Pigmentary retinal degeneration treatment. Symptoms and treatment of retinitis pigmentosa. General principles of therapy for various types of retinal dystrophy

Retinal pigmentosa degeneration (RPD) is a relatively rare, inherited disease that is associated with impaired functioning and survival of rods, retinal photoreceptors responsible for peripheral black and white twilight vision. Cones, another type of photoreceptor, are located mostly in the macula. They are responsible for central daytime color vision with high acuity. Cones are involved in the degenerative process for the second time.

Inheritance can be sex-linked (passed from mother to son with an X chromosome), autosomal recessive (disease genes are needed from both parents), or autosomal dominant (a pathological gene is enough from one of the parents). Since the X chromosome is most commonly involved, men are more affected than women.

People with PDS usually discover that they are sick by noticing a loss of peripheral vision and the ability to navigate in poorly lit spaces. The progression of the disease is highly variable. In some, the sight is very weakly affected, in others the disease gradually leads to complete blindness.

Often the disease is discovered in childhood when symptoms appear, but sometimes they can appear already in adulthood.

Signs (symptoms)

Poor vision at dusk in both eyes

Frequent trips and collisions with surrounding objects in low light conditions

Gradual narrowing of the peripheral visual field

• Rapid eye fatigue

Diagnostics

Retinitis pigmentosa is usually diagnosed before adulthood. Often found when the patient begins to complain of difficulty seeing at dusk and at night. To make a diagnosis, it is usually enough for a doctor to look at the fundus with an ophthalmoscope to see the characteristic accumulations of pigment there. An electrophysiological study, called electroretinography, may be ordered to provide more detail on the severity of the disease. Perimetry allows you to assess the state of the visual fields.

Treatment

There is no standard and truly effective treatment for retinitis pigmentosa. Stimulating procedures can be prescribed - electrical and magnetic stimulation - in order to "stir up" the diseased retina, force the surviving photoreceptors to take over the functions of the dead and try to somehow stop the natural course of the disease. In addition, doctors may resort to the so-called vasoreconstructive surgery, which tries to improve the blood supply to the retina. All of these procedures have limited efficacy.

Despite the scarcity of the current armament of the ophthalmologist in the battle with PDS and other hereditary diseases of the retina, this area is actively developed by scientists. It constantly acquires new information, which inspires restrained optimism that in the relatively near future a radically new approach to the preservation and restoration of vision in this category of patients will be proposed.

Retinitis or retinitis pigmentosa is characterized by damage to the retinal rods. The disease for a long time proceeds without clear manifestations and threatens with complete blindness. It develops at any age, including children. If the pathology occurs in a patient under 20 years of age, the ability to read is preserved, if retinitis occurs in people over 45 years of age, visual acuity is less than 0.1 and a person cannot read.

What are the causes of the disease?

According to statistics, pigmentary dystrophy is diagnosed in 1 out of 5,000 people. In most cases, retinitis affects men.

Pathology occurs as a result of a change in the work of one or more genes. The cause of dystrophy is considered a genetic predisposition. The disease is inherited through the male line and can be combined with a deterioration in the functioning of the ears. A factor influencing gene damage has not been identified. The name of the disease arose on the basis of changes in the eye. There are pigment spots of the fundus, located along the vessels of the retina. Over time, the pigmentation of the epithelium decreases, and the inner shell of the eye becomes like a translucent vascular web.

The pigment that forms spots on the retina, accumulating, forms deposits similar to bone bodies. When they spread, hyperpigmentation occurs. Visual cells are damaged, and the epithelium near the spots becomes thinner. Due to the progression of the disease, pigmented areas spread throughout the eye. After damage to the retina, they appear in the central part of the organ and on the iris. Vessels are narrowed, they are difficult to detect during the examination. In this case, blanching of the nerve disk and its depletion are observed. Pigmentary degeneration of the retina is diagnosed immediately on both.

How does pathology manifest itself?

One of the first indicators of the disease is the deterioration of the vision of objects in the dark.

Dispigmentation is accompanied by the following symptoms:

• Hemeralopia. The patient loses the ability to distinguish objects in the dark, the ability to navigate in space worsens in low light. The reason for the violation is damage to the sticks. This symptom is considered the first manifestation of the dystrophic process, appearing several years before the onset of obvious changes in the retina.
• Deterioration of peripheral vision. The lateral sticks are immediately damaged, and gradually the process moves to the center. This leads to a narrowing of the field of view, the patient develops tunnel vision.
• Decreased visual acuity and color vision. It occurs in the last stages of the development of the disease, when cones are involved in the pathological process. Later, the patient becomes blind.

In the main group of patients, children of preschool age. In children, it is difficult to detect changes in vision, because the disease remains undetected for a long time. The initial stage of PDS development lasts up to 5 years. If left untreated, complications develop, such as glaucoma or cataracts. Gradually, vitreous atrophy occurs. Loss of vision due to pigmentary dystrophy is irreversible.

Diagnostics

For the timely detection of retinal dystrophy in children, it is necessary to systematically visit an ophthalmologist with them.

A pigment spot on the retina requires immediate treatment. Otherwise, the pigments will spread throughout the eyeball, reducing vision. Pathological hyperpigmentation and retinal dystrophy in children under 6 years of age is detected when the baby can no longer navigate normally in space, therefore, if relatives have such a disease, you should regularly take the child to an ophthalmologist to examine the fundus.

