Retinal disorder. Retinopathy. Lattice retinal dystrophy

Pathological conditions of the retina and optic nerve are often predetermined by cardiovascular, neurological and other diseases, as well as endocrine disorders, which necessitates general coordinated treatment of such patients by an ophthalmologist and a doctor of the appropriate specialty. In addition, changes in the fundus are given great diagnostic and prognostic significance.

It should be especially noted that diseases of the retina, primarily vascular and dystrophic lesions, are today one of the main causes of blindness and visual impairment, which indicates the need for early diagnosis and timely comprehensive treatment by both an ophthalmologist and general practitioners.

Anatomy of the retina

Retina(retina) - peripheral part of the visual analyzer. It develops from the anterior part of the brain bladder, so it can be considered a part of the brain located in the periphery. There are 10 layers in it: 1) a layer of pigment epithelium; 2) layer of rods and cones; 3) external limiting membrane; 4) outer nuclear layer; 5) outer reticular layer; 6) inner nuclear layer; 7) internal reticular layer; 8) layer of multipolar (ganglionic) cells; 9) layer of nerve fibers; 10) internal limiting membrane. There are 3 specific visual neurons in the retina:

1. Rods and cones ( cellula optica bacilliformis et conformis).

2. Bipolar cells ( neurocytus bipolaris).

3. Ganglion cells ( neurocytus ganglionaris).

Rods have very high light sensitivity, provide twilight and peripheral vision, there are a lot of them (about 130 million), they are located along the entire periphery of the retina to the border of its optical part ( ora serrata).

Cones are located mainly in the area of ​​the central fovea of ​​the macula, there are about 7 million of them. They provide formal vision and color perception.

The first neuron lies on a layer of pigment epithelium, firmly connected to the choroid, which ensures the continuous restoration of molecules of visual pigments (rhodopsin and iodopsin), necessary for the photochemical process of vision. Thus, the function of the retina is closely related to the state of the choroid itself.

The second neuron is associative.

The third neuron has long processes that form the optic nerve.

The internuclear layers of the retina consist of fibrous structures and form the skeleton of the retina. The processes of ganglion cells form the optic nerve, which exits the orbit through the optic foramen. In the middle cranial fossa, in the area of ​​the sella turcica, a partial crossing of the fibers of the optic nerves of both eyes occurs (only the medial fibers cross). After the chiasm, the so-called optic tract is formed, which contains fibers from the retinas of both eyes. The subcortical center of the visual analyzer is the external geniculate body, and the cortical center is the calcarine groove in the occipital lobe of the brain ( fissura calcarina).

The blood supply to the retina is carried out from the central retinal artery, the trophism of its outer parts is provided by the choriocapillaris layer of the choroid. The retina does not have sensitive innervation, so damage to it does not cause pain.

A normal fundus of the eye looks like this: the optic disc is pink, its boundaries are clear, the arteries and veins of the retina are of uniform caliber, the ratio of the caliber of the artery to the caliber of the vein is 2:3, there are no focal changes.

Diagnostics retinal diseases is based on data from ophthalmoscopy, fluorescein angiography, functional and electrophysiological studies (visual acuity, visual field, color perception, dark and light adaptation, electroretinography, electrical sensitivity of the optic nerve to phosphene, optical coherence tomography).

The patients' complaints are nonspecific and consist of dysfunction of central vision (photopsia, metamorphopsia, decreased visual acuity, central scotomas, impaired color perception) or peripheral vision (limitation and loss of vision, decreased dark adaptation).

Ophthalmoscopic changes may be as follows:

1. Changes in the caliber, walls and course of blood vessels.

2. Hemorrhages of various shapes, sizes and prevalence.

3. Diffuse or local opacities of the retina (foci).

4. Pigment deposits (foci, mottling).

Retinal pathology is extremely diverse. Among retinal diseases, the following main forms are distinguished:

1. Diseases associated with general diseases of the body.

2. Inflammatory diseases.

3. Dystrophic changes.

4. Retinal detachment.

5. Neoplasms.

6. Developmental anomalies.

Let us dwell on those diseases of the retina that are most common; doctors of all specialties should be familiar with them.

