RU2710058C2 - Method for optimizing readings for yag-laser vitreolysis of floating turbidity - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, in particular to ophthalmology. Anamnesis is collected with assessment by point system of symptomatic complaints of patient P: 0 points - absence of complaints, 1 point - periodic weak opacifications, 2 points - periodic moderate turbidity, 3 points - intermittent turbidity, 4 points - permanent pronounced turbidity. When performing ophthalmoscopy, the structure of the vitreal cavity is examined by using non-contact dioptres lenses 60, 78 through a slit lamp, stating the absence of D = 0 or the presence of D = 1 opacity of the vitreous body. If they are available, additional studies are carried out, such as determining the distance from the vitreous body to the retina and lens by ultrasonic scanning. This examination is initially performed visually in all eyeball planes. Distance from turbidity to the retina (L1) and to the lens (L2) is then measured and evaluated in points as equal to 1 at a distance of more than 3 mm or as equal to 0 at a distance of less than 3 mm. Risk factors (N) are identified, which can reduce acuity and/or field of vision, for which an optical coherent tomography of macula, periphery of retina, optic nerve, perimetry, and in the absence of risk factors N = 1 point, availability of N = 0. Further, the obtained test results are used to determine readings for YAG-laser vitreolysis of floating turbidity by calculating the coefficient (K) by the original formula. If K = 0, absence of readings for YAG-laser vitreolysis is determined. If K > 0, the presence of indications for YAG-laser vitreolysis in floating opacifications of the vitreous body.EFFECT: method enables optimizing the indications for YAG-laser vitreolysis by enabling to prevent a risk of developing complications, improving visual functions and improving the quality of life.1 cl, 2 ex

Description

The invention relates to medicine, in particular to ophthalmology, and can be used to optimize the indications for YAG laser vitreolysis in patients with floating opacities in the vitreous body.

The high relevance of the problem of floating opacities in the vitreous consists in a high percentage of patients (according to statistics up to 76%) of the adult population complaining of the inability to drive a car, work on a computer, read books, while 33% significantly worsen the quality of life [Webb BF , Webb JR, Schroeder MC, North CS. Prevalence of vitreous floaters in a community sample of smartphone users. Int J Ophthalmol. 2013; 6: 402-405]. According to studies by several authors, patients are willing to sacrifice 1.1 years out of every 10 years of their remaining lives to get rid of the symptoms associated with floating opacities. Moreover, patients are willing to accept an average of 11% risk of death and 7% risk of blindness in order to get rid of the symptoms of floating “floats”, “midges” [Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011; 152: 60-65].

Clinically, this disease can manifest itself in a variety of complaints by patients about floating opacities in the form of flying flies, various shapes, floating clouds, and other forms accompanied by flicker, which intensify with eye movement.

Currently, there is no single classification of floating turbidity.

Two categories of floating opacities in the vitreous body are distinguished:

- asymptomatic - the absence of patient complaints of turbidity, which are determined by the doctor during the study (biomicroscopy and ophthalmoscopy), as well as with additional studies: OCT, ultrasound, photographic recording

- symptomatic - the presence of patients' complaints of turbidity, which reduce vision, worsen the quality of life.

The mechanism of laser vitreolysis at the present stage is the vaporization of turbidity, which occurs due to optical breakdown: in a short time, an electric field of high frequency with a temperature of 4000 degrees is formed on an area of 4-8 microns, a plasma is formed and turbidity turns into gas [Karickhoff JR, Laser Treatment of eye Floaters, Washington Medical Publishing LLC, Fall Church, 2016] [Johnson JH http://www.thefloaterdoctor.com/how-laser-works/.

There is a method of YAG-laser vitreolysis in patients with traumatic hemophthalmus, described in the same patent of the Russian Federation No. 2297834, class. A61K 31/66, A61P 27/02, A61N s. 04/21/2005 g, op. 04/27/07 (Helmholtz Moscow Scientific Research Institute of Eye Diseases).

This method seems to be closest in technical essence to the claimed one and is selected as a prototype.

It uses the functional activity of blood platelets as the main indicator for conducting YAG-laser vitreolysis. With a platelet aggregation coefficient of 30.0 mm or higher, surgery is prescribed.

The formula of the known method has the following form.

A method for conducting YAG laser vitreolysis in patients with traumatic hemophthalmus, characterized in that the functional activity of blood platelets is determined before the YAG laser vitreolysis and, with a platelet aggregation coefficient of 30.0 mm or higher, disaggregation therapy is carried out 1 day before the YAG laser vitreolysis. Moreover, for disaggregation therapy, thrombotic ACC can be used once in an amount of 50 mg. On the next day, YAG-laser vitreolysis is carried out according to a known method.

