Symptoms of retinopathy and methods of treating inflammatory pathology

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A gradual decrease in vision, a feeling of a veil before the eyes - most modern people face this, and only a few seriously think about the causes of such symptoms.

If the situation repeats itself day after day and gradually acquires new disturbing aspects, the possibility of developing retinal vascular changes or retinopathy, a dangerous disease that causes serious complications, cannot be ruled out.

What is retinopathy

There are several problems that may lie behind the diagnosis of retinopathy, since it is diagnosed when any lesions of the retina of the eyeball (retina) are detected. The disease is based on vascular disorders, against the background of which the blood supply to the retina deteriorates, which leads to:

• retinal dystrophy – death of eyeball tissue;
• optic nerve atrophy (optic neuropathy) – destruction (destruction) of nerve fibers (complete or partial) due to lack of nutrients, in which first individual cells die, and then the entire nerve trunk;
• loss of vision (up to complete blindness).

Most experts argue that retinopathy is not characterized by an inflammatory origin, but this opinion is not entirely correct: some types of the disease (mostly diabetic retinopathy) are characterized by an inflammatory response to non-enzymatic glycosylation products - this is a key mechanism of tissue damage in diabetes. A couple more important points:

• People first started talking about retinopathy (under a specific name) in 1910, but this diagnosis meant sudden blindness, often caused by a traumatic brain injury and characterized by patches of hemorrhages on the retina.
• The disease affects people of all ages, including newborns (retinopathy mainly affects premature babies). Every year the number of people receiving this diagnosis is growing.

Etiology

The reasons for the development of the primary forms of this disease have not yet been clarified by specialists, and therefore there are no reliable measures to protect against them. Secondary retinal vascular changes appear against the background of a number of pathologies, among which the most dangerous are:

• hypertonic disease;
• systemic atherosclerosis;
• diabetes mellitus of both types;
• obesity;
• injuries of the eyeball and sternum;
• diseases of the hematopoietic system;
• toxicosis during pregnancy.

Varieties

In official medicine, there are 2 broad groups of this disease: primary and secondary. The first (an alternative name is idiopathic) is characterized by an unspecified etiology and the absence of an inflammatory process. There are 3 types of retinopathy mentioned in this group:

• Central serous - characterized by damage to the pigment epithelium located in the macular zone of the retina; The lesion is predominantly unilateral. Patients with this form of retinopathy have a history of frequent stress and migraines.
• Acute posterior multifocal - predominantly affects both eyes, characterized by the formation of flat gray lesions, which, after disappearing, leave areas of depigmentation.
• External exudative (Coats disease) - characterized by the accumulation of exudate, cholesterol, hemorrhages under the retinal vessels. All changes occur on the outer part of the fundus. The lesion is unilateral, the development of the disease is slow.

Secondary retinopathy develops against the background of chronic diseases or injuries (craniocerebral or direct eye injuries), which may be accompanied by inflammatory processes. This category includes:

• Hypertensive retinopathy - occurs against the background of persistent arterial hypertension, disorders of the kidneys (for this reason it can also be referred to as renal retinopathy). It is characterized by spasm of arterioles, destruction of their walls and tissues. The severity is directly related to the degree of hypertension.
• Diabetic – the disease will progress against the background of diabetes mellitus, nephropathy, obesity, high levels of sugar and lipids in the blood, anemia. When treating the disease, a visit to an endocrinologist is required.
• Atherosclerotic - the name determines the cause of the disease: it occurs due to atherosclerosis (deposition of plaques on the vascular walls). Treatment involves addressing the underlying cause, not the vision. The stages of development are the same as for the hypertensive form.
• Traumatic - occurs due to injuries to the chest, leading to compression of the arteries and hypoxia of the retinal tissue. As a result, depletion of the optic nerve, hemorrhages and other organic changes are observed.
• Postthrombotic – typical for elderly people with a history of ischemia, hypertension, and atherosclerosis. Progresses after thrombosis of the central veins or arteries that supply nutrients to the retina.
• Retinopathy due to blood pathologies - occurs against the background of diseases of the hematopoietic system: leukemia, multiple myeloma, brain tumor, anemia, polycythemia.

Symptoms

At the 1st stage of the disease, there are no obvious manifestations; diagnosis can only be made based on the results of an examination by an ophthalmologist. At the border of stages 2-3, as vascular disorders develop, a person will experience:

• decreased vision;
• floating spots before the eyes (scotomas);
• hemophthalmos (blood entering the vitreous body);

In a person suffering from diabetes, the disease will begin with farsightedness (visual acuity is impaired when examining nearby objects), the appearance of a veil before the eyes and vision. With any form of the disease, it is also possible that there is a violation of color perception, a decrease in the contrast of the picture before the eyes, and the appearance of flashes of light or sparks in the field of vision.

