RU2354337C1 - Method of recovering binocular functions in case of concomitant strabismus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to ophthalmology. Laser stroboscopy is carried out during 5 days, 2 times a day with 1 hour interval. First 10 minutes each eye is influenced in turn, then for 5 minutes both eyes are influenced simultaneously. Distance to speckle is 1 m.

EFFECT: recovering binocular functions with elimination of anisoaccomodation, enhancing binocular interaction, increasing visual acuity.

3 cl, 2 ex

Description

The present invention relates to ophthalmology and is intended to restore binocular functions with friendly strabismus.

The restoration of binocular functions, the elements of which are bifoveal fusion, fusion reserves, relative accommodation, stereo effect, deep perception of space, is carried out using orthoptics and diploptics. At the same time, orthoptics is treatment on devices with a complete artificial separation of the visual fields of both eyes, diploptics is treatment in natural and close conditions [Avetisov ES, Kashchenko TP A way to restore binocular vision with strabismus. // Discoveries, inventions, industrial designs, trademarks. Bulletin - 1977. - No. 8. - Auth. testimonial. 548274].

Orthoptic exercises are usually carried out on devices with a mechanical separation of the fields of view, the most important of which is a synoptophore. Paired test objects for both eyes are mobile and can be located at any strabismus angle.

The purpose of the exercises is the elimination of functional scotomas, the development of bifoveal fusion and fusion reserves.

Orthoptic treatment further limits the possibility of restoring binocular functions in vivo and provides cure for only 25-30% of patients. This is due to the artificial conditions of vision on these devices. Therefore, after reaching a symmetrical position of the eyes, treatment is carried out to restore binocular functions without mechanical separation of the visual fields.

One of the diploptic treatment methods is the method of binocular sequential images developed by TP Kashchenko [TP Kashchenko Methods of research and restoration of binocular functions, diploptic system .// Collection of scientific works in memory of A.V. Roslavtsev. - M., 1999. - S.69-79]. The method helps to restore bifoveal fusion, eliminate functional scotomas and restore binocular vision.

There are a number of diploptic methods in which diplopia is excited by various dissociative ("provocative") methods: using prisms, color filters of increasing density. Use computer programs "EYE", "contour", based on the color separation of the fields of view. The method of binarimetry, when two pair tests are presented on a binarimeter in “free haploscopy”, diploptic exercises when creating artificial aniseikonia by gradually increasing the size of one of the monocular images no more than 5%, a method of phase haploscopy using liquid crystal glasses [Avetisov ES, Kashchenko T.P. A way to restore binocular vision. // Discoveries, inventions, industrial designs, trademarks. Bulletin - 1977. - No. 15. - Auth. testimonial. 554865], [Rabichev I.E. Binarimetry methods in diploptic treatment of friendly strabismus. Abstract. dis ... cand. honey. sciences. - Irkutsk, 1988. - 24 p.].

The existing system for restoring binocular functions with friendly forms of strabismus is mainly designed to eliminate the phenomenon of suppression and restore fusional ability. Functional treatment for accommodation disorders in patients with strabismus is limited only by the use of individual methods and is not systematized.

The closest analogue of the present invention is a method of the same purpose, including the reception of separation of accommodation and convergence (the method of "dissociation"), which "teaches" binocular fusion under the increasing load on the accommodation apparatus with negative lenses, as well as relaxation with positive spherical lenses under the control of binocular fusion in conditions of color, raster and polaroid separation of the fields of view [Avetisov ES, Kashchenko TP A method of restoring binocular vision. // Discoveries, inventions, industrial designs, trademarks. Bulletin - 1977. - No. 15. - Auth. testimonial. 554865]. The child overcomes the doubling excited at the same time and achieves binocular fusion of the tests of the four-point device, which he observes during the exercise.

The method contributes to the development of bifixation, fusion and relative accommodation.

However, this method can be applied only after restoration of the bifixation reflex and in the presence of unstable binocular vision, which limits the application of this method in a certain group of patients with scotoma, monocular and simultaneous nature of vision.

Disclosure of the invention.

The objective of the invention is to develop a new method for the treatment of friendly strabismus, based on a direct effect on the accommodation apparatus.

The technical result of the invention is the elimination or reduction of the angle of squint, increasing visual acuity and restoration of binocular functions with the elimination of anisoaccomodation, enhancing binocular interaction.

The technical result is achieved due to the normalization of monocular and binocular tonuses of accommodation of the squinting and fixing eyes using laser stroboscopy in the mode we developed.

Known methods of laser stroboscopy, which, in order to reduce visual fatigue, are aimed at relaxing the excessive tone of the ciliary muscle, improving the accommodative ability of the eye in people with asthenopic complaints.

Earlier, studies of the tone of accommodation with friendly strabismus were not carried out, although there is evidence of a decrease in the volume of absolute accommodation with strabismus, especially of the monolateral type, as well as the presence of aniso accommodation (Smolyaninova I.L., Aznauryan I.E. et al.).