To make a diagnosis, the visual acuity and features of peripheral vision are checked. The doctor examines the retina for changes characteristic of pigmentary dystrophy. With the development of the disease, pigments are found, collected in dense formations and zones of dystrophic damage to the epithelium. The optic disc in retinal hyperpigmentation is pale and the blood vessels are constricted. Dystrophy of the eye tissue occurs in a diabetic due to a constantly elevated glucose level. To confirm the diagnosis, a number of electrophysiological studies are prescribed. Emoksipin drops improve microcirculation and lengthen the time to stop bleeding, in case of damage to the vessels of the eye.

In most cases, the treatment of retinitis pigmentosa is carried out with the help of the complex use of drugs that allow to normalize blood circulation in the eye and provide the retina with the necessary nutrition. Assign funds such as:

• "Emoxipin". Restores microcirculation.
• "Taufon". Eye drops. Stimulate the regeneration of tissues of the visual apparatus.
• A nicotinic acid. Normalizes metabolic processes and blood circulation in the body.
• "No-shpa" + "Papaverine". The combination of drugs provides an antispasmodic effect and a decrease in pressure in the vessels.

The eye's retina (retina) It is the inner membrane of the organs of vision and consists of light-sensitive photoreceptors and nerve cells. It is on this most important visual element that the clarity of the formation of an image received from the outside and transmitted to the brain depends.

There are two types of receptor cells located in the retina: rods and cones. Rods with high light sensitivity are responsible for peripheral vision and allow a person to see in the dark. In contrast, cones control central vision and need more light to function properly, which they use to recognize different colors and fine details.

Retinal dystrophy - what is it?

Retinal dystrophy, also sometimes called retinal degeneration is a collective medical term that generalizes a whole group of ophthalmic pathologies that are inherited, arising independently (for example, with age) or developing as a result of other diseases affecting the organs of vision (for example, etc.).

Retinal dystrophy is usually an ever-progressive and often irreversible disease condition, mainly manifested in old age, but it can also develop in young people and even in children. Absolute loss of vision in this disease is extremely rare, but if the problem is ignored, such an outcome is quite possible.

Pathogenesis

Many pathological processes that form both inside the eye and in the human body as a whole can contribute to the emergence of a group of diseases called retinal dystrophy. Depending on the initial cause, during the development of this disease, the destruction of the central or peripheral part of the tissues of the eye retina occurs first, and in some cases, atrophy affects the entire organ. This eventually leads to a gradual decrease in visual acuity and the emergence of other negative visual symptoms. At first, such a painful condition may be asymptomatic, which complicates its early detection.

With further progression of the disease, retinal degeneration occurs already at the cellular level and primarily covers the photoreceptors of the eye, the functional purpose of which is to provide vision (especially distant) and organize the perception of natural colors by the eye. In this case, as a rule, both eyeballs suffer.

Initially, negative symptoms of dystrophy are found in one eye, and after some time (sometimes it can take several years), this process spreads to the second eye. Approximately 7-8 years after the onset of the formation of this disease, the patient has a decrease in vision in relation to both organs of vision. Over time, retinal dystrophy can even cause disability.

Classification

All forms of retinal dystrophy have similar negative signs, which are united by a common process of progression of vision dysfunction and degenerative-dystrophic regeneration of retinal tissues. Today, there are many varieties of this disease, which are most often classified depending on the main cause of its occurrence and localization in the eyeball.

According to the etiology of the development of retinal dystrophy, they are divided into primary (hereditary) and secondary (acquired).

hereditary dystrophies

Hereditary retinal dystrophies include those diseases that arise as a result of the patient's genetic predisposition to their development, that is, inherited by his parents. These include dotted white and pigmentary dystrophy, Stargardt's disease , Refsum , besta and many other pathologies of a similar nature, but the first two are especially distinguished, since they are the most common. As a rule, the symptoms of such dystrophies manifest themselves in childhood and increase as the child grows up.

Acquired dystrophies

Retinal dystrophies from this group mainly affect the elderly, but can also develop in children and adult patients who have suffered trauma to the eyeball or some eye diseases. In adulthood, such forms of the disease often occur against the background of a metabolic disorder in the tissues of the eye and / or in the presence of other age-related visual pathologies (for example,). In this group of dystrophies, the age macular degeneration and serous choriopathy that are found most often.

In turn, depending on the concentration of the development of the pathological process in the retina, all dystrophies are divided into generalized, central and peripheral.

Generalized

In the generalized form of the disease, both central and peripheral parts of the retina are affected. Such dystrophies are divided according to the type of disturbance in the organs of vision, the type of inheritance and modifications in the fundus.

Central

Central retinal dystrophy is characterized by disorders in the tissues of the eyeball occurring in its middle segment called macula , as a result of which pathologies of this nature are also called - macular degeneration . Diseases from this group are characterized by a classic ophthalmoscopic picture and their progressive course.

Peripheral

Peripheral retinal dystrophy mainly affects the edges of the optically passive part of the organ of vision, located near the dentate line. If, together with the retina, the vitreous body is involved in the pathological process and choroid (ocular choroid), then this pathology is called peripheral chorioretinal dystrophy . In the case when the disease also captures the vitreous body, it is called - vitreochorioretinal peripheral retinal dystrophy .

The types of retinal dystrophy that ophthalmologists most often have to deal with are described below.

