RU2612596C1 - Method for eye ischemic diseases and postoperative eye conditions treatment for patients of presbyopic age - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for treatment of eye diseases associated with impaired blood supply on the background of age-related changes of the cervical spine, as well as in the rehabilitation period after an ophthalmic surgery, patients of presbyopic age shall perform physical exercises in a predetermined sequence. Exercises are performed 1-2 times a day, 5-7 times each, at a slow pace. The starting point for the exercise is the position of sitting on a chair with back kept straight.

EFFECT: method can improve eye blood circulation for patients of presbyopic age at various ocular pathology and postoperative conditions without increasing the risk of general and local complications.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in the treatment of eye diseases associated with circulatory disorders due to age-related changes in the cervical spine, as well as in the rehabilitation period after undergoing ophthalmic interventions in patients of presbyopic age.

Age-related changes in the cervical spine can have a significant effect on the hemodynamics of the eyes, on their functional state and on the rate of development of age-related diseases, such as retinal dystrophy, cataracts, glaucoma, as well as on the rate of rehabilitation after eye surgery.

Features of the anatomical structure of the cervical spine, namely the small size of the vertebrae, the relatively poorly developed muscle corset, as well as the high mobility of the department, predispose degenerative-dystrophic changes to it earlier. Under the influence of the main risk factors - physical inactivity and external influences (prolonged static load, scoliosis, unprepared movement, hypothermia, etc.), microtraumatization of the ligamentous apparatus of the intervertebral joints occurs, followed by an increase in the area of the articular surface and narrowing of the openings of the transverse processes of the cervical vertebrae (location a. vertebralis), which, in turn, can predispose to the formation of chronic vertebro-basilar insufficiency (VBI). However, there is not always a correlation between the size of the openings of the transverse processes of the cervical vertebrae and the severity of VBI (MV Markelova et al. “Anatomical and physiological prerequisites for the occurrence of VBI according to MSCT” // Manual therapy, 2008, No. 4 (32) In this regard, it is important to remember the second mechanism of chronic cerebrovascular accident - impaired venous outflow due to chronic pathological spasm of the neck muscle corset in response to developing degenerative degenerative changes in the vertebrae. Attention should be paid to the atlanto-occipital articulation - the vertebral artery in this place is most susceptible to compression by a large occipital tubercle, therefore, when selecting therapeutic gymnastics, head-throwing exercises should be avoided.

Visual disturbances in VBI can occur according to the type of loss of visual fields (scotomas, homonymous hemianopsia, cortical blindness, less often - visual agnosia) or the appearance of photopsies. With damage to the brain stem, dysfunctions of the cranial nerves occur - oculomotor disorders (diplopia, converging or diverging strabismus, vertical distance of the eyeballs), peripheral paresis of the facial nerve, bulbar (less often - pseudobulbar) syndrome. These symptoms appear in various combinations, their isolated occurrence due to reversible ischemia in the vertebro-basilar system is much less common. It should be taken into account the possibility of combined damage to the brain structures that are supplied from the systems of the carotid and vertebral arteries (Kamchatnov P.R., Chuguiov A.V., Umarova H.Ya. Vertebrobasilar insufficiency - issues of diagnosis and treatment. Neurology - 2005 - T. 7. - No. 2, p. 18).

There is a method of treating eye diseases (E. S. Avetisov et al. Physical education for myopia. M: Soviet Sport, 1993, pp. 26-29, 32, 40, 41), which consists in the fact that they perform general gymnastics, morning hygienic gymnastics, eye gymnastics, a physical break during work or study, self-massage, hardening of the body. This method is intended to improve the health and prevent the progression of myopia and suggests creating gymnastic complexes in such a way that they include exercises for various muscle groups and joints, contain general developmental, breathing exercises, as well as exercises for the external and internal muscles of the eyes. This method of treatment includes various sports complexes, compiled for children, young people, for people with short and medium myopia, and is designed in such a way that the blood supply to the eyes improves due to an increase in minute volumetric blood flow of the body.

