Резюме
Недзвецька О.В.¹, Петрушенко Д.О.² Доплерографічне дослідження гемодинаміки в артеріях ока й орбіти при хронічній алкогольній інтоксикації.
Приведені результати дослідження кровотоку в артеріях ока й орбіти при хронічній алкогольній інтоксикації у 81 хворого (162 ока) з алкогольною токсичною нейроретинопатією (АТН), а також у 30 практично здорових осіб (60 очей). Виявлені порушення вказують на значну роль судинного фактору в розвитку АТН. Зміни характеру кровотоку центральної артерії сітківки на стадії набухання АТН, що мав вигляд «сплесків», свідчило про наявність перешкоди току крові в просвіті її мілких гілок. При цьому відбувалося значне достовірне зниження гостроти зору до 0,24±0,02 проти 0,88±0,01 на стадії гіперемії, що вказує на значну роль часткової оклюзії гілок центральної артерії сітківки в зниженні зорових функцій при АТН.
Ключові слова: доплерографія, алкогольна токсична нейроретинопатія, орбітальна артерія, центральна артерія сітківки, задні короткі циліарні артерії, задні довгі циліарні артерії.

Резюме
Недзвецкая О.В., Петрушенко Д.А. Допплерографическое исследование гемодинамики в артериях глаза и орбиты при хронической алкогольной интоксикации.
Приведены результаты изучения кровотока в артериях глаза и орбиты при хронической алкогольной интоксикации у 81 больного (162 глаза) алкогольной токсической нейроретинопатией (АТН), а также у 30 практически здоровых лиц (60 глаз). Выявленные нарушения указывают на значительную роль сосудистого фактора в развитии АТН. Изменение характера кровотока центральной артерии сетчатки на стадии набухания АТН, который имел вид «всплесков», свидетельствовало о наличии препятствия току крови в просвете её мелких ветвей. При этом происходило значительное достоверное снижение остроты зрения до 0,24±0,02 против 0,88±0,01 на стадии гиперемии, что указывает на значительную роль частичной окклюзии ветвей центральной артерии сетчатки в снижении зрительных функций при АТН.
Ключевые слова: допплерография, алкогольная токсическая нейроретинопатия, орбитальная артерия, центральная артерия сетчатки, задние короткие цилиарные артерии, задние длинные цилиарные артерии

Summary
Nedzvetska O.V., Petrushenko D.О. Dopplerography study of haemodynamics in the eye and orbit arteries at chronic alcohol intoxication.
The article represents the results of the study of blood flow in the eye and orbit arteries at chronic alcohol intoxication in 81 patient (162 eyes) with alcoholic toxic neuroretinopathy (ATN) as well as in 30 practically healthy persons (60 eyes). The revealed changes confirm the important role of vascular factor in development of ATN. Spectral waveform in the central retinal artery at the stage of swelling had a character of “splashes”, which сould be connected with presence of  blood flow obstacle in its brunches. Simultaneously the remarkable visual acuity reduction to 0,24±0,02 versus 0,88±0,01at the stage of hyperemia was observed. Thus the partial occlusion of  branches of the central retinal artery can play a significant role in reduction of the visual functions at alcoholic toxic neuroretinopathy.
Key words: dopplerography, alcoholic toxic neuroretinopathy, orbital artery, central retinal artery, posterior long ciliary arteries, posterior short ciliary arteries.

Рецензент: д.мед.н., проф. А.М. Петруня

УДК 617.731-002-005:616-099-085

¹Харківська медична академія післядипломної освіти

Харьковская медицинская академия последипломного образования

61176, г. Харьков, ул.Корчагинцев, 58

Kharkov medical academy of Postgraduate Education

61176, Kharkov, 58 str.Korchahyntsev 

²КЗ Сумська обласна клінічна лікарня

КУ Сумская областная клиническая больница

MI Sumy regional hospital

daria_petrushenko@ukr.net

Introduction. At chronic alcohol intoxication (CAI) the system haemodynamics disturbances as well as increase in permeability of histohaematic barriers develop [6]. The eye is involved in the pathological process simultaneously with other organs and systems. Solitary investigations devoted to haemodynamics disturbances at CAI does not illuminate the entire spectrum of these disorders [4,5].

Purpose - Dopplerography study of haemodynamics disturbances in the eye and orbit arteries at CAI.