Spot white dystrophy

This form of dystrophy is a congenital disease and manifests itself in a patient from early childhood. As a rule, visual impairment in a child begins at preschool age and progresses irresistibly in the future.

Pigmentary degeneration of the retina

The mechanism of development of pigmentary dystrophy, unfortunately, is not yet fully understood, but it is known for certain that this disease appears as a result of a malfunction in the work of photosensitive eye cells responsible for dark adaptation of vision. Such a disease occurs simultaneously in both eyes, proceeds rather slowly and is manifested by alternating periods of exacerbation and transient relief. Most often, the first symptoms of the pigmented form of dystrophy begin to occur at school age, and by the age of 20 it is clearly diagnosed by an ophthalmologist and requires treatment. At the same time, the patient already has and narrowing of the visual field, which becomes tubular.

Central chorioretinal dystrophy

This disease is also called serous choriopathy . It usually forms in men after 20 years of age due to the accumulation of effusion from the eye vessels directly under the retina. Such exudate interferes with the normal metabolism and nutrition of the retina, as a result of which its gradual atrophy develops. In addition, the effusion contributes to retinal detachment over time, which in itself is a serious complication that can lead the patient to absolute blindness. A characteristic symptomatology of this dystrophy is the appearance of distortions in the image of a wave-like nature in the field of view, as if a person sees a picture through a layer of water.

age-related retinal dystrophy

Such dystrophy also refers to macular (central), and it was named age-related due to the occurrence mainly in older people after 50-60 years. This disease occurs in two basic clinical forms of development, namely:

• dry form (non-exudative);
• wet form (exudative).

Both of these forms develop under conditions of age-related changes in the structure of the walls of the eye microvessels. Against the background of this pathology, there is damage to the vascular structure in the central zone of the retina (macula), which is responsible for the high resolution performance of vision, which allows a person to notice and differentiate the smallest details of the surrounding objects at close range.

However, even in the case of a severe course of this disease, the onset of complete blindness is extremely rare, since the patient's peripheral areas of the retina remain intact, which makes it possible for him to partially see and normally navigate in a familiar environment. The most severe course of age-related dystrophy leads a person to the loss of the ability to write and read.

dry form

This type of this dystrophy is characterized by the accumulation of cellular waste products among the blood vessels and the retina itself, which are not removed in time due to a violation of the microvascular structure and the overall functionality of the eye. These products of nearby cell activity are chemicals that appear as small or large yellow bumps called drusen and are deposited in tissues just below the retina.

The dry variety of this dystrophy occurs in 90% of cases of all existing macular degeneration and is considered a relatively benign form of the disease, since it proceeds rather slowly, gradually reducing visual acuity over a long period of time.

There are three successive stages in the development of non-exudative age-related macular degeneration:

• At an early stage, the presence of small drusen in the eye is noted. At the same time, the patient still does not notice any visual impairment and sees well.
• In the intermediate stage, several small or one large drusen are found in the central part of the retina, which narrow the field of view, as a result of which the patient sometimes observes a cloudy spot in front of the eyes. The only sign of the disease at this stage is the person's need for bright light, used for writing or reading.
• With the development of a pronounced stage, a large dark spot is constantly present in the patient's field of vision, which does not allow him to see the vast majority of surrounding objects.

wet shape

Exudative type of macular degeneration is diagnosed in 10% of patients and is characterized by an unfavorable prognosis for its development, since it leads to rapid loss of vision and quite often causes retinal detachment.

With this form of the disease, new blood microvessels that are not normally present grow directly under the retina. The structure of these vessels is not typical for eye tissues and therefore their walls are easily damaged, resulting in exudate effusion that accumulates under the retina. As a result of this process, gradually accumulating exudate begins to put pressure on the retina, thereby contributing to its detachment. Against the background of such drastic changes, there is a rapid deterioration in vision, which, if not timely and / or inadequately treated, can turn into complete blindness.

Lattice dystrophy

Of all the varieties of peripheral dystrophies, this vitreochorioretinal pathology ranks first in terms of the likelihood of development and occurs in 63% of patients with a similar diagnosis. This type of disease is considered hazardous to health, since it provokes the greatest risk of the possibility of retinal detachment. In two cases out of three, lattice dystrophy manifests itself in men over the age of 20, which in itself speaks in favor of its hereditary origin. This disease can affect one or two eyeballs with approximately the same frequency, after which it slowly progresses throughout the rest of life.

Examination of the fundus of the eye with lattice dystrophy reveals narrow, white, wavy stripes in the form of ladders or lattices, which are formed by collapsed blood vessels filled with hyaline. Between them, areas of thinning of the retina are formed, which have a specific appearance of red or pinkish foci. These areas may develop tears or cysts, eventually leading to retinal detachment. In addition, there is a liquefaction of the vitreous body in the area of ​​​​its attachment to the altered area of ​​the retina, and, on the contrary, their dense adhesion is observed along the edges of the dystrophy area. For this reason, zones of excessive tension appear in the retina, the so-called tractions, on which valve-shaped small gaps subsequently form. It is through them that the liquid fraction of the vitreous body seeps under the retina, thereby provoking its detachment.

Dystrophy "Traces of the snail"

This type of dystrophy is fixed by ophthalmologists in patients with a diagnosis of progressive and is manifested by the appearance of perforated defects and dashed inclusions on the surface of the retina. As a rule, all such damages are concentrated linearly and, upon examination, resemble the trace of a snail left on the asphalt (in fact, this pathology got its figurative name for this reason). Quite often, this dystrophy is accompanied by the formation of tears in the tissues of the eye, which can lead to retinal detachment.

