What is retinopathy?
Retinopathy - damage to the retinal vessels, leading to disruption of the blood supply to the retina, its degeneration, optic nerve atrophy and blindness. Retinopathy is painless: it marks the appearance of floating spots (cattle) and veils before the eyes, a progressive decrease in vision. Diagnosis of retinopathy requires the consultation of specialists (ophthalmologist, neurologist, cardiologist, endocrinologist), studies of acuity and visual fields, performing ophthalmoscopy, biomicroscopy, fluorescent angiography of the fundus, electrophysiological studies, ultrasound of the eye. In retinopathy, it is necessary to achieve compensation for concomitant diseases, the appointment of vasodilators, vitamins, anticoagulants, hyperbaric oxygenation, laser coagulation of the retina.
Central serous retinopathy
The etiology of primary retinopathy remains unknown, therefore they are classified as idiopathic. Central serous retinopathy (central serous retinitis, idiopathic yellow spot detachment) is more often detected in men 20–40 years old who do not have somatic diseases. In the history of patients indicate a postponed emotional stress, frequent migraine-type headaches. In central serous retinopathy, retinal damage is usually unilateral.
Symptoms of central serous retinopathy include micropsia (reduction in the size of visible objects), the appearance of cattle, a decrease in acuity and a narrowing of the visual fields. An important differential diagnostic sign is the improvement of vision when using weakly positive lenses.
The pathological picture of central serous retinopathy is characterized by serous detachment of the pigment epithelium in the macular area, which is determined in the process of ophthalmoscopy as a limited oval or circular bulging of a darker color than the surrounding retinal tissues. Typically, the absence of the foveal reflex (light strip around the central fossa of the retina), the presence of yellowish or grayish precipitates.
In the treatment of central serous retinopathy, laser coagulation of the retina is used. Therapy is aimed at strengthening the vascular wall, improving microcirculation, reducing retinal edema, oxygen-oxygen therapy is prescribed. In 80% of cases, with timely active treatment of serous retinopathy, it is possible to stop retinal detachment and restore vision to its original level.
Acute posterior multifocal pigment epitheliopathy
This form of retinopathy can be one- or two-sided. In acute posterior multifocal pigment epitheliopathy, multiple flat subretinal foci of grayish-white color are formed, with the reverse development of which depigmentation areas are formed. On examination of the fundus, perivascular edema of the peripheral retinal vessels, tortuosity and dilation of the veins, optic disc, edema, are determined.
A significant proportion of patients experience clouding of the vitreous body, episcleritis and iridocyclitis develop. Central vision is disturbed early, central or paracentral scotomas appear in the field of view.
Treatment of the posterior multifocal pigment epitheliopathy is carried out conservatively, including the administration of vitamin therapy, vasodilator drugs (vinpocetine, pentoxifylline, etc.), angioprotectors (solcoseryl), retrobulbar injections of corticosteroids, hyperbaric oxygen therapy. The prognosis for this form of primary retinopathy is generally favorable.
External exudative retinopathy
The development of external exudative retinopathy (Coates disease, external exudative retinitis) is mainly noted in young men. Retinal damage is more often unilateral. In this form of retinopathy, exudate, hemorrhages, and cholesterol crystals accumulate under the vessels of the retina. Changes are usually localized on the periphery of the fundus of the eye, the lesion of the macular area is rare. Often, retinal angiography reveals multiple microaneurysms, arteriovenous shunts.
The course of external exudative retinopathy is slow and progressive. Treatment is carried out by laser coagulation of the retina and hyperbaric oxygenation. The prognosis is aggravated by retinal detachment, requiring urgent intervention, the development of iridocyclitis and glaucoma.
Pathogenetic hypertonic retinopathy is associated with arterial hypertension, renal failure, toxemia of pregnant women. In this form of retinopathy, a spasm of the fundus arterioles is noted, followed by elastofibrosis or hyalinosis of their walls. The severity of the lesion is determined by the degree of hypertension and the duration of the course of hypertension.
