Peripheral vision and dark adaptation deteriorate. This means that they have difficulty seeing in dark rooms and have difficulty distinguishing objects located to the side of them. As complications develop, patients may experience more obvious and dangerous symptoms.
Kinds
Depending on the nature of the pathological changes in the retina, several types of peripheral degeneration are distinguished. Only an ophthalmologist can distinguish them after performing an ophthalmoscopy - examination of the fundus of the eye. During the examination, the doctor can see the retina, which lines the inside of the eyeball.
Lattice
It occurs in approximately 65% of cases and has the most unfavorable prognosis. According to statistics, it is lattice dystrophy that most often leads to retinal detachment and loss of vision. Fortunately, the disease has an indolent course and progresses slowly throughout life.
Lattice degeneration is characterized by the appearance of narrow white stripes on the fundus of the eye, which in appearance resemble a lattice. They are empty vessels of the retina filled with hyaline. Between the white cords, areas of thinned retina that have a pinkish or red tint are visible.
According to the type of snail trail
This type of peripheral retinal degeneration most often develops in people with high degrees of myopia. The pathology is characterized by the appearance of peculiar perforated defects on the retina, which outwardly resemble a snail's footprint on the asphalt. The disease leads to ruptures of the retina with its subsequent detachment.
Frost-like
Is hereditary disease, affecting men and women. Frost-like peripheral dystrophy is characterized by the appearance of whitish deposits on the retina of the eye, which outwardly resemble snow flakes.
Cobblestone type
Refers to the least dangerous retinal PVCRD. Occurs more often in older people and people with. The disease is practically asymptomatic and has a relatively favorable course. It extremely rarely leads to ruptures or.
In cobblestone dystrophy, multiple foci of degeneration are visible in the fundus. They have White color, elongated shape and uneven surface. As a rule, all lesions are located in a circle, at the very periphery of the fundus.
Retinoschisis
The disease is hereditary. It leads to delamination of the retina and the formation of huge cysts filled with fluid. Retinoschisis is asymptomatic. In some cases, it is accompanied by local loss of vision at the location of the cyst. But since the pathological foci are on the periphery, this goes unnoticed.
Small cystic
The pathology is also called Blessin-Ivanov disease. Small cystic retinal retinal retinal retina is accompanied by the formation of many small cysts on the periphery of the fundus. Usually the disease has a slow course and a favorable prognosis. However, in rare cases, cysts can rupture, causing retinal tears and detachments.
Causes
A considerable part of peripheral chorioretinal retinal dystrophies are hereditary diseases. In 30-40% of cases, the development of the disease is provoked by high degrees of myopia, in 8% - by. Retinal damage can also result from systemic or ophthalmic diseases.
Possible causes of the development of peripheral degenerations:
- hereditary predisposition, the presence of PVCD in close relatives;
- myopia (myopia) of any degree;
- inflammatory diseases eye (endophthalmitis, iridocyclitis, etc.);
- previous injuries and surgical interventions;
- diabetes mellitus and other diseases of the endocrine system;
- intoxication and viral infections;
- atherosclerosis and diseases of the cardiovascular system;
- frequent and prolonged exposure to the sun without sunglasses;
- lack of vitamins and minerals that are necessary for the normal functioning of the retina of the eye.
In persons young acquired retinal degenerations most often develop against the background of myopia high degree. In older people, pathology occurs due to disruption of normal blood circulation and metabolism in the tissues of the eyeball.
Symptoms
At first, peripheral retinal dystrophy does not manifest itself in any way. Occasionally, it may make itself felt with bright flashes or the flickering of spots before the eyes. If the patient has impaired lateral vision, he for a long time doesn't notice this. As the disease progresses, a person realizes that he needs brighter light when reading. Over time, he may develop other visual impairments.
Most frequent symptoms PVHRD:
- Narrowing of visual fields. The patient has difficulty seeing objects located on the periphery. He has to turn his head to see them. In the most severe cases People develop what is called tunnel vision.
- The appearance of cattle. Defects in the visual field may not be noticeable or may appear as black or colored spots. In the first case, they can be identified using additional methods research – perimetry and campimetry.
- Nyctalopia. Peripheral retinal degeneration leads to damage to the rods, the light-sensitive elements responsible for night vision. For this reason, the pathology is often accompanied by night blindness ( poor eyesight at dusk).
- Metamorphopsia. The symptom is manifested by distortion of the contours and sizes of visible objects.
- Blurred vision. A person may feel as if he is looking at the world through fog or a thick layer of water.
When complications occur (retinal rupture or detachment), the patient experiences sparks, lightning, and bright flashes before the eyes. Subsequently, a dark curtain forms in the field of vision, preventing normal vision. These symptoms are extremely dangerous, so if they occur, you should immediately consult a doctor.
At-risk groups
Peripheral chorioretinal retinal dystrophy most often affects people with a high degree of myopia. This is due to the fact that with myopia the eyeball grows in length. Consequently, this leads to severe stretching and thinning of the retina. As a result, it becomes extremely susceptible to dystrophic processes.
The risk group also includes people over 65 years of age and patients with diabetes mellitus, atherosclerosis, and hypertension. All these people have retina various reasons suffers from lack of oxygen and nutrients. All this is a powerful impetus for the development of dystrophy.
Which doctor treats peripheral retinal dystrophy?
The treatment of retinal retinal retina is performed by a retinologist. He specializes in the diagnosis and treatment of diseases of the posterior segment of the eyeball (vitreous body, retina and choroid).
If complications develop, the patient may require the help of an ophthalmic surgeon or laser ophthalmologist. These specialists perform complex surgeries to treat retinal tears and detachments. In difficult situations, their help allows you to preserve and even restore partially lost vision.