Hoarfrost dystrophy

The frost-like variety of dystrophy is a hereditary pathology and can affect both women and men. In this case, both eyes usually suffer simultaneously, on the retina of which whitish or yellowish inclusions appear, similar in structure to snow flakes. Such lesions in most cases are located near the already thickened retinal microvessels.

Dystrophy "Cobblestone"

Dystrophy called "Cobblestone" mostly affects the distant parts of the eyeball, directly located in the region of its equator. This type of disease is characterized by the appearance on the retina of individual pathological foci of white color, which have an uneven surface and an elongated shape. Often these foci have a circular arrangement. Most of all, this type of dystrophy affects patients with, as well as the elderly.

Small cystic dystrophy (Blessin-Ivanov disease)

As the name suggests, small cystic dystrophy occurs due to the formation of small cysts in the peripheral regions of the fundus. Over time, areas of retinal detachment and perforated holes may appear in the area of ​​these neoplasms. However, this type of dystrophy is characterized by a rather slow course and therefore has a favorable prognosis.

Leber's taperetinal children's amaurosis

Leber's amaurosis can develop at the age of 2-3 years and even in a newborn baby. When it occurs in a child, there is a sharp deterioration in visual perception, indicating the onset of the disease, and further slow progression of the pathology, sometimes over many years.

X-chromosomal juvenile retinoschisis

With this ophthalmological disease, retinal detachment occurs simultaneously on both organs of vision. In the area of ​​such bundles, large cysts are formed, which are gradually filled with glial protein. Due to such deposits, radial lines (similar in shape to the spokes of a bicycle wheel) or star-shaped folds appear on the retina.

Other types of pathologies of this nature, such as Refsum's disease , peripapillary atrophy of the choroid , nyctalopia and other similar diseases are relatively rare and are of interest only to a narrow circle of ophthalmologists.

Important! It should be remembered that the result of untimely or improper treatment of almost any kind of dystrophic changes in the eyes will be retinal atrophy , which with a high degree of probability will lead to absolute loss of vision.

What is retinal atrophy?

Translated from Greek, the word atrophy” means starvation, that is, the lack of nutrition. In the context of ophthalmic diseases, retinal atrophy is a pathological process of reducing the volume of eye tissues, characterized by a pronounced change in their cellular structure.

The cause of this pathology can be various eye diseases and, first of all, multiple dystrophies that disrupt the adequate nutrition of the organs of vision. It is much more difficult to treat retinal atrophy than the initial visual impairment, and often simply impossible. That is why in the treatment of eye diseases it is very important to diagnose the initially present disease in time and try to eliminate it in the most effective way, since atrophy can have irreversible consequences leading to tissue death.

Causes

According to statistics, confirmed by the results of many studies of this disease, it was found that retinal dystrophy is “younger” every year, that is, it is increasingly manifested in middle-aged people. Today, not only elderly patients, but also people with bad habits and a hereditary predisposition to certain eye diseases fall into the risk group for the development of this pathology. Another serious circumstance contributing to the occurrence of retinal dystrophy has recently become an unfavorable environmental situation, which negatively affects all the senses, and in particular the eyes.

However, age is recognized as the main risk factor for retinal dystrophy, and the prevalence of this disease in the age category of patients under 60 years old is only 1%, and already after the age of 70 years - about 20%. It is for this reason that ophthalmologists recommend that all people at risk after the age of 45 undergo an annual examination of the state of the organs of vision, which will help to notice the emerging problem in time and take adequate and timely measures to solve it. In addition, in 30-40% of cases, retinal dystrophy occurs in people with, in 6-8% of cases in conditions hyperopia and in 2-3% of cases with normal vision. The total set of primary factors in the development of dystrophy can be figuratively divided into two main groups, namely, general and local.

Common reasons for the formation of this group of diseases include:

• frequent exposure to the eyes of direct rays of the sun and other negative types of radiation;
• age-related vascular changes in the organs of vision;
• serious viral infections in the past;
• excessive plasma levels;
• various (poisoning with poisons, bacterial toxins, alcohol, etc.);
• severe chronic diseases (from the thyroid gland, heart, kidneys, etc.);
• persistent food shortage minerals And .

The local causes of retinal dystrophy include:

• genetic predisposition;
• inflammatory pathologies of the eyes;
• previous operations on the organs of vision;
• in any form of expression;
• previous eye injury;
• present.

Additional circumstances contributing to the earlier development of this pathology are smoking, as well as gender and race. It is known that people with white skin and blue eyes and women in general are more susceptible to retinal dystrophy. By and large, any external or internal factors that disrupt blood flow and natural metabolism in the eyeball can lead to retinal dystrophy.

Symptoms of retinal dystrophy

At the initial stages of its development, most types of retinal dystrophy may not manifest themselves subjectively for a long time or be expressed very weakly. As a rule, the first clinical symptoms of this group of pathologies begin to disturb the patient in the middle or even severe phases of the course of the disease.

