Metabolic angiopathy of the neck vessels. Retinal angiopathy: a disease that should not be started. The causes of angiopathy. Symptoms

Angiopathy is a complex compound term. But it does not mean a disease, but a morphological syndrome. Nobody comes to the doctor with a complaint of "angiopathy". Therefore, this state must be found, and thus its existence must be proved.

• Translated from the medical language, "angio" + "pathos" means disease or, literally, vascular suffering.

Vessels are found in all, with few exceptions, human organs and tissues. Even the vessels themselves have the smallest vessels feeding them. After all, the blood that flows through them inside cannot nourish the vessel itself. For this there are the smallest vasa vasorum, or "vessels of the vessels."

The provision of tissue with a vasculature is called vascularization. There are no vessels at all in the articular cartilage so that they do not interfere with movement, as well as in the transparent, light-refracting optical media of the eye.

But already very close, in the region of the posterior pole of the eyeball, there is an amazing structure - the retina, or the retina of the eye. It perceives light - the energy of photons falling on it is transformed into chemical reactions, and then into an electrical impulse, which instantly rushes to the brain. Moreover, the cells that perceive light and color differ from each other.

They are called rods and cones. In addition to them, the retina contains many auxiliary cell types. And, of course, the blood supply to this most important area (and after all, through sight we get most of the information about the world around us) must be at a high level.

But sometimes this vasculature begins to lose its function. What, from a medical point of view, is retinal angiopathy?

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Retinal angiopathy - what is it?

Retinal angiopathy is a pathological condition caused by a dysregulation of the nervous tone of the retinal vessels and other reasons in which blood circulation is impaired, and changes appear in the fundus.

It is important that in almost 100% of cases there is a symmetrical lesion - retinal angiopathy in both eyes. This suggests that the reason lies not in the eye, but in the general suffering of the body. But if a pathology is detected in one eye, but not in the other, then this is more likely an ophthalmological, neurological or even neurosurgical problem.

It should not be surprising that it is precisely the nervous regulation of vascular tone that underlies angiopathy. After all, trophism, that is, tissue nutrition, depends on the work of the autonomic nervous system. And it is a "target" for various vascular damaging factors.

• It should be said that angiopathy of the vessels of the eyes is the "tip of the iceberg".

The fact is that the study of the fundus in a dark room, or with the help of a modern ophthalmoscope, is a unique opportunity to see a functioning "piece" of a person's vascular bed without any opening, dissection of tissues, and without any interference in the process. It is enough just to look through the pupil into the eye.

This is not possible in other organs. Therefore, a patient who has found this phenomenon can immediately be referred to a risk group, for example, for angiopathy of the vessels of the kidneys. What are the reasons for the appearance of vascular disorders in the retina?

About the causes of angiopathy

In addition to the disorder of vegetative - trophic influences on blood vessels, there are the following reasons:

• Manifestations of cervical osteochondrosis, in which there is a temporary reduction in blood flow, including in the retina;
• Injury (concussion or contusion of the brain);
• Syndrome of intracranial hypertension (it is caused by increased cerebrospinal fluid pressure, as a result of its excessive production, or insufficient absorption, or occlusion of the cerebrospinal fluid flow);
• Bad habits, especially smoking, which is always very harmful to blood vessels;
• Old age itself is an unmodifiable factor in the development of angiopathy;
• Diseases of the blood (thalassemias, hemolytic anemias, microspherocytosis and others);
• Toxic effects at work;
• Chronic arterial hypertension, or essential hypertension, is one of the most common causes of retinal angiopathy;
• Chronic autoimmune diseases leading to vascular damage (vasculitis).

As you can see, the list of reasons is quite long. But, despite all their diversity, there are not so many options for the development of this disease. In total, there are five separate types of development of angiopathy.

Types of angiopathy - features

The most convenient is a mixed classification, which reflects the most common variants of pathological changes in blood vessels. The following types of damage are encountered:

Diabetic angiopathy. The mechanism of its development is that the nerves that control the vascular tone “fail”, since hyperglycemia causes polyneuropathy, including in the retina. As a result, blood flow decreases, thrombosis of small vessels occurs. All this leads to diabetic blindness;

Hypertensive retinal angiopathy. It is very common, especially in old age. It develops with a sufficient experience of arterial hypertension. In the initial stages of the disease, it is not determined;

Hypotonic variant of angiopathy. Opposite to hypertensive. The tone of the small vessels of the retina is reduced, and as a result, their overflow with blood develops, the blood flow rate decreases. As a result, favorable conditions arise for the formation of blood clots;

Traumatic variant of angiopathy. It is associated with vascular compression of large vessels supplying the retina at a considerable distance from it;

Juvenile, or a youthful option. The most unfavorable in terms of prognosis for vision. Perhaps the development of cataracts or increased intraocular pressure - glaucoma.

Unlike previous types, this option is characterized by frequent hemorrhages, both in the retina and in the vitreous, and the addition of an inflammatory component. In this case, angiopathy of the retinal vessels can lead to its detachment, especially against the background of high intraocular pressure.

Angiopathy symptoms

Of course, most of the symptoms relate to the function of the organs of vision:

• there is a "cloudiness" before the eyes;
• reduced visual acuity with the progression of myopia;
• the appearance of photopsies - "flies", "lightning" before the eyes.

In the event that the process of angiopathy is associated with a systemic vascular process - for example, vasculitis - then there may be nosebleeds, other types of hemorrhages, disorders in the vessels of the lower extremities.

