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OPHTHALMOLOGY
INVENTION
Patent of the Russian Federation RU2242003

METHOD FOR PREDICTING COMPLICATIONS AFTER ANTIGLAUCOMATOUS OPERATION
IN CONGENITAL GLAUCOM

The name of the inventor: Teplinskaya L.E. (RU); Khvatova A.V. (RU); Mazanova EV (RU)
The name of the patent holder: Moscow Research Institute of Eye Diseases. Helmholtz (RU)
Address for correspondence: 105062, Moscow, ul. Sadovaya-Chernogryazskaya, 14/19, MIIGGB them. Helmholtz
The effective date of the patent: 2003.06.09

(EN) The invention relates to ophthalmology. The method is characterized in that the content of immunoglobulin A and the presence of autoantibodies to DNA in the serum and / or tear fluid of the diseased eye are determined before the operation, and when the serum IgA is lower than the lower limit of the age norm and / or the IgA is reduced in tears and / or the presence of autoantibodies to DNA Predict postoperative complications. The method allows to predict the outcome of the operation and choose the appropriate optimal preventive treatment

DESCRIPTION OF THE INVENTION

The invention relates to ophthalmology and is intended for preoperative prediction of the development of complications after antiglaucomatous operations with congenital glaucoma.

It is known that the main way to treat congenital glaucoma is surgical. Only surgical methods manage to eliminate obstacles to outflow of intraocular fluid created by various structural anomalies of the drainage zone. The effectiveness of surgical intervention according to different authors varies from 92.3% to 100.0% in the next and from 46.0% to 83.3% at long-term follow-up.

Virtually all authors noted a decrease in the hypotensive effect in the long term after the operation. The reason for the instability of the achieved results of treatment many authors consider excessive scarring and active regeneration in the surgical intervention zone caused by the proliferation of fibroblasts of the tenon capsule and the epicles in the operation area: presumably between conjunctiva, tenon and episclera, and in the excision of trabeculae and the helm of the canal (Sidorov E. G. et al. The use of cytostatics as anti-scabic remedies after antiglaucomatous surgeries in childhood and young age, Vestnik Ophthalmol., 1992. - No. 3.-C.5-7).

At the same time, a number of postoperative complications, namely, hyphema, hemophthalmia, cilioploidal detachment, keratopathy, EED, retinal detachment, and can predetermine the adverse outcome of treatment of congenital glaucoma (Turach M., Aktan G., Idil A. Medical and surgical aspects of Congenital glaucoma // Acta.Ophthal.Scand - 1995. - Vol.73, No. 3. - P.261-263).

In this regard, the problem of predicting the burdensome course of the postoperative period is topical and its solution is associated with the choice of therapeutic tactics before the operation and in the immediate postoperative period.

It is believed that in children the processes of proliferation in the zone of intervention in the early postoperative period are more active than explain the lower efficiency of fistulizing operations than in adults (Sidorov EG et al. The use of cytostatics as anti-scab agents after antiglaucomatous operations in children and Young age / / News ophthalmol - 1992. - № 3. - C.5-7). The cause of poor prognosis in patients with congenital glaucoma is filtering operations in individuals previously operated on for glaucoma (Fulcher N. et al., Long-term follow up of primary trabeculectomy for infantile glaucoma / Brit.J.Ophthal .- 1996. - Vol. 80, No. 6. - P.499-502). It has been suggested that the patient's early age is an unfavorable factor for maintaining fistula functioning and normal filtration (Detry-Morel M. et al., Trabeculectomy in congenital glaucoma: retrospective medium and long term results, Bull., Soc. Belge Ophtalmol., 1996. V .262, p.143-151). The aggravated course of the disease has been observed in those patients who are diagnosed at the age of 2 months or after 2 years.

It is noted that the risk of an unfavorable outcome increases in patients with terminal stages of the disease, with forms of glaucoma associated with anomalies of the eye and phacomatoses (aniridia, Sterge-Weber syndrome) (Sidorov EG et al. Clinic, some questions of pathogenesis and treatment of glaucoma in Young age // News ophthalmol - 1993. - № 4. - С.32-34).

Methods of predicting the complications of operations with congenital glaucoma, based on the use of immunological tests in the literature available to us, we have not met.

In recent years, a lot of work has appeared on the study of the immunological concept of etiopathogenesis of primary glaucoma and some postoperative complications in adults (Stukalov SE, Zakharova IA, Dobrica TA, Kramorenko Yu.S.). The participation of immune and involution processes in the pathogenesis of primary open-angle glaucoma has been established. There were no studies on immunological research in congenital glaucoma. Given this, the purpose of our studies was to study the immune status of children with congenital glaucoma. We established the relationship between the outcome of surgical interventions, postoperative complications and immunoglobulin A (IgA) deficiency and the presence of autoantibodies (AAT) to DNA, which was the basis for developing immunological tests to predict adverse outcomes of operations.

The technical result of the invention is to improve the accuracy of predicting the development of complications of the early and late postoperative periods by using more specific and objective criteria: a low IgA level and / or AAT to DNA in serum and / or lacrimal fluid before an antiglaucomatous operation.

The technical result is achieved by the fact that before the operation for congenital glaucoma in children, the content of IgA and AAT to DNA in tear fluid and serum and at IgA concentrations below the lower limit of the age norm and / or the presence of AAT to DNA in serum and / or lacrimal Fluids predict the development of early and late postoperative complications.