In the development of hypertensive retinopathy there are 4 stages. The stage of hypertensive angiopathy of the retina is characterized by reversible functional changes affecting the retinal arterioles and venules.
In the stage of hypertensive angiosclerosis, the damage to the retinal vessels is organic in nature and is associated with the sclerotic consolidation of the vascular walls and a decrease in their transparency.
The stage of hypertensive retinopathy is characterized by the presence of focal changes in the retinal tissue (hemorrhages, plasmorrhages, lipid deposits, protein exudate, zones of ischemic infarction), partial hemophthalmia. In patients with hypertensive retinopathy, visual acuity is reduced, scotomas (floating spots) appear before the eyes. Usually, on the background of antihypertensive therapy, these changes regress and the symptoms disappear.
In the stage of hypertensive neuroretinopathy, angiopathy, angiosclerosis and retinopathy itself are associated with the phenomena of optic disc dysfunction, exudation, and retinal detachment. These changes are more characteristic of malignant hypertension and renal-induced hypertension. The stage of hypertensive neuroretinopathy may result in optic nerve atrophy and irreversible loss of vision.
Diagnosis of hypertensive retinopathy includes consultation with an ophthalmologist and a cardiologist, ophthalmoscopy and fluorescence angiography. The ophthalmoscopic picture is characterized by a change in the caliber of the retinal vessels, their partial or total obliteration, the Salus-Gunn symptom (displacement of the vein into the deep retinal layers due to pressure on it by the stressed and compacted artery in the area of their intersection), subretinal exudation, etc.
In hypertensive retinopathy, arterial hypertension is corrected, anticoagulants, vitamins are prescribed, oxygen barotherapy and laser coagulation of the retina are performed. Complications of hypertensive retinopathy are recurrent hemophthalmia and retinal vein thrombosis. The prognosis of hypertensive retinopathy is serious: a significant reduction in vision and even the development of blindness are not excluded. Retinopathy aggravates the course of the underlying pathology and pregnancy, and therefore can be a medical basis for artificially terminating a pregnancy.
The cause of atherosclerotic retinopathy is systemic atherosclerosis. Changes occurring in the retina in the stages of angiopathy and angiosclerosis are similar to those in hypertensive retinopathy, small capillary hemorrhages, deposits of crystalline exudate along the veins, paleness of the optic disc appear in the neuroretinopathy stage.
The main methods of ophthalmic diagnosis of atherosclerotic retinopathy are direct and indirect ophthalmoscopy, angiography of retinal vessels. Special treatment of atherosclerotic retinopathy is not carried out. The most important is the therapy of the underlying disease - the appointment of antiplatelet agents, anti-sclerotic, vasodilator drugs, angioprotectors, diuretics. With the development of neuroretinopathy courses of electrophoresis with proteolytic enzymes are shown. Occlusion of retinal arteries and optic nerve atrophy are often complications of atherosclerotic retinopathy.
The pathogenesis of diabetic retinopathy is caused by the presence of type 1 or type 2 diabetes. The main risk factors for the development of retinopathy are the duration of diabetes, severe hyperglycemia, nephropathy, arterial hypertension, obesity, hyperlipidemia, and anemia. Diabetic retinopathy is the most frequent and serious complication of diabetes and is the main cause of low vision and blindness.
In the development of this form of the disease, stages of diabetic angiopathy, diabetic retinopathy and proliferating diabetic retinopathy are isolated. The first two stages (angiopathy and simple retinopathy) proceed with the same changes as the similar stages of hypertensive and atherosclerotic retinopathy. In the early stage of proliferating diabetic retinopathy, neovascularization of the retina develops, in the late stage, the newly formed vessels undergo growth and recurrent hemorrhages into the vitreous, proliferation of glial tissue. Fiber tension and deformation of the vitreous body determine the development of traction retinal detachment, which is the cause of incurable blindness in diabetic retinopathy.