Of course, one of the main consequences of retinal angiopathy is its degeneration.

Retinal angiopathy in a child

The detection of this pathology in a child is always of great concern to parents. Just like that "from scratch", it cannot arise.

Retinal angiopathy in both eyes in a child is often the result of a difficult pregnancy, placental insufficiency, and threatening birth asphyxia.

But nevertheless, the most common reason for the appearance of this pathology in newborns and in children under the age of one year is intrapartum (intranatal) trauma, as well as the development of intracranial hypertension syndrome, which can be determined by bulging fontanelles and anxiety of the baby.

Parents who are concerned about feeding problems and visits to a pediatrician, vaccinations, often 2 forget 2 to examine the fundus of the baby. And this is exactly the study that can quickly and painlessly determine the presence of angiopathy and allow you to start timely treatment.

Treatment of angiopathy - drugs and methods

On the Internet you can often read that “having discovered angiopathy,” the doctor immediately prescribes drugs. This, of course, is correct, but for some reason they forget that without correction of the underlying disease, no drug will achieve the desired effect.

So, with diabetes mellitus, normoglycemia must be achieved, or the blood sugar figures must be reduced as much as possible. In case of hypertension, a mandatory correction of blood pressure is required. And only then drugs are prescribed. These include:

1. Drugs that improve microcirculation ("Trental", "Pentoxifylline");
2. Eye drops are prescribed, which locally affect the regeneration processes;
3. Shown are the infusion of antioxidant drugs that improve the metabolism of nerve tissue "Berlition", drugs of alpha - lipoic acid;
4. Neuroprotective drugs (Cytoflavin, Cavinton)

Retinal angiopathy, the treatment of which is carried out without reducing the level of intracranial and intraocular pressure (if necessary), is doomed to failure, since the main pathological mechanisms will continue to operate. In addition, physiotherapy is required.

In some cases, parabulbar injections are indicated, and in severe forms of angiopathy, in which retinal detachment occurs, surgical treatment is indicated.

Forecast

In the event that angiopathy is diagnosed at a stage that does not cause visual disturbances, then the prognosis for eye function is favorable.

In the event that the condition worsens for the underlying disease (most often, diabetes, especially the first type) or hypertension (a crisis occurs) - you need to conduct frequent examinations with an ophthalmologist, and conduct preventive treatment of retinal angiopathy even before it begins increased complaints. Of course, along with this, all attempts should be made to stabilize the patient's condition.

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As a rule, this condition is more common in old age. Retinal angiopathy - what is it, how does it occur and in what diseases does it occur? Let's talk about this in more detail.

The essence of pathology and its danger

It should be noted that retinal angiopathy is not an independent diagnosis. This is the name of the process that takes place in the vessels and leads to insufficient blood flow. Most often, this angiopathy is systemic in nature and occurs in many diseases, which will be discussed below. In almost 100% of cases, we are talking about retinal angiopathy in both eyes.

In rare cases, when signs of angiopathy appear on only one side, a person needs consultation with an ophthalmologist or vascular neurosurgeon, since the asymmetric process indicates local problems: thrombotic lesions of retinal vessels, tumor process and other disorders.

Types of angiopathy of the eye

This condition can be classified in many different ways. The most accessible for understanding are two classification options: according to the gradient of arterial pressure and according to the defeat of individual links of the vascular bed.

So, according to the difference in pressure, they distinguish:

• Hypertensive retinal angiopathy. As a rule, this option is accompanied by a disease of essential hypertension. The second reason is symptomatic cerebral arterial hypertension, in which the pressure in the cerebral vessels rises. A characteristic sign of this disorder is the appearance of punctate hemorrhages (hemorrhages) in the retinal tissues. As a compensatory mechanism, blood pressure can rise in pregnant women in the 2nd and 3rd trimesters, which contributes to the development of functional hypertensive retinal angiopathy. After giving birth, it goes away on its own. Retinal angiopathy associated with hypertension occurs most often in old age.
• Hypotonic retinal angiopathy. This type of vascular tone disorders is much less common and is manifested by a significant overflow of vessels, especially small ones, with blood, a decrease in the tone of the vascular wall, and the presence of stagnant manifestations in the fundus. A complication can be a thrombotic process occurring in the vessels, as well as their pronounced pulsation. This type often accompanies the course of arterial hypotension, that is, it develops in people with a tendency to low blood pressure.

They also distinguish between venous and arterial retinal angiopathy. This division is for the most part conditional. The division into arterial and venous angiopathy appeared on the basis of examination data, in which one can immediately see the lesion of one or another section. But this classification does not affect the treatment and prognosis.

Finally, you can come across the term retinal neuroangiopathy - what is it? The retina itself, despite its complex structure, consists mostly of nervous tissue: after all, the peripheral part of the visual analyzer consists of rods that receive light and cones that are responsible for color vision. Therefore, all vessels supplying the retina provide nerve tissue. For this reason, the diagnosis of neuroangiopathy refers to angiopathy, in which there may be certain visual disturbances, such as flies before the eyes or colored spots.

Causes of angiopathy

Most often, hypertensive retinal angiopathy develops.

Many conditions and diseases can be its source, for example:

• arterial hypertension (hypertension);
• intracranial hypertension syndrome (increased intracranial pressure);
• functional disorders responsible for changes in vascular tone (for example, vegetative-vascular dystonia);
• smoking and alcohol abuse;
• consequences of craniocerebral trauma.

