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

    Retinal dystrophy is a pathological process that often leads to loss of vision.

    Causes of retinal dystrophy

    There are congenital or secondary( acquired), localized central( located in the macular area) or peripheral.

    Vision at

    Hereditary retinal dystrophy:

    1. Generalized
    - pigmentary( taperotinal) degeneration,
    - congenital amaurosis of Leber,
    - congenital nictalopia( lack of night vision)
    - congenital dysfunction syndrome in which color perception is impaired or complete color blindness present

    2. Peripheral
    - X-chromosome juvenile retinoschisis
    - Wagner's disease
    - Goldman-Favre disease

    3. Central
    - Stargardt disease( yellow-spotted dystrophyI)
    - Best's disease( yolk dystrophy)
    - age-related macular degeneration

    Secondary result from various injuries or diseases of the eye( myopia, glaucoma, etc.)

    Symptoms

    retinal dystrophy When pigmentary degeneration of the retina affected pigment epithelium and the photoreceptor cells..The first signs appear in early childhood. Characteristic specific symptoms: pigment foci( bony bodies), atrophic disk of the optic nerve and narrowed by arterioles.

    Pigmented degeneration of

    With , congenital amaurosis of Leber is seen from birth or children lose sight up to 10 years. Features: the absence of central vision, nystagmus, keratoconus, strabismus, etc. Throughout the fundus there are various degenerative foci( white and pigmented type salt with pepper, bone bodies), the optic nerve disk is pale, the vessels are narrowed.

    X-chromosome juvenile retinosis refers to hereditary vitreo-chorioretinal dystrophies. In this case, the retinal bundle occurs, on the periphery, cysts are formed, in which hemorrhages can occur. In the vitreous body, hemophthalmos, strands that can lead to detachment of the retina.

    Wagner's disease is manifested by myopia, deconsciousness, pigmentary dystrophy and preretinal membranes with a transparent vitreous body.

    Goldman-Favre disease - hereditary dystrophy has a progressive course, the main manifestations of which are bone bodies, retinosis and degeneration of the vitreous.
    Stargardt disease - affects the macular area. A characteristic feature on the fundus is a "bullish eye" in the central zone, that is, a dark area with a light ring surrounded by round hyperemia. Symptoms are a decrease in visual acuity to 20 years, a violation of color perception and spatial contrast sensitivity.

    Stargardt's disease

    Bestast's yolk dystrophy - in the macular area a yellowish foci resembling egg yolk is formed. At the age of about 10-15 years, there is a decrease in vision, distortion of the shape of objects, "fog" before the eyes. Both eyes are affected to varying degrees.

    Age( involutional, senile) central retinal dystrophy is one of the most common causes of vision loss in people over 50 with a hereditary predisposition.

    Age-related macular degeneration

    There are 2 forms:

    - non-exudative - characterized by the redistribution of pigment, druses, sites of retinal degeneration. The foci can merge, resembling a picture of a "geographical map".Druzes are located under the pigment epithelium and have a yellowish-white color, it is possible that they are vitrified into the vitreous. There are soft( with fuzzy boundaries), solid( have clear boundaries) and calcified. The course of non-exudative form is benign, develops slowly

    - exudative - several stages develop in its development: exudative detachment of pigment epithelium, exudative detachment of neuroepithelium, neovascularization, exudative hemorrhagic detachment, reparative stage. Quickly leads to blindness. Risk factors for developing age-related macular degeneration: blue eyes and white skin, a diet low in vitamins and minerals, increased cholesterol levels, smoking, hypertension, hypermetropia, cataracts, and surgery on the eye.

    The main complaints of patients with retinal dystrophy : decreased visual acuity often on two eyes, narrowing of the field of view or appearance of cattle, niktalopia( poor vision in the dark), metamorphosis, violation of color perception.

    If you have any of the above symptoms, you should contact a specialist who will put the correct diagnosis and prescribe a treatment.

