RU2441572C1 - Method for early preclinical diagnostics of dystrophic retina alterations - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention is referred to the field of medicine, namely ophthalmology, and can be used for early preclinical diagnostics of dystrophic alterations of retina periphery. The method of ultrasound biomicroscopy is used to detect structural spatial areas of retina with altered value of echodensity ratio. If in one of the retina sectors there is the detection of one disruption of adhesion of outer retina layers to inner choroid layers with formation of closed optically transparent curvilinear surface, with the bulge directed towards hyaloid body with the length from 50 mm to 500 mm, and/or in form of fixation on the inner retina surface by one structural spatial alteration in form of open curvilinear surface (OCS), directed with its open part towards the retina tissue and with the bulge directed towards hyaloid body with the length from 50 mm to 500 mm, and the echodensity ratio of OCS lies within the range from 20% to 70% of echodensity ratio of retina, the conclusion is made on early preclinical dystrophic alterations of retina periphery. ^ EFFECT: method provides for expansion of diagnostic tools range. ^ 1 dwg, 6 dwg, 5 ex

Description

The invention relates to medicine, namely to ophthalmology, can be used for early preclinical diagnosis of dystrophic changes in the periphery of the retina.

Peripheral degeneration is one of the most important pathogenetic mechanisms for the development of retinal detachment. By peripheral degeneration is meant a change in the structure and function of the periphery of the retina. According to statistics, peripheral retinal dystrophies develop in nearsighted people in 30-40% of cases, in far-sighted people in 6-8%, in people with normal vision in 2-5% of cases. Unlike central degenerations, the patient cannot notice any changes in the severity and quality of his vision. An ophthalmologist is consulted in advanced stages when the lesion can reach the central parts of the retina. Therefore, the development of a method for early preclinical ultrasound diagnosis of dystrophic changes is one of the important tasks of ophthalmology. Timely detection of early dystrophic changes in the periphery of the retina allows us to study the dynamics of the process and determine the necessary tactics for the treatment of dystrophic changes in the periphery of the retina.

The authors are not aware of literary sources that contain information about the development of a method for early preclinical ultrasound diagnosis of dystrophic changes.

The technical result of the invention: the expansion of the arsenal of diagnostic tools and the development of a method for early preclinical diagnosis of dystrophic changes in the periphery of the retina.

The technical result is achieved by the fact that in the method of early preclinical diagnosis of dystrophic changes in the periphery of the retina, which consists in identifying by ultrasound biomicroscopy the structural spatial zones of the retina with a changed acoustic density coefficient, and if in one of the sectors of the retina their presence is recorded as one violation of the fit of the outer layers retinal tissue to the inner layers of the choroid with the formation of a closed optically transparent curved surface facing convexity towards the vitreous, with a length of 50 μm to 500 μm and / or in the form of fixation on the inner surface of the retina of one structural change in the form of an open curved surface (RCP), facing its open part towards the retinal tissue, and the convex part towards the vitreous bodies with sizes from 50 μm to 500 μm, and the acoustic density coefficient of the RCP lies in the range from 20% to 70% of the acoustic density coefficient of the retina, then we conclude that there are early preclinical dystrophic exert them, the periphery of the retina.

Developed by the authors, the set of essential distinguishing features of the invention is necessary and sufficient for the unique achievement of the claimed technical result.

The invention is illustrated by drawings (Figs. 1, 2, 3) and images in UBM images (Figs. 4, 5, 6).

Figure 1 - diagram of a closed curved surface (ZKP).

Figure 2 - diagram of an open curved surface (RCP).

Figure 3 is a simultaneous combination of RFP and RCP.

Figure 4 - image of a closed curved surface (ZKP).

5 is an image of an open curved surface (RCP).

6 is an image of a simultaneous combination of RFP and RCP.

In the drawings are indicated:

1 - the inner layers of the choroid

2 - retinal tissue

3 - vitreous

4 - closed curved surface (ZKP)

5 - open curved surface (RCP).

Figures 4-6 are simultaneously UBM images of patients in the indicated examples 1, 2, 3.

