RU2391949C1 - Retinopathy of prematurity in cicatricial phase anatomico-functional outcome forecasting method - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention belongs to medicine, notably to ophthalmology, and can be used for early diagnostics and forecasting of retinopathy of prematurity in cicatricial phase outcome. Diagnostic study of macular area of retina with optical coherence tomography is made. Tomography meant to find out volume of macular area, retina thickness in fovea and at the edge of it. If volume of macular area is no less than 6.9±0.1 mm³, retina's thickness in fovea is no less than 216±12 mcm, retina's thickness at the edge of fovea is no less than 255.7±4 mcm, there is the possibility of retina's hypoplasy in macular area and decrement of visual acuity.

EFFECT: method provides precise forecast of hypoplasy of macular area and decrement in visual acuity, raise of treatment effectivity in children with retinopathy of prematurity in cicatricial phase by means of prophylactic groups correct organisation and optimal treatment.

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Description

The invention relates to medicine, in particular ophthalmology, and can be used for early diagnosis and prognosis of the outcome of retinopathy of premature premature (PH) in the cicatricial phase.

The prototype of the invention is a method for predicting the anatomical and functional outcome of retinopathy of premature infants in the cicatricial phase, which consists in determining the anatomical changes in the retina by optical coherence tomography of the macular region of the retina (A. Rudnik. Comprehensive assessment of the state of children's vision in the cicatricial period of retinopathy of premature infants. Abstract of diss. Candidate of Medical Sciences, St. Petersburg, 2006). The disadvantage of this method is the inability to allocate a risk group for the development of hypoplasia of the macular region and reduce visual acuity.

The objective of the invention was the development of a method that provides high accuracy of the allocation of groups according to the anatomical and functional results of retinopathy premature in the cicatricial phase (pH of the Russian Federation).

The technical result when using the invention is to obtain criteria for predicting the development of hypoplasia of the macular region and reducing visual acuity for the formation of groups according to pH outcomes in the cicatricial phase.

The proposed method is as follows: using optical coherence tomography of the macular region (OCT MO) of the retina on a Stratus OCT instrument from Carl Zeiss (Germany), the volume of the macular region, the thickness of the fovea, and the thickness of the retina at the edge of the fovea are determined. If the volume of the macular region is at least 6.9 ± 0.1 mm ³ , the fovea thickness is at least 216 ± 12 μm, and the retinal thickness at the fovea edge is at least 255.7 ± 4, the development of macular region hypoplasia and a decrease in visual acuity are predicted.

A study was performed by the OCT MO method to determine the thickness of the fovea, the volume of the macular region, and the thickness of the retina at the edge of the fovea in children (see table) with different stages of pH in the cicatricial phase (22 eyes) and in the control group without pH (24 eyes). The average thickness of the fovea in the study group was increased to 216 ± 12 μm, the volume of the macular region was increased to 6.9 ± 0.1 mm ³ , and the thickness of the retina at the edge of the fovea was 255.7 ± 4. In the control group, the volume of the macular region was 5.5 ± 0.1 mm ³ , the fovea thickness was 156 ± 11 μm, and the retina thickness at the fovea edge was 159 ± 9 μm. The difference in indicators between these groups is statistically significant (P <0.005). The clinical significance of the absence of the foveolar fossa and its thickening is that it continues to deepen after birth to 15 months due to the movement of nerve fibers, neurons of the inner nuclear layer to the periphery, and the cones of the photoreceptors move to the center. Thus, the results of OCT of MO suggest incomplete differentiation of the fovea microstructure, which leads to hypoplasia of the MO and a decrease in visual acuity in children with pH.

The positive effect of the application of the proposed method is to increase the effectiveness of treatment of children with pH in the cicatricial phase due to the correct formation of dispensary groups, the choice of optimal tactics for managing patients. The developed method was tested in 54 children.

The proposed method is illustrated by the following clinical examples.

Example 1

Stepanova V.V., born on September 20, 1996.

DS: pH III Art. OD RF

PH II, Art. OS RF.

High OD myopia with complex myopic astigmatism, moderate OS myopia. OCT MO carried out.