In the initial stages, diabetic retinopathy is manifested by a steady decrease in visual acuity, the appearance of a veil before the eyes and floating spots that periodically disappear. Difficult to read and do petty work. In the late proliferating stage, complete loss of vision occurs.
Conducting an ophthalmoscopy under mydriasis allows a detailed examination of the fundus of the eye and the identification of changes characteristic of diabetic retinopathy. The functional state of the retinal peripheral zones is investigated using perimetry. Using ultrasound eyes are determined areas of seals, hemorrhages, scars in the thickness of the eyeball. Electroretinography is performed to determine the electrical potential and assess the viability of the retina. To clarify the state of the retina, laser scanning tomography and retinal angiography are used.
Additional information in the complex of ophthalmologic examination of patients with diabetic retinopathy is obtained by determining visual acuity, biomicroscopy, eye diaphanoscopy, determining the critical frequency of flicker fusion (CFFF), etc.
Treatment of diabetic retinopathy should be controlled by an ophthalmologist and an endocrinologist (diabetologist). Careful control of blood glucose levels, timely taking of antidiabetic drugs, vitamins, antiplatelet agents, angioprotectors, antioxidants, microcirculation improving agents are necessary. With retinal detachment, coagulation is applied. In case of marked changes in the vitreous body and scar formation, vitrectomy, vitreoretinal surgery is indicated.
Complications of diabetic retinopathy are cataracts, hemophthalmus, clouding and cicatricial changes of the vitreous body, retinal detachment, blindness.
The development of traumatic retinopathy is associated with a sudden and sharp compression of the chest, in which spasm of arterioles occurs, retinal hypoxia occurs with the release of transudate into it. In the short term after injury, hemorrhages and organic changes in the retina develop. Traumatic retinopathy can lead to atrophy of the optic nerve.
Consequences of the contusion of the eyeball are changes that have been called the Berlin retinal opacification. This form of traumatic retinopathy is associated with subchoroidal hemorrhage and edema of the deep retinal layers, the release of transudate into the space between the retina and the choroid.
For the treatment of traumatic retinopathy, vitamin therapy is prescribed, tissue hypoxia is controlled, hyperbaric oxygenation is carried out.
General characteristics of the disease
Retinopathy is a serious retinal vascular disorder. Most often, the disease occurs in newborns and is called retinopathy of prematurity. In most cases, retinal blood supply disorders occur under the influence of high oxygen concentrations in the incubator. They are vital for ensuring the respiration of a newborn with undeveloped lungs, but often lead to the development of retinopathy of prematurity.
The highest percentage of retinopathy of prematurity is found, oddly enough, in countries with a high level of development of medicine. The neonatal technologies of these states are capable of supporting the lives of babies with a 500-gram weight who were born earlier than 3 months and earlier. However, the imperfection of these technologies leads to vision pathologies, since the conditions of the incubator are significantly different from the natural environment for the development of the child - the female uterus.
In less developed countries, the problem of retinopathy of prematurity does not have such relevance for the sole reason that the overall survival rate of prematurely born babies with low birth weight is much worse.
Symptoms of retinopathy
Symptoms of retinopathy of prematurity can be direct and indirect. The second group of symptoms of retinopathy includes a small weight of the child (less than 1.5 kg), an unstable condition after birth, and the use of auger in the first weeks of life.
Indirect symptoms of retinopathy of prematurity in the first two years of life are visual impairment, strabismus, the predominant use of one of the eyes.
The main symptom of retinopathy is retinal vascular underdevelopment, abnormal formations of connective tissue in the area of the retina, and then the lens. To diagnose these pathologies is possible only with the help of special ophthalmic equipment.
Stages of retinopathy of prematurity
Depending on the severity of the disease, several stages of retinopathy of prematurity are distinguished.
