RU2394470C1 - Method of examination of peripheral retina, choroid and vitreous body - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmology and aims at examination of peripheral retina, choroid and vitreous body. Silicon tray ultrasound biomicroscopy in maximum eye aversion is performed. The tray is represented by two truncated cones adjoining an aperture with their smaller bases in a contact plane. An ultrasonic sensor is positioned in all hour angles at 4 to 18 mm from the limb at a scanning angle to 90° to a plane passing through an investigated structure.

EFFECT: method allows improving diagnostic performance in investigating peripheral retina, choroid and vitreous body in any ophthalmic pathology, including in patients with a small pupil, opaque intraocular medium, eye hypotension observed.

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Description

The present invention relates to ophthalmology and is intended for the study of peripheral parts of the retina, choroid and vitreous.

In the diagnosis of various pathological conditions of the anterior segment of the eye, ultrasound biomicroscopy, proposed by Canadian scientists J. Charles Pavlin and F. Stuart Foster in 1990, was widely used. The method is non-invasive, allows you to examine in detail the relationship of structures and the state of the tissues of the anterior segment of the eye in various pathological conditions. The quality of the study does not depend on the pupil width, the presence of turbid media (corneal edema, hyphema, cataract, hemophthalmos), hypotension.

The use of this method to study the peripheral structures of the eye was limited due to a number of shortcomings in the research methodology: insufficient disclosure of the subject's palpebral fissure, unsatisfactory parameters of the bath used, restriction in the movement of the sensor, insufficient depth of ultrasound penetration.

The closest analogue of the proposed research method is a method of the same purpose, which is a cycloscopy using a three-mirror Goldman lens (J. Kansky, S. A. Milevsky, B. E. Damato. Fundus Diseases. 2008. M .: MEDpress-inform). Using a rectangular mirror of this lens allows you to examine the periphery of the fundus from the equator to the dentate line. The study is carried out under local anesthesia. A layer of immersion liquid (gel) is applied to the concave central part of the lens. The edges of the lens lead over the eyelids of the patient. Through a rectangular mirror spend inspection of the periphery. The disadvantages of this method of research are:

1. The ability to conduct research only in the presence of mydriasis, because the narrow pupil does not allow visualization of the periphery of the fundus; however, not all patients can achieve drug-induced mydriasis;

2. Mandatory availability of transparent optical media. Corneal edema, cicatricial changes in the cornea, hyphema, cataract, hemophthalmus, accompanying a number of pathological conditions, completely impede this study;

3. The inability to use this method of research for hypotension.

The objective of the invention is to develop a new approach to diagnosis by ultrasonic biomicroscopy, which allows to eliminate the disadvantages of the closest analogue due to the improvement of research methods.

The technical result of the invention is to improve the quality of diagnosis, including in patients with a narrow pupil, with opaque intraocular media, in the presence of hypotension of the eye.

The technical result is achieved through the use of an improved model of the bathtub, which is made of silicone and has the original shape and dimensions (Figure 1), positioning the ultrasound sensor over all time meridians at a distance of 4 to 14 mm from the limb with a scanning angle of up to 90 ° to the plane passing through the structure under study.

The bath used differs from the plastic bath proposed by the manufacturer of the ultrasonic biomicroscope. Due to the shape of the bath, the maximum range of motion of the sensor to the sides and to the surface of the eye is achieved, which increases the depth of penetration of ultrasound and, accordingly, an overview of the structures under study. In the study, the sensor is removed from the holder, which allows you to change the scanning angle, conducting diagnostics not only when it is perpendicular to the structures under investigation, as stated by the manufacturer. The positioning of the sensor relative to the studied structures is carried out on all time meridians at the maximum possible distance from the limb with a scanning angle of up to 90 ° to the plane passing through the studied structure, which allows you to accurately determine the location and extent of pathological changes.

The method is as follows. The patient is placed in a supine position. Before the study, drip anesthesia is performed. Over the eyelids, the edges of the silicone bath are brought into the conjunctival cavity. The bath is filled in 2/3 with immersion liquid (saline). The ultrasonic sensor is removed from the handle-holder and lowered into an immersion medium. With the maximum abduction of the patient’s eye to the side, an overview of all structures of the extreme periphery of the eye (retina, choroid, and vitreous body) is performed, positioning the sensor along all time meridians at a distance of 4 to 14 mm from the limb with a scan angle of up to 90 ° to the plane passing through the study structure.

Example 1

Patient V., 58 years old, came to the clinic complaining of visual impairment, the appearance of photomorphopsies, “lightning flashes” in his right eye. From the anamnesis, it is known that the patient was diagnosed with age-related cataract 2 years ago.

A month ago, the patient suffered a concussion of moderate severity of the right eye (punch).

On examination: VIS OD = 0.07n / k.

Objectively: OD is calm. The cornea is transparent, the anterior chamber is of medium depth, the moisture is clean, the pupil is round, 3 mm, the lens is cloudy in all layers. The fundus reflex is pink. IOP p / p - the norm.

