Involutional central chorioretinal dystrophy. Clinical and angiographic signs

Exudative (serous) detachment of the retinal pigment epithelium.

This is the accumulation of fluid between the Bruch membrane and the RPE. Most often, it is detected in drusen and other manifestations of age-related macular degeneration (including choroidal neovascularization). Detachment can be of various sizes. In contrast to serous detachment of the sensory part of the retina, detachment of the pigment epithelium is ϶ᴛᴏ a rounded domed local formation with clear contours. Visual acuity can remain quite high, but refraction is shifted towards hyperopia.

Serous detachment of the neuroepithelium is often combined with detachment of the pigment epithelium. At the same time, a greater prominence of the focus is noted, it has a discoid shape and less clear boundaries.

During the development of the pathological process, a flattening of the focus may occur with the formation of local atrophy of the RPE or rupture of the RPE with the formation of a subretinal neovascular membrane.

Hemorrhagic detachment of the pigment epithelium or neuroepithelium, as a rule, is a manifestation of choroidal neovascularization. It can be combined with serous detachment.

Choroidal neovascularization is the ingrowth of newly formed vessels through defects in Bruch's membrane under the pigment epithelium or under the neuroepithelium. Pathological permeability of newly formed vessels leads to sweating of fluid, its accumulation in the subretinal spaces and to the formation of retinal edema. Newly formed vessels can lead to the appearance of subretinal hemorrhages, hemorrhages in the retinal tissue, sometimes breaking through into the vitreous. In this case, significant functional disorders can occur (1).

Risk factors for the development of subretinal neovascularization are considered to be confluent soft drusen, foci of hyperpigmentation, extrafoveal geographic atrophy of RPE.

Suspicion of subretinal neovascularization by ophthalmoscopy should cause retinal edema in the macular zone, solid exudates, retinal pigment epithelium detachment, subretinal hemorrhages, and / or retinal hemorrhages. Hemorrhages are small. Hard exudates are rare and usually indicate that subretinal neovascularization was relatively long ago.

These signs should serve as an indication for fluorescence angiography.

Disciform scar formation. The disc-shaped cicatricial lesion is the final stage in the development of subretinal neovascularization. Ophthalmoscopically in such cases, a gray-white disc-shaped lesion is determined, often with pigment deposition. The size of the lesion can be different: from small, less than 1 disc diameter optic nerve (Optic nerve disc), up to large, which exceeds the entire macular zone in area. The size and localization of the focus are of fundamental importance for the preservation of visual functions.

This pathology is a chronic dystrophic process with a predominant lesion of the choriocapillary layer of Bruch's membrane and pigment epithelium. According to statistics, involutional central chorioretinal dystrophy (CCRD) is the leading cause of central vision loss in the second half of life in the population of developed countries. The severity of the disease is due to the central localization of the process and, as a rule, bilateral lesion.

Etiology

There are many unclear points in the etiology of involutional CHRD. According to recent data, the disease is considered genetically determined with an autosomal dominant mode of inheritance.

Pathogenesis

The beginning of the dystrophic process is the appearance of drusen in the central and paracentral zones of the retina. Drusen are an accumulation of colloidal substance between Bruch's membrane and pigment epithelium. Drusen can be hard or soft. The former leave behind zones of atrophy of the pigment epithelium and the choriocapillary layer. The latter can lead to exudative detachment of the pigment epithelium, and then neuroepithelium (Fig. 6-1, 6-2).

Further development of the process is accompanied by the appearance of subretinal neovascularization and the transition of the disease to the exudative-hemorrhagic stage. In the future, resorption of hemorrhages and the development of fibrous scar tissue are possible.

Diagnostics

In most cases, diagnosis is not difficult and is based on data from ophthalmoscopy and FAGD.

Fig. 6-1. Detachment of the pigment epithelium (schematically). PE - writing epithelium; MB - Bruch's membrane; EOPE - exudative detachment of the pigment epithelium; HC - choriocapillaries.

