RU2484768C1 - Method of predicting course of glaucoma optic neuropathy - Google Patents

Method of predicting course of glaucoma optic neuropathy Download PDF

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RU2484768C1
RU2484768C1 RU2012103955/14A RU2012103955A RU2484768C1 RU 2484768 C1 RU2484768 C1 RU 2484768C1 RU 2012103955/14 A RU2012103955/14 A RU 2012103955/14A RU 2012103955 A RU2012103955 A RU 2012103955A RU 2484768 C1 RU2484768 C1 RU 2484768C1
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course
chu
during
predicted
glaucoma
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RU2012103955/14A
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Александр Терентьевич Максименков
Ирина Александровна Захарова
Роман Васильевич Авдеев
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Государственное бюджетное образовательное учреждение высшего профессионального образования "Воронежская государственная медицинская академия им. Н.Н. Бурденко" Министерства здравоохранения и социального развития Российской Федерации
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Abstract

FIELD: medicine.
SUBSTANCE: invention relates to field of medicine, namely to ophthalmology. Method includes carrying out measurements of indices in biologically active points (BAP). Indices are measured in paraorbital BAP V2 tsuan-chu, TR23 Chi-chu-kung, with application of apparatus "DETA-D". In measurement voltage 1.25+1% volts, current 12.5+1% microamperes are used. Parameters are analysed twice: during primary visit and after nine days. If in the first visit the parameter was higher than 60 conventional units (C.u.), and during observation period is decreased by 5-8 c.u., stabilised course is predicted. If the parameter in the first visit was lower than 49 c.u., and during observation period it decreased by 7-11 c.u., non-stabilised course is predicted.
EFFECT: method reduces time for carrying out diagnostics.
1 ex, 1 tbl

Description

The invention relates to medicine, namely to ophthalmology, and can be used to predict the course of glaucoma optical neuropathy.

A known method for predicting the course of glaucomatous optic neuropathy (US Pat. RU No. 2235503. Authors: Kurysheva N.I., Deev A.I., Gryzunov Yu.A., 2003). The authors conduct a laboratory study, while in the tear fluid of a patient with glaucoma they determine the levels of total and effective concentration of albumin and calculate their ratio (ECA / OKA) and, if it is lower than or equal to 0.3, they predict the risk of progression of glaucoma optical neuropathy over the next year.

The disadvantages of the method, in the opinion of the authors themselves, which they set out in the design of the second method, is the absence in some clinics of an expensive device - a fluorimeter, which is necessary to determine the binding capacity of tear albumin.

A known method for predicting the course of glaucomatous optic neuropathy, based on the implementation of cluster analysis of crystallograms of tear fluid (US Pat. RU No. 2281023. Authors: Kurysheva NI, Kolentsev MN, Denisov AB, etc., 2006) . An unfavorable prognosis of the course of glaucomatous optical neuropathy is determined when the length of the prevailing crystallogram chains exceeds 13 pixels for the peripheral zone of the crystallogram and 12 for the central zone, and the difference in their light intensity is below 52 for the peripheral zone and 44 for the central zone.

The disadvantages of the method include:

- the impossibility of using it in eye clinics, and even more so in outpatient conditions, due to the lack of expensive devices to study crystallograms;

- lack of trained specialists in crystallographic analysis;

- high labor costs associated with the implementation of the method.

Also similar is a method for diagnosing the nature of the course of glaucoma, which consists in determining perfusion pressure, hemodynamic and rheological blood parameters and calculating the glaucoma stability index (GHI) (US Pat. RU No. 2187983. Authors: Egorov VV, Bachaldin IL, Sorokin E.L., 2002). By the magnitude of the GIS, a stable or unstabilized course of glaucoma is predicted.

The disadvantages of the method are the high labor costs for performing calculations according to the formulas and expensive equipment for determining the speed of blood flow in the supralateral artery.

A known method for predicting the nature of the course of primary glaucoma after normalization of intraocular pressure (US Pat. RU No. 2346644. Authors Egorov VV, Smolyakova GP, Borisova TV). Using the Imedis-Fall apparatus probe electrode, the authors find a biologically active reproducible point on the phalanges of the fingers. In this case, an inductor is installed on the eye and bipolar pulses with frequencies of 70.0 are applied to it; 98.5; 1600; 880; 787; 727 Hz, with a current amplitude of 30%. When the electrical parameters of the reproducible biologically active point are from 80 to 70 conventional units (conventional units), a stable glaucomatous process is predicted. When the values of these parameters from 70 to 40 conventional units predict an unstable glaucomatous process with a slow nature of progression. With their values below 40 srvc. predict an unstable glaucomatous process with a rapid nature of progression.