Diagnostics
Methods used to diagnose peripheral degenerations.
| Method | Description | results |
|---|---|---|
| Visiometry | The patient is seated at a certain distance from Sivtsev’s table and asked to read the letters in different rows. If he experiences difficulties, his vision is checked with correction (lenses of different strengths). | The method allows you to detect myopia or other disorders visual perception. A decrease in visual acuity that cannot be corrected indicates damage to the retina of the eye. |
| Perimetry | The patient's visual fields are checked. Instead of perimetry, campimetry can be performed or an Amsler grid can be used. | During the examination, a narrowing of the visual field or the appearance of scotomas is revealed. The location of the defects gives an idea of the localization of foci of degeneration. |
| Ophthalmoscopy | Having previously dilated the pupil, the doctor examines the fundus of the eye. For this purpose, he can use a direct or indirect ophthalmoscope. If it is necessary to examine distant areas of the retina, he uses a three-mirror Goldmann lens. | With ophthalmoscopy, an experienced ophthalmologist can see pathological changes in the retina. Since all dystrophies look different, they can be distinguished visually. |
| Sclerocompression | The manipulation is performed during ophthalmoscopy. The doctor gently presses the sclera, trying to move the retina closer to the center. | Sclerocompression makes it possible to examine the most distant areas of the fundus. |
| Instrumental methods | To clarify the diagnosis, the patient may undergo optical coherence tomography or electrophysiological studies. | Modern techniques make it possible to obtain a clear picture of the condition of the retina and the location of degenerative foci. |
Treatment
To date, there are no methods that can completely cure peripheral vitreochorioretinal dystrophy of the retina. The progression of the disease can be stopped with the help of medication, physiotherapy, laser and surgical treatment. The correct approach to combating the disease allows you to preserve your vision and avoid dangerous complications.
Drugs that help slow the progression of dystrophy:
- Antiplatelet agents (Acetylsalicylic acid, Ticlopidine, Clopidogrel). Useful for hypertension and cardiovascular diseases. They thin the blood and inhibit thrombus formation, thereby protecting the retina from hypoxia.
- Vasodilators and angioprotectors (Actovegin, Vinpocetine, Pentoxifylline). Relieves spasm of retinal vessels and protects vascular walls from damage. They improve blood circulation in the retina, preventing its destruction.
- Vitamin and mineral complexes (Okyuvite-Lutein, Blueberry-Forte). Saturate the retina with nutrients, vitamins and minerals. Slow down the course of degenerative processes.
- Biological regulators (Retinolamine). Restore the permeability of retinal vessels and normalize the functioning of photoreceptors. They stimulate reparative processes, that is, they accelerate the restoration of the retina.
You can strengthen the retina and prevent its detachment using laser treatment. During the procedure, the specialist solders the retina to the choroid, which is located underneath it. This allows you to limit the foci of degeneration.
Prevention
There is currently no specific prevention of the disease. You can reduce the risk of developing dystrophy with the help of eye exercises and proper nutrition. Very useful in this regard biologically active additives, containing zinc, vitamins E, A, group B. Protecting your eyes from ultraviolet radiation with sunglasses also helps to avoid illness.
Peripheral dystrophies retinas develop more often in older people and in people with high degrees of myopia. The reason for this is stretching of the retina or impaired blood circulation and metabolism in it.
To combat degenerations, medications, physiotherapy, laser and surgical techniques. Laser coagulation of the retina today is considered the most effective method treatment of pathology. With its help, it is possible to limit dystrophic foci and prevent the spread of the pathological process.
Useful video about peripheral retinal dystrophy
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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
The retina is a specific structural and functional unit of the eyeball, necessary for capturing the image of the surrounding space and transmitting it to the brain. From an anatomical point of view, the retina is a thin layer nerve cells, thanks to which a person sees, since it is on them that the image is projected and transmitted along the optic nerve to the brain, where the “picture” is processed. The retina of the eye is formed by light-sensitive cells, which are called photoreceptors, since they are able to capture all the details of the surrounding “picture” that appears in the field of vision.Depending on which area of the retina is affected, they are divided into three large groups:
1.
Generalized retinal dystrophies;
2.
Central retinal dystrophies;
3.
Peripheral retinal dystrophies.
With central dystrophy, only the central part of the entire retina of the eye is affected. Since this central part of the retina is called macula, then the term is often used to denote dystrophy of the corresponding localization macular. Therefore, a synonym for the term “central retinal dystrophy” is the concept of “macular retinal dystrophy”.
In peripheral dystrophy, the edges of the retina are affected, while the central areas remain undamaged. With generalized retinal dystrophy, all parts of the retina are affected - both central and peripheral. A special case is age-related (senile) retinal dystrophy, which develops against the background of senile changes in the structure of microvessels. According to the location of the lesion, senile retinal dystrophy is central (macular).
Depending on the characteristics of tissue damage and the characteristics of the course of the disease, central, peripheral and generalized retinal dystrophies are divided into numerous varieties, which will be discussed separately.
Central retinal dystrophy - classification and brief description of varieties
Depending on the characteristics of the pathological process and the nature of the resulting damage, the following types of central retinal dystrophy are distinguished:
- Stargardt's macular dystrophy;
- Yellow-spotted fundus (Franceschetti's disease);
- Best's vitelline (vitelliform) macular degeneration;
- Congenital cone retinal dystrophy;
- Colloid retinal dystrophy Doina;
- Age-related retinal degeneration (dry or wet macular degeneration);
- Central serous choriopathy.
Central chorioretinal retinal dystrophy
Central chorioretinal dystrophy of the retina (central serous choriopathy) develops in men over 20 years of age. The reason for the formation of dystrophy is the accumulation of effusion from the vessels of the eye directly under the retina. This effusion interferes with normal nutrition and metabolism in the retina, resulting in its gradual degeneration. In addition, the effusion gradually detaches the retina of the eye, which is very severe complication a disease that can lead to complete loss of vision.Due to the presence of subretinal effusion characteristic symptom This dystrophy is a decrease in visual acuity and the appearance of wave-like curvatures of the image, as if a person is looking through a layer of water.
Macular (age-related) retinal degeneration
Macular (age-related) retinal degeneration can occur in two main clinical forms:1. Dry (non-exudative) form;
2. Wet (exudative) form.
Both forms of macular degeneration of the retina develop in people over 50–60 years of age against the background of senile changes in the structure of the walls of microvessels. On the background age-related dystrophy Damage occurs to the vessels of the central part of the retina, the so-called macula, which provides high resolution, that is, allows a person to see and distinguish the smallest details of objects and the environment at close range. However, even with severe course In age-related dystrophy, complete blindness occurs extremely rarely, since the peripheral parts of the retina remain intact and allow a person to partially see. Preserved peripheral parts of the retina allow a person to navigate normally in his usual environment. In the most severe course of age-related retinal dystrophy, a person loses the ability to read and write.
