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Ковальова К.І. Разробка нового методу дослідження м’язового балансу очей і бінокулярного злиття у хворих з непрозорими оптичними середовищам
27.05.2014, 11:57

Резюме
Ковальова К.І. Разробка нового методу дослідження м’язового балансу очей і бінокулярного злиття у хворих з непрозорими оптичними середовищами.
Розроблено новий метод, що дозволяє визначити наявність бінокулярного злиття (фузії) і відповісти на питання, чи працює сенсорний канал девіації у хворих з непрозорими оптичними середовищами. Розроблено новий метод визначення м’язового балансу очей у хворих з непрозорими оптичними середовищами , який дозволяє в передопераційному періоді визначити і прогнозувати можливість відновлення бінокулярного співробітництва при формуванні симетричною і асиметричною рефракції. Показано, що розроблена методика дозволяє визначити величину косоокості у осіб з непрозорими оптичними середовищами, зниженою гостротою зору і з монокулярним характером зору.
Ключові слова: бінокулярний зір , катаракта, артифакія , сіноптофор

Резюме
Ковалева Е.И. Разработка нового метода исследования мышечного баланса глаз и бинокулярного слияния у больных с непрозрачными оптическими средами.
Разработан новый метод, позволяющий определить наличие бинокулярного слияния (фузии) и ответить на вопрос, работает ли сенсорный канал девиации у больных с непрозрачными оптическими средами. Разработан новый метод определения мышечного баланса глаз у больных с непрозрачными оптическими средами, который позволяет в предоперационном периоде определить и прогнозировать возможность восстановления бинокулярного сотрудничества при формировании симметричной и асимметричной рефракции. Показано, что разработанная методика позволяет определить величину косоглазия у лиц с непрозрачными оптическими средами, пониженной остротой зрения и с монокулярным характером зрения.
Ключевые слова: бинокулярное зрение, катаракта, артифакия, синоптофор

Summary
Kovaleva E.I. Development of a new method of studying muscular balance and eye binocular fusion in patients with opaque optical media.
A new method for determining the presence of binocular fusion (fusion) and to answer the question whether the sensory channel deviation in patients with opaque optical media. A new method for determining the eye muscle balance in patients with opaque optical media that allows preoperatively identify and predict the possibility of recovery of binocular cooperation in the formation of symmetric and asymmetric refraction. It is shown that the developed method allows to determine the magnitude of strabismus in patients with opaque optical media , reduced visual acuity and vision monocular character.
Key words: binocular vision , cataract, pseudophakia, sinoptofor

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

УДК 617.741-007.21

ГУ "Институт глазных болезней и тканевой терапии им. В.П.Филатова НАМН Украины"

65061, Украина, г. Одесса, Французский бульвар, 49/51

SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”

65061, Ukraine, Odessa, Frantsuzskii Bulvar, 49/51

oko_66@mail.ru

Іntroduction. As already mentioned , the state of muscular balance eye largely determines the forecast recovery of binocular functions in their violations related to ametropia , amblyopia , strabismus , including in patients with cataracts , pseudophakia . Diplopia and strabismus is one of the main reasons tion or absence of binocular instability of view after surgery [2-5].

By the nature of the following forms of diplopia :

1) muscle - due to paresis , damage and disturbance of the balance of the eye muscles , and 2) the touch - through the mechanism of diffusion disorder , and 3) mixed , in which both of these factors are present [1].

Diplopia after cataract extraction with intraocular lens implantation referred to as a mixed form . In such cases often revealed geteroforiya which is combined with aniseikonia , the difference in visual acuity paired eyes , lack of dominant eye . For small angles of strabismus adaptation can occur spontaneously or after orthoptic exercises or after the application of a prismatic correction. To compensate for the large deviation angles recommended additional operational and orthoptic treatment, the use of prismatic correction [ 5-9 ] .

State motor system may affect the stability of the sensor system and the mechanism of binocular vision in general.

As you know, normal binocular vision (BV) is implemented in static and dynamic balance of optical, sensory and motor functions of the eye. When psevdofakia binocular balance can be obtained in eyes with emetropic refraction , visual acuity equal , identical amplitude pseudoaccommodation convergence and, in the absence of imbalances in the motor system. It should be noted that the ideal binocular molar balance is nothing more than an artificial model " standard " binocular system. In reality, we usually encounter with the presence of anatomical and functional asymmetry in individual sub- systems of the mechanism of binocular vision , and the mechanism provides synchronous their work. This asymmetry can be characterized by imbalances of static and dynamic refraction, the difference in visual acuity paired eyes, an imbalance in the motor system of the eye, and many other factors. Each of these factors alone or a combination there of can lead to instability as the optomotor system bifiksation and complete loss of binocular vision.

Patients with pseudophakia geteroforiya occurs in 80 % of patients and in 30% it is more than 6.0 diopters Pr [ 10-14 ] .

