Macular degeneration - Causes, Symptoms and Treatment .MF .
retinal dystrophy - a disease process, often resulting in loss of vision.
Causes of macular degeneration
There are congenital or secondary (acquired), central localization (located in the macular area) or peripheral.
vision in AMD
Hereditary retinal dystrophy:
- pigment (tapetoretinalnoy) degeneration,
- Leber congenital amaurosis,
- congenital night-blindness (lack of night vision)
- syndrome of cone dysfunction atwhich disturbed color perception, or there is full tsvetoslepota
- X-chromosomal juvenile retinoschisis
Wagner's disease - a disease Goldmann-Favre
- Stargardt's disease (zheltopyatnistaya dystrophy)
- Best's disease (yolk dystrophy)
- age-related macular degeneration
Secondary arise from a variety of injuries and diseases of the eye (myopia, glaucoma and others.)
Symptoms of macular degeneration
When pigmentary degeneration of the retina is affected pigment epithelium and photoreceptor cells.The first symptoms appear
When Leber congenital amaurosis blindness occurs at birth or children lose their vision to 10 years.Features:. Lack of central vision, nystagmus, keratoconus, strabismus, etc. Across the bottom of the eye are determined by a variety of degenerative lesions (white and pigmented types of salt and pepper, bone cells), optic disc pale, narrowed vessels.
X-chromosome juvenile retinoschisis refers to hereditary vitreohorioretinalnym dystrophy.Thus there is a separation of the retina, at the periphery of the cyst form, in which bleeding can occur.The vitreous body hemophthalmus, cords, which can lead to retinal detachment.
Wagner disease manifests myopia, reshinoshizisom, pigmentary degeneration and preretinal membranes with a transparent vitreous.
Goldmann-Favre disease - hereditary dystrophy is a progressive course, the main manifestations of which are bone calf retinoschisis and degeneration of the vitreous body.
Stargardt's disease - affects the macular area.A characteristic feature of the fundus - "bull's eye" in the central zone, ie a dark area with a light ring surrounded by round hyperemia.Symptoms include decreased visual acuity to 20 years, a violation of color and spatial contrast sensitivity.
yolk dystrophy Best - formed a yellowish center, reminiscent of egg yolk in the macular area.At the age of about 10-15 years, there decreased vision, distortion of objects, "fog" in front of his eyes.Both eyes are affected in varying degrees.
age (involutional, senile), central retinal dystrophy - one of the most common causes of visual loss in people over 50 years with a hereditary predisposition.
Age-related macular degeneration
There are 2 forms:
- nonexudative - is characterized by a redistribution of pigment, friends, sites of retinal degeneration.Outbreaks may merge, recalling the painting "geographical map".The Druze are located under the pigment epithelium and have a yellowish-white color, perhaps their prominirovanie vitreous.There are soft (with fuzzy boundaries), solid (have clear boundaries) and calcified.Current nonexudative form benign, develops slowly
- exudative - several stages in its development: exudative pigment epithelial detachment, exudative detachment of the neuroepithelium, neovascularization, exudative-hemorrhagic detachment, reparative stage.Quickly leads to blindness.
risk factors for age-related macular degeneration: blue eyes and white skin, a diet low in vitamins and minerals, increased cholesterol levels, smoking, hypertension, hyperopia, cataract surgeries on the eye.
main complaints of patients with retinal dystrophies : decreased visual acuity often two eyes, narrowing the field of vision or the appearance of cattle, night-blindness (poor vision in the dark), metamorphopsia, disturbance of color vision.
When any of the above symptoms should consult a specialist, who will deliver the correct diagnosis and prescribe treatment.
survey with retinal dystrophy
for diagnosis is necessary to conduct such studies:
- visometry - visual acuity of the normal (in the initial stage) to complete blindness.Correction can not be;
- perimetry - narrowing of the field of view, from the appearance of the livestock to the tubular;
- Amsler test - a simple way to diagnose macular degeneration subjective.The patient is asked to close one eye and look at a point in the center of the Amsler grid at arm's length, then slowly bring the test, not looking up from the center.Normally, lines are not distorted
Amsler Test: 1. rate 2. Pathology
- refractometry - to diagnose refractive errors (retinal degeneration is possible with high myopia);
- biomicroscopy reveals comorbidities;
- ophthalmoscopy performed after medical pupil dilation, preferably with a Goldman lens for a more detailed examination of the retina, in particular periphery.When different types of dystrophies doctor sees a different picture of the fundus;
- definition color vision - Rabkin tables, etc .;
- electroretinography - indicators of reduced or is not registered in most hereditary dystrophies;
- adaptometry - study of dark adaptation - the reduction or absence of the dark with the defeat of cones;
- fluorescence angiography to determine the areas where you need to carry out laser coagulation of the retina;
- optical coherence tomography retinal
Druze optic disc on OCT
- HRT (Heidelberg retinotomografiya);
- US eyes;
- clinical analyzes;
- consulting physician, pediatrician, geneticist and other professionals when indicated.
Treatment of retinal dystrophy
Depending on the clinical picture and the type of dystrophy prescribe.Almost always symptomatic treatment as all degeneration, besides the secondary, have a hereditary character or predisposition.
uses the following methods of treatment: conservative, laser, surgical (vitreoretinal surgery, skleroplombazh with detachment, and others.)
- Antiplatelet agents (Ticlopidine, clopidogrel, acetylsalicylic acid) - are taken orally or parenterally;
- vasodilators and angioprotectors (No-spa, papaverine, komplamin, Ascorutinum);
- anti-sclerotic funds designated mostly elderly people - methionine, simvastatin, atorvastatin, clofibrate, etc .;
- combined vitamin preparations (Okyuvayt-lutein, bilberry-forte et al.), And intramuscular vitamin B;
- tools to improve microcirculation (pentoksifillinparabulbarno or intravenously)
- polypeptides of the retina cattle (Retinalamin) parabulbarno daily for 10 days.In subtenon administered 1 time in half a year;
- biogenic stimulators - aloe, FIBS, ENKAD (for the treatment of tapetoretinalnoy dystrophy applied intramuscularly or subkonyunktivalno);
- topically applied taufon drops emoksipin 1 drop 3 times a day or constantly at the doctor's discretion.
When exudative form of age-related macular degeneration dexamethasone 1 ml administered parabulbarno and furosemide intravenously.When haemorrhage heparin is used, etamzilat, aminocaproic acid, prourokinase.In marked edema in subtenon administered triamcinolone.Route of administration, dosage and duration of treatment depends on the individual case.
Physiotherapy also effective in retinal dystrophies: using electrophoresis with heparin, but-shpoy, nicotinic acid, etc., magnetic therapy, the stimulation of the retina low-energy laser radiation..
The most effective treatment is considered laser coagulation of the retina at which delimit the damaged areas of healthy tissue, thereby halting the progression of the disease.
In the formation of vitreoretinal adhesions and neovascular membranes recommended vitrectomy .
When hereditary retinal dystrophy unfavorable prognosis, almost always lead to blindness.
When age-related macular degeneration is shown inpatient treatment 2 times a year, as well as the recommended wearing sunglasses and smoking cessation.
Ophthalmologist Letyuk TZ