The technical result is the development of a method for predicting the course of glaucoma optical neuropathy, characterized by a significant reduction in the time required for high-quality diagnostics, which does not require highly qualified ophthalmologist and the availability of expensive diagnostic equipment. It is possible to use the method not only in specialized eye clinics, but also in an outpatient setting.

The technical result is achieved by determining the state of the paraorbital BAT - tsuan-chu, si-chu-kun using the domestic medical diagnostic device "DETA-D" manufactured by the research and production enterprise "ELIS". The study is carried out using a voltage of 1.25 ± 1% volts with flowing currents of 12.5 ± 1% microamps. When exposed to a biologically active point of such currents, a confrontation of the internal electromotive force (EMF) with the supplied current occurs (Ragulskaya MV, Lyubimov VV Instrument study of the effects of natural magnetic fields on human BAT: methods, means, results // Journal of Radio Electronics No. 11. M .: Nauka, 2000), as a result of which, on a scale of an electrical measuring apparatus, graduated in arbitrary units, a stable position of the arrow is formed in the range from zero to one hundred. The resistance of the internal electromotive force (EMF) to the transmitted current corresponds to a certain functional state of the acupuncture point.

In this way, 78 patients (156 eyes) were examined, of which 19 eyes with an initial stage, 75 eyes - developed and 62 - far advanced stages of primary glaucoma.

The control group consisted of 35 patients (70 eyes) without pathology of vision.

The groups did not have statistically significant differences by gender, age, or the presence of concomitant diseases.

During treatment, all patients underwent intraocular pressure compensation: in 79 eyes - medically, in 77 eyes - surgically. Among the patients there were five people with opaque optical media, which did not allow using objective methods to objectively assess the visual function and condition of the optic nerve head.

Indicators of functional activity were determined for all patients at five points of the paraorbital region, the most informative were measurements at two points - tsuan-chu, si-chu-kun. The measurements at these points were taken into account by us when processing the results of the study. The studies were carried out at the patient’s initial visit to the hospital, at discharge from the hospital on the ninth day, six months later and one year after discharge.

When processing the results of the study, we noted that in healthy patients the indications on the scale of the device were 51.2 conventional units (conventional units) with fluctuations within the group from 49.7 to 50.5 conventional units.

In those patients whose visual acuity and field of vision tended to increase after treatment, that is, visual functions improved - EMF indicators in the paorbital BAT tsuan-chu and si-chu-kun upon admission to treatment were more than 60 conv. units and during the entire period of the control examination during the observation period decreased by 5-8 conventional units

In those patients whose visual acuity and field of vision, despite the treatment, continued to deteriorate, that is, visual function did not stabilize - the emf values in the paraorbital BAT tsuan-chu and sy-chu-kun upon admission to treatment were less than 49 conv. units and during the entire period of the control examination during the observation period decreased by 7-11 conventional units

At the same time, both in patients with an improvement in visual functions and in patients with a continuing deterioration in visual functions after treatment, the intraocular pressure was normalized.

Thus, our studies suggest that the emf values in paraorbital BAT tsuan-chu and syu-chu-kun are objective criteria that allow predicting the course of glaucoma optical neuropathy. Evaluation of the dynamics of EMF at these points during initial treatment and again after nine days allows us to conclude that the course of glaucoma optic neuropathy is stable or unstable, which in turn allows timely treatment adjustment. Of particular importance is the method for assessing the condition of patients with opaque cornea and lens.

The generalized results of the study are presented in the table.