However, this set of exercises is not designed for people of presbyopic age who have lost the elasticity of the lens and its ability to accommodation (from 45 years and older). In patients of an older age group, exercises for the internal muscles of the eye cannot bring a positive effect due to the resistance of the sclerosing lens, which reaches maximum density, volume and weight with age (Scammon RE, Hesdorffer M.V. Growth in mass and volume of the human lens in postnatal life. // Arch. Ophthal., 1937, V. 17, p. 104-112), while weakening the strength of the zinc ligament (Strusova N.A. Extracapsular cataract extraction with simultaneous implantation of IOL with irido-intracapsular fixation. // Dis ... Ph.D. - M. - 1984. - S. 66-97). And the active movement of the eyeball with the maximum amplitudes, against the background of age-related weakness of the zinc ligament, can lead to the appearance of phacodonezus, with a subsequent increase in the risk of developing subluxation of the lens, cataract and secondary glaucoma. Excessive eyeball mobility in myopes and older people during exercise can lead to macular rupture (De Bustros S, Thompson JT, Michels RG, et al. Vitrectomy for vitreomacular traction syndrome with macular detachment // Retina, 1995, 15:19, R2-7).

A known method of treating eye diseases, covering a wider range of ocular pathology (Kolpakov S.P., Kogan A.S. A method of treating eye diseases. RF Patent No. 2105534 of 02.27.98), in which due to the combined effect on the human body and improvement local and general blood circulation increases visual acuity with myopia, hyperopia, including age-related, with degeneration of the retina, atrophy of the optic nerve, macular degeneration, strabismus, in the initial stages of glaucoma and cataracts - a prototype. The method consists in performing general gymnastics with weights daily 2 times a day, conducting self-massage of biologically active points Shi-xuan and He-gu, the cervical spine, scalp at the seams of the parietal and temporal bones and the occipital tubercles, in performing gymnastics for the eyes from six exercises in a sitting position at a table with a straight back, with closed eyes and the last phalanges of the index, middle, ring fingers with maximum amplitude of eyeball movements, laid on the eyelids amomassazha in subsequent work with the text binocular and turn right and left eyes at the maximum or minimum possible for the perception of the text away from the eye, depending on the type of refractive disorders. The authors recommend a combination massage that includes massage of the scalp, eyeballs in various positions, neck, back, eight preset biologically active points on the legs, arms, and face. According to the authors, the proposed method allows to restore visual acuity in such eye diseases as myopia, hyperopia, amblyopia, glaucoma and cataract in the initial stages, retinal dystrophy, macular degeneration, keratoconus, as well as treat strabismus due to the complex effect and improve the general and intraocular circulation .

The advantages of the described method include the improvement of regional and general hemodynamics due to gymnastics, self-massage of biologically active points and visual work at different distances. However, expanding the indications for this treatment complex, the authors do not take into account the age-related physiology of the eye and the specific risks of developing complications in age-related ophthalmic diseases. For example, with myopia in presbyopic age, there is a loss of retinal elasticity with its thinning, the formation of peripheral zones of dystrophy, retinoschisis, pre-tears and retinal tears in combination with excessive vitreous mobility (Curtin BJ The Myopias. Basic scince and clinical management. // Philadelphia: Harper & Row 1985, p. 297-299). Therefore, performing eye exercises "with the maximum amplitude of eyeball movements" in such cases is strictly contraindicated, as it can provoke the development of retinal detachment, especially with simultaneous "laying on the eyelids ... fingers." The same contraindications apply to cases of retinal dystrophy and macular degeneration recommended by the authors for this type of treatment, without first examining a specialist in fundus pathology and deciding on indications for restrictive laser retinal coagulation. In addition, macular degeneration is often combined with vitreomacular traction syndrome, with the formation of preretinal membranes, newly formed vessels, areas of thinning and cysts in the most functionally important area of the retina.

