Horioretinalny dystrophy – the involutional dystrophic changes affecting mainly horiokapillyarny layer of a vascular cover of an eye, a pigmentary layer of a retina and the vitreous plate (Bruch's membrane) located between them. Distortion of straight lines, emergence in sight of blind spots, light flashes, loss of clearness of sight, ability to the letter and reading belong to symptoms of horioretinalny dystrophy. The diagnosis of horioretinalny dystrophy these oftalmoskopiya, checks of visual acuity, Amsler's test, a kampimetriya, the laser scanning tomography, confirm to perimetry, elektroretinografiya, a fluorescent angiography of vessels of a retina. At horioretinalny dystrophy carry out medicamentous, laser, photodynamic therapy, electro-and magnetostimulation, and also a vitrektomiya, a revaskulyarization and a vazorekonstruktion of area of a retina.
In ophthalmology horioretinalny dystrophy (an age makulyarny degeneration) belongs to vascular pathology of an eye and is characterized by gradual irreversible changes of makulyarny area of a retina with considerable loss of the central sight of both eyes at patients 50 years are more senior. Even in hard cases horioretinalny dystrophy does not cause a total blindness as peripheral sight remains within norm, but ability to performance of accurate visual work (reading, the letter, management of transport) is completely lost.
On pathogenesis distinguish the following forms of age horioretinalny dystrophy: dry atrophic (neekssudativny) and damp (ekssudativny). Dry horioretinalny dystrophy – an early form of a disease, meets in 85-90% of cases, is followed by an atrophy of a pigmentary epithelium and gradual decrease in sight, and damage of the second eye develops no later than 5 years after a disease of the first. In 10% of cases dry horioretinalny dystrophy passes into more severe and swift-flowing damp form which is complicated by an otsloyka pigmentary and a neuroepithelium of a retina, gemorragiya and cicatricial deformation.
Reasons of horioretinalny dystrophy
Horioretinalny dystrophy is multiple-factor pathology, mechanisms of emergence and which development is up to the end not clear. Horioretinalny dystrophy can develop as a congenital disease with autosomno-prepotent type of inheritance or to be a consequence of infectious and inflammatory, toxic and traumatic damages of an eye.
Development of horioretinalny dystrophy can be the cornerstone primary involutional changes of makulyarny area of a retina and Bruch's membrane, atherosclerosis and the violation of microcirculation in a horiokapillyarny layer of a vascular cover damaging action of ultra-violet radiation and free radicals on a pigmentary epithelium, violation of exchange processes.
Persons get to a risk zone on horioretinalny dystrophy 50 years, mainly female, with light pigmentation of an iris of the eye of an eye are more senior; immune and endocrine pathology, arterial hypertension; abusing smoking; the cataracts which transferred surgical treatment.
Symptoms of horioretinalny dystrophy
The clinical course of horioretinalny dystrophy chronic, slowly progressing. In an initial stage of a neekssudativny form of horioretinalny dystrophy of the complaint are absent, visual acuity long remains within norm. In certain cases there can be a distortion of straight lines, a form and the size of objects (metamorfopsiya). Dry horioretinalny dystrophy is characterized by congestions of colloidal substance (retinalny Druzes) between Bukh's membrane and a pigmentary epithelium of a retina, redistribution of a pigment, development of defects and atrophies of a pigmentary epithelium and a horiokapillyarny layer. Owing to these changes under review there is a limited site where sight is strongly weakened or completely is absent (the central scotoma). Patients with a dry form of horioretinalny dystrophy can show complaints to doubling of objects, decrease in clearness of sight close, existence of blind spots under review.
In development of an ekssudativny form of horioretinalny dystrophy allocate several stages. At a stage of an ekssudativny otsloyka of a pigmentary epithelium rather high sharpness of the central sight (0,8-1,0), emergence of the temporary not expressed violations of a refraction can be observed: far-sightedness or an astigmatism, signs of a metamorfopsiya, rather positive scotoma (a translucent spot in sight of an eye), fotopsiya. The small elation of a retina in the form of a dome in makulyarny area (a zone of an otsloyka) having a clear boundary comes to light, Druzes become less distinguishable. At this stage process can be stabilized, perhaps independent prileganiye of an otsloyka.
At a stage of an ekssudativny otsloyka of a neuroepithelium of the complaint, generally remain the same, visual acuity decreases more, the illegibility of borders of an otsloyka and puffiness of the raised retina zone is noted.
Sharp decrease in visual acuity (to 0,1 and below) with loss of ability to the letter and reading is characteristic of a stage of a neovaskulyarization. The Ekssudativno-gemorragichesky otsloyka pigmentary and a neuroepithelium is shown by formation of the big white-pink or gray-brown accurately delimited center with pigment congestions, neogenic vessels, the retina acting in a vitreous body kistovidno changed. At a rupture of neogenic vessels subpigmentary or subretinalny hemorrhages, in rare instances – development of a gemoftalm are noted. Sight keeps at a low level.
The cicatricial stage of horioretinalny dystrophy proceeds with formation of fibrous fabric and formation of a hem.
Diagnosis of horioretinalny dystrophy
In diagnosis of horioretinalny dystrophy existence of characteristic displays of a disease (different types of metamorfopsiya, positive scotoma, a fotopsiya), results of check of visual acuity, an oftalmoskopiya, the test of the test of Amsler for distortion of sight, a kampimetriya (a research of the central field of vision) matters.
The most informative diagnostic methods at horioretinalny dystrophy are the optical coherent and laser scanning retina tomography, computer perimetry, an elektroretinografiya, a fluorescent angiography of vessels of a retina allowing to reveal the earliest signs of defeat. In addition tests can be applied to check of color sensation, contrast of sight, the sizes of the central and peripheral visual fields.
Carrying out the differential diagnosis of horioretinalny dystrophy from a melanosarkomy horioidea is necessary.
Treatment of horioretinalny dystrophy
In treatment of horioretinalny dystrophy use medicamentous, laser, surgical methods, an elektrookulostimulyation and magnetostimulation that allows to stabilize and to partially compensate a state since the complete recovery of normal sight is impossible.
Medicamentous therapy at a neekssudativny form of horioretinalny dystrophy includes intravenous, parabulbarny administration of dezagregant and anticoagulants of direct and indirect action, vasoprotectives, vasodilating medicines, antioxidants, hormones, enzymes, vitamins. The retina lazerstimulyation by the low-intensive radiation of the semiconductor laser an out-of-focus red spot is carried out.
At an ekssudativny form of horioretinalny dystrophy local and general dehydrational therapy and sectoral laser coagulation of a retina for the purpose of destruction of a subretinalny neovascular membrane, elimination of hypostasis of makulyarny area is shown that allows to prevent further distribution of dystrophic process. Perspective techniques of treatment of ekssudativny horioretinalny dystrophy are also photodynamic therapy, transpupillyarny thermotherapy of a retina.
Surgical treatment of horioretinalny dystrophy is the vitrektomiya (at a neekssudativny form for the purpose of removal of subretinalny neovascular membranes), a revaskulyarization of a horioidea and vazorekonstruktivny operations (at a neekssudativny form for improvement of blood supply of a retina). The visual acuity indicator favorable for treatment makes from 0,2 and above.
The forecast concerning sight at horioretinalny dystrophy in general adverse.