Old age is also an unmodifiable factor; it automatically indicates an increased risk of angiopathy.

A special type of pathology is diabetic retinoangiopathy. It appears when the patient has diabetes mellitus. The damaging factor is the high content of glucose, which damages blood vessels.

Diabetic retinal angiopathy develops most rapidly in insulin-dependent diabetes mellitus, or type 1 diabetes. In this case, defeat at a young age is possible, there are cases of diabetic cataract with subsequent blindness at the age of up to 20 years.

In type 2 diabetes, this condition develops in old age. Often, by this time, the patient already has a background angiopathy of the retina, on which new symptoms are superimposed, characteristic of diabetic vascular disorders.

Other causes of angiopathy development can be systemic lesions of blood vessels and blood diseases: periarteritis nodosa, thrombocytopenic purpura, Vakez disease or erythremia. Sickle cell anemia or autoimmune disorders can also cause this condition.

Symptoms and Diagnosis

The signs of retinal angiopathy are nonspecific, that is, they can exist in different diseases. So, when it is detected and the subsequent diagnosis of diabetes mellitus, they begin to treat the underlying disease. As a result of correct tactics, the symptoms of angiopathy decrease and disappear altogether.

These include the following complaints:

• deterioration of vision, the appearance of fog, flies before the eyes;
• the occurrence of headaches;
• regular nosebleeds;
• transient ischemic attacks with the development of neurological symptoms and their complete disappearance within a day.

Symptoms such as severe pain in the joints of the legs or recurrent hematuria (blood in the urine) and swelling, bruising and hemorrhages, and even trophic ulcers, cause a certain concern. It would seem that this is all far from the eyes. In fact, retinal angiopathy, the symptoms of which we have considered, is just the tip of the iceberg. All vessels in the body, which simply cannot be seen, are affected.

Treatment

First of all, the diagnosis must be carefully carried out and the main diagnosis made, since, not knowing the true cause, you can only slightly improve the condition. Treatment of retinal angiopathy without regard to etiology is doomed to failure. So, in diabetes mellitus, the main condition is to stop the increase in blood sugar levels and reduce it to normal, since it is the high concentration of glucose that affects the vessels.

The basic principles of therapy are as follows:

• improvement of microcirculation in capillaries. For this, Trental, Pentoxifylline are used;
• multivitamin and mineral complexes, the appointment of B vitamins - thiamine, pyridoxine;
• the use of alpha lipoic acid (berlition) as an antioxidant;
• low-carbohydrate diet and glucose-lowering therapy for diabetes;
• weight loss;
• rejection of bad habits;
• normalization of blood pressure levels;
• the fight against peripheral edema;
• lowering blood cholesterol levels, bringing the atherogenic index back to normal.

The selection of glasses, visual gymnastics and preventive supervision by an ophthalmologist are important factors.

Treatment of retinal angiopathy at the initial stage with folk remedies may bring some improvement. It must be remembered that there are no local remedies acting only on the vessels of the eyes. The treatment acts on the vessels of the whole body. In the treatment of angiopathy, herbal preparations are taken to lower blood pressure, soothing decoctions.

In conclusion, I would like to note that hypertensive retinal angiopathy is a marker of diseases that carry the risk of sudden death. It is known that heart attack and stroke are directly related to the course of arterial hypertension and atherothrombosis. Therefore, timely detection of angiopathy and the fight against atherosclerosis can not only prolong life, but also make its course full and joyful.

Useful video about retinal angiopathy

Angiopathy is a pathology of blood vessels that develops as a result of impaired nervous regulation. A decrease in the tone of blood vessels leads to disruption of their functioning, as well as a change in the structure of the vascular walls. The pathological process can be localized in different parts of the body or be generalized, it can affect blood vessels of various sizes. The progression of angiopathy leads to the development of irreversible changes in the body due to circulatory disorders.

The synonym is vasopathy.

Angiopathy - damage to blood vessels due to a disorder of nervous regulation

Causes and risk factors

At the heart of the pathological process in the vessels is a disorder of neuroregulation, leading to a violation of vascular tone, paresis and spasms of micro- and sometimes macrovascular. There can be many reasons for the development of neuroregulatory disorders.

The main risk factors for all forms of angiopathy:

• congenital features of the walls of blood vessels;
• diseases of the hematopoietic system;
• metabolic disorders;
• traumatic injury;
• overweight;
• elderly age;
• the presence of bad habits;
• passive lifestyle.

The development of angiopathy in patients with diabetes mellitus is a natural process, which leads to the progression of the disease. Diabetic angiopathy occurs against the background of inadequate treatment of diabetes mellitus, it is promoted by uncompensated metabolic disorders, deterioration of oxygen supply to tissues, as well as hormonal changes that aggravate metabolic disorders and contribute to the development of pathological processes in the vascular wall.

The risk factors for the development of angiopathy of the lower extremities, in addition to diabetes mellitus, include:

• pathological processes in the brain, spinal cord, as well as in peripheral nerves, leading to a violation of the innervation of the vessels;
• vascular lesions of the microvasculature of the legs in autoimmune diseases;
• arterial hypo- and hypertension with the development of hyalinosis of the vessel walls;
• hypothermia of the lower extremities;
• industrial hazards (in particular, exposure to the body of toxic substances, vibration disease).

The progression of angiopathy leads to the development of irreversible changes in the body due to circulatory disorders.

Retinal angiopathy develops against the background of osteochondrosis of the cervical spine, presbyopia of the eyes (impaired focus of vision on closely spaced objects, which is associated with natural age-related changes).

