Офтальмохирургия (Oct 2015)
ESTIMATION OF EFFICIENCY OF COMPLEX TREATMENT OF OPTIC NEURITIS BY MAGNETIC RESONANCE TRACTOGRAPHY
Abstract
Purpose. To study the efficacy of complex treatment for optic neuritis using neuroprotectors according to magnetic resonance (MR) tractography findings.Material and methods. The study included 23 patients (31 eyes) with optic neuritis. They were divided into two groups of patients depending on the type of treatment. The control group consisted of 11 patients (15 eyes), who received a standard conservative therapy: anti-inflammatory, decongestants, desensitizing therapy. The patients of the main group (12 patients, 16 eyes) in addition to the above complex, received Cerebrolysin intravenously 10.0ml in 10ml of saline solution during 10 days, then Gliatilin (choline alfoscerate) in tablets 0.4gr 3 times per day for 2 months. The standard ophthalmic methods and special investigation methods were performed in all patients. The MR tractography was carried out using the magnetic resonance imaging BRIVO-355/1.5 Tesla GE (USA).Results. On admission to the hospital the visual acuity of the patients in both groups averaged 0.23±0.14, the total limit of visual field (TLVF) was mean 324.0±6.8є. As a result of performed therapy the main group of patients showed an increase in visual acuity up to 0.59±0.05 (p<0.05). In the control group the visual acuity was 0.38±0.04, which although were higher than basic data, but not statistically authentic. In the control group, the TLVF 1 month after the treatment increased in comparison with the initial data 1.17 times and was mean 382.4±7.2є. Dynamics of indices of the TLVF in the main group 1 month after the combined treatment with neuroprotectors showed an mean improvement 48.2±6.4є (increase of 1.54 times). After the performed therapy in the control group 7 patients preserved thinning in fibers of optic radiation, some rupture of fiber filaments of occipital forceps at the site of attachment to optic radiation were observed in 3 patients. In the main group after the neuroprotective therapy the relationship of the fibers of the optic tract was restored in 8 patients. Thinned fibers of occipital forceps at the site of attachment to the optic radiation was visualized within the norm after the treatment.Conclusion. 1. Method of magnetic resonance tractography allows to visualize non-invasively pathways of white matter and to assess an extent of their damage in inflammatory diseases of the optic nerve and tract. Changes on the MR tractography images indicate a damage in fibers from the optic tracts to the optic radiation, reflecting the degree of damage in different levels of the visual system. 2. Changes on MR tractography images in patients with optic neuritis can serve as objective criteria to evaluate the efficacy of the treatment method.
