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Macular edema: types (diabetic, cystic) and their features

Macular edema ("Irwin-Grass syndrome") is characterized by scientists as a postoperative complication. The cause of its occurrence and pathogenesis have not yet been finally established, but it was noticed that after certain types surgical intervention, the frequency of manifestation of this syndrome is several times higher than with others.

The macula (macula) makes it possible to distinguish colors, small details, provides clear vision, therefore, its damage leads to serious visual impairment and causes significant discomfort.

Irwin-Grass syndrome occurs as a result of the accumulation of fluid in the layers of the macula and there are three types of it:

• Cystic macular edema of the eye (CMO). The mechanisms of occurrence are hypoxic and (or) inflammatory.
• Diabetic macular edema (DME);
• Age-related degeneration.

Cystic macular edema

This type of macular edema is often triggered by the phacoemulsification procedure used to treat cataracts. In most cases, CMO appears 6-10 weeks after surgery. A common factor in the development of edema is the tension that occurs between the retina and the vitreous.

Macular edema is also called Irwin-Grass syndrome.

The causes of cystic macular edema can also be the following ophthalmic disorders and diseases such as: uveitis, Behcet's syndrome, cyclitis, HIV, CMV, etc. Also, in some cases, retinitis pigmentosa (dysfunction pigment epithelium retina).

Sometimes, cystic macular edema can go away without any treatment. The transition of the disease to a chronic form can lead to damage to the retina (its photoreceptors) with fibrous degeneration. With cystic macular edema of the eye, treatment with non-steroidal anti-inflammatory drugs is indicated.

Diabetic macular edema

The emergence of DMO is provoked by complications of diabetes mellitus (the appearance of diabetic retinopathy).

Diabetic macular edema has two forms:

• focal (does not apply to the macular zone);
• diffuse (affects the central region of the retina and causes its degeneration).

DMO develops as a result of impaired capillary permeability and thickening of the vascular membranes. It is macular edema that leads to vision loss in diabetes.

Diabetic macular edema got its name because of the main cause of its development - diabetes.

Age-related degeneration

This type of macular edema occurs under the influence of age-related changes in people over 40 years old. The exudative (wet) form occurs in about 20% of all cases.

Women are more likely to suffer from this pathology than men. The causes of AMD are: heredity, excess weight, bad habits, injuries, poor ecology and vitamin deficiency in the body.

The symptoms of this disease are as follows: difficulties in reading (loss of letters), distorted color perception and perception of the shapes of objects. On the last stages therapy does not give the expected therapeutic effect.

Causes and symptoms

Macular edema of the retina is a complication that often occurs against the background of the following pathologies ( common reasons occurrence):

• retinopathy;
• thrombosis of the central retina (its branches);
• uveitis;
• tumors (including mushroom-shaped);
• retinal detachment (local);
• autoimmune pathologies (collagenosis);
• all kinds of defeat eyeball;
• glaucoma;
• retinal disinsertion.

Macular edema can be provoked not only by eye diseases.

The appearance of macular edema can also provoke such diseases and pathological conditions: atherosclerosis, rheumatism, blood and kidney diseases, allergic reactions, brain pathologies and some infectious diseases (toxoplasmosis, HIV and tuberculosis).

Irwin-Grass syndrome is accompanied by the following symptoms:

• deteriorating central vision;
• photophobia (photophobia) occurs;
• the image takes on a pink tint;
• decreased visual acuity (mostly in the morning);
• deformations of straight lines appear.

Diagnostics

One of the main methods for diagnosing macular edema is OCT (optical coherence tomography).

Optical coherence tomography is the main diagnostic method for suspected macular edema.

With the help of OCT, it is possible to assess:

• fundus structure;
• thickness;
• volume;
• vitreoretinal relationships.

The following diagnostic measures can also be used:

• amsler test (detects the presence of cattle and metamorphopsia);
• fluorescent angiography (helps to identify ischemic and vascular disorders of the retina with occlusion of the central vein);
• ophthalmoscopy (retinal edema is detected by the picture of the fundus);
• heidelberg retinal tomography (the thickness of the retina is estimated).

For each specific case, a specific diagnostic algorithm and treatment tactics are selected.

Treatment

Treatment of macular edema of the retina can be carried out by such methods: medication, laser, folk and surgical.

Traditional medicine will not cure macular edema, but will only help relieve symptoms.

Drug therapy (conservative method)

When treating with a drug method, anti-inflammatory medicines (steroid and non-steroidal hormones) in such dosage forms:

• injections;
• tablet form;
• eye drops.

The most commonly assigned are the following medications: Avastin, Lucentis, Kenalog, Diclogen. But in the presence of pronounced changes in the vitreous, this method is ineffective. In such cases, removal of the vitreous body (vitrectomy) is indicated.

Surgery

Surgical treatment consists of removing the vitreous humor. The operation takes about 3 hours and anesthetics are used to relieve pain.