Hypertensive retinal angiopathy in the early stages is asymptomatic or has mild symptoms. Patients experience a slight decrease in visual acuity, the appearance of glare, flashes, lines and / or dots before the eyes.

With the progression of hypertensive angiopathy, the following are noted:

• frequent bleeding in the eye;
• expansion of the veins of the fundus;
• a significant decrease in visual acuity (up to blindness);
• narrowing of the visual fields;
• regular headaches;
• frequent nosebleeds;
• detection of blood impurities in urine, feces;
• increased irritability, emotional instability, anxiety;
• disorders of attention and memory;

Changes in blood vessels are reversible with normalization of blood pressure.

Angiopathy of the cerebral vessels is manifested, first of all, by persistent headaches, possibly a violation of orientation in space, hallucinations.

With arterial angiopathy, cardiac disorders, thrombus formation are observed.

Diagnostics

The use of certain diagnostic methods depends on the form of angiopathy. Most often, they resort to contrast x-ray examination of blood vessels (angiography).

Diagnosis of angiopathy of the lower extremities includes the following methods:

• rheovasography- functional diagnostics of the vessels of the extremities, which makes it possible to assess the state of venous and arterial blood flow;
• capillaroscopy- non-invasive examination of capillaries;
• ultrasound examination of the vessels of the lower extremities with duplex scanning;
• thermal imaging- the image is obtained by registering thermal radiation from organs, which allows you to get an idea of ​​the blood circulation in them, and therefore the function of the vessels;
• arteriography- X-ray contrast study of the arteries.

The main methods for diagnosing retinal angiopathy include direct and indirect ophthalmoscopy (an instrumental method for examining the fundus).

Cerebral angiopathy is diagnosed using computed or magnetic resonance angiography of the cerebral vessels.

A complication of cerebral angiopathy can be a significant decrease in the quality of life due to intense and prolonged attacks of headache, stroke.

Treatment

Treatment of angiopathy consists, first of all, in the treatment of the underlying disease and / or the elimination of unfavorable factors that caused the development of angiopathy.

The condition for the successful treatment of diabetic angiopathy is the compensation of the underlying disease, that is, the normalization of metabolism. One of the main methods of treatment is diet therapy - easily digestible carbohydrates are excluded from the diet, the total amount of carbohydrates and animal fats is reduced. If necessary, potassium preparations, angioprotectors, antispasmodics and anticoagulants are prescribed. In the presence of severe ischemia of the lower extremities, gravitational plasmapheresis is shown, which helps to cleanse the blood, reduce ischemic pain, and also speed up wound healing. In addition, a set of exercises for medical gymnastics is prescribed.

Angiopathy of the lower extremities can be treated with both conservative and surgical methods, depending on the severity. Conservative therapy consists in the appointment of vasoactive drugs, drugs that improve blood circulation, normalizing the tone of the vascular wall.

Surgical treatment of macroangiopathy of the lower extremities consists in prosthetics of the affected blood vessels. In some cases (advanced stage, severe intoxication, gangrene), the lower limb is amputated. The level of amputation is set depending on the viability of the tissues of one or another part of the lower limb.

In the treatment of hypertensive angiopathy, the normalization of blood pressure is of primary importance. The administration of vasodilating drugs, diuretics is shown.

With retinal angiopathy, drugs are prescribed that improve microcirculation and tissue metabolism.

In addition to the main treatment, physiotherapy is often prescribed. Laser therapy, magnetotherapy, acupuncture, and therapeutic mud are effective.

Possible complications and consequences

Retinal angiopathy can be complicated by glaucoma, cataract, retinal detachment, optic nerve atrophy, partial or complete loss of vision.

Against the background of severe angiopathy of diabetic etiology, diabetic foot syndrome, gangrene, as well as intoxication of the body with a high risk of death develop.

Arterial angiopathy is complicated by the formation of blood clots, the development of angina attacks, and myocardial infarction.

Hypertensive angiopathy occurs against the background of severe hypertension, as well as a genetic predisposition to this pathology.

A complication of cerebral angiopathy can be a significant decrease in the quality of life due to intense and prolonged attacks of headache, stroke.

Forecast

The prognosis for various forms of angiopathy largely depends on the timeliness of the initiation of treatment, as well as on the patient's compliance with the doctor's prescriptions.

With timely adequate treatment of diabetic angiopathy of the lower extremities, as a rule, it is possible to avoid the development of gangrene and amputation. In the absence of the necessary treatment, gangrene develops in about 90% of cases of diabetic angiopathy within five years from the onset of the pathological process. Mortality in such patients is 10-15%.

With the right treatment of retinal angiopathy, the prognosis is usually good. The prognosis worsens with the development of the pathological process in pregnant women. During childbirth, the patient may experience a complete loss of vision, for this reason, a cesarean section is indicated for such patients.

Prophylaxis

In order to prevent the development of angiopathy, it is recommended:

• dispensary observation of patients with concomitant diseases who are at risk of developing angiopathy;
• correction of excess weight (especially in patients with diabetes mellitus);
• rejection of bad habits;
• sufficient physical activity;
• avoiding excessive physical exertion;
• avoidance of stressful situations.

YouTube video related to the article:

Retinal angiopathy in most cases affects both eyes. Modern diagnostic methods make it possible to identify pathology at an early stage. It is important to notice the first symptoms, which, among other things, we will discuss in this article.

