RU2730971C1 - Method for prediction of functional angular block of anterior eye chamber at latent stage of closed angular glaucoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For diagnosing the functional angular block of the anterior eye chamber at the latent stage of the closed-angular glaucoma, the angle of the anterior eye chamber (AAC) in the upper sector is measured in scotopic conditions, if observing the width of the AAC less than 12 angular degrees and the positive mydriatic sample, a functional angular block is diagnosed.

EFFECT: method provides more accurate diagnosis of a functional angular block of an anterior eye chamber at an early preclinical (latent) stage of closed-angular glaucoma, enables reducing the time of examination and using a minimum of the working space in ambulatory receptions.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used to predict the functional angular block of the anterior chamber of the eye at the latent stage of angle-closure glaucoma.

Latent stage of angle-closure glaucoma is a pre-pathological condition found in the literature under the name of functional angular block (Shchuko A.G., Chesheiko E.Yu., Yurieva T.N. Criteria for differential diagnosis of functional angular block - latent stage of angle-closure glaucoma. Bulletin of Orenburg State University . 2012; 148 (12): 239-243), leading in the absence of adequate treatment to an increase in intraocular pressure (IOP) and the development of glaucomatous neuroopticopathy. Diagnostics of the functional angular block (FAB) has its own difficulties, since the disease can be asymptomatic and absolutely not disturb patients who turn to an ophthalmologist only for the selection of glasses due to hyperopia, or for the purpose of surgical correction of vision, so as not to use additional correction due to active lifestyle and professional requirements. Often, IOP at the latent stage of angle-closure glaucoma is within normal limits, since patients visit a doctor in the daytime, and periods of increased intraocular pressure at night under conditions of pupil dilation remain unrecorded.

The main diagnostic method for FAB is gonioscopy, which allows visualizing the structures of the anterior chamber angle of the CPC, to determine the degree of opening of the CPC. However, the method does not allow determining the width of the CPC in angular degrees, it is quite subjective (the description of the gonioscopic picture is documented in words or diagrams), requires the use of local anesthesia (not possible in case of allergy to anesthetics), and provides for contact with the eye (risks of infection when using a gonioline lens).

A known method for predicting FAB in the presence of posterior vitreous detachment (RF patent for invention №2423077). But in this method, gonioscopy is again used, and an ultrasound examination of the posterior segment of the eye is additionally carried out to identify the posterior detachment of the vitreous body. The second test again involves eye contact.

The closest analogue of the alleged invention is a method for predicting the functional blockade of the CCP using an optical coherence tomograph, including determining the width of the CCP, while determining the total width of the CCP in 4 quadrants in angular degrees, conducting a Hymes test and with the total width of the CCP less than 45 ° and a positive sample Himes predict a functional blockade of the Criminal Procedure Code (RF Patent for invention No. 2567278).

The disadvantages of this method is that it is assumed that the patient is face down for one hour, since the Hymes test is used. In an outpatient setting, there is often no organizational opportunity for patients to stay in a horizontal position for such a long time. Hospitalization in a hospital for this method of forecasting in the conditions of modern reality is difficult and not always feasible. In addition, not all patients, especially aged ones, can lie face down for an hour (on the elbow of their own hand).

In this method, the UPC is measured in all four sectors, which lengthens the study time when conducting outpatient appointments. The authors do not specify in what light conditions the CPC was studied, as well as how illumination affects the width of the CPC.

The objective of the invention is to provide a method for predicting the functional angular block of the anterior chamber of the eye in the latent stage of angle-closure glaucoma.

The technical result of the proposed invention is an accurate prediction of the functional angular block of the anterior chamber of the eye in the early preclinical (latent) stage of angle-closure glaucoma with reduced study time and the use of a minimum working space in an outpatient setting.

The technical result is achieved by the fact that in the method for predicting the functional angular block of the anterior chamber of the eye at the latent stage of angle-closure glaucoma, including determining the width of the CCP, according to the invention, in scotopic conditions the width of the CCP is measured in the upper sector, a mydriatic test is carried out and when the width of the CCP is less than 12 angular degrees and a positive mydriatic test predict a functional angular block.