The disadvantage of this method is the lack of an integrated approach to determine the indications for YAG-laser vitreolysis with floating opacities, since only one factor is taken into account - the level of platelet aggregation coefficient. This indicator is important mainly for traumatic hemophthalmia, and other risk factors and the causes of the appearance of turbidity are not taken into account in this work.

For the successful conduct of YAG - laser vitreolysis of floating opacities and obtaining an effective result, other significant parameters are also important, such as: the presence of symptomatic complaints of the patient, visualization of opacification by a doctor, the distance from the opacification to the retina to the lens of at least 3 mm: no risk factors (uncompensated glaucoma, concomitant eye diseases), reducing the maximum corrected visual acuity.

The objective of the present invention is to optimize the indications for YAG laser vitreolysis of floating opacities in the vitreous body to prevent the risk of complications, stabilize and improve visual functions.

The problem is solved in that in a method for optimizing indications for a YAG laser vitreolysis of floating opacities, including collecting an anamnesis of the patient's condition, conducting an ophthalmoscopy of the eye with revealing opacities, determining indications for laser eye treatment, ACCORDING TO THE INVENTION that the history is collected according to the assessment point system of symptomatic complaints of the patient R: 0 points - no complaints, 1 point - periodic slight turbidity, 2 points - periodic moderate turbidity, 3 points - periodic expressed opacities, 4 points - constant pronounced opacities, when performing ophthalmoscopy, the structure of the vitreous cavity is examined by using contactless lenses 60, 78 diopters through a slit lamp, stating the absence of D = 0 or the presence of D = 1 opacities of the vitreous body, and if any, conduct additional studies, such as determining the distance from the opacification of the vitreous to the retina and lens using ultrasound scanning, which is initially carried out visually in all planes of the eyeball, then from They measure the distance from clouding to the retina (L1) and to the lens (L2) and evaluate it in points as equal to 1 at a distance of more than 3 mm or equal to 0 at a distance of less than 3 mm, risk factors (N) that can reduce the severity and / or field of view, for which optical coherence tomography of the macula, the periphery of the retina, optic nerve, perimetry is performed, and in the absence of risk factors N = 1 point, the presence of N = 0, then the results of the studies are used to determine if there are indications for YAG laser vitreolysis of floating turbidity computing to coefficient (K) according to the formula:

K = PxDxL1xL2xN,

and when the value of the coefficient K = 0, the absence of indications for the YAG laser vitreolysis is determined, and for K> 0, the presence of indications for the YAG laser vitreolysis with floating opacities of the vitreous is determined.

In the inventive method, conducting an anamnesis with the assessment of symptomatic complaints of the patient on a point system and performing an ophthalmoscopy to visualize the presence of opacities together with determining, if any, using ultrasound scanning, performed survey in all planes of the eyeball, such indicators as the distance from the opacification of the vitreous to the retina and the lens, the detection of eye pathology that reduces the maximum corrected visual acuity by conducting optical coherent tomography of poppy li, the periphery of the retina, optic nerve, perimetry, provides the most complete examination of the eyes and obtaining reliable qualitative indicators of their condition. Evaluation of the patient’s symptomatic complaints according to the scoring system and scoring of the distance from the opacification of the vitreous to the retina and lens in combination with the revealed eye pathology make it possible to quantify and unambiguously the indicator of the necessity or inappropriateness of YAG-laser vitreolysis with floating opacities of the vitreous.

EFFECT: obtaining qualitatively reliable and complete data on the state of the eye and unambiguous quantification of an indicator of the necessity or inappropriateness of a laser operation.

The inventive method has a novelty in comparison with the prototype, differing from it by the presence of such essential features as the assessment of history data on a point system of symptomatic complaints of the patient as: 0 points - no complaints, 1 point - periodic slight turbidity, 2 points - periodic moderate turbidity, 3 points - Periodic pronounced opacities, 4 points - Permanent pronounced opacities, examination when performing an ophthalmoscopy of the structure of the vitreous cavity by the use of contactless lenses 60, 78 diopters through the slits a lamp with a sight of the absence (D = 0) or presence (D = 1) of opacification of the vitreous body, conducting additional studies if there are opacities, such as determining the distance from the opacification of the vitreous to the retina and lens using ultrasound scanning, this scan is reviewed all planes of the eyeball, measuring the distance from the clouding to the retina (L1) and to the lens (L2), evaluating it in points as equal to 1 at a distance of more than 3 mm or as equal to 0 at a distance of less than 3 mm, revealing the fact risk (N), reducing the maximum corrected acuity and / or field of view by conducting optical coherence tomography of the macula, the periphery of the retina, optic nerve, perimetry, subsequent determination by the results of studies of the presence of indications for YAG laser vitreolysis of floating opacities with the calculation of the coefficient (K ) according to the formula: K = PxDxL1xL2xN, and determination at a value of the coefficient K = 0 of the absence of indications for the YAG laser vitreolysis, and for K> 0, the presence of indications for the YAG laser vitreolysis for floating opacities of the vitreous body, providing in aggregate the achievement of a given result.