Despite the abundance of types of retinal dystrophies, their negative symptoms are largely similar to each other and are most often expressed by the following phenomena:

• limited field of view;
• weakening of visual acuity (may be in one or two eyes);
• the need for bright lighting used for writing or reading;
• the appearance of a wave-like distorted picture before the eyes (reminiscent of the feeling of looking through a layer of water);
• appearance with a cat (various obstructions in front of the eyes in the form of spots, fog, curtain, etc.);
• development nyctalopia (reduced ability to see at dusk);
• problems with color discrimination (perception of colors that do not correspond to the real picture);
• periodic formation of flashes or "flies" before the eyes;
• the inability to correctly identify a resting object from a moving one;
• development metamorphopsia (distorted assessment by the organs of vision of colors, shapes and arrangement of objects in real space).

If a person has any of the above symptoms, he should urgently contact a specialized specialist for a detailed examination and appointment, if necessary, of adequate treatment. It is not recommended to postpone your own visit to the ophthalmologist for a long time, because without appropriate therapy, any retinal dystrophy can progress rapidly and eventually provoke its detachment, and hence complete loss of vision.

Analyzes and diagnostics

Diagnosis of dystrophic changes in the retina requires a professional approach and a complete examination of the tissue structure of both organs of vision. In this case, it would be most appropriate to conduct a set of studies that will help to accurately establish the present disease.

During a visit to the hospital, the ophthalmologist may prescribe the following diagnostic procedures and measures to the patient:

• general clinical tests;
• ophthalmoscopy (instrumental method of examination of the fundus);
• perimetry (method of studying the boundary limits of peripheral vision);
• Amsler test (a method for diagnosing existing dystrophy using a dotted grid drawn on paper);
• adaptometry (check dark adaptation);
• optical tomography of the retina;
• Ultrasound of the eyeball;
• biomicroscopy (detailed analysis of the tissue structure of the eye);
• visometry (a method for checking visual acuity based on the use of 4 special tables);
• fluorescein angiography (a technique for examining the eye vessels with intravenous administration of an organic pigment);
• refractometry (instrumental determination of eye refraction);
• measurement ;
• color vision assessment using the Rabkin table;
• electroretinography (technology for studying the functionality of the retina using light stimulation).

Treatment of retinal dystrophy

Degenerative changes in the eye retina that have already occurred are virtually impossible to completely eliminate by means of modern medicine, therefore, any treatment of pathologies of this group is aimed at slowing down and / or stopping the further progression of the disease and, in essence, is symptomatic.

In general, the therapeutic methods used in the treatment of retinal dystrophies can be divided into: medical, surgical and laser. Depending on the type of the disease and the severity of its course, their individual or complex use in most cases makes it possible to stop the further development of the disease, reduce the severity of negative clinical symptoms, and even partially improve visual function.

The doctors

Medications

In the drug therapy of various retinal dystrophies, the prescription of drugs from the following drug groups is practiced:

• (mostly and and groups).
• Antiplatelet agents - therapeutic agents that prevent vascular thrombosis (, Ticlopidin , etc.). These drugs can be given as intravenous injections or tablets.
• Eye drops, including biological substances and vitamins, which help to improve the material metabolism and repair of the cellular structure (, etc.).
• Vasodilators And angioprotectors - drugs that strengthen and dilate the vessels of the circulatory system (, Complamin , etc.). They can be given intravenously or taken orally.
• Lipid-lowering drugs - drugs that reduce the content of plasma cholesterol (, etc.). Used only in patients with .
• Medicinal preparations that enhance vascular microcirculation (,). Mostly solutions of these funds are injected into the eyes.
• Mineral and vitamin complexes containing elements important for the adequate functioning of the organs of vision (, etc.).
• Polypeptides produced using bovine retinal tissues ( Retinolamine ). The introduction is practiced directly into the structure of the eye.
• - a drug that inhibits the growth of new pathological vessels. It is mainly used in the treatment of age-related retinal degeneration.

Treatment with all the above medications, as a rule, is carried out in courses that are carried out several times during the year (at least twice).

In addition, in the treatment of macular degeneration in the wet form, intravenous administration and intraocular administration are sometimes practiced. In the event of a hemorrhage in the eye, to stop it and resolve the hematoma, it is prescribed intravenously, Prourokinase or . In order to relieve puffiness in the treatment of any type of retinal dystrophy, they resort to injection into the eye.

Procedures and operations

Together with drug treatment, in order to correct vision and reduce the negative manifestations of retinal dystrophies, some physiotherapy methods can also be used, namely:

• intravenous laser blood irradiation;
• electrophoresis With , ;
• electrical stimulation retina;
• magnetotherapy ;
• retinal stimulation using low-energy laser radiation;
• photostimulation retina.

If there are indications for surgical operations, surgical intervention is possible, including:

• vitrectomy ;
• laser photocoagulation of the retina ;
• revascularizing operations;
• vasoreconstructive operations.

Principles of therapy for central retinal dystrophies

What to do with age-related retinal dystrophy and others? First of all, patients with such forms of the disease are shown complex drug therapy, including the course use of A, E and B, vasodilators , antiplatelet agents And angioprotectors . As a rule, courses of treatment with these groups of drugs are carried out at least 2 times in 12 months, which in most cases can significantly reduce the progression or even completely stop the development of the pathology, thereby maintaining vision at the existing level.

In the case when a patient is diagnosed with a more severe phase of macular degeneration, then, together with drug treatment, the above methods of physiotherapy are prescribed or operations are performed to restore natural blood flow in the retina. The specific method of physiotherapy used should be selected by an ophthalmologist, based on the existing picture of the disease and its course. Along with taking medications, all physiotherapeutic procedures are also carried out in courses 2-4 times a year.