Primary retinopathy

The clinical picture of the disease, which does not have severe chronic pathologies among its prerequisites, is characterized by mild symptoms at the initial stage and slow progression in the external exudative form. As the disease progresses, each type of retinopathy acquires specific manifestations. Central serous is characterized by:

• narrowing of the viewing angle;
• decreased vision;
• scotomas (defects in the visual field, blind spots);
• micropsia (perception of the size of visible objects being reduced).

Upon examination, a person with the central serous form will notice gray or yellow precipitates (pigment epithelium particles on the posterior surface of the cornea), oval dark edema in the macular area. In acute posterior multifocal form, the following are added to the general symptoms:

• blurred vision;
• scotomas;
• episcleritis (inflammation of the outer layer of the sclera);
• swelling in blood vessels (peripheral);
• swelling of the optic nerve.

The external exudative form differs from other primary types of retinopathy in its erased symptoms: it is determined during diagnostic procedures when venous shunts and microaneurysms are detected on the periphery of the fundus. Due to the slow progression and absence of obvious symptoms, this form is noticed when retinal detachment and glaucoma develop.

Secondary

In the traumatic form of the disease, a person experiences hemorrhage, hypoxia with the release of exudate, blurred vision, and swelling of the retinal layers.

Postthrombotic is similar to it: here, too, oxygen starvation of the retinal tissue and hemorrhage occurs, but occlusion (impaired patency) of blood vessels is added.

The remaining forms should be considered according to their degrees of development. Hypertension can occur in 4 stages:

• Angiopathy (reversible processes in arterioles and veins).
• Angiosclerosis (decreased transparency in blood vessels, increased density, leading to organic damage).
• Active retinopathy (pathological lesions on the retina, scotomas, decreased vision).
• Neuroretinopathy (nerve swelling, exudation, retinal detachment).

Atherosclerotic disease proceeds similarly, only here a change in the color of the optic nerve, deposition of exudate on the veins and hemorrhage on the capillaries are added. In diabetics, as in hypertensive patients, the clinical picture depends on the stage of development of the disease:

1. Background: expansion of veins, formation of microaneurysms on the walls of capillaries (they look like red dots). There are no clearly defined symptoms.
2. Preproliferative: small hemorrhages, deposits of lipid exudate around the macula, tendency to edema. The phenomena are reversible.
3. Proliferative (proliferating): an increase in glial cells, a dark veil before the eyes, the growth of new vessels with aneurysms into the vitreous body, its deformation, tractional retinal detachment.

In newborns

A separate type of disease is background retinopathy in newborns (preretinopathy) of premature infants, which is not included in the list of other types.

It is directly related to the incomplete development of the retina in a child who was born during its formation.

The process of complete formation of vessels in the temporal zone ends only at the 40th week, so the earlier the birth occurs, the less area the retina is covered by vessels. Ophthalmologists say that babies are at particular risk:

• those born at the 31st week or earlier (avascular zones - devoid of blood vessels or with poor blood supply - the retina will be observed along the periphery of the temporal and nasal sides);
• having a body weight of less than 1500 grams;
• with an unstable general condition;
• who received a blood transfusion or were prescribed long-term oxygen therapy (stay in an incubator) - additional oxygenation inhibits glycolysis (tissue respiration) in the retina;
• at birth the mother experienced severe bleeding;
• who were born to a woman with chronic inflammatory diseases of the reproductive system, aggravated during pregnancy.

In premature babies, the disease is accompanied not only by vascular disorders of the retina, but also by changes in the vitreous body (the substance located between the lens and the retina).

Under the influence of external factors, the child does not develop further blood vessels, but they grow inside the eye (into the vitreous body), which leads to the growth of vascular and connective tissue, and retinal detachment.

The development of the disease occurs in several stages:

1. The appearance of a white line between areas of the retina with and without vessels.
2. Formation of a hole at the site of the dividing line.
3. Ingrowth of blood vessels in the zone of failure into the vitreous body.
4. The beginning of the retinal detachment process.
5. Complete detachment of the retina and blindness.

All children who receive this diagnosis are observed by an ophthalmologist. Retinopathy of prematurity at stages 1-2 is often characterized by a tendency to regress: manifestations of the disease can disappear completely; pre-retinopathy in adults is rarely diagnosed.

With the rapid progression of the disease, a sharp dilation of the vessels of the retina and iris, severe edema of the vitreous, and hemorrhages, a posterior malignant form is diagnosed, which is difficult to treat.

Late complications of neonatal retinopathy:

• myopia;
• strabismus;
• glaucoma;
• amblyopia (unilateral or bilateral visual impairment);
• retinal disinsertion.

Diagnostics

The primary method of examining a patient with suspected retinopathy is ophthalmoscopy, used for children and adults: examination of the fundus of the eye with a special instrument using an ophthalmoscope. Afterwards, if necessary, several more diagnostic procedures are prescribed:

• tonometry (checking intraocular pressure);
• perimetry (study of the boundaries of visual fields);
• laser scanning of the retina;
• angiography (contrast x-ray examination of blood vessels);
• biomicroscopy of the eye;
• Ultrasound of the eye;
• differential diagnosis (especially for the hypertensive form, similar to occlusion of the central retinal vein).