Retinal angiopathy is clearly diagnosed using ophthalmoscopy, the result of which is shown in the picture

Angiopathy is a pathological condition of the vessels located in the fundus, which is characterized by a violation of their tone. The vessels have a convoluted course, they can be simultaneously narrowed and expanded. As a result, there is a failure in blood supply as well as nervous regulation.

Such a picture on the fundus is not something isolated, for example, ICD-10 does not distinguish retinal angiopathy as a separate nosological unit, considering it in the complex of the background disease in which it is observed.

The retina is very thin and well vascularized, therefore it is highly sensitive to metabolic disturbances in the body, and in most cases one of the first is affected in some diseases occurring with metabolic failure.

Causes of pathology

This condition is considered polietiologic, since a wide range of diseases can be complicated by damage to the vessels of the fundus. More susceptible to this are those who are over 30 years old, which is explained by a gradual increase in the incidence of general somatic diseases.

The etiological factors are:

• essential or symptomatic arterial hypertension;
• diabetes;
• systemic vasculitis;
• hematological diseases;
• toxic effects;
• disorders of nervous regulation;
• osteochondrosis of the cervical spine;
• bad habits;
• eye and neck injuries;
• conditions with increased intracranial pressure,
• congenital vascular pathologies of the retina.

Types of retinal angiopathy

Due to the important distinctive features of the course of angiopathy in some diseases, it is advisable to separate them into a separate type. Below will be considered the stages, course options and morphological changes in the fundus in certain types of angiopathy.

Hypertensive

The picture shows the anatomy of the retina, its microscopic structure

With this type of angiopathy, its consequence is damage to the vessels of the eye by increased pressure of the arterial bed, which can be a manifestation of both essential hypertension and symptomatic hypertension due to certain diseases, for example, such as thyrotoxicosis, glomerulonephritis, etc.

Secondary hypertension, as a rule, proceeds more aggressively than hypertension, therefore it leads to dystrophic changes in blood vessels faster.

The process is characterized by a staged course. Consider their ophthalmoscopic signs:

1. The initial stage of angiopathy proceeds with narrowing of the arteries, which is a compensatory physiological protective response to increased pressure in the capillary, and a simultaneous expansion of the veins, which have increased tortuosity.
2. In the future, the vessel wall begins to lose its elasticity, due to its ischemia, since oxygen is delivered worse to the spasmodic artery, through the so-called its own vessels (vasa vasorum). This activates the process of fibrosis of the middle choroid. The venous bed expands even more and a pronounced stagnation of blood develops in it.
3. The progression of the process leads to the transition to the stage. When small hemorrhages appear on the surface of the retina, as a result of which it becomes saturated with blood and gradual destruction.
4. The last stage is called neuroretinopathy, since dystrophic changes are transferred to the optic nerve tissue, causing its edema, and subsequently - atrophy.

Only if arterial hypertension is relieved at the initial stage of angiopathy, the reverse development of pathological changes in the fundus and natural restoration of vision is possible.

Diabetic

Laser coagulation of the retina is one of the most effective and safe interventions to prevent the progression of angiopathy

The most common variant of angiopathy, which often develops within 8-10 years after the onset of the disease, if there is no competent therapy. With this pathology, a complex lesion of the vessels of the microvasculature occurs throughout the body.

In diabetes, processes in the retina also develop in stages:

1. Non-proliferative stage. The retinal vessels are so affected that their walls become thinner and, unable to withstand the blood pressure, burst. At this stage, edema of the macular region already occurs, which is noted when examining the fundus. It is difficult to recognize the disease at this stage, but it is very important, since the treatment will be most effective. The patient may be worried about a slight deterioration in vision and injection of the sclera.
2. Preproliferative. The veins of the retina are most affected by changes, their ducts expand, and pathological tortuosity develops. Unable to withstand the tension, the venous vessels rupture, forming small hemorrhages, mixing with the lymphatic fluid, they form infiltrates.
3. Proliferation stage. It got its name from the formation of new vessels, which acts as a response to retinal ischemia and is aimed at improving the access of nutrients. The problem is the weakness of the walls of the newly formed capillaries. Hemorrhage is increasingly occurring, affecting the vitreous humor. Retinal tissue nutrition is aggravated up to it, which leads to irreversible loss of vision.

Under the condition of a well-chosen treatment, pathological changes in the retina are partially reversible only at the stage of preproliferation.

Hypotonic

It is characterized by a loss of vascular tone and, as a result, their expansion and tortuosity. In them, the blood flow rate decreases, the permeability of the walls increases.

This impairs microcirculation in the retina and leads to loss of visual function.

Traumatic

It occurs after injury to the head, eyes, cervical spine, chest compression.

These conditions contribute to a sharp increase in intracranial pressure, and so it grows sharply and the vessels are not "used" to such values ​​- they rupture and hemorrhagic saturation of the fundus.

Youthful

One of the rarest forms of angiopathy is called Eales disease. It affects young men, in most cases the process is bilateral. The etiology of the disease has not been studied. According to the latest studies in this area, in 2011, a relationship was found with an increase in the level of interleukins 6 and 10, as well as tumor necrosis factor in persons with this ailment.

If you look at the essence of the process, then the primary inflammatory reaction occurs near the venous vessels (periphlebitis), which ultimately leads to infiltration of the retina with white blood cells. This contributes to the aggravation of blood supply and the development of ischemic zones. The last stage in the course of the disease is neovascularization (the appearance of new vessels), as in diabetic angiopathy.

