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ІНФОРМАЦІЙНІ ТЕХНОЛОГІЇ В МЕДИЦИНІ
© Sh. R. Abdullayev
UDC 617. 713-002:616. 992[-073. 7 Sh. R. Abdullayev
The Assessment of Optical Coherence Tomography Role in Keratomicosis
Tashkent Institute of Postgraduate Medical Education (Tashkent)
The paper is written within the research on planned scientific research work «Innovations in Private, General Surgery and Emergency Medical Aid», National registration number: 02090009.
Relevance. Keratomikosis is a great problem in ophthalmological practice due to its severe clinical course and low recognition which often leads to severe outcomes with formation of persistent corneal opacity and vision loss [1, 3].
In recent years, diseases caused by conditionally pathogenic microorganisms, including fungus, increased significantly. Every fifth person of the planet is affected by mycotic infection. Mycosis is most widespread pathology of human being [4]. At the present time more than 400 types of fungus are well known, 50 of them are considered pathogenic for eye [5].
The study of the eyeball’ anterior structure is an integral part of the eye examination. However, the traditional diagnostic methods (light biomicroscopy, ophthalmoscopy) are not enough informative to express edema, infiltration and significant corneal clouding.
In recent years contactless methods of examination are widespread, one of them is optical coherence tomography examination.
Ch. Wirbeluer et al. (2007) in their study showed a good correlated relationship between optical coherence tomography results and histological findings of cornea. OCT clearly differentiates which part of the cornea (anterior epithelium, stroma or endothelium) is affected [2]. There are a lot of experimental studies that demonstrate the optical coherence tomography with image resolution about 2. 1 microns which allow visualizing the structure of the eye tissue at the cellular level.
Purpose. To determine the informative value of anterior eye optical coherence tomography in patients with keratomicosis.
Methods. 13 patients with fungal diseases of eye which are have been treated at the Republican Eye Clinic. Ophthalmological study: external examination, visiometry, contactless tonometry, perimetry, ophthalmoscopy, biomicroscopy, autorefractometry, A-scan and OCT.
Mycological research. Material for planting (scraping off the conjunctiva and cornea) was placed on the medium Saboura with agar. Then the tubes were put into incubator at the temperature 37° C. In describing the culture of the fungus called attention to its appearance,
shape, texture, color and shades. Then colonies had been studied directly in vitro at low magnification of the microscope: the nature of aerial mycelium, overall structure of the spore-bearing system, characteristics and location of the spores. Later, the colonies of fungal cultures were transferred to a glass slide under a microscope at 40H90 magnification and determined the nature of mycelium, spore structure, location and other elements of the culture.
The clinical finding of patients with keratomicosis is small swelling of the eyelids and conjunctiva. As a rule, a central infiltration and its satellites presents in the cornea. The infiltrates are in grayish-white color with scalloped edges. Ulcerated surface of infiltrates has a dry texture and rise above the level of cornea. The necrotic mass is surrounded by furrow, which captures all layers of the stroma. From furrow outwardly depart grayish lines, so-called zone of infiltration. Infiltration zone is surrounded by a swollen ring with clear margins. In the area of the ring there is edematous stroma with the bands, so-called striae, which are located in the middle and deep layers.
There is one case that revealed the characteristic features of fungal corneal ulcer.
Patient K. K. (amb. card № 8558), 46 years old, called to Republican Eye Hospital on May 23, 2012 with complains of photophobia, tearing and pain in the left eye.
ANAMNESIS: First manifestation is one year ago. The patient appealed to private clinic. Treatment: Cipro-let 2,5 % eye drops, Chloramphenicol 0,25 % eye drops and Tetracycline eye ointment. Despite the treatment photophobia, tearing, pain had intensified and vision acuity had declined.
At the Fig. 1-4 optical coherent tomography of left eye clearly shows the depth and borders of the defect of cornea before and after treatment.
OBJECTIVE: OD - calm. OS - blepharospasm, tearing, photophobia, mixed injection, edematous cornea, infiltrate 4x4 mm in the optical zone. Infiltrate is grayish color with irregular density and rise above the surrounding tissue. The cornea is edematous around the infiltration. Vis = OD - 1,0; OS - 0,09 not corrected. Tonometry OD / OS = 16/15 mm Hg.