Cardiovascular diseases lead to various changes in the fundus. Thus, in hypertension, these changes reflect the pathogenesis of vascular disorders that occur in the body and have great diagnostic and prognostic significance. According to the classification of A.Ya. Vilenkina, M.M. Krasnov, distinguish: hypertensive angiopathy, hypertensive angiosclerosis, hypertensive retinopathy, hypertensive neuroretinopathy.

At hypertensive angiopathy there is expansion, tortuosity of the veins, narrowing of the arteries, and their uneven caliber. Observed in stage I-II A of hypertension.

At hypertensive angiosclerosis in addition to the above-described phenomena of angiopathy, an uneven light reflex appears along the thickened walls of the arteries, symptoms of copper and silver wire, and a symptom of arteriovenous decussation (Salus-Hun degrees I, II and III).

Salus-Hun sign I: conical narrowing of the vein on both sides of the artery at the point of their intersection, the vein takes on the appearance of an hourglass. Salus-Hun sign II: at the site of the arteriovenous chiasm, the vein bends in an arcuate manner and is pushed into the thickness of the retina. Salus-Hun III symptom: the vein at the intersection cannot be distinguished, since it is covered by the edematous retina. This phenomenon is typical for stages II B - III stages of hypertension.

At hypertensive retinopathy lesions and hemorrhages appear in the retina, vision decreases. Observed in stage III hypertension.

Hypertensive neuroretinopathy- unfavorable prognostic sign. The optic nerve is involved in the process. Swelling of the optic disc occurs, hemorrhages and swelling of the retina around it appear. Visual acuity decreases, the field of vision narrows. Observed in stage III hypertension.

However, there may not be a complete parallel between the clinical course of hypertension and the fundus picture.

Treatment. The underlying disease is treated. For retinopathy, in addition, absorbable therapy (fibrinolysin, parabulbar gemase), angioprotectors, antioxidants (emoxipine, dicinone, doxium) are used; for neuroretinopathy, diuretics and osmotic agents are also used.

At renal hypertension there is a narrowing of the arteries, expansion of the retinal veins without pronounced sclerotic changes, with a large number of exudative foci and plasmorrhagia. A typical star shape is in the macular area. This is a bad prognostic sign; in the words of old authors, it is a “death knell” for the patient. Previously, it was believed that the life expectancy when such changes appear in the fundus is 1-3 years, but now, thanks to effective treatment, in many cases it is possible to achieve a significant improvement in the general condition of the patient with complete or partial reverse development of hypertensive changes in the fundus.

Diabetes mellitus is a common cause of severe retinal lesions, which are called diabetic retinopathy. They consist in the appearance of microaneurysms, hemorrhages, exudative foci; in the terminal phase - the development of proliferating processes, the appearance of newly formed vessels, the proliferation of connective tissue, the development of secondary retinal detachment.

Treatment consists in the use of angioprotectors, absorbable agents, and anabolic hormones. In recent years, photo- and laser coagulation and cryotherapy have been used. The prognosis is unfavorable.

General vascular pathology of the body leads to the development of retinal diseases such as acute obstruction of the central retinal artery, thrombosis of its central vein.

Obstruction of the central retinal artery caused by spasm (50%), thrombosis (45%) or embolism (5%) of the artery. It occurs, in addition to patients with hypertension, in young people suffering from endocarditis, in particular rheumatic, and chronic infectious diseases.

Patients complain of sudden loss of vision, including light perception. In the fundus, a sharp narrowing of the arteries, swelling of the retina, and the “cherry pit” symptom are determined. As a result of the disease, optic nerve atrophy develops.

Treatment: vasodilators (0.1% atropine solution retrobulbar, intravenous - nicotinic acid, aminophylline, trental; sublingual - nitroglycerin), thrombolytic agents, anticoagulants.

Forecast- unfavorable. Treatment is effective when applied within the first 2-4 hours after illness.

