RU2803690C1 - Method of predicting the presence of pathology of the vitreomacular interface in chronic myeloid leukemia - Google Patents

Abstract

FIELD: medicine; oncohematology; ophthalmology.

SUBSTANCE: invention can be used to predict the presence of pathology of the vitreomacular interface in chronic myeloid leukemia. The patient's age, and duration of the disease are determined, a general blood test, and coagulogram are performed, the erythrocyte sedimentation rate and prothrombin index are determined. If the patient is aged 51 years or older and the duration of the disease is more than 12 years, if the erythrocyte sedimentation rate in the general blood test is more than 25 mm/hour and the prothrombin index is 70% or lower, the presence of vitreomacular interface pathology is predicted.

EFFECT: method provides the possibility of simple, effective prediction of the presence of pathology of the vitreomacular interface in chronic myeloid leukemia due to data on age, duration of the disease, platelet sedimentation rate and prothrombin index.

1 cl, 1 dwg, 2 ex

Description

The invention relates to medicine, namely to oncohematology and ophthalmology, and is intended to predict the presence of pathology of the vitreomacular interface in chronic myeloid leukemia.

The vitreomacular interface is the area of contact between the posterior hyaloid membrane and the internal limiting membrane of the retina in the projection of the macular region.

There is a known method of treating vitreomacular traction syndrome (Patent RU 2619 991 C1; 2017.05.22) by intravitreal administration of an enzyme preparation, characterized in that collagenase is used as an enzyme preparation in an amount of 1-100 collagenase units per 0.05-0.1 ml of balanced saline solution, while the collagenase solution is injected into the retrolental space of the vitreal cavity through a puncture of the sclera in the projection of the flat part of the ciliary body with a needle 10-11 mm long.

However, this method is intended to treat vitreomacular traction syndrome and not to predict the presence of vitreomacular interface pathology in patients with chronic myeloid leukemia.

There is a known method of surgical treatment of diseases of the vitreomacular interface (Patent RU2775807C1; 2022.07.11). Scleral ports of 25-27 Ga are installed, subtotal vitrectomy is performed, and the posterior hyaloid, epiretinal, and internal limiting membranes are removed. In this case, vitrectomy is performed through two scleral ports: one of which is intended for a vitreotome, the other for a chandelier combined with an irrigation flow. The method allows to reduce tissue trauma, reduce the phototoxic effect of light on the retina through the use of mercury or xenon-mercury chandelier and move the illuminator as far as possible from the macular zone, which promotes rapid rehabilitation of the patient in the postoperative period and reduces the risk of developing light-induced retinopathy.

However, this method is intended for the surgical treatment of vitreomacular interface diseases, and not for predicting the presence of vitreomacular interface pathology in patients with chronic myeloid leukemia.

We took as a prototype a method for predicting the development of vitreoretinal traction in peripheral retinal dystrophies (Patent RU 2558976), for this, using optical coherence tomography, the thickness of the peripheral part of the normal retina is measured in the area in front of the defect and in the area of the defect, the coefficient (K) is calculated, determined by formula: K = thickness of the normal retina in the area in front of the defect / thickness of the retina in the area of the defect, and with K values below 0.88, the presence of vitreoretinal traction in peripheral retinal dystrophies is determined.

However, this method is used to predict the development of vitreoretinal traction in peripheral retinal dystrophies and is not intended to predict the presence of vitreomacular interface pathology in chronic myeloid leukemia.

The technical objective of the present invention is to create a simple, effective method for predicting the presence of vitreomacular interface pathology in chronic myeloid leukemia, which will help in determining further diagnostic tactics - for timely referral of the patient to optical coherence tomography, and treatment of ophthalmological pathology.

The technical result is a simple, effective way to predict the presence of pathology of the vitreomacular interface in chronic myeloid leukemia, based on data on age, duration of the disease, platelet sedimentation rate and prothrombin index.

The method can be carried out by any outpatient doctor (therapist, hematologist, family doctor, ophthalmologist).

The method is carried out as follows: in patients suffering from chronic myeloid leukemia, the age, duration of the disease is determined, a general blood test, a coagulogram are performed, the erythrocyte sedimentation rate (hereinafter ESR) and the prothrombin index (hereinafter PTI) are determined;

at the age of 51 years and older and the duration of the disease more than 12 years, with ESR values in the general blood test of more than 25 mm/hour and PTI of 70% or lower, the presence of pathology of the vitreomacular interface is predicted.

These criteria for the claimed method (age, duration of the disease, ESR, PTI) were determined as a result of analysis of medical documentation of inpatients and outpatient visits of 40 patients with a verified diagnosis of chronic myeloid leukemia.

Of these, 18 (45%) patients did not have vitreomacular interface disorders (group 1), 22 (55%) patients had vitreomacular interface disorders (group 2). Average age in groups: group 1 – 43.4±2.2 years, group 2 – 51.6±2.5 years (differences are statistically significant, p=0.017). Duration of the disease: group 1 – 5.6±1.0 years, group 2 – 10.4±1.0 years (differences are statistically significant, p<0.05). ESR in group 1 – 18.2 + 5.8 mm/hour, in group 2 – 29.2 + 4.5 mm/hour (differences are significant at the p≤0.001 level). PTI in group 1 – 96.6 + 10.5%, in group 2 – 72.5 + 9.5% (differences are significant at the p≤0.001 level).