Our task was to develop a new method and apparatus that would identify patients with opaque optical media not only the ability to merge, but the magnitude and angle of strabismus. As already noted , the data obtained by this method can be used to predict the possibility of binocular recovery of view of patients with cataract after implantation of intraocular lenses, as well as for the selection of patients for the correction of aphakia monovision.

The aim of this work was the development of new methods for studying muscular balance and eye binocular fusion in patients with non- transparent optical media.

Material and methods.

The basis of the new method uses the concept of mutually determine the position of the visual axes of the eyes on a special sinoptofor, which allows the patient to produce tests with opaque optical media.

The problem is solved in that the test objects imposed on each eye, are formed by the grating and monochromatic coherent light source. Focusing the image of the test special optical system at the node eye that allows you to test the image on the retina at the opaque lens.

The possibility of bringing the test objects sinoptofor with an opaque media permits, as well as on normal sinoptofor determine not only the presence or absence of diffusion, but the magnitude of the deviation.

We have developed a model of the new sinotipe device. General view of the device and its schematic diagram shown in Figure 1 and 2.

 

The apparatus comprises an optical head 1, 2 periscope mirror, lens 3 , coherent point light sources 4 and diffraction grating 5, forming the image on the retina, represents a test objects to merge or combine .

Optical heads are associated with a mechanical device that allows you to move the test objects in the visual field of each eye in the frontal plane of the axes X, Y.

Light from a coherent monochromatic source is focused on the surface of a plane-parallel plate and the objective lens in the focus - smiling nodal point of the optical system of the eye. The diffraction grating in the form of plane-parallel plates 5 have different thicknesses and are arranged on the disc rotating is regulated at a range of measurement of retinal visual acuity ( RVA) . RVA boundary measurements from 0.03 to 1.0.

Methods of working with the instrument. Optical head was set at a distance equal to the distance between the centers of the pupils and the angular scale of the instrument recorded in the zero position. The patient's head is mounted on the front set-up.

To determine the ability to merge in front of each patient's eye glass set Bagolini or sticks Maddox.

Banded glass is a bitmap filter - (grating) , which is almost transparent, and does not reduce the visual acuity of the patient. Glass inserted into a frame mounted in the optical heads sinoptofor . One of the glass at an angle of 135 degrees, the second angle 45, i.e. in mutually perpendicular directions. Patient through a filter with each eye will see a glowing object at the same time more luminous line, co-orientation perpendicular to the direction parallel to the Torah raster strokes.

Initial studies suggest a patient with one eye fixed center of the test object. Then, in view of the second eye is administered the same test object and move it to a position from which one tax centers monocular tests into a single image .

Patient with normal binocular fusion when looking at shining - point object through both filters must see is common to both eyes simultaneously to two additional light crossed lines that pass through the center of the dough. The same pattern should vi- do patients with normal binocular vision in the study by method Bagolini [1].

After exploring the nature of the merger, the doctor, the angular scales of the instrument determines the relative position of the visual axes of the eyes, the magnitude and direction of muscle imbalance .

The fundamental difference of our proposed technique is that we are able to sinoptofor determine the safety of sensory channel binocular vision in patients with opaque media by optical and implement forecast the possibility of recovery of binocular in vivo after cataract extraction and recovery of the transparency of optical media .

This forecast was made ​​on the basis of data on the nature of binocular fusion in combination with data on the angle of deviation determined by measuring scales ethyl sinotipe device.

Study of the diagnostic capabilities of the developed method - in 50 patients with unilateral senile cataract, varying degrees of maturity. Age of patients was from 55 to 76 years. Refraction eyes determined from the condition of emmetropia. Mean values ​​of preoperative visual acuity better eye without violations of transparency optical media when looking into the distance is 0.7 - 0.85.

Average value pre-eye visual acuity immature cataracts were in the range of 0.02 to 0 15. Predicted RVA was at least 0.4 - 0.6.

Results and discussion .

Table 3 presents data on the distribution of patients with cataracts and pseudophakia of the largest deviation determined by various methods to IOL.

As seen from Table unable to conduct the study in 100 % of cases using just Girshberg method. Thus , 90 % of patients have a deviation of up to 5 angular degrees.

Table 3

Distribution of patients with cataracts and pseudophakia largest deviation determined by various methods to IOL

Method

Method of Distribution of patients largest deviation in angular degrees to IOL implantation (N = 50)

to 5,0

6,0 - 10,0

11,0 -15,0

Determine cannot

Hirschberg

45

90%

5

10%

0

0

Maddox

8

16%

2

4%

0

40

90%

Sinoptofor

9

18%

0

0

41

82%

New Method

34

68%

12

24%

0

4

8%

 

 

According to sensory tests requiring perception and evaluation of one-to- two position test objects (using Maddox and sinoptofor) , used to follow accordingly managed to hold only 18 % - 20 % of patients.