Thrombosis of the central retinal vein occurs mainly in elderly people suffering from hypertension and atherosclerosis. Patients complain of a sudden sharp decrease in vision, but complete blindness does not occur. The fundus shows multiple hemorrhages, plasmorrhages, dilation and tortuosity of the veins, intermittency of their course, retinal edema, blurring of the boundaries of the optic nerve head (the so-called “crushed tomato” symptom).

Prognosis for vision bad, but more favorable than in the case of obstruction of the central retinal artery. After resorption of hemorrhages, atrophic foci form in the retina, and in some patients secondary glaucoma develops.

Treatment: direct and indirect anticoagulants, thrombolytic and absorbable drugs.

Inflammatory diseases of the retina

These include metastatic retinitis, chorioretinitis. They arise as a result of microorganisms entering the bloodstream from any purulent focus.

The patient's complaints depend on the location of the process. Lesions of the central parts of the retina are accompanied by metamorphopsia, decreased visual acuity, and the appearance of scotomas; with peripheral localization of the lesions, complaints may be absent.

Diagnosis established by ophthalmoscopy. In the fundus of the eye, yellowish-white lesions with unclear boundaries are visible, which rise above the retina; over time, atrophic chorioretinal lesions develop in their place.

Treatment: anti-inflammatory and resorption therapy, comprehensive examination of the patient to establish the etiology of the disease.

Dystrophic changes in the retina

The following types of dystrophic changes in the retina are distinguished:

1. Hereditary generalized dystrophies (retinal pigmentary dystrophy, Leber congenital amaurosis).

2. Hereditary peripheral retinal dystrophies.

3. Hereditary central retinal dystrophies.

4. Age-related retinal dystrophies.

Retinal pigmentary dystrophy (RPD). The disease is familial and hereditary in nature with a recessive type of inheritance.

Complaints of patients: decrease and loss of vision at dusk (hemeralopia), then a narrowing of the visual field develops, in the terminal stage - visual acuity decreases, up to complete blindness.

With PDS, pigment foci in the form of bone bodies appear in the fundus of the eye, starting from the periphery, which subsequently invade the central parts. The retinal vessels narrow sharply. The optic disc becomes pale, with a waxy tint, and in the terminal stage its complete atrophy develops. The prognosis is unfavorable.

Treatment: vasodilators, metabolic drugs, vitamins, tissue therapy, hormones, anabolic steroids, revascularization operations, retroscleroplasty, physiotherapeutic treatment (ultrasound, phonophoresis, electrophoresis, electrical stimulation using “phosphene”, magnetic therapy).

Hereditary macular degeneration. There are a large number of clinical forms, which differ in the fundus picture and the nature of the clinical course.

The diseases are familial and hereditary in nature, transmitted in a recessive or dominant manner and are characterized by a steadily progressive course. Macular dystrophy appears in preschool or school age, sometimes in adolescence. It should be remembered that macular degeneration in children is also observed in the first year of life with Tay-Sachs and Niemann-Pick diseases.

Tay-Sachs disease (familial amaurotic idiocy) is characterized by blindness with typical changes in the macula (a grayish-white lesion with a “cherry pit” in the center), strabismus and nystagmus, mental retardation up to complete dementia, progressive muscle weakness. Death occurs before two years of age.

Niemann-Pick disease (reticuloendothelial sphingomyelinosis) is characterized by a grayish-white lesion with a “cherry pit” in the macula, a yellowish atrophic optic disc, exophthalmos, nystagmus, enlarged liver, spleen, and mental and physical development retardation. Death occurs before two years of age.

Age-related retinal dystrophies are peripheral and central. Peripheral dystrophies can lead to retinal rupture and detachment. Cryopexy and laser coagulation are performed prophylactically.

Macular degeneration is extremely common; according to various authors, its frequency among people over 50 years of age is 15 - 29%. Patients complain of a gradual decrease in vision, as a result, vision decreases to hundredths, and a central absolute scotoma appears.

Clinically, there are 2 forms of age-related sclerotic macular degeneration: “dry” and exudative-hemorrhagic. In the “dry” form, there are atherosclerotic changes in the retinal vessels in the fundus, deposits of lipids, cholesterol, hyaline (drusen) in the retina, depigmentation, and atrophic foci.