Treatment of retinopathy

The therapeutic regimen is drawn up according to the stage and form of the disease: in case of secondary retinopathy, a mandatory impact on the root cause is required - treatment of hypertension, diabetes, atherosclerosis, etc. At the initial stages of the development of the disease, conservative methods are recommended:

• the use of drops based on hormones;
• local use of vitamin solutions;
• the use of drugs that improve microcirculation.

Depending on the disease that provoked retinopathy, the doctor may prescribe angioprotectors, diuretics, antihypertensives, vasodilators, and antisclerotic drugs. For neuroretinopathy, electrophoresis with drugs that have proteolytic properties is recommended. If conservative methods do not give effect, the following are prescribed:

• laser coagulation (removed tissue is cauterized with a laser beam);
• cryosurgical coagulation (“freezing” of the detached retina);
• oxygen barotherapy or hyperbaric oxygenation (exposure to tissues with oxygen in pressure chambers);
• vitrectomy partial or complete (removal of the vitreous body);
• vitreoretinal surgery (combined surgery on the retina and vitreous body to restore normal eye anatomy).

Traditional methods

Reducing the severity of symptoms and reducing the rate of progression of the disease are the only goals pursued by traditional medicine recipes: retinal vascular changes cannot be cured with their help. All non-traditional methods should be perceived as an addition to the main treatment regimen for retinopathy. Effective options (therapeutic course - 2-3 weeks):

• Grind a fresh aloe leaf and squeeze through cheesecloth. Place 2-3 drops into the conjunctival sac at night (for each eye).
• Blend fresh lingonberries in a blender and squeeze through cheesecloth. Drink 50 ml juice before meals 3 times a day.
• Pour a tablespoon of blueberries into a glass of boiling water and leave for an hour. Drink this remedy per day, dividing it into 3-4 doses.

Forecast

Doctors call irreversible only the malignant form of the disease in premature babies and secondary in blood diseases. With proper treatment, primary retinopathy in adults can be completely eliminated if therapy is started in a timely manner . It is more difficult to deal with the secondary one - if the root cause is not eliminated, then:

• hypertensive and traumatic lead to severe loss of vision and blindness;
• with atherosclerosis, atrophy of the optic nerve occurs;
• diabetic provokes cataracts, hemophthalmos, retinal detachment.

Prevention

The main way to protect against the secondary form of retinopathy in people at risk is observation by relevant specialists: endocrinologists, neurologists, cardiologists, traumatologists, etc. This recommendation is relevant for people with diabetes, hypertension, atherosclerosis, and kidney diseases. A few more points:

• During pregnancy, women at risk for premature delivery need to be regularly monitored by an obstetrician-gynecologist.
• Premature babies are monitored by an ophthalmologist until adulthood.
• In order to reduce the risk of the primary form of the disease, stress and emotional experiences should be avoided.
• Control your diet: your diet should contain folic acid, vitamins A, E, PP, ascorbic acid, selenium, zinc, chromium.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

Source: https://vrachmedik.ru/852-retinopatiya.html

Retinopathy. Types of disease and treatment methods

Retinopathy is a complex pathological process that begins with the destruction of the vessels of the visual organs. During its further development, the blood circulation of the retina is disrupted. She becomes dystrophic. All this leads to depletion of the optic nerve. The result is blindness.

In ophthalmology, retinopathy refers to a number of deformations of the retina that occur for various reasons. In this case, the retina is not damaged due to other diseases of the visual organs. There are also no inflammatory processes observed.

ICD-10 code

Other retinal diseases (H35).

Type of retinopathy

The classification of retinopathy is so broad that each type of disease should be considered separately. The clinical picture in each case may be strikingly different from the etymology of other types of disease. The main types of retinopathy are primary and secondary diseases.

Primary retinopathy is a non-inflammatory pathology. It is characterized by damage to the pigment epithelium in the macular zone of the retina. The reasons for the development of the disease still remain a mystery. Most often, men aged 20 to 40 who have been in a stressful situation encounter it. At the same time, they notice the following symptoms:

• Narrowed field of view.
• The appearance of a veil before the eyes.
• Visual impairment due to floating spots.
• Problems affecting central vision.

The primary type of diseases includes:

• External exudative retinopathy.
• Central serous retinopathy.
• Acute posterior multifocal retinopathy.

Secondary retinopathy is characterized by destruction of the retina due to general diseases of the body. Among them are diabetes mellitus, atherosclerosis, and hypertension. Based on the diseases that cause secondary retinopathy, its classification is compiled. This is how retinopathy differs:

• Diabetic.
• Atherosclerotic.
• Traumatic.
• Hypertensive.
• Caused by blood diseases.

Retinopathy of premature babies deserves special attention. She was allocated to a separate group.