As shown by our studies conducted in various groups of patients with strabismus (accommodation, partially accommodation, non-accommodation), accommodation suffers with all types of strabismus. At the same time, the data obtained using laser stroboscopy (laser stroboscopy is also used for diagnostic purposes to determine the tonus of accommodation from 1 m and from 0.33 m) showed a violation of the tonus of accommodation: with accommodative strabismus, it decreases on the eye that most often fixes, with partially accommodative strabismus - in both eyes and with non-accommodative strabismus - more often on the squinting eye. Anisoaccommodation was detected. The change in the tonus of accommodation is more pronounced with 1 m than with 0.33 m. The accommodation data on AK / A 01 showed a decrease in this indicator on the most-squinting eye for all types of strabismus. It was also revealed a pathological increase in the ratio of accommodative convergence to accommodation with accommodation forms of strabismus. Based on the foregoing, it was decided to act on the accommodation apparatus using laser stroboscopy in order to restore impaired accommodation ability. Laser stroboscopy in the mode developed by us, as shown by our studies, directly affects the accommodation apparatus:

increases the tonus of accommodation, eliminates aniso-accommodation, enhances binocular interaction, which leads to a decrease or disappearance of the strabismus angle, increased visual acuity (due to normalization of accommodation ability and simultaneous stimulation of retinal photoreceptors) and to the restoration of binocular functions.

The implementation of the invention.

To determine the possibilities of laser stroboscopy when restoring visual functions in patients with friendly strabismus, 15 people with accommodative and partially accommodative strabismus were selected (after surgical elimination of strabismus).

The method is as follows: a laser strobe device consists of a rotating cylinder and a helium-neon laser located at a distance of 5 m from it. Laser light, when reflected from the matte surface of the cylinder, interferes and is perceived as a luminous dot (speckle). The patient is presented with a diffuse horizontal dynamic laser speckle from a distance of 1 m. In the first 10 minutes, they act alternately on each eye, and then 5 minutes on both eyes. A corrective lens is placed in the test frame with the force necessary to stop the “grain” movement. Then, depending on the state of the tonus of accommodation, the lens power is reduced by 0.25-0.5 diopters with the hypodynamic form of accommodation dysfunction and the patient is asked to fix laser speckle for 5 minutes. In repeated cycles, the change of lenses with a gradual decrease of 0.25-0.5 diopters was carried out in case of stopping the movement of "graininess". A positive effect will be when the value of the corrective lens tends to zero. Laser stroboscopy is performed for 5 days, 2 times a day with an interval of 1 hour.

The patient shrinks at a distance of 1 m from the speckle cylinder. A similar mode was chosen due to a violation of the tone of accommodation for distances of 1 m than for distances from 0.33 m. In contrast to the known methods of treatment, training and strengthening the action of the weakened ciliary muscle occur. In the first 10 minutes, they act alternately on each eye to normalize the monocular tonus of accommodation, and then 5 minutes on both eyes at the same time to enhance binocular interaction 2 times a day at intervals of 1 hour to enhance the effect, for 5 days spent daily. The total duration of one session is 15 minutes. Examination of patients was carried out a week after treatment, after 3 months the effect was preserved, and after 6 months a decrease in tone was noted. It is preferable to repeat the treatment every 6 months.

As our data showed, treatment with laser stroboscopy led to the normalization of monocular and binocular accommodation tones, and to a decrease in accommodation anisometropia. There was a normalization of the indicators of the volume of absolute accommodation more often than the squinting eye in 76% of cases. Correction studies showed that in 8 patients after treatment the strabismus angle disappeared, and in the remaining 7 patients it became less than 10 °.

The impact on the accommodation apparatus contributed to an increase in visual acuity by 0.1-0.4 (in 27% of cases).

Normalization of the tonus of accommodation, accompanied by a decrease in the angle of strabismus, as well as an increase in visual acuity, changed the nature of the patients' vision. After treatment, the number of patients with binocular vision increased from 26% to 60%.

Treatment had a positive effect on the value of fusion reserves. In 20% of patients, normalization of both positive and negative fusional reserves was noted; in one patient, reserves appeared for the first time.

Thus, (at small angles of deviation up to 10 °) it is advisable to begin treatment with a laser stroboscope, and at large angles, the first step should be surgery, followed by the inclusion of a laser stroboscope.

The proposed method increases visual acuity, eliminates or reduces the angle of strabismus, restores visual functions by eliminating anisoaccomodation and enhancing binocular interaction.

Clinical example 1. Patient O., 10 years old. Before treatment. Diagnosis: friendly, accommodative, alternating (often OD) strabismus. Hm moderate.

Prior to treatment, Vis OU 0.8 b / c and s / c. refraction Hm +3.5 diopters deviation alternates 8-10 ° without correction, 0 ° with correction. The volume of absolute accommodation more often squinting eyes 3.0 diopters, most fixing eyes 7.0 diopters. Coefficient AK / A 5.7 ave. Dptr / Dptr. The tonus of accommodation from 1 m more often to the squinting eye is -0.7 diopters, most of the fixing eyes –0.4 diopters, the “binocular” tonus of accommodation is –0.55 diopters. From 0.33 meters, the tonus of accommodation more often squinting eyes -2.0 diopters, most fixing eyes -1.9 diopters, "binocular" tone -2.1 diopters. The nature of vision from 1 meter is binocular, from 2.5 and 5 meters at the same time. OY = SY = 7 ° with correction. No fusional reserves.