For stage V of retinopathy, complete retinal detachment caused by excessive stretching of eye tissue is characteristic. For stage I retinopathy of prematurity, respectively, minimal vascular disorders of the retina are characteristic. Stage III retinopathy is considered a threshold. During her child goes to the treatment of retinopathy using laser coagulation techniques.
Diagnosis of retinopathy
Routine examination for retinopathy of prematurity is carried out every 2 weeks a month after the birth of the child. Examinations continue until the complete formation of retinal vessels.
If symptoms of retinopathy are present, the examination is carried out every week or 1 time in 3 days. Diagnosis of the disease is carried out using an indirect binocular ophthalmoscopy apparatus. Atropine is pre-buried in the child's eyes to expand the pupil. Additionally, in the diagnosis of retinopathy of prematurity, ultrasound of the eye can also be used.
Scheduled ophthalmologic examinations in patients with diabetes mellitus are performed every 5 years.
In the treatment of retinopathy of prematurity, timely initiation of therapy is extremely important. At stage I of the disease, dynamic monitoring of the state of the retina is recommended. One of the supporting measures at this stage is the treatment of retinopathy with cryoretinopathy (freezing of the peripheral areas of the retina).
When the third stage of the disease is reached, laser treatment of retinopathy is performed - cauterization of the periphery of the retina with a laser. Scars are formed at the site of burns. The vision in this area of the retina is lost, but with the help of laser treatment of retinopathy, it is possible to maintain central vision and prevent retinal detachment.
In the diabetic form of vascular disorders of the retina, the treatment of retinopathy is also predominantly laser. However, since the pathologies of retinal blood supply in this case are a complication of the underlying disease, control of blood glucose levels is more important in the treatment of diabetic retinopathy. Timely correction of the blood is the best prevention of further progression of diabetic retinopathy.
In severe stages of the disease, surgical treatment of retinopathy with the help of a vitrectomy technique is possible. Due to its use, blood clots are removed from the eye cavity and the vitreous body. Thus, access to a retina is facilitated. After restoration and attachment of the retina with a laser, the vitreous body of the eye is replaced with a special oil or gas.
This method of surgical treatment of retinopathy is highly effective, however, it has a high risk of complications in the form of increased intraocular pressure.
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The information is generalized and is provided for informational purposes only. At the first signs of illness, consult a doctor. Self-treatment is dangerous to health!
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Acute posterior multifocal retinopathy
This type of retinopathy can affect the retina on one side or the other. Accompanied by the formation of many small hemorrhages under the retina, leaving a whitish tint, with the formation of areas with lost pigmentation or pigmentary degeneration. Examination of the bottom of the eye reveals edemas localized around blood vessels and deformity of the veins.
Most patients have clouding of the vitreous body, the development of inflammatory processes around the episcleral tissue and the iris. Retinopathy is accompanied by a violation of central vision, blind spots appear in sight.
The treatment is rather conservative and includes:
- Vitamin therapy - includes vitamins A, B1, B2, B6, B12 in standard dosage,
- Drugs that expand vessels - Cavinton, pentoxifylline and others,
- Microcirculation Correctors - Solcoseryl,
- Retrobulbar injections - the introduction of medicinal solutions into the eye, through the skin in parts of the lower eyelid,
- As practice shows, the treatment of such methods in this form of retinopathy in most cases passes without complications and produces a favorable effect.
Retinopathy is quite diverse, and effective treatment depends on the quality of diagnosis and proper treatment in the early stages of the disease. Most types of the disease have similarity in the possibility of preventing the development of the disease in the early stages. It should be borne in mind that an important role in the prevention of retinopathy is played by the coherence of the actions of specialists of various profiles.
In order to prevent the development of retinopathy, an outpatient observation by an ophthalmologist of patients with essential hypertension, diabetes mellitus, atherosclerosis, kidney disease, blood diseases, injuries, pregnant women with nephropathy, etc. is necessary.