Material and methods

81 male patient (162 eyes) with alcoholic toxic neuroretinopathy (ATN), smokers, in-patients of the narcological department of Sumy Regional Narcological Health Center with the diagnose of “Mental and behavioral disorders due to use of alcohol” aged from 30 to 60 years with the history of chronic alcohol abuse from 10 to 20 years were examined.  The patients were divided into groups according to pathogenetic classification of the stages of optic nerve swelling of any origin by Zhaboyedov G. D., Skrypnik R. L. (1992) [1] based on the ophthalmoscopic image of the eye fundus: A – the stage of hyperemia, B – the stage of swelling, C – the stage of dystrophy. In the same way as it was done by Zhaboyedov G. D., Skrypnik R. L. in point of diabetic optic neuropathy the pathogenetic stages of ischemia and glial atrophy in ATN were joined into the stage of dystrophy. There were 32 men (63 eyes, 38,41%) at the stage of hyperemia (the group A), 33 men (65 eyes, 39,63%) at the stage of swelling (the group B), 17 men (34 eyes, 20,73%) at the stage of dystrophy (the group C). The control group included 30 almost healthy male volunteers (60 eyes), smokers of the same age range. According to the one-way ANOVA all the groups did not vary in age.

The visual acuity and colour vision were examined. The biomicroophthalmoscopy using the Goldmann lense was held. The colour vision was examined by Rabkin Y. B. method. In order to estimate the colour vision the index of the colour vision was proposed. The index is a percentage of the number of tables which the patient reads to the total number of the main tables without demonstrational ones which is 25.

The investigation of the eye and orbit arteries blood flow was held by transorbital method by means of an ultrasound diagnostic device Toshiba “Aplio” (Japan). Colour and power Doppler imaging were used. The arteries were identified according to the anatomical localization and blood flow direction. The following haemodynamics parameters were measured: Vmax – maximal systolic flow velocity; Vmed – mean flow velocity; Vmin – the end-diastolic (minimal) velocity; PI – pulsatility index; RI – resistivity index. The orbital artery (OA), the central retinal artery (CRA), the posterior short (PSCA) and long ciliary arteries (PLCA) were examined [2,3,7,8]. The statistical analysis was performed by means of  the program “SPSS 15.0 for Windows”.

Results and discussion

The visual acuity at the stage of hyperemia was 0,88±0,01; at the stage of swelling it was significantly lower than at the stage of hyperemia (0,24±0,02); at the stage of dystrophy the visual acuity was 0,17±0,02, which tended to be lower than at the stage of swelling, but the difference was not statistically significant. The visual acuity in the control group was 0,99±0,04. The index of colour vision was reliably lower at every next stage of ATN: at the stage of hyperemia it was 85,14±1,0%, at the stage of swelling – 45,66±1,31%; at the stage of dystrophy –37,18±1,72%. In the control group the index of colour vision was 99,47±0,18%. The examined indexes of visual functions were significantly lower at all stages of ATN than in the control group.

At the stage of hyperemia ATN (the group A) blood flow velocities in all examined arteries were significantly lower (Р<0,05) than in the control group (Tab. 1). In OA all measured blood flow velocities were equally lower than in the control group without significant changes in РІ and RI. In PSCA and PLCA the decrease in Vmin was more significant ( 2,99 and 1,59 times lower than in the control group respectively) with moderate reduction of Vmax (1,57 and 1,26 times lower than in the control group respectively) and Vmed (1,64 and 1,57 times lower than in the control group respectively). In CRA just Vmin was 2,13 times significantly lower than in the control group. Consequently the pulsatility index (PI) increased (in the CRA PI was 1,22 times higher than in the control group, in the PSCA – 1,30 times higher, in the PLCA – 1,37 times higher), which might be a sign of elasticity reduction of the arteries vascular wall due to the processes of sclerosis in consequence of the toxical injury at CAI. Besides the significant increase in the RI was obtained: in the CRA – the RI was 1,24 times higher than in the control group, in the PSCA – 1,24 times higher, in the PLCA – 1,11 times higher. It may indicate

the initial occlusion of the small branches of the arteries.

At the stage of swelling ATN (the group B) blood flow velocities in the OA tended to further decrease (Tab. 1), but just Vmin was 1,57 times significantly lower than at the stage of hyperemia and 2,03 times lower than in the control group. RI was reliably higher than in the control group.

In the CRA the significant changes in the spectral velocity waveform were observed (Tab. 1, Pic. 1, Pic. 2). Though Vmax was high enough (10,73±0,11 sm/s, which was 1,54 times lower than in the control group) the pulsation wave faded away soon, and Vmin reached 0,51±0,03 sm/s, which was 10,25 times lower than in the control group, besides in 13,8% cases Vmin equaled zero. Thereafter the decrease in Vmed (it was 1,64 times lower than in the control group) and the increase in РІ (it was 1,49 times higher than in the control group and 1,16 times higher than in the group А) were observed. Thus the blood flow had a character of “splashes”. Besides the significant increase of the RI was observed (it was 1,4 times higher than in the control group and 1,13 times higher than in the group А), which сould be connected with progression of the CRA brunches occlusion as compared with the stage of hyperemia. The changes in the spectral velocity waveform were similar to those at the ischemic optic neuroretinopathy [6] but differed from the last ones by higher Vmax and Vmed and a bit lower Vmin, which might be caused by obstacles of the blood flow in the lumen of smaller branches of the CRA at ATN [3,7,8].

