Ultrasonografia oculo-orbitara in glaucom
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Transcript of Ultrasonografia oculo-orbitara in glaucom
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HEMODINAMICA ARTERELOR HEMODINAMICA ARTERELOR RETROBULBARE RETROBULBARE IIN GLAUCOMUL CU N GLAUCOMUL CU
UNGHI DESCHISUNGHI DESCHISevaluare ultrasonograficevaluare ultrasonograficaa
Georgeta MercuGeorgeta Mercut, t, Alexandru AndriAlexandru Andrittoiuoiu. . Florica BFlorica Baarjovanurjovanu
Spitalul Militar CraiovaSpitalul Militar Craiova, Romania, Romania
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INTRODUCEREINTRODUCERE
CDI a fost recent introdusCDI a fost recent introdusaa iin evaluarea n evaluarea pacienpacienttilor cu GUD ilor cu GUD ssi neuropatie optici neuropatie opticaa glaucomatoasglaucomatoasaa - rolul factorului vascular ca - rolul factorului vascular ca mecanism patogenic mecanism patogenic
a fost deja dovedita fost deja doveditaa o rela o relattie strie straansnsaa iintre ntre afectarea autoreglafectarea autoreglaarii circularii circulattiei retiniene iei retiniene ssi i crecressterea TIO >30 mmHgterea TIO >30 mmHg
existexistaa o cert o certaa rela relattie ie iintre severitatea bolii ntre severitatea bolii ssi i concluziile evaluconcluziile evaluaarilor Doppler regionale rilor Doppler regionale
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OBIECTIVEOBIECTIVE
evaluarea caracteristicilor hemodinamice evaluarea caracteristicilor hemodinamice retrobulbare la un lot de pacienretrobulbare la un lot de pacientti cu GUD i cu GUD iin n diferite stadii de evoludiferite stadii de evoluttie - prin metoda ie - prin metoda Doppler spectral Doppler spectral
stabilirea unor corelastabilirea unor corelattii ii iintre parametrii ntre parametrii spectrali spectrali ssi TIOi TIO
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METODA DE STUDIUMETODA DE STUDIU
Identificarea prin CDI Identificarea prin CDI ssi Doppler spectral a i Doppler spectral a arterelor retrobulbare (A.Oft, ACR, ACSP)arterelor retrobulbare (A.Oft, ACR, ACSP)
Evaluarea parametrilor spectraliEvaluarea parametrilor spectrali IP indexul de pulsatilitateIP indexul de pulsatilitate RI indexul de rezistenRI indexul de rezistentata S velocitatea sistolicS velocitatea sistolicaa maxim maximaa (m/s) (m/s) D velocitatea end-diastolicD velocitatea end-diastolicaa (m/s) (m/s) S/D raportul velocitS/D raportul velocitatatilor sistolicilor sistolicaa ssi i
diastolicdiastolicaa TAMx velocitatea medie (m/s)TAMx velocitatea medie (m/s)
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LOTUL DE STUDIULOTUL DE STUDIU
N 14 pts (28 ochi) confirmaN 14 pts (28 ochi) confirmatti cu GUDi cu GUD VVaarsta 66.78+/-9.8 ani (45-80)rsta 66.78+/-9.8 ani (45-80) Sex M/FSex M/F:: 1.3 1.3 TIO 26+/-10.4 (20-52 mmHg)TIO 26+/-10.4 (20-52 mmHg) TIO > 30 mmHg 17.9% TIO > 30 mmHg 17.9%
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REZULTATEREZULTATEPARAMETRI SPECTRALI AI A. OFTALMICE PARAMETRI SPECTRALI AI A. OFTALMICE IIN N GUD (N=28 ochi)GUD (N=28 ochi)
PIPI RIRI SS
(m/s)(m/s)
DD
(m/s)(m/s)
S/DS/D TAMx TAMx
(m/s)(m/s)
MEDIAMEDIA 1.581.58 0.810.81 0.440.44 0.090.09 4.94.9 0.220.22
DEV.STDDEV.STD 0.330.33 0.190.19 0.180.18 0.050.05 1.561.56 0.090.09
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A. OFTALMICA. OFTALMICaa - PROFIL SPECTRAL - PROFIL SPECTRAL
Parametrii de velocitate Parametrii de velocitate ssi de rezisteni de rezistentata sunt sunt i in limite normale (TIO - 26 n limite normale (TIO - 26 mmHg)mmHg)
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PARAMETRI SPECTRALI AI ARTEREI PARAMETRI SPECTRALI AI ARTEREI CENTRALE A RETINEI (ACR)CENTRALE A RETINEI (ACR)
PIPI RIRI SS
(m/s)(m/s)
DD
(m/s)(m/s)
S/DS/D TAMxTAMx
(m/s)(m/s)
MEDIAMEDIA 1.731.73 0.810.81 0.090.09 0.0280.028 6.176.17 0.080.08
DEV.STDDEV.STD 0.490.49 0.090.09 0.030.03 0.0120.012 2.352.35 0.0270.027
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ACR - PROFIL SPECTRALACR - PROFIL SPECTRAL
Velocitatea diastolicVelocitatea diastolicaa este redus este redusaa iar indicii de rezisten iar indicii de rezistentata (PI (PI sisi RI) sunt semnificativ crescuRI) sunt semnificativ crescutiti. TIO=26mmHg. TIO=26mmHg