    Examination for retinal dystrophy

    For diagnostics it is necessary to conduct such studies:

    - visometry - visual acuity from normal( in the initial stage) to complete blindness. Correction is not amenable;
    - perimetry - narrowing the field of view, from the appearance of cattle to tubular vision;
    - Amsler test - the simplest subjective way of diagnosing macular degeneration. The patient is asked to close one eye and look at the point in the center of the Amsler grid at arm's length, then slowly bring the test closer, without taking his eyes off the center. Normally, lines are not distorted

    Amsler test: 1. norm 2. Pathology

    - refractometry - for diagnosis of refractive errors( degeneration of the retina is possible with high myopia);
    - biomicroscopy allows to identify concomitant pathology;
    - ophthalmoscopy is performed after a drug dilated pupil, preferably with a Goldman lens for a more detailed examination of the retina, in particular the periphery. With different kinds of dystrophy the doctor sees a different picture of the fundus;
    - definition of color vision - tables of Rabkin and others;
    - electroretinography - the indices are reduced or not recorded in the majority of hereditary dystrophies;
    - adaptometry - study of dark adaptation - decrease or absence of dark vision in case of cone infection;
    - fluorescent angiography for determining areas where laser retina laser coagulation is necessary;
    - optical retinal coherence tomography

    Dysplasia of the optic nerve wheel at OCT

    - HRT( Heidelberg retinotomography);
    - ultrasound of the eye;
    - general clinical tests;
    - consultation of the therapist, pediatrician, genetics and other specialists on indications.

    Treatment of retinal dystrophy

    Treatment is prescribed depending on the clinical picture and type of dystrophy. Almost always treatment is symptomatic, since all degenerations, except for secondary ones, are hereditary in nature or predisposition.

    The following treatment methods are used: conservative, laser, surgical( vitreoretinal surgery, scleroplastomy with detachment, etc.).

    . Medication:

    - desaggregants( Ticlopidine, Clopidogrel, acetylsalicylic acid) - taken orally;
    - vasodilator preparations and angioprotectors( No-shpa, Papaverin, komplamin, askorutin);
    - antisclerotic drugs are prescribed mainly to elderly people - methionine, simvastatin, atorvastatin, clofibrate, etc.;
    - combined vitamin preparations( Okuvaite-lutein, Cernica-forte, etc.), as well as intramuscularly B vitamins;
    - means improving microcirculation( pentoxifyllineparabulbarno or intravenously)
    - polypeptides from the retina of cattle( Retinalamin) parabulbarno daily for 10 days. Subtennion space is administered once every six months;
    - biogenic stimulants - aloe, FIBS, enkad( for the treatment of taperotinal dystrophy used intramuscularly or subconjunctivally);
    - topically apply drops taufon, emoksipin 1 drop 3 times a day at all times or at the doctor's discretion.

    In the exudative form of age-related macular degeneration, 1 ml of dexamethasone is administered parabulbar, and furosemide is intravenously dripped. When hemorrhages apply heparin, etamzilate, aminocaproic acid, prourokinase. With expressed edema, triamcinolone is injected into the subtenon space. Routes of administration, dosage and duration of treatment depend on each specific case.

    Physiotherapy is also effective in retinal dystrophies: use electrophoresis with heparin, no-spike, nicotinic acid, etc., magnetotherapy, stimulation of the retina by low-energy laser radiation.

    laser retinal coagulation is considered to be the most effective method of treatment, in which the damaged areas are delineated from healthy tissues, thereby inhibiting the development of the disease.

    Vitreoretinal splices and neovascular membranes are recommended vitrectomy .

    In hereditary dystrophies of the retina, the forecast is unfavorable, almost always leading to blindness.

    With age-related macular degeneration, hospital treatment is shown twice a year, and also the use of sunglasses and smoking cessation are recommended.

    Doctor ophthalmologist Letyuk T.Z.