Retinopathy as a result of diabetes

The second name for diabetic retinopathy is non-proliferative. The development of the disease occurs slowly. First, the elasticity of the vessels of the visual organs gradually decreases. Then they become fragile and hemorrhage occurs in the retina. There are three stages of diabetic retinopathy:

1. Background. It is accompanied by dilation of the veins in the retina and the appearance of microscopic protrusions on the walls of the capillaries. There are no other symptoms.
2. Preproliferative. Small hemorrhages form on the retina. Exudates of lipid compounds are deposited in the macular area.
3. Proliferative early stage. Vascular tumors form in the retina. The newly formed vessels are fragile, so protrusions appear on them.
4. Proliferative late stage. The vessels formed in the retina slowly grow into the vitreous body. It becomes deformed, causing hemorrhages. The retina peels off.

Pathology can be identified using the following studies:

• Determination of the degree of visual acuity and boundaries of the visual field.
• Examination of the fundus to determine the condition of the blood vessels of the eyes and the optic nerve head.
• Ultrasound, the purpose of which is to identify the presence of compactions, hemorrhages and scars.
• Determination of retinal functionality based on its electrical potential.
• Measuring intraocular pressure.

During diabetic retinopathy, a person experiences difficulty reading. Floaters or a veil appear before his eyes. They hurt. Treatment of pathology is associated with eliminating the cause of its occurrence.

External exudative disease

The risk group includes young and middle-aged men. External exudative retinopathy is characterized by a unilateral manifestation. Deposition of cholesterol crystals and point formation of hemorrhages occurs. The periphery of the fundus is most often affected.

Pathology leads to decreased visual acuity. It can cause retinal detachment or glaucoma. During illness, the capillaries in the retina slightly dilate. The treatment method suitable in this case is laser coagulation.

Central serous pathology

If objects located far away appear small and blind spots appear in the field of vision, this indicates a central serous disorder. The reasons for its appearance have not yet been fully studied. However, most often the disease is detected in men from 18 to 40 years of age after severe stress. It can be cured using laser coagulation of the retina.

Acute posterior multifocal retinopathy

This type of disease manifests itself as follows:

• Papilledema occurs.
• The vessels in the retina dilate.
• The vitreous body becomes less transparent.
• The iris and ciliary muscle are affected by the inflammatory process.
• Visual acuity decreases.
• Scotomas form in the field of view.

The disease can be cured using a conservative method. In this case, vitamins, corticosteroids, and drugs to protect and dilate blood vessels are used.

Retinopathy due to high blood pressure

Renal dysfunction and hypertension lead to hypertensive retinopathy. In this case, the following stages of the disease are distinguished:

1. Angiopathy. It is distinguished by the reversibility of pathological processes.
2. Angiosclerosis. The blood vessels of the eyes are damaged due to the fact that their tissues become denser and lose transparency.
3. Retinopathy. Severe symptoms are observed - scotomas, decreased visual acuity, hemophthalmos. At this stage, the disease can be cured.
4. Neuroretinopathy. If the disease is not treated, a person may go blind. This occurs due to swelling of the nerve, the appearance of exudates and retinal detachment.

The main study that allows us to identify all lesions of the visual organs in this case is ophthalmoscopy. A therapist, cardiologist and endocrinologist are involved in diagnosing the disease. For treatment, drugs are used whose action is aimed at:

• normalization of metabolic processes;
• blood thinning;
• improvement of microcirculation;
• lowering cholesterol levels;
• saturation with vitamins.

Conservative therapy is aimed at relieving symptoms associated with the disorder that contributed to the development of retinopathy. It can be completely cured only through laser coagulation.

Atherosclerosis as a cause of retinopathy

Atherosclerotic retinopathy occurs against the background of plaque formation in the vascular cavity. They grow and block the blood flow, aggravating the patient's condition. The essence of treating the disease is to reduce lipid levels. A patient with this pathology is prescribed drugs that prevent the formation of blood clots and dilate blood vessels. Medicines that improve the conduction of nerve impulses are also used.

Why injuries lead to retinopathy

Traumatic retinopathy is associated with injuries that place severe pressure on the chest. Blood vessels narrow. Oxygen does not reach the retina well. She gets damaged. If the retina becomes cloudy, this indicates an eyeball contusion. Partial removal of the vitreous will help cope with the disease.

Blood diseases and retinopathy

Retinopathy can be caused by leukemia, severe anemia, or multiple myeloma. The pathology develops against the background of hemorrhages in the visual organs and blood flow disorders. Because of this, blood clots form in the vessels. The retina does not receive enough oxygen and is damaged.

Retinopathy in premature babies

The main reason for the development of retinopathy in children born in the early stages (less than 32 weeks) is underdevelopment of the retinal vessels. The disease is aggravated by low birth weight, intrauterine infections, respiratory and cardiovascular failure. Astigmatism, glaucoma, myopia and other deviations in visual function are often observed as complications.