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PARAMETRI SPECTRALI AI ARTEREI PARAMETRI SPECTRALI AI ARTEREI CILIARE SCURTE POSTERIOARE (ACSP) - CILIARE SCURTE POSTERIOARE (ACSP) - RAM NAZALRAM NAZAL
PIPI RIRI SS
(m/s)(m/s)
DD
(m/s)(m/s)
S/DS/D TAMxTAMx
(m/s)(m/s)
MEDIAMEDIA 1.551.55 0.780.78 0.110.11 0.030.03 4.574.57 0.080.08
DEV.STDDEV.STD 0.490.49 0.080.08 0.020.02 0.010.01 2.12.1 0.0380.038
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ACSP - PROFIL SPECTRALACSP - PROFIL SPECTRAL
Velocitatea diastolicVelocitatea diastolicaa este redus este redusaa iar indicii de rezisten iar indicii de rezistentata (PI (PI sisi RI) semnificativ crescuRI) semnificativ crescutiti. TIO=26 mmHg. TIO=26 mmHg
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INDEXUL DE PULSATILITATE INDEXUL DE PULSATILITATE (GUD vs Normali)(GUD vs Normali)
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
A.Oft ACR ACSP
PI-normaliPI-GUD
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INDEXUL DE REZISTEN|{INDEXUL DE REZISTEN|{ (GUD VS Normali) (GUD VS Normali)
0.66
0.68
0.7
0.72
0.74
0.76
0.78
0.8
0.82
A.Oft. ACR ACSP
RI-normaliRI-GUD
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VELOCITATEA SISTOLICVELOCITATEA SISTOLICAA (GUD vs Normali) (GUD vs Normali)
00.05
0.1
0.150.2
0.250.3
0.35
0.40.45
0.5
A.Oft ACR ACSP
S-normaliS-GUD
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VELOCITATEA DIASTOLICVELOCITATEA DIASTOLICAA(GUD vs Normali)(GUD vs Normali)
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
A.Oft ACR ACSP
D-normaliD-GUD
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RAPORTUL S/DRAPORTUL S/D(GUD vs Normali)(GUD vs Normali)
0
1
2
3
4
5
6
7
A. Oft ACR ACSP
S/D-normaliS/D-GUD
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TAMx TAMx (GUD vs Normali)(GUD vs Normali)
0
0.05
0.1
0.15
0.2
0.25
A. Oft ACR ACSP
TAMx-normaliTAMx-GUD
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LOT TIO >30 mmHgLOT TIO >30 mmHg PARAMETRI SPECTRALI AI A. OFTALMICEPARAMETRI SPECTRALI AI A. OFTALMICE
PIPI RIRI SS
(m/s)(m/s)
DD
(m/s)(m/s)
S/DS/D TAMxTAMx
(m/s)(m/s)
MEDIAMEDIA 1.461.46 0.750.75 0.510.51 0.120.12 4.24.2 0.260.26
DEV.STDDEV.STD 0.270.27 0.670.67 0.140.14 0.040.04 0.830.83 0.080.08
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LOT TIO > 30 mmHgLOT TIO > 30 mmHgPARAMETRI SPECTRALI AI ACRPARAMETRI SPECTRALI AI ACR
PIPI RIRI SS
(m/s)(m/s)
DD
(m/s)(m/s)
S/DS/D TAMxTAMx
(m/s)(m/s)
MEDIAMEDIA 1.851.85 0.890.89 0.090.09 0.020.02 6.26.2 0.0830.083
DEV.STD.DEV.STD. 0.450.45 0.060.06 0.0070.007 0.0020.002 1.821.82 0.0240.024
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LOT TIO > 30 mmHgLOT TIO > 30 mmHgPARAMETRI SPECTRALI AI ACSPPARAMETRI SPECTRALI AI ACSP
PIPI RIRI SS
(m/s)(m/s)
DD
(m/s)(m/s)
S/DS/D TAMxTAMx
(m/s)(m/s)
MEDIAMEDIA 1.951.95 0.830.83 0.0950.095 0.0230.023 4.164.16 0.0380.038
DEV.STDDEV.STD 0.440.44 0.070.07 0.0130.013 0.0050.005 0.680.68 0.0130.013
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CORELACORELATTII STATISTICEII STATISTICE
TIO >30 mmHg se coreleazTIO >30 mmHg se coreleazaa cu modific cu modificaarile rile hemodinamice depistate la Doppler spectral hemodinamice depistate la Doppler spectral iin ACR n ACR ssi ACSP i ACSP ssi nu la nivelul A. oftalmice.i nu la nivelul A. oftalmice.
CorelaCorelattii:ii: TIO - RI ACR TIO - RI ACR r r = 0.89= 0.89 TIO - S/D ACR TIO - S/D ACR r r = 0.40= 0.40 TIO - RI ACSP TIO - RI ACSP r r = 0.66= 0.66 TIO - S ACSP TIO - S ACSP r r = 0.78= 0.78 TIO - D ACSP TIO - D ACSP r r = 0.74= 0.74
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CONCLUZIICONCLUZII
GUD asociazGUD asociazaa modific modificaari hemodinamice detectabile ri hemodinamice detectabile prin analiza Doppler spectralprin analiza Doppler spectralaa a arterelor retrobulbare a arterelor retrobulbare
Principalele modificPrincipalele modificaari hemodinamice constau ri hemodinamice constau iin:n:
- sc- scaaderea velocitderea velocitatatii sistolice ii sistolice
- sc- scaaderea velocitderea velocitatatii diastoliceii diastolice
- sc- scaaderea TAMxderea TAMx
- cre- cressterea PI terea PI ssi RIi RI Aceste modific[ri sunt accentuate Aceste modific[ri sunt accentuate iin GUD hipertensiv n GUD hipertensiv
(TIO> 30 mmHg) (TIO> 30 mmHg) ssi pot fi estimate ca o mi pot fi estimate ca o maasursuraa a a severitseveritatatii boliiii bolii