Deep-lying environments are not ophthalmoscopically due to cataracts.

Cycloscopy of the peripheral parts of the retina using a three-mirror Goldman lens is not possible due to the opacity of the lens.

The method of ultrasound biomicroscopy was used to study the peripheral fundus of the fundus according to the method described above. On the 10 'meridian, at a distance of 9 mm from the limb, when the ultrasound probe was positioned at an angle of 65-90 ° to the studied structures, a local slit-like retinal detachment, gross opacification of the peripheral parts of the vitreous body were found. On the 12 'meridian, at a distance of 10 mm from the limb, when the sensor was localized at an angle of 70-90 ° to the studied structures, zones of uneven echogenic density of the retina were revealed, indicating the presence of gross degenerative changes in the peripheral parts of the retina.

Considering the examination data, the patient is recommended to perform cataract extraction with subsequent posterior closed vitrectomy in the right eye.

Example 2

Patient V., 67 years old, turned to the optometrist with complaints of the appearance of floating opacities in her right eye. From the anamnesis it is known that the patient has narrow-angle developed glaucoma in the stage of compensation of intraocular pressure against the background of prolonged use of pilocarpine 0.1%. VIS OD = 0.1 sph - 3, OD = 0.5. IOP OD = 24 mm Hg

Objectively: OD is calm. The cornea is transparent. The anterior chamber is of medium depth, the moisture is clean. The iris is subatrophic, the pigment border is leached. The pupil is round, narrow, 2 mm. The initial clouding of the lens in the cortical layers. Fundus: optic nerve disc pale pink, clear borders. The vessels are sclerotic. Detailed inspection is difficult because drug dilated pupil in this case is undesirable because of the likelihood of developing an acute attack of glaucoma.

Cycloscopy to examine the peripheral parts of the retina is impossible due to severe myosis. The patient underwent ultrasound biomicroscopy of the periphery of the fundus according to the method described above. On the meridian 9 ', 9 mm from the limb, changing the angle of inclination of the ultrasound probe from 45 to 90' to the structures under study, an increase in the echogenic density of the outer layers of the vitreous body, a local change in the structure of the retina, and the area of retinal separation were found. The diagnosis of senile retinoschisis is established. Given the impossibility of conducting restrictive laser coagulation of the retinoschisis area due to myosis, the patient is recommended to regularly visit an ophthalmologist for observation.

Example 3

Patient D., 42 years old, complained of a sharp decrease in vision, redness, pain in his left eye. From the anamnesis it is known that ten days ago the patient received an injury to his left eye in everyday life (hit when falling on a stone). He was urgently hospitalized at the place of residence with a diagnosis of Severe concussion of the left eye, traumatic mydriasis with rupture of the sphincter of the pupil, partial hemophthalmus, hypotonic syndrome. Conservative treatment of positive dynamics did not. The patient was transferred for urgent reasons to the surgical department to resolve the issue of surgical treatment.

VIS OS at admission = correct light projection, hand movement in the face. Objectively: OS - a mixed injection of the eyeball. The cornea is moderately swollen. The front camera is small, uneven. The moisture is clean. The pupil is wide, 5 mm, there is no reaction to light. The crystalline lens is transparent. Blood clots in the vitreous. The reflex is pink. IOP p / p - severe hypotension, tonometry according to Maklakov impossible.

Details of the fundus are not visible due to edema of the cornea and partial hemophthalmus. An ultrasound scan (B-scan) revealed gross floating opacities in the vitreous body (hemophthalmos), localized high choroid detachment in the upper and inner quadrants.

Cycloscopy using a three-mirror Goldman lens to examine the peripheral fundus and to clarify the localization of CHO is impossible due to turbid environments (retinal edema, hemophthalmus) and severe hypotension.

Ultrasonic biomicroscopy performed by the above method revealed a high detachment of the ciliary body and an detachment of the choroid with a length of 8 'to 12' in the inner and outer quadrants.

The patient underwent surgical treatment - the release of suprachoroidal fluid with hemming of the ciliary body to the sclera strictly in the inner and outer quadrants from 8 'to 12', taking into account the data of UBM.

When repeated ultrasound biomicroscopy was performed a day after the operation, a complete closure of the cyclodialysis gap was found.

The vascular membrane is adjacent.

At discharge: VIS OS = 0.5. IOP OS = p / p norm.

Thus, the proposed method allows to improve the quality of diagnosis by examining the peripheral parts of the retina, choroid and vitreous body for any eye pathology, including patients with a narrow pupil, with opaque intraocular media, in the presence of eye hypotension.

Claims (1)

A method for studying the peripheral parts of the retina, choroid and vitreous body, characterized in that they conduct ultrasound biomicroscopy with the maximum abduction of the eye using a silicone bath having the form of two truncated cones in contact with smaller bases with an opening in the plane of contact, while the ultrasound probe is positioned on all hourly meridians at a distance of 4 to 14 mm from the limb with a scanning angle of up to 90 ° to the plane passing through the structure under study.

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