SU1680155A1 - Method for restoring the bifoveal fusion - Google Patents

Abstract

The invention relates to ophthalmology and is intended to restore the bifoveal fusion in patients with strabismus complicated by abnormal retinocortical correspondence. The purpose of the invention is to reduce the duration of treatment. The treatment begins with the stimulation of foveol by figured blind objects with similar contours and distinctive marks for each eye, a positive sequential image is used in the training process, during training the patient with ever increasing speed fixes attention on the sequential image of the right or left eye, such training continue until the squint is eliminated, after which the glare of the peripheral retina with foveol shielding is used in the treatment; a negative sequential image, as an additional stimulus for strengthening the bifoveal fusion, is proposed to consider small optotypes against a light (white) background and this treatment is continued until functional recovery. The method allows to restore the biphoveal fusion 1.6-2.6 times earlier and 1.6-2.2 times more often (98.8%) than during treatment in a known manner. 1 hp ff.

Description

The invention relates to ophthalmology and is intended to restore bifoveal fusion in patients with strabismus, complicated by abnormal retino-cortical correspondence.

The purpose of the invention is to reduce the duration of treatment.

The method is carried out as follows.

The presence of evidence for its conduct is determined. These include: the central visual fixation of both eyes, the same visual acuity or the presence of their functional inequality is not higher than 1st

degree, the presence of anomalous retino-cortical correspondence in the study by the method of Chermak.

If there is evidence, the patient is prescribed an occlusion: alternate with functional equality of the eyes or alternately-direct if there is a 1st degree of functional inequality in visual acuity.

The peculiarity of the visual perception of patients with strabismus complicated by anomalous retino-cortical correspondence is the duality of the direct directions, which are in alternative relationships with each other.

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Therefore, before starting treatment, using the illumination method according to Chermak, the patient’s attention is paid to the fact that each of the consecutive images is located directly in front of the corresponding eye, that the presence of two directions is directly the result of a wrong cross-eyed vision (the effect of anomalous correspondence), the right one, in view of the vision, there should be only one direction directly, that, in accordance with this vision, both streaky consecutive images should be visible in one place and as a result form a figure of a cross. After the patient has realized the validity of the reasoning of the doctor, they proceed directly to the implementation of the method for the restoration of the BFV.

In a dark room, the patient or simultaneously, or sequentially (using a large refractive Ophthalmoscope BO-58) stimulate the foveal areas of both eyes with figured following fields in the form of paired images that have additional brand details that are different for the right and left eyes. . After the glare, the patient closes both eyes. In this case, in the field of view of each of them, a positive sequential image appears, which repeats the shape of the stimulating field. In patients with strabismus, complicated by anomalous retino-cortical correspondence, these transfectal sequential images are perceived as located in different places. The patient is offered first to fix his attention on one of the successive images so that in this case there would be a feeling that the image is located directly in front of the patient.

As soon as such perception of this image is achieved, what the patient must inform the physician of, he is asked to fix attention in another consistent manner in a similar way.

When the perception of the second image is reached as being directly in front of the patient, the first image is perceived as located to the side, and therefore the patient is recommended to re-fix the attention on the first image.

He is further recommended to continue this alternate fixation of attention on the images at ever increasing speed, with an obligatory perception of each of them at the moment of fixing attention as located directly in front of the patient,

Moreover, in most patients, after 1–10 min, a bifoveal fusion occurs,

It is controlled by the presence in the merged image of the parts-marks of both eyes.

After reaching bifovealnogo or, in most cases, patients stop alternately fixing attention on the images, because due to the merger, the image becomes single. This leads to an immediate violation of the bifoveal fusion and the divergence of successive images.

0 to different places. To prevent this, it is recommended that the patient, after restoring the bifoveal merger, continue alternately fixing attention on one or the other image, using

5 of this additional, different for the right and left eye parts-brand.

In the process of training, after a certain period of time, one or both consecutive images disappear from the patient because of their natural attenuation. In this case, the light is repeated and the training continues. The duration of one training session is 15-30 minutes, during the day 3-5 sessions are held,

5 The treatment by the proposed method is continued continuously until the bifoveal fusion becomes a stable form of binocular visual perception of successive images after exposure. With

With this, immediately after the glare, the patient sees a single, consistent, positive image to the end of its existence. It usually takes from 5 to 30 days of treatment to achieve a stable bifoveal fusion.