How to cure

Symptoms of retinopathy in premature infants are detected at the 4th week of life. The disease of 1st and 2nd degrees of severity can go away on its own. In order to track its dynamics, the doctor examines the child every 2 weeks. The need for such frequent inspections can be explained as follows:

Retinopathy of prematurity of the 3rd degree is treated with cryocoagulation and laser coagulation of the avascular zone of the retina. These treatment methods are used within 3 days after the pathology is diagnosed. If grade 4 or 5 retinopathy is detected, preference is given to circular scleral buckling or transciliary vitrectomy.

Source: https://VseProGlaza.ru/bolezni/retinopatiya/

Retinopathy

The concept of “retinopathy” in ophthalmology refers to pathological changes in the retina of various origins that are not associated with inflammation (primary retinopathy), as well as retinal lesions that develop as a result of other diseases (secondary retinopathy).

Primary retinopathy includes central serous, acute posterior multifocal and external exudative retinopathy. Secondary retinopathy includes diabetic, hypertensive, traumatic, and retinopathy due to blood diseases.

Retinopathy of prematurity is identified as a separate form, which is studied not only by ophthalmology, but also by pediatrics.

The etiology of primary retinopathy remains unknown, so they are classified as idiopathic.

Central serous retinopathy (central serous retinitis, idiopathic macular detachment) is more often detected in men 20-40 years old who do not have somatic diseases.

In the anamnesis, patients indicate emotional stress and frequent migraine-type headaches. In central serous retinopathy, retinal damage is usually unilateral.

The pathomorphological picture of central serous retinopathy is characterized by serous detachment of the pigment epithelium in the macular region, which is determined during ophthalmoscopy as a limited oval or round protrusion of a darker color than the surrounding retinal tissue. Typically the absence of a foveal reflex (a strip of light around the central fovea of ​​the retina), the presence of yellowish or grayish precipitates.

Laser coagulation of the retina is used in the treatment of central serous retinopathy. Therapy is carried out aimed at strengthening the vascular wall, improving microcirculation, reducing retinal edema; oxygen barotherapy is prescribed. In 80% of cases, with timely active treatment of serous retinopathy, it is possible to stop retinal detachment and restore vision to the original level.

Acute posterior multifocal pigment epitheliopathy

This form of retinopathy can be unilateral or bilateral. In acute posterior multifocal pigment epitheliopathy, multiple flat subretinal foci of grayish-white color are formed, with the reverse development of which areas of depigmentation are formed. When examining the fundus, perivascular edema of the peripheral vessels of the retina, tortuosity and dilatation of the veins, and swelling of the optic disc are determined.

In a significant proportion of patients, opacification of the vitreous body occurs, episcleritis and iridocyclitis develop. Central vision is impaired early, and central or paracentral scotomas appear in the field of vision.

Treatment of posterior multifocal pigment epitheliopathy is carried out conservatively; includes the prescription of vitamin therapy, vasodilators (vinpocetine, pentoxifylline, etc.), angioprotectors (solcoseryl), retrobulbar injections of corticosteroids, hyperbaric oxygenation. The prognosis for this form of primary retinopathy is usually favorable.

External exudative retinopathy

The development of external exudative retinopathy (Coats disease, external exudative retinitis) is predominantly observed in young men. Retinal damage is often unilateral.

With this form of retinopathy, exudate, hemorrhages, and cholesterol crystals accumulate under the retinal vessels. Changes are usually localized on the periphery of the fundus; damage to the macular zone occurs rarely.

Often, retinal angiography reveals multiple microaneurysms and arteriovenous shunts.

The course of external exudative retinopathy is slow and progressive. Treatment is carried out by laser photocoagulation of the retina and hyperbaric oxygenation. The prognosis is aggravated by retinal detachment, requiring urgent intervention, and the development of iridocyclitis and glaucoma.

Pathogenetically, hypertensive retinopathy is associated with arterial hypertension, renal failure, and toxicosis of pregnancy. With this form of retinopathy, spasm of the fundus arterioles is observed, followed by elastofibrosis or hyalinosis of their walls. The severity of the lesion is determined by the degree of hypertension and the duration of hypertension.

The development of hypertensive retinopathy is divided into 4 stages. The stage of hypertensive retinal angiopathy is characterized by reversible functional changes affecting the arterioles and venules of the retina.

In the stage of hypertensive angiosclerosis, damage to the retinal vessels is organic in nature and is associated with sclerotic compaction of the vascular walls and a decrease in their transparency.

Patients with hypertensive retinopathy experience decreased visual acuity and scotomas (floating spots) appear in front of the eyes.

Typically, with antihypertensive therapy, these changes regress and symptoms disappear.

In the stage of hypertensive neuroretinopathy, angiopathy, angiosclerosis and retinopathy itself are joined by the phenomena of optic disc edema, exudation, and foci of retinal detachment. These changes are more typical for malignant hypertension and hypertension of renal origin. The stage of hypertensive neuroretinopathy can result in optic nerve atrophy and irreversible vision loss.

Diagnosis of hypertensive retinopathy includes consultation with an ophthalmologist and cardiologist, ophthalmoscopy and fluorescein angiography.