Congenital

This type is due to the underdevelopment of the wall of the vascular bed. Most often occurs in premature babies, or children with a pathological course of embryogenesis.

Under the competent supervision of an ophthalmologist, nothing threatens the baby's vision. However, we note that much depends on the degree of vascular damage in a particular situation.

Retina angiopathy symptoms

It is preferable to conduct a fundus examination with a digital ophthalmoscope, it minimizes the chance of an inaccurate result

Despite the diversity of the species composition of angiopathies, all patients present with similar complaints. The only difference is in the degree of their severity and the rate of increase.

Let's consider the main symptoms:

• blurred vision;
• small "flies" before the eyes;
• dropout of image fields;
• flashes, lightning in the eyes;
• decrease in the clarity of the perceived picture.

If you have a risk of developing one of the diseases that contribute to retinal damage, then listen to yourself very sensitively, since this may be one of the first manifestations of the underlying pathology.

Diagnostic methods

Making the correct diagnosis is often straightforward. The set of measures includes the identification of the underlying underlying disease, if it is not idiopathic angiopathy, as well as changes in the fundus.

You can examine the retina using:

1. (simple visual examination after instilling pupil-dilating drops);
2. ophthalmochromometry (the method is similar to ophthalmoscopy, however, its essence consists in the reflection of light waves from the retina);
3. coherent tomography;
4. ultrasound examination;

Tomography and angiography are more complex methods and are used either in cases when it was not possible to accurately establish changes in the fundus by simple methods, or when subsequent surgery is expected.

Treatment of angiopathy

The initial stages are easily treatable with the help of well-chosen medicines.

Therapy of this pathology consists of two directions: relief of the background disease, regression of changes in the fundus. Each of them is important in its own way and is impossible without the other.

To improve the condition of the retina, various drugs are used that have a beneficial effect on the vascular wall and microvasculature.

• Trental, Piracetam, Vasonit (effect on microcirculation).
• Parmidin, Calcium Dobezilate (improvement of vascular health).
• Aspirin, Clopidogrel (prevent blood clots).
• Taufon, Vizualon, Oftan-Katakhrom (eye drops, promote proper blood circulation in the vessels of the eye).

The medical method alone will help only patients with an early stage of the disease, in other cases the effect will only be in reducing the degree of progression of angiopathy.

Treatment of background pathology is reduced to the field of narrow medical specialists. Briefly, we note that patients with diabetes mellitus need to follow a low-carbohydrate diet and control glucose levels either with hypoglycemic drugs (Metformin, Glibenclamide, Glickvidon, etc.), or subcutaneous insulin injections.

Those who suffer from arterial hypertension are shown a comprehensive examination to exclude a secondary etiology of the disease. Therapy is reduced to constant monitoring of the blood pressure level by taking medications, among which there are several groups of pathogenetic effects. It is also important to follow a specific diet.

Never try to heal yourself. Diseases such as diabetes mellitus and essential arterial hypertension require competently selected and adjusted therapy, which can only be prescribed by a doctor.

The advanced stage of the angiopathy process can be eliminated only with the help of surgical intervention, which implies exposure to argon rays. At the moment, it has no alternative and is widely used to help patients regain their vision.

Prevention of vascular retinopathy

When the process is running, surgery is the only way to preserve vision.

The indisputable principle has long been known: "It is easier to prevent a disease than to cure!" Not everyone thinks it is advisable to follow the instructions of doctors before the onset of serious symptoms. But you need to accept the fact that no method has been developed more efficiently than prevention, and only it will help preserve your vision without health consequences.

Let's consider its main points:

1. People, especially in the 35-year-old category, need to undergo a medical examination annually with the obligatory measurement of blood pressure and glucose levels. For the older age category (after 50 years), an annual fundus examination by an ophthalmologist is also indicated.
2. If the patient already has a background disease, the doctor's recommendations on taking prescribed medications and the frequency of visits to control the course of the process should be strictly observed.
3. The use of multivitamin complexes for the eyes (Visiomax, Okovit, Focus, etc.) will provide comprehensive support for vision.
4. Quitting alcohol, smoking and other bad habits, enriching your diet with vegetables and fruits - all this will have a positive effect not only on the eyes, but on the whole body.
5. A healthy lifestyle, increased physical activity, daily exercise for the eyes.

Summing up, we can say with confidence that retinal angiopathy is a formidable disease that can lead to complete and irreversible loss of visual function. But there are both medical treatment methods that are effective in the early stages, and operational. Therefore, it is important to keep an eye on your eyes, which will allow you to see a specialist on time and preserve the opportunity to see the beauty of our world.

You will learn information about the structure of the retina, its diseases, diagnostic features from the video:

The human body is a single whole and pathological processes occurring in one organ or system, often have manifestations in a completely different place. For example, retinal angiopathy in both eyes is a secondary manifestation or consequence of certain diseases.

Object of defeat

The retina is a unique formation consisting, on the one hand, of photoreceptor cells, and on the other, of nerve cells. The photosensitive part of the retina occupies the inner surface of the eye from the dentate line to the point where the optic nerve (disc) originates. Here, there are no photosensitive cells at all, and the long processes of the ganglion cells intertwine and give rise to the optic nerve.

In contrast to this area, the retina has a place with the highest concentration of color-sensitive cells - cones. This is the macula (macula) and its central depression. It provides the clearest perception and visual acuity. With distance from the center to the periphery, photosensitive cone cells begin to mix with cells of another type - rods, which almost completely occupy the periphery. These cells are highly sensitive to light and provide us with vision at dusk, but they do not perceive color. Due to this arrangement of perceiving cells, a person develops central and peripheral vision.

