Retinal detachment: symptoms, treatment and causes of pathology
Mar 19, 2018
Detachment of the retina is called the separation of the neuroepithelial layer of the retina from the pigmentary one.This is a formidable pathological condition that can lead to loss of vision.According to statistics, the frequency of occurrence is 8-24 cases per 100,000 population per year.The disease is more often recorded in the elderly.But even young people can face this ailment if there is myopia or eye trauma.Table of contents:
Diseases and causes of
The retina consists of the neurosensory and pigment layers.When exposed to certain unfavorable factors, the neurosensory part exfoliates from the retinal pigment layer.
There are such types of retinal detachment:
- Regmatogenic( primary, idiopathic);
Regmatogenic retinal detachment develops against the background of degenerative changes in the retina, when the membrane loses its strength and integrity.In this case, through the holes formed, the gap of the sensorensor layer penetrates the liquid from the vitreous body, which exfoliates it from the pigment layer.
Most often, retinal degeneration occurs in the elderly.Ophthalmologists are referred to the risk group of patients with myopia, as well as hypertension, diabetes mellitus.In addition, there are hereditary forms of retinal dystrophy.
The traction detachment of the retina is caused by traction( retraction) of the neurosensory retina by an altered vitreous body.It is a transparent, gel-like substance that fills the cavity of the eye.In some diseases, the structure of the substance changes, in it are formed dense fibers in the form of strands attached to the retina, which stretch it, which leads to further detachment.
Exudative detachment of the retina is provoked by the accumulation between layers of the retina of fluid from the vessels of the choroid.This can be observed due to arterial hypertension, vasculitis of retinal vessels, neoplasms, inflammatory and infectious processes.
Factors predisposing to the development of retinal detachment are:
- Presence of peripheral vitreochorioretinal dystrophies;
- Injuries of the eye;
- Congenital pathology of the organ of vision;
- Diabetic retinopathy;
- Lifting heavy weights;
- Presence of detachment, retinal dystrophy in close relatives.Symptoms of retinal detachment
The first signs that will allow a person to suspect a rheumatogenic retinal detachment are the appearance of photopsy in the form of flashes in front of the eyes.If there is a rupture of the vessel, the person observes the appearance of flashing flies( black dots) in front of the eyes.Soon, there are complaints of turbidity, blurred vision, the appearance of a veil before your eyes.
Tractive retinal detachment is usually not accompanied by photopsy and flashing of flies.Changes in the field of vision progress slowly.
For the exudative detachment of the retina, the appearance of photopsy is also not typical.But it is worth noting that changes in the field of view are occurring rapidly and are progressing quite rapidly.
A significant role in the development of the clinical picture of the disease is played by the fact in which part of the retina detachment occurred.Thus, with a central detachment of the retina, there is a sharp deterioration in the color perception or visual acuity.And with peripheral retinal detachment, in particular, localized in its lower layers, the symptoms may be absent even for many months.
To confirm retinal detachment, it is necessary to undergo certain studies. The approximate research package includes:
- Determination of visual acuity, which will reveal the damage to the central area of the retina;
- Study of lateral vision with perimetry to detect lesions of peripheral retinal sites;
- Measurement of eye pressure with tonometry, with retinal detachment, this indicator can be reduced;
- Carrying out electrophysiological studies allows assessing the viability of the neurosensory layer of the retina, as well as the optic nerve;
- The ultrasound examination allows estimating the size of the exfoliated retina, as well as the condition of the vitreous humor;
- The examination of the fundus( ophthalmoscopy) allows to determine the localization of the retinal rupture.
The results of the study will allow the doctor to choose the necessary treatment strategy.
Treatment of retinal detachment
It is medically impossible to cure retinal detachment.The longer the disease exists, the more the nerve cells of the retina, the rods and cones die, the chance of restoring vision decreases.Therefore, if you have any suspicious symptoms, you should contact your ophthalmologist and, if confirmed, go through a surgical procedure.
Surgical treatment methods used for retinal detachment can be divided into two groups:
- Extragranular( intervention is performed on the surface of the sclera);
- Endovateral( interventions are carried out from the inside of the eyeball);
Extrascleral surgical methods
The goal of any operation performed with retinal detachment is the approach of the exfoliated neurosensory layer to the pigmentary layer.When performing an extra-scleral surgical intervention, this can be achieved by creating scleral depressions( scleral sealing).Thanks to the created impressions, the retinal ruptures are clogged, and the liquid concentrated under the retina is absorbed by the choroid vessels.
Before filling the sclera, the ophthalmologist determines the exact location of the rupture( rupture) of the retina and marks their projection on the sclera.Then, a special seal( silicone sponge) of the required size is cut out, which is sewn to the sclera, specifically in the projection zone of the retinal rupture.Thus, the seal attached to the sclera pushes it inward and thereby pushes the outer capsule of the eye, the choroid to the retracted retina.
In addition, there is an operation of balloon sclera.To the sclera, a catheter with a balloon is temporarily ligated at the projection site of the retinal rupture.The inflated balloon presses on the sclera and forms an area of depression, due to this the membranes of the eye approach the retina.
Blocking the rupture of the retina in this way makes it possible to achieve resorption of the liquid collected under the retina and subsequently to produce retinal laser coagulation.The balloon is removed after the formation of the retina adhesion.
Endovitreal Surgical Techniques
With endovitral intervention in the area of the ciliary body, three microsections are made.Through one incision into the vitreous body, the ophthalmologist inserts a cannula, through which saline is supplied.This is necessary to maintain the normal tone of the eyeball during surgery.A second illuminator is inserted through the second incision, and the third surgical instrument is vitreotome.
A variety of endovitreal operation is transciliary vitrectomy, which is the removal of the vitreous body through the ciliary body.Especially carefully removed all kinds of strings, which actually provide traction of the retina.Instead of the removed vitreous enter liquid silicone, saline or special gas, which press the retina to the choroid.
Laser treatment methods
With this method of treatment, the doctor acts on the laser for dystrophically altered areas, tears, retinal detachments.As a result, scars form, which attach the edges of the rupture or exfoliated retina to the choroid.Similar changes in the result prevent penetration, as well as concentrating the liquid under the retina.The formation of a strong adhesion occurs in about two weeks.The lack of progression of retinal detachment, its stretching beyond the coagulated tissue testifies to the success of the laser coagulation.
The special feature of this method is that the laser promotes rapid temperature increase and tissue clotting, which makes the operation bloodless.In addition, the operation is done out-patient, the duration of it is not more than half an hour.However, not every case of detachment of the retina ophthalmologist can be eliminated only by laserocoagulation.
After the operation, the patient remains disabled for a month.At this time, physical activities, lifting weights, body slopes, visiting the bath are prohibited.Further increase in physical activity is possible after consultation of a doctor.In the postoperative period, drug therapy is provided with mandatory use of anti-inflammatory, antibacterial, reparative drugs.
In case of opacity, loss of vision on the operated eye, you should consult an ophthalmologist.It is recommended to periodically inspect the second eye for early diagnosis of a possible retinal detachment.
Grigorova Valeria, medical reviewer