The ophthalmoscopic picture is characterized by a change in the caliber of the retinal vessels, their partial or total obliteration, the Salus-Hun symptom (displacement of the vein into the deep retinal layers due to pressure on it from a tense and compacted artery in the area of ​​their intersection), subretinal exudation, etc.

For hypertensive retinopathy, arterial hypertension is corrected, anticoagulants and vitamins are prescribed, oxygen barotherapy and laser coagulation of the retina are performed.

Complications of hypertensive retinopathy are recurrent hemophthalmos and retinal vein thrombosis. The prognosis of hypertensive retinopathy is serious: a significant decrease in vision and even the development of blindness cannot be ruled out.

Retinopathy aggravates the course of the underlying pathology and pregnancy, and therefore can become a medical basis for artificial termination of pregnancy.

Atherosclerotic retinopathy

The cause of the development of atherosclerotic retinopathy is systemic atherosclerosis. The changes that occur in the retina in the stages of angiopathy and angiosclerosis are similar to those in hypertensive retinopathy; in the stage of neuroretinopathy, small capillary hemorrhages, deposits of crystalline exudate along the veins, and blanching of the optic disc appear.

The main methods of ophthalmological diagnosis of atherosclerotic retinopathy are direct and indirect ophthalmoscopy, angiography of retinal vessels. There is no special treatment for atherosclerotic retinopathy.

Complications of atherosclerotic retinopathy often include occlusion of the retinal arteries and optic nerve atrophy.

Diabetic retinopathy

The pathogenesis of diabetic retinopathy is caused by the presence of diabetes mellitus type 1 or 2.

The main risk factors for the development of retinopathy are the duration of diabetes, severe hyperglycemia, nephropathy, arterial hypertension, obesity, hyperlipidemia, and anemia.

Diabetic retinopathy is the most common and serious complication of diabetes and is the leading cause of low vision and blindness.

In the development of this form of the disease, the stages of diabetic angiopathy, diabetic retinopathy and proliferating diabetic retinopathy are distinguished. The first two stages (angiopathy and simple retinopathy) occur with the same changes as similar stages of hypertensive and atherosclerotic retinopathy.

In the early stage of proliferating diabetic retinopathy, neovascularization of the retina develops; in the late stage, ingrowth of newly formed vessels and recurrent hemorrhages into the vitreous body and proliferation of glial tissue occur.

Tension of the fibers and deformation of the vitreous body cause the development of tractional retinal detachment, which is the cause of incurable blindness in diabetic retinopathy.

In the initial stages, diabetic retinopathy is manifested by a steady decrease in visual acuity, the appearance of veils and floating spots before the eyes, which periodically disappear. Difficulty reading and doing small work. In the late proliferating stage, complete loss of vision occurs.

Using an ultrasound of the eye, areas of compaction, hemorrhage, and scars in the thickness of the eyeball are determined. Electroretinography is performed to determine the electrical potential and assess the viability of the retina.

To clarify the condition of the retina, laser scanning tomography and retinal angiography are used.

Additional information in the complex ophthalmological examination of patients with diabetic retinopathy is obtained by determining visual acuity, biomicroscopy, diaphanoscopy of the eye, determining the critical flicker fusion frequency (CFFR), etc.

Treatment of diabetic retinopathy should be carried out under the supervision of an ophthalmologist and an endocrinologist (diabetologist).

Careful monitoring of blood glucose levels, timely intake of antidiabetic drugs, vitamins, antiplatelet agents, angioprotectors, antioxidants, and agents that improve microcirculation are necessary.

For retinal detachment, laser photocoagulation is used. In case of pronounced changes in the vitreous body and scar formation, vitrectomy and vitreoretinal surgery are indicated.

Complications of diabetic retinopathy include cataracts, hemophthalmos, clouding and cicatricial changes in the vitreous, retinal detachment, and blindness.

Retinopathy in blood diseases

Retinopathy can develop with various pathologies of the blood system - anemia, polycythemia, leukemia, multiple myeloma, Waldenström's macroglobulinemia, etc.

Each of the forms is characterized by a specific ophthalmoscopic picture. Thus, with retinopathy caused by polycythemia, the retinal veins acquire a dark red color, and the fundus of the eye becomes cyanotic. Retinal vein thrombosis and optic disc edema often develop.

With anemia, the fundus of the eye, on the contrary, is pale, the retinal vessels are dilated, the color and caliber of the arteries and veins are the same. Retinopathy in anemia can be accompanied by subretinal and extraretinal hemorrhages (hemophthalmos), exudative retinal detachment.

In myeloma and Waldenström's macroglobulinemia, as a result of dysproteinemia, paraproteinemia, and blood thickening, retinal veins and arteries dilate, microaneurysms, thrombotic occlusions of veins, and hemorrhages in the retina develop.

Treatment of retinopathy associated with pathology of the blood system requires treatment of the underlying disease, laser coagulation of the retina. The prognosis for visual function is serious.