In the exudative-hemorrhagic course of the disease, a yellowish-white disc-shaped lesion appears in the fundus, surrounded by hemorrhages. Subsequently, the lesion protrudes into the vitreous body, so it must be differentiated from a neoplasm of the choroid (melanoblastoma) - this is the so-called pseudotumor lesion.

Treatment: for “dry” macular degeneration - physiotherapeutic methods of treatment, vitamin therapy, metabolites, vasodilators, antioxidants, revascularization operations, ligation of the temporal artery, retroscleroplasty. For edematous form - angioprotectors, antioxidants, resorption therapy, laser coagulation, cryopexy.

Retinal dystrophy is a factor that can lead to the development retinal detachment, especially when the eye is stretched (with high myopia). Retinal detachment can also occur under the influence of cicatricial changes in the vitreous body. Most often, the immediate cause is injury or physical stress. The development of retinal detachment is due to the fact that the retina is anatomically closely connected with the underlying tissue in only two places: near the dentate line at the flat part of the ciliary body and near the optic nerve head.

Patients complain of the appearance of flashes of light or “lightning” (photopsia) in the periphery of the visual field - in the area opposite the retinal tear. Then there is a feeling of a “curtain”, which is advancing from the same side - from the periphery of the field of vision to its center, a narrowing of the field of vision occurs, most often from above.

With ophthalmoscopy, the detachment zone looks like a bubble or sail of a grayish color, against which the retinal vessels look dark and the tears look bright red.

Before hospitalization, such a patient must be provided with bed rest, preferably with a binocular patch. Urgent hospitalization is indicated.

Treatment- surgical. A scleral depression operation is performed with diathermocoagulation or cryopexy to develop scar tissue that holds the detached retina. In recent years, laser photocoagulation, as well as intravitreal surgical interventions, have been widely used in the treatment of retinal detachment. During these operations, vitrectomy is performed (removal of the altered vitreous body, vitreoretinal moorings and proliferative epiretinal membranes). In order to press the retina onto the choroid, gases that expand (perfluoroorganic compounds) or silicone oil are injected. If necessary, the shortened detached retina is dissected and straightened with fixation of the edges using cryo- or endolaser coagulation. In some cases, microscopic retinal nails and magnets are used.

Retinoblastoma (glioma)- malignant neoplasm of the retina, which occurs in the first months or years of a child’s life. There are 4 stages in its course.

Stage I – initial. A localized tumor node in the retina is identified.

Stage II – growth into the eye cavity, into the angle of the anterior chamber. A characteristic symptom is “amaurotic cat's eye”, the pupil is dilated, yellowish in color, intraocular pressure is increased.

Stage III – tumor growth into the orbit. Exophthalmos may appear. The tumor grows rapidly anteriorly and has the appearance of a cauliflower.

Stage IV – metastasis to distant organs, growth into the cranial cavity.

Differential diagnosis is carried out with retrolental fibroplasia, in which intraocular pressure is normal, as well as with the outcome of purulent septic endophthalmitis, which is usually accompanied by ocular hypotony. The most informative diagnostic methods are: ultrasound, computed tomography, radioisotope research. Diaphanoscopy is less informative.

Treatment: in stages I and II – enucleation; in III and IV – exenteration of the orbit followed by x-ray and chemotherapy.

Forecast adverse.

Retinopathy of prematurity

According to modern concepts, retinopathy (RO) is a vascular proliferative lesion of the retina, which occurs mainly in premature infants and, in some cases, leads to irreversible blindness.

ROP occurs, on average, in 20% of premature infants, of which in 5–7% pathological changes lead to complete loss of vision.

It has been proven that ROP develops in somatically, neurologically and perinatally complicated children. However, low birth weight (1500g or less), gestational age at birth of 32 weeks or less, and oxygen therapy administered for more than 30 days are the most significant and consistent risk factors.

In ROP, there is an active phase and a regression phase. The active phase is divided into five stages:

І stage– at the border of the vascularized and avascular zones of the retina, a white demarcation line is formed, which is an accumulation of vascular-forming mesenchymal tissue.

Stage II– a protrusion forms in the area of ​​the demarcation line, which can become pink as a result of intraretinal neovascularization. The protrusion begins to prominence above the level of the retina.