The treatment was carried out according to the above method. The patient was planted at a distance of 1 m from the speckle screen. A lens of +3.5 diopters in front of each eye was placed in a test frame. In the first 10 minutes, they acted alternately on each eye, and then 5 minutes on both eyes simultaneously. The patient tried to stop the movement of the laser grain. After the effect was achieved, the lens power was reduced by 0.25 diopters. The first session is +3.5 diopters, the second session is +3.25 diopters, the third session is +3.0 diopters, etc. reached +1.0. A decrease in the strength of a positive lens leads to increased tonus of accommodation. The treatment was carried out for 5 days, 2 times a day with an interval of 1 hour.

After treatment: Vis OU 1.0 b / c and s / c. refraction Hm +3.5 diopters deviation at the initial position 0 ° without correction, when uncoupling installation movements by the type of esotropy, 0 ° with correction. The volume of absolute accommodation is more often 7,0 diopters of the eye that is squinting, and more than 9,0 diopters of the fixing eye. Coefficient AK / A 4.9 ave. Dptr / Dptr. The tone of accommodation from 1 m more often to the miter of the eye is -0.8 diopters, most of the fixing eyes -0.75 diopters, the “binocular" tone of accommodation is -0.75 diopters from 0.33 meters, the tone of accommodation more often to the miter of the eye is -2.5 diopters, more often fixing eye -2.4 diopters, "binocular" tone -2.4 diopters. The nature of vision is binocular throughout. OY = SY = 0 ° with correction. Fusion reserves +4.0; -2.0.

Thus, the normalization of the accommodation apparatus led to the normalization of visual functions: to increase visual acuity, decrease the angle of strabismus, and restore binocular vision.

Clinical example 2. Patient A., 6 years old. Before treatment. Diagnosis: friendly, partially accommodative, alternating (often OS) strabismus. Amblyopia of a weak degree, OS Hm of a weak degree.

Prior to starting treatment Vis bc OD 0.8; OS 0.6 and c / c OD 1.0 OS 0.7, refraction Hm OD +2.5 OS +2.75 diopters, deviation alternates 25 ° without correction, 17-20 ° with correction. The volume of absolute accommodation more often squinting eye 2.0 diopters, most fixing eyes 6.0 diopters. Coefficient AK / A 5.5 ave. Dptr / dptr. The tonus of accommodation from 1 m more often to the squinting eye is 6.0 diopters, most of the fixing eyes -0.5 diopters, the "binocular" tonus of accommodation is 0.5 diopters. From 0.33 meters, the tonus of accommodation more often squinting the eye -1.8 diopters, most fixing the eyes -1.7 diopters, "binocular" tone -1.8 diopters. The nature of vision is monocular throughout. OY = 20 ° with correction of SY - scotoma.

Surgical intervention: recession MRM 4 mm, resection MRL 8 mm. Deviation 0-7 °. No corrections. 0 ° -3 ° with correction.

After 1 month, a laser stroboscope treatment course was conducted. After treatment, the tonus of accommodation normalized and amounted to -0.8 diopters from the distance of 1 m more often than the eyes-squeezing eye, more often -0.75 diopters fixing the eyes and the binocular tonus of accommodation increased to -0.8 diopters, which leads to increased binocular interaction. From 0.33 meters the tonus of accommodation more often squinting eyes -2.6 diopters, most fixing eyes -2.5 diopters, "binocular" tone -2.7 diopters. An increase in visual acuity was noted both without corrections, and with correction Vis b / c OD 0.9; OS 0.7-0.8 and c / c OD 1.0 OS 1.0, refraction Hm OD +2.5 OS + 2.75 diopters decreased deviation without glasses and completely disappeared in glasses: deviation 0-3 ° without correction alternates, 0 ° with correction. The volume of absolute accommodation increased more often with the squinting eye to 5.0 diopters, most of the fixing eyes to 8.0 diopters. The AK / A ratio decreased to 4.5 ave. Dptr / dptr. The nature of vision is simultaneous from 5 to 2.5 m, and from 1 m - unstable binocular. OY = 5 ° with correction SY = OY. No fusional reserves.

The proposed method can also be used after surgery to eliminate the residual strabismus angle, increase visual acuity, restore binocular vision by normalizing monocular and binocular accommodation tones of the more often squinting and most fixing eyes.

Claims (3)

1. A method of restoring binocular functions with friendly strabismus, characterized in that they perform laser stroboscopy for 5 days 2 times a day at intervals of 1 hour, with each eye acting alternately in the first 10 minutes, and then in both eyes for 5 minutes simultaneously with a speckle distance of 1 m. 2. The method according to claim 1, characterized in that at a strabismus angle of more than 10 °, surgical elimination of strabismus is preliminarily performed. 3. The method according to claim 1, characterized in that the treatment is repeated after 6 months.