A new method of research was conducted in 92 % of patients. New methods of micro- and small-angle strabismus identified respectively 68% and 24 % of the patients ( p <0.05) .

We have already noted that the ability to achieve binocular vision depends on the angle of strabismus. It is known that micro-and small-angle strabismus usually can be offset by existing patient's fusional reserves, and patients with large angles, it is necessary to carry - risk group in which binocular vision after surgery may not be. In accordance with this provision, all patients can be conditionally divided into 3 groups, one group with a deviation of up to 5, and the other from 6 to 10 and group with a deviation of more than 10 degree angle.

From this perspective , the analysis of the data showed that a group which can be compensated strabismus binocular vision definiteness Hirschberg method was 90 %, and a new method of 68 % (P <0,05). The group of patients with small angles of strabismus in which there is a risk of decompensation of binocular vision after surgery according to methods yes Hirschberg was 10% , and a new method 24 % (P <0,05). It must be stressed that the increased risk was 14% of the strength for an erroneous determination not only by micro- Girshberg but strabismus angles greater than 5 degrees.

Table 4 shows the distribution of patients with pseudophakia largest deviation determined by various methods after IOL implantation .

TABLE 4 .

Distribution of patients with cataracts and pseudophakia largest deviation determined by various methods after IOL implantation

method

Method of Distribution of patients largest deviation

( carbon deg) after IOL implantation (N = 50)

to 5,0

6,0 – 10,0

 

11,0 -15,0

 

determine

cannot

 

Hirschberg

45

90%

5

10%

0

0

Maddox

38

76%

10

20%

2

4%

 

0

Sinoptofor

36

72%

10

20%

0

0

New Method

38

76%

11

22%

1

2%

0

 

 

Analysis of the data showed that the group of patients, which can be compensated strabismus binocular vision defined less Hirschberg was 90 % and 76% of the new method ( prior to surgery 68 %) (P <0.05).

Group of patients with small-angle strabismus, in which there is a risk of decompensation of binocular vision after IOL implantation method according to Hirschberg was only 10%, and a new method 24 % (P <0,05).

Notes that data on the nature of eye muscle balance after IOL implantation method Maddox on sinoptofor and a new method practically coincided , indicating the possibility of their use for the prediction of recovery of binocular function in patients with cataracts.

In Table 5, we present data on the nature of binocular of view of patients with unilateral pseudophakia and symmetrical refraction as a function of the state of muscular balance of the eyes, aniseikonia , visual acuity.

TABLE 5 .

Nature of binocular vision in patients with pseudophakia and symmetrical

Refrac­tion, depending on the balance of the eye muscle, aniseikonia, visual acuity

Indicators of visual function without correction

 

patients

(N = 50)

 

Character of binocular distance vision

number of patients

 

 

UCVA

 

geteroforiya

(pr diopt)

 

anisotropy

 (pr diopt)

aniseyconia (%)

 

 

 

 

to 5.0

6-10

To 5,0

6.0-10

leading eye

 

fellow eye

 

binocular

20

15

-

-

1.5±1,1

0.85±1.5

0.7±1,7

35

 

monocular

-

-

5

5

4.0±2,2

0.8± 2.5

0.35±0,25

10

 
 
 

Diplopia

 

-

-

5

3.0±1,5

0.75±0.5

0.5±0.8

5

 

 

As the table shows, the lack of binocular vision was found in 10 % of patients. Cause of decompensation of binocular vision is a combination of more than 4.5-6 % aniseikonia, strabismus, etc. more 9.0-16.0 diopters difference in acute and company of the leading pair of eyes more than 0.4.

Patients with binocular vision, these figures differed. So, the value of aniseikonia was 1.5 ± 1.1%, the value geteroforia to 16 diopters ave., the difference in visual acuity less than 0.2 paired eyes. ( P <0.05)

It is interesting to note that 20% of patients who after surgery was absent stereopsis had both micro- and small-angle strabismus.

Conclusions.

1. To improve the efficiency of the intraocular correction to new methods of diagnosis in patients with opaque optical media. The basis for new diagnostic methods is the use of the principle of binocular research sinotipe functions on the device in conjunction with a laser procedure retinovisionmetria.

2 . A new method for determining the presence of binocular polar merger (fusion) and to answer the question whether the sensory channel deviation in patients with opaque optical media.

3 . A new method for determining the eye muscle balance in patients with opaque optical media that allows you to preoperation period and predict the possibility of recovery of binocular cooperation in the formation of symmetric and asymmetric refraction.

4 . It is shown that the developed method allows to determine magnitude of strabismus in patients with opaque optical media, reduced visual acuity and vision monocular character and traditional methods of diagnosis of strabismus implement these studies do not allow sufficient accuracy.

 

Литература

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