Chorioretinal dystrophy of the retina. Central chorioretinal retinal dystrophy

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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

• 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

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

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. Against the background of 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 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 large in size. This spot does not allow a person to see most of the 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

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 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

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.

At lattice dystrophy White, narrow, wavy stripes are visible on the fundus, forming gratings 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 along the edges of the area of ​​dystrophy, vitreous, 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

Frost-like retinal dystrophy

Retinal dystrophy "cobblestone"

Small cystic retinal dystrophy Blessin–Ivanov

Retinal pigmentary dystrophy

Pediatric Leber's taperetinal amaurosis

X-chromosomal juvenile retinoschisis

Congenital retinal dystrophy

• 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

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

Local causative factors of 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 sun rays on the eyes;
• White skin and blue eyes.

Retinal dystrophy - symptoms and signs

• 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 Retinal dystrophy is characterized by the 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 “cobblestone” type.

This photo shows dry age-related macular degeneration retina.

Retinal dystrophy - treatment

General principles of treatment of various types of retinal dystrophy

Drug therapy for retinal dystrophy involves the use of the following groups of drugs:
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 that promote repair and improve 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.

Also used in courses for the treatment of retinal dystrophies following methods physiotherapy:

• 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 blood irradiation (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

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 sprouting, abnormal vessels. 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

Retinal dystrophy - laser treatment

Examples therapeutic treatment laser dystrophy - is stimulation of the retina, during which the affected areas are irradiated in order to activate them metabolic processes. 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 dystrophy is coagulation of blood vessels or delimitation of the affected area of ​​the retina. IN 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)

Vitamins for retinal dystrophy

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. Richest in vitamins A, E and group B fresh vegetables and fruits, grains, nuts, etc. 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

• 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 biologically active additives with zinc.

Retinal dystrophy - folk remedies

Peripheral chorioretinal dystrophy (PCRD) is a thinning of distant areas of the retina, which can cause rupture and detachment. The pathology does not manifest itself at first: symptoms arise only when a rupture occurs.

Peripheral retinal dystrophy - what is it? PCRD of the retina - form dystrophic disease retina. Unlike CCRD, the pathology consists of a peripheral change in the fundus of the eye, which leads to rupture and subsequent detachment of the retina (retina).

In certain parts of the periphery of the retina, blood flow is disrupted, which causes metabolic processes to slow down and dystrophic foci to form - thinned areas of the retina.

Often, peripheral retinal dystrophy develops in older people, like AMD, as well as in those who suffer from myopia. Pathology can be chorioretinal and vitreochorioretinal (PVCR). In the first case we are talking about defeat choroid and the retina of the eye, in the second - the retina and vitreous body.

Peripheral dystrophy develops as a result of:

• severe intoxication of the body;
• myopia;
• mechanical damage to the organs of vision;
• persistently elevated blood pressure;
• dysfunction of the secretory glands;
• hereditary predisposition;
• transferred infectious diseases;
• atherosclerosis;
• problematic pregnancy;
• disturbances of blood flow in the vessels of the inner lining of the retina (angiopathy);
• pathologies of the organs of vision of an inflammatory nature.

It is known that the degenerative process that spreads to the retina can be associated with a person’s bad habits and stressful rhythm of life.

Bad habits, myopia and eye trauma are one of the reasons for the development of PCRD.

Pathology occurs at any age - both in adults and children.

Clinical picture

Peripheral chorioretinal dystrophy of the retina develops asymptomatically, which significantly complicates the ability to diagnose this pathology in a timely manner.

Specific complaints arise in the patient when the retina ruptures. Manifestations of PCRD include:

• the appearance of flashes and flickering “flies” before the eyes;
• noticeable decrease in visual acuity;
• the appearance in the field of vision of a volumetric spot that is visible to both eyes.

If these symptoms appear, you must urgently contact an ophthalmologist, otherwise there is a high risk of developing blindness and subsequently disability.