III stage– fibrovascular extraretinal proliferation forms at the site of the protrusion.

Stage IV- incomplete retinal detachment.

Stage V– total retinal detachment.

Currently, it is generally accepted that there are no sufficiently effective methods of conservative treatment of ROP (World Forum of Pediatric Ophthalmologists, London, 2000).

Surgical treatments for ROP include cryotherapy, laser photocoagulation, and lensvitrectomy combined with scleral buckling.

Mandatory requirements for the work of a neonatologist and ophthalmologist are the need to promptly inform parents of premature newborns, especially those with low and extremely low birth weight, about the possibilities of the occurrence and severity of manifestations of ROP, the potential seriousness of this disease and the importance of timely ophthalmological examinations.

The retina is one of the most important structures of the organ of vision. After all, it receives all signals coming from the outside and transmits them through the optic nerve to the brain.

If unfavorable conditions arise, this structure suffers no less than others. Retinal diseases are unpleasant, and they also cause serious problems with vision, possibly to the point of complete loss.

Causes

Heredity plays a big role in the occurrence of retinal pathologies. Injuries during childbirth and developmental anomalies also have a negative impact.

It is worth highlighting the most significant reasons:

• Vascular changes;
• Inflammatory processes, diseases of the eyeball;
• Diabetes mellitus, hypertension, rheumatism, atherosclerosis;
• Traumatic brain injuries;
• Stress;
• Eclampsia during pregnancy;
• Neoplasms.

Primary damage is extremely rare. Usually the cause is some kind of chronic disease that lasts for a long time. So, retinal diseases are only a mirror of another problem.

Symptoms

The initial stage practically does not manifest itself, or the symptoms will be minimal. It is worth noting that there are no particularly specific symptoms; they all occur when other structures of the eye are affected.

Main symptoms:

• Orientation is disturbed when there is poor lighting or twilight;
• Visual acuity decreases, myopia develops;
• The perception of the picture of the surrounding world is distorted, a veil appears before the eyes;
• Double vision, flashes and glare appear;
• Loss of lateral vision;
• Impaired color perception;
• Complete loss of vision.

Retinal pathologies

This problem most often affects older people, those over fifty. The exception is detachment in young people, the reasons for which are different.

There are groups of frequently occurring pathologies. As a consequence of dystrophic changes that can affect the central zone or periphery. They may be congenital or appear as a consequence.

One of the most common is vascular disease, angiopathy. It occurs with a long course of hypertension and diabetes mellitus. All retinal damage occurs secondary to existing concomitant pathology.

Inflammatory diseases lead to damage to the structures of the eye. For example, retinitis. This process can move from one eye to the other. The cause can be both viruses and bacteria, exposure to toxic substances on the body, and allergies.

Neoplasms of a benign or malignant nature lead to damage to the retina. They arise for a number of reasons, heredity, exposure to carcinogens, cell mutations, toxins and others.

Very often all these processes occur without any manifestations. And pathology is revealed only when obvious symptoms occur. Meanwhile, the retina becomes thinner and may rupture or detach.

Retinal tear

When a rupture occurs, partial or complete detachment of the retina occurs. Where the fabric has peeled off, moisture is absorbed. In this case, a sharp decrease in visual acuity occurs.

A macular hole occurs when fusion of the retina and vitreous body occurs. This usually happens in the central part.

Valvular - occurs if the vitreous body is damaged. When it peels off, it tears the retina.

In traumatic brain injuries, the rupture occurs along the dentate line.

With dystrophies, perforated lesions occur and sclerosis of the retina occurs.

A retinal tear usually occurs due to excessive pressure, trauma, or stress. The difference from chronic pathologies is that here the symptoms are much more pronounced and they arise acutely.

Therapeutic measures

Very often, diagnosis is carried out too late; in this case, surgical treatment cannot be avoided.

If the problem was identified at the initial stages and the cause was found out, then you need to deal with it. Remove the inflammatory process, control blood pressure, blood sugar, etc.

Today, laser therapy is widely used. Using a laser, it is possible to strengthen this structure and prevent its detachment.