This procedure can be accompanied by complications: increased intraocular pressure, corneal edema, retinal detachment, nevascular hematoma and endophthalmitis.

The period of vision restoration after surgery depends on the extent and degree of the lesion. In some cases, full restoration of vision is not possible even after treatment.

Avastin is prescribed for withdrawal inflammatory process with macular edema.

Laser treatment

Laser therapy is the most effective and in some cases irreplaceable method (especially in the treatment of DMO in focal form). The essence of this procedure for Irwin-Grass syndrome is to strengthen the eye vessels that allow fluid to pass through.

In addition to the above methods, the traditional method (alternative medicine) is also successful. Especially effective are:

• tinctures of medicinal plants that normalize intravascular pressure (mountain ash and hawthorn);
• eating a sufficient amount of vegetables and fruits rich in nutrients (including collagen).

This method is used as an auxiliary one and is not able to replace traditional methods of treatment (it is especially important to understand this in cases where pathology occurs in a child).

S.Yu. Astakhov, M.V. Gobedgishvili

Department of Ophthalmology
State Medical University named after acad. I.P. Pavlov,
St.-Petersburg
Purpose: to improve functional results of efficacy of phacoemulsification surgery and results of postoperative rehabilitation after phacoemulsification.
Materials and methods: 90 patients (50 males and 40 females) with diagnosed senile cataract and / or POAG after phacoemulsification, phacotrabeculotomy or nonpenetrating deep sclerectomy were included into the study.
Results: Keratopathy was diagnosed in all patients in the first day after surgery.It reduced by 2-3 day of postoperative period. Visual acuity of 0.7-1.0 was detected in the first day after surgery in patients with diagnosis of senile cataract.
In 10 patients after phacotrabeculotomy ciliochoroid detachment was found. In 5% of patients macular edema was diagnosed in 2 months after surgery. In case of macular edema of the size more then 500 micrometers, triamcinolon injections were made intravitreally and NSAIDs were prescribed until complete disappearance of edema.
Conclusion: There was found a necessity of forming of clinical groups according to associated internal and ophthalmologic diseases. These may allow detecting possible complications in each group in postoperative period and giving the recommendation of their prophylaxis.

