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  • Detachment of the retina - Causes, symptoms and treatment. MF.

    Retinal detachment is a condition in which the separation of the neuroepithelium( rods and cones) from the pigment layer occurs. The disease leads to rapid loss of vision.

    Retinal detachment

    Reasons for retinal detachment

    For reasons of development, the detachment can be:

    - dystrophic( primary, rhegmatogenous) - is associated with rupture of the retina. In this case, the liquid accumulates under the neuroepithelium and separates it from the underlying layers.
    - traction - is associated with retinal tension in the sites of vitreoretinal fusion with the formation of cords in the vitreous humor( often with recurrent hemophthalms, especially in diabetes mellitus)
    - exudative( secondary) occurs with various eye diseases( tumors, inflammatory diseases, hemorrhages, central thrombosisveins of the retina and its branches, retinopathy of prematurity, etc.).In this case, the liquid accumulates in the subretinal space( between the retina and the choroid)

    The following types of vitreochoretinal dystrophies lead to a rheumatogenic detachment:

    1. Equatorial( localized in the equatorial area of ​​the retina):
    - latticular dystrophy - often occurs in the upper-outer quadrant - characterizedformation of thinning and ruptures between intertwined white lines that are obliterated vessels
    - hole gap
    - valvular rupture

    Detachment with rupture

    - gap with a lid
    - abnormal pigmentation

    2. Paraoralnye( located at the dentate line-retinal space attached to choroid)
    - cystoid degeneration - localized on retinal periphery formed cysts which may coalesce and possible rupture their walls. When examining the fundus look like bright red rounded transparent formations.
    - retinoschisis - retinal bundle. Occurs with hereditary diseases, high myopia, in old age. When progressing, giant cysts are formed, whose walls are ruptured
    - chorioretinal atrophy - white atrophic foci with pigmented margins are formed that merge. It rarely leads to detachment.

    3. Mixed. Risk factors for retinal detachment:

    Vitreochorionetinal peripheral dystrophies, high complicated myopia, eye trauma( penetrating or concussion), presence of detachment on one eye or near relatives.

    Symptoms of retinal detachment

    Symptoms in peripheral vitreochorioretinal dystrophies are absent. With detachment, patients complain of the appearance of a veil before the eyes, the loss of the field of view, increasing in size. Patients describe the symptom as the appearance of a "dark curtain".

    Vision in retinal detachment

    Before these symptoms, there may be "lightning and sparks" in the eyes( fps), the shape and size of objects( metamorphopsia), floating opacities are distorted.

    If you experience any of the symptoms described above, you should immediately contact your doctor!

    Examination for retinal detachment

    The following research methods are required for diagnosis:

    - determination of visual acuity( from the norm in case of peripheral detachment to blindness), not corrected by lenses;
    - perimetry - the field of view falls on the side opposite to the detachment;
    - tonometry - it is possible to reduce the intraocular pressure by an average of 5 mm Hg;
    - biomicroscopy - destruction, hemorrhages, striations, detachment of the vitreous body;
    - examination in transmitted light - vitreous body opacities are possible;
    - indirect and direct ophthalmoscopy, as well as with the Goldman lens and binocular, always with a wide pupil. Small changes in size are clearly visible when pressing on the sclera. Partly or completely disappears the reflex of the fundus, the part of the detachment is whitish in color, the vessels are full-blooded and crimped. The gaps are red and have a different shape. With a rheumatogenic detachment, the retina has a wrinkled appearance, moves when the head moves, pigment cells, hemophthalmia, retinal ruptures are present in the anterior part of the vitreous humor. When the traction detachment is visible vitreoretinalnye strands or neovascular membranes. When exudative, the detachment site can move with the movements of the head, the retina is smooth and it is possible to raise it to the lens
    - the ultrasound of the eye

    of the ultrasound in the detachment

    - optical coherence tomography
    - electroretinography - its parameters are not registered or reduced

    Laboratory methods( general blood tests, urine, blood sugar, determination of glucose tolerance, biochemical analyzes, etc.), consultations of a therapist, endocrinologist, genetics according to indications.

    Treatment for retinal detachment

    The success of the treatment depends entirely on the term of the diagnosis. The earlier the operation is performed, the greater the chances of restoring vision. Basically, surgical methods are used, only with the threat of detachment or spreading it to the macular area before the operation, which is carried out in the near future, it is necessary to impose a binocular bandage and observe a strict bed rest.

    There are many methods, but the most common ones will be described below:

    - pneumoretinopexia - an air bubble is introduced into the vitreous humor, which "presses" the exfoliated retina to the choroid. Effective in pathology in the upper parts. If other areas of the retina are affected, the patient is asked to assume a specific head position. The air dissipates within a few weeks. During this time, additional methods of treatment - cryopexy( "weld" the retina to the underlying layers with the help of liquid nitrogen) or laser coagulation of the retina are carried out.

    - scleroplasty operations - local and circular scleral closure. At the same time, the silicone band is sewn to the sclera locally or vkrugovuyu. In this case, the outer shells approach the exfoliated retina, and conditions are created for its adherence. With a large accumulation of exudative fluid, it is drained. The operation is not complicated, it is carried out practically in any hospital, in which there is a microsurgical ophthalmologic department.

    - with the help of special equipment and in the presence of a trained specialist, performs endovitral operations of .The most common - vitrectomy, produce an excision pathologically altered vitreous body, together with strands and shvartami. Perfluoroorganic compounds, gases or silicone oil are introduced into the retina to fill its volume and adhere to the retina. It is also possible to remove the preretinal membranes.

    - laser treatment methods - laser coagulation of the retina - coagulates are applied, thus "welding" the reticular shell around the edges of the detachment or in the places of its possible development.

    Laser dystrophy

    - exudative detachment of the retina is to be treated only after eliminating the cause that caused the disease.

    Possible complications of surgical treatment: repeated detachment of the retina, increased intraocular pressure, vascular closure, cataract, refractive abnormalities.

    After surgery for retinal detachment, patients are under constant supervision of an ophthalmologist. Contraindicated work associated with heavy physical labor, head inclinations, vibration and the effects of high temperatures.

    Doctor ophthalmologist Letyuk T.Z.