Dry (non-exudative) age-related macular degeneration The retina is characterized by the accumulation of waste products of cells between the blood vessels and the retina itself. These waste products are not removed in a timely manner due to disruption of the structure and function of the microvessels of the eye. Waste products are chemical substances, which are deposited in the tissues under the retina and look like small tubercles yellow color. These yellow tubercles are called Druze.
Dry retinal dystrophy accounts for up to 90% of cases of all macular degeneration and is a relatively benign form, since its course is slow, and therefore the decrease in visual acuity is also gradual. Non-exudative macular degeneration usually occurs in three successive stages:
1.
Early stage Dry age-related macular degeneration of the retina is characterized by the presence of small drusen. At this stage, the person still sees well and is not bothered by any visual impairment;
2.
The intermediate stage is characterized by the presence of either one large drusen or several small ones localized in the central part of the retina. These drusen reduce a person's field of vision, as a result of which he sometimes sees a spot in front of his eyes. The only symptom at this stage of age-related macular degeneration is the need for bright light for reading or writing;
3.
The pronounced stage is characterized by the appearance of a spot in the field of vision, which is dark in color and big size. This spot prevents a person from seeing most surrounding picture.
Wet macular degeneration of the retina occurs in 10% of cases and has an unfavorable prognosis, since against its background, firstly, there is a very high risk of developing retinal detachment, and secondly, vision loss occurs very quickly. With this form of dystrophy, new blood vessels, which are normally absent, begin to actively grow under the retina of the eye. These vessels have a structure that is not typical for the eye, and therefore their membrane is easily damaged, and fluid and blood begin to leak through it, accumulating under the retina. This effusion is called exudate. As a result, exudate accumulates under the retina, which puts pressure on it and gradually peels off. That is why wet macular degeneration is dangerous due to retinal detachment.
With wet macular degeneration of the retina, a sharp and unexpected decrease in visual acuity occurs. If treatment is not started immediately, complete blindness may occur due to retinal detachment.
Peripheral retinal dystrophy - classification and general characteristics of types
The peripheral part of the retina is usually not visible to the doctor during a standard fundus examination due to its location. To understand why the doctor does not see the peripheral parts of the retina, you need to imagine a ball through the center of which the equator is drawn. One half of the ball up to the equator is covered with a mesh. Further, if you look at this ball directly in the region of the pole, then parts of the grid located close to the equator will be poorly visible. The same thing happens in eyeball, which also has the shape of a ball. That is, the doctor can clearly distinguish the central parts of the eyeball, but the peripheral parts, close to the conventional equator, are practically invisible to him. This is why peripheral retinal dystrophies are often diagnosed late.Peripheral retinal dystrophies are often caused by changes in the length of the eye against the background of progressive myopia and deterioration of blood circulation in this area. As peripheral dystrophies progress, the retina becomes thinner, resulting in the formation of so-called tractions (areas of excessive tension). These tractions, if they exist for a long time, create the preconditions for a tear in the retina, through which the liquid part of the vitreous seeps under it, lifts it and gradually peels off.
Depending on the degree of danger of retinal detachment, as well as on the type of morphological changes, peripheral dystrophies are divided into the following types:
- Lattice retinal dystrophy;
- Retinal degeneration of the “snail traces” type;
- Frost-like degeneration of the retina;
- Cobblestone retinal degeneration;
- Small cystic degeneration of Blessin-Ivanov;
- Retinal pigmentary dystrophy;
- Pediatric Leber's taperetinal amaurosis;
- X-chromosomal juvenile retinoschisis.
Lattice retinal dystrophy
Lattice retinal dystrophy occurs in 63% of cases of all types of peripheral dystrophy. This type of peripheral dystrophy provokes the most high risk development of retinal detachment, therefore it is considered dangerous and has an unfavorable prognosis. Most often (in 2/3 of cases) lattice retinal dystrophy is detected in men over 20 years of age, which indicates its hereditary nature. Lattice dystrophy affects one or both eyes with approximately equal frequency and then progresses slowly and gradually throughout a person's life.
With lattice dystrophy, white, narrow, wavy stripes are visible on the fundus, forming lattices or rope ladders. These stripes are formed by collapsed and hyaline-filled blood vessels. Between the collapsed vessels, areas of thinning of the retina are formed, which have characteristic appearance pinkish or red lesions. In these areas of the thinned retina, cysts or tears can form, leading to detachment. The vitreous body in the area adjacent to the area of the retina with dystrophic changes is liquefied. And at the edges of the area of dystrophy, the vitreous body, on the contrary, is very tightly fused to the retina. Because of this, areas of excessive tension on the retina (traction) arise, where small tears are formed that look like valves. It is through these valves that the liquid part of the vitreous penetrates under the retina and provokes its detachment.