BACTERIOLOGICAL STUDY: The inoculation of corneal scraping had revealed Candida spp. The optical coherence tomography of cornea had done at the 1st,
Patient: Karamov, Kahramon
Patient ID: -Diagnosis: -
IR 20* ART ♦ OCT 15° (8.3 mm) ART (8> Q: 33 fHRI
DOB: Dec/12/1966
Exam.: Aug/27/2012
Comment: -
Fig. 1. General view of the anterior optical coherence tomography.
Fig. 2. Anterior optical coherence tomography at the 1-st day. The borders and depth of defect
of cornea is clearly visible.
Fig. 3. Anterior optical coherence tomography at the 5-th day. The corneal defect is decreased
diagnostic method for assessment of anterior eye statement in patients with fungal corneal ulcer which allows the disease monitoring and verification of the depth and length of corneal defect.
2. Optical coherence tomography allows estimating the state of the anatomical structures of the eye (Des-cemet’s membrane, the angle of the anterior chamber, iris, lens) in cornea opacity.
Literature
1. Maychuk Y F. Clinical forms of keratomicosis. Diflucan in modern therapy / Y F. Maychuk // Refractive surgery and ophthalmology. - 2004. - № 1. - S. 44-48.
2. Sarodia U. Visualisation of aqueous shunt position and patency using anterior segment optical coherence tomography / U. Sarodia [et at.] // Am. J. Ophthalmol. - 2007. - Vol. 143. - P 1054-1056.
3. Suzuki K. A case of hypertrophic pachymeningitis impeding differential diagnosis of mycosis of orbital apex syndrome / K. Su-zuki,Y Suzuki, Y Yokoi [et at.] // Nippon Ganka Gakkai Zasshi. - 2010. - Vol. 114(8). - P 687-91. Japanese.
4. Karelin D. A. The success of medical mycology / D. A. Karelin. - 2005. - P 122.
5. Sergeev A. Y Mycotic infection / A. Y Sergeev, Y V. Sergeev. - M.: Bionom press. - 2004. - P 3.
5th and 10th day. OCT of the left eye had defined the borders and depth of the corneal defect.
Thus, the presented clinical case demonstrates the possibility of the anterior optical coherence tomography as a diagnostic method for assessing the dynamics of cornea measurements.
Conclusion.
1. Optical coherence tomography is high informative, contactless, reliable, accurate, noninvasive
УДК 617. 713-002. 44-073-08
ОЦІНКА РОЛІ ОПТИЧНОЇ КОГЕРЕНТНОЇ ТОМОГРАФІЇ ПРИ КЕРАТ0МІК03АХ
Абдуллаєв Ш. Р.
Резюме. В сучасній офтальмології оптична когерентна томографія відіграє важливу роль в діагностиці кератомікозів, оскільки оцінює ступінь ураження рогівки, а саме його глибину, площу, стан передньої камери при грибкових ураженнях рогівки. Особливе значення надається даним оптичної когерентної томографії при оцінці динаміки лікування кератомікозів.
Ключові слова: кератомікози, когерентна томографія.
УДК 617. 713-002. 44-073-08
ОЦЕНКА РОЛИ ОПТИЧЕСКОЙ КОГЕРЕНТНОЙ ТОМОГРАФИИ ПРИ КЕРАТОМИКО3АХ
Абдуллаев Ш. Р.
Резюме. В современной офтальмологии оптическая когерентная томография играет немаловажную роль в диагностике кератомикозов, так как оценивает степень поражения роговицы, а именно её глубину, площадь, состояние передней камеры при грибковых поражениях роговицы. Особенное значение придается данным оптической когерентной томографии при оценке динамики лечения кератомикозов.
Ключевые слова: кератомикозы, когерентная томография.
UDC 617. 713-002. 44-073-08
The Assessment of Optical Coherence Tomography Role in Keratomicosis
Abdullayev Sh. R.
Summary. The optical coherence tomography plays an important role in the in modern ophthalmology to diagnose keratomicosis and to assess the depth and area of corneal damage. Particularly, the most important thing is the evaluation of the dynamics of treatment in keratomicosis.
Key words: coherence tomography, keratomicosis.
Стаття надійшла 22. 01. 2013 p.
Рецензент - проф. Воскресенська Л. К.