Currently, the method for predicting the presence of pathology of the vitreomacular interface in chronic myeloid leukemia has sufficient grounds for clinical use in practical healthcare and widespread implementation in algorithms for preventive examinations. In addition, very important in the claimed method is the ability to early predict the presence of pathology of the vitreomacular interface at an outpatient appointment in a polyclinic setting by a doctor of any specialty. This may serve as a reason for early referral of patients for additional examination - optical coherence tomography, which will allow for the future development of methods of drug or surgical correction to prevent blindness and low vision in patients with chronic myeloid leukemia.

Examples of implementation of the invention:

Clinical example 1

Patient M., 69 years old, is being treated by a hematologist with chronic myeloid leukemia, which was diagnosed 18 years ago. Since the diagnosis, she has been taking imatinib, since 2013 - dasatinib, since 2017 - nilotinib 400 mg 2 times a day. The big molecular answer is lost. Denies diabetes mellitus and hypertension. Complete blood count: erythrocytes – 3.2×10 ¹² /l, hemoglobin – 103 g/l, leukocytes – 6.3×10 ⁹ /l, platelets – 460×10 ⁹ /l, ESR – 26 mm/h. Coagulogram – fibrinogen 6.2 g/l, prothrombin time – 11.2 seconds, INR – 0.9, APTT – 26.5 seconds, PTI – 64.4%. She had not previously undergone a comprehensive ophthalmological examination. Taking into account the history (age, duration of the disease), laboratory parameters (ESR and PTI), on the recommendation of a hematologist, she was referred to an ophthalmologist with suspected pathology of the vitreomacular interface. At the time of examination by an ophthalmologist, he complains of low vision in the right eye, distortion of the shapes of objects, and conjunctival hemorrhages every two to three months. She has been experiencing problems with vision for the last 2–3 years.

Visual acuity: OD – 0.1 s/k -2.25 =0.2; OS – 0.4 s/k -1.0 = 1.0. IOP: OD/OS – 16/17 mmHg. (Topcon, Japan). Objectively: the palpebral fissures are formed correctly, the position of the eyes is correct. The corneas of both eyes are transparent and spherical. The relief of the irises is without features. The lenses are sclerotic. The fundus of the right eye: the optic disc is pale pink, the vessels are of medium caliber, and in the macular area there is a prominent grayish focus with unclear contours. The fundus of the left eye is without features. Based on the results of an ophthalmological examination, the patient was diagnosed with mild myopia in both eyes. The presence of pathology of the vitreomacular interface of the right eye is predicted.

The patient was recommended to undergo optical coherence tomography of the macular region of both eyes, the results of which revealed a violation of the vitreomacular interface - detachment of the posterior vitreous plate with macular fixation in both eyes.

A linear scan of optical coherence tomography of the retina of the macular region in the horizontal plane through the central fovea (RTVue-2000 OCT device) of patient M., suffering from chronic myeloid leukemia, is shown in the figure. White arrows show the pathology of the vitreomacular interface - a detachment of the posterior vitreous plate with macular fixation is visualized.

The given clinical example indicates that a patient is aged 69 years (51 years and older) and the duration of the disease with chronic myeloid leukemia is 18 years (more than 12 years), with an ESR of 26 mm/hour (above 25 mm/hour) and PTI of 64, 4% (below 70%) had pathology of the vitreomacular interface (detachment of the posterior vitreous plate with paramacular fixation).

Clinical example 2

Patient N., 47 years old, is seen by a hematologist with a diagnosis of chronic myeloid leukemia established 5 years ago. She has been taking imatinib 400 mg per day since diagnosis. Complete blood count: erythrocytes – 4.2×10 ¹² /l, hemoglobin – 123 g/l, leukocytes – 4.8x10 ⁹ /l, platelets – 330×10 ⁹ /l, ESR – 15 mm/h. Coagulogram – fibrinogen 2.7 g/l, prothrombin time – 13.2 seconds, INR – 1.1, APTT – 27.3 seconds, PTI – 83%. The patient was referred to an ophthalmologist for examination. He has no complaints from the organ of vision. Visual acuity: OD – 1.0; OS – 1.0. IOP: OD/OS – 15/14 mmHg. (Topcon, Japan). Objectively: the palpebral fissures are formed correctly, the position of the eyes is correct. The corneas of both eyes are transparent and spherical. The relief of the irises is without features. The lenses are transparent. The fundus of both eyes: the optic disc is pale pink, the boundaries are clear, the vessels are of medium caliber, in the macular area and along the periphery without features. The patient underwent a Schirmer test, according to which the level of tear production OD/OS was 15/16 mm, indicating the absence of inhibition of tear production. Based on the results of an ophthalmological examination, the patient was diagnosed: At the time of examination, no ophthalmological disorders were identified. An optical coherence tomography examination of the macular region of both eyes was performed, the results of which revealed no violations of the vitreomacular interface.

The given clinical example indicates that a woman is aged 47 years (less than 51 years) and the duration of the disease with chronic myeloid leukemia is 5 years (less than 12 years), with an ESR of 15 mm/hour (less than 25 mm/hour) and a PTI of 83% ( above 70%) no pathology of the vitreomacular interface was detected.

Claims (2)

A method for predicting the presence of pathology of the vitreomacular interface in chronic myeloid leukemia, characterized by the fact that the patient’s age, duration of the disease are determined, a general blood test, a coagulogram are performed, the erythrocyte sedimentation rate and prothrombin index are determined; at the age of 51 years and older and the duration of the disease more than 12 years, with erythrocyte sedimentation rate in the general blood test of more than 25 mm/hour and a prothrombin index of 70% or lower, the presence of vitreomacular interface pathology is predicted.