Peripheral retinal dystrophy of the “snail traces” type
Peripheral retinal dystrophy of the “snail trace” type develops in people suffering from progressive myopia. Dystrophy is characterized by the appearance of shiny streak-like inclusions and holey defects on the surface of the retina. Typically, all defects are located on the same line and, when examined, resemble a snail's footprint left on the asphalt. It is precisely because of the external resemblance to the track of a snail that this type of peripheral retinal dystrophy received its poetic and figurative name. With this type of dystrophy, breaks often form, leading to retinal detachment.Frost-like retinal dystrophy
Frost-like retinal dystrophy is a hereditary disease that occurs in men and women. Usually both eyes are affected at the same time. Yellowish or whitish inclusions resembling snow flakes appear in the retinal area of the eye. These inclusions are usually located in close proximity to thickened retinal vessels.Retinal dystrophy "cobblestone"
Cobblestone retinal dystrophy usually affects the distant parts located directly in the equator of the eyeball. This type of dystrophy is characterized by the appearance on the retina of individual, white, elongated lesions with an uneven surface. Typically these lesions are located in a circle. Most often, cobblestone dystrophy develops in older people or in those suffering from myopia.Small cystic retinal dystrophy Blessin–Ivanov
Blessin-Ivanov small cystic retinal dystrophy is characterized by the formation of small cysts located on the periphery of the fundus. In the area of the cysts, holes may subsequently form, as well as areas of retinal detachment. This type of dystrophy has a slow course and a favorable prognosis.Retinal pigmentary dystrophy
Retinal pigmentary dystrophy affects both eyes at once and manifests itself in childhood. Small foci of bony bodies appear on the retina, and the waxy pallor of the disc gradually increases optic nerve. The disease progresses slowly, as a result of which a person’s field of vision gradually narrows, becoming tubular. In addition, vision deteriorates in the dark or twilight. Pediatric Leber's taperetinal amaurosis
Pediatric Leber taperetinal amaurosis develops in a newborn child or at the age of 2–3 years. The child's vision deteriorates sharply, which is considered the beginning of the disease, after which it slowly progresses.X-chromosomal juvenile retinoschisis
X-chromosomal juvenile retinoschisis is characterized by the development of retinal separation simultaneously in both eyes. Huge cysts form in the area of the dissections, gradually filling with glial protein. Due to the deposition of glial protein, star-shaped folds or radial lines appear on the retina, resembling the spokes of a bicycle wheel.Congenital retinal dystrophy
All congenital dystrophies are hereditary, that is, they are transmitted from parents to children. Currently known the following types congenital dystrophies:1. Generalized:
- Pigmentary dystrophy;
- Leber's amaurosis;
- Nyctalopia (lack of night vision);
- Cone dysfunction syndrome, in which color perception is impaired or complete color blindness is present (a person sees everything as gray or black and white).
- Stargardt's disease;
- Best's disease;
- Age-related macular degeneration.
- X-chromosomal juvenile retinoschisis;
- Wagner's disease;
- Goldman-Favre disease.
Retinal dystrophy during pregnancy
During pregnancy, a woman’s body undergoes a significant change in blood circulation and an increase in metabolic rate in all organs and tissues, including the eyes. But in the second trimester of pregnancy there is a decrease in blood pressure, which reduces blood flow to the small vessels of the eyes. This, in turn, can provoke a deficiency of nutrients necessary for the normal functioning of the retina and other structures of the eye. And inadequate blood supply and deficiency of nutrient delivery is the cause of the development of retinal dystrophy. Thus, pregnant women have an increased risk of retinal dystrophy. If a woman had any eye diseases before pregnancy, for example, myopia, hemeralopia and others, this significantly increases the risk of developing retinal dystrophy during pregnancy. Because the various diseases eyes are widespread in the population, the development of retinal dystrophy in pregnant women is not uncommon. It is precisely because of the risk of dystrophy with subsequent retinal detachment that gynecologists refer pregnant women for consultation with an ophthalmologist. And for the same reason, women suffering from myopia need permission from an ophthalmologist to give birth. naturally. If the ophthalmologist considers the risk of fulminant dystrophy and retinal detachment during childbirth to be too high, he will recommend a cesarean section.
Retinal dystrophy - causes
Retinal dystrophy develops in 30–40% of cases in people suffering from myopia (myopia), in 6–8% against the background of hypermetropia (farsightedness), and in 2–3% with normal vision. The entire set of causative factors of retinal dystrophy can be divided into two large groups - local and general.To the locals causal factors and retinal dystrophy include the following:
- Hereditary predisposition;
- Myopia of any severity;
- Inflammatory eye diseases;
- Previous eye surgeries.
- Hypertonic disease;
- Diabetes;
- Past viral infections;
- Intoxication of any nature (poisoning with poisons, alcohol, tobacco, bacterial toxins, etc.);
- Increased blood cholesterol levels;
- Deficiency of vitamins and minerals entering the body with food;
- Chronic diseases (heart, thyroid, etc.);
- Age-related changes in the structure of blood vessels;
- Frequent exposure to direct sunlight on the eyes;
- White skin and blue eyes.
Retinal dystrophy - symptoms and signs
At the initial stages, retinal dystrophy, as a rule, does not manifest itself with any clinical symptoms. Various signs retinal dystrophies usually develop at moderate or severe stages of the disease. With different types of retinal dystrophies, a person experiences approximately the same symptoms, such as:- Decreased visual acuity in one or both eyes (the need for bright light for reading or writing is also a sign of decreased visual acuity);
- Narrowing of the field of view;
- The appearance of scotoma (spot or sensation of a curtain, fog or obstruction in front of the eyes);
- A distorted, wave-like image before the eyes, as if a person is looking through a layer of water;
- Poor vision in darkness or twilight (nyctalopia);
- Impaired color discrimination (colors are perceived as different, not corresponding to reality, for example, blue is seen as green, etc.);
- Periodic appearance of “floaters” or flashes before the eyes;
- Metamorphopsia (incorrect perception of everything related to the shape, color and location in space of a real object);
- Inability to correctly distinguish a moving object from a stationary one.
In addition to the above clinical symptoms characteristic of retinal dystrophy following signs identified during objective examinations and various tests:
1.
Distortion of lines on Amsler test. This test involves a person looking with each eye in turn at a point located in the center of a grid drawn on a piece of paper. First, the paper is placed at arm's length from the eye, and then slowly brought closer. If the lines are distorted, this is a sign of macular degeneration of the retina (see Figure 1); 
Figure 1 – Amsler test. At the top right is a picture seen by a person with normal vision. At the top and bottom left is the image that a person sees with retinal dystrophy.
2.
Characteristic changes on the fundus (for example, drusen, cysts, etc.).
3.
Reduced electroretinography readings.
Retinal dystrophy - photo
This photograph shows retinal dystrophy of the “snail track” type.
This photograph shows retinal dystrophy of the “cobblestone” type.
This photograph shows dry age-related macular degeneration of the retina.
