RU2555387C2 - Method of treating amblyopia in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to ophthalmology, and can be used in treating amblyopia in children. One 10-minute procedure involves alternating 1-2-minute exposure to green-range laser speckle structures at wavelength 0.5-0.65 mcm and red-range laser speckle structures at wavelength 0.63-0.7 mcm. Laser fluence is (4-8)×10^-5 W/cm². That is combined with autoscan exposure to a travelling magnetic field from temporal lobes to an occipital region by bitemporal method at a scan frequency of 90-180 Hz. A field density is 30-45 mT. The procedures are daily for 10 days.

EFFECT: method provides stimulating the maximum count of retinal cells responsible for colour vision, prevents the eye tissue adaptation to laser light, optimises delivering visual pulses along the visual pathway to the visual cortex.

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Description

The invention relates to medicine, in particular to ophthalmology, and will find its application for the treatment of amblyopia of various etiologies in children.

The prevalence of amblyopia of various species is quite high. The most frequently detected dysbinocular amblyopia with strabismus (69.9-87% of the total number of cases detected). Refractive amblyopia with hyperopia is 12.5-20% [Libman E.S. Proceedings of the Russian Interregional Symposium "Elimination of Eliminated Blindness: WHO World Initiative". Moscow, 2003, p. 42]. Obscuration amblyopia is the most severe form of amblyopia, is much less common and is due to congenital opacification of the lens in a child. Such amblyopia is treated immediately after surgical replacement of the lens in the first 6 months of a child’s life.

A known method of treating amblyopia [Patent No. 2128029, Bull. No. 9, 1999], which includes the combined effects of electromagnetic and infrared laser radiation on the posterior parts of the eyeball and the intracranial sections of the visual analyzer, as well as the effects on the orbital part of the circular muscle of the eye with incoherent radiation with a wavelength of 0.86-0.93 μm and power of 120 mW. The intensity of the acting magnetic field is 20-45 mT, and the wavelength of infrared laser radiation is 0.89 μm with a radiation power of 2-10 mW.

The disadvantage of this method is the absence in the spectrum of coherent and incoherent radiation of the visible part, which does not allow direct stimulation of the macular region of the retina of the eye where the cone cells responsible for color vision are concentrated. The effectiveness of this method of treatment of amblyopia is low.

A known method of treating amblyopia [E.V. Tumennik. Use of the LOT-01 apparatus for low-intensity laser therapy in ophthalmology. Materials of the Scientific and Practical Conference "Complex use of lasers in ophthalmology, new technologies, equipment." Kaluga, 1999, pp. 44-45] using the LOT-01 apparatus, which acts on the anterior and posterior segments of the eye with a spot of a red laser with a speckle structure at a wavelength of 0.63 microns, a power range of 0.1-0.3 mW and exposure of 4 minutes per eye for 5 daily procedures. According to the author, the therapeutic effect consists in increasing visual acuity by 25-30% and lasts on average up to 3 months.

The disadvantage of this method is the low treatment efficiency and the instability of maintaining the achieved results due to the stimulation of only part of the cells of the macular region of the retina and the lack of stimulation of the entire optic tract as an important component of the pathogenesis of amblyopia.

Closest to the proposed (prototype) is a method of treating dysbinocular amblyopia in children [Patent No. 2267339, publ. 2006.01.10], which includes the combined, simultaneous contact action of pulsed laser infrared (IR) radiation with a wavelength of 0.89 microns and a pulsed power of 8 to 20 mW, pulsed incoherent infrared radiation with a wavelength of 0.86-0.96 microns with an average power of 60 ± 39 mW, pulsed red radiation with a wavelength of 0.6-0.7 μm with a frequency of 2 Hz and a constant magnetic field with induction of 35 ± 10 mT to the occipital-parietal region of the head, neck, short sinuses and biologically active points (BAP) using a magneto-infrared laser tera of the rutic apparatus RIKTA-04/4, in this case, initially they act with a scanning movement from top to bottom on the occipital-parietal region of the scalp from the coronary suture of the parietal bone to the occipital foramen along the midline of the aponeurosis and on the parietal region from the upper temporal line to the mastoid process on both sides with a pulsed power of IR radiation of 20 W with a frequency of pulsed laser and incoherent IR radiation of 1000 Hz with pulsed red radiation and a constant magnetic field lasting 2-4 minutes, then act on the neck area with a radiator ДУШ1 with a pulse power of IR radiation of 20 W with a frequency of pulsed laser and incoherent radiation of 50 Hz with pulsed red radiation and a constant magnetic field by scanning movement paravertebrally from top to bottom along the extensor muscles of the back from the occipital foramen to C6-Th2 with a duration of exposure 2 -4 min, then act on the carotid sinuses on both sides of the main emitter with a pulsed power of laser IR radiation of 8 watts with a frequency of pulsed laser and incoher total radiation of 50 Hz, with pulsed red radiation and a constant magnetic field with an exposure of 2 min, then act on the symmetrical BAT with the main emitter with an acupuncture optical nozzle KON-1 with a pulse power of laser IR radiation of 8 W, with a frequency of pulsed laser and incoherent IR radiation 1000 Hz ..., the course of treatment is 8-12 sessions.

