Rupture of a retina
The rupture of a retina is the acquired pathology of an organ of vision which is followed by violation of integrity of a mesh cover with high risk of its further otsloyka. Clinical displays of a disease are fotopsiya, "front sights" or "veil" before eyes, the central or peripheral scotomas. Diagnostics of a rupture of a retina is based on results of an oftalmoskopiya, viziometriya, tonometriya, biomicroscopy, a fluorescent angiography, OCT, ultrasonography in the V-mode. At a lamellyarny gap carrying out laser coagulation is recommended. Extensive defeat or a through makulyarny gap are the indication to performance of a vitrektomiya.
Rupture of a retina
The rupture of a retina represents linear or roundish defect of a mesh cover which arises idiopathic or against the background of specific triggers. The first description of a gap in the field of a makula was submitted in 1869 by the German ophthalmologist Mr. Knapp. In 2013 the Russian ophthalmologists L. I. Balashevich and Ya. V. Bayborodov described clinical cases of development of this pathology owing to laser radiation. The disease is most widespread among female persons. As a rule, meets after 60 years. At young age traumatic damages are the main reason of development. Feature of a rupture of a retina is that at 45% of patients the clinical symptomatology does not correspond to true changes of an internal cover of an eye. Often it leads to hypodiagnostics and diagnosis on late terms.
Reasons of a rupture of a retina
Formation of a perforated gap can be caused by peripheral dystrophy of a retina. At the same time in a zone of thinning sinekhiya between an internal cover of an eyeball and a vitreous body are formed. These unions can also provoke valvate gaps. Hit of colloidal masses from a cavity of a vitreous body in space between it and a retina is the cornerstone of pathogenesis. At the same time the expressed sinekhiya are the trigger of a gap and the subsequent otsloyka. Violation of integrity of an internal cover of an eye in the field of a projection of the gear line is provoked by injuries of an eye or yatrogenny damages.
The Makulyarny rupture of a retina of traumatic genesis arises when passing a shock wave by the longitudinal size of an eyeball. Non-compliance with medical recommendations in the postoperative period after treatment of a regmatogenny otsloyka can be the Etiologichesky factor of this pathology. An important role in the mechanism of development of a rupture of a retina is played by atrophic changes in area of foveolyarny photoreceptors, increase in intraocular pressure, formation of an epiretinalny membrane. Also the trigger of this disease are destructive changes in a zone of a vitreous body and the central horioretinalny dystrophy.
Damage of an internal cover of an eye to a yellow spot appears against the background of early cystous sclerous dystrophy of a makulyarny zone or retinalny ischemia. Ruptures of a retina in the field of a flat part of a tsiliarny body develop at the closed eyeball injury. At the same time process is aggravated often by a local contusion. Developing of this pathology is promoted by the increased physical activities, head injuries, a psychoemotional overstrain, increase in intraocular pressure, a miopiya in the anamnesis.
Symptoms of a rupture of a retina
Distinguish complete and lamellyarny separations of a retina. At a complete separation there is a damage of all layers of an internal cover of an eyeball, at lamellyarny partial violation of integrity of superficial departments is noted. The clinical symptomatology of a disease is defined by extent of involvement in pathological process of layers of a retina and damage localization. At a number of patients a rupture of a retina long time has a latent current or is shown only at the raised visual loadings. At unilateral process symptoms of pathology can arise when closing a healthy eye.
At a complete separation of a retina patients show complaints to sudden emergence of "light flashes" before eyes. This symptom develops in connection with a tension of an internal cover of an eyeball or irritation of an optic nerve. Lamellyarny damage only in rare instances leads to development of fotopsiya. At the same time they appear in the dark room or against the background of an emotional overstrain more often. In most cases patients cannot specify the exact time of a rupture of a retina. In rare instances the disease is inclined to independent regression with the subsequent restoration of visual functions.