The method is as follows: this study is carried out on the apparatus of the company "Sonomed" (USA), patients in a horizontal position, after preliminary anesthesia, a silicone funnel was placed on the eye, physiological saline was poured inside this funnel. The sensor was placed perpendicular to the flat part of the ciliary body and the periphery of the eyeball was examined over the entire circumference in 12 sectors from the flat part of the ciliary body to the equator, which made it possible to identify the localization and extent of changes in the periphery of the retina. During this study, a violation was found of the fit of the outer layers of the retinal tissue to the inner layers of the choroid with the formation of a closed optically transparent curved surface (ZKP), convex towards the vitreous (Figs. 1, 4). ZKP means the surface discovered by the researchers, limiting the volume of optically transparent retinal tissue. Normally, retinal tissues are not optically transparent. The length of the ZKP along the circumference of the retina lies in the range from 50 μm to 500 μm. In addition, the presence on the inner surface of the retina of one structural change in the form of an open curved surface (RCP) was recorded. RCP refers to a surface that limits the volume of retinal tissue with a modified acoustic density coefficient. This surface faces its open part towards the retinal tissue, and convex towards the vitreous body with sizes from 50 μm to 500 μm, while the acoustic density coefficient lies in the range from 20% to 70% of the acoustic density coefficient of the retina (Figure 2, 5 )

The authors conducted extensive clinical studies, which allowed us to determine the values of the intervals of the parameters indicated in the claims, which is confirmed by the above clinical studies.

Studies have shown that ZKP and RCP can occur both separately from each other, and together (Fig.3, 6). The detection of one PCR and / or RCP in one of the sectors suggests the presence of dystrophic changes in the periphery of the retina.

The set of essential distinguishing features set forth in the formula allows early diagnosis of diseases of the peripheral zone of the retina that precede the onset of dystrophic in the central zone of the retina.

The method is illustrated by the following examples.

Example 1

Patient K., 63 years old.

Diagnosis: Mild myopia, complicated cataracts on OD.

Complaints: decreased vision in the distance of the right eye.

Visual acuity OD = 0.2 shp-3.0 = 0.6 n / k;

IOP = 19 mmHg

Eye length = 24.12 mm.

In biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, in the crystalline lens: initial clouding in the nuclear layers.

With ophthalmoscopy: the optic nerve disc is pale pink, the macular zone - the reflex is reduced, the vessels - Sallus II, no visible changes at the periphery.

B-scan: destruction of the vitreous body 2-3 tbsp., Partial posterior detachment of the vitreous body 1.8 mm high with fixation at the optic nerve head, in the macular zone and equator, vitreous mobility 2-3 mm.

The patient carried out the diagnostic method according to the invention.

UBM: on the periphery of the retina in the segment at 3 o’clock, an optically transparent retinal PCR with a length of 80 μm was detected (Figure 4).

Thus, the patient revealed the presence of early preclinical dystrophic changes in the periphery of the retina.

Example 2

Patient L., 65 years old.

Diagnosis: Initial nuclear cataract for OD.

Complaints: decreased vision in the distance of the right eye.

Visual acuity OD = 0.4 shp + 2.0 = 0.7 n / k;

IOP = 21 mmHg

Eye length = 23.12 mm.

In biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, in the crystalline lens: initial clouding in the nuclear layers.

With ophthalmoscopy: the optic nerve disc is pale pink, the macular zone - the reflex is reduced, the vessels - Sallus II, no visible changes at the periphery.

B-scan: destruction of the vitreous body 1-2 tbsp., Partial posterior detachment of the vitreous body 1.3 mm high with fixation at the optic nerve head and in the macular zone, vitreous mobility 1-2 mm.

The patient carried out a diagnostic method according to the invention.

UBM: on the periphery of the retina in the segment for 5 hours, RCP of the retina with an acoustic density coefficient of 70% of the acoustic density of the retina, size 140 μm, was detected (Figure 5).

Thus, the patient revealed the presence of early preclinical dystrophic changes in the periphery of the retina.

Example 3

Patient P., 61 years old.

Diagnosis: Initial nuclear cataract on OS.

Complaints: decreased vision in the distance of the left eye.

Visual acuity OS = 0.6 shp-1.0 = 0.9 n / k;

IOP = 18 mmHg

Eye length = 23.92 mm.

In biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, in the crystalline lens: initial clouding in the nuclear layers.