Traumatic retinopathy

The development of traumatic retinopathy is associated with sudden and sharp compression of the chest, during which spasm of the arterioles occurs, hypoxia of the retina occurs with the release of transudate into it. In the immediate period after the injury, hemorrhages and organic changes in the retina develop. Traumatic retinopathy can lead to optic nerve atrophy.

The consequences of contusion of the eyeball are changes called Berlin's opacification of the retina. This form of traumatic retinopathy is associated with subchoroidal hemorrhage and edema of the deep retinal layers, the release of transudate into the space between the retina and the choroid.

To treat traumatic retinopathy, vitamin therapy is prescribed, tissue hypoxia is combated, and hyperbaric oxygenation is carried out.

The forms of retinopathy listed above primarily occur in adults. A special form of the disease is retinopathy of prematurity, associated with underdevelopment of the retina in children born from premature birth.

To complete the formation and maturation of all eye structures, premature babies need visual rest and oxygen-free local tissue respiration (glycolysis).

On the other hand, nursing premature babies and stimulating metabolic processes in vital organs requires additional oxygenation, which leads to inhibition of glycolysis in the retina and choroid.

The greatest risk of developing retinopathy of prematurity are children born at a gestation period of less than 31 weeks, with a birth weight of less than 1500 g, unstable general condition, receiving long-term oxygen therapy, and having undergone blood transfusions.

In the initial stages of retinopathy of prematurity, spontaneous recovery can occur, so observational tactics are used. In other cases, laser coagulation or cryoretinopexy is indicated, and if ineffective, scleroplasty or vitrectomy is indicated.

In order to prevent the development of retinopathy, it is necessary to monitor patients with hypertension, diabetes mellitus, atherosclerosis, kidney disease, blood diseases, injuries, pregnant women with nephropathy, etc. by an ophthalmologist.

Prevention of retinopathy of prematurity requires careful management of pregnancy in women at risk for premature birth and improvement of conditions for caring for premature babies. Children who experienced retinopathy during the neonatal period should be examined by a pediatric ophthalmologist annually until age 18.

An important role in the prevention of retinopathy is played by the coordination of the actions of specialists in various fields: ophthalmologists, endocrinologists, cardiologists, neurologists, obstetricians-gynecologists, pediatricians, traumatologists, etc.

Source: https://www.KrasotaiMedicina.ru/diseases/ophthalmology/retinopathy

Retinal diseases

The retina is the thinnest inner layer of the eye, adjacent throughout its entire length from the inside to the vitreous body, and from the outside to the choroid of the eyeball. The retina is responsible for image perception and is sensitive to light. Learn more about how the retina works.

Retinal pathologies can occur with various general and systemic diseases - hypertension, diabetes mellitus, kidney and adrenal gland diseases, as well as with eye injuries and traumatic brain injuries. Some infectious diseases (flu, etc.) can be complicated by retinal diseases.

Main “risk groups”

• People with moderate and high degrees of myopia;
• pregnant women;
• elderly people with diabetes.

The initial stages of the disease may not be accompanied by any symptoms , so if you are at risk, be sure to undergo vision diagnostics using modern equipment. This examination will reliably determine whether you need treatment. If you are scheduled for surgery, do not put off surgery for too long.

Before surgery, you need to protect your eye from possible damage in every possible way.

If diseases of the retina of a dystrophic nature are detected, with its thinning and rupture in the periphery, it is strengthened using a laser.

Otherwise, any sufficiently strong tension can lead to detachment, requiring immediate surgical intervention. It is better to prevent such a situation. Moreover, detachment can occur when urgent provision of qualified ophthalmological care is impossible (at the dacha, on a trip, etc.)

Inflammatory disease of the retina - retinitis

Retinitis is an inflammatory disease of the retina, which can be either unilateral or bilateral. This inflammatory disease of the retina can be either infectious or toxic-allergic in nature. Retinitis can occur due to a number of infectious diseases. For example, such as: AIDS, syphilis, viral and purulent infections, etc.

Symptoms of retinitis depend on the location of the process on the retina. But the main one is a decrease in visual acuity and a change in the field of vision. There are cases where retinal damage is initially limited to small areas, which then enlarge, leading to progressive loss of vision. Retinitis is treated with medication.

Hemorrhages in the retina are more often related to vascular diseases and lead to decreased visual acuity, retinal detachment, secondary glaucoma, retinal dystrophy and other diseases.

The causes of retinal hemorrhage may be associated with hardening of blood vessels in old age, due to thrombosis (blockage) of the central retinal vein or one of its branches. Also, retinal hemorrhage can be caused by diabetes, heart defects, blood diseases, skin burns, bruises, etc.

Retinal detachment is the separation of the retina of the eye from the choroid. When the retina ruptures, the intraocular fluid penetrates under it and peels off from the choroid. If retinal detachment occurs, you should immediately consult a doctor, as delay may result in blindness.

Retinal detachment is usually treated surgically.