The intervention is performed under local anesthesia and does not require lengthy preparation or rehabilitation. After the intervention, you need to protect your eyes from exposure to ultraviolet rays.

Open operations have the goal of creating pressure on the tissue using special means, such as balloons.

Diseases of the visual apparatus are too serious a problem. Therefore, if symptoms occur, you should immediately seek help from a specialist. After all, wasting time can lead to irreversible loss of vision. Take care of your health.

Currently, medicine already knows many different pathologies of the retina. The most dangerous and common of all these ailments is retinal detachment. The level of development of modern medicine, fortunately, makes it possible to successfully combat this disease.

Types of diseases

There are three groups into which all diseases can be divided: inflammatory, dystrophic and vascular, which usually arise as a result of hypertension and diabetes.

The most common dystrophic pathologies include:

Retinal vascular diseases include: retinal angiopathy, diabetic retinopathy, central vein thrombosis (CVT) and central retinal artery embolism (CRA). As a result of pathological processes in the vessels, a local circulatory disorder occurs, which becomes the cause of vein thrombosis and arterial obstruction.

There are also very rare pathologies, for example, retinitis pigmentosa, which occurs in only 1 person out of 5 thousand. The rarest diseases include: hypoplasia and aplasia of the fovea, angiomatosis and tumors of the retina, as well as anomalies of its development.

Diseases of the posterior part of the eye, in addition to retinal pathology, also include diseases of the vitreous body (VF). The most common ones are:

• Developmental anomalies of CT (hyperplasia, remnants of vessels)

Causes

The most common cause of retinal damage is eye trauma, but the pathological process can also develop due to various other factors:

1. diseases not directly related to the organs of vision (hypertension, atherosclerosis, diabetes mellitus, kidney and blood diseases, rheumatism, meningitis);
2. eye diseases (myopia, farsightedness, various inflammatory and degenerative processes);
3. infectious diseases (syphilis, tuberculosis, toxoplasmosis, all kinds of viral diseases and purulent infections);
4. brain injuries;
5. allergy;
6. poisoning;
7. stress.

Symptoms

The main symptom of the pathological process in the retina is the appearance of the so-called “veil”, which is localized at the site of the lesion and cannot be treated independently. The "veil" tends to increase in size over time and spread over the entire visual field.

In addition, the following symptoms may be characteristic signs of retinal diseases: the appearance of sudden flashes in the form of lightning and sparks, distorted images, difficulties in reading, the appearance of black spots in the field of view, the manifestation of micropsia and macropsia, local loss or narrowing of the visual field, decreased visual acuity vision, as well as poor vision at night.

Since there is no sensitive innervation in the inner shell of the eye, any pathology of the retina develops painlessly.

Diagnostics

To diagnose retinal diseases, the following types of studies are used:

• tonometry – measurement of IOP (intraocular pressure);
• visometry - a study of the level of visual acuity, which allows you to determine the condition of the affected area and vital central areas;
• electrophysiological examination of the eye (EPI) - assessment of the viability of retinal and optic nerve cells;
• computer perimetry – examination of visual fields to determine the condition of the peripheral areas of the retina;
• ophthalmoscopy is an examination of the fundus of the eye, which allows one to determine the lesions of the retina, the location and number of breaks. In addition, in the presence of detached areas of the retina, ophthalmoscopy makes it possible to assess their condition, the strength of their connection with the vitreous body, and also identify areas that require increased attention during treatment;
• optical coherence tomography (OCT);
• Amsler test to test the central visual area;
• computed tomography of the eye;
• ultrasound examination (ultrasound);
• magnetic resonance imaging (MRI).

Treatment

Therapeutic measures for diseases of the retina are determined primarily by the cause of the pathological process and its stage. For example, in case of detachments and ruptures, immediate surgical intervention is necessary. For other conditions, as a rule, conservative therapy is used with specificity characteristic of the type of disease.

Thus, for the treatment of dystrophy (including pigmentary dystrophy), special medications are used that help normalize the blood supply and nutrition of the retina and the optic nerve. The therapeutic course is divided into two stages and lasts one year. In the case of Best's disease, drugs to effectively strengthen the walls of blood vessels, antioxidants, and prostaglandin inhibitors are necessarily prescribed.