It is known that the CPC is always already at the top, and at the bottom - wider than in the lateral parts of the eye (Arkhipova A.N., Turkina K.I. Objective assessment of the anterior chamber angle in healthy eyes using optical coherence tomography. Ophthalmological statements. 2017; 10 (3): 18-21. Doi: 10.17816 / OV10318-21). It is enough informative to measure the CPC only in the upper sector. Even if in other sectors the CPC is not critical, the patient still remains at risk for the formation of FAB, because the process has already started and will inevitably lead to further displacement of the irido-lens diaphragm anteriorly.

The provocative mydriatic test adds information about the dynamic state of the drainage system, simulates possible nocturnal ophthalmic hypertension in a wide pupil, does not require additional conditions for the patient to stay in an outpatient setting (a separate room with a couch), and is in any case necessary for examining the posterior pole of the eyes. With a narrowing of the UPC in the upper sector of less than 12 angular degrees and a positive mydriatic test, FAB is predicted.

These conclusions are based on our research. We examined 17 eyes with a predisposition to FAB precisely at the latent stage of angle-closure glaucoma, where, according to gonioscopy data, the CPC ranged from closed to narrow. On the DRI OCT Triton Plus optical coherence tomograph using Line (V) Anterior seg. 6.0 mm in all patients under scotopic conditions, the UPC was measured in angular degrees in the upper sector. It is in the upper sector that the CPC is less narrow. In conditions of insufficient illumination, the diameter of the pupil increases, the root of the iris blocks the UPC, thereby creating conditions for imitation of FAB. Then, after pneumotonometry performed on a NIDEK TONOREF-II autorefkeratotonometer, a mydriatic test was performed, and 30 minutes later, pneumotonometry was performed again. With an increase in IOP by more than 5 mm Hg. the mydriatic test was considered positive, if by a lesser value - negative. To compare the results, the eyes were divided into two groups depending on the results of the mydriatic test. The first group - eyes with a positive mydriatic test, and the second group - eyes with a negative mydriatic test. When analyzing the data obtained, it turned out that the value of the UPC in the upper sector varied from 0 to 18 angular degrees. In eyes with a CPC of less than 12 angular degrees, the mydriatic test was positive, and with a CPC of 12 or more angular degrees, the mydriatic test was negative. Based on this, a conclusion was made about the possibility of FAB occurrence at the latent stage of angle-closure glaucoma with a CPC value in the upper sector of less than 12 angular degrees. Thus, this method can be used to predict FAB in the latent stage of angle-closure glaucoma on an outpatient basis.

The method is carried out as follows.

In persons with a latent stage of angle-closure glaucoma under scotopic conditions, the UPC is measured in the upper sector (for example, on an optical coherence tomograph), then ophthalmotonus is measured (for example, on a pneumotonometer). After that, the mydriatic is instilled once. After 30 minutes, the ophthalmotonus is measured again. In the event that the IOP rises by 5 mm Hg, the mydriatic test is considered positive, if by a smaller value - negative. If the value of the UPC in the upper sector is less than 12 angular degrees and a positive mydriatic test, a functional annular block is predicted.

The method is confirmed by the following examples.

Example 1

Patient B., 57 years old, applied to the "Eye Clinic of Doctor Belikova" LLC with complaints of decreased distance and near vision. It is known from the history that the patient wears +1.5 distance glasses and +3.5 reading glasses in both eyes. But he doesn't want to use glasses, he turned to see without glasses. After an ophthalmological examination, the diagnosis was made:

Angle-closure glaucoma in both eyes, latent stage. Mild hyperopia in both eyes. Presbyopia in both eyes.

Ophthalmological examination data:

Distance visual acuity of the right eye without correction 0.2. With sph correction + 1.5 = 1.0. Close up without correction 0.1. With sph correction + 4.0 = 1.0.

Distance visual acuity of the left eye without correction 0.1. Corrected sph + 1.75 = 1.0. Close up without correction 0.1. With sph correction + 4.25 = 1.0.

Data of pneumotometry of the right eye 19 mm Hg.