This can be extrascleral ballooning or filling (the purpose of such treatment is to achieve adherence of the retina to the choroid), then laser coagulation and vitrectomy are performed (used to remove scars and blood from the vitreous). Surgical treatment methods usually require restriction of visual work and physical activity. Read more about the treatment of retinal detachment.

Retinal tumors are neoplasms of the retina that can be malignant or benign. Most often, tumors develop in childhood: in the first months of life in 20% of cases, in the first years in 55%. In 25% of patients, the process affects both eyes. The most common of retinal tumors are gliomas, which arise from the outer layer of the retina.

In the early stages, thickening of the retina occurs and this can only be determined by examining the fundus and ultrasound of the eye. After some time, the tumor takes up most of the eye. Due to the development of the tumor, the eyeball protrudes and its mobility is limited. Vision disappears.

Retinal tumors must be treated as soon as possible and in specialized ophthalmology departments of hospitals. If treatment is delayed, it can lead to irreversible consequences. Of the modern techniques for retinal tumors, the most effective are low-temperature (cryogenic) therapy and photocoagulation. Surgical treatment methods are organ-preserving.

Retinal dystrophy

Retinal dystrophy is usually caused by disorders in the vascular system of the eye. It mainly affects older people, whose vision gradually deteriorates. Very often, degenerative changes in the retina accompany moderate and high degrees of myopia. The fact is that usually in this case the size of the eyeball is increased, and the retina lining its back surface is stretched, which leads to dystrophy.

Modern treatment of this condition, as well as other types of dystrophies (many inflammatory and vascular diseases of the retina lead to dystrophies), occurs using an argon laser. The main goal of this treatment is to strengthen and, in the case of retinal detachment, to postoperatively limit the retinal tear.

The principle of treatment is based on the fact that laser exposure leads to a sharp increase in temperature, which causes coagulation (clotting) of the tissue. Thanks to this, the operation is bloodless. The laser is very precise and is used to create fusions between the retina and uvea of ​​the eye (i.e., strengthening the retina). Read more about laser coagulation of the retina.

Age-related macular degeneration (AMD)

The most common cause of vision loss in people over 50 years of age. In VMD, the central part of the retina, the so-called macula macula, is affected.

The main risk factors for developing AMD are:

• age over 50 years;
• cardiovascular diseases (atherosclerosis, hypertension);
• genetic predisposition;
• gender (more common in women).

In the initial stages, the disease occurs unnoticed by the patient and can only be detected during an appointment with an ophthalmologist. With the progression of AMD and its transition to the so-called neovascular form, the patient may notice decreased vision, a feeling of curvature of lines, blurred and disappearing areas. If these symptoms occur, urgent consultation with a doctor is necessary.

Currently, the most effective treatment for AMD is intravitreal (i.e., inside the eye) administration of LUCENTIS and EYLEA, drugs that block the growth of new vessels under the retina.

These drugs can not only preserve, but also improve the vision of a patient with AMD. Treatment methods for AMD also include retinal laser photocoagulation and photodynamic therapy.

Read more about the treatment of age-related macular degeneration of the retina.

Diabetic retinopathy

In diabetes, the vessels of the retina are affected, which leads to a disruption in the supply of oxygen to the tissues and the development of diabetic retinopathy.

Diabetic retinopathy usually develops 5-10 years after the onset of diabetes.

In type I diabetes mellitus (insulin-dependent), diabetic retonopathy proceeds rapidly and proliferative diabetic retinopathy .

This form of the disease is characterized by the formation of new vessels that grow from the retina into the vitreous body and cause hemorrhages in it, and also enhance scarring processes in the vitreous body and can cause the development of retinal detachment.

In type II diabetes mellitus (insulin-dependent), changes mainly occur in the central zone of the retina. Diabetic maculopathy occurs , resulting in decreased central vision.

Another form of diabetic retinopathy is background retinopathy , in which pathological changes occur only in the retina of the eye.

Due to disturbances in the area of ​​the capillary vessels of the retina, small hemorrhages, deposits of metabolic products, and retinal edema occur.

Treatment methods for diabetic retinopathy:

Retinal tear

Retinal tears most often occur in nearsighted people due to mechanical tension of the pathologically altered vitreous body. Patients note black threads in front of the affected eye, as well as light flashes. First, the edge of the tear in the retina begins to peel off, which later leads to retinal detachment.

To eliminate this, at the stage of holes or breaks, areas of the healthy retina are fixed using laser photocoagulation. Scarring occurs at retinal coagulation points. As a result, a strong connection between the retina and the choroid occurs. The coagulation technique involves applying 2-3 rows of coagulates around the hole or rupture.

Retinal angiopathy

Angiopathy is a lesion of blood vessels, the cause of which is most often general diseases (vegetative-vascular dystonia, hypertension, diabetes mellitus, etc.). Most often, angiopathy is caused by lesions of blood vessels and is expressed by spasms and paresis of blood vessels.

Also among the problems that can arise with the retina are injuries, burns, and retinal swelling . This condition is extremely dangerous and can cause low vision and blindness.

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Source: https://excimerclinic.ru/retina/