Complications of PCRD

A dangerous consequence of retinal degeneration is sharp deterioration vision and possible blindness. When retina peels off, it gets worse first peripheral vision, while the central one is preserved, as is fairly high visual acuity. But after some time, as the detachment progresses, the area of ​​the “curtain” increases, which limits the fields of peripheral vision. Once the retinal detachment reaches central departments, vision drops sharply - from 100% to 2-3%.

If the retinal detachment has reached the central part, the patient loses up to 2% of vision.

With total detachment, blindness occurs.

Forms of pathology

Based on the fact that it is PCRD, the following types of retinal dystrophy are distinguished, depending on the nature of the lesion:

• lattice. In this case, the lesion has the appearance of a lattice. This type of dystrophy usually affects both eyes at once;
• retinoschisis, or retinal separation. Usually occurs in the elderly;
• "snail tracks" The name of this form is due to the fact that the retinal lesions resemble mucous traces of the cochlea;
• small cystic. The degenerative process occurs as a result of injuries that provoke the formation of small cysts;
• "cobblestone pavement." A rare form in which layers of pigment clusters form on the outer part of the retina;
• frost-like. With the development of a pathological process, formation occurs yellow spots on the retina of both the left and right eyes simultaneously.

If peripheral chorioretinal dystrophy of any form is detected in a pregnant woman, it is prescribed C-section. Natural childbirth are contraindicated, since any straining can lead to premature rupture of the retina of the affected eye.

With PCRD, the possibility of spontaneous childbirth is excluded, only cesarean section.

PCRD is a contraindication for military service. If such a disease is present, a man is exempt from conscription.

Identification and diagnosis

In order to identify pathology, preliminary medicinal dilation of the pupil is required. Next, the fundus is examined using a special lens.

In addition, such diagnostic measures, such as ultrasound of the eyeball, visual field examination, optical tomography.

Methods for correcting the condition

To treat peripheral retinal dystrophy, basic methods such as conservative treatment (medications and eye injections), laser therapy, and surgery are used.

Medicines

Well conservative therapy involves the use of the following medications:

• drugs to strengthen blood vessels (Papaverine, Ascorutin);
• drugs to prevent blood clots ( Acetylsalicylic acid);
• eye drops to stimulate metabolism (Taufon);
• vitamin B and complexes (Cherinka-forte).

Medicines can be injected directly into vascular network eyes in the form of injections to improve microcirculation.

Ascorutin is prescribed as a vasodilator.

Laser therapy

PPLC of the retina (peripheral preventive laser coagulation of the retina) is an event aimed at strengthening the area retina in order to prevent its detachment. The laser beam acts only on the lesions, without affecting undamaged areas. It “seals” the tissue, isolating the damaged area. In this way, the course of the pathological process can be stopped.

Surgery

Treatment of retinal PCRD requires surgical intervention, provided that other methods do not provide treatment, and the pathology is characterized by severe course. During the operation, the specialist either removes the affected vessels or restores the patency of the vascular bed of the eyes using grafts.

Physiotherapy

For retinal dystrophy, such types of physiotherapeutic procedures as electrical stimulation of the retina, magnetic therapy, electrophoresis with the administration of Heparin are useful.

Taking vitamins

At home, a patient with PCRD can take vitamins A, B, E in tablets and complexes that contain them.

Home treatment

Traditional methods of treatment are used only as a complement to the main therapy.

You can instill a solution prepared by mixing 10 ml into your eyes fresh juice, obtained from aloe leaves, and 50 g of natural mumiyo. Use the resulting composition in the morning and evening for 9 days.

Retinal dystrophy is an extremely dangerous disease characterized by a chronic progressive process of destruction of eye tissue. The impetus for the development of dystrophy can be a violation of metabolic processes and the appearance in tissues of qualitatively and quantitatively changed metabolic products.

The retina of the human eye is a very thin layer of nervous tissue located between the vitreous body and the choroid of the eyeball. She plays important role in the perception, transformation, transmission to the brain and processing of visual images received by a person. When the retina is damaged, problems with vision occur (up to its complete loss).

Causes of development of retinal dystrophy

Retinal dystrophy can be either an acquired disease or caused by a hereditary genetic factor.

