Otsloyka of a retina
Otsloyka of a retina – pathology of a mesh cover of an eye at which there is its separation from the subject horioidea (a vascular cover). Otsloyka of a retina is followed by sharp deterioration in sight, emergence of a veil before an eye, the progressing narrowing of a field of vision, flashing of "front sights", "sparks", "flashes", "lightnings" etc. Diagnostics tonometriya, biomicroscopy carry out by means of a vizometriya, perimetry, oftalmoskopiya, ultrasonography of an eye, electrophysiological researches. Treatment is carried out surgical (sealing skler, ballonirovany skler, a transtsiliarny vitrektomiya, vitreoretinalny operation, cryocoagulation, etc.) or laser methods (laser coagulation of a retina).
Otsloyka of a retina
Otsloyka of a retina – dangerous on an outcome and the most difficult pathological state in surgical ophthalmology which is annually diagnosed for 5-20 people on each 100 thousand population. Today the otsloyka of a retina is the leading reason of a blindness and disability; at the same time 70% of cases of this pathology develop at persons of efficient age.
At an otsloyka of a retina the layer of photoreceptor cages (sticks and flasks) owing to certain reasons separates from an external layer of a retina – a pigmentary epithelium that leads to violation traffic and functioning of a mesh cover. If in time not to give specialized help, the otsloyka of a retina can lead to sight loss quickly enough.
Reasons and classification
On the mechanism of formation of pathology distinguish regmatogenny (primary), traumatic and secondary (ekssudativny and traction) an otsloyka of a retina.
- Development of a regmatogenny otsloyka of a retina is connected with a rupture of a mesh cover and hit of liquid under it from a vitreous body. This state develops when thinning a mesh cover in zones of peripheral dystrophies. At different types of dystrophies of a retina (trellised, clustery, , etc.) the gap in degenerately changed area can be provoked by the sharp movements, excessive physical tension, a craniocereberal trauma, falling or to arise spontaneously. By the form defect primary otsloyka of a retina can be puzyrevidny or flat; on extent of peeling – limited or total.
- Otsloyka of a retina of traumatic genesis is caused by eye injuries (including operating rooms). At the same time peeling of a mesh cover can happen at any time: directly at the time of a trauma, to a paste after it or several years later.
- Emergence of a secondary otsloyka of a retina is observed against the background of various pathological processes of an eye: tumoral, inflammatory (at uveita, retinita, horioretinita), okklyuzionny (occlusion of the central artery of a retina), a diabetic retinopathy, crescent and cellular anemia, toxicoses of pregnancy, a hypertension etc.
- To a secondary ekssudativny (serous) otsloyka of a retina gives a liquid congestion in subretinalny space (under a retina). The traction mechanism of an otsloyka is caused by a tension (traction) of a retina the fibrinozny tyazha or neogenic vessels growing into a vitreous body.
As the factors increasing risk of an otsloyka of a retina serve short-sightedness, an astigmatism, degenerate changes of an eye bottom, surgical interventions in the eyes, diabetes, vascular pathology, pregnancy, cases of similar pathology at close relatives, etc.
In most cases the otsloyka of a retina develops in one eye, 15% of patients have a risk of developing of bilateral pathology. In the presence of a bilateral cataract the risk of a bilateral otsloyka of a retina increases to 25-30%.
Symptoms of an otsloyka of a retina
At the beginning of a disease symptoms harbingers – so-called light phenomena appear. Flashes of light (fotopsiya) before eyes and zigzag lines (metamorfopsiya) concern to them. At a rupture of a retinalny vessel flashing of "front sights" and black points before eyes, eye pains appears. These phenomena demonstrate the irritation of photosensitive cells of a retina caused by traction from a vitreous body.
At further progressing of an otsloyka of a retina before eyes there is "veil" (according to patients, "a wide blind, a curtain") which increases over time and can occupy the most part or all field of vision.
Quickly visual acuity decreases. Sometimes in the mornings for some time visual acuity improves, and fields of vision extend that is connected with a partial rassasyvaniye of liquid during sleep and an independent prileganiye of a retina. However during the day symptoms of an otsloyka of a retina return again. Temporary improvement of visual functions happens only at a recent otsloyka of a retina; at long existence of defect the retina loses elasticity and mobility in view of what cannot adjoin independently into place.
At a rupture of a retina in the lower departments of an eye bottom the otsloyka progresses rather slowly, within several weeks or months, is long without causing defects of a field of vision. Such option of an otsloyka of a retina is very artful as it comes to light only when involving in process of a makula that burdens the forecast concerning visual functions. At localization of a rupture of a retina in the top departments of an eye bottom, on the contrary, peeling of a mesh cover progresses quickly enough, within several days. The liquid accumulating in subretinalny space, the weight otslaivat a retina on a significant area.