Fig. 6-2. Detachment of the pigment epithelium with serous detachment of the neuroepithelium. PE - pigment epithelium; MB - Bruch's membrane; EONE - exudative neuroepithelium detachment; EOPE - exudative detachment of the pigment epithelium; HC - choriocapillaries.

CHRD classification

The classification is based mainly on the stages of development of the dystrophic process. There are 3 forms of the disease.

I. Non-exudative form: retinal drusen, pigment epithelial defects, pigment redistribution, atrophy of the pigment epithelium and choriocapillary layer.

II. Exudative form:

1. the stage of exudative detachment of the pigment epithelium;
2. the stage of exudative neuroepithelium detachment;
3. neovascular stage;
4. the stage of exudative-hemorrhagic detachment of the pigment epithelium and neuroepithelium.

III. Cicatricial form.

Clinic

Drusen ophthalmoscopically represent round or oval light yellow subpigmented lesions. Their sizes are different, they can be point or drain, with indistinct boundaries. Drusen do not cause a decrease in visual functions (Fig. 6-3, 6-4, 6-5, 6-6, 6-7, 6-8).

On fluorescent angiograms, drusen begin to fluoresce in the early phases with the extinction of fluorescence in the late venous phase (Fig. 6-9, 6-10, 6-11, 6-12).

Atrophy of the choriocapillary layer and pigment epithelium most often becomes the clinical manifestations of the non-exudative form of CCRD (Fig. 6-13, 6-14).

With exudative detachment of the pigment epithelium, the focus is round or oval, with clear boundaries, it is better determined by ophthalmoscopy in reflected light. Visual functions are slightly reduced.

On a fluorescent angiogram, the serous fluid in the area of \u200b\u200bdetachment of the pigment epithelium is early stained with contrast, causing a focus of hyperfluorescence with clear boundaries (Fig. 6-15, 6-16).

Exudative detachment of neuroepithelium does not have clear boundaries, arises as a result of a violation of the barrier function and destruction of the connection of cells of the pigment epithelium. There is a significant decrease in visual functions. On the fluorescent angiogram, in contrast to the picture with the detachment of the pigment epithelium, there is a slow staining of the transudate without clear boundaries (Fig. 6-17, 6-18, 6-19).

The development of the subretinal neovascular membrane hidden under the exudate is not always possible to diagnose. However, there are a number of ophthalmoscopic symptoms that suggest neovascularization. Among them are discoloration of neuroepithelium detachment (dirty gray or slightly greenish tint), the appearance of perifocal hemorrhages and the deposition of solid exudate. Big role in the diagnosis of subretinal neovascularization, FAGD plays. The subretinal neovascular membrane is defined in the early phases as a lace or bicycle wheel. In the late phases in the area of \u200b\u200bneovascularization, there is a prolonged bright extravasal hyperfluorescence (Fig. 6-20, 6-21). Rupture of newly formed vessels leads to subpigmented or subretinal hemorrhages (Fig. 6-22, 6-23, 6-24, 6-25, 6-26). In rare cases, a breakthrough of hemorrhage into the vitreous body with the development of hemophthalmos is possible. The cicatricial form is characterized by the development of fibrous tissue with the formation of a scar (Fig. 6-27).

Treatment

In the non-exudative form, antiplatelet agents and vasodilators are prescribed, stimulation of the retina with low-energy laser radiation is indicated. In the exudative form, dehydration therapy (local and general) and laser coagulation of the retina in the central zone are used. With neovascularization, direct laser coagulation of the subretinal neovascular membrane is performed.

Surgical treatments are aimed primarily at improving the blood supply to the posterior pole of the eye and include different kinds revascularizing and vasoreconstructive operations.

Literature

1. Katsnelson L.A., Forofonova T.I., Bunin A.Ya. Vascular diseases of the eyes. - M .: Medicine, 1990. - S. 176-182.
2. Gass J.D. Senile disciform macular degeneration // Amer. J. Ophthalmol. - 1967. - Vol. 63, No. 3. - P. 617-629.
3. Gass J.D. Stereoscopic atlas of macular deseases. - St. Louis etc .: CV Mosby Co., 1977.-411p.
4. Schats H., Burton T., Lawrence A., Maurice F. Interpretation of fundus fluorescein angiography. - St. Louis, 1978.