The use of the proposed set of exercises for the eyes can provoke the appearance of a macular rupture with an irreversible loss of visual functions. The authors do not distinguish between a wet and dry form of macular degeneration, which apply different treatment standards, including conservative, laser and surgical, but in no case are recommended exercises "with a maximum amplitude of eyeball movement" and "eyeball massage in different positions" , which will lead to an increase in edema and progressive loss of vision with a wet form of macular degeneration.

Farsightedness in presbyopic patients has an anterior displacement of the iridocrystalline diaphragm and a narrowing of the anterior chamber angle, which increases the risk of developing angle-closure glaucoma (Ochiai H, Chihara E, Chuman H, Sawada A, Akita J. Age and increased incidence of "forward bowing" of the iris in normal eyes. // J. Glaucoma - 1998 - 7 (6) - p. 408-412). The authors of the complex of exercises ignore this fact and offer to exert finger pressure during self-massage on the eye with a deficiency of intraocular space and a tendency to obstruct the front outflow of intraocular fluid. Such tactics can lead to the development of an acute attack of angle-closure glaucoma, which is characteristic mainly for “short” eyes with farsightedness.

When starting treatment of diseases such as cataracts and glaucoma, the authors of the proposed method do not take into account that the term “glaucoma" means a large group of diseases of various etiologies and pathogenesis, and cataracts are not only age-related, but also associated with other serious diseases of the eye and body, as well as the effects of head or eye injuries. By regularly exerting finger pressure on the glaucoma eye during self-massage, while increasing intraocular pressure, glaucoma can be transferred to a more severe stage with an irreversible loss of visual function. When recommending cataract patients to perform exercises with the maximum amplitude of eyeball movement, it is necessary to be sure not only of the absence of retinal diseases, but also of normal capsular-ligamentous support of the lens, in the absence of pseudoexfoliation syndrome, senile or post-traumatic phacodonesis. Otherwise, the regular implementation of the proposed exercises can lead to the progression of cataracts and phacodonesis, with the formation of secondary glaucoma against the background of pigment dispersion.

The development of therapeutic exercises for elderly patients should take into account the anatomical and functional changes in the eyes, the course of age-related eye pathology and all the risks of complications. The appointment of general exercises can only be carried out taking into account all therapeutic diagnoses and under the supervision of a specialist.

The present invention solved the problem of developing a set of exercises to improve blood circulation in patients of presbyopic age with ocular pathology of ischemic origin and postoperative conditions, without increasing the risk of general and local complications.

Achievable technical result is an improvement in eye blood circulation in patients of presbyopic age with various ocular pathologies and postoperative conditions.

With regular and correct execution of the set of exercises we developed, the severity of the muscle tone of the pericranial muscles, muscles of the posterior cervical group, trapezius muscles decreases, which, in turn, helps to normalize the tone of the veins of the pericranial zone and improve the venous outflow. In accordance with modern concepts, the improvement of venous outflow is one of the main mechanisms affecting the improvement of microcirculation.

The set of exercises is selected in such a way as to first reduce the muscle tone of the largest muscles (trapezius muscles, posterior cervical muscle group), and then the smallest muscles of pericranial muscles (lower oblique muscles, suboccipital muscles, temporal muscles, etc.) with the aim of maximally uniform impact on muscle tone.

As a result of the developed set of exercises, the effect of normalizing the venous outflow due to an increase in the range of movements in the intervertebral joints of the cervical spine and craniovertebral transition, as well as the regression of the pathological tone of the tense muscles of the posterior cervical group, trapezius muscles, in contrast to the prototype, without the risk of developing common and local complications among patients of an older age group and operated patients.

The safety of moderate physical exertion for elderly, operated patients, as well as patients with myopia and glaucoma in the proposed set of exercises is ensured by: excluding overextension of the cervical spine, the slow pace of exercises without extreme leads of the eyeballs, the absence of finger pressure on the eyeballs, and also due to pathogenetically a well-thought-out sequence of exercises to prevent the occurrence of abnormal muscle tone of the paravertebral region at the cervical level.