The disadvantages of this method are:

- cumbersomeness and the practical impossibility of implementing all the declared combined effects;

- the use of visible radiation only red, which does not allow to fully stimulate the macular region of the retina and achieve restoration of color vision;

- the use of a constant magnetic field and manual scanning exposure when stimulating cortical structures, which does not meet the principles of resonance effects in physiotherapy and can give a result that is far from optimal.

The aim of the present invention is to reduce treatment time and restore visual acuity with amblyopia, regardless of its nature and pathogenesis, as well as simplifying the treatment and increasing the throughput of equipment and personnel.

The essence of the invention consists in alternating actions on the visual analyzer for 1-2 minutes with a red speckle laser structure (wavelength 0.63-0.7 μm, with a green speckle structure in green (wavelength 0.5-0, 65 μm) at a radiation power density of (4-8) · 10 ^-5 W / cm), while continuously exposed to a constant magnetic field with an intensity of 30-45 mTl in the direction from the temporal lobes to the occipital region in the automatic scanning mode using the temporal technique with scanning frequency of 90-180 Hz. The procedure is carried out daily for 10 days, the total duration of the procedure is 10 minutes.

The technical result achieved by the implementation of the method:

- provides stimulation of the maximum number of retinal cells responsible for color vision,

- optimized conduction of visual impulses along the visual path to the visual cortex,

- due to the alternation of the effects of red and green lasers, the adaptation of eye tissues to laser radiation is prevented and the therapeutic effect is increased,

- disinhibition of cones is achieved even with a high degree of amblyopia.

We substantiate the declared distinguishing features.

Additional exposure to the laser speckle structure of the green wavelength range (0.5-0.65 μm) allows, along with cells (cones) of the macular region of the retina, sensitive to the red wavelength range, to further stimulate cells that are sensitive to the green range. This expands the stimulating effect in dysbinocular and obscuration amblyopia and achieves a higher treatment result. In addition, the green speckle structure of laser radiation has a higher, compared with the red, vasoactive effect on the muscle structures of the eye. This improves blood flow and nutrition of the ciliary muscle, which is important in the treatment of refractive amblyopia.

The alternation of red and green exposure during one procedure is important from the point of view of preventing the adaptation of eye tissues to exposure to only one wavelength. Any adaptation leads to a decrease in the response of tissues and a decrease in the therapeutic effect.

The radiation power density (4 ÷ 8) · 10 ^-5 W / cm ² (integrated output power 0.5-1 mW) when each of the two effects of the laser spectrum is exposed for 1-2 min gives the best effect of disinhibition of cone cells even with amblyopia high degree. Values of a power density of more than 8 · 10 ^-5 W / cm ² (integral> 1 mW) with an exposure of each exposure for more than 2 min give a hyper-excitability effect (according to the study of visual evoked potentials) with subsequent depletion of the response and a decrease in amplitude.

The simultaneous implementation of laser stimulation of the retina of the eye and magnetic exposure in a scanning mode according to the bitemporal technique in the direction from the temporal lobes to the occipital region allows optimal conditions for conducting an excitation pulse from the retina to the visual cortex along the visual pathway.

The choice of the scanning frequency of the magnetic field in the range of 90-180 Hz corresponds to the normal speed of the excitation pulse along the visual path [Hubel D. Brain, eye, vision. M., Science, 1982]. This provides resonant conditions for magnetotherapy, which are best absorbed by the body.

The choice of magnetic field induction on the surface of emitters of 30-45 mT is due to the creation of significant values of induction (0.1-0.5 mT) at the level of the optic nerve, chiasm and other elements of the visual pathway in the brain structures. Induction values above 45 mT can have a damaging effect on cortical structures adjacent directly to the cranium [A.M. Demetsky, A.B. Alekseev. Artificial magnetic fields in medicine. Minsk, Belarus, 1981].

