• Chorioretinitis - Causes, symptoms and treatment. MF.

    Chorioretinitis is an acute or chronic inflammation of the posterior part of the choroid with retinal involvement. There are congenital and acquired.


    Causes of chorioretinitis

    The following conditions lead to the development of the disease:

    - infections( toxoplasmosis, tuberculosis, syphilis, herpes virus), including local( ENT organs, oral cavity);
    - radiation;
    - some toxins( for example, prolonged hemophthalmus leads to chorioretinitis, since the destroyed elements of blood can be toxic);
    - allergic reactions;
    - autoimmune conditions;
    - immunodeficiencies( in HIV-infected people, in weakened people, after long-term treatment);
    - injury.

    Symptoms of chorioretinitis

    Depending on the localization of the process, chorioretinitis can be central( in the macular zone), peripapillary( region around the optic nerve disk), equatorial( around the equator) and peripheral( near the dentate line).In the prevalence are divided into focal, multifocal disseminated( several foci), diffuse. There are acute( up to 3 months) and chronic( often relapse).

    Depending on the location, there are typical complaints. Peripheral chorioretinitis can be asymptomatic, they are detected during a preventive examination. When the macular area is affected, the patient notices fogging and decreased visual acuity, dark spots, flashes( fps), sparks before the eyes, the shape and size of the objects are distorted( metamorphopsia, micropsia and macropsias), the patient is difficult to navigate at dusk( hematolopia, "night blindness".

    Any of these symptoms may indicate a serious eye disease, so you should immediately contact an ophthalmologist.

    Diagnosis of chorioretinitis

    To confirm the diagnosis, the following studies are performed:

    - determination of visual acuity( decreases with central chorioretinitis, not corrected);
    - perimetry, including computer( possibly the emergence of cattle, or dark spots, decreases the contrast sensitivity of the retina);
    - refractometry - does not change with chorioretinitis;
    - biomicroscopy - detect changes in the vitreous;
    - examination in transmitted light - opacities in the vitreous are possible;
    - ophthalmoscopy with a wide pupil and with a Goldman lens. Depending on the shape and stage of the different picture of the fundus. Classical changes: grayish-yellowish foci with fuzzy boundaries, protruding into the vitreous( at the stage of infiltration), along the vessels of exudate, hemorrhages are possible. Further, the boundaries become clear, and pigmentation occurs in the focus region. Over time, retinal and vascular atrophy develops in the affected area. An ophthalmoscopic picture of other choroiditis will be described later;
    - fluorescent angiography reveals a change in the vessels of the fundus( microaneurysms, shunts, etc.);
    - electroretinography allows to determine the functional state of the retina;
    - optical coherent tomography of the retina - determine the morphology of the inflammatory focus;
    - ultrasound reveals changes and opacities in the eyes

    Uzi in chorioretinitis

    To determine the cause of chorioretinitis, the following methods are used: general clinical blood and urine tests, blood for RW, hepatitis, HIV infection, toxoplasmosis, herpes, cytomegalovirus, chest fluorography, Mantoux according to the testimony. If necessary, consult a therapist, pediatrician, infectious disease specialist, immunologist, allergist, venereologist, phthisiatrist, ENT doctor, dentist.

    Features of the clinical picture of some chorioretinitis

    Toxoplasmic chorioretinitis is almost always congenital. Infection occurs in utero. Lesions are also detected in the central nervous system and other organs. The periods of remission alternate with exacerbations. Chronic foci have clear boundaries with coarse pigmentation. With the active process, infiltration appears along the edges of the old lesions. Fresh foci are pronounced into the vitreous, retinal detachment, retinal hemorrhages with the subsequent formation of a neovascular membrane are possible.

    Toxoplasmic chorioretinitis

    TB chorioretinitis secondary, that is, occurs in the presence of a primary focus, often in the lungs. On the fundus there are disseminated tuberculosis, after treatment there are chorioretinal scars. Tuberculosis-allergic inflammation of the vascular membrane does not have characteristic distinctive features.

    Tuberculous chorioretinitis

    Syphilitic chorioretinitis is characterized by a picture of "salt and pepper" on the fundus. In this case, the foci of pigmentation alternate with foci of fibrosis and atrophy.

    Chorioretinitis in HIV infection occurs against the background of immunodeficiency and often has a cytomegalovirus cause. It is characterized by a widespread widespread defeat, has a necrotic and hemorrhagic nature, it is difficult to treat and leads to blindness.

    Treatment of chorioretinitis

    Treatment should be timely and individually appointed. Local therapy is ineffective, except for parabulbar and retrobulbar injections. The following groups of drugs are used:

    - etiotropic - aimed at eliminating the cause of chorioretinitis. At bacterial antibiotics of a wide spectrum before detection of the originator are applied. Then, depending on the sensitivity, certain antibiotics are prescribed. In viral chorioretinitis, interferons, inducers of interferonogenesis and antiviral drugs are used. With syphilitic chorioretinitis antibiotics of the penicillin group are prescribed for a long course of up to 1 month( if intolerance, then doxycycline, macrolides or cephalosporins).If the process is caused by toxoplasm, then sulfadimezine and pyrimethamine are used with folic acid and vitamin B12.Tuberculous chorioretinitis is treated with a phthisiatrician. An approximate list of drugs for the chronic process: isoniazid and rifampicin, streptomycin, kanamycin and hormonal agents. Herpetic infection is treated with acyclovir 0.2 grams 5 times a day, cytomegalovirus - ganciclovir intravenously drip

    - anti-inflammatory drugs, including hormonal. For example, indomethacin, diclofenac or hydrocortisone and dexamethasone inside, intramuscularly, intravenously or topically( prolonged drug for parabulbar injection every 2 weeks - Diprospan)

    - detoxification therapy - for example, hemodez or glucose solution 5% 400 ml intravenously drip

    -Immunotherapy - depending on the severity of the process, immunosuppressors are used( with active chorioretinitis fluorouracil, mercaptopurine) or immunostimulants( for example, with HIV infection levamisole)

    - hyposensitizing(Suprastin, Claritin, Erius, etc.)

    - To increase the body's resistance, vitamins( C, group B, preferably multivitamin preparations) are shown

    - local enzymes are used to accelerate resorption of the inflammatory focus, for example retrobulbar fibrinolysin,haemase, histochrome or lidase

    - in the absence of response to treatment, severe or prolonged course of chorioretinitis, it is shown to use extracorporeal detoxification methods such as hemosorption, plaquemaferez.

    Physiotherapeutic treatment of is of great importance for a speedy recovery. A good effect is from electrophoresis with lidase or fibrinolysin.

    To slow the spread of inflammation, laser coagulation of the retina is used, thereby delimiting chorioretinal foci from healthy tissues. When forming a chorioretinal membrane or detachment, vitrectomy is necessary.

    Complications of chorioretinitis

    Chorioretinitis is a serious disease that causes untimely or inadequate treatment for complications such as retinal detachment, a neovascular membrane, recurrent retinal hemorrhages, retinal vein thrombosis and others that can be blinded.

    Doctor ophthalmologist Letyuk T.Z.