The authors selected exercises, with regular performance of which there are signs of improved blood supply to the eyeballs and improved visual function.

A set of exercises is recommended for patients with ischemic eye diseases (dry form of age-related macular degeneration, glaucoma atrophy of the optic nerve, initial cataract, high myopia, etc.), as well as for patients who underwent surgery on the eyeball (not earlier than 1 month after surgery).

In rare cases, in patients with severe stenosis of the brachiocephalic arteries, symptoms of vertebrobasilar insufficiency, such as transient dizziness, may appear or resume, in connection with which such patients should begin exercises with a minimum load of 2-3 repetitions, adding every 2-3 days the next exercise from the complex, depending on tolerance. A set of exercises should be performed daily, at least 30 days. The best result is achieved with the daily implementation of the complex throughout life.

The method is as follows:

exercises are performed 1-2 times a day every day, 5-7 times each, at a slow pace, carefully, avoiding the execution of maximum volumes of movements and pain. Starting position - sitting on a chair with a straight back, looking straight ahead. Exercises are performed in the following sequence:

1. Reach for the sun. Lower your arms and shoulders, reach with your fingertips to the floor, and the top of your head - up, stretching the cervical spine. Alternate strenuous pulling up with periods of relaxation.

2. Royal nod. Lower your shoulders, stretch your neck up and perform short light nods, as if greeting the crowd. Perform nods to the right to the “times” account, directly to the “and” counts. Repeat similar movements in the other direction.

3. Turning the head to the sides. Turn your head to the right to the “times” count, then return to the starting position to the “and” counts, then continue to smoothly turn your head in different directions, without lowering your chin.

4. Tilting the head to the sides. At the “times” count, slowly stretch your right ear toward the right shoulder, at the “and” counts, return your head to its original position, then repeat the movement to the left side and continue to do incomplete inclinations, trying not to raise your shoulders.

5. Warm up the shoulder girdle. Bend your elbows and perform circular movements in the shoulder joints from front to back one full revolution at the expense of "one", "two", etc.

6. The turtle. On the count of times, slightly extending the chin forward, raise the shoulders up, as if trying to reach the back of the head, on the count of “and” lower the shoulders down, returning the chin to its original position. Repeat the movement, performing the exercise at half strength.

7. Goose drinks water. Slowly tilt your head down with your chin toward your chest, and gently raise your head, directing your chin forward and up. The back should be involved in the exercise: round the back when moving the head down and straighten when moving the head up. Perform the exercise on the count of "times", tilting your head, on the count of "and", raising your head.

8. The front semicircle. Stretch your chin to your right shoulder, and then make a smooth, slow semicircle at the count of times, draw your chin closer to your chest and end the movement at your left shoulder. Then reverse the movement from the left shoulder to the right to the account “and”.

9. Uzbek dance. Join your arms above your head to form a ring. Try to pull the chin forward and to the side at a small amplitude, without moving your arms and shoulders, like dancing Uzbeks do. To the “time” account - forward and to the right, to the “and” account - the initial position, to the “two” account - forward and to the left.

10. Reach for the sun. Lower your arms and shoulders, reach with your fingertips to the floor, and the top of your head - up, stretching the cervical spine. Alternate strenuous pulling up with periods of relaxation.

Clinical example 1.

Patient S., 73 years old, was under observation for the dry form of age-related macular degeneration of both eyes. Against the background of conservative therapy (taking lutein and zeaxanthin preparations), the visual acuity of both eyes was equal to 0.6 with correction (sph + 0.5), without positive dynamics when observed for 1 year. According to optical coherence tomography (OCT), intraretinal fibrosis was observed in the macular region of both eyes.

The patient was recommended the above set of exercises for constant daily performance.

After 3 months of regular exercise, an increase in visual acuity of both eyes was noted to 0.75 with the initial correction. According to OCT, there were no significant anatomical changes in the macular zone.