OD fovea thickness - 222 ± 12 microns,

The volume of the macular region 7.01 ± 0.11 mm ³ ,

The thickness of the retina at the edge of the fovea is 258 ± 6 μm,

OS fovea thickness - 214 ± 13 μm,

The volume of the macular region is 6.95 ± 0.15 mm ³ ,

The thickness of the retina at the edge of the fovea is 254 ± 2 μm.

The patient was predicted a high risk of macular hypoplasia and decreased visual acuity. Further, with spectacle correction:

Example 2

Samuseva E.A. 02.02.97 born,

DS: PH I Art. OD RF

PH I, Art. OS RF.

Mild myopia in both eyes.

OCT MO carried out.

OD fovea thickness - 157 ± 3 μm,

The volume of the macular region of 5.6 ± 0.1 mm ³ ,

The thickness of the retina at the edge of the fovea is 154 ± 5 μm,

OS fovea thickness - 152 ± 4 microns,

The volume of the macular region 5.5 ± 0.1 mm ³ ,

The thickness of the retina at the edge of the fovea is 150 ± 6 μm.

The patient is predicted the normal development of the macular region and high visual acuity.

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Using the developed method, it is possible to predict in children with various stages in the cicatricial phase. Thus, predicting the anatomical and functional outcome of pH in the cicatricial phase can reduce the number of serious complications due to the optimal management of patients.

Indicators of the macular region of the retina in children with retinopathy premature in the cicatricial phase No. FULL NAME. Year of birth The volume of the macular region in mm ³ Fovea thickness in microns Retinal thickness at the edge of the fovea in microns OD OS OD OS OD OS one Galiev Renat 05/29/1990 6.37 ± 0.15 6.5 ± 0.2 209 ± 11 228 ± 9 221 ± 13 232 ± 10 2 Shaykhlislamova Ilnara 05/21/1997 6.06 ± 0.12 6.37 ± 0.2 179 ± 38 165 ± 7 251 ± 14 224 ± 7 3 Kozhurina Julia 03/29/1996 6.91 ± 0.16 6.63 ± 0.1 202 ± 30 212 ± 30 241 ± 16 233 ± 13 four Yarmullina Ilnara 11/12/1993 7.05 ± 0.2 6.44 ± 0.17 199 ± 14 223 ± 21 212 ± 11 236 ± 6 5 Tumasheva Lilia 01/03/1995 4.53 ± 0.1 4.78 ± 0.12 134 ± 3 175 ± 8 186 ± 11 226 ± 9 6 Gainullin Arthur 10/15/1997 6.68 ± 0.13 6.43 ± 0.17 232 ± 12 144 ± 3 256 ± 11 234 ± 7 7 Safiullin Marcel 04/15/1998 6.78 ± 0.13 275 ± 11 261 ± 17 8 Gumerov Renat 03/25/1996 6.34 ± 0.17 238 ± 13 259 ± 7 9 Borisova Diana 12/31/1991 6.27 ± 0.12 6.31 ± 0.15 222 ± 15 214 ± 5 248 ± 11 239 ± 4 10 Nigmatullin Marcel 02/22/1999 6.56 ± 0.2 6.47 ± 0.17 263 ± 3 234 ± 7 271 ± 11 258 ± 17 eleven Nenasheva Valya 02/12/1990 6.36 ± 0.14 250 ± 13 268 ± 11 12 Sabitova Olya 06/20/1990 6.49 ± 0.16 6.42 ± 0.15 214 ± 9 226 ± 9 246 ± 11 263 ± 17

Claims (1)

A method for predicting the outcome of retinopathy of premature infants in the cicatricial phase, including the study of the macular region of the retina using optical coherence tomography, characterized in that the volume of the macular region, the thickness of the fovea, the thickness of the retina at the edge of the fovea and the volume of the macular region is at least 6.9 ± 0, are determined. 1 mm ³ , fovea thickness not less than 216 ± 12 μm, retinal thickness at the fovea edge not less than 255.7 ± 4 μm predict the risk of macular hypoplasia and decreased visual acuity.