	Draining drusen in the macular and central areas of the fundus
	Draining drusen in the central and paracentral regions
	Druze. FAGD. Late phase. Fluorescence of solid druses in the central zone of the fundus.
	Druze. FAGD. Arteriovenous phase. Fluorescence of multiple solid druses.
	Druze. FAGD. Late phase. Fluorescence of confluent druses in the central zone of the fundus.
	Druze. FAGD. Late phase. Hyperfluorescence of multiple druses; hyperfluorescence of the subretinal neovascular membrane in the macular region with perifocal hypofluorescence of the retina, respectively, in the area of \u200b\u200bhemorrhages.
	FAGD. Late phase. Non-exudative CCRD, hypo- and hyperfluorescence zones are caused by pigment redistribution.
	Detachment of the pigment epithelium. The focus is rounded with clear boundaries in the central zone of the retina.
	FAGD. Arteriovenous phase. Detachment of the pigment epithelium against the background of drusen. Hyperfluorescence of pigment epithelium detachment.
	FAGD. Late phase. Hyperfluorescence of exudative neuroepithelium detachment.
	FAGD venous phase. Cicatricial form of CCRD with a zone of hyperfluorescence in the region of the subretinal neovascular membrane.
	FAGD late phase. Extravasal hyperfluorescence in the area of \u200b\u200bthe subretinal neovascular membrane and hypofluorescence in the area of \u200b\u200bhemorrhages.
	Exudative hemorrhagic stage of the CHRD. Hyperfluorescence of neuroepithelial detachment with hypofluorescence in the area of \u200b\u200bhemorrhages. FAGD. Arteriovenous phase.
	Hemorrhagic detachment of pigment epithelium in a patient with CHRD.
	Hemorrhagic detachment of the pigment epithelium. FAGD. Arteriovenous phase. Hypofluorescence due to the shielding effect of subretinal hemorrhage.
	Exudative-hemorrhagic stage of disciform CCRD (pseudotumorous).
	FAGD arteriovenous phase. Hyperfluorescence in the zone of separation of the pigment epithelium.

The pigment epithelium of the retina is a layer of cells localized outside its neural sheath. This layer is formed by specific light-sensitive tissue elements that provide the most important functions of the organ of vision.

Detachment of the pigment epithelium occurs due to a violation of the normal adherence of the pigment epithelium to Bruch's membrane. Pathology can occur due to inflammatory, vascular or dystrophic processes. The existence of a detachment can be prolonged, with practically no dynamics of the process, it can disappear spontaneously, it can transform into a hemorrhagic detachment due to the invasion of the vessels of the choroid. True, most often the penetration of serous fluid from under the detached pigment epithelium into the subretinal space provokes the appearance of serous detachment of the retinal neuroepithelium. In addition, rupture of the detached area of \u200b\u200bthe pigment epithelium (spontaneous or due to intense laser coagulation) is not excluded. This leads to a sharp decrease in visual function.

Detachment of pigment epithelium is usually a one-sided process. More common in young men.

Disease Signs and Diagnostic Criteria

With partial detachment of the macular region of the sensory retina from the pigment epithelium with a clear and pure serous fluid, blurred vision or fog appears before the eyes. Visible objects are curved and reduced in size. Fluctuation of visual acuity according to the tables is determined in the range of 1.0 - 0.4. Examination with the Amsler grating reveals curvature of straight lines, the presence of scotoma is often detected.

To diagnose the disease, the following ophthalmological examinations are prescribed:

• Visometry.
• Ophthalmoscopy.
• Perimetry
• Fluorescence angiography.
• Testing with Amsler grid.

In addition, mandatory laboratory tests are prescribed: general analysis blood
and urine; blood on RW and sugar.

You may need an ECG and consultation with a therapist.

