness of the nerve fiber layer 135 μm and peripheral thickness 263 μm. Diagnosis: Retrobulbar neuritis of both eyes. After 3 years of repeated occurrence of OH, the patient was not observed.

Example No. 2.

Patient T., 43 years old, complained of complaints of decreased vision, pain when moving behind the eyeballs. From the anamnesis it became known that for 2 weeks is under the supervision of an ENT doctor with a diagnosis of Chr. 2-sided catarrhal maxillary sinusitis, period of exacerbation. Three days ago, the above complaints appeared. Currently, visual acuity was 0.4 n / a in the right eye and 0.5 n / a in the left eye. During OCT, it was revealed that the optic disc diameter was 2.10 mm, the peripapillary thickness of the layer of nerve fibers was 100 μm, and the thickness of the periphova was 215 μm. After 1.8 years, the patient was again admitted to the clinic, where she was diagnosed with Chronic retrobulbar neuritis of both eyes, an exacerbation period, against the background of hr. 2-sided in / maxillary sinusitis.

Example No. 3.

Patient K., 36 years old, asked about newly arising complaints of decreased vision, the appearance of a veil in front of his eyes, and a narrowing of his visual field within a week. From the anamnesis it is known that 7 months ago I was treated in a clinic with a diagnosis of Optic neuritis in both eyes (against the background of multiple sclerosis). Visual acuity is 0.2 n / a in the right eye and 0.4 n / a in the left eye. OCT indices were as follows: optic nerve disc diameter 1.7 mm, peripapillary thickness of the nerve fiber layer 92 μm, and periphova thickness 199 μm. The patient was diagnosed with Chronic retrobulbar neuritis of both eyes, an exacerbation period, against the background of multiple sclerosis. After 1 year 6 months, he was again admitted to the hospital with a diagnosis of Chronic retrobulbar neuritis, an exacerbation period. Partial atrophy of the optic nerves of both eyes, against the background of multiple sclerosis.

Table Groups People (eye) Diameter of the optic disc (mm) The peripapillary thickness of the layer of nerve fibers (microns) Foveola (micron) Recovery 51 (42) 2.18 and above 125 and higher 231.3 and higher Chronic course 19 (15) 1.37-2.17 99.7-124.9 190-231.2

Claims (1)

A method for predicting the outcomes of optical neuritis (OH), which consists in determining the diameter of the optic disc, the peripapillary thickness of the nerve fiber layer and the thickness of the perifovea, characterized in that when the values of the diameter of the optic disc are from 1.37 to 2.17 mm, the peripapillary thickness of the nerve layer fibers from 99.7 to 124.9 microns and perifove thickness from 190 to 231.2 microns predict a chronic course of OH; with an optic nerve disc diameter of 2.18 mm and above, a peripapillary thickness of the nerve fiber layer from 125 μm and above, and a perifove thickness of 231.3 μm and above, recovery is predicted.