Left eye pneumotometry data 20 mm Hg.

Pachymetry data of the right eye 551 μm.

Left eye pachymetry data 552 μm.

Biomicroscopy data of both eyes: the cornea is transparent, the anterior chamber is smallish, the lens is transparent, the iris is structural.

Data from gonioscopy of both eyes: the angle of the anterior chamber in the upper and temporal sectors is closed, in the lower and nasal sectors it is narrow.

Anterior chamber depth data - right eye 2.64 mm, left eye 2.62 mm.

Anteroposterior axis length data - right eye 22.31 mm, left eye 22.29 mm.

Optical coherence tomography data of the optic nerve discs in both eyes - no pathological changes.

Computer perimetry data - single areas of depression in the nasal sector peripherally in both eyes.

Ophthalmoscopy data of both eyes: optic nerve discs pale pink contours clear, macular zone without pathology, periphery without features, retina intact, adjoining.

Data of the width of the CPC in scotopic conditions according to OCT of the anterior segment in the upper sector: right eye 5 °, left eye - 7 °. The CPC in both eyes in the upper sector is less than 12 °.

The patient underwent a mydriatic test. Pneumotonometry data 30 minutes after instillation of mydriatic: right eye - 25 mm Hg, left eye - 27 mm Hg. On the right eye, IOP increased by 6 mm Hg, on the left eye by 7 mm Hg, which is more than 5 mm Hg. differences before and after instillation in both eyes.

Considering the width of the CPC in scotopic conditions less than 12 ° in the upper sector and a positive mydriatic test in both eyes, the patient was predicted to have a functional angular block. In order to prevent an attack of angle-closure glaucoma, with a refractive purpose, the patient (taking into account the patient's desire to see without glasses) underwent phacoemulsification with the implantation of multifocal three-focus intraocular lenses in both eyes.

Example 2

Patient L., 39 years old, applied to Doctor Belikova's Eye Clinic LLC for a preventive examination. Ophthalmological examination data:

Distance visual acuity of the right eye without correction 0.8. Corrected sph + 0.25 = 1.0.

Distance visual acuity of the left eye without correction 0.9. Corrected sph + 0.25 = 1.0.

Right eye pneumotometry data 21 mm Hg.

Data from pneumotometry of the left eye 21 mm Hg.

Pachymetry data of the right eye 549 μm.

Left eye pachymetry data 546 µm.

Biomicroscopy data of both eyes: the cornea is transparent, the lens is transparent, the iris is structural.

Data from gonioscopy of both eyes: the angle of the anterior chamber in all sectors is narrow, examination of the Schlemm's canal is difficult.

Anterior chamber depth data right eye 2.74 mm, left eye 2.71 mm.

Optical coherence tomography data of the optic nerve discs in both eyes - no pathological changes.

Computer perimetry data - no pathology.

Ophthalmoscopy data of both eyes: optic nerve discs pale pink contours clear, macular zone without pathology, periphery without features, retina intact, adjoining.

Data of the width of the CPC in scotopic conditions according to OCT of the anterior segment in the upper sector: right eye 13 °, left eye 14 °. The CPC in both eyes in the upper sector is more than 12 °.

The patient underwent a mydriatic test. Pneumotonometry data 30 minutes after instillation of mydriatic: right eye - 24 mm Hg, left eye - 25 mm Hg. On the right eye, IOP increased by 3 mm Hg, on the left eye by 4 mm Hg, which is less than 5 mm Hg. differences before and after instillation in both eyes.

Considering the width of the CPC in scotopic conditions of more than 12 ° in the upper sector and a negative mydriatic test in both eyes, at the moment a functional angular block is not predicted, but the patient was left for dispensary observation.

Claims (1)

A method for diagnosing the functional angular block of the anterior chamber of the eye at the latent stage of angle-closure glaucoma, including determining the width of the anterior chamber of the eye (APC), characterized in that under scotopic conditions, the width of the APC in the upper sector is measured, a mydriatic test is performed and when the width of the APC is less than 12 angular degrees and a positive mydriatic test diagnose a functional angular block.