Prevention of retinopathy of premature babies requires careful management of pregnancy in women at risk of preterm birth, improving the conditions of nursing premature babies. Children who have undergone retinopathy in the neonatal period should be examined by a pediatric ophthalmologist each year up to 18 years.
An important role in the prevention of retinopathy is played by the coherence of the actions of specialists of various profiles: ophthalmologists, endocrinologists, cardiologists, neurologists, obstetrician-gynecologists, pediatricians, traumatologists, etc.
- central serous,
- sharp back multifocal,
- external exudative.
- hypertensive retinopathy,
- retinopathy for blood disorders,
Retinopathy of prematurity does not belong to these groups.
Hypertensive retinopathy progresses against the background of a dysfunction of the kidneys, arterial hypertension. For the disease characteristic is spasm of arterioles and the subsequent destruction of their walls and tissues. The severity of this form depends on what stage of hypertension is observed in humans.
Hypertensive retinopathy occurs in 4 stages:
- angiopathy. The processes that occur in the venols and arterioles are reversible,
- angiosclerosis. Vascular tissues become more dense and lose their transparency. As a result, this leads to organic damage to the vascular of the eye,
- retinopathy. It is characterized by the formation of pathological foci on the retina, as well as partial hemophthalmia. At this stage, the symptoms of the disease are manifested - scotomas, a decrease in visual function. If you treat hypertension at this stage, then the retinopathy of the eyes will completely disappear,
- neuroretinopathy. Edema of the nerve, exudation, detachment of the retina joins the already existing eye lesions. Without treatment, a person may lose his sight.
This type of disease progresses solely against the background of diabetes. The pathological process proceeds in three stages:
- background retinopathy. Retinal veins slightly expand, and microaneurysms form on the walls of capillaries. Visually, they look like red dots. There are no symptoms indicating ailment at this stage,
- preproliferative. It is characterized by the formation of several small or medium hemorrhages on the retina. There is a tendency to edema. Lipid exudate deposits are formed around the macula. All manifestations of the preproliferative form are reversible,
- proliferative retinopathy. It is of two subspecies - early and late. At the early stage, neovascularization forms on the surface of the retina, and at the later stage new formed vessels gradually grow into the vitreous (the body tries to normalize the blood circulation by creating new vessels). Aneurysms are also formed in new vessels. The number of hemorrhages increases and deformity of the vitreous occurs. Proliferative retinopathy leads to traction retinal detachment. It is impossible to restore it, even with the help of surgical intervention. Proliferative retinopathy often affects people of working age.
The post-thrombotic form begins to progress after a certain period of time after a thrombosis of the central arteries or veins that feed the retina has occurred. Thrombosis usually occurs on the background of an eye injury, glaucoma, tumors of the visual apparatus.
- acute retinal hypoxia,
- hemorrhages in the tissue of the retina,
- occlusion of vessels. Entails a decrease in visual function, up to a complete loss of vision.
The post-thrombotic form of pathology often develops in elderly patients who have a history of hypertension, vascular atherosclerosis, coronary artery disease and so on.
Treatment of retinopathy depends on the stage of the process. There are 2 main areas:
- Conservative - instillation of drops prescribed by an ophthalmologist. Most often it is vitamin and hormone preparations.
The choice of surgical method depends on the stage of the process. As a rule, laser or cryosurgical (liquid nitrogen) coagulation of the retina or vitrectomy (removal of the vitreous body) is performed by experienced ophthalmic surgeons in specialized medical institutions. Half of the patients have a tragic discrepancy between a successful surgical solution of the problem (that is, a technically successful operation) and the lack of vision of the operated patient. Many causes and factors lead to such unsatisfactory results. These include underdevelopment of retinal photoreceptors and their damage both in the process of retinopathy itself and during surgical treatment, the presence of severe concomitant CNS pathology, congenital damage to the visual pathways and subcortical centers.