Modern medicine also has effective methods for stimulating the retina of the eye, which use a unique infrared laser.

It is necessary to understand that the development of severe complications can only be avoided by timely, qualified medical care. Therefore, it is very important to consult a doctor at the first symptoms of the disease.

Prevention

Measures to prevent various retinal diseases are slightly different, but they agree on the main thing - the most important principles for preventing the disease are: maintaining a healthy lifestyle, getting rid of bad habits and proper balanced nutrition.

Thank you

The site provides reference 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!

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 effusion under the retina, a characteristic symptom of 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 chemicals that are deposited in the tissues under the retina and appear as small yellow bumps. 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. The early stage of 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 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

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 the characteristic appearance of 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

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. Since various eye diseases 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 sunlight 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 listed 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 in the fundus (for example, drusen, cysts, etc.).
3. Reduced electroretinography readings.

Retinal dystrophy - photo

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

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 cattle (the drug Retinolamine). 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.

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 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 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 stops 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 of therapeutic treatment of dystrophy with a laser are retinal stimulation, 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)

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. 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

• 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

Responsible for the perception of light and the creation of the primary image, so disruption of its function can cause blindness.

Patients need to know about such a disease as retinal dystrophy: what it is, is it dangerous. This disease is more common among older people.

Retinal dystrophy is a degenerative disease

Retinal dystrophy is a degenerative disease characterized by a gradual impairment of the visual function of the eye.

Retinal dystrophy primarily affects central vision and for this reason does not cause complete blindness in the patient. This disease is most common in older people, which is why it is also called senile retinal dystrophy.

Retinal dystrophy is one of the most common causes of vision loss worldwide. The risk of developing the disease increases significantly upon reaching 55 years of age.

Pathology can develop over several years. The early stage of retinal dystrophy is often asymptomatic, which is why doctors diagnose the disease late.

From the point of view of the development mechanism, two types of pathology are distinguished:

1. Non-exudative form. This type of disease is characterized by the appearance of yellow deposits in the central region of the retina. Small deposits may not cause serious visual impairment, but yellow spots increase in size over time. Gradually, the growth of deposits causes noticeable symptoms of the disease: dimming of vision, deterioration of photosensitivity, impairment. In later stages of retinal dystrophy, thinning of the light-sensitive layer of cells also occurs, which leads to tissue atrophy and death. The atrophic course of the disease is characterized by the appearance of blind spots in the field of vision. Gradually, complete loss of central vision occurs.
2. Exudative form. This type of retinal dystrophy has distinctive features. Abnormal blood vessels gradually form in the choroid of the patient's eye, allowing blood and fluid to pass into the retinal area. This pathological phenomenon is called choroidal neovascularization. The release of blood and fluid into the tissue causes distortion of vision: the patient sees wavy lines instead of straight lines, and the appearance of many blind spots in the field of vision. Prolonged release of exudate into the retinal area ultimately leads to complete loss of central vision.

Most patients have a non-exudative form of retinal dystrophy. It is noted that in many cases the non-exudative form gradually turns into an exudative one.

This video will explain what retinal dystrophy is:

Reasons for the development of the disease

Aging causes a gradual breakdown of all functions of the human body. Tissues become less elastic, the amount of fluid decreases, and the regenerative reserve is lost.

The retina of the eye is no exception. From a certain age, irreversible changes may begin to form, leading to retinal dystrophy.

However, some evidence suggests that heredity also influences the development of the disease. Scientists have identified a specific gene disorder and linked it to the pathology.

The gene that influences the appearance of retinal dystrophy normally determines the development of the human immune system. This hereditary region is responsible for the synthesis of proteins involved in protecting the body from various pathogenic factors.

Also notes the role in the disease of the gene responsible for the development of new blood vessels during embryonic development. Excessive activity of this gene is directly related to the abnormal growth of new vessels in the retina during the exudative form of the disease.

Risk factors

Retinal dystrophy may not only occur in older people, although the likelihood of developing the disease increases significantly with age.