5 In order to strengthen the obtained bifoveal fusion, the training is continued and then 1-3 times a day until the squint is eliminated.

Since, as a result of the treatment, a stable bifoveal fusion is achieved, during the period of supporting training, alternating fixation of attention on the images or their additional details x-marks are not needed.

5 If a patient has obtained a stable bifoeial fusion of positive consecutive images, then after restoring orthotropy with a surgical operation, the type of light used is changed (if there is no stable bifoveal merger or positive consecutive images, then the same treatment described above continues). Namely, irritation of the peripheral regions of the retina of both eyes with shading of their fool with curly, identical in shape and size objects, having additional marks for the right and left eyes is applied. After such light stimulation, the patient, in a bright room, looks with two eyes on a bright background (screen) that is 30-40 cm away from his eyes,

Against this background, he develops negative sequential images in the form of a figured transfeveal area of enlightenment against the background of a dark spot, corresponding in size to the area of the peripheral retinal light.

As a rule, this results in a single, merged negative sequential image, containing the marks of both eyes. If the fusion of consecutive images has not come, then the patient is recommended to achieve their fusion by applying a method of quick alternate fixation of attention on each of them with the perception of the fixed image directly in front of him.

When the bifoveal fusion is restored to the patient, in order to strengthen the bifweval fusion, as a supplementary stimulus for the fusion, small optotypes are presented against a light background, which he combines with the transfovial zone of enlightenment and merges.

As a light background and optotypes, we recommend that patients use the book reading: the correctness of the bifovealnogo if at the same time the patient is contacted by the presence of additional parts-marks in the merged negative sequential image. Exercises with a negative sequential manner are carried out 1-3 times a day until a complete functional recovery and removal from the dispensary, i.e. for 2.5-3 years after the removal of the occlusion and the recovery of binocular vision.

Example 1. Vit Ks, 5 years. The condition of both eyes: visual acuity of 0.6; with glasses 0.8. reserves of accommodation 7.0 D, refraction 0 ° - hypermetropi 3.75 D; 90 ° - hypermetropi 2.0 D; the eyes are calm, the environments are transparent, the fundus of the eye is not changed, the visual fixation is central. Points-cylinders + 1.25 D, axis 90 °. Squint is non-accommodative, alternating, descent between 12-15 ° with hyperinfratropia 3-5 °, mild U-syndrome. According to Chermak, the intratropic anomalous retino-cortical correspondence; on the synoptophor, the subjective angle is squint + 8 °, objective + 16 ° with a vertical component of 4 ave dptr, a color test and a Bagolini test - monocular vision, with a prism of 8 apt dptr - simultaneous; with prism 20 pr. diopter - pathological binocular vision.

From the anamnesis: strabismus was observed at the age of 3 months, treatment with glasses and alternate occlusion started from 1.5 years. From the age of 2.5 years - penalization of the periphery, from 3 years of training for the accommodation reserve, at 3.5 years - the bimedial recession of 4 mm each. Before the operation to the age of 4.5, due to a good cosmetic result, the parents stopped the treatment. At the age of 4.5 years, recurrent squint and low vision. Continued treatment in special children: glasses, alternate occlusion, peripheric penalization, training of the accommodation reserve. The acuity of the vision with a correction from 0.3 is increased to 0.8, the reserves of accommodation from 2.0 to 7.0 D. therefore it is accepted

5 decision to start an orthoptic treatment with the proposed method of restoring the bifoveal fusion.

Before starting treatment with the proposed method of restoring the bifoveal

0 If the patient is illumined in a dark room, the light of both eyes is shown on Chermak (the right eye is in the horizontal position of the blind strip, the left eye is in the vertical position).

5 Then the patient's attention was paid to

that each of the visible patients (with

eyes covered after glare) sex of successive images is located

when attention is fixed on it right before

0 with the corresponding eye (horizontal in front of the right, vertical in front of the left eye} and directly in front of the patient. At the same time, with abnormal retix-cortical correspondence, both followers of the patient perceive as simultaneously located in different places, in this case The ACU is the image of the right eye to the left of the image of the left eye, i.e., as it were, it has simultaneously two visual directions in the right direction.