Retinal dystrophy - treatment
General principles of treatment of various types of retinal dystrophy
Since dystrophic changes in the retina cannot be eliminated, any treatment is aimed at stopping further progression of the disease and, in fact, is symptomatic. For the treatment of retinal dystrophies, medications, lasers and surgical methods treatments to stop the progression of the disease and reduce the severity clinical symptoms, thereby partially improving vision.Drug therapy for retinal dystrophy consists of the following groups: medicines:
1.
Antiplatelet agents– drugs that reduce thrombus formation in blood vessels (for example, Ticlopidine, Clopidogrel, acetylsalicylic acid). These drugs are taken orally in tablet form or administered intravenously;
2.
Vasodilators And angioprotectors
– drugs that dilate and strengthen blood vessels (for example, No-shpa, Papaverine, Ascorutin, Complamin, etc.). The drugs are taken orally or administered intravenously;
3.
Lipid-lowering drugs
– drugs that lower blood cholesterol levels, for example, Methionine, Simvastatin, Atorvastatin, etc. The drugs are used only in people suffering from atherosclerosis;
4.
Vitamin complexes
, which contain elements important for the normal functioning of the eyes, for example, Okyuvit-lutein, Blueberry-forte, etc.;
5.
B vitamins
;
6.
Drugs that improve microcirculation
, for example, Pentoxifylline. Typically, drugs are injected directly into the structures of the eye;
7.
Polypeptides, obtained from the retina of a large cattle(Retinolamine drug). The drug is injected into the structures of the eye;
8.
Eye drops containing vitamins and biological substances, promoting repair and improvement of metabolism, for example, Taufon, Emoxipin, Ophthalm-Katachrome, etc.;
9.
Lucentis– a remedy that prevents the growth of pathological blood vessels. Used for the treatment of age-related macular degeneration of the retina.
The medications listed above are taken in courses, several times (at least twice) throughout the year.
In addition, for wet macular degeneration, Dexamethasone is injected into the eye, and Furosemide is administered intravenously. When hemorrhages develop in the eye, heparin, Etamsylate, aminocaproic acid or Prourokinase are administered intravenously in order to quickly resolve and stop it. To relieve swelling in any form of retinal dystrophy, Triamcinolone is injected directly into the eye.
The following physiotherapy methods are also used in courses for the treatment of retinal dystrophies:
- Electrophoresis with heparin, No-shpa and nicotinic acid;
- Photostimulation of the retina;
- Stimulation of the retina with low-energy laser radiation;
- Electrical stimulation of the retina;
- Intravenous laser irradiation blood (ILBI).
- Laser coagulation of the retina;
- Vitrectomy;
- Vaso-reconstructive operations (crossing the superficial temporal artery);
- Revascularization operations.
Approaches to the treatment of macular degeneration of the retina
First of all, a comprehensive drug treatment, which consists of a course of taking vasodilators (for example, No-shpa, Papaverine, etc.), angioprotectors (Ascorutin, Actovegin, Vazonit, etc.), antiplatelet agents (Aspirin, Thrombostop, etc.) and vitamins A, E and group B. Typically, courses of treatment with these groups of drugs are carried out several times during the year (at least twice). Regular courses of drug treatment can significantly reduce or completely stop the progression of macular degeneration, thereby preserving a person’s vision.If macular degeneration is in a more severe stage, then along with drug treatment, physiotherapy methods are used, such as:
- Magnetic stimulation of the retina;
- Retinal photostimulation;
- Laser stimulation of the retina;
- Electrical stimulation of the retina;
- Intravenous laser blood irradiation (ILBI);
- Surgeries to restore normal blood flow in the retina.
If a person has wet dystrophy, then first of all laser coagulation of sprouting, abnormal vessels is performed. During this procedure, a laser beam is directed to the affected areas of the retina, and under the influence of its powerful energy, blood vessels are sealed. As a result, fluid and blood stop sweating under the retina and peeling it off, which stops the progression of the disease. Laser coagulation of blood vessels is a short-term and completely painless procedure that can be performed in a clinic.
After laser coagulation it is necessary to take drugs from the group of angiogenesis inhibitors, for example, Lucentis, which will inhibit the active growth of new, abnormal vessels, thereby stopping the progression of wet retinal macular degeneration. Lucentis should be taken continuously, and other medications should be taken in courses several times a year, as with dry macular degeneration.
Principles of treatment of peripheral retinal dystrophy
The principles of treatment of peripheral retinal dystrophy consist in carrying out the necessary surgical interventions (primarily laser coagulation of blood vessels and delimiting the zone of dystrophy), as well as subsequent regular courses of medication and physiotherapy. If you have peripheral retinal dystrophy, you must completely stop smoking and wear sunglasses.Retinal dystrophy - laser treatment
Laser therapy is widely used in the treatment various types dystrophies, since the directed laser beam, which has enormous energy, allows you to effectively influence the affected areas without affecting the normal parts of the retina. Laser treatment is not a homogeneous concept that includes only one operation or intervention. On the contrary, laser treatment of dystrophy is a combination of various therapeutic techniques which are carried out using a laser. Examples therapeutic treatment laser dystrophy - is stimulation of the retina, during which the affected areas are irradiated in order to activate metabolic processes in them. Laser stimulation of the retina in most cases gives an excellent effect and allows you to stop the progression of the disease for a long time. An example of surgical laser treatment for dystrophy is coagulation of blood vessels or delimitation of the affected area of the retina. In this case, the laser beam is directed to the affected areas of the retina and, under the influence of the released thermal energy, literally glues and seals the tissue and, thereby, delimits the treated area. As a result, the area of the retina affected by dystrophy is isolated from other parts, which also makes it possible to stop the progression of the disease.