Retinopathy of prematurity is a serious eye disease that develops predominantly in extremely premature babies, accompanied by changes in the retina and vitreous body. The main risk factors for retinopathy of prematurity are as follows:
- short gestational age (i.e. the degree of fetus maturity)
- low birth weight
- intensity and duration of mechanical ventilation and oxygen therapy (stay in the incubator)
- concomitant fetal abnormality
- the presence of the mother of chronic inflammatory gynecological diseases during pregnancy, bleeding during childbirth.
Retinopathy of prematurity occurs due to preterm birth, followed by nursing of newborns in oxygen incubators. Oxygen has an adverse effect on eye tissue, causing active growth of retinal vessels, which subsequently leads to a significant reduction in vision.
Course of illness Edit
In the development of retinopathy of prematurity there are 3 periods.
- Active (up to 6 months of age), including changes in retinal vessels (changes in arteries, varicose veins, vascular tortuosity, clouding of the vitreous body, hemorrhages in the vitreous body, the formation of tears and retinal breaks with retinal detachment.
- The period of reverse development (from 6 months to 1 year). Possible in the early stages of the active period to changes in the vitreous body.
- Cicatricial period (after 1 year of life). Accompanied by the formation of moderate and high myopia, tears and retinal detachment, the development of lens opacities, increased intraocular pressure, a decrease in eyeballs (subatrophy).
Diagnosis in children Edit
Terms of examination by an ophthalmologist for premature babies: The first examination should be carried out in the first week of life, then every 2 weeks until the age of 36 weeks. In the future, the survey is carried out monthly until the age of 6 months. If retinopathy of prematurity is detected, examinations are performed once a week until the disease has fully regressed. In case of “plus” disease, the examination is carried out 1 time in 3 days. After 1 year of life, children with cicatricial retinopathy of prematurity are observed by an oculist for life.
Which doctor treats retinopathy?
The diagnosis and treatment of various retinopathy is done by an ophthalmologist. In severe illness, he sends a person to consult a retinologist - a doctor who specializes in retinal diseases. In addition, the patient is seen by an endocrinologist, a neuropathologist, a therapist, a cardiologist, or another relevant specialist.
Acute Multifocal Pigment
This type of retinopathy can cause damage to both eyes, and can be observed from one side. When performing ophthalmoscopy, one can observe the swelling of the damaged vessels of the retina and optic nerve head, the increase in veins.
Patients complain of loss of areas of the visual field, the quality of vision decreases, inflammation of the eyeball and iris is observed. For the treatment of this form of retinopathy, local anti-inflammatory drugs, vasodilator eye drops, vascular-strengthening agents, and hyperbaric oxygenation are used. With timely correct treatment, the prognosis is quite favorable.
This form of retinopathy is most common in young and middle-aged males. In most cases, is characterized by unilateral course and slow progression.
This form is localized at the edges of the retina, the macula is rarely affected. When ophthalmoscopy revealed multiple outpourings of blood and intraocular fluid in the area under the retina.
With such retinopathy of the eye, surgery is required. Due to the accumulation of exudate, retinal detachment can occur, then an urgent operation is required to save vision. Also among the complications of external exudative retinopathy is the development of inflammation of the iris, increased intraocular pressure and, as a result, glaucoma.
Secondary forms of retinopathy develop on the background of various diseases, so they are also called background. The causes of the pathological process in the tissues of the eye can be diabetes, hypertension, mechanical damage to the eyes, diseases of the blood and blood-forming organs, vascular sclerosis.
Background in hematological diseases
The development of the disease is possible in some blood diseases:
- tumor formations in the blood plasma,
- low hemoglobin
- increased red blood cell levels.
Symptoms vary depending on the provoking factor. Such forms entail extremely serious consequences up to complete blindness. Requires systematic treatment of the underlying pathology. For severe retinal lesions, surgical treatment can be used.