Retinal vein thrombosis - Causes, symptoms and treatment. MF.

Retinal vein thrombosis is an acute circulatory disturbance in the central vein or its branches.

Thrombosis of the central retinal vein

Reasons for retinal vein thrombosis

Occurs as a result of blockage of the vessel, which can be caused by atherosclerosis, hypertension, diabetes mellitus, especially when blood pressure and blood sugar are jumped. In young people, infectious diseases can lead to thrombosis, for example, influenza, sepsis, focal infections of the oral cavity and paranasal sinuses. Also in the development of venous thrombosis retinal ophthalmic hypertension( increased intraocular pressure), edema of the optic nerve, pressure from the outside of the eyeball( tumors) are important.

Risk factors:

sedentary lifestyle, obesity, heart and vascular disease, endocrine disorders, especially in inadequate treatment.

Symptoms of retinal vein thrombosis

The disease develops gradually and leads to a complete loss of vision only with late-onset treatment. Thrombosis of the branches of the central vein is often detected accidentally during preventive examination.

Types of occlusion: non-ischemic( visual acuity above 0.1) and ischemic( extensive bleeding into the retina, with fluorescent angiography determining large areas of absence of capillary perfusion).

There are several stages:

1. The stage of prethrombosis - enlarged, convoluted, stagnant veins of uneven caliber, dashed single hemorrhages, edema of the macular area is possible. Complaints may be absent, sometimes visual acuity decreases and periodic blurring of vision occurs.
2. Thrombosis of the central vein of the retina or its branches - on the fundus there appear dashed hemorrhages throughout the retina( if the central vein is injured) or in the pool of one or more branches, soft exudates, the boundaries of the optic nerve disk are unclear or not defined, edema inmacular area, possible hemorrhages in the vitreous. There are typical complaints: reduced visual acuity to the count of fingers, the appearance of scotoma( loss of part of the field of vision), shroud, fog before the eyes.

Thrombosis of the branch

3. Post-thrombotic retinopathy - appears several months after venous thrombosis. Visual acuity is restored slowly. On the fundus, old hemorrhages, hard exudates, and newly formed vessels are determined. In the central zone, cystic edema of the macula, on the optic nerve disk, neovascularization( abnormal growth of vessels where normal should not be).
4. is possible for repeated thrombosis of the central vein of the retina or its branches .

Diagnosis of retinal vein thrombosis

The diagnosis is not difficult. The following research methods are used:

- visometry - can be visual acuity from the norm to the finger count,
- perimetry - possibly the appearance of scotoma,
- biomicroscopy - possibly opacification of the vitreous,
- ophthalmoscopy, including examination with the Goldman lens - on the eyeday - syndrome of "crushed tomato" -shaped haemorrhages on all or part of the retina, its edema, veins dilated and tortured, newly formed vessels,
- fluorescent angiography - for the final diagnosis.

Fluorescence angiography

- Optical coherent tomography of the retina,
- general blood tests, urine, blood sugar, coagulogram, clotting time, cholesterol, lipids, protein fractions,
- blood pressure measurement, ECG,
- consultation of therapist, cardiologist, neurologist, an endocrinologist according to the testimony.

Treatment of retinal vein thrombosis

Treatment should be started immediately after diagnosis. Groups of drugs that are prescribed for retinal vein thrombosis:

- antihypertensive drugs .Often the cause of thrombosis is high blood pressure. Assign nifedipine or phenygidine 1 tablet under the tongue, intravenously papaverine and dibazol, intramuscular lasix, which, in addition to reducing blood pressure, reduces retinal edema. To reduce pressure on the retinal vessels from the outside, instill hypotensive drops, for example timolol 0.5%( Arutimol, Kuzimolol).
- fibrinolytics for the restoration of blood flow in the affected vessel - plasminogen parabulbarno( eye prick) for 0.5 ml daily for 1-2 weeks
- direct anticoagulants, for example heparin, are shown after treatment with fibrinolytics, 500 ED parabulbar5 days.
- antiplatelet agents is used to prevent recurrent thrombosis. For example, acetylsalicylic acid( aspirin), clopidogrel( Plavix) and others are necessarily under the control of indicators of the blood coagulation system.
- hormonal preparations are applied topically and systemically. They reduce inflammation and swelling. Parabulbarno enter dexone for 1-2 ml per day for 7-10 days. It is also possible intravenous drip every other day for 1-2 weeks.
- for the improvement of microcirculation use intravenous infusion of rheopolyglucin and pentoxifylline( Trental).
- angioprotectants ( etamzilate, dicinone, emoxipine).
- antispasmodics ( Papaverin, No-shpa, Riabal).
- vitamins ( C, group B).

After a few months, the laser coagulation of the retina is performed, and with increasing macular edema, the central zone is delimited from the affected vessels.

Complications of

Prognosis of disease with timely treatment is favorable. With inadequate therapy, subatrophy and atrophy of the optic nerve, central region dystrophy, retinal neovascularization, recurrent retinal hemorrhages and hemophthalmia, secondary glaucoma may develop.

Doctor ophthalmologist Letyuk T.Z.