If the patient suffers from a wet form of dystrophy, then first of all he is shown laser coagulation to stop the growth of abnormal blood vessels. During this procedure, the doctor directs the laser beam to the affected segments of the retina, where, under its powerful action, the so-called “soldering” of unnecessary vessels occurs. As a result of such manipulation, the exudate stops penetrating under the retina and peeling it off, thereby stopping the further progression of the disease. Laser coagulation itself is a short, painless and uncomplicated procedure, which is often carried out even in a conventional clinic.

After laser coagulation, the patient needs to take angiogenesis inhibitors on an ongoing basis (, Macugen ), which will further inhibit the germination of new abnormal microvessels.

Principles of therapy for peripheral and generalized retinal dystrophies

Treatment of retinitis pigmentosa and other types of peripheral and generalized dystrophies primarily consists in carrying out appropriate surgical manipulations (usually for such pathologies, the same laser coagulation and surgical delimitation of the dystrophy area are used), followed by the appointment of regular medication and physiotherapy courses. When diagnosing peripheral dystrophy, the patient should protect his eyes from sunlight and be sure to stop smoking (in the presence of this bad habit in the past).

Treatment of retinal dystrophies with a laser

Method laser therapy is widely used in the treatment of various forms of retinal dystrophy, since the directed laser beam has tremendous energy, which allows it to effectively affect the damaged areas of the eye without affecting its normal areas. Laser treatment is not the same type of operation, which includes only one type of intervention, but on the contrary, it is a whole complex of various therapy methods carried out using a laser beam.

An example of the effective therapeutic use of a laser in the treatment of dystrophy is the retinal stimulation , the purpose of which is to activate metabolic processes in the eye tissues. During this procedure, only the affected areas of the eye are irradiated, which, after its completion, in most cases regain some of the lost functions. The course of such laser stimulation is very effective and allows you to stop the development of the disease for a long time.

As a surgical instrument, a laser beam in ophthalmology is most often used for vascular coagulation or isolating a problem area of ​​the retina. During such operations, the thermal energy of the laser is able to literally “solder” damaged tissues, thereby preventing the spread of the disease further.

Surgical treatment of retinal dystrophies

Surgical interventions in the tissues of the eyeball are practiced only in the case of a severe course of the disease, when drug treatment and laser therapy are found to be ineffective. In the case of dystrophic changes in the retina, ophthalmic operations can be divided into two types - vasoreconstructive and revascularizing.

• Vasoreconstructive operations are carried out with the help of special transplants and are designed to restore the correct microvascular bed in the organs of vision.
• Revascularizing interventions are performed with the aim of eliminating pathologically enlarged microvessels and the maximum possible opening of normal vessels.

Such surgical operations can only be done by an experienced ophthalmologist surgeon and only in a hospital setting.

Treatment of retinal dystrophy with folk remedies

Treatment of retinal dystrophy with folk remedies can only be practiced in conjunction with the methods and preparations of official medicine, since this disease is considered quite severe and progressive. Folk remedies for the treatment of retinal dystrophy include various vitamin and mineral mixtures that can provide the organs of vision with the necessary natural substances that improve their nutrition and maintain functionality.

Among the most conducive to eye health folk recipes are the following:

• Rinse the wheat grains and lay them in a thin layer on the bottom of a suitable dish, pouring a small amount of water on top. Place the wheat in a well lit and warm area for the fastest germination. After the appearance of green shoots, rinse the grains again and grind them with a meat grinder. Store the finished mass in the refrigerator, using it every morning in the amount of 14 tablespoons.
• Pour 1 tbsp. l. celandine with boiling water and boil water over low heat for several minutes. After cooling the broth, it can be instilled into the eyes 3 drops three times a day for a month.
• Dissolve 50 g of mummy in 10 ml of fresh aloe juice and instill a few drops into the eyes twice a day. The prepared solution should be stored in the refrigerator, and before the instillation procedure, warm it to room temperature. Such treatment can be continued for 9 days, after which it is necessary to take a break for at least a month.
• In a 1:1 ratio, mix goat's milk (fresh) with boiled water. Instill a couple of drops of this mixture in the sore eye, then cover it with a thick cloth for 30 minutes. The course of such treatment can be a maximum of a week.
• Mix 5 parts of pine needles with 2 parts of rose hips and 2 parts of onion peel, then pour boiling water over everything and boil for 10 minutes. Cool the resulting broth, strain and drink for the next month at 0.5 liters per day, dividing this portion into several doses.

Prevention

Prevention of the occurrence of dystrophies of the eye retina is to follow the following simple rules:

• Avoid eye strain and give them rest as often as possible.
• Practice eye gymnastics (bury your eyes, “write out” eights with them; look from a distant object to a near one; close your eyes tightly, and then open your eyes sharply and wide, etc.).
• Do not expose your eyes to harmful radiation, including sunlight.
• Take A, E and B groups.
• Eat well, trying to include as many fresh fruits and vegetables in your diet as possible.
• Get rid of excess weight.
• Give up bad habits and, first of all, smoking.
• Take zinc supplements.
• Annually pass or take place inspection and the ophthalmologist.