The method is carried out as follows. In a patient before an antiglaucomatous operation, tear and serum are taken by traditional methods and the IgA content and the level of antibodies to DNA are determined.

Quantitation of immunoglobulin A is carried out by radial immunodiffusion, proposed by Mancini et al. The essence of the method is that a standard human serum with known immunoglobulin content and test sera of the patient or other biological fluids is added to the agar in which the monospecific antisera is pre-dispersed. Antigens diffuse through the gel and interact with monospecific serum against the corresponding immunoglobulin, forming a ring of precipitation around the well, the diameter of which is proportional to the concentration of the antigen. Monospecific and reference sera were obtained in the Research Institute of Microbiology and Epidemiology. N.F. Gamaleya AMN and MNII vaccines and sera them. I.I. Mechnikov. The obtained data were compared with the level of immunoglobulin A in the serum of healthy children by age norms (Stephanie DV, Veltishchev Yu.E Immunology and immunopathology of childhood / Manual for doctors .- M .: Medicine, 1996). The level of immunoglobulin A in a tear fluid was compared with their content in healthy children (Zaitseva NS et al. Immunological methods in the diagnosis of uveitis / Methodical recommendations, 1989). The concentration of immunoglobulin A in the test materials was expressed in mg%.

To determine the level of antibodies to DNA in serum and tear, enzyme-linked immunosorbent assay (ELISA) was used, serum was studied at 1:50 dilution, lacrimal fluid 1:10 (NE Yastrebova, Development and study of diagnostic capabilities of enzyme-linked immunoassay test systems Antigen preparations of Staphylococcus aureus and DNA .. Thesis .... Candidate of Medical Sciences - M., 1988). The reaction is evaluated on a multiscan spectrophotometer (Finland) based on the IF reaction index, which is the quotient of the optical density of the analyzed serum (tear) from the optical density of the pooled serum (tears) in the same dilution. An IF-reaction with an index> 2 was considered positive and a manifestation of a strongly pronounced autoimmune process (NE Yastrebova, 1988).

If the patient shows a decrease in IgA below the lower limit of the age norm and / or the presence of autoantibodies to DNA in the blood serum and / or lacrimal fluid, postoperative complications are predicted.

Example 1. Patient B. 11 years old
Diagnosis: OS - Congenital glaucoma, III form, developed, uncompensated (Sturge-Weber syndrome). On the eve of the operation, a study of tear fluid and blood serum for the presence of autoantibodies to DNA. In the tear fluid of the OS, autoantibodies to DNA were detected (IF-response index = 0.24), which predicts the probability of complications after surgery. Trabeculectomy was performed on the OS. In the postoperative period (on the second day), the development of a cilioploidal detachment (CCH).

Example 2. Patient K., age 9 years
Diagnosis: OU - Congenital glaucoma, I form, developed, OD - compensated, OS - uncompensated. On the eve of the operation, blood serum and tear fluid were tested for IgA levels. The level of IgA in the tear before surgery - OD - 12 mg% corresponds to the norm, OS - 2 mg%, which is low and predicts the development of complications. Trabeculectomy was performed on the OS. On the 2nd day after the operation on the OS - hyphema (the level in the anterior chamber is 3 mm, the suspension of blood elements in the anterior chamber), the IgA content in the tear is 0 mg%. As a result of the treatment, the complication was managed only for 14 days, IgA in the tear - 2 mg%. At inspection in 1 month after operation OS: the moisture of anterior chamber is transparent, IOP = 18-20 mm Hg. The content of IgA in tears increased to 12 mg%.

Example 3. Patient S., 1 year 5 months
Diagnosis: OU - Congenital glaucoma, I form, OD - far-gone, uncompensated, OS - initial compensated. On the eve of the operation, blood serum and tear fluid were tested for IgA levels. There was a sharp decrease in serum IgA (trace concentrations), which predicts the development of complications. Trabeculectomy was performed on OD. Operation and the early postoperative period proceeded without complications.

After 8 months recurrence of IOP rise in OD to 28-30 mm Hg. Art. And signs of scarring in the zone of operation were noted. A second operation was performed.

Example 4. Patient M., 1 year 7 months
Diagnosis: OU - Congenital glaucoma, I form, far-reaching stage, uncompensated. On the eve of the operation, a blood serum and tear fluid test was performed to determine the level of IgA autoantibodies to DNA. A sharp decrease in the level of IgA in the tear fluid OU (2 mg%) and the presence of autoantibodies to DNA in the lacrimal fluid OD (the index of the IF-reaction = 0.3) is noted, which predicts the development of complications. The course of treatment with thymalin was administered intramuscularly. Trabeculectomy was performed on OD. The operation and the early postoperative period proceeded without complications, which indicates a positive immunomodulating effect of thymalin.

Thus, the antiglaucomatous operation in the presence of IgA levels below the lower limit of the age norm and / or the presence of autoantibodies to DNA in the blood serum and / or in the lacrimal fluid predicts postoperative complications.

CLAIM

The method for predicting complications after antiglaucomatous operation in congenital glaucoma, characterized in that before the operation, the content of immunoglobulin A and the presence of autoantibodies to DNA in serum and / or tear fluid of the diseased eye is determined and when serum IgA is lower than the lower limit of the age norm and / In the tear and / or presence of autoantibodies to DNA, postoperative complications are predicted.

print version
Date of publication 06.01.2007gg