Chorioretinal dystrophy of the retina
Content:
- What is chorioretinal dystrophy?
- The causes of chorioretinal dystrophy
- Chorioretinal dystrophy symptoms
- Chorioretinal dystrophy diagnosis
- Chorioretinal dystrophy treatment
What is chorioretinal dystrophy?
Chorioretinal dystrophy (CHRD) is a dystrophy of the central part of the retina. Synonyms: central dystrophy, senile macular degeneration. This is an age-related pathology that occurs at the age of 50-60 and is more often observed in women.
With age-related retinal degeneration, gradual irreversible changes occur in the macular (central) area of the retina, the consequence of which is a significant loss of central vision. The retinal tissue is replaced by fibrous tissue with the formation of scars. Usually this process develops in parallel in both eyes, but in some cases it can occur ahead of time in one eye.
Even in severe cases, CCRD does not lead to complete blindness, since peripheral vision remains within normal limits. However, this completely loses the ability to perform work requiring clear vision (reading, writing, driving, etc.).
The incidence of the disease increases with age: at the age of 51–64 years it is 1.6% of the total population, at the age of 65–74 years - 11%, over 75 years old - 28%.
The disease has a chronic, slowly progressive course. It should be differentiated from retinal detachment - these are different pathologies.
The causes of chorioretinal dystrophy
The causes and etiology of CHRD are not fully understood.
The list of factors that increase the likelihood of its development includes:
- Hereditary predisposition;
- Weakening of the immune system;
- Circulatory disorders in the vascular system of the eyes;
- Endocrine pathologies (diabetes mellitus);
- Myopia (myopia) of moderate to high degree;
- Problems with the cardiovascular system (hypertension, atherosclerosis);
- Excessive exposure of the eyes to ultraviolet radiation;
- Infectious, toxic or traumatic eye damage;
- Poor nutrition;
- Having bad habits.
Chorioretinal dystrophy develops under the influence of a combination of factors. It can be either a congenital disease with an autosomal dominant type of transmission, or a consequence of an infectious-inflammatory process.
Additional risk factors include:
- Female;
- Light pigmentation of the skin and iris of the eyes;
- Smoking abuse;
- Surgical treatment of cataracts in history.
Chorioretinal dystrophy symptoms
There are two forms of CHRD: non-exudative (dry, atrophic) and exudative (wet).
Dry non-exudative dystrophy is an early form of the disease and occurs in 85-90% of cases. It is characterized by metabolic disorders between the vessels and the retina. Colloidal substances (decomposition products) accumulate between the basal layer formed by the vascular and retinal membranes and the retinal pigment epithelium, pigment redistribution and atrophy of the pigment epithelium occur.
The disease starts asymptomatically and progresses slowly. Visual acuity remains normal for a long time, but there may be a curvature of straight lines, bifurcation, distortion of the shapes and sizes of objects. Gradually, the image becomes blurred when looking directly (like through a layer of water), visual acuity begins to decrease. This process can stabilize at some stage, but it can also lead to a complete loss of central vision.
In the second eye, the disease begins to develop no later than five years after the defeat of the first. In 10% of cases, dry dystrophy turns into a more severe wet form. In this case, the penetration of fluid (blood) through the walls of the newly formed vessels and its accumulation under the retina occurs.
Exudative dystrophy has four stages of development:
- Detachment of the pigment epithelium. Visual acuity remains, weak manifestations of hyperopia or astigmatism, the appearance of fog or cloudy spots before the eyes are possible. The process can have the opposite development (adhesion of detachment sites).
- Detachment of the neuroepithelium. Added to the above symptoms is a significant decrease in vision, up to the loss of the ability to read and write. Blurred borders and edema of the detachment zone, pathological proliferation of blood vessels are noted.
- Hemorrhagic detachment of the pigment and neuroepithelium. Vision remains low. A large pink-brown focus of pigment accumulation with clear boundaries is formed. The cystoid retina protrudes into the vitreous body. When the newly formed vessels rupture, hemorrhages occur.
- Cicatricial stage. At the site of the lesion, fibrous tissue forms and a scar is formed.
Chorioretinal dystrophy diagnosis
The diagnosis is established on the basis of patient interviews, visual acuity tests, ophthalmoscopy, campimetry and Amsler test (studies of the central visual field).
From instrumental diagnostic methods are used:
- Computer perimetry;
- Laser scanning tomography of the retina;
- Electroretinography;
- Fundus fluorescence angiography.
Chorioretinal dystrophy treatment
The choice of treatment tactics depends on the form and stage of the process. The main goal is its stabilization and compensation. Treatment methods: medical, laser, surgical.
In the non-exudative form, intravenous injections of antiplatelet agents, anticoagulants and angioprotectors, vasodilators (Cavinton), antioxidants (Emoxipin), and vitamin therapy are prescribed. Treatment should be continuous and take courses 2 times a year (in autumn and spring).
In the exudative form, general and local treatment is carried out, laser coagulation (cauterization) of the retina is possible in order to eliminate edema and destruction of the neovascular (formed from pathological vessels) membrane. This allows you to suspend the further development of the dystrophic process.
Surgery is used to improve the blood supply to the back of the eye. This can be vitrectomy (removal of a part of the vitreous body), vasoreconstruction, revascularization (restoration of a normal microvascular network).
The prognosis is generally unfavorable, since it is impossible to restore vision. But even with a complete loss of central vision, peripheral vision remains, sufficient for self-service in everyday life and orientation in space.
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The author of the article: Degtyareva Marina Vitalievna, ophthalmologist, ophthalmologist
