Retinopathy is a lesion of the inner shell of the eye-the retina. The main cause of retinopathy is vascular disorders that lead to circulatory disorders in the membrane. Disorders occur against the background of systemic diseases, among which problems of the cardiovascular system, arterial hypertension, diabetes, and increased blood viscosity play a large role.
With a long course of retinopathy causes a significant decrease in visual acuity and deterioration of the quality of life of patients. Timely diagnosed changes in the fundus and correction of the general state of the body allows you to restrain the speed of pathological processes and maintain high vision.
How does the retina work?
The inner (sensitive) shell of the eye-the retina-is a very thin, highly differentiated tissue that is responsible for light perception. It has two parts: peripheral and central. The central part is the macula, it is very small, only 5 mm, but it is extremely important! The macula is responsible for object vision and the ability to distinguish colors. The peripheral part occupies the main area of the retina and provides lateral and twilight vision. Nutrition of this shell is carried out at the expense of large arteries, which, dividing, form a layered capillary network, as well as due to the vascular membrane of the eye, which is located directly under the retina. Violation of blood circulation in these small vessels is detrimental to the cells of the light-receiving shell, because there is a violation of their nutrition. This is especially important for the central zone, because there are the most active processes. Therefore, a patient with diseases of the vascular system is at an increased risk of vision loss.
There are several types of retinopathy, depending on the cause.
1) Diabetic retinopathy.
Diabetes mellitus is the most common endocrine disease, and its complications are one of the most serious medical and social problems. It accounts for about 5% of blindness worldwide! This is the most common cause of retinopathy. Diabetic retinal lesions are very insidious, they develop gradually and may not have any symptoms even in the advanced stages.
The surest way to prevent the development of the disease is early diagnosis and control of stable blood sugar levels.
There are several stages in the progression of diabetic angiopathy.
1-non-proliferative retinopathy. It is characterized by increased permeability of blood vessels. The earliest manifestation is the protrusion of the capillary walls (microaneurysms) and their extension. This is due to the death of cells that maintain the elasticity of the walls and provide tight intercellular connections. Vascular permeability increases and hemorrhages and accumulation of substances in the retina with their hardening appear — the main signs of diabetic retinopathy. If this happens in the central part, it will lead to a significant deterioration of vision. This condition is called macular edema.
In addition, in the stage of non-proliferative retinopathy, a sharp deterioration in the blood supply to the macula can occur (similar processes occur in brain stroke). This leads to a sharp loss of vision and is practically untreatable.
2-preproliferative retinopathy. In other words, this is a far-reaching first stage. When the vascular disorder is significant, there is no adequate treatment, then it goes into stage 3.
3-proliferative retinopathy. It is characterized by the appearance of new vessels, which normally do not exist on the retina. The danger is that these vessels are defective, their walls are too fragile. In the event of a rupture, a hemorrhage occurs that remains in front of the retina or goes inside the eye, into the gel — like mass that fills the eye cavity-the vitreous body. A significant hemorrhage leads to a decrease in vision and then surgical intervention is necessary. Frequent hemorrhages lead to the appearance of pathological cords between the vitreous body and the retina. Over time, it shrinks and pulls the inner shell, which ultimately leads to a terrible complication — a rupture and detachment of the retina.
Control of blood glucose and lipids, blood pressure level.
Laser treatment-panretinal laser coagulation is performed at stage 3 of the disease. In this case, laser burns are applied to the entire area of the retina, excluding the central one.
In this case, areas with impaired blood circulation are destroyed.
Focal laser coagulation and lattice-type coagulation — for the treatment of macular edema
Vitrectomy-removal of the vitreous body, through special micro-incisions, in order to remove blood clots and cords that pull the retina. The operation is performed under anesthesia.
Medical method. In order to stop the neoplasm of pathological vessels, drugs called anti-VEGF are injected into the eye cavity. They inhibit the growth of new and cause desolation of existing vessels, reducing the risk of bleeding. Also in the treatment of macular edema, steroid drugs are used, which are injected into the eye cavity in the operating room. More often, systemic administration with a certain frequency is required to control the development of retinopathy.