Table. Indicators of the functional state of paraorbital BAT in patients with unstabilized and stabilized glaucoma. Groups Observation period BAT Visual acuity line of sight Quan Zhu Soo-joo-kun Upon enrolment 47.7 ± 2.1 47.2 ± 2.3 0.1 ± 0.04 196 ± 29.51 Unstable course
n = 72
At discharge (after 9 days) 47.1 ± 2.7 46.8 ± 2.6 0.1 ± 0.04 187 ± 28.33
After 6 months 44.8 ± 2.5 43.9 ± 2.1 0.1 ± 0.04 171 ± 28.41 In a year 39.7 ± 2.8 # 38.8 ± 2.2 0.1 ± 0.04 160 ± 27.33 Upon enrolment 60.5 ± 1.9 * 60.2 ± 1.8 0.5 ± 0.04 298 ± 17.93 Steady flow
n = 84
At discharge (after 9 days) 56.5 ± 1.4 55.8 ± 1.8 0.5 ± 0.04 312 ± 18.45
After 6 months 54.1 ± 2.4 52.8 ± 1.6 0.6 ± 0.04 331 ± 20.33 In a year 52.4 ± 2.2 # 51.7 ± 1.8 0.6 ± 0.04 340 ± 20.1 * # Control group n = 70 51.5 ± 0.4 50.9 ± 0.2 0.7 ± 0.03 480 ± 1.81 Note: the marks indicate - * significant differences from the control group at p <0.05; # - significant differences from the level before treatment at p <0.05

The data presented indicate that in patients with a stable course of glaucoma, which is confirmed by the preservation of visual functions, indicators of the functional state of paraorbital BAT Tsuan Zhu and Syu Zhu-kun as a result of therapeutic measures approach the indicators of the control group. In the group of patients with unstable glaucoma, indicators of the functional state of paraorbital BAT Tsuan-Zhu and Syu-Zhu-kun continue the negative dynamics of deviation from the norm, despite the treatment.

The method allows you to quickly, simply and objectively evaluate the current condition of a patient with glaucoma optic neuropathy, predict the further course of the glaucoma process, choose treatment tactics, improve the accuracy of predicting the outcome of surgical treatment, and, first of all, in patients with opaque cornea and lens, when there is no objective way assess the visual function and condition of the optic nerve head.

The method is non-invasive, technically and financially available to any healthcare institution.

Clinical example.

Patient L., born in 1932, was admitted to the ophthalmic department of the 17th City Clinical Hospital on February 8, 2010 with a diagnosis of open-angle glaucoma 3 in the stage of the right eye. Open angle glaucoma 4a stage of the left eye. Initial cataract of both eyes. 02/09/10 - anti-glaucoma surgery on the right eye and vasorestruction of the superficial temporal artery.

Duration of observation Visual function Investigated BAP Visual acuity IOP Field of view along 8 meridians Quan Zhu Soo-joo-kun Right eye Upon enrolment 0.1 thirty 245 45 40 On the 9th day of observation 0.1 16 250 fifty 45 A month later 0.1 eighteen 230 45 45 In a year 0.1 22 195 40 35 Left eye Upon enrolment 0.01 26 70 45 45 On the 9th day of observation 0.01 25 65 45 45 A month later 0.01 25 at the level of light perception 45 40 In a year 0.01 28 at the level of light perception 35 thirty

In a patient, the emf at the studied points was less than 50 in both eyes and during the observation continued to decrease both in the right eye, despite normalization of IOP by surgery, and in the left, on which the IOP remained unstable. A year later, visual function declined sharply.

Claims (1)

  1. A method for predicting the course of glaucomatous optic neuropathy, including measuring indicators at biologically active points (BAP), characterized in that the parameters are measured in paraorbital BAT tsuan-chu, siu-chu-kun using the apparatus "DETA-D" at a voltage of 1, 25 ± 1% V, currents flowing 12.5 ± 1% μA, readings are examined twice - during initial treatment and after nine days; if the indicator at initial treatment was more than 60 conventional units (cu) and during the observation period decreased by 5-8 cu, then a stable course is predicted; if the indicator at initial treatment was less than 49 cu and during the observation period decreased by 7-11 cu, then an unstabilized course is predicted.
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RU2528817C1 (en) * 2013-07-23 2014-09-20 государственное бюджетное образовательное учреждение высшего профессионального образования "Северо-Западный государственный медицинский университет им. И.И. Мечникова" Министерства здравоохранения Российской Федерации Method for prediction of risk of progressing glaucomous optic neuropathy

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RU2528817C1 (en) * 2013-07-23 2014-09-20 государственное бюджетное образовательное учреждение высшего профессионального образования "Северо-Западный государственный медицинский университет им. И.И. Мечникова" Министерства здравоохранения Российской Федерации Method for prediction of risk of progressing glaucomous optic neuropathy

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