If the rupture of a retina is followed by a back otsloyka or hemorrhage in a vitreous body, patients note emergence of "front sights" or "veil" before eyes. Localization of pathological process in peripheral departments leads to emergence of defects of a field of vision. At a makulyarny rupture of a retina visual acuity decreases that is connected with accumulation of liquid in subretinalny space. The central scotomas arise only at increase in the amount of damage. At the same time increase in intraocular pressure provokes an atrophy of an optic nerve that can become the blindness reason. In case of an excentric arrangement of defect visual acuity remains within norm. Complications of a rupture of a retina: otsloyka, gifema, or atrophy of an optical nerve.
Diagnostics of a rupture of a retina
Diagnostics of a rupture of a retina is based on anamnestichesky yielded, results of an oftalmoskopiya, viziometriya, tonometriya, biomicroscopy, the optical coherent tomography (OCT), ultrasound examination (ultrasonography) of an eyeball in the V-mode. By means of an oftalmoskopiya it is possible to find defect of a rounded or longitudinal shape with localization in the field of a flat part of a tsiliarny body, a foveolyarny zone or peripheral departments of a retina. The rupture of a retina can have the different duration and depth. At penetration through all layers at the bottom of a zone of damage violation of integrity of a pigmentary epithelium and the dystrophic centers in the form of points of yellow color is visualized. On the periphery of a gap the retina has edematous edges.
Extent of decrease in visual acuity is defined by method of a viziometriya. At an excentric gap visual functions are not broken. Extensive defects of a retina lead to a blindness. Accession of a gifema or gemoftalm stimulates increase in intraocular pressure that is confirmed by a tonometriya method. The biomicroscopic research allows to find a zone of a rupture of a retina with accurate edges. In subretinalny space the liquid congestion is defined. Over a zone of damage connecting fabric which can form a pseudo-membrane over time comes to light. At the long course of a disease on the periphery of a gap there are cystous changes with the subsequent giperplaziya or an atrophy of a retina.
By means of OCT the zone of a rupture of a retina and change of surrounding fabric is visualized. This method gives the chance to determine the extent and depth of defect, and also to estimate a condition of a vitreomakulyarny surface. Ultrasonography in the V-mode allows to reveal a gap, to investigate a condition of a retina and vitreous body. An auxiliary method of diagnostics in ophthalmology is the fluorescent angiography which helps to differentiate a rupture of a retina from a horioidalny neovaskulyarization.
Treatment of a rupture of a retina
Tactics of treatment depends on localization, duration and depth of a rupture of a retina. At insignificant damage of an internal cover or a lamellyarny gap dynamic observation at the ophthalmologist since these defects are inclined to independent regression is recommended to patients. In case of lack of signs of regeneration laser coagulation is carried out. During operation the argon laser which properties lead to local temperature increase with further coagulation is used. Surgical intervention is carried out under regional anesthesia. Advantage of this technique is the possibility of influence on the limited site.
At a complete makulyarny separation of a retina carrying out a vitrektomiya is expedient. During endoscopic surgery three small sections are carried out. Through the first section there is a giving in a liquid eye for maintenance of intraocular pressure. The second access is necessary for ensuring lighting. The third section is used for performance of surgical manipulations. Under repeated increase with the help of vacuum tweezers removal of a membrane of a vitreous body is made. At the final stage of operation the damaged site of a retina is fixed by means of a perftordekalin or other artificial polymers. This method allows to avoid yatrogenny traction peeling of a retina and to somewhat restore visual acuity.
Forecast and prevention
Specific prevention of a rupture of a retina it is not developed. Nonspecific preventive measures come down to observance of safety rules on production during the work with the materials demanding wearing goggles or a helmet. The forecast for life and working capacity at a rupture of a retina depends on extensiveness of defeat. At insignificant damages of an internal cover of an eyeball independent regression is possible. Patients with this type of damage need to be observed at the ophthalmologist. Timely diagnostics and treatment of other forms provide the favorable forecast. In the absence of adequate therapy there is a high risk of development of a blindness and a further invalidization of the patient.