Pathological changes in the central region of the retina often worsen the functional results of cataract surgery.
There are a number of retinal diseases that do not make it possible to obtain high visual acuity after surgery (age-related macular degeneration, retinal rupture, diabetic retinopathy, etc.). In the case of severe lens opacity, the final postoperative visual function remains unclear. Only after the transparency of the optical media of the eye is restored, it becomes possible to obtain complete information about the state of the retina, including with the help of special diagnostic methods.
However, there are pathological changes in the retina associated with surgical treatment. Macular edema is considered one of the late postoperative complications. This condition after cataract extraction was first described by S.R. Irvine in 1953. Today, the above-described postoperative complication is formulated as Irvine-Gass syndrome. Despite numerous clinical and laboratory studies for more than half a century, the cause and pathogenesis of this syndrome remain unclear.
The type of surgery affects the incidence of cystic macular edema. N.S. Jaffe, H.M. Daymen et al. (1982) showed that extracapsular cataract extraction is much less likely than intracapsular, causes the development of macular edema. After extracapsular cataract extraction, the frequency of its occurrence is from 2 to 6.7% (Mentes J. et al., 2003).
In recent years, the technique of removing the lens has changed dramatically. Currently, phacoemulsification (PE) is the main method of cataract extraction in most ophthalmological clinics in the world.
The objective advantage of this method over traditional extracapsular cataract extraction is considered to be a small (1.8-3.0 mm) valve self-sealing incision, which makes it possible to minimize the number of postoperative complications and thereby achieve high visual acuity already in the first day after the intervention.
Despite the constant improvement of the surgical technique for removing cataracts, this operation is inevitably accompanied by an inflammatory reaction (Adabashyan S.A., 2000). Surgical trauma to the iris and ciliary body or epithelial cells of the lens induces the synthesis of prostaglandins, and also increases the intensity of oxidative reactions. Free radicals and lipid peroxidation products are one of the main damaging factors that cause destruction of eye tissue during inflammation. (Katargina L.A. et al., 2003). Their number may depend on the power and duration of exposure to ultrasound (US) during PE and / or different types and models of phacoemulsifiers (Aust S., 2009).
Thus, as a result of surgical trauma, not only postoperative stress on the organ of vision occurs, but also trauma to the uveal tract, which leads to impaired microcirculation and increased glycolysis, followed by the development of tissue hypoxia. In turn, hypoxia contributes to the violation of the permeability of cell membranes. The severity of the course of postoperative inflammation depends on the type of surgery and is most pronounced after extracapsular cataract extraction.
However, despite the 42-year experience of phacoemulsification in clinical practice, the problem of studying the functional results of surgical intervention in early and late postoperative periodassociated with the effect of ultrasound energy on the intraocular structures, in particular on the elements of the outer layers of the retina and the pigment epithelium.
It is known that ultrasound has a damaging effect on the cornea (the development of edema due to the loss of endothelial cells), and the degree of its changes depends on the power and time of ultrasound exposure to the eye tissue. The question of the possible effect of ultrasound on the retina in PE is still unresolved.
With FE, the progression of destruction of the vitreous body is also noted. There is evidence that the high mobility of the vitreous body, caused by vitreous destruction, enhances contusion-traction effects on the vitreoretinal interface and contributes to the emergence of retinal pathology (Makha-cheva Z.A., 1994). R. Grewing, B. Rao believe that PE does not affect the change in the thickness of the retina after surgery in the absence of concomitant ocular pathology.
In 2004, N.S. Galoyan proved that the use of ultrasound phacoemulsification leads to changes in the morphological state of the central retinal zone in eyes without concomitant ocular pathology (the changes are reversible and completely disappear a month after PE).
It has not yet been proven whether YAG laser discision contributes to secondary cataract an increased risk of developing macular edema.
The macular area within a radius of 20 ° from the fixation point responds to surgical intervention. Postoperative edema of the macular region of the retina, expressed to varying degrees, is not always visualized by ophthalmoscopy.
Today, there are modern research methods that allow you to identify even minimal changes in the morphology of the retina and to conduct an objective dynamic observation of the pathological condition.
Methods for assessing retinal thickness can be divided into subjective and objective. Currently, the most commonly used techniques for subjective assessment of retinal edema (thickening) are retinal biomicroscopy using aspherical or contact lenses, as well as stereophotography of standard retinal fields, which is more common in European countries and the United States (Fig. 1). Of objective methodsthat allow us to assess the thickness of the retina, today there are several: retinal confocal tomography (HRT), fluorescence angiography (FAG) and optical coherence tomography (OCT) (Lobo C., 1999; Verano M., 1999; Yoshi-da A. , 2000).
Of the objective methods for diagnosing macular edema, OCT is considered the safest and most informative. The main advantage of this method is a quantitative assessment of the thickness of the retina, with its help it is possible to objectively, quickly and accurately diagnose pathological changes in the central zone of the retina. OCT ranks 1st in terms of efficiency in early diagnosis macular edema.
In OCT, the tissue is illuminated (probed) by radiation, the source of which is a superluminescent diode. The use of low-intensity near-infrared light as probe radiation is particularly attractive due to its non-invasiveness and relatively weak absorption of light in the range of 700-1300 nm by biological tissues.
The method is based on determining the degree of radiation reflection depending on the time of its propagation in the medium. In the OCT image, the contrast between different microstructures of the tissue occurs due to the different scattering properties of its elements.
OCT is universal method evaluating the structure of tissues with a layered structure, however, it is advisable to use it only in cases where the depth of interest of interest is no more than 2 mm. It shows an image of the tissue structure in the same orientation as a histological specimen cut perpendicular to the tissue surface.
The most widely developed diagnostic capability of the method in the pathology of the retina, in particular the macular zone (Fig. 2, 3).
On the tomogram, all layers of the retina (from the pigment epithelium to the inner border membrane) and part of the choroid and vitreous body are visualized. When mapping the retina healthy person the macular area, the average thickness of which is 200-250 microns, is indicated in green, with natural thinning in the foveola zone (blue, average thickness 170 microns).
On the tomogram, white areas are indicated with a thickness of more than 470 microns, red - 350-470 microns, orange - 320-350 microns, yellow - 270-320 microns, green - 210-270 microns, blue - 150-210 microns.
Recent data on the incidence of macular edema after uncomplicated phacoemulsification indicate that the frequency of subclinical forms of the latter, detected by optical coherence tomography, reaches 41% (Lobo C. L. et al., 2004).
According to I. Perente's study, an increase in retinal thickness by the end of the 1st month after surgery was established. And by the 3rd month, its return to the initial norm is noted (Biro Z. et al., 2006).
In the literature, it is noted that an increase in the thickness of the retina in the central regions (according to OCT) is a manifestation of subclinical macular edema and can further lead to the development of cystic macular edema (Biro Z. et al., 2006).
The initial thickening of the retina in the center by 80 μm or more can be considered a prognostic factor for the development of macular edema. To standardize the approach to the diagnosis of this pathology, it is better to focus on the percentage change in the initial retinal thickness in the center.
The results of the S.J. Kim testify that the initial thickening of the retina in the center by 40% according to OCT is a reliable and significant criterion for the development of macular edema after surgical treatment.
The risk of developing macular edema increases in the presence of a previous eye injury, as well as in a patient with glaucoma, diabetes mellitus, myopia, retinal and vitreous dystrophy, inflammation of the choