What is epiretinal fibrosis of the eye. Preparing for the operation

In people old age often occur various problems with vision. One of the diseases that cause them is epiretinal fibrosis of the eye. What is it, it's hard to imagine the young healthy person. But people who have crossed the sixty-year milestone are faced with similar ailment often.

Epiretinal fibrosis of the eye: what is it

The initial stage of the disease most often goes unnoticed by a person. At this stage, an epiretinal membrane begins to form in the center. It looks like a thin transparent film.

The whitish formation begins to deform the retina. It pulls her in. Due to this effect, the retina becomes wrinkled and folded.

Over time, the epiretinal membrane begins to become stiffer and thicker. Fibrotic changes cause and contribute to its ruptures. All this is manifested in the deterioration of human vision.

Symptoms

The manifestation of signs of the disease becomes a complete surprise for the elderly. They feel the symptoms that accompany epiretinal fibrosis of the eye. What is it and why vision problems began - the old people cannot understand.

Most often, patients notice such anomalies:

there are blind spots;
straight lines are bent;
having trouble seeing small objects;
there are problems when reading;
the ability to see in a poorly lit place worsens;
blurred picture;
the contours of objects are distorted;
double vision.

With absence medical assistance manifestation of pathology is enhanced. The correct description of the symptoms to the doctor has great importance to determine the degree of development of the disease and the need for the timing of its treatment.

Causes

For correct diagnosis and the fight against the disease, it is important to determine not only the forms of its manifestation, but also the causes. In most cases, epiretinal ocular fibrosis develops idiopathically. Its occurrence has no reason. Doctors conclude that this is happening against the background age-related changes organism.

However, in some cases, there are factors that give impetus to the development of an anomaly. Their determination is important for correct diagnosis and treatment prognosis.

There are cases when a disease such as uveitis caused epiretinal fibrosis of the eye. What it is? Inflammation choroid eyeball. Uveitis is a collective inflammation. The pathological process can be localized in different departments shells of the eye.

Other causes of epiretinal fibrosis of the eye are:

retinal detachment;
transferred ophthalmic operations;
retinopathy caused by diabetes;
injury.

Diagnostics

Early application for medical care increases the chances of vision recovery. An ophthalmologist and a surgeon will be able to correctly diagnose epiretinal fibrosis of the retina.

The specialist must visual inspection patient and listen to their complaints. To collect a complete anamnesis, the following data are specified:

time of appearance of the first signs of the disease;
vision problems in the past;
receiving eye injuries;
symptoms of concomitant diseases;
the presence of any chronic ailments.

Very often, when examining very old people, epiretinal fibrosis of the eye and cataracts are diagnosed. In this case, treatment is carried out for both diseases at once. A correctly compiled medical history helps the specialist to prescribe the optimal scheme for dealing with pathologies.

Folk remedies

Very rarely, the separation of the film that deforms the retina occurs spontaneously. Vision begins to gradually recover. Sometimes helps to defeat epiretinal fibrosis

For example, a remedy is prepared from lingonberry leaves, calendula flowers and medicinal chamomile. Herbs are crushed and mixed in equal amounts. A decoction is made from them. Take this remedy twice a day for a month and a half. Before doing this, you should definitely consult a doctor.

Preparing for the operation

In most cases, self-rejection of the film does not occur. The patient is increasingly developing epiretinal fibrosis of the eye. Treatment in this case is only surgical.

Before surgery, the patient is examined by an endocrinologist, an otolaryngologist and a dentist. These doctors examine the patient for the possibility of postoperative complications.

The next stage of preparation for surgery is the delivery of tests. Blood and urine tests are done:

showing the level of sugar;
are common;
for hepatitis, HIV, Wasserman reaction.

The last stage of preparation is the removal of the electrocardiogram and the study of the fluorogram. After that, the day of the operation is scheduled.

Surgical intervention

The process of getting rid of the anomaly takes place under local anesthesia. To carry out the operation, you must have:

special solutions;
devices for their delivery to the eye;
diverging lenses;
a device that supplies light;
microscope.

Only an experienced ophthalmic surgeon should remove the affected membrane, eliminating epiretinal fibrosis of the eye. The operation is very delicate and requires the precision of a doctor's work. It consists of several stages:

at the site of the fibrous formation, the vitreous body is removed;
the tissue located in the molecular region is excised;
to prevent displacement of the retina, the missing volume is filled with saline.

With a successful outcome of the surgical intervention, the patient sees again the world no abnormal distortion.

Sometimes a second operation may be required.

Recovery

With a successful outcome, the patient goes home on the same day. The doctor prescribes the use of antibacterial and anti-inflammatory eye remedies. Their use helps:

reduce the risk of infection;
reduce the likelihood of edema;
prevent complications.

periodic visits to the doctor;
temporary cessation of driving;
avoidance of watching TV, reading, using a computer;
no mechanical impact on the eyes (friction, pressure, scratching);
wearing sunglasses.

It is also worth remembering that the development of epiretinal fibrosis of the eye cannot be prevented. There are no methods for preventing the disease. However, early detection of the disease is quite possible. For this, it is necessary to undergo an examination by an ophthalmologist every six months.

The epimacular membrane, or epiretinal fibrosis, is the result of an accumulation of collagen. As a result of this, on inner surface retina in the central region, a kind of membrane appears, leading to visual impairment.

The largest volume of the eyeball falls on the substance of the vitreous body, which also consists of a jelly-like compound. Due to this, the shape of the eyeball is preserved. It contains a large number of fibers that are tightly attached to the retina at one end. Over time, the volume of the vitreous decreases and it shrinks and then moves away from the surface of the retina. Most often this does not lead to any consequences. However, sometimes the surface of the retina is damaged, which triggers regeneration processes. As a result, scar tissue is formed, which is tightly attached to the retina. If the scar tissue shrinks, then the shape of the retina also changes. If it is located in the central macular region, then the clarity of central vision decreases.

Causes

The main reason for the formation of the epiretinal membrane is the removal of the vitreous substance from the surface of the retina. Typically, such changes are characteristic of patients older than fifty years. The risk of this pathology increases with age.

Also, epiretinal fibrosis can be a consequence of eye diseases, including uveitis, retinal detachment. The risk of epimacular membrane formation is increased in patients with diabetes mellitus (diabetic retinopathy). Another cause of this pathology is trauma to the eyeball, as well as surgical treatment for ophthalmic diseases.

Manifestations of epiretinal fibrosis

With the epimacular membrane, visual function is impaired, which suffers to varying degrees (ranging from minor deviations to severe dysfunction). Often patients complain of a decrease in image clarity and distortion of the contours of surrounding objects. There may also be difficulty in reading, especially in small print, making it difficult for patients to see small items. The blind spot may increase in size. Most often, epiretinal fibrosis is located only on one side, and pathological changes do not progress over time.

Diagnosis of epiretinal fibrosis

To diagnose the disease, it is enough to conduct ophthalmoscopy and carefully examine the structures of the fundus. To establish the correct diagnosis, you also need to perform angiography. In advanced cases, it reveals various changes including macular edema.

Additional fluorescein angiography helps to exclude other pathologies of the eye. Optical coherence tomography can also be done to measure the thickness of the macula and look for signs of macular edema.

Treatment options for epiretinal fibrosis

Sometimes the epimacular membrane does not require medical intervention. Usually this concerns a slight visual impairment. All minor deviations eventually become invisible and the patient ceases to pay attention to them, since they do not interfere with his life. Conservative methods of treatment used for other eye diseases, in this case, do not lead to an improvement in the condition. Sometimes the scar tissue spontaneously separates from the retina, which leads to the restoration of vision.

If epiretinal fibrosis is accompanied by severe dysfunction of the organs of the optical system, and the patient's quality of life is reduced, surgical treatment is performed. Most often, vitrectomy is prescribed, in which part of the vitreous substance in the zone of membrane formation is removed. This prevents retinal shift. Instead of the removed substance, they introduce saline solution. As a result, the transparency of the optical media is maintained, and visual impairment does not occur. Together with the substance of the vitreous body, the scar tissue in the macular region is also excised. Before the start of the operation, local drip anesthesia is performed. After removal of the pathological focus, anti-inflammatory and antibacterial drops for eyes that will reduce the severity postoperative edema and reduce the risk of secondary infection.

The effectiveness of the operation is quite high, but it is not always possible to fully restore visual function. Most of these interventions are carried out in outpatient, that is, in the evening the patient can leave the clinic. The rehabilitation period lasts about three months.

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Questions and answers on: fibrosis of the vitreous body of the eye

2016-03-28 15:15:00

Natalia asks:

Hello! I am 33 years old. In 2007, I sharply lost my vision on my left eye. I went to the Filatovo Institute in Odessa. After a number of examinations, Dagnosis was put: the outcome of the uveitis, fibrosis of the vitreous, epitheral membrane, vitreoretine litter, antiquity of the retina with a macular rupture .WE HAVE DONE TWO OPERATIONS AFTER THE FIRST WE PUMPED SILICONE OIL., AND AFTER THE SECOND GAS TAMPONAD. AFTER THE OPERATIONS I DID NOT SEE AND I DON'T SEE ONLY THE LOOK OF THE FACE TO ME SPILLED. BECAUSE THERE ARE DEFECTS. .BUT THIS IS NOT ALWAYS. WHEN THE LIGHT IS MORE DIMMER, IT IS EASIER FOR ME. HEALTHY EYE, A HE IS THE ONLY ONE OF ME AND SEES 100%. IS IT POSSIBLE TO TAKE TREATMENT NON-SURGICALLY? OPERATINGLY? PLEASE tell me! I HAVE TWO SMALL CHILDREN I WANT TO SEE HOW THEY GROW! I WILL BE VERY GRATEFUL IF YOU ANSWER AS EARLY AS POSSIBLE.

Responsible Molebnaya Oksana Vasilievna:

Unfortunately, with a long-term inflammatory process, which led to severe complications in one eye, the so-called. sympathetic inflammation also in the second eye, which causes at least severe consequences. In such cases, they go to remove the sympathetic - diseased eye. But what is the cause of uveitis in the left eye? Have you been tested for HIV, cytomegalovirus and herpes virus?

2012-11-01 15:50:02

Antonina asks:

Hello. I am 75 years old. Diabetes mellitus 20 years old, now insulin. Passed an examination by an ophthalmologist: right eye - lens cloudy, fibrosis of the vitreous body, the retina is adjacent. Cataract.
Retinopathy. Vision 0.06 right and left 0.10. What is the percentage of vision after replacement of the vitreous body and lens? And on the replacement of a vitreous body is how much dangerous? If the operation does not lead to an improvement in vision, is it possible to at least stop its loss, and how? Many thanks in advance for your reply.

Responsible Prokhvachova Elena Stanislavovna:

Dear Antonina. vitreous replacement surgery itself is complex and risky, predicting visual acuity after surgical treatment hard in your case. However, if this operation is not performed, then tractional retinal detachment will occur due to fibrous bands in the vitreous body, in which case the prognosis for vision is doubtful even after the operation.

2011-06-17 22:02:09

Julia asks:

Hello, 1.5 years ago I gave birth to a child with uveitis, retinal detachment, fibrosis of the vitreous body, in general, one eye does not see, after birth it was examined for cytomegalovirus, the analysis was negative, but before pregnancy I noticed blisters on my genitals in the form of herpes, but the doctors did not pay attention to this and they didn’t say anything, please tell me if I have a chance to give birth to a second child and what needs to be done for this? thanks

Responsible Serpeninova Irina Viktorovna:

Good afternoon. Be sure to undergo medical genetic counseling. Take a blood test for Ig M, Ig G and avidity of Ig G to CMV, Herpes vir, toxoplasmosis, rubella. Examine by PCR for chlamydia, mycoplasmosis, ureaplasmosis.

2010-05-08 12:33:14

Tatyana asks:

Good afternoon. I have fibrosis of the vitreous body since childhood, of course, I can’t see it in my left eye. Belmo of the cornea, are there any prospects from a cosmetic point of view (it is clear that insight will not happen)? I am a young girl, so this is very important to me. I really hope for an answer

Responsible Averyanova Oksana Sergeevna:

Corneal transplantation is possible, but the prognosis of clear engraftment (cosmetic outcome) depends on initial state eye, the most important moments of which are intraocular pressure and the presence of vascularization (newly formed vessels) in the cornea). Therefore, to evaluate the transfer forecasts, it is necessary to face-to-face consultation in the corneal transplant department.

2009-09-08 19:25:59

Lisa asks:

Good afternoon. My brother received a penetrating injury to his left eye a month ago (the screwdriver went in 2.5 cm from below). An operation was performed, the eye remained intact, but does not see anything, light perception is partially preserved with an incorrect projection, the field of vision is absent. Diagnosis: vitreous fibrosis, retinal detachment. He is offered to undergo an operation, but they say that after it his vision will not be restored anyway. I want to know more about this operation and is there any point in doing it? What is the threat to the eye if the operation is not performed? Is there a threat to healthy eye with this diagnosis?

Relevance. Fibrosis of the vitreous body is the outcome of hemophthalmia, and also develops with uveitis various genesis which greatly reduces visual acuity.
Intravitreal hemorrhages in 27% of cases lead to functional disorders, and in 5-7% to anatomical death of the eye. Blood and its decay products, which are in the vitreous body for a long time, have a toxic effect on various retinal structures, resulting in their irreversible changes. In addition, the organization of not only hemorrhages, but also inflammatory changes in the uveal tract leads to the formation of moorings and traction retinal detachment. That's why timely treatment fibrous changes in the vitreous body is an urgent problem.
To date, there are two ways to treat vitreous fibrosis: conservative and surgical. Conservative treatment is aimed at accelerating the resorption of connective tissue elements in the vitreous body, however, it requires a long time and final result not known. Vitrectomy shows quick effect and the method is the main one when fibrotic changes are accompanied by traction syndrome and retinal detachment. It should be noted that the possibility of complications in vitreoretinal interventions ranges from 15-46%.
In this regard, it seems relevant to search for new methods of influencing the altered vitreous body without opening the eyeball as a non-invasive treatment.

Target research: determination of the possibility and effectiveness of Nd:YAG laser vitreolysis in patients with vitreous fibrosis of various origins.

Materials and methods. For Nd:YAG-laser exposure, a Visulas-YAG II laser device manufactured by Karl Zeiss (Germany) was used. Pulse energy 0.8-9.2 mJ, number of pulses from 2 to 150, number of sessions 3-12. The criterion for the end of the session was the state of the vitreous body - saturation with destroyed fibrous fragments and their approach to the outer boundaries of the vitreous cavity or the total energy of Nd:YAG laser exposure up to 700 mJ, calculated in experimental studies.
Nd:YAG laser treatment of the vitreous body was performed on the patient after clinical examination and localization of fibrosis ultrasonic methods studies (volume, acoustic density) against the background of maximum mydriasis in outpatient settings under local anesthesia. If necessary, the session was repeated, increasing the energy of the Nd:YAG laser exposure from sparing (without damaging vitreous body fibrils) to destroying destructive formations. Between sessions of YAG laser treatment, conservative therapy, including local administration of corticosteroids, fibrinolytics, and, if necessary, hemostatic drugs, as well as mandatory control of IOP.
Nd:YAG laser exposure was performed on 15 patients (15 eyes) aged 30 to 67 years (mean age 47.5 years). Visual acuity was in the range of 0.01-0.3. The patients were divided into 2 groups: group 1 - 5 patients (5 eyes) with fibrosis formed on the background of hemophthalmia, prescription from 3 to 6 months, group 2 - 10 people (10 eyes) - fibrosis formed against the background of the transferred inflammatory uveal process. Previous conservative therapy in both groups had no positive effect.

results and discussion. After the treatment in the 1st group, an increase in visual acuity was observed in 3 patients up to 0.4, in 1 patient the visual acuity did not change (0.05), in one patient it increased to 0.6, and then decreased to 0.2 due to recurrence of hemophthalmia, but was significantly higher compared to baseline (0.04). After completion of treatment with Nd:YAG laser vitreolysis in 3 patients, it became possible to perform panretinal laser coagulation. In the 2nd group, an increase in visual acuity was recorded in 5 patients by 0.3-0.4, in 2 by 0.1-0.2, in 3 patients the visual acuity did not change due to the presence of cicatricial changes in the macular region, which were detected only after complex treatment. Thus, an increase in visual acuity was obtained in 12 patients with vitreous fibrosis of various origins.

conclusions:
1. Nd:YAG laser vitreolysis can be used in patients with vitreous fibrosis of various etiologies.
2. Nd:YAG-laser effect on vitreous fibrosis leads to destruction connective tissue, increasing the mobility of the vitreous body with an increase in the effect of conservative therapy.
3. Nd:YAG laser vitreolysis should be carried out with caution, since uveitis and/or hemophthalmos may recur during treatment.

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Age-related macular degeneration is one of the main causes of central vision loss in the adult population. Increasing the life expectancy of people and improving the quality of diagnosis brings this disease to the first place among the causes of persistent vision loss.

The causes of the onset and progression of this disease are still not well understood and at present all the efforts of doctors are aimed only at stabilizing the pathological process and visual functions.

The disease includes a set of pathological changes in the central zone of the retina associated with age, which can be divided into stages or forms. Depending on the form and course of AMD, various methods of treatment are offered. All Methods treatment of AMD based on early accurate diagnosis, so on early stages disease adequate treatment can stop the progression and prolong for years vigorous activity associated with the writing and reading of our patients.

Non-exudative forms of AMD are the initial stage of the disease, the period of precursors. As a rule, visual impairment does not occur. At this stage, dynamic observation, antioxidants and retinoprotectors in the form of nutritional supplements are important.