After 1 year of performing the complex of exercises in combination with conservative therapy, an increase in visual acuity of the right eye to 0.8 with initial correction was noted, the functional data of the left eye remained at sph + 0.5 = 0.75 and the absence of negative dynamics according to OCT.

The patient was satisfied with the treatment results, continues to perform the recommended set of exercises daily.

Clinical example 2.

Patient K., 62 years old, underwent surgical treatment of angle-closure glaucoma in both eyes (phacoemulsification with IOL implantation) with the outcome in the normalization of intraocular pressure. However, the visual acuity of the right eye was 0.5, and the left eye 0.4 a month after the operation, against the background of optical glaucoma neuropathy. The patient was assigned a set of exercises according to the method described above. After one month of regular exercise, the patient subjectively noted an improvement in color perception, however, visual acuity remained within the original range. After two months of exercise, the visual acuity of the right eye reached 0.65, and the left 0.5, while expanding the boundaries of the field of view by 3-5 degrees. After six months of exercise, the visual acuity of the right eye reached 0.7, and the left 0.55 with the expansion of the boundaries of the field of vision of the right eye by another 2-3 degrees. The patient is satisfied with the treatment results and continues to perform the recommended set of exercises.

Claims (3)

1. A method of treating ischemic eye diseases and postoperative eye conditions in presbyopic patients, including performing a set of exercises in the following sequence: “reach the sun” exercise - arms and shoulders are lowered, fingertips are pulled to the floor, and the top of the head is up, stretching the cervical spine spine, alternating intense pulling up with periods of relaxation; exercise “royal nod” - shoulders are lowered, cranes up and perform short nods, as if greeting the crowd, moreover, nods to the right side are counted “once”, and directly - to the account “and”, then similar movements are repeated the other way; exercise "turning the head to the sides" - turn the head to the right to the count "once", then return to the starting position to the count "and", then continue to smoothly turn the head in different directions, without lowering the chin; exercise "head tilts to the sides" - at the expense of "times" slowly stretch the right ear toward the right shoulder, at the expense of "and" return the head to its original position, then repeat the movement to the left side and continue to make partial tilts, trying not to raise the shoulders; exercise “warm-up of the shoulder girdle” - the arms are bent at the elbows, perform circular movements in the shoulder joints from front to back, one full revolution per account; exercise “turtle” - on the account of “times”, slightly extending the chin forward, raise the shoulders up, as if trying to reach the back of the head, into the account “and” lower the shoulders down, returning the chin to its original position, perform the exercise at half strength; exercise “goose drinks water” - slowly tilt your head down, pointing your chin towards the chest, and gradually raise your head, directing your chin forward and up, while the back is involved in the exercise: round the back when moving the head down and straighten when moving the head up, perform the exercise on the count of "times", tilting the head, on the count of "and", raising the head; exercise “front semicircle” - stretch the chin to the right shoulder, and then make a smooth slow semicircle at the “times” count, draw the chin closer to the chest and end the movement at the left shoulder, then perform the reverse movement from the left shoulder to the right to the account “and” ; exercise "Uzbek dance" - join hands above your head, forming a ring, trying to pull your chin forward and to the side, without moving your arms and shoulders, to the count of "times" - forward and to the right, to the count of "and" - the starting position, to the count of " two ”- forward and to the left; “stretch to the sun” exercise - lower your arms and shoulders, stretch with your fingertips to the floor, and the top of your head - up, stretching the cervical spine, alternating intense pulling up with periods of relaxation; exercises are performed 1-2 times a day daily, 5-7 times each, at a slow pace, the starting position for performing the exercises is the sitting position on a chair, with a straight back. 2. The method according to p. 1, characterized in that the exercises are performed in the indicated sequence, adding the next exercise from the complex after mastering the previous one. 3. The method according to p. 1, characterized in that the complex of exercises is performed daily for at least 30 days.