In accessible terms for the patient, he was told that such a perception is the result of his incorrect vision with two eyes, caused by strabismus: There are two paths in front of you, one goes straight in one direction, the other in the other, is it possible to follow both tracks - no

0 - So, there can only be one track right in front of you - Yes.

-Then the friend will be right in front of you or on the side, aside.

5 - Aside.

-You look at me, right before you or on the side

-Pr mo

-And my hand at this time right before you or on the side

-Side.

-So how many years should be right before you One or two

With the answer, two all reasonings with the patient begin first, with new examples. When answering If, as you say, one, then when the cavities are visible directly in front of each eye, and this is directly one, the cavities must be in the same place or in different places.

When answering in different places, all the reasoning begins anew. When answering in one place: As they will then be visible House, fungus, cross. The correct answer is a cross. With him, the final provocative control question: And the middle bars will be visible in one place or in different places. When answering in one place, it is clear that the patient understood everything correctly and realized that his vision was defective, he came to the idea of what kind of perception he should receive with the right vision.

As you know, a consistent image after light quickly disappears. Therefore, in the wake of this reasoning, periodically, as the image weakens or disappears, repeated glares are carried out according to Chermak.

Known, developed by T.P. Kashchenko method 5 prototype was used in the treatment of 80 children with strabismus complicated by abnormal retino-cortical correspondence. Children age 6-11 years.

The first manifestations of the bifoveal fusion were obtained after 3-56 treatment sessions (an average of 19.6). Sustained microfusion was obtained in 49 patients (61.3%) in 11-93 training sessions (an average of 34.3%). ).

A known prototype method was used in the treatment of 37 degeas of the same age and with a similar condition.

The first manifestations of the bifoveal fusion were obtained after 11-92 sessions of training (an average of 26.6), a stable bifovevalous fusion was obtained in 17 patients (45.9%) for 27-116 training sessions (an average of 57.4).

When testing prototype methods, we did not conduct more than 120 training sessions. If within this limit a bifibeous confusion did not occur, then the treatment was transferred to the proposed method.

The proposed method treated 160 patients with strabismus.

The first manifestations of a bifoveal fusion of positive consecutive images were obtained during 1–17 training sessions (on average, after 3.2 sessions).

A stable bifoveal effect was obtained in 158 patients (98.8%) in 7-82

training sessions (an average of 21.9).

In 2 children, the resulting bifoveal fusion remained unstable until the end of treatment. When switching to a bifoveal fusion of negative consecutive images with a short-term violation of the bifoveal fusion eliminated by the operation of strabismus, 6 out of 158 children (3.8%) were observed.

This violation is easily eliminated by alternately fixing consecutive images.

The method reduces the duration of treatment until the stable bifoveal merger is restored 1.6-2.6 times and increases

the frequency of favorable treatment outcomes is 1.6-2.2 times.

Claims (1)

Invention Formula t. A method of restoring the bifoveal fusion, including the light of the phoreolar zones of the retinas, followed by the merging of successive images, characterized in that, in order to shorten the treatment time in patients with strabismus, complicated by abnormal retino-cortical correspondence, the light of the foveol is performed with the same figure blindness. with test marks other than the right and left eyes, with closed eyes fix the patient's attention alternately with increasing speed on the positive consecutive images from the right and left eyes so that the fixed image is perceived to be located directly in front of the patient, after the appearance of the bifoveal merger of positive consecutive images fix the patient's attention on the test marks of the resulting consecutive images and when a stable bifoveal fusion of positive sequential images is achieved, the exercises are repeated without alternate fixation followed by the restoration of orthotropy and the presence of of a stable bifoveal fusion of positive consecutive images of an ectomy of the peripheral-retinal plots of the retinas with blinding fields with foveol shaped screening of the same Forms and sizes of objects with test marks excellent for the right and left eye and conducting exercises with negative consecutive images to bifoveal-resistant similarly to exercises with positive fusion, with a consistently achieved bimo consistent images. a real fusion of exercise with a denial2. The method according to p. 1, of tl and h and yushchi and with consistent serial images so that, with the purpose of strengthening, bifoveal-conduction is carried out against the background of optotypes.