With detachment of the pigment epithelium, the edges of the detachment are seen more clearly than in the case of central serous chorioretinopathy. This process is characteristic of central serous chorioretinopathy and age-related macular degeneration.

Treatment

For the treatment of retinal pigment epithelium detachment, the patient must be placed in an ophthalmological hospital for a period of 14 days, where conservative and surgical methods can be applied to him.

The goal of treatment is to achieve anatomical fit of the retina, reduce the size of the central scotoma, and improve visual acuity.

Conservative treatment of the disease, as a rule, includes injections (subconjunctivally) of corticosteroids, the use of angioprotectors and antioxidants, and the use of nonspecific anti-inflammatory drugs and diuretics. Osmotherapy, drugs with vasodilating and antihistamine properties are prescribed.

In the absence of effect from the use of conservative therapy for 3 weeks or in case of recurrence of the disease, laser coagulation is performed. It can also be carried out after 2 months with positive dynamics from conservative therapy or if a very quick restoration of vision is required, which is associated with the patient's profession.

The general disability of the patient is 3-4 weeks. After discharge from the hospital, he is shown a medical examination.

Physical activity, work with a tilt of the torso, concussion or vibration, as well as exposure to toxic and toxic substances are contraindicated. People involved in mental work need to reduce the amount of work.

Among possible complications disease - its relapse.

20.04.2018

Retinal detachment. These words have been heard by every person throughout life in one context or another, and they are invariably accompanied by anxiety and fear. As a condition, retinal detachment really refers to vision, if not life-threatening. Delaying treatment, untimely access to a doctor, diagnostic errors and other stumbling blocks on the way to getting rid of this condition threaten with irreversible loss of vision.

What is the retina and why is it important?

Imagine an eye in a sagittal, that is, sagittal, section. The surface of the eye is covered by a transparent membrane called the conjunctiva. Above the pupil, the conjunctiva passes into the cornea. The sclera is located under the conjunctiva - it is white, and under the cornea is the iris, in the center of which is the pupil. Behind the pupil is the lens, and behind it is the vitreous humor.

It fills most the intraocular space, and between it and the sclera is the retina, or retina. Its function is the perception of light rays collected and refracted by the cornea and lens. In other words, this structure of the organ of vision is responsible for the coordinated work of the visual analyzer, converting the received light impulses into electrical ones, which are subsequently transmitted to the cortical analyzer along the optic nerve.

The retina consists of an unevenly distributed number of two types of nerve cells - rods and cones. The former are responsible for light perception, the ability to distinguish the outlines of objects in the dark, and also to navigate in space. They are located relatively evenly over the entire surface of the retina, but still there are more of them on the periphery. Cones are responsible for the difference in colors, their shades and visual acuity in general. This type of nerve cells is focused in the central part of the retina, since it is on this area that refracted light rays are projected.

A thin choroid is located between the sclera and the retina, which provides power to the peripheral part of the visual analyzer. Detachment of the retina from the choroid entails a violation of its trophism, which means necrotization and loss of the ability to transform and transmit further light impulses. In other words, a person simply loses his sight.

Causes of retinal detachment

The reasons for the development of such a serious pathological process are usually divided into groups, in connection with which there are several etiological types of retinal detachment.

1. Traction, the vast majority of cases of which are associated with pathology vitreous... Closely adhering to the retina, the vitreous body can create tension in some of its parts during the formation of connective tissue cords or vascular invasion. Similar changes in the vitreous body occur in particular with diabetic retinopathy, and therefore diabetics should regularly visit an ophthalmologist for preventive purposes.
2. With rhegmatogenous retinal detachment, its rupture occurs in the place where its normal structure is transformed or thinned. The transformation of the sites often occurs due to dystrophic changes that may not be diagnosed before the rupture appears. A person simply begins to feel the symptoms accompanying this pathology, without the slightest suspicion of their nature. For this reason, rhegmatogenous detachment is also called primary or idiopathic, that is, one whose cause cannot be accurately determined. The fluid produced by the vitreous body falls under the detachment site, and due to the disturbance of trophic processes, the retina in this place dies off, and with it the patient's vision "perishes". A rupture in dystrophically altered places can occur with excessive physical activity, trying to lift a weight, when making sudden movements or even at rest.
3. Secondary retinal detachment resulting from existing diseases of the functional structures of the eye. These include infectious and inflammatory diseases eyes, neoplasms, thrombosis, retinopathy and hemorrhage.
4. Traumatic retinal detachment. This view pathology is provoked by trauma, and subsequent detachment can occur both at the time of its receipt, and within hours / months / years after the action of the traumatic factor. Detachments that have arisen against the background belong to the same category. surgical intervention.
5. Serous (exudative) retinal detachment, which occurs during the accumulation of fluid behind the retina. At the same time, the retina itself does not undergo tears or dystrophic changes.

