The term "regmatogenous retinal detachment" refers to a pathological process characterized by a violation of the integrity of the thinnest layer of nervous tissue, while fluid from the vitreous body penetrates underneath it. The development of the disease is dangerous in that it can lead to complete loss of vision. If the first alarming signs occur, you need to contact an ophthalmologist. Based on the results of the diagnosis, the doctor makes the most effective treatment regimen, which includes surgical methods.
Development mechanism
Regmatogenous retinal detachment is a multifactorial disease. This is a pathology of a primary nature, which is a consequence of a rupture of the nervous tissue.
There are two main mechanisms for the development of the disease:
- The occurrence of regmatogenous retinal detachment against the background of thinning of this layer. As a rule, a similar condition appears in the process of natural aging of the body. For many people, the disease does not manifest itself in any way, however, it can be a health hazard. Over time, transverse defects form on the retina, through which liquid from the vitreous body begins to penetrate under it, causing delamination. In addition, often zones of dystrophy occur after an injury to the eye.
- The occurrence of regmatogenous retinal detachment due to tension. The vitreous is a gel-like substance that is 99% water. It is very tightly connected with the retina at the base of the latter, most loosely - in areas of localization of large blood vessels. In the process of natural aging of the body, the vitreous body liquefies, the retina stretches. As a result, a detachment occurs, which is not always accompanied by a rupture of tissue.
Since the disease is multifactorial in nature, in most cases, both mechanisms are immediately detected in patients. The risk of regmatogenous detachment of the eye increases significantly under the influence of provoking factors.
Causes
The pathology development process may start in the presence of one or more unfavorable factors:
- Chronic inflammation of the choroid or vascular membranes.
- Myopia. This is a condition in which a person does not distinguish between objects located at a far distance from him. Myopia is considered one of the main causes of regmatogenous detachment.
- Aphakia. This is a pathological condition in which the lens is absent in the eye. The disease can be both congenital and acquired in nature.
- Artifakia. This term refers to the implantation of an artificial lens, which serves as a replacement for a removed or initially absent lens.
- Injuries of various nature, including operating. It is also considered one of the common causes of regmatogenous retinal detachment. Pathology can occur instantly (that is, during or immediately after injury) or after several years.
In addition, the risk of developing an ailment increases with age. According to statistics, the disease is most often diagnosed in people from 40 to 70 years old. In young people, pathology is usually a consequence of eye injury.
In ICD-10, regmatogenous retinal detachment has the code H33.0.
Signs
At the initial stage of the development of the disease, precursors appear - light phenomena. These are states that are characterized by the appearance of photopsies and metamorphopsies before the eyes. In the first case, patients complain of periodic episodes of flashes of light, in the second - the presence of lines in the form of zigzags.
If rupture of the retinal vessel occurs, black dots or flies flash before the eyes. In addition, painful sensations arise. A similar phenomenon is observed when the vitreous is tensioned, as a result of which the photosensitive cells are irritated.
Regardless of the causes, the symptoms of retinal detachment appear the same. With the progression of the disease, the flies become larger. Patients complain that a veil appeared in front of their eyes, which gradually increases and occupies almost the entire field of vision.
In addition, they begin to see much worse. A decrease in visual acuity is the main sign of retinal detachment. As a rule, the patient sees better in the morning after waking up. This is due to the fact that during sleep, the liquid from the vitreous body dissolves a little, and the retina can return to its place. A similar condition is typical for individuals whose detachment occurred several days or weeks ago. If this defect occurs long ago, the thin nervous tissue loses its mobility and becomes inelastic. Because of this, she cannot return to her place on her own. In any case, even in patients whose rupture has occurred recently, signs of retinal detachment return within a day.
If the integrity of the thin tissue is violated in the lower parts of the fundus, the disease develops slowly, the duration of the process can be several weeks or many months. However, the patient does not notice any defects in the field of view. This condition is dangerous in that it is detected, as a rule, only with damage to the macula - the center of the retina. In such a case, it is customary to talk about a running process and an unfavorable prognosis.
If exfoliation has occurred in the upper parts of the fundus, the pathology, on the contrary, progresses very quickly (within a few days). In this case, the patient needs emergency medical care. With untimely intervention of doctors, total detachment can occur. At the same time, the outlines of objects become curved, and central vision drops very sharply.