There is also an increased risk of the disease in patients with a family history of retinal dystrophy, which is explained by a hereditary transmission mechanism.

Other risk factors:

• Belonging to the Caucasian race. At the same time, women get sick more often.
• Smoking. This bad habit negatively affects the health of the microvasculature.
• Excessive exposure to sunlight. Ultraviolet radiation can cause pathological processes in the retina.
• Excessive consumption of fatty foods.
• Aging. The highest risk is observed in the age group from 60 to 90 years.
• Lack of physical activity and excess weight. In this category of people, retinal dystrophy occurs twice as often as in other people.
• High blood pressure. The constant effect of hypertension on the vessels of the eye can cause degenerative processes in the retina.
• Light eye color. Researchers have long established that a decrease in the intensity of pigmentation may be associated with the risk of developing retinal dystrophy.
• Side effects of medications. The effects of antimalarial drugs and some antipsychotics can affect the condition of the retina.
• High concentration of bad cholesterol in the blood.

These risk factors can also accelerate the onset of the disease in people with a hereditary predisposition.

Symptoms of the disease

Retinal dystrophy is a progressive disease, due to which the intensity of symptoms may gradually increase.

At an early stage of the disease, there may be a complete absence of symptoms. In addition, damage to only one eye can be asymptomatic for quite a long time.

Symptoms of the exudative form:

1. Distortion of the contours of objects in the central field of vision.
2. Impaired visual acuity.
3. Significant decrease in clarity of vision even with a slight lack of light.
4. Blurred and blind areas in the field of view.
5. Problems with face recognition.
6. The non-exudative form of the disease may be characterized by the presence of specific symptoms:
7. A blurry spot in the field of view (instead of a blind spot).
8. Rapid worsening of symptoms.
9. Hazy vision.
10. Inability to recognize small print.

As already mentioned, the disease does not affect peripheral vision, so complete blindness does not occur even at the late stage of retinal dystrophy.

Diagnostics

Retinal dystrophy can be detected during a routine ophthalmological examination. The most noticeable early diagnostic sign is the appearance of yellow spots and thickening of eye pigment.

During the examination, the doctor may also ask the patient to look at the Amsler grid. This is a peculiar pattern of straight lines, reminiscent of a chessboard. A patient with retinal dystrophy will observe distorted lines.

Other diagnostic methods:

• . This method makes it possible to study the vessels of the eye. The doctor injects the dye intravenously and after a while uses special equipment to assess the condition of the eye's blood vessels. During the diagnostic process, abnormal vessels can be identified.
• Optical coherence tomography. The method allows you to obtain images of the retina in a cross section, thanks to which the doctor can assess the condition of the structure. The method is also used to evaluate the effectiveness of treatment.
• Retinal biopsy followed by histological examination.
• Multifocal electroretinography.

Early diagnosis of retinal dystrophy is very important, since the most effective methods are available only in the early stages of the disease.

Treatment and prevention

Scientists have not yet developed treatment methods that can completely relieve patients from retinal dystrophy.

However, modern therapeutic and surgical methods make it possible to slow down the development of the disease and prevent the occurrence of dangerous complications.

Drug treatment:

• Drugs that reduce the growth of abnormal blood vessels. These drugs are used to treat the exudative form of the disease. Preventing the growth of new vessels significantly smoothes the symptomatic picture and partially restores the patient’s visual acuity.
• Vitamins and microelements. Ascorbic acid, tocopherol, beta-carotene, zinc, honey and other beneficial substances can have a beneficial effect on eye health and reduce the symptoms of retinal dystrophy.
• Antioxidants.

Invasive treatment methods:

1. Laser therapy. High-energy laser light is used to destroy actively growing abnormal blood vessels in the eye.
2. Photodynamic laser therapy. This two-step method combats choroidal neovascularization much more effectively.

The following methods of preventing the disease exist:

• To give up smoking.
• A diet low in fat, especially cholesterol.
• Moderate physical activity.
• Losing excess weight.

The listed preventive measures are most relevant for older people. It is also recommended that patients at risk undergo an ophthalmological examination at least once a year.