The method is as follows. In the patient’s sitting position, in front of him on the table at a distance of 25-35 cm from the eyes, there is a laser radiation source forming a speckle structure of the red wavelength range on the emitting surface, for example, from the RUBIN attachment to the AMO-ATOS device. After 1-2 minutes, the emitter of the red wavelength range is changed to the emitter of the green range, for example, from the prefix EMERALD. At the same time, the HEADBAND prefix of the modified AMO-ATOS apparatus is used, where a pair of traveling magnetic field emitters is located temporally on the patient’s head. In this case, the direction of movement of the traveling magnetic field (scan) is determined by the apparatus design in the direction from the temporal lobes to the occipital region when the magnetic field is induced on the surface of the emitters 30-45 mT. The exposure is carried out monocularly in a slightly darkened room or using a tube for fixing the gaze, daily according to the claimed scheme in the course of 10 sessions, with a total session duration of 10 minutes.

The method is implemented in the Tambov branch of MNTK Eye Microsurgery and in the Saratov Center for Laser Vision Correction (Scorpio LLC).

The effectiveness of the claimed method was determined for 13 young children (6-11 months) with obstructive amblyopia after removal of congenital cataracts with aphakia without concomitant ocular pathology. The control group consisted of 10 children, with aphakia, operated on at the same time, but who underwent pleoptic treatment according to the prototype method.

In addition, the effectiveness of the claimed method was evaluated in children with refractive (18 people) and dysbinocular (22 people) amblyopia at the age of 4-8 years. Control groups consisted of 11 and 15 people, respectively, treated by the prototype method. Determination of visual acuity with aphakic correction in older children was carried out by traditional methods. In young children, visual acuity was assessed by indicators of visual evoked potentials. As incentives, chess patterns 12 × 14 in size were presented, presented with a frequency of reversal of 1.88 per second. The appearance of visual evoked potentials on a 110 ° chessboard pattern corresponded to a visual acuity of 0.01; 55 ° - 0.02; 28 ° - 0.04; 14 ° - 0.07; 7 ° 0.14.

In all cases, visual acuity was evaluated 3-4 months after the treatment.

The treatment results are summarized in table.

Visual acuity of the amblyopic eye of a child before and after treatment of various types of amblyopia according to the claimed method and the prototype method. Type of Amblyopia Statistical indicators The claimed method Prototype method before treatment after treatment before treatment after treatment Obscuration n fifteen fifteen 10 10 M + m 0.038 ± 0.001 0.125 ± 0.007 0.034 ± 0.002 0.072 ± 0.004 Refractive n eighteen eighteen eleven eleven M + m 0.22 ± 0.08 0.51 ± 0.07 0.25 ± 0.03 0.36 ± 0.06 Dysbinocular n 22 22 fifteen fifteen M + m 0.08 ± 0.001 0.2 ± 0.02 0.06 ± 0.002 0.1 ± 0.001

The table shows that the treatment according to the claimed method allowed to achieve an increase in visual acuity with obscuration amblyopia by 3.2 times (relative to the original), by the prototype method - 2.1 times. With refractive amblyopia - 2.3 times and 1.4 times, respectively, with dysbinocular - 2.5 and 1.6 times, respectively.

Clinical example 1

Patient T., born in 2001, outpatient card 13010726, was treated at the Tambov branch of MNTK from 01 to 12 April 2013 with a diagnosis of mild myopia, complex myopic astigmatism OD, moderate myopia, complex myopic astigmatism, refractive amblyopia weak degree of OS.

VOD = 0.3 s -1.0; -1.0 ax 145 = 0.9,

VOS = 0.1 s -4.0; -4.0 ax 180 = 0.5.

After the course of treatment according to the specified scheme:

VOD = 0.4 s -1.0; -1.0 ax 145 = 1.0,

VOS = 0.2 s -4.0; -4.0 ax 180 = 0.6.

Clinical example 2 \.

Patient E., born in 2005, outpatient card 12080909, was treated since 25.03. to 04/05/2013 with a diagnosis of complex hyperopic astigmatism, high-grade amblyopia OS

VOD = 1.0,

VOS = 0.03 n / k.

At the end of treatment according to the specified scheme:

VOD = 1.0,

VOS = 0.08-0.1 n / a.

Claims (1)

A method for the treatment of amblyopia in children, including a combined effect on the visual analyzer of laser radiation in the red range and a magnetic field on the head area with daily procedures for 10 days, characterized in that during a single procedure lasting 10 minutes alternate the exposure for 1-2 minutes with laser speckle structures of the green range with a wavelength of 0.5-0.65 microns and the red range with a wavelength of 0.63-0.7 microns with a radiation density of (4-8) · 10 ^-5 W / cm ² with simultaneous exposure to traveling magnetic field in The pressure of the temporal lobe in the occipital region an automatic scanning technique with bitemporal scanning frequency of 90-180 Hz for the induction of the magnetic field of 30-45 mT.