If in time not to give help, there can be an otsloyka of all quadrants of a retina, including makulyarny area – a full, total otsloyka. When peeling a makula there are curvatures and fluctuations of objects with the subsequent sharp falling of the central sight.
Sometimes at an otsloyka of a retina there is a diplopiya caused by decrease in visual acuity and development of the latent squint. In certain cases the otsloyka of a retina is followed by development of a slow iridotsiklit, gemoftalm.
Diagnostics of an otsloyka of a retina
At suspicion on an otsloyka of a retina full ophthalmologic inspection as early diagnostics allows to avoid irreversible loss of sight is necessary. In case of existence in the anamnesis of ChMT, the patient has to be without fail consulted not only by the neurologist, but also the ophthalmologist for an exception of gaps and signs of an otsloyka of a retina.
The research of visual functions is conducted by check of visual acuity and definition of fields of vision (static, kinetic or computer perimetry). Losses of fields of vision arise on the party opposite to an otsloyka of a retina.
By means of biomicroscopy (including on use of a lens of Goldman) existence of pathological changes of a vitreous body decides (tyazhy, destructions, hemorrhages), peripheral sites of an eye bottom look round. These tonometriya are characterized by moderate decrease in VGD in comparison with a healthy eye.
The key role in recognition of an otsloyka of a retina belongs to a direct and indirect oftalmoskopiya. The Oftalmoskopichesky picture allows to judge localization of gaps and their quantity, relationship of an otsloyenny retina with a vitreous body; allows to reveal the sites of dystrophy requiring attention at surgical treatment. At impossibility of carrying out an oftalmoskopiya (in case of pomutneniye in a crystalline lens or a vitreous body) performance of ultrasonography of an eye in the V-mode is shown.
The diagnostic complex at an otsloyka of a retina joins methods of a research of entopichesky phenomena (an autooftalmoskopiya phenomenon, mechanophosphene, etc.).
For assessment of viability of a retina and visual electrophysiological researches – definition of a threshold of electric sensitivity and lability of an optic nerve, CFMF (critical frequency of merge of flashings) are conducted.
Treatment of an otsloyka of a retina
Detection of pathology demands immediate surgical treatment. The delay with treatment of this pathology is fraught with development of persistent hypotonia and a subatrophy of an eyeball, a chronic iridotsiklit, a secondary cataract, incurable blindness. The main objective of treatment of an otsloyka of a retina consists in rapprochement of a layer of photosensitive receptors with a pigmentary epithelium and creation of soldering of a mesh cover with the subject fabrics in a gap zone.
In surgery of an otsloyka of a retina ekstraskleralny and endovitrealny techniques are applied: in the first case intervention is carried out on a skleralny surface, in the second - in an eyeball. Treat ekstraskleralny methods sealing and ballonirovany skler.
Ekstraskleralny sealing assumes a podshivaniye to a skler of a special silicone sponge (seal) which creates the site of a vdavleniye skler, blocks ruptures of a retina and creates conditions for gradual absorption accumulated under a liquid retina capillaries and a pigmentary epithelium. Sealing skler can be options of ekstraskleralny sealing at an otsloyka of a retina radial, sectoral, circular ().
Ballonirovany skler at an otsloyka of a retina it is reached by a temporary podshivaniye in a zone of a projection of a rupture of a special balloon catheter when which inflating there is an effect similar to sealing (a vdavleniye shaft skler and a rassasyvaniye of subretinalny liquid).
Endovitrealny methods of treatment of an otsloyka of a retina can include vitreoretinalny operation or a vitrektomiya. In the course of a vitrektomiya removal of the changed vitreous body and introduction instead of it special medicines (liquid silicone, physiological solution, special gas) which pull together a retina and a vascular cover is made.
The retinas and laser coagulation of a retina allowing to achieve formation of horioretinalny soldering belong to the sparing methods of treatment of an otsloyka of a retina cryocoagulation of gaps and subclinical . Kriopeksiya and a lazerkoagulyation of a retina can be used both for prevention of an otsloyka of a retina, and in the medical purposes independently or in combination with surgical techniques.
Forecast and prevention
The forecast depends on prescription of pathology and timeliness of treatment. The operation performed in early terms after development of an otsloyka of a retina usually promotes a favorable outcome.
In most cases it is possible to warn an otsloyka of a retina. For this purpose patients with a miopiya, retina dystrophy, diabetes, injuries of the head and an eye need regular preventive inspection at the ophthalmologist. Survey of the oculist is included into the standard of conducting pregnancy and allows to prevent an otsloyka of a retina at the time of delivery. Heavy physical activities, heavy lifting, occupations some sports are contraindicated to patients of risk groups on emergence of an otsloyka of a retina.
At identification of sites of dystrophy of a retina in the preventive purposes the kriopeksiya or a lazerkoagulyation of a retina is carried out.