It cannot be reliably asserted about the connection between retinal detachment and the following factors, but it has been noticed that they often accompany the pathology that has arisen. These include:

• Elderly age. People over sixty years of age have a higher risk of developing the condition compared to younger people.
• High grade mopia. Up to half of the world's cases of retinal detachment are accompanied by high degrees of myopia.
• Postponed operations on the eyes. Statistics say about forty percent of cases of pathology in response to eye surgery.
• Availability hypertension, and especially hypertensive crises.

These risk factors should alert their owners to the occurrence of such a serious pathology and urge patients to carefully monitor their own health in order not to miss initial signs detachment of the retina.

Signs of retinal detachment

Retinal detachment requires everyone to know its symptoms, not just those who are most at risk of its occurrence. So, we remember them.

• Before the eyes there is a flickering of black dots, which interfere with concentrating on the object in question, do not disappear after rest or sleep.
• At the very beginning of the detachment, the patient may pay attention to the appearance of flashes in the eyes, which appear in the form of glare, lightning, and spots of light.
• Also at this stage, patients note the curvature of straight lines, the oscillation of the objects under consideration, their trembling and blurring.
• A progressive decrease in visual acuity appears, the time frame of which is very narrow: with massive detachment, a person can lose sight in just a few hours.
• A black spot, veil, or line appears. This blackness is the site of detachment, which no longer perceives and does not transmit light pulses further for processing to the central organ. nervous system - the brain. The localization of the invisible area in the field of view is determined by the localization of the retinal detachment site. This symptom progresses to complete loss of vision as the patient progresses.

Important! When a dark veil appears at a doctor's appointment, it is necessary to clarify from which side it began to spread.

• Retinal detachment, a symptom of which is a narrowing of the visual field, is called marginal, or peripheral. In such a situation, vision begins to fade from the edges. After sleep and in the morning hours, this symptom decreases somewhat, which the patient mistakenly takes for an improvement in the clinical condition.
• In some cases, a symptom of retinal detachment is the loss of letters, words or sections of text from the field of vision when reading. This indicates the capture of the central part of the retina by the pathological process.

The insidiousness of this pathology is that, for all its seriousness, it does not cause pain. With this course of the disease, a person may not rush to see a doctor, "because it does not hurt", writing off the occurrence of retinal detachment and its symptoms for overwork, nervous shocks and other life circumstances. Instead of going to an ophthalmologist immediately, such patients spend precious hours sleeping and resting, believing that everything will go away by itself in the morning.

And if in the morning, after a long stay in a horizontal position, the retina "falls" into place, adhering more closely to the choroid and the symptoms of the disease decrease, a person may even refuse to visit a doctor, referring to positive dynamics.

Only effective method treatment - surgical intervention, and the earlier it is carried out, the more chances the patient has in the hope of returning full vision.

Diagnostics of the retinal pigment epithelium detachment

Despite the fact that in ophthalmic practice, retinal detachment with its symptoms is an urgent condition, before starting treatment for this condition, it is necessary to conduct a comprehensive medical examination of the patient.