The haemodynamics indexes of PSCA and PLCA did not show significant difference between groups A and B (Tab. 1) though RI tended to increase.

At the stage of dystrophy ATN (the group С) in the ОА Vmed was significantly lower than in the group В with consequent 44,35% increase in РІ (Tab. 1). The haemodynamics indexes of CRA did not show significant difference between groups C and B. In PSCA Vmax was significantly lower than in the group В (11,16±0,25 sm/s vs 14,53±0,18 sm/s in the group B) which caused the decrease in PI. In the PLCA the PI was significantly 5,96% higher than in the group B due to lower Vmed. Thus compared to the stage of swelling further deterioration of haemodynamics indexes of the eye and orbit arteries blood flow with significant decrease in blood flow velocities and increase in PI in OA and PLCA due to sclerosis processes in the vascular wall were observed.

Conclusions

1. The dopplerography study revealed significant decrease in the eye and orbit arteries blood flow velocities with the increase in the pulsatility and resistivity indexes at all stages of alcoholic toxic neuroretinopathy which confirmed the direct influence of the vascular factor on its development.
2. The following dopplerography features of the eye and orbit arteries blood flow were characteristic for the stages of alcoholic toxic neuroretinopathy. At the stage of hyperemia moderate decrease in the arteries blood flow velocities was observed. Wherein for the central retinal artery, posterior short and long ciliary arteries the lower Vmin than in the control group (2,13, 2,99 and 1,59 times lower respectively) was characteristic. It was accompanied  by 23,53%, 24,24% and 10,77% increase in RI respectively, which might indicate the initial occlusion of small branches of the arteries. The main feature of the stage of swelling was the change in spectral velocity waveform in the central retinal artery which acquired the character of “splashes”. Though Vmax was high enough the pulsation wave faded away soon, and Vmin reached 0,51±0,03 sm/s, besides in 13,8% cases Vmin equaled zero. At the stage of dystrophy further decrease in the pulsatility index in the orbital artery and posterior long ciliary arteries due to sclerosis processes in the vascular wall were observed.
3. The characteristic change in spectral velocity waveform of the central retinal artery at the stage of swelling accompanied the significant decrease in the visual acuity to 0,24±0,02 versus 0,88±0,01 at the stage of hyperemia, which might indicate the significant role of the partial occlusion of small branches of the central retinal artery in visual functions deterioration at ATN.

Література

1. Жабоедов Г.Д. Поражения зрительного нерва / Г.Д. Жабоедов, Р.Л. Скрипник. – Київ: Здоров'я, 2006. – 472 с.
2. Катькова Е.А. Диагностический ультразвук. Офтальмология: практическое руководство / Е.А.Катькова; под ред. А.В. Зубарева. - М.: Фирма СТРОМ, 2002. – 120 с.
3. Киселёва Т.Н. Ультразвуковые методы исследования кровотока в диагностике ишемических поражений глаза / Т.Н. Киселёва. // Вестник офтальмологии. – 2004. – № 4. – С. 3-5.
4. Принципи лікування патології органа зору та порушень мікроциркуляції у хворих на хронічний алкоголізм: метод. рекомендації / [за ред. І.М. Логай, Т.В. Дегтяренко, В.М. Фролова та ін.]. – Луганск: ЛГМУ, 1999. – 17 с.
5. Руженков В.А. Обоснование применения ультрафиолетового облучения крови при лечении хронического алкоголизма / В.А. Руженков, Т.Г. Дронова // Эфферентная терапия. – 2002. – Т. 8, № 1. – С. 32-35.
6. Фролов В.М. Иммунные и микрогемодинамические нарушения при патологии печени и их коррекция / В.М. Фролов, Б.П. Романюк, А.М. Петруня. – Луганск: ЛГМУ, 1994. – 108 с.
7. Kaiser H.J. Ocular Blood Flow / H.J. Kaiser, J. Flammer, Ph. Hendrickson. – Basel: Karger, 1996.
8. Williamson Т. Color Doppler ultrasound imaging of the eye and orbit / Т. Williamson, A. Harris // Surv-Ophalmol. – 1996. – № 40 (4). – P. 255-267.