Retinal dystrophy - surgical treatment (operation)
Operations are performed only in severe cases of dystrophy, when laser therapy and drug treatment are ineffective. All operations performed for retinal dystrophies are conventionally divided into two categories - revascularization and vasoreconstruction. Revascularization operations are a type surgical intervention, during which the doctor destroys abnormal vessels and opens normal ones as much as possible. Vasoreconstruction is an operation during which the normal microvascular bed of the eye is restored using grafts. All operations are performed in a hospital setting by experienced doctors.Vitamins for retinal dystrophy
In case of retinal dystrophy, it is necessary to take vitamins A, E and group B, since they ensure the normal functioning of the organ of vision. These vitamins improve the nutrition of eye tissue and, with long-term use, help stop the progression of dystrophic changes in the retina.Vitamins for retinal dystrophy must be taken in two forms - in special tablets or multivitamin complexes, as well as in the form of food products rich in them. Fresh vegetables and fruits, cereals, nuts, etc. are richest in vitamins A, E and group B. Therefore, these products must be consumed by people suffering from retinal dystrophy, since they are sources of vitamins that improve the nutrition and functioning of the eyes.
Prevention of retinal dystrophy
Prevention of retinal dystrophy consists of following simple rules:- Do not overstrain your eyes, always give them rest;
- Do not work without eye protection from various harmful radiation;
- Do eye exercises;
- Eat well, including fresh vegetables and fruits in your diet, as they contain large amounts of vitamins and microelements necessary for the normal functioning of the eye;
- Take vitamins A, E and group B;
- Take zinc supplements.
Retinal dystrophy - folk remedies
Traditional treatment of retinal dystrophy can only be used in combination with traditional medicine methods, since this disease is very serious. TO traditional methods Treatments for retinal dystrophy include the preparation and consumption of various vitamin mixtures, which provide the organ of vision with the vitamins and microelements it needs, thereby improving its nutrition and inhibiting the progression of the disease. Before use, you should consult a specialist.
Restrictive peripheral laser coagulation of the retina.
Peripheral retinal dystrophies are an invisible danger. The main problem of this undoubtedly dangerous disease is that a person is not bothered by any subjective manifestations, up to and including the occurrence of retinal detachment.
There is a common misconception that this condition occurs only in people with a high degree of myopia (myopes), however this is not true and occurs in people with 100% vision (emmetropes) and farsighted people (hypermetropes).
The peripheral zone of the retina is practically invisible during normal fundus examination. To visualize these sections, pupil dilation is required (mydriasis, cycloplegia). It is there that degenerative changes develop, which can lead to retinal tears and detachment.
Peripheral vitreochorioretinal dystrophy (PVCRD)– a disease that can be caused by many reasons: inflammatory diseases of the eyes, traumatic brain injury and injuries to the organ of vision, hypertension, atherosclerosis, diabetes, intoxication, past infections, hereditary factors, increase in size anterior-posterior size eyeball.
The occurrence of dystrophies is possible at any age, with equal probability in men and women. However, it has been proven that in people with myopia, peripheral degenerative changes in the retina are much more common, because With myopia, the length of the eye increases, resulting in stretching of its membranes and thinning of the retina at the periphery. The essence of this pathological process is the deterioration of blood flow in local areas of the retinal periphery, which leads to metabolic disorders and the appearance of dystrophic foci. The dystrophic focus is a sharply thinned area of the retina.
Under the influence of a) physical activity, and especially - work associated with lifting, carrying heavy objects, vibration, climbing to heights or diving under water, acceleration and b) psycho-emotional stress, increased visual load - ruptures occur in the weakest areas of the retina. The occurrence of ruptures is facilitated by changes in the vitreous that appear in the form of adhesions (vitreoretinal adhesions). These adhesions, joining one end to a weak area of the retina and the other to vitreous body more often than other reasons contribute to the occurrence of retinal tears. The presence of even very small holes in the retina, located close to each other, poses a threat of their fusion and the formation of a large holey defect. The combination of retinal tears and stretching in myopia (myopia) is especially dangerous.
The main types of peripheral retinal dystrophies:
- lattice dystrophy;
- dystrophy of the “snail track” type;
- frost-like dystrophy;
- cobblestone degeneration;
- cystic retinal dystrophy;
- retinoschisis - retinal separation.
Retinal tears.
Based on their type, retinal tears are divided into:
- perforated;
- valve;
- by type of dialysis.
Retinal disinsertion.
Through the hole formed in the retina, the intraocular fluid and peels it off. The retina that has lagged behind its usual place ceases to function, i.e. ceases to perceive light as a stimulus. Patients with retinal detachment describe this fact as the appearance of a black or gray opaque “curtain” in front of the eye, through which nothing can be seen. The size of the “curtain” that interferes with viewing depends on the area of the detached retina. As a rule, part of the peripheral vision disappears first. Central vision is initially preserved. Quite high visual acuity is also maintained. But it won't last long. As the detachment spreads, the area of the “interfering curtain” increases. As soon as the retinal detachment reaches the central parts, visual acuity drops from 100% to 2-3%, i.e. Such a person with a sore eye is able to see only the movement of objects near the face. This “vision” can be provided by a partially preserved or partially adjacent retina in other areas. If the retinal detachment is total, then there is no need to talk about any vision. For such a person, complete darkness sets in in this eye.
Diagnostics.
A complete diagnosis of peripheral dystrophies and retinal tears is complex and is only possible when examining the fundus of the eye by an ophthalmic surgeon under conditions of maximum medicinal dilation of the pupil.
Treatment of dystrophies and ruptures.
When peripheral dystrophies and retinal tears are detected, treatment is carried out, the purpose of which is to prevent detachment. Execute limiting peripheral laser coagulation of the retina, as a result of which “sticking” occurs, and within 2-4 weeks the retina fuses with the underlying membranes of the eye at the points of exposure to laser radiation. Restrictive peripheral laser coagulation It is performed on an outpatient basis and is well tolerated by patients. The essence of the operation is to treat thinned areas of the retina with a laser. Using laser radiation, the so-called “soldering” of the retina is performed. weak points and around the breaks, adhesions of the retina with the underlying tissues form. The operation is performed on an outpatient basis, under local drip anesthesia. Before treatment, the pupil is dilated with special drops, then anesthetic drops are instilled, and the patient is placed behind the device, pressing his forehead and chin to a special stop. A special contact lens, through which light is directed into the eye and laser ray. The patient returns home on the same day.
It must be taken into account that the process of formation of adhesions takes some time, so after laser coagulation it is recommended to follow a gentle regime.
Prevention.