The applicant is not aware of technical solutions that have the indicated distinguishing features, the combination of which would allow the result indicated by the applicant to be obtained, therefore, he considers that the claimed method meets the criterion of “inventive step”.

The inventive method can find wide application in ophthalmology and therefore meets the criterion of "industrial applicability".

The inventive method of optimizing indications for a YAG laser vitreolysis of floating turbidity is as follows.

A patient’s history is collected with a score of P according to the patient’s symptomatic complaints system as: 0 points — no complaints, 1 point — periodic mild turbidity, 2 points — periodic moderate turbidity, 3 points — periodic pronounced turbidity, 4 points — constant pronounced turbidity. An eye ophthalmoscopy is performed, while examining the structure of the vitreal cavity by using non-contact lenses of 60, 78 diopters through a slit lamp. Sight (fix) the absence of D = 0 or the presence of D = 1 opacities of the vitreous body. In the presence of opacities, the following additional studies are performed. The distances from the opacification of the vitreous to the retina and lens are determined using ultrasound scanning, which is initially carried out visually in all planes of the eyeball. Then measure the distance from clouding to the retina (L1) and to the lens (L2), evaluate it in points as equal to 1 at a distance of more than 3 mm or as equal to 0 at a distance of less than 3 mm.

Next, risk factors (N) are identified that can reduce the maximum corrected acuity and / or field of vision, for which optical coherence tomography of the macula, the periphery of the retina, optic nerve, and perimetry is performed. In the absence of risk factors, N = 1 point, the presence of N = 0, then it is determined by the obtained research results the availability of indications for the YAG laser vitreolysis of floating turbidity, calculating the coefficient (K) by the formula:

K = PxDxL1xL2xN. When the value of the coefficient K = 0, the absence of indications for a YAG laser vitreolysis is determined, and for K> 0, the presence of indications for a YAG laser vitreolysis with floating opacities of the vitreous is determined.

More specifically, the method is carried out by a comprehensive examination of the patient as follows.

A conversation is conducted with the patient to collect an anamnesis. When collecting an anamnesis, the severity of symptomatic complaints is assessed, which are assessed according to the point system: 0 points - no complaints, 1 point - periodic slight turbidity, 2 points - periodic moderate turbidity, 3 points - periodic pronounced turbidity, 4 points - constant pronounced turbidity

Conduct a traditional examination: with ophthalmoscopy and biomicroscopy, the doctor must ophthalmoscopy these opacities by using contactless lenses 60, 78 diopters through a slit lamp. The presence of visibility in the field of vision of an ophthalmologist is assessed as 1, the lack of visibility - 0.

When fixing turbidity (D = 1) conduct additional research. The distance from the opacification of the vitreous body to the retina and lens is determined using an Accutom B-skan plus ultrasound device (USA) or any other ultrasound device with an ophthalmic probe for studying the structure of the posterior segment of the eye. The B-scan technique is carried out contactly through closed eyelids using a probe with a frequency of 10 MHz with a resolution of 0.15 mm in depth, with a working surface diameter of 1.0 cm x 1.8 cm. The study is carried out in a patient's sitting position. Initially, an overview scan is performed, placing the probe sequentially in all planes of the eyeball. Measure the distance from clouding to the retina (L1) and to the lens (l2). Estimate the distance from clouding to the retina and lens. If the distance from the clouding to the retina and lens is less than 3 mm, then consider it equal to 0, if more than 3 mm, then evaluate as equal to 1.

In case of detection of risk factors N by ophthalmoscopy in the form of changes in the retina or optic nerve, optical coherence tomography (OCT) of the macula, the periphery of the retina, optic nerve, and perimetry are performed to identify eye pathologies that can reduce the maximum corrected visual acuity or field of vision. Such diseases include uncompensated glaucoma, age-related macular degeneration in the stage of neovascularization (late stage), diabetic angioretinopathy, and other diseases. According to the results obtained, the presence of indications for YAG is determined — the presence of indications for the YAG laser vitreolysis of floating turbidity, calculating the coefficient (K) by the formula: K = P × D × L1 × L2 × N. When the value of the coefficient K = 0, the absence of indications for a YAG laser vitreolysis is determined, and for K> 0, the presence of indications for a YAG laser vitreolysis with floating opacities of the vitreous is determined.

