The vitreous is a transparent gel that fills the cavity of the eyeball and is placed behind the lens. Outside it is surrounded by a membrane, inside it is divided into channels (paths). If liquefaction, wrinkling, or detachment of this gel is observed, then eyes are referred to as DST.
What it is?
The appearance of various in shape, size or degree of turbidity in the vitreous body indicates degenerative processes. Most often diagnosed are pathologies in which the properties of a given environment change.
Normally, it is transparent, but contains special filaments - fibrils. With age-related changes or due to certain diseases, they become less elastic and can break, which leads to visual impairment. In this case, destruction of the vitreous body of the eye develops. It should be noted that such disorders respond poorly to therapy, and destructive changes in the elderly are practically not treated (with appropriate therapy, they can only be slowed down).
Etiology
As a rule, the destruction of the vitreous body of the eye, the causes of which can be very diverse, is the result of mechanical damage to the eyes, smoking, drug use or certain medications. Pathological changes associated with the natural process of aging of the body are also distinguished. In addition, in the presence of myopia, under the influence of prolonged and frequent stress on the organs of vision, nervous shocks, destruction of the vitreous body of the eye can also develop.
If etiological factors are indicated, dystrophy or inflammation in the retina, physical exhaustion, retinopathies, choroidal lesions, and metabolic changes in the eyeball should also be mentioned.
It is important to remember that sharp destructive changes can be harbingers of retinal detachment, in which there is a complete and irreversible loss of vision, so timely consultation with an ophthalmologist is mandatory.
Characterization of destructive changes in the vitreous body
When its liquefaction develops, then, as a rule, pathological changes are observed in the central areas. The periphery of the vitreous does not change. In most cases, voids are formed that are filled with fiber particles and coagulation products. Also, strands or films can be observed that float freely in a liquefied medium or attach to the fundus, which leads to sharp pathological changes in vision.
The destruction of the vitreous body of the eye in the most severe manifestation is its wrinkling. It is accompanied by tension of vitreoretinal joints, which in severe cases leads to photopsy, rupture of the retina, the appearance of hemorrhages in the vitreous body.
It should be noted that such destructive changes are easier to detect on microscopic specimens. Diagnosing a problem using clinical research methods is very difficult and requires a lot of medical experience.
Clinical manifestations
When the destruction of the vitreous body develops, the symptoms of this disorder may include the appearance of various kinds of floating elements in front of the eyes, which become more noticeable when looking at the monochrome space - a white wall, snow or sky. Patients may also notice turbidity. It occurs due to changes in the refraction of light passing through the optical system of the eye and is associated with casting a shadow on the retina, which reduces the quality of vision and may indicate more serious damage to the eyes. Late treatment to a doctor can lead to complete loss of vision.
Destroyed vitreous fibrils appear to the patient as grains, spots, threads or films, which significantly impair visibility and move after eye movements.
It should be noted that one of the most common reasons for contacting an ophthalmologist is a complaint about the appearance of "flying flies" in front of the eyes, which cannot be eliminated. After appropriate examinations, it is precisely the destruction of the vitreous body.
The symptom of the "golden rain"
Sometimes patients who turn to the ophthalmologist complain of the appearance of golden sparks with eye movements. Where do they come from?
Functional pathologies of various organs (for example, the kidneys, liver, or endocrine glands) lead to metabolic disorders and cause changes in the colloidal media of the body and their mineral composition. This also applies to the vitreous body, in which pathological local changes develop and precipitation and coagulation processes take place, as well as the deposition of crystals, whose dimensions are insignificant - not more than 0.05 mm.
Similar deposits are called synchisis scinlillans. They consist mainly of cholesterol or tyrosine, accumulate in a significant amount in a liquefied vitreous body, and when eye movements swing like a pendulum, begin to shimmer and glow, which determines the symptom of "golden rain", which is a rare form of destruction and makes the patient seek medical attention help.
Diagnostics
The destruction of the vitreous body of the eye is detected using technically simple manipulation - ophthalmoscopy. With filamentous destructive changes, optically empty cavities are detected, which have the form of vertical slots or various shapes. The anterior border plate of the vitreous body without specific changes, but immediately after it you can see gray-white fibers. They can have different thicknesses and sag in the form of garlands.
If the pathological process progresses, then the above voids merge, forming a single cavity. This is accompanied by a destruction of the structure of the vitreous. With ophthalmoscopy, fragments of fibril filaments can be seen. If the clouding is located near the retina, then it is quite difficult to see (even with large sizes).
I must say that such changes are most often found in the elderly, as well as in patients who are simultaneously diagnosed with high myopia or degenerative lesions of the inner membranes of the eye.
Pharmacological therapy
Despite the fact that medicine (including ophthalmology) is at a fairly high level, today there are no effective means that would prevent the destruction of vitreous fibrils or contribute to the disappearance of already destroyed. Most of the pharmacological drugs prescribed for destruction only prevent the progression of pathological changes. That is why care should be taken with medicines whose manufacturers claim that their products can cure DST.
As a rule, instillations of 2% potassium iodide or 3% Emoxipin, which is administered parabulbar, are used topically. For oral administration, absorbable drugs are prescribed, for example, Wobenzym or Traumeel C. In addition, patients are advised to undergo a course of vitamin therapy. So, the treatment of eye DST should include the intake of ascorbic acid and group B vitamins.
If necessary, physiotherapeutic procedures can be prescribed - electrophoresis with lidase and ultrasound therapy.
Laser treatment
Today, laser manipulations are becoming increasingly popular, which with DST are the most effective for the destruction of floating turbidity. Such treatment is minimally invasive, but requires high qualifications and professionalism of the doctor. It provides for the destruction by the laser of opaque fragments in the vitreous body, which decompose into smaller particles that do not affect vision.
Vitreous laser surgery is called vitreolysis. It may include dissection of vitreorhinal adhesions. If local vitreous hernias develop, which cause pupil deformation and improper placement of the intraocular lens, the corresponding part of the CT is excised. In this case, a YAG laser is used. The pulse energy is selected individually (from 1.5 to 8.0 mJ). The success of the operation depends on the viscosity and transparency of the vitreous, as well as on the size of the opacities.
Surgical treatment
Surgical treatment for the destruction of the vitreous body of the eye is called vitrectomy. Such therapy involves the partial or complete removal of CT, which is carried out using a vitrectomy system consisting of a vitreotome (cutting tool) and an endo-illuminator.
When is vitrectomy used? As a rule, it is carried out in case of damage to the vitreous body due to open injuries, with its clouding, as well as with hemorrhages and retinopathy.
The duration of the operation is from 30 to 90 minutes. It is performed under local or general anesthesia; it can have one or several stages, which depends on the stage and type of pathology.
To replace the vitreous body, artificial polymers are used, as well as balanced saline solutions. Most often, they take liquid perfluororganic substances, gases or silicone oil. Any substitute for the vitreous should be as transparent as possible, with the appropriate viscosity and refractive power. It also should not succumb to resorption or cause a toxic, inflammatory or allergic reaction.
After the operation, patients are advised to see an ophthalmologist, limit physical and visual stress, and sudden changes in temperature. Otherwise, the risk of inflammatory complications, repeated hemorrhages, cataracts, high intraocular pressure or retinal vascular occlusion increases.