Factors that increase the risk of developing the disease:

• eye injuries;
• serious illnesses internal organs(liver, kidneys, adrenal glands, etc.);
• scleroderma;
• rheumatoid arthritis;
• complications caused by or ARVI;
• other eye diseases (for example, or);
• disruption of blood supply to cells;
• infectious diseases;
• pregnancy;
• diabetes;
• intoxication;
• hormonal imbalance;
• elderly age;
• smoking;
• dysfunction thyroid gland;
• poor nutrition;
• weight disorders;
• elevated cholesterol levels, etc.

Chorioretinal retinal dystrophy

One type of dystrophy is chorioretinal retinal dystrophy (age-related macular degeneration), which is accompanied by a slowly progressive, chronic process of loss of central vision in both eyes. The disease predominantly develops in people over 50 years of age. Moreover, it is diagnosed in women more often than in men. Even the most complex forms of the disease do not lead to complete loss of vision, since with this type of dystrophy peripheral vision is preserved. Chorioretinal retinal dystrophy can be of two types:

On initial stages chorioretinal retinal dystrophy does not appear, and visual acuity remains normal. Later, the symptoms of dry retinal dystrophy are expressed as follows:

• there is an accumulation of colloidal substance between the Buch membrane and the retinal pigment epithelium;
• pigment redistribution occurs;
• the pigment epithelium atrophies;
• the choriocapillaris layer atrophies;
• Doubling of objects begins, their clarity decreases when viewed at close range;
• Blind spots form in the field of vision.

With the development of wet type dystrophy, the following occurs:

• periodic occurrence of refractive errors (for example, farsightedness);
• shapes, straight lines, and sizes of objects are distorted;
• formation of translucent spots in the field of view;
• there is a slight dome-shaped elevation of the retina in the area of ​​its detachment;
• Maybe a sharp decline vision (usually at the stage of neovascularization);
• the formation of a focus of pigment accumulation (can be light pink or gray-brown);
• neoplasm of vessels (which can rupture, forming subpigmented or subretinal - rarely hemophthalmos can form);
• cystic changes in the retina;
• formation of fibrous tissue;
• the appearance of scars.

Peripheral retinal dystrophy

Peripheral retinal dystrophy is another type of dystrophy. It represents degenerative changes in the retina of the eye, localized in its peripheral parts and not affecting the macular zone (the area of ​​clearest vision). The disease is hereditary and genetic in nature and very often develops in myopic people.

Video: Peripheral retinal dystrophy - says an ophthalmologist

Peripheral retinal dystrophy can have the following types:

• "lattice" dystrophy;
• dystrophy of the “snail track” type;
• degenerative retinoschisis;
• “white without pressure”;
• small cystic degeneration;
• "snowflakes";
• "cobblestones";
• honeycomb degeneration;
• paraoral pigmentary degeneration.

Retinal pigmentary dystrophy

One of the rarest types of dystrophy is retinal pigmentary dystrophy, caused by a hereditary genetic factor. Can be transmitted in the following ways:

Video: Retinal dystrophies: central and peripheral

• from mother to son with an X chromosome;
• through transmission of disease genes from both parents (autosomal recessive method);
• through the transmission of a pathological gene to a child by one of the parents (autosomal dominant method).

Retinitis pigmentosa affects men more often than women.

Symptoms of retinal dystrophy of this type are:

• poor vision in the twilight (both eyes see poorly);
• frequent trips, collisions and loss of balance in low light conditions;
• gradual narrowing of the peripheral visibility zone;
• increased eye fatigue.

Treatment of retinal dystrophy

Depending on the type of disease and the cause of its development, an individual treatment is selected for each patient. complex therapy. The decisive factors in determining it are:

• how long ago the retina began to detach;
• detachment dimensions;
• number of breaks in the detachment;
• locations of ruptures, etc.

The main treatment method for retinal dystrophy is laser surgery. Cryopexy (cold exposure) can also be used to close a retinal tear. To improve sealing performance, a silicone seal is sutured to the eyeball, shaped like a cord. By applying pressure to the wall of the eye, it allows the detached retina to be brought closer to the choroid.