In some cases, regmatogenous retinal detachment is accompanied by diplopia. This is a pathological condition in which there is a bifurcation of objects visible to a person. Also, detachment may be accompanied by iridocyclitis and hemophthalmia. In the first case, we are talking about inflammation of the ciliary body and the iris, in the second - hemorrhage into the vitreous body.
Severity
There are several stages of regmatogenous retinal detachment:
- A. Another name is minimal. This is the initial stage of the development of pathology, in which pigment cells are found in the vitreous body. Slight floating haze appears in the field of view.
- B - moderate regmatogenous retinal detachment. It is characterized by a decrease in the number of membranes in the vitreous. In this case, the edges of the rupture of the nervous tissue begin to wrap.
- C. This stage is considered severe. It is characterized by the presence of folds of the retina. Moreover, they can be detected in 1, 2 or 3 quadrants.
- D is a massive stage. At this stage, the folds are fixed and extend immediately to 4 quadrants. In this case, a funnel-shaped detachment occurs. It can be wide, narrow or closed.
Diagnostics
When the first alarming signs appear, you need to contact an ophthalmologist. Primary diagnosis is based on anamnesis. The doctor must provide the following information:
- What symptoms are currently bothering you
- how long they appeared;
- whether their severity increases with physical exertion;
- whether visual disturbances were previously detected;
- the nature of the patient's professional activities;
- Does the next of kin have rheumatoid detachment?
In order to make an accurate diagnosis, an ophthalmologist prescribes a comprehensive study. It includes physical and instrumental methods.
These include:
- Determination of visual acuity. This is a basic diagnostic method, the essence of which is to assess a person’s ability to perceive two different points that are located as close to each other as possible. For this, the patient is invited to sit on a chair standing 5 m from the wall on which tables with letters are located. If a person distinguishes all 10 lines with each eye, this indicates an excellent visual acuity of 1.0.
- Tonometry. The method by which you can find the indicator of intraocular pressure. There are several ways to carry it out. Most often, non-contact tonometry is used in practice . It is carried out as follows: a device is installed opposite the eye, which generates a stream of air. It moves with a certain speed towards the cornea. As soon as they collide, the fundus is slightly deformed. The obtained indicators are recorded by special sensors.
- Perimetry. A method that involves evaluating the field of view, usually using the Donders test. The patient is located at a distance of 1 m from the doctor, fixing his eyes on his nose. Then the subject closes one eye, the specialist - the other. The ophthalmologist begins to show an object with distinguishable outlines, gradually leading it along the conditional meridians from the peripheral zone to the central one. Normally, both people should simultaneously detect the object. The study is considered reliable if the doctor’s field of view is not disturbed.
- Biomicroscopy The method in which the doctor gets the opportunity to assess the condition of the visible parts of the patient’s eye with a multiple increase. For this, a special device is used - a slit lamp.
- Indirect binocular ophthalmoscopy. The doctor directs a light source into the patient’s eye, after which he examines the eyeball with the help of special lenses.
- Refractometry Opposite the device, the patient's head is fixed. Then he should look at the picture with each eye (individually). Gradually she changes the sharpness. The results of the study are displayed on the monitor. Conclusion options: good vision, myopia, farsightedness.
- Ultrasound After the introduction of anesthesia, the sensor is applied directly to the open eyeball.
Based on the results of a comprehensive examination, the doctor chooses the most effective treatment method. Conservative methods of therapy for this pathology are not used. Treatment of regmatogenous retinal detachment involves only surgical intervention. It should be performed as soon as possible after diagnosis. Any delay is fraught with serious complications.
Operational methods
With retinal detachment of a regmatogenic nature, the following methods are used:
- Extrascleral. These include ballooning and filling.
- Endovitreal - vitrectomy.
- Cryocoagulation of ruptures.
- Laser treatment.
Extrascleral methods are effective only if the gap resulting in detachment has occurred recently (up to 1 month).
Balloning is an operation that is performed on the surface of the protein membrane (sclera). The essence of the method is as follows: the surgeon identifies the place of rupture and, accordingly, exfoliation. After that, he sews a balloon made of an elastic material to the protein membrane. Then this small container is filled with gas or liquid. Gradually, an impression site forms on the eyeball. Due to this, the rapprochement of the shells occurs, as a result of which the regmatogenous detachment is eliminated. An operation is effective if no more than 1 in 4 retinal quadrants is affected.