Retinal diseases are mainly manifested by a decrease in visual acuity, field defects, and impaired adaptation. Since this membrane has no innervation, diseases are painless. Also, the retina itself does not have blood vessels, and its nutrition is carried out thanks to the choroid. However, there is no functional sense in separating these structures. Therefore, in diseases of the vascular plexus, they speak of retinal angiopathy in both eyes (OU – oculi utriusque).

What is retinal angiopathy? This is the name of the disorder of the mechanisms of regulation of contraction and expansion in its vessels. As a result, neuroangiopathy leads to a nutritional disorder of the retina, dystrophic processes occur in it, the possible consequences of which are detachment and loss of vision.

How does it manifest

Narrowing symptoms are mainly related to the quality of vision. A person can see "lightning", "sparks", vision deteriorates, the picture becomes cloudy and blurred, myopia progresses.

Usually this disease is typical for the older age group. Here it is important to undergo an examination to clarify the diagnosis, since presbyopia - senile deterioration of vision - gives similar symptoms.

Arteriospasm of retinal vessels can take place against a background of headache, nosebleeds, and hypertension attacks.

Causes

Angioneuropathy can have a different origin, but it usually has a background nature due to some pathology, therefore it is called background retinal angiopathy.

So it could be:

• intoxication of the body;
• leukemia;
• high blood pressure;
• vasculitis of autoimmune origin, rheumatoid arthritis;
• congenital pathology of vascular connective tissue;
• blood diseases (anemia);
• increased intracranial pressure;
• violation of the nervous regulation of vascular tone;
• damage to the cervical spine or osteochondrosis.

Retinal angiodystonia is common and may be background in smokers or people taking drugs that affect the general vascular tone.

Research methods

Fundus vessels and their condition are of great diagnostic value. Most often, a mirror ophthalmoscope is used in a polyclinic. This is a concave mirror with a hole in the center. This shape makes it possible to collect and direct a beam of light through the pupil expanded with the help of special drops to the retina.

With ophthalmoscopy, it is possible to detect expansion or narrowing of the vessels of the fundus, protrusion of their walls (aneurysm), change in shape

A more detailed study is carried out by the method of fluorescent vasography. A special substance is injected into the bloodstream. It spreads throughout the bloodstream. Fundus vasoconstriction can be detected and photographed in great detail in contrasting light with a specific wavelength.

Kinds

Retinal vascular angiopathy, being a consequence of a certain genesis, can be called diabetic, hypotonic, hypertensive, traumatic, youthful.

Diabetic

Against the background of diabetes, as you know, damage to the circulatory system occurs in general, affecting large and small vessels. Diabetic angiopathy occurs when the endothelial layer of microvessels is damaged by high concentrations of glucose, as a result of which their permeability is impaired, and the capillary wall edema occurs. Also, a change in the composition of the blood in diabetes mellitus leads to the formation of blood clots, which easily clog the small vessels of the retina.

With the combination of these changes, the retinal vessels are narrowed, and the blood flow in them slows down or stops altogether. This leads to a violation of the blood supply to the tissue, oxygen starvation and, as a result, to atrophy.

In addition to small blood clots and edematous vessels, in diabetes, microbleeds often occur on the retina, since the vessels are easily injured. The accumulation of glucose and metabolic products in the walls makes the capillaries extremely fragile.

Hypotonic

Symptoms of retinal angiopathy can also occur with a decrease in total blood pressure (hypotension) in the peripheral vessels. Blood flow slows down, which is a prerequisite for blood thickening and blood clots. Violation of resistance to blood pressure in peripheral vessels, as a rule, occurs with pathology in the vasomotor center of the brain or the vagus nerve.

Hypotonic retinal angiopathy gives a definite picture during ophthalmoscopy:

• small vessels are clearly visible, but have a pale appearance;
• there is no "doubling" of the wall;
• the form is sluggish, sinuous, instead of the usually more straightforward.

The lumen of the arteries increases, the pressure decreases, the formation of blood clots is possible, with prolonged blood stasis, swelling increases, and opacity appears on the retina.

Hypertensive

Retinal vascular angiopathy in both eyes is still more often caused by high blood pressure.

The fundus picture is mixed, since the changes affect both the vessels and the retinal tissue itself, but it is always directly dependent on the stage of development of the disease and its severity.

High pressure damages the central artery and small vessels. As a result, their parts are replaced by glial cells, and the vessel loses its elasticity, hardening increases the risk of rupture and hemorrhage. Another mechanism of vascular damage and a decrease in their inner diameter is the deposition of atherosclerotic plaques.

Damage to the retina is mainly due to the sweating of exudate, which delaminates the tissue.

Swelling in a confined space, as well as fibrin threads during ophthalmoscopy, give a picture of "cotton wool" and whitish spots

Hypertensive vasopathy gives the vessels a branched appearance (Gvist symptom), they are dilated, the diameter is uneven, and tiny hemorrhages are observed in places.

Typically, angiopathies of the retinal vessels of the hypertensive type can undergo a reverse development during treatment of the underlying disease.

If the nervous regulation of vascular tone is disturbed, retinal angiopathy occurs in a mixed type.