• Examination with an ophthalmoscope will allow you to assess the localization, shape and size of the pathological process. The presence of retinal ruptures is confirmed or refuted.
• Research is carried out using contact and non-contact lenses.
• With chronic retinal detachment, electrophysiological research methods are used to assess the functionality of the eye and, at the same time, make a prognosis regarding the restoration of vision in the patient.
• In the case of concomitant eye diseases that make it difficult to study with lenses or an ophthalmoscope, ultrasound is used.
• Perimetry and assessment of the visual acuity indicator are performed, which makes a proper contribution to determining the magnitude and localization of the pathological process.
• In addition, intraocular pressure is measured, which can be reduced in comparison with a healthy eye.

Detachment of the retina: symptoms in an ophthalmoscope

Normally, a fundus examination with an ophthalmoscope using plus lenses gives a red reflex. This is the name of the reflection of light from the inner surface of the eye, and it is really red. This color is due to the translucence of the vessels through the retina, which, as mentioned above, serves as a source of powerful blood supply and nutrition to the retina.

With its detachment, the red reflex from the fundus disappears, leaving behind a gray or whitish color. This is the picture with massive or complete detachment. Detachment of a small height indicates itself only by a change in the clarity of the viewed vessels, their course or size. However, an experienced ophthalmologist will notice such minor changes.

Detachment of the pigment layer of the retina of great height is defined as a tall bladder filled with a grayish or white cloudy liquid, it can fluctuate with eye movement. Old detachments leave behind rough areas of the retina that are subject to wrinkling, folds and scars.

With the help of an ophthalmoscope, the doctor can determine the presence of a rupture. The gap looks even more red against the general background of the fundus due to the better visibility of the choroid. If the pathological process could be diagnosed at the stage when further treatment will give positive results, the doctor can make a prediction regarding the prospects for treatment and the progression of the disease based on one ophthalmoscopy.

Retinal detachment: is it possible to return vision?

There is no definite answer to this question. In order to find out the forecasts of treatment results in each specific case, you must personally visit the doctor. Remember: the earlier you see your doctor about treatment, the more results it will give.

There is only one method of treatment for retinal detachment, and it is surgical. But there are already two types of it, and they are divided into extrascleral, that is, those that are produced through the sclera, and endovitreal, where the vitreous body acts as the access point to the diseased area.

The principle of both types of surgery is to block the gap, as well as bring the retina closer to choroid... Both serve to restore adequate trophism of the retina, which is the key to the return and preservation of vision.

Of course, such a threatening problem should be addressed to medical institutionswho have a sufficient level of qualifications and an impeccable reputation. Undoubtedly, each person wants to meet the most friendly attitude, close attention and reasonable cost for services.

In Moscow, a multidisciplinary medical Center named after Svyatoslav Fedorov. Constantly improving their qualifications, European standards of treatment and attentive nursing staff - what awaits you when you contact our medical center.

Remember, retinal detachment does not tolerate diagnostic or therapeutic failures. Save your sight with us!

Cost of retinal detachment surgeries:

Central chorioretinal is degenerative changes on the retina in the zone of best vision. In the area of \u200b\u200bthe macula, blood does not flow to the cells, so they gradually die off and are replaced connective tissue... If untreated, a person completely loses central vision. The disease in the early stages is asymptomatic, so it is difficult to diagnose it at an early stage of development. To slow down the pathological process, complex treatment drugs, physiotherapy, surgical intervention.

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What is Central Chorioretinal Dystrophy?

Central chorioretinal dystrophy or CCRD is a malnutrition of the retina in the macula or zone of best vision. An alternative name for the pathology is senile macular degeneration. The disease is considered age-related, because it occurs most often in older people over 60 years old, mainly in women.

During aging, retinal tissue degeneration is observed, which leads to irreversible changes in the macular area. As a result, the person loses most of the central vision. Tissues distant from the vessels die and subsequently scar - they are replaced by fibrous connective tissue. The pathological process in most cases affects both eyes, but rarely can progress faster on one of the retinas.

At the same time, in the absence of timely treatment, CCRD does not lead to complete loss of vision. does not extend to the peripheral retina, so the person continues to see objects at the edges of the visual field. But in this case, he becomes unworkable, as he loses the basic abilities that require clear vision: writing, reading, driving.