Filling is a type of surgical intervention that is also performed on the surface of the protein coat. The doctor at the stage of diagnosis determines the location, shape and size of the exfoliated area. Based on this information, a seal is made consisting of a biocompatible material. Ophthalmic clinics typically use sponge silicone.
When retinal detachment, the operation is performed as follows: the surgeon makes a conjunctival incision, through which the seal is superimposed on the gap. After that, it is fixed with sutures. If the pathology was accompanied by severe edema, drainage is performed. The final step is suturing of the conjunctival incision.
Vitrectomy is a surgical intervention in the process of which the vitreous body is partially or completely removed. Instead, a substance with similar properties is introduced. This method is considered minimally invasive, since during the operation a minimum of perforations is done.
Cryocoagulation of ruptures involves the use of low temperatures. The algorithm for the operation is as follows: the doctor drips an anesthetic drug into the patient’s eyes, while he begins to act, the surgeon drops the cryoapplicator into liquid nitrogen. Then the latter is placed on the eyeball. Due to the use of ultra-low temperatures, a high penetration rate is achieved, while there is no effect on the protein membrane and muscle tissue. Cryocoagulation can be considered both as an independent and as an auxiliary method of treatment of regmatogenous detachment.
Laser treatment is also performed under local anesthesia. This is a modern method, which is considered the safest due to the minimal risk of complications. When retinal detachment, the operation is carried out according to the following algorithm: the doctor directs a high-precision laser beam into the lesion, which contributes to the fusion of the vascular and nerve membranes. The doctor monitors the progress of the operation with a microscope. Its duration is about 20 minutes, after it, the patient can immediately begin his daily activities.
Features of the postoperative period
For all patients who underwent surgery in the thinnest nervous tissue, the recommendations are the same. In the early recovery period (first month), the following rules must be observed:
- Reduce the intensity of physical activity. It is forbidden to lift objects weighing more than 3 kg and engage in the gym. Regular walks and swimming are allowed.
- Constantly monitor the position of the head. It is forbidden to tilt it down (for example, when tying shoelaces, working in the garden, washing your hair with your body bent forward). The same applies to choosing a position for a night's rest. It is undesirable to sleep on your stomach.
- Avoid the occurrence of any disease. Even a commonplace cold is a provoking factor for the development of serious complications. The main preventive measure is to avoid places where a large number of people are regularly concentrated.
- It is forbidden to expose the body to high temperatures. It is necessary to temporarily exclude visits to the sauna, bathhouse and solarium. The same applies to hot tubs.
- If the postoperative period fell on summer time, you should avoid visiting the beach in the daytime. You also need to constantly wear sunglasses with a maximum degree of protection and a hat.
- Strictly follow the treatment regimen. After the operation, medication is indicated, the action of which is aimed at accelerating the restoration of the function of the nervous tissue.
After 1 month, you must go to the ophthalmologist for an examination (even if there are no complaints). The doctor will assess the condition of the operated organ and, if necessary, make adjustments to the drug treatment regimen.
Throughout the rest of his life, a person should follow the recommendations below:
- Do not expose the body to high-intensity physical activity;
- avoid situations in which injury to the operated eye may occur;
- avoid intoxication;
- Do not stay in the sun for a long time.
It is necessary to consult a doctor if after the intervention there are disturbing signs, for example, spots in the field of vision.
Forecast
The outcome of the operation depends on the duration of the development of the disease. If the intervention was carried out in a timely manner, vision after retinal detachment returns within 2-3 months (for older people this period is longer).
The most favorable situation is one in which the lesion of the macula, the very center of the nervous tissue, does not have time to occur. Otherwise, after retinal detachment, it is impossible to accurately predict the degree of improvement; it depends on a large number of factors.
Effects
Ignoring the problem can lead to:
- the development of chronic inflammatory processes;
- cataract
- complete loss of vision.
In order to prevent this, you need to contact an ophthalmologist when the first alarming symptoms appear. Currently, operations are successfully carried out even in advanced cases. If the result of the development of the disease was total blindness, doctors will not be able to do anything.
Finally
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