2) Hypertensive retinopathy. Microscopic signs of the lesion in some cases are the first signs of arterial hypertension. It is more common in patients older than 40 years. During the pathology, several stages are also identified.
1-there is a narrowing of the retinal capillaries and an increase in the tone of their walls. The process is completely reversible.
2-prolonged increase in pressure causes thickening of the vessel walls. There is a violation of nutrition in certain areas of the retina.
3-damage to the retinal nerve fibers is added to the above processes. Local retinal hemorrhages and edema appear. My vision is getting worse.
4 — is irreversible. There is a thickening of the tissues, their compaction. This provokes a significant narrowing of the vessels. The nutrition of tissues is disrupted, as a result of this, the optic nerve disc begins to suffer, its boundaries are blurred. Around the macular region, foci of retinal necrosis form a typical star shape.
Symptoms of arterial retinopathy: deterioration of vision, the appearance of flies in front of the eyes, with a sharp increase in blood pressure, flashes appear in front of the eyes, distortion of objects. This is the so-called aura before a hypertensive crisis.
Treatment. Detection of vascular changes in the fundus by an ophthalmologist indicates the need for active treatment of hypertension. Usually, therapy is prescribed to reduce blood pressure to the required level. But it is very important to control the pressure and prevent a sharp increase in its level. Vitamins and drugs are also prescribed to strengthen the walls of blood vessels and normalize the nutrition of ischemic areas.
3) Retinopathy of prematurity. It occurs in some children who were born prematurely or with a low birth weight. When a baby is born too early, the retinal blood vessels do not have time to grow normally. In the early stages, there are only minor changes and no obvious symptoms. In later stages, the retina may peel off, causing blindness. This disease is very extensive, requires complex and long-term treatment by a pediatric ophthalmologist. It is very important to contact a specialist as early as possible.
4) Retinopathy in anemia.
Anemia is a decrease in the total amount of hemoglobin in the blood. At the same time, the entire body suffers, including the organs of vision. With various types of anemia, there is a pallor of the skin and mucous membranes, hemorrhages under the conjunctiva and in the thickness of the eyelids. There is a lack of oxygen supply to all tissues, because hemoglobin is its carrier. Multiple retinal hemorrhages also occur on the fundus. The most severe manifestation is a star shape in the macular area and retinal detachment.
Treatment. The cause of anemia varies, and treatment depends on the type of specific anemia.
With anemia associated with large blood loss-it is necessary to restore the volume of circulating blood by transfusion.
With anemia associated with a deficiency of iron, vitamin B6, B12 or folic acid-appropriate drugs are prescribed that should make up for the deficiency of this substance or improve its synthesis in the body.
There are also hereditary forms of anemia associated with impaired hemoglobin synthesis and the presence of defective red blood cells that cannot perform the functions of oxygen transport. In such cases, red blood cell masses are transfused with normal red blood cells, which allow the transport of oxygen to the cells in the proper volume.
5) Central serous retinopathy. The disease develops spontaneously. Men between the ages of 30 and 50 are more likely to have it than women. The main risk factors are stress, steroid use, sleep disorders, and even aggressive behavior. Usually only one eye is affected, but there are cases when the process develops in both eyes. Fluid begins to accumulate under the retina. This leads to a slight detachment of the retina.
Symptoms: there is a distortion, blurring of the central vision, objects may have the wrong size (increase or decrease in size), their distortion may occur, and even a violation of color vision.
In most cases, self-healing occurs after a few weeks or months. If the fluid does not go away for a long time, anti-inflammatory and dehydration (reducing the production of fluid) drugs are prescribed. In about half of cases, there is a relapse of the disease. Therefore, dynamic observation of the condition is important, as long-term detachment can lead to irreversible loss of vision.