SU1735776A1 - Method for making differential diagnosis of acute disturbances of retinal blood vessels blood circulation - Google Patents

Abstract

Use: medicine, in particular, ophthalmologists, for the differential diagnosis of acute monocular circulatory disorders in the vessels of the central artery basin and the central retinal vein. Summary of the invention: simultaneously determine the coagulation and fibrinolytic activity of the tear fluid in both eyes of the patient, calculate the value of the local coagulation coefficient K by the formula: K HbUz / X3 Ub, where Xb and X3 are the coagulation activity of the tear fluid of the patient and the healthy eye; Ye and Y3 - fibrinolytic activity of the tear fluid (U / ml) of a sick and healthy eye, and with a local coagulant coefficient of 1.3 or less, a spasm or embolism in the pool of the central retinal artery is diagnosed, from 1.4 to 1.9 - hemorrhage from 6.1 to 9.6 - thrombosis in the basin of the central retinal artery and from 10.1 or more - thrombosis in the basin of the central retinal vein. The application of the method in medical practice will allow, with an accuracy of up to 94.6% and more, to carry out a differential diagnosis of acute circulatory disorders in the retinal vessels. 1 tab. C / S

Description

The invention relates to medicine, in particular to the field of ophthalmology, and can be used for the differential diagnosis of acute circulatory disorders in retinal vessels.

There is a method of differential diagnosis of acute circulatory disorders in the vessels of the body, including and the organ of vision, by examining the state of the coagulation-fibrinolytic balance of blood taken from the cubital vein.

The disadvantage of this method is its low sensitivity (accuracy), due to the fact that blood taken from the ulnar vein to a much lesser extent characterizes disturbances of the components of the hemostasis system than blood (or other

biological material) from the region of pathological changes.

Closest to the proposed solution is a method for the diagnosis of thrombosis in retinal vessels by determining the fibrinolytic activity of the tear fluid of the sore eye.

The main disadvantages of this method are the inability to make differential diagnostics between thrombosis in the basin of the central artery and in the basin of the central vein of the retina, as well as the lack of accuracy of the differential diagnosis between hemorrhage from the retinal vessels and the embolism in its arterioles.

The purpose of the invention is to improve the accuracy of the method.

with a

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The goal is achieved by initially determining the coagulation and fibrinolytic activity of the lacrimal fluid (SJ) of both eyes of the subject, and then calculate the value of the local coagulation coefficient K by the formula v - Xb Oz X Ch Ub

where Hb and X3 - coagulation activity of SJ (s) of the patient and healthy eyes;

Ye and Y3 - LF fibrinolytic activity (U / ml) of the sick and healthy eye,

at a local coagulant coefficient not exceeding 1.3, spasm or embolism is diagnosed, from 1.4 to 1.9 - hemorrhage, from 6.1 to 9.6-thrombosis in the central artery and from 10.1 to 20.3 - thrombosis in the basin of the central retinal vein.

The local coagulatory coefficient is the quotient of the ratio of the coagulation-fibrinolytic balance (Hb: Ye) of the patient and the coagulation-fibrinological balance (X3: Y3) of the healthy eye. At the same time, only the ratio of the coagulation-fibrinolytic balance of the patient's tears to that of the healthy eye allows to obtain reliable and different values of the local coagulatory coefficient for each type of acute circulatory disturbance in the vessels of the eye.

The method is carried out as follows.

Coagulation and fibrinolytic activity is determined in the lacrimal fluid of both eyes.

The coagulation activity of the tear fluid is determined by the following method. In a glass test tube, 0.1 ml of citrated donor plasma is mixed with 0.01 ml of tear fluid. Then, 0.1 ml of a 0.277% calcium chloride solution is added to it and a stopwatch is started. After the jelly clot forms in the tube, time is recorded. At the same time, a control sample is made in which the tear fluid is replaced with 0.01 ml of saline. The result (in seconds) is the difference between the clot formation time in the control and in the experimental samples.

The fibrinolytic activity of the tear fluid is determined by the following method. Prefabricated fibrin plates that are stored at 2-4 ° C. Trephine from filter paper cut circles with a diameter of 2 mm, one

of which moistened with a tear of the right eye, the second - the left eye, the third with a solution of fibrinolysin containing in 1 ml of 250 U of the drug. Cup with located on

The samples are placed in a thermostat at 37.0 ° C for 18 hours. The result is taken into account in the lysis zones formed around each of the samples in the form of a fibrin gel clearing, which is measured in two diametrically directions in mm and the results are multiplied. The fibrinolytic activity of the tear fluid is then calculated already in the ED of plasmin using the formula

l 5szh wasp

A - - ooi, Ofl

where A is the fibrinolytic activity of a tear, U / ml;

CShs size of the fibrin gel lysis zone around a sample of the tear fluid 0, mm;

Zfl - size around the sample with fibrinolysis.