Atrophic forms of AMD develop slowly, but inevitably lead to loss of central vision. As a rule, the disease is found in both eyes, possibly with varying degrees of severity. Currently, periodic courses of vascular and retinoprotective (improving nutrition of the retina) treatment are carried out as a treatment. Patients are advised to use sunglasses on the street.

Exudative forms of AMD are different severe course and severe visual impairment. At first, before the loss of central vision, patients notice the curvature of the contours of objects, straight lines, text. It is becoming more and more difficult to do small work at a distance close to the eyes (sewing, knitting, reading and writing). The reason lies in rapid growth And high activity newly formed vessels located under the retina. Newly formed vessels have a thin permeable wall, which eventually leads to edema (accumulation of fluid under the retina) and hemorrhage in the central zone of the retina. In the end stage of AMD, there is a loss of central visual functions due to the development of atrophy or scarring, peripheral vision, as a rule, remains unaffected. All efforts in treatment exudative form AMD is aimed at combating newly formed vessels. Currently, the use of anti-VEGF drugs has become widely practiced.

epiretinal macular fibrosis

Epiretinal macular fibrosis may be primary disease retina, and a consequence (complication) of other eye diseases(inflammatory, vascular, trauma, etc.).

Most often, primary epiretinal macular fibrosis occurs after 50 years, but in Lately there is a tendency to "rejuvenation". The disease begins with the appearance of a membrane (thin film) on the surface of the retina, usually in or near the central zone. The contraction of the membrane causes wrinkling and deformation of the underlying retina, and as the membrane thickens, a pronounced deformation and even partial flat detachment of the retina occurs.

At the initial stages of development, epiretinal fibrosis is asymptomatic. This condition does not require intervention, it is enough dynamic observation. As the progression progresses, there may be a curvature of the outlines of objects and straight lines and a noticeable decrease in visual acuity. In such cases, it is advisable to carry out surgical intervention - separation and removal of the membrane.

IN rare cases the membrane can peel off on its own, which leads to the disappearance of all symptoms.

An idiopathic macular hole is a penetrating tissue defect in the center of the retina. It usually occurs over the age of 60. The reason lies in the traction of the exfoliated posterior hyaloid membrane fixed to the center of the retina. The disease develops in stages, and in the early stages it is asymptomatic. For more late stages the patient notes a black spot in front of the eye, often detected by chance when closing a healthy eye. Peripheral vision is not affected. Retinal examination alone is often sufficient to make the diagnosis; optical coherence tomography may be required to document the diagnosis and clarify the stage. At the first stage of the disease - the threat of the formation of a macular hole - no treatment is carried out, since at this stage spontaneous reverse development. At later stages, surgical intervention is indicated - posterior vitrectomy with the elimination of the traction factor.

Central serous chorioretinopathy

This is a common pathology of the fundus, affecting mainly young patients. This disease is idiopathic and so far much of the causes and development of this disease remains unclear. Vision is usually not severely affected. Patients often complain of blurred vision in one eye, the appearance of curvature of the contours of objects and straight lines. Diagnosis does not present any difficulties, however, to determine the further tactics of treating the patient, fluorescein angiography is indicated. It depends on the results of this examination whether you will be offered simple observation and conservative treatment, laser treatment or intravitreal administration of an anti-VEGF drug.

Diabetic ritinopathy

Damage to the organ of vision in diabetes mellitus occupies a special place, as it significantly affects the quality of life of people. And out of all clinical manifestations Diabetic eye damage is most dangerous retinopathy, being the main cause of progressive and irreversible vision loss up to blindness, which occurs 25 times more often in diabetic patients than in the general population.

The main factor in the development and progression of DR is chronic hyperglycemia, i.e. high level Sahara.

Currently, in most European countries, a classification is used, according to which there are three main forms of retinopathy:

nonproliferative retinopathy;
preproliferative retinopathy;
proliferative retinopathy.

The decrease in visual acuity in diabetic retinal damage occurs as a result of three reasons. Firstly, due to the presence of maculopathy (retinal edema in the central zone), central vision may suffer. Secondly, at the stage of proliferative retinopathy, hemorrhages that arise from newly formed vessels cause sharp deterioration vision. Third, the formation, growth, and contraction of fibrovascular tissue leads to tractional retinal detachment, resulting in severe and often irreversible visual loss.

Timely identification of the most early manifestations eye diabetes is priority, since in the later stages of the process, treatment is already unpromising.