Retinal angiopathy during pregnancy

Toxic hypertension in women in position is often reflected in the state of the retinal vessels. High blood pressure is caused by an increase in blood volume to ensure the growth of the fetus, changes in hormonal levels, pressure fluctuations during emotional reactions of a woman. Hypertensive angiopathy occurs. At the same time, the walls of the vessels become more and more extensible. Retinal angiopathy during pregnancy is dangerous with the possibility of rupture of blood vessels and the formation of large hemorrhages, which threaten with loss of vision and retinal detachment.

A woman with an ophthalmological diagnosis must definitely prepare for childbirth under the supervision of the attending physician, and in the event of a threat of retinal detachment, delivery is carried out by cesarean section.

After the end of pregnancy, as the cause of retinal angiopathy, symptoms can independently regress

Traumatic

The causes of retinal angiopathy lie in trauma to the head, neck, compression of the ribs and even fracture of long bones. The danger for the vascular formations of the eye is represented by leukocyte emboli, which are formed at the sites of damage. As a result of blockage by an embolus, small vessels are exsanguinated, and many foci of blanching appear on the retina. This phenomenon is called Purcher's retinopathy. Treatment of retinal angiopathy in this case is not provided, the state of vision may independently improve or worsen.

Youthful

It is not reliably known about this type of retinal angiopathy, what it is. It is manifested by constant inflammation of blood vessels, frequent hemorrhage into the inner visual layer and the structure of the eye, proliferation of connective tissue. As a result, cataracts, glaucoma, and retinal detachment occur.

Retinal angiopathy in children

Damage to the retina in newborns is usually associated with heredity, congenital diseases, or the process of childbirth.

Narrow arteries, edema of the optic nerve head, hemorrhage along the vessels of the fundus can be determined with glomerulonephritis or wrinkled kidneys. This is a manifestation of renal retinopathy. Angiodystonia in this case requires elimination of renal inflammation as the root cause.

Eye examinations in newborns are challenging but doable

Retinal angiopathy in a child in the form of limited sac-like or fusiform dilations and tortuosity of blood vessels, spreading first to the periphery, and then to the central region of the fundus, is a manifestation of diabetes mellitus. With a hereditary nature of this disease, an analysis should be made for diabetes in infants in order to start treatment of this endocrine disease on time. This will allow to avoid further damage to the vessels and the optic nerve head, diabetic blindness.

Imbalance in blood pressure regulation in children can provoke hypertensive angiopathy. Most often it occurs with cerebral hypertension. Damage to the optic nerve is added to the change in the blood vessels of the eyes in a child.

In children and adolescents, a sudden decrease in visual acuity due to vascular pathology and minor hemorrhages can occur after infectious diseases such as tuberculosis, toxoplasmosis, viral infections. A special feature of the so-called Eales disease (retinal angiopathy in a child) is often recurrent punctate hemorrhages, manifested by the sudden appearance of a dark spot or painful loss of vision due to hemorrhages.

Treatment

How to treat angioedema depends on its type and cause. The diagnosis of retinal angiopathy only indicates the nature of the changes that befell this structure.

If the cause of the changes is high blood pressure, then first of all, hypertension is treated with various groups of antihypertensive drugs.

Relaxation of the walls of constricted vessels is achieved by vasodilators - a group of vasodilating drugs. Usually they are taken by the course according to the instructions.

In critical situations, they are administered as follows: nitroglycerin - sublingual, retrobulbar - solution of atropine and papaverine sulfate, intravenous - aminophylline, intramuscular - solution of nicotinic acid, under the conjunctiva - solution of caffeine 10%.

Angioprotectors are also used. This group of drugs is indicated for use in any type of angioretinopathy. Depending on the mechanism of action, they block the production of inflammatory mediators and vascular damaging factors (hyaluronidases). In addition, they promote vasodilation, improve microcirculation, and reduce edema of the drugs dicinone, parmidin, complamin, doxium, peritol.

The formation of blood clots is inhibited by tiklid, divascan, diabeton.

Strengthens the walls of the capillary network with enalapril, prestarium, tritace, vitamins K and rutin.

The group of retinoprotectors is usually a means that improves metabolism in the retina and eliminates angioedema of its vessels. Drops for angiopathy, which can be prescribed by an ophthalmologist, are Emoxipin, Taufon, Quinax, Emoxy-Optic.

Since diabetic angioedema of the retina is caused by the damaging effect of glucose, it is first of all necessary to eliminate hyperglycemia. For this, either insulin or hypoglycemic drugs are prescribed (depending on the type of diabetes). In addition, it is necessary to deal with the violation of capillary permeability and eliminate increased vascular permeability.

Most often, you can find recipes using parsley juice, infusion of dill, caraway seeds, blue cornflower herb, tea from black currant leaves or rowan fruits

The basis of treatment is diet correction, antidiabetic drugs, blood pressure control, angio- and retinoprotectors. In some cases, surgical intervention may be required - photocoagulation of the retina or removal of large hemorrhages, recovery in case of retinal detachment. Also, the question is surgically resolved if the narrowed vessels have undergone thrombosis or embolism.

Treatment of retinal angiopathy is also carried out with folk remedies, only it should be understood that they provide additional help against the background of therapy for the primary disease.

Plants are mainly used to help "cleanse" blood vessels from atherosclerotic plaques, help strengthen the vascular wall, rich in vitamins and antioxidants.

It is important to remember that after 30 years, the likelihood of developing one or another type of retinal angiopathy increases, therefore, in addition to prophylactic intake of folk remedies, you should regularly undergo an examination by an ophthalmologist.