Methodology surgical intervention could be as follows:

• local filling of the retina in the area of ​​the gap (necessary for partial retinal detachment);
• circular filling (necessary in cases where the retina is completely detached);
• vitrectomy (removal of the vitreous body and its subsequent replacement with liquid silicone, saline solution, perfluorocarbon compound in the form of liquid or gas);
• laser coagulation (allows you to limit the areas of retinal rupture, the areas of greatest thinning).

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Central chorioretinal retinal dystrophy (CRRD) is characterized by irreversible degenerative changes, originating in the choriocapillaris layer vascular system eyes, which affect the pigment layer of the retina and Bruch's membrane. Another name for this disease is senile macular degeneration, which indicates that this type of pathology usually occurs in older people and is manifested by impaired central vision. There are two forms of chorioretinal retinal dystrophy: wet ( exudative), which occurs in 9 out of 10 cases, and dry(non-exudative), occurring in 1 out of 10 cases.

Risk group

Those most at risk of the disease are primarily older people over 60 years of age. It is known that the pathology is inherited, which is why relatives of patients with chorioretinal dystrophy also need to carefully monitor the condition of their vision. Patients with atherosclerosis are also at risk.

Causes

Chorioretinal dystrophy can be congenital or occur as a result of trauma or various infections. The disease can also develop due to microcirculation disorders in the chorioretinal layer.

Often the pathological process affects people over 60 years of age who have immune or endocrine system, in patients who have undergone surgical intervention for cataracts, as well as for those who abuse tobacco smoking.

Symptoms (signs)

In the case of a non-exudative form of pathology, the quality of vision may remain unchanged for a long time, after which the manifestation of metamorphopsia is observed - a characteristic distortion of straight lines. In the future, a central scotoma may appear - a lesion that falls out of sight. Atrophic process choriocapillaris layer and pigment epithelium continues, causing a significant decrease in central vision.

The exudative form of the disease is characterized by patient complaints about an image visible as if through a layer of water, curvature of straight lines, the appearance of translucent spots and flashes of light before the eyes. If left untreated, the next stage of the disease can manifest itself as a sharp decrease in vision, during which patients are practically deprived of the ability to read and write.

Diagnostic methods

It is important for the diagnosis of pathology to have characteristic features: distortion of straight lines and loss of lesions from the field of view. Distortion is assessed using the Amsler test, and campimetry is used to examine central vision. It is possible to conduct studies of contrast, color perception and the size of visual fields.

To obtain more detailed information, laser scanning or optical coherence tomography, vascular fluorescein angiography and electroretinography are used.

Treatment

Therapy for chorioretinal retinal dystrophy is aimed at stabilizing the processes of tissue degeneration. You should not expect treatment to restore the quality of your vision.

To treat the disease, medication, laser and, in rare cases, surgical methods are used. In the non-exudative form of the disease, drugs are used to slow down the degeneration process, and the retina is stimulated using a helium-neon laser.

In the case of the exudative form, dehydration therapy is carried out, and laser coagulation of the retina and subretinal membranes is used, for which it is recommended to use a krypton laser. Intravitreal (intraocular) injections of drugs such as Lucentis, Avastin, Eylea give good results.

With regard to restoration of vision quality, the prognosis is unfavorable.

– involutional dystrophic changes affecting mainly the choriocapillaris layer of the choroid, the pigment layer of the retina and the vitreous plate located between them (Bruch’s membrane). Symptoms of chorioretinal dystrophy include distortion of straight lines, the appearance of blind spots in the field of vision, flashes of light, loss of clarity of vision, and the ability to write and read. The diagnosis of chorioretinal dystrophy is confirmed by ophthalmoscopy, visual acuity testing, Amsler test, campimetry, laser scanning tomography, perimetry, electroretinography, fluorescein angiography of retinal vessels. For chorioretinal dystrophy, medication, laser, photodynamic therapy, electrical and magnetic stimulation, as well as vitrectomy, revascularization and vasoreconstruction of the retinal area are performed.