However, in the initial stages of eye diabetes, pathological changes in the retina are not accompanied by visual disorders, so patients themselves seek medical help, as a rule, late. In this regard, great responsibility is placed on the work of dispensary ophthalmological observation and on the shoulders of the patient himself, serious attitude and whose responsible approach will help to reduce the existing risk of vision loss due to eye diabetes.

There are two main directions in the treatment of diabetic retinal lesions:

The most stable compensation of diabetes mellitus and direct treatment of diabetic retinopathy.

Laser coagulation of the retina is the only effective way treatment of diabetic retinopathy. Laser coagulation in diabetic retinal lesions is aimed at stabilizing the process, and an increase in visual acuity is not always achieved. In severe proliferative retinopathy with the development of recurrent vitreous hemorrhages and traction retinal detachment, laser coagulation is futile. In such cases, surgical treatment - vitrectomy may be indicated.

With persistent maculopathy, schemes for intravitreal administration of an anti-VEGF drug are being developed.

Retinitis Coats

Coats disease is congenital disease, which typically manifests itself in childhood in boys and affecting one eye. Most cases are diagnosed before the age of 20, with a peak in detection at the end of the first decade.

The reason for treatment may be strabismus, leukocoria, or a red sore eye in a far advanced form. Older children and, less frequently, adults may complain of reduced visual acuity in one eye.

Diagnosis is usually based on fundus examination—cycloscopy may sometimes require fluorescein angiography.

In mild cases of the disease, dynamic observation is sufficient - examinations every six months. With a progressive course, numerous repeated sessions of laser coagulation are indicated and more careful monitoring is required, since relapses of the disease are possible within 5 years after complete regression. With a far-reaching stage of the disease with the development of retinal detachment, surgical treatment is indicated.

Eales' disease

The disease has been known since 1880, when the occurrence of recurrent hemorrhages in the vitreous body was first described in young people against the background of complete health.

Eales' disease is a chronic inflammation of the vessels of the periphery of the retina, accompanied by repeated hemorrhages and a gradual decrease in vision. The disease predominantly affects middle-aged males and is usually bilateral.

Patients complain of the appearance of floating "flies" or a decrease in visual acuity in one eye. In severe cases, repeated hemorrhages lead to traction retinal detachment and secondary neovascular glaucoma.

There is no medical treatment for Eales' disease. hormone therapy usually not effective. the only effective method treatment is timely laser coagulation of the retina, which allows to stabilize pathological process and save the remaining vision.

In some cases, when a retinal detachment occurs, there is a need for surgical treatment.

Fundus examination - cycloscopy should be performed annually. A case of disease recurrence tens of years after the apparent stabilization of the process is described.

Thrombosis central vein retina or its branches

This state represents acute disorder blood circulation in the central retinal vein or its branches, threatening irreversible vision loss.

The disease usually occurs in people over 50 years of age against the background of arterial hypertension, diabetes mellitus, atherosclerosis, thrombophilia and other blood diseases.

Usually, patients report a unilateral painless sharp decrease in vision that occurs against the background of high blood pressure, after physical or emotional load, after overheating, drinking alcohol. As a rule, patients can clearly indicate when vision has decreased. Depending on the localization of the process, there may be complaints about the appearance of a spot in front of the eye, the appearance or increase in floating “flies”, loss of visual fields, and distortion of the contours of objects.

Treatment should be started immediately. This emergency, requiring urgent hospitalization to the hospital. Best effect will be observed with timely and comprehensive treatment of the patient, the prognosis for vision will largely depend on visual acuity at the time of treatment. To dissolve a thrombus that occludes a vein, thrombolytic drugs are used, which are effective only in the first seven days from the onset of the disease. In the future, there will be no effect from their use.

Another direction of complex treatment is the maximum reduction intraocular pressure, absorbable therapy and antioxidants. In the presence of diffuse edema in the center of the retina, the issue of lattice laser coagulation is being decided. Recently, intravitreal administration of an anti-VEGF drug has been successfully used as a method of treating macular edema.

With the threat of the appearance of newly formed vessels due to prolonged ischemia of the retina and the development of neovascular glaucoma, as a complication of thrombosis of the central retinal vein, panretinal laser coagulation of the retina should be performed, which is carried out in several sessions. aim laser treatment is not an increase in visual functions, but the prevention of the development of neovascular glaucoma.

Occlusion central artery retina

The disease is an acute blockade of blood circulation in the central retinal artery by a thrombus. It usually occurs in people over 60 years of age. The development of this disease is based on different reasons, the main ones are:

arterial hypertension;
atherosclerosis;
pathology of the heart valves;
tumors;
eye injury;
systemic diseases.