With ophthalmoscopy: the optic disc is pale pink, the macular zone - the reflex is reduced, the vessels - angiosclerosis, no visible changes on the periphery.

B-scan: destruction of the vitreous body 1-2 tbsp., Partial posterior detachment of the vitreous body 2.5 mm high with fixation at the optic nerve head and in the macular zone, vitreous mobility 1-2 mm.

The patient carried out the diagnostic method according to the invention.

UBM: on the periphery of the retina in a segment of 8 hours, a combination of RCP of the retina and PCR of the retina was revealed. Optically transparent ZKP was 200 microns long. RCP had an acoustic density coefficient of 60% of the acoustic density of the retina, 200 microns in size. (Fig.6).

Thus, the patient revealed the presence of early preclinical dystrophic changes in the periphery of the retina.

Example 4

Patient W., 62 years old.

Diagnosis: Initial cortical cataract for OD.

Complaints: decreased vision in the distance of the right eye.

Visual acuity OS = 0.7 shp + 1.0 = 0.9 n / k;

IOP = 19 mmHg

Eye length = 23.52 mm.

During biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, in the crystalline lens: initial opacities in the cortical layers.

With ophthalmoscopy: the optic nerve disc is pale pink, the macular zone - the reflex is reduced, the vessels - hypertonic anhylopathy, no visible changes at the periphery.

B-scan: destruction of the vitreous body 1-2 tbsp., Partial posterior detachment of the vitreous body 2.7 mm high with fixation at the optic nerve head, vitreous mobility 1-2 mm.

The patient carried out the diagnostic method according to the invention.

UBM: on the periphery of the retina in the 6-hour segment, a combination of RCP of the retina and PCR of the retina was revealed. Optically transparent ZKP was 50 microns long. RCP had an acoustic density coefficient of 20% of the acoustic density of the retina, 50 microns in size.

Thus, the patient revealed the presence of early preclinical dystrophic changes in the periphery of the retina.

Example 5

Patient V., 64 years old.

Diagnosis: Initial nuclear cataract on OS.

Complaints: decreased vision in the distance of the left eye.

Visual acuity OS = 0.5 shp-1.5 = 0.8 n / k;

IOP = 20 mmHg

Eye length = 24.12 mm.

In biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, in the crystalline lens: initial clouding in the nuclear layers.

With ophthalmoscopy: the optic nerve disc is pale pink, the macular zone - the reflex is reduced, the vessels - are changed according to age, no visible changes are seen on the periphery.

B-scan: destruction of the vitreous body 1-2 tbsp., Partial posterior detachment of the vitreous body 2.8 mm high with fixation at the optic nerve head and in the macular zone, vitreous mobility 1-2 mm.

The patient carried out the diagnostic method according to the invention.

UBM: on the periphery of the retina in the segment at 7 o’clock a combination of retinal RCP and PCR of the retina was detected. Optically transparent ZKP was 500 microns long. RCP had an acoustic density coefficient of 70% of the acoustic density of the retina, 500 microns in size.

Thus, the patient revealed the presence of early preclinical dystrophic changes in the periphery of the retina.

The use of the invention at the Federal State Institution of Scientific and Technological Centers “Eye Microsurgery” in 69 patients with 102 eyes showed an unambiguous achievement of the claimed technical result in the diagnosis of dystrophic changes in the periphery of the retina.

Claims (1)

A method for early preclinical diagnosis of dystrophic changes in the periphery of the retina, which consists in revealing by ultrasound biomicroscopy the structural spatial zones of the retina with a changed value of the acoustic density coefficient, and if in one of the sectors of the retina their presence is recorded as one violation of the fit of the outer layers of the retinal tissue to the inner layers of the choroid with the formation of a closed optically transparent curved surface, convex towards the vitreous body, pr with a length of 50 μm to 500 μm, and / or in the form of fixation on the inner surface of the retina of one structural change in the form of an open curved surface (RCP), facing its open part towards the retinal tissue, and the convex part towards the vitreous body with sizes from 50 microns to 500 microns, and in this case, the coefficient of acoustic density of the RCP lies in the range from 20% to 70% of the coefficient of acoustic density of the retina, it is concluded that there are early preclinical dystrophic changes in the periphery of the retina.

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