Speaking about prevention, first of all, we mean the prevention of the formation of breaks and retinal detachment. The main way to prevent these complications is timely diagnosis peripheral dystrophies, followed by regular monitoring and, if necessary, limiting peripheral laser coagulation.
The specialists of the Ophthalmological Center for Laser Microsurgery of the Medina Clinic are fluent in both the method of peripheral peripheral laser coagulation of the retina and other methods of laser interventions for eye pathologies.
Contact your ophthalmologist for a referral to the Medina Clinic and receive a 5% discount on laser eye treatment!
– the inner sensitive membrane of the eye. Its main function is the transformation of a light stimulus into a nerve signal and its primary processing. Retinal degeneration is a disease that impairs the basic function of visual analyzer and in some cases leads to blindness.
Classification of peripheral retinal degeneration
Depending on the nature and localization of changes in the retina, several types of peripheral degeneration are distinguished.Depending on changes in the fundus, the following types of peripheral degenerative changes in the retina are distinguished:
- Microcystic: also called Blesing-Ivanov retinal degeneration. The disease affects middle-aged people, but also occurs in children. The lesion is located at the edge of the dentate line, that is, along the periphery of the visual area. It is complicated by retinal tears, leading to its gradual retina. Upon examination, multiple red dots are noted on the pale background of the fundus.
- According to the type of cobblestone street: it is less dangerous condition, which is accompanied by the formation of spots devoid of pigment closer to the edge of the fundus. This pathology rarely leads to detachment, usually occurs in older people, has a benign course, but requires regular monitoring by an ophthalmologist.
- Lattice: a limited process of thinning and fibrosis of the retina with obliteration (collapse) of its vessels. The pathology occurs in 65% of patients and most often leads to blindness.
- According to the type of cochlear mark: a white stripe forms on the fundus of the eye, caused by micro-tears of the retina; usually observed with high degrees of myopia.
- Palisade: a type of lattice, looks like several white stripes.
- Frost-like: this is a hereditary pathology, accompanied by the formation of multiple light spots on the retina, similar to snow flakes.
- Retinoschisis: a hereditary pathology accompanied by local detachment and degeneration of the retina due to the formation of large cystic formations. The course of the disease is asymptomatic.
Causes of pathology and its manifestations
Peripheral retinal degeneration can occur for a number of reasons:
- myopia (especially high degree);
- (farsightedness);
- , Stickler;
- previous inflammatory eye diseases;
- eyeball injury;
- oncological diseases;
- heavy;
- hereditary pathology.
According to statistics, peripheral retinal degenerations develop in people with myopia in 30-40% of cases, with farsightedness in 6-8% of cases, and in people with normal vision in 2-5%. The disease can affect anyone age groups, including children. A hereditary factor plays a role - the pathology is more common in men (68% of cases).
Patients with peripheral retinal degeneration may not have any complaints. In other cases they are concerned about:
- flashes in the form of lightning;
- spots before the eyes;
- loss of visual field;
- reducing its severity.
Diagnosis of retinal degeneration
To determine the type and cause of pathology, ophthalmologists use the following research methods:
- determination of visual acuity with correction – moderate and high myopia is more often determined;
- (determination of the visual field) – there is a loss of the visual field, which corresponds to the zone of degeneration;
- – measurement intraocular pressure. No changes are observed. In rare cases, there is an increase in intraocular pressure after surgical treatment;
- EPI – electrophysiological examination of the eye, a method for studying retinal function;
- – may be normal. Occasionally there are signs of chronic uveitis, hemorrhage into the vitreous body. The presence of these signs requires additional treatment;
- examination of the fundus in case of drug-induced mydriasis (pupil dilation) using a Goldmann lens.
When examining the fundus of the eye, the doctor detects the following changes:
- lattice degeneration - a network of thin white stripes, sometimes they can resemble snowflakes;
- cystic degeneration - multiple round or oval bright red formations that can merge;
- retinoschisis - the retina becomes grayish-white in color, has the appearance of small cystic dystrophy, which can progress into giant cysts, and breaks appear;
- chorioretinal atrophy has the appearance of atrophic foci with a pigmented border, which can merge;
- dystrophy of the type of snail track - whitish, somewhat shiny holey defects that merge and become similar to the track of a snail;
- cobblestone dystrophy - white ring defects that have an oblong shape.
Treatment of peripheral degeneration
If there is a high risk of retinal detachment, laser coagulation is performed. For this disease, doctors use a variety of treatment methods:
- spectacle or contact correction, which is carried out to improve the patient’s quality of life;
- laser coagulation of the retina;
- drug treatment.
Laser coagulation of the retina is carried out to prevent retinal detachment in patients with increased risk development of such a complication. Risk factors, and therefore indications for laser coagulation, include:
- the presence of retinal detachment in the fellow eye;
- cases of retinal detachment in the family;
- aphakia or pseudophakia (absence of a lens or its implant);
- high myopia;
- Availability systemic diseases(Marfan, Stickler syndrome);
- progressive course of degeneration;
- formation of retinal cysts.
In other cases, prophylactic laser coagulation is not required. The procedure is carried out in outpatient setting, after treatment, limit physical activity for 7 days.
Drug treatment is carried out to improve nutrition and condition of the retina. The following drugs are used:
- Antioxidants – methylethylpyridinol (emoxipin eye drops) 1 drop 3 times a day in conjunctival sac for 1 month, repeat course after 3 months; trimetazidine (preductal) 1 tablet orally with meals 2 times a day.
- Means that improve metabolism in the retina - vitamins A, E, C, group B, minerals (zinc, copper) in multivitamin complexes, 1 tablet 1 time per day after breakfast. The course of treatment is up to 6 months. Mildronate 1 tablet 2 times a day, course from 4-6 weeks. Repeated course 2-3 times a year.
- Antiplatelet agents – pentoxifylline (trental) 1 tablet 3 times a day, taken for up to 2 months; acetylsalicylic acid (thrombo ass) orally after meals in the morning, long-term use.
- Drugs that improve the condition of the vascular wall - extracts of ginkgo biloba (tanakan) 1 tablet 3 times a day, with meals; blueberry preparations, 1 tablet 1 time per day, course of treatment from 1 to 3 months.