As a rule, patients report an acute unilateral and painless loss of vision that develops within a few seconds. Sometimes there are episodes of transient loss of vision before complete loss of vision.

The prognosis for vision in the future is usually unfavorable. In most cases, visual acuity remains at the level of light perception. The exception is in the case of additional blood supply to the area fossa retinal cilioretinal artery, when visual acuity can be restored to the original, but nevertheless there are significant losses in the visual fields.

There is no proven treatment for visual acuity, but this is an ophthalmic emergency and theoretically, the timely displacement of a thrombus can prevent the development irreversible changes vision. Attempts to displace the thrombus make sense in the first 48 hours from the onset of the disease. Therefore, in this case, it is urgent to contact an ophthalmologist for help, and at the stage first aid to massage the eyeball, the purpose of which is to first cause the collapse of the lumen of the vessel, and then sharply expand it. If necessary, the patient can massage the eyeball on their own using the following technique.

The patient's head should lie low to avoid orthostatic relative deterioration of the blood supply to the retina.
Fingers of the hand are pressed through the closed eyelid on the eyeball.
The eyeball is pressed into the orbit at first weakly, then with intensification and after 3-5 seconds it is suddenly released.
After a few seconds, the process is repeated.

Anterior and posterior ischemic neuropathy

A disease that is most common in the elderly. Based on partial or complete disc infarction optic nerve or its retrolamellar part, caused by occlusion of the vessels supplying the optic nerve.

The risk factors for development are arterial hypertension, diabetes, hypercholesterolemia, collagenoses, antiphospholipid syndrome, hyperhomocysteinemia, sudden hypotensive conditions etc.

The onset of the disease is most often manifested by a sudden unilateral loss or significant decrease in vision without any previous visual impairment. Decreased vision is usually detected upon awakening, indicating a likely association with nocturnal hypotension.

Medical care is aimed at restoring and improving blood circulation in the system supplying the optic nerve and preventing the development complete atrophy optic nerve.

congested optic disc

Congestive optic disc is characterized by edema that develops against the background of increased intracranial pressure. A stagnant disc is almost always bilateral. Usually, visual disturbances appear only at the stage of optic nerve atrophy ( far advanced), so often a congestive optic disc is a diagnostic finding during an examination by an ophthalmologist.

Clinical manifestations of increased intracranial pressure can be headache, sudden nausea and vomiting, impaired consciousness, transient episodes of blurred vision and double vision.

Causes of increased intracranial pressure:

Obstruction of the ventricular system (congenital or acquired)
Volumetric intracranial masses, including hematomas
Meningitis, subarachnoid hemorrhage, trauma accompanied by diffuse cerebral edema
Severe systemic arterial hypertension
Idiopathic intracranial hypertension
hypersecretion cerebrospinal fluid tumor choroid plexus brain.

All patients with congested discs should be evaluated by a neurologist and neurosurgeon to rule out intracranial masses.

Optic neuritis

Optic neuritis is a lesion of the optic nerve due to an inflammatory, infectious, or demyelinating process.

Demyelinating neuritis is most common in multiple sclerosis. The onset of the disease is manifested by a subacute unilateral decrease in vision. Sometimes a decrease in vision is accompanied by dotted white or colored flashes or sparks. There is often pain on moving the eye or discomfort that precedes the loss of vision and usually lasts for several days. In most cases, defects appear in the field of view.

Deterioration of visual functions lasts from several days to two weeks in further recovery vision occurs within six months. With repeated attacks, atrophy of the optic nerve develops.

Although some patients with optic neuritis do not have clinically detectable systemic demyelinating disease, next row observations indicates a close relationship between optic neuritis and multiple sclerosis.

In patients with optic neuritis and initially normal brain MRI, the risk of developing multiple sclerosis over the next 5 years is 16%, and in patients with established multiple sclerosis, optic neuritis develops in 70% of cases.

Given all of the above, when making a diagnosis of optic neuritis, the doctor will definitely refer you to an MRI of the brain.

Suggested treatment hormonal drugs and interferon allows you to speed up recovery up to 2-3 weeks. However, the treatment does not affect the final visual acuity.

Optic neuritis in infectious diseases is much less common. Disease may be the cause paranasal sinuses nose. Such neuritis is characterized by recurring episodes of unilateral visual loss, severe headaches, and signs of sinusitis. In this case, the treatment is carried out in conjunction with an otolaryngologist. Therapy - local and systemic use antibiotics.