In total, 358 patients were examined according to the claimed method, of which 135 patients were operated on. The coefficient K was determined for each patient. With a value of K over 0, surgical treatment was performed with YAG-laser vitreolysis, with K equal to 0, no operations were performed.

Example 1. Patient K., 28 years old, (IB No. 2017) complained of floating opacities in front of the right eye, which appeared 3 months ago and interrupted the patient from reading periodically.

Surveys revealed that

Vis OD = 0.1 s sph - 3.0 = 1.0 Vis OS = 1.0 IOP OD / OS = 18/19 mm. Hg. Art.

P = 3 Symptomatic complaints (3 - periodic pronounced turbidity)

D = 1 visualization of clouding by the doctor (1 - there is the appearance of clouding by the doctor)

L1-0 distance to the retina (0 - less than 3 mm)

L2-1 distance to the lens (1 - more than 3 mm)

N = 1 - absence of risk factors.

Thus, according to the formula: the coefficient K = PxDxL1xL2xN = 3x1x0x1x1 = 0, that is, YAG laser vitreolysis is not shown.

In this regard, the patient did not undergo laser vitreolysis, since the distance from the turbidity to the retina was less than 3 mm. It was suggested that the patient should be observed and decide on the operation after increasing the clouding distance to the retina of more than 3 mm.

Example 2 .. Patient S., 63 years old, complained of floating opacities in front of his right eye for 4 months. Turbidity in the form of a fly constantly floated in front of the eye, making it difficult to read and look into the distance.

A comprehensive survey was carried out, which revealed that Vis OD = 0.2 with sph - 2.0 = 0.9

Vis OS = 0.5 sph - 1.0 = 1.0 IOP OD / OS = 17/19 mm. Hg. Art.

P = 4 - the presence of symptomatic complaints (constant pronounced turbidity)

D = 1 - visualization of clouding by the doctor (1 - there is visibility)

L1 = 1 - distance to the retina (1 - more than 3 mm)

L2 = 1 - distance to the lens (1 - more than 3 mm)

N = 1 - absence of risk factors

Thus, the presence of K = PxDxL1xL2xN = 4x1x1x1x1 = 4 made it possible to establish indications for YAG - laser vitreolysis.

The patient underwent YAG laser vitreolysis, the operation was successful, floating turbidity was vaporized. The patient ceased to see floating turbidity, his quality of life improved, as his vision was restored and his ability to read books and look into the distance was free.

In comparison with the prototype, the proposed method allows to optimize the indications for YAG laser vitreolysis, making it possible to prevent the risk of complications, improve visual functions and improve the quality of life. In comparison with the prototype, the proposed method allows to optimize the indications for YAG laser vitreolysis, preventing the risk of development complications, improve visual function and improve quality of life.

Claims (1)

A method for optimizing indications for a YAG laser vitreolysis of floating opacities, including collecting an anamnesis of the patient's condition, conducting an ophthalmoscopy of the eye with revealing opacities, determining indications for laser eye treatment, characterized in that the anamnesis is collected with an assessment based on a point system of symptomatic complaints of patient P: 0 points - no complaints, 1 point - periodic slight turbidity, 2 points - periodic moderate turbidity, 3 points - periodic pronounced turbidity, 4 points - constant pronounced turbidity, when performing ophthalmoscopy, the structure of the vitreous cavity is examined by using contactless lenses 60, 78 diopters through a slit lamp, ascertaining the absence of D = 0 or the presence of D = l opacities of the vitreous body, and if any, conduct additional studies, such as determining the distance from the opacification of the vitreous body to the retina and lens using ultrasound scanning, which is initially carried out visually in all planes of the eyeball, then measure the distance from the turbidity to the retina (L 1) and to the lens (L2) and evaluate it in points as equal to 1 at a distance of more than 3 mm or equal to 0 at a distance of less than 3 mm, risk factors (N) are identified that can reduce visual acuity and / or field, for which conduct optical coherence tomography of the macula, the periphery of the retina, optic nerve, perimetry, and in the absence of risk factors N = 1 point, the presence of N = 0, then determine the evidence for the YAG laser vitreolysis of floating opacities by the obtained research results, calculating the coefficient (K) by the formula K = P × D × L1 × L2 × N, and for the value of the coefficient K = 0 determines the absence of indications for a YAG laser vitreolysis, and at K> 0 - the presence of indications for a YAG laser vitreolysis with floating opacities of the vitreous body.