In children

Since some forms of retinal dystrophy are hereditary, it is very important to notice its development in a child in time if this pathology appears in a family history. The risk of dystrophy in children is very high when it is inherited according to the dominant pattern, and its progression in this case occurs rapidly. This disease in a child develops, as a rule, in two eyes at once, and its most characteristic symptom is a violation of color perception. In addition to it, children can simultaneously experience a shudder of the eyeball and even nucleation.

It should be remembered that until today there are no effective drugs that can completely cure this ailment. That is why the timely detection of this disease in a child and the adoption of appropriate medical measures to a greater extent will help to stop the pathological process and preserve vision.

During pregnancy

Diet for retinal dystrophy

As such, a diet for retinal dystrophy is not provided, however, in order to prevent its development or reduce the progression of this disease, it is recommended to eat foods rich in minerals and vitamins that are beneficial for the eyes.

Forecast

As a rule, most forms of retinal dystrophy are diagnosed already at the later stages of their development, and therefore the prognosis for the restoration of normal visual acuity in these pathologies is unfavorable. All drugs and methods used for the treatment of this disease are aimed at stopping its progression and maintaining vision at the current level.

List of sources

• Astakhov Yu.S., Angelopulo T.V., Dzhaliashvili O.A. Eye diseases for general practitioners: Reference book. 2001.– S. 147-150.
• Danilichev V.F. Modern ophthalmology. S-P.: Piter, 2000.- 668 p.
• Semenov A.D. Lasers in opto-reconstructive eye microsurgery: Dis. ... Dr. med. nauk.- M., 1994.-46 p.
• Fedorov S.N., Yartseva N.S., Ismankulov F.O. Eye diseases: A textbook for medical students. Universities. - M., 2005. - 432 p.
• Katsnelson L.A., Forofonova T.N., Bunin A.Ya. Vascular diseases of the eye. - M.: Medicine, 1990.-270p.

The most important structure of the eye, which has a complex structure that allows it to perceive light impulses. The retina is responsible for the interaction of the optical system of the eye and the visual parts of the brain: it receives and transmits information. retinal dystrophy usually caused by disorders in the vascular system of the eye. It mainly affects the elderly, whose vision is gradually deteriorating. With retinal dystrophy, the photoreceptor cells responsible for distance vision and color perception are affected. Retinal dystrophy at first can be asymptomatic and often a person does not even suspect that he has such an insidious disease.

Retinal dystrophies can be divided into:

1. Central and peripheral. Peripheral retinal dystrophy is most often present in nearsighted people. Decreased blood circulation in the eye with myopia leads to a deterioration in the delivery of oxygen and nutrients to the retina of the eye, which is the cause of various peripheral retinal dystrophies.
2. Congenital (genetically determined) and acquired.
   • "senile" dystrophy develops most often after 60 years. This type of retinal dystrophy can be combined with the development of senile cataracts caused by aging.
   • Pigmentary retinal dystrophy - associated with disruption of the photoreceptors responsible for twilight vision. This type of retinal dystrophy is quite rare and belongs to hereditary diseases.
   • Point white retinal dystrophy - usually occurs in childhood and progresses with age. This type of dystrophy is hereditary.

Causes of retinal dystrophy

The causes of retinal dystrophy are different, but for the most part these are general diseases (diabetes mellitus, atherosclerosis, hypertension, kidney disease, adrenal glands) and local (myopia, uveitis), as well as a genetic predisposition.

Symptoms of retinal dystrophy:

• decreased visual acuity;
• loss of peripheral vision and the ability to navigate in poorly lit spaces.

How to diagnose retinal dystrophy?

In order to confirm or refute the diagnosis of "retinal dystrophy", it is necessary to undergo a thorough examination of the visual system. In the Excimer ophthalmological clinic, diagnostics are performed using a complex of modern computerized equipment and allows you to get a complete picture of the patient's vision.

Examination of patients with suspected retinal dystrophy includes:

• determination of visual acuity;
• study of visual fields (perimetry) in order to assess the state of the retina on its periphery;
• optical coherence tomography;
• electrophysiological study - determination of the viability of the nerve cells of the retina and optic nerve;
• ultrasound examination of the internal structures of the eye - A-scan, B-scan;
• measurement of intraocular pressure (tonometry);
• examination of the fundus (ophthalmoscopy).

Treatment of peripheral retinal dystrophy with a laser (peripheral prophylactic laser coagulation)

Very often, dystrophic changes in the retina accompany moderate and high degrees of myopia. The fact is that usually in this case the size of the eyeball increases, and the retina lining its inner surface is stretched, which leads to dystrophy. Modern treatment of this condition, as well as other types of dystrophies (many inflammatory and vascular diseases of the retina lead to dystrophies), occurs with the help of an argon laser. The main goal of this treatment is to strengthen the retina.

The laser is a unique surgical instrument that has given ophthalmic surgeons completely new possibilities. The principle of treatment is based on the fact that laser exposure leads to a sharp increase in temperature, which causes coagulation (coagulation) of the tissue. This makes the operation go smoothly. The laser has very high precision and is used to create adhesions between the retina and choroid of the eye (i.e., strengthen the retina) in order to prevent retinal detachment. For the operation, a special lens with an anti-reflective coating is put on the patient's eye. It allows the radiation to completely penetrate the eye. Laser radiation is fed through special light guides, and the surgeon has the ability to control the progress of the operation through a stereomicroscope, direct and focus the laser beam.

main goal (peripheral prophylactic laser coagulation) prevention is precisely that - reducing the risk of retinal detachment, and not improving vision. What kind of vision will be after surgery depends largely on whether there are any concomitant eye diseases that affect the ability to see well. The main thing - do not delay the solution of the problem.

