Central serous horioretinopatiya
The central serous horioretinopatiya is the pathology of an organ of vision which is characterized by a serous otsloyka of a neyroepitelialny layer of a retina in combination with peeling of a pigmentary epithelium or without it. It is clinically shown by decrease in visual acuity, emergence of "spots" before eyes, macro - or mikrofotopsiya, metamorfopsiya, is more rare photophobia. Diagnostics of the central serous horioretinopatiya includes carrying out a fluorescent angiography, vizometriya, oftalmoskopiya, biomicroscopy, perimetry, OCT. Drug treatment comes down to dehydrational and sosudoukreplyayushchy therapy. In the absence of effect laser coagulation of a retina is shown.
Central serous horioretinopatiya
The central serous horioretinopatiya is the disease in ophthalmology which is shown splitting of layers of a retina in connection with increase in permeability of a membrane of Bruch and infiltration of plasma from horioidea capillaries through a pigmentary epithelium of a retina. For the first time pathology was described by the German surgeon-ophthalmologist Albert von Grefe in 1866. Males are ill 8 times more often than women. As a rule, pathology occurs at people of young and average age groups. With age the number of binocular damages of an organ of vision increases. According to statistical data, at 52% of patients the disease develops after application of exogenous steroids. The central serous horioretinopatiya is more widespread among residents of Spain and Asia, is seldom observed at the Afro-Americans.
The central serous horioretinopatiya arises in connection with increase in permeability of capillaries of own vascular cover of an eyeball. A plasma exit in surrounding fabrics leads to a serous otsloyka of a neurotouch layer of an internal cover of an eye. As a rule, sites of peeling correspond to places of the raised ekssudation. Development of this process is caused by violation of transport of ions of sodium and potassium through a pigmentary layer. Also pathology of a vascular wall (a horioidalny vaskulopatiya) acts as the trigger of a disease. Local violation of microcirculation in the field of own vascular cover is the reason of secondary dysfunction of a pigmentary epithelium.
Persons with arterial hypertension, a hormonal imbalance in the anamnesis since the blood circulation mechanism in horioidy is adjusted by the level of cortisol and adrenaline enter into risk group of development of the central serous horioretinopatiya. As an etiologichesky factor change of a hormonal background during pregnancy often acts. The tone of the autonomic nervous system exerts impact on a condition of vessels. Persons with hyperactivity of sympathetic department are subject to bigger risk of a disease, than people with prevalence of a tone of parasympathetic nervous system. The burdened allergic anamnesis, presence of an atopiya at close relatives contributes to development of the central serous horioretinopatiya.
In special cases the disease develops against the background of system pathologies (Cushing's syndrome, system red a wolf cub). Increase in permeability of capillaries of a vascular cover of an eye is provoked by uncontrolled introduction of the steroids, administration of drugs containing in the structure a sildenafil citrate or psychotropic drugs. Less often developing of pathology is caused by a complication after organ transplantation. The idiopathic central serous horioretinopatiya as it is not possible to establish a disease etiology is in most cases diagnosed.
From the clinical point of view distinguish a sharp, subsharp and chronic current of the central serous horioretinopatiya. The sharp current is characterized by sudden absorption of serous liquid on average in 1-6 months. At the same time visual acuity is restored to reference values. At a subsharp current spontaneous permission comes for one year. Preservation of a clinical picture speaks more than 1 year about process synchronization. Patients show complaints to morbidity in an eye-socket, emergence of translucent spots before eyes. Decrease in visual acuity slowly progresses. Patients note violation of visual functions more often in the morning. The secondary tranzitorny gipermetropiya develops.
Specific symptom of this pathology is increase or reduction of the size of the considered subject that indicates development macro - or mikrofotopsiya. At the same time the form of objects can be distorted (metamorfopsiya). High degree of mikrofotopsiya at unilateral defeat leads to violation of binocular sight. Violation of color perception or photophobia arise extremely seldom, however patients consider the most comfortable average illumination of the room. Progressing of a disease leads to emergence of the central scotomas. Patients can point to frequency of emergence of symptomatology at a sharp current of the central serous horioretinopatiya.
Diagnostics of the central serous horioretinopatiya is based on carrying out a fluorescent angiography, vizometriya, oftalmoskopiya, biomicroscopy, perimetry, the optical coherent tomography (OCT). At the sharp course of a disease by means of a fluorescent angiography it is visualized one and more sites of an ekssudation through a pigmentary epithelium. Often at a chronic current diffusion infiltration comes to light what points fluorescence strengthening to. The method of a vizometriya diagnoses decrease in visual acuity within 0,2-0,3 dioptries. At the same time refraction gipermetropichesky. Oftalmoskopicheski is found serous peeling of a neyroepitelialny layer, violation of integrity of a pigmentary layer, a subretinalny congestion of fibrinous masses and a lipofustsin.
More detailed inspection can be performed by an eye biomicroscopy method with use of special lenses (60, 78 ) or a contact three-mirror lens of Goldman. At the same time the zone of a serous otsloyka which has an appearance of the pro-mining center with an indistinct contour is defined. The defeat zone form roundish, is limited to the arc-shaped reflex. In the field of a horioretinopatiya Rem pretsipitata come to light. When carrying out perimetry the central scotomas are defined. For OCT the liquid congestion between neyroepitelialny and pigmentary layers is visualized. Differential diagnostics of the central serous horioretinopatiya is carried out with a horioidalny neovaskulyarization, horioretinity, horioidea tumors.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Conservative treatment of the central serous horioretinopatiya comes down to performing dehydrational and sosudoukreplyayushchy therapy. For the purpose of reduction of puffiness of an internal cover of an eye parabulbarny injections of glucocorticosteroids are shown. Also this group of medicines has antiallergic effect. For carrying out dehydration purpose of diuretics is recommended. For the purpose of normalization of fabric metabolism in days of reception of diuretichesky means use of medicines of potassium and magnesium is expedient. Strengthening of a vascular wall is reached when using vasoprotectives, polyvitaminic complexes.
In case of positive dynamics at the subsequent visits to the ophthalmologist (the 10th, 30th days) repeated parabulbarny injections of glucocorticosteroids are necessary. In the absence of effect of drug treatment or a frequent recurrence of a disease laser coagulation of a retina is shown. Focal coagulation is carried out to areas of defeat of a pigmentary epithelium. If defect settles down in a zone of a papillomakulyarny bunch or at distance less than 500 microns from a foveola, the makula barrage is recommended. After carrying out laser coagulation for 3-7 days instillations of nonsteroid resolvents in the form of drops are carried out. Criterion of efficiency of treatment is improvement of visual acuity on 0,1 and more, reduction of expressiveness of the central scotomas on 5-10 ° and reduction of hypostasis of a makula by 5-10%.
Forecast and prevention
Specific preventive measures for development of the central serous horioretinopatiya it is not developed. Nonspecific prevention comes down to application of steroids in minimum effective dosages, to restriction of a psychoemotional overstrain, control of level of arterial pressure. To the patients who are entering into risk group or having this disease in the anamnesis it is necessary to undergo 2 times a year inspection at the ophthalmologist with obligatory measurement of intraocular pressure, carrying out an oftalmoskopiya and vizometriya.
The forecast at the central serous horioretinopatiya for life and working capacity rather favorable as pathology is inclined to a frequent retsidivirovaniye, and restoration of visual acuity does not provide elimination of other clinical displays of a disease.