With age, the risk of pathology increases:

• from 51 to 64 years of age, the probability of developing CHRD is 1.6%;
• from 65 to 74 years old - 11%;
• in people over 75, the risk reaches 28%.

The disease is chronic and slowly progresses. CHRD does not lead to retinal detachment. Dystrophic changes affect the choriocapillary layer, the retinal pigment layer and the Bruch's membrane located between them, or the vitreous plate.

The reasons

Chorioretinal dystrophy does not occur for one specific reason. The development of pathology is provoked by several factors:

• hereditary predisposition, if the disease manifested itself in one of the parents or close relatives;
• the presence of high myopia;
• circulatory disorder in the eye vessels, microcirculation disorder in the choreocapillaries;
• the effect of free radicals and ultraviolet rays on the retina;
• injury eyeball, severe poisoning or infection;
• bad habits;
• weakening of immunity;
• diseases endocrine system: diabetes, damage to the thyroid gland;
• pathology of cardio-vascular system: high blood pressure, atherosclerosis, increased blood clotting and a tendency to form blood clots;
• unbalanced diet, obesity.

CHRD can arise as a congenital disease that is inherited in an autosomal dominant way, or as an acquired pathology. In the latter case, retinal dystrophy is provoked by intoxication, severe infectious and inflammatory disease or eye injury.

REFERENCE. The risk group includes not only women, but also people with light iris and skin. The likelihood of pathology increases in patients who have recently undergone surgery cataracts.

Useful video

Retinal dystrophy what is it:

Signs of the disease

The dry form of CCRD begins asymptomatically and is characterized by a slow course, therefore, at first, the patient does not complain of discomfort or pain. The person maintains normal visual acuity. In some cases, patients note:

• distortion of the shape and size of visible objects;
• distortion of straight lines;
• bifurcation of objects;
• the appearance of blind spots;
• over time, the image fades, as if a person is looking through a glass of water;
• visual acuity decreases slowly.

Pathology can stop at some stage and no longer manifest or continues to progress until a person completely loses central vision. In this case, the disease first affects one eye. Changes in the other become noticeable only after 5-6 years.

Possible complications

Degenerative changes in the retina lead to a sharp deterioration in vision, which is not restored after undergoing drug therapy or surgery. In some cases, CHRD leads to a complete loss of central vision. As a result, a person sees only 2-3% outside world on the periphery of the retina. If the pathological process continues to progress and the retina begins to exfoliate in the peripheral areas, complete blindness may develop.

With CHRD, the following complications are possible:

• increased intraocular pressure, which increases the risk of developing angle-closure glaucoma;
• hemorrhage in the vitreous cavity;
• clouding of the transparent media of the eyeball.

Retinal detachment in CCRD leads to the formation of chorioretinal scars at the junction of the macular zone with the choroid of the fundus. With timely treatment, vision is not restored, because the area of \u200b\u200bbest vision is partially overgrown with connective tissue. A person sees dark spots before his eyes.

Prevention

To prevent the development of pathology, you should adhere to several principles:

• take multivitamin complexescontaining vitamins A, B, E, dietary supplements with zinc;
• perform daily exercises from the complex of gymnastics for the eyes;
• balance the diet, supplementing it with fresh fruits and berries with a high content of minerals and vitamins;
• protect eyes from ultraviolet radiation and sunlight;
• do not overstrain your eyesight, give your eyes a rest;
• if possible, get rid of bad habits.

On the early stages the disease is asymptomatic, therefore, you should undergo a preventive examination by an ophthalmologist at least 2 times a year every 6 months.

Conclusion

Central chorioretinal dystrophy affects the retina in the macular region. In this case, with the progression of the disease, the patient is able to distinguish only objects on the periphery of vision. He will not be able to see in front of him, so his reading or writing skills are lost.

To slow down the development of the pathological process, complex treatment is prescribed. The person takes medications and undergoes physiotherapy. With low efficiency conservative treatment prescribe laser coagulation of the retina or perform surgical intervention.

Anastasia Zharova

Internet journalist, copywriter.

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