General information

Symptoms of chorioretinal dystrophy

The clinical course of chorioretinal dystrophy is chronic, slowly progressive. In the initial period of the non-exudative form of chorioretinal dystrophy there are no complaints, visual acuity remains within normal limits for a long time. In some cases, distortion of straight lines, shape and size of objects may occur (metamorphopsia). Dry chorioretinal dystrophy is characterized by accumulations of colloidal substance (retinal drusen) between Buch's membrane and the retinal pigment epithelium, redistribution of pigment, development of defects and atrophy of the pigment epithelium and choriocapillary layer. As a result of these changes, a limited area appears in the visual field where vision is severely weakened or completely absent (central scotoma). Patients with the dry form of chorioretinal dystrophy may complain of double vision, decreased clarity of near vision, and the presence of blind spots in the visual field.

There are several stages in the development of the exudative form of chorioretinal dystrophy. At the stage of exudative detachment of the pigment epithelium, a fairly high acuity of central vision (0.8-1.0), the appearance of temporary unexpressed refractive errors: farsightedness or astigmatism, signs of metamorphopsia, relatively positive scotoma (a translucent spot in the field of vision of the eye), photopsia can be observed. A slight elevation of the retina in the form of a dome is detected in the macular area (detachment zone), which has clear boundaries; drusen become less distinguishable. At this stage, the process can stabilize, and the detachment may adhere independently.

At the stage of exudative detachment of the neuroepithelium, complaints generally remain the same, visual acuity decreases in to a greater extent, there is unclearness of the boundaries of the detachment and swelling of the elevated area of ​​the retina.

The stage of neovascularization is characterized by a sharp decrease in visual acuity (to 0.1 or lower) with loss of the ability to write and read. Exudative-hemorrhagic detachment of the pigment and neuroepithelium is manifested by the formation of a large white-pink or gray-brown clearly demarcated focus with accumulations of pigment, newly formed vessels, and a cyst-shaped retina protruding into the vitreous body. When breaking newly formed vessels Subpigment or subretinal hemorrhages are observed, and in rare cases, the development of hemophthalmos. Vision is kept low.

The cicatricial stage of chorioretinal dystrophy occurs with the formation of fibrous tissue and the formation of a scar.

Diagnosis of chorioretinal dystrophy

In the diagnosis of chorioretinal dystrophy, the presence of characteristic manifestations of the disease (various types of metamorphopsia, positive scotoma, photopsia), the results of testing visual acuity, ophthalmoscopy, the Amsler test for visual distortion, and campimetry (study of the central field of vision) are important.

The most informative diagnostic methods for chorioretinal dystrophy, optical coherence and laser scanning tomography of the retina, computer perimetry, electroretinography, fluorescein angiography of retinal vessels are used, which allow identifying the earliest signs of damage. Additionally, tests can be used to check color perception, visual contrast, and the size of the central and peripheral visual fields.

A differential diagnosis of chorioretinal dystrophy and choroidal melanosarcoma is necessary.

Treatment of chorioretinal dystrophy

In the treatment of chorioretinal dystrophy, medication, laser, surgical methods, electrical oculostimulation and magnetic stimulation are used, which allows stabilizing and partially compensating the condition, since complete restoration of normal vision is impossible.

Drug therapy for non-exudative forms of chorioretinal dystrophy includes intravenous, parabulbar administration of disaggregants and direct and anticoagulants. indirect action, angioprotectors, vasodilators, antioxidants, hormones, enzymes, vitamins. Laser stimulation of the retina is performed using low-intensity radiation from a semiconductor laser with a defocused red spot.

In the exudative form of chorioretinal dystrophy, local and general dehydration therapy and sectoral laser coagulation of the retina are indicated in order to destroy the subretinal neovascular membrane and eliminate edema of the macular area, which helps prevent further spread of the degenerative process. Promising methods for treating exudative chorioretinal dystrophy are also photodynamic therapy and transpupillary thermotherapy of the retina.

Surgical treatment of chorioretinal dystrophy is vitrectomy (in non-exudative form to remove subretinal neovascular membranes), choroidal revascularization and vasoreconstructive surgery (in non-exudative form to improve blood supply to the retina). The visual acuity index favorable for treatment is 0.2 or higher.

The prognosis for vision with chorioretinal dystrophy is generally unfavorable.