Patients with peripheral retinal degeneration should avoid strenuous exercise and heavy lifting, as this is a risk factor for developing retinal detachment. Sometimes it is necessary to change the nature and place of work. Patients are monitored by an ophthalmologist for fundus examinations every six months. After laser photocoagulation of the retina, patients are unable to work for 2 weeks. With proper and timely treatment, the prognosis is favorable.
Ophthalmologist N. G. Rozhkova talks about peripheral retinal dystrophy.
Dystrophy of the peripheral retina is a hidden danger. This area of the retina is not visible during normal fundus examination, but it is here that pathological processes, subsequently leading to retinal ruptures and detachment. This dangerous disease can occur in any person, regardless of gender and age.
Peripheral vitreochorioretinal dystrophy (PVRD) occurs in people not only with myopia and hypermetropia, but also with normal vision. The disease is practically asymptomatic, until retinal detachment.
The main causes of PVCRD currently include hereditary factors, as well as eye injuries and traumatic brain injuries, atherosclerosis, diabetes mellitus, hypertension and other diseases.
PVCRD is especially often detected in people with myopia. With myopia (myopia), the length of the eye is increased, and all its membranes, including the retina, are stretched and thinned. Thinning of the retina, especially in peripheral parts, leads to deterioration of blood flow, metabolic disorders and the formation of foci of dystrophy.
The dystrophic focus is a sharply thinned area of the retina. In most cases, such changes affect not only the retina, but also the adjacent vitreous body and the choroid.
Under the influence of injuries, physical activity (especially work associated with lifting and carrying heavy objects, vibration, climbing to heights or diving under water, acceleration), stress, as well as increased visual load, ruptures occur in weak areas of the retina, which subsequently lead to detachment retina. This is largely facilitated by changes in the vitreous body that appear in the form of vitreoretinal adhesions. These adhesions, joining one end to the dystrophic focus and the other to the vitreous body, more often than other causes contribute to retinal ruptures.
The combination of retinal tears and stretching in myopia is especially dangerous.
Main types of peripheral retinal dystrophies
Lattice dystrophy
It is most often detected in patients with retinal detachment. There is a hereditary predisposition to this species dystrophy. As a rule, it is found in both eyes. Examining the fundus of the eye, the doctor sees many empty vessels, forming bizarre lattice-like figures, between which cysts and ruptures form. Pigmentation in this zone is disturbed; at the edges of the lesion is fixed to the vitreous body by cords, which can easily tear the retina both in the zone of dystrophy and next to it.
Dystrophy of the “snail track” type
The dystrophy zone has an elongated shape in the form of an uneven whitish shiny ribbon with multiple small breaks. By appearance resembles a snail's trail. Often leads to the formation of large retinal tears.
Frost-like dystrophy
Hereditary form of dystrophy. The changes are most often symmetrical in both eyes. When viewed, they look like snow flakes located next to empty vessels.
Cobblestone degeneration
It looks like many light, round lesions on the periphery of the retina, sometimes with clumps of pigment. Rarely leads to the formation of retinal tears and detachment.
Small cystic retinal dystrophy
Multiple small round or oval reddish cysts are identified in the fundus. Cysts often coalesce and can form retinal tears.
Retinoschisis – retinal separation
As a rule, this is a hereditary pathology - a malformation of the retina. Acquired dystrophic retinoschisis usually occurs with hypermetropia and myopia, as well as in old age.
Retinal tears
Based on their type, retinal tears are divided into:
- perforated;
- valve;
- by type of dialysis.
Hole breaks most often occur as a result of lattice and small cystic dystrophies, there is a gaping hole in the retina. A rupture is called a valve rupture when a section of the retina partially covers the rupture site. Valve ruptures appear as a result of vitreoretinal traction, which pulls and tears the retina. When a tear forms, the area of vitreoretinal traction will be the valve apex. Dialysis represents line break retina along the dentate line - the place of attachment of the retina to choroid. In most cases, dialysis is associated with blunt trauma eyes.
Retinal disinsertion
Through the hole formed in the retina, intraocular fluid enters under the retina, peeling it off. The retina that has lagged behind its usual place ceases to function, i.e. ceases to perceive light as a stimulus. Patients with retinal detachment describe this fact as the appearance of a black “curtain” in front of the eye, through which nothing can be seen. The size of the “curtain” that interferes with viewing depends on the area of the detached retina. As a rule, part of the peripheral vision disappears first. Central vision is preserved at the first moment, as is fairly high visual acuity. But it won't last long. As the detachment spreads, the area of the interfering “curtain” increases. As soon as the retinal detachment reaches the central parts, visual acuity drops from 100% to 2–3%, i.e. Such a person with a sore eye is able to see only the movement of objects near the face. This is provided by the partially preserved or partially adjacent retina in other areas. If the retinal detachment is total, that eye experiences complete darkness.
| Retinal disinsertion | Lattice dystrophy | Retinal detachment with valve rupture | |||
| Frost-like dystrophy with multiple ruptures | Retinal detachment with tear | Funnel retinal detachment | |||
Diagnostics. Treatment of dystrophies and ruptures. Prevention
A complete diagnosis of peripheral dystrophies and retinal breaks is complex and is only possible when examining the fundus of the eye by an experienced ophthalmologist under conditions of maximum medicinal dilation of the pupil using a special three-mirror Goldmann lens, which allows you to see the outermost parts of the retina.
When peripheral dystrophies and retinal tears are detected, treatment is carried out, the purpose of which is to prevent detachment. Laser coagulation of the retina is performed, as a result of which the retina first sticks together and then, within 7–10 days, fuses with the underlying membranes of the eye at the points of exposure to laser radiation. Laser coagulation is performed on an outpatient basis and is well tolerated by patients. It must be taken into account that the process of formation of adhesions takes some time, so after laser coagulation it is recommended to follow a gentle regime.
When talking about prevention, we primarily mean the prevention of retinal tears and detachment. The main way to prevent these complications is timely diagnosis of peripheral dystrophies, followed by regular monitoring and, if necessary, preventive laser coagulation.
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