Cost of basic services

Service	Price, rub.)	By map
Treatment of retinal diseases
Preventive peripheral laser coagulation (PPLC) I category of complexity ?	9500 ₽	8700 ₽
Prophylactic peripheral laser coagulation (PPLC) II category of complexity ? Strengthening of the retina with laser exposure on the periphery is used to treat retinal dystrophy and prevent retinal detachment. The degree of complexity is determined by the volume of the damaged area of ​​the retina	12300 ₽	11400 ₽
Prophylactic peripheral laser coagulation (PPLC) III category of complexity ? Strengthening of the retina with laser exposure on the periphery is used to treat retinal dystrophy and prevent retinal detachment. The degree of complexity is determined by the volume of the damaged area of ​​the retina	17200 ₽	16100 ₽
Laser coagulation in diabetes mellitus, CVD thrombosis ? Laser procedure for the treatment of diabetic and hypertensive retinopathy.	32100 ₽	29800 ₽
Laser procedure for secondary cataract (YAG laser) ? Removal of clouding of the posterior capsule of the eye from the optical zone with a laser.	18500 ₽	17500 ₽
Barrage of the macular area ? Surgery to treat some forms of central retinal dystrophy.	11000 ₽	10100 ₽
Intravitreal administration of LUCENTIS/EILEA for the treatment of age-related macular degeneration (1 injection) ? Injection therapy for the treatment of age-related macular degeneration.

Pigmentary dystrophy of the retina is a fairly rare disease. It occurs in 1 person out of 5000, and in total there are approximately 100 million carriers of the defective gene that causes retinitis pigmentosa worldwide. With the development of this pathology, the eye, initially a light-absorbing structure, turns into a light-reflecting structure, which inevitably becomes the cause of blindness. Men are more susceptible to the development of retinitis pigmentosa, and the disease can occur both in childhood and in adulthood. According to statistics, the majority of patients with retinitis pigmentosa under the age of 20 retain visual acuity above 0.1 and the ability to read, while in 45-50-year-old patients, visual acuity decreases to a value below 0.1, and they can no longer read.

Retinitis pigmentosa or, in other words, retinitis pigmentosa, is characterized by degeneration of photoreceptors and pigment epithelium, as a result of which the ability to transmit signals from the retina to the cerebral cortex is lost. With this pathology, a characteristic accumulation of the pigment substance is also clearly observed in the picture of the fundus. The degenerative process with the deposition of pigment causes the disappearance of photosensitive cells and receptors, causing the retina to lose its susceptibility to light signals. As a result, a person loses his sight.

Pigmentary dystrophy of the retina was first described in 1857 by D. Donders, and after 4 years the hereditary nature of this pathology was established. The type of heredity affects important indicators of the disease: the age of onset, the rate of progression, and the prognosis of visual functions. There are the following types of inheritance:

• Sex-linked: transmission of the defective gene from mother to son with an X chromosome is the least common, but the prognosis is the most unfavorable;
• Autosomal recessive: defective genes are passed on from both parents;
• Autosomal dominant: the transmission of disease genes from one of the parents.

signs

Retinitis pigmentosa often occurs in childhood, it is characterized by three symptoms:

• Small accumulations of pigment in the fundus;
• The optic disc has a waxy pallor;
• Narrowing of arterioles.

In the future, the patient's visual acuity may deteriorate, while pigmentary changes are observed in the macular region, and macular edema may occur. Patients with retinitis pigmentosa have an increased risk of developing myopia, posterior subcapsular cataracts, and open-angle glaucoma.

In childhood, retinitis pigmentosa is quite difficult to diagnose. The first tangible symptom that manifests itself in a child at an early stage of the pathological process is poor orientation at night - often the disease is detected precisely by this manifestation. This disorder is also characterized by the inability to distinguish colors in the dark - this is called night blindness. In addition, the initial stages of pigmentary dystrophy, especially in children, manifest themselves as a headache and flashes of light in the eyes.

With the progression of the disease, an ongoing process of retinal degeneration occurs, eventually leading to impaired peripheral vision. According to ophthalmologists, vision becomes tunnel - this occurs in the second stage of the disease.

At the last stage of the disease, a person loses not only peripheral, but also central vision. Blindness sets in.

Treatment of retinitis pigmentosa

There are currently no effective treatments for retinitis pigmentosa. Although it should be noted that constant and not unsuccessful research is being carried out in this direction. More recently, thanks to new achievements in electronics and cybernetics, a huge step has been taken in this area. The essence of the new technique is to install a small photodiode-sensor with a transmitter on the retina. The received light information from the surrounding world comes to the transmitter through an ultra-thin wire. The perception of information occurs through special glasses with receiver glasses. Of course, this is not full vision, but, nevertheless, a person becomes able to see. Experiments have shown that a blind patient acquires the ability to distinguish between light and darkness, as well as to see the outlines of large objects. There is no doubt that this development can make the life of blind people much easier. This experimental technique is currently in the testing phase.

To treat retinitis pigmentosa, a method of slowing down the degenerative process of the retina is also used. It includes the use of stimulating procedures, for example, magnetic stimulation, as well as taking preparations with blueberry extract and vitamin A, parabulbar injections of Retinalamin.

Video of our specialist about the disease