The main cause of parainfectious optic neuritis is a viral infection. In addition, it can develop after vaccination. In children, this form of neuritis is much more common than in adults. The disease usually develops 1-3 weeks after viral infection and decreased vision is accompanied by neurological symptoms (headache, attaxia).

Treatment is usually not required due to a favorable prognosis, suggesting fast recovery visual functions. However, with severe or bilateral lesions, hormonal therapy is indicated.

Chorioretinal inflammatory diseases(chorioretinitis)

Causes of chorioretinitis can be infectious and non-infectious.

Most often, the disease is detected in young, healthy adults who come to the doctor with complaints of decreased vision and floaters before the eye, photophobia. When the focus of inflammation is localized in the central zone of the retina, central vision suffers significantly.

In addition to toxoplasmosis infectious cause chorioretinitis can be: toxocariasis, cytomegalovirus, herpes virus, secondary syphilis, candidiasis, histoplasmosis, tuberculosis.

With a well-established diagnosis, confirmed laboratory methods research treatment is carried out by an infectious disease specialist.

Hereditary dystrophic and degenerative diseases retina

Retinitis pigmentosa is a group of hereditary dystrophic diseases of the retina characterized subjectively by night blindness and loss of peripheral vision. Almost a quarter of all patients maintain high visual acuity and the ability to read throughout their lives. However, an annual examination is necessary to detect a significant drop in visual acuity, which may be due to a potentially treatable cause, such as cystic macular edema or cataracts.

Stargardt's disease is the most common form of genetically inherited retinal dystrophy that occurs in adolescence. The onset of the disease occurs at the age of 10-20 years. There is a bilateral gradual decline central vision. Most patients maintain average visual acuity in at least one eye.

Best's disease is a rare hereditary dystrophic disease retina. The disease usually progresses slowly through five stages and ends in macular atrophy with loss of central vision. In general, the prognosis is quite good, as most patients retain sufficient reading vision in at least one eye throughout their lives. If there is a pronounced decrease in vision, this usually occurs slowly and begins after 40 years.

Albinism is a group of genetically inherited diseases, which are based on a violation of the synthesis of the melanin pigment and which can be characterized either by an isolated eye lesion(ocular albinism), or systemic lesion eyes, skin and hair.

Important Clinical signs This

Low visual acuity
pendulum horizontal nystagmus
Red tint of the iris.

Pathogenetically substantiated treatment hereditary diseases retina does not exist. There is an opinion and several experimental clinical studies indicating positive dynamics and stabilization dystrophic process retina with periodic use of drugs - tissue bioregulators.

Retinal disinsertion

This is the separation of the retina from the underlying pigment epithelium. The main types of retinal detachment: rhegmatogenous, exudative, traction.

Rhegmatogenous retinal detachment occurs a second time against the background of a through rupture of the retina, as a result of which fluid from the vitreous body enters under the retina. Retinal breaks are a common condition, most often occurring with myopia, pseudophakia, and after trauma. In many cases, ruptures are bilateral and multiple, occurring against the background of degenerative anomalies, developmental anomalies, and trauma.

Many ruptures are asymptomatic, sometimes ruptures are manifested by floaters in front of the eye and flashes of light, without affecting visual acuity. However, if a retinal detachment develops, there is a progressive loss of visual field.

About 60% of all ruptures occur against the background of specific changes - peripheral degenerations. These are pathologically thin areas of the retina in which breaks spontaneously form. Peripheral degenerations retinas predisposing to retinal detachment (ethmoid, "cochlea mark", degenerative retinoschisis), as well as breaks, are subject to laser coagulation in order to prevent rhegmatogenous retinal detachment.

Rhegmatogenous detachments are subject to surgical treatment, and the postoperative prognosis for vision depends on the duration of the disease and the prevalence of detachment. If retinal detachment does not capture the central (macular zone) and fresh, postoperative prognosis for the restoration of vision is relatively high.

Exudative retinal detachment is retinal detachment due to intraretinal or subretinal fluid leakage. By definition, such detachment is not associated with a retinal tear. It is necessary to look for signs of the underlying cause of exudation (leakage) of fluid, such as inflammation, vascular changes or tumors. Depending on the causes of exudation, etiopathogenetic treatment is used.

The main causes of traction retinal detachment are: proliferative diabetic retinopathy, retinopathy of prematurity, penetrating trauma to the posterior segment of the eye. This is the most severe complication underlying disease leading to blindness. In such cases, surgical treatment is indicated.