The value of the local coagulatory coefficient is then calculated by the formula

v- Hb-Y3

to

where K is the ratio of coagulation-fibrin-linguistic balance of the tear fluid

0 sick and healthy eyes;

Ub and Y3 - fibrinolytic activity of the tear fluid of the sick and healthy eyes, and with this indicator of 1.3 or less

5 diagnose a spasm or embolism in the basin of the central artery of the retina, from 1.4 to 1.9 - hemorrhage, from 6.1 to 9.6 - thrombosis in the basin of the central artery of the retina, from 10.1 and more diagnose thrombosis

0 in the basin of the central retinal vein.

PRI me R 1. Patient M., 56 years old. Was admitted to the hospital 10 hours after a sudden decrease in the vision of the right eye, diagnosed with the direction of central vein thrombosis

5 retina of the right eye. On examination: the visual acuity of the right eye is 0.08 not corrected, the left one is 1.0. Ophthalmoscopically determines several fresh hemorrhages in the retina of the right eye. Due to the fact

0 that their appearance is different from the classical picture of thrombosis of the central retinal vein, and there is also no asymmetry of caliber and stroke of the venules of the retina when comparing both eyes, there is a need for

5 carrying out a differential diagnosis between thrombosis of the central retinal vein and hemorrhage due to hypertonic retinopathy that occurred in a patient. Blood is collected from the subject.

from the ulnar vein for coagulological analysis, as well as tears from both eyes. The study of venous blood revealed some tendency to hypercoagulation (plasma recalcification time 80 s, APTT 35 s), which can occur both in thrombosis with secondary hemorrhages and in primary hemorrhage with secondary thrombosis. At the same time, the coagulation and fibrinolytic activity of the tear fluid of the sore eye, respectively, 130 s and 150 U / ml, and the healthy 60 s and 1000 U / ml. The value of the coefficient K, calculated by the formula

130-yooo 144

TO

60 150

corresponds to the ratio of coagulation-fibrinolytic balance of tear fluid characteristic of thrombosis in the basin of the central retinal vein (more than 10.1) Based on the data obtained in the study of the tear fluid, the patient was diagnosed with thrombosis of the central retinal vein, which was confirmed in the process of patient curation.

PRI mme R 2. Patient L., 43 years old. He was admitted to the clinic 5 hours after the injury (he fell on ice while skating) with a complaint of a decrease in the vision of the left eye. On examination: the visual acuity of the right eye is 1.0, the left is 0.1, it is not corrected, in the field of view of the left eye there is an absolute central scotoma. No other abnormalities have been identified. On radiographs of the left orbit, no bone traumatic changes (including those from the canal of the optic nerve) were detected. It has been suggested that there may be an acute circulatory disorder in the vessels feeding the optic nerve. In order to clarify the diagnosis, coagulological studies of the venous blood and tear fluid in both eyes of the patient were made. The results of the blood test corresponded to the normal values established for the corresponding age and sex. The coagulation and fibrinolytic activity of the tear fluid in the sore eye was determined to be 60s and 1120 U / ml. The value of the coefficient K after the corresponding calculation turned out to be equal to 1.41 and was within the limits of the interval of the coefficient determined during the examination of patients with hemorrhage. Subsequently, the diagnosis of hemorrhage in the optic nerve tissue and orbit was confirmed after the appearance of signs of an old hematoma under the skin of the upper eyelid of the left eye.

The data presented in the table show that the proposed method has a much higher accuracy in the differential diagnosis of acute circulatory disorders in

retinal vessels. Increasing the accuracy of differential diagnosis is achieved mainly due to the delimitation of thrombosis in arterioles and venules of the retina (by 100%), as well as embolism or spasm in

the basin of the central artery of the retina and hemorrhage from the retinal vessels (50%).

The greatest value of the proposed method takes in cases of violation

Claims (1)

the transparency of the optical media of the eye, as well as damage to the optic nerve when the ophthalmoscopy becomes impracticable. DETAILED DESCRIPTION OF THE INVENTION A method for the differential diagnosis of acute circulatory disorders in retinal vessels, including the determination of fibrinolytic activity of the tear fluid, characterized in that, to increase the accuracy of the method, the coagulation and fibrinolytic activity of the tear fluid of both eyes is determined, and then the local coagulological value is calculated coefficient by the formula „X6-Ouze KHZ UB where K is the ratio of the coagulation-fibrinolytic balance of the tear fluid of a sick and healthy eye; Xe and X3 - coagulation activity of the tear fluid of the sick and healthy eyes; Ub and Uz - fibrinolytic activity of the tear fluid of a sick and healthy eye, and if this indicator is 1, 3 or less, a spasm or embolism of the central retinal artery is diagnosed, from 1.4 to 1.9 - hemorrhage, from 6.1 to 9.6 - thrombosis in the basin of the central retinal artery, from 10.1 and more diagnose thrombosis in the basin of the central retinal vein. Note: The diagnostic value of differential diagnosis of acute circulatory disorders in retinal vessels: I thrombosis in arterioles and venules: 2-thrombosis and hemorrhage; 3- thrombosis and embolism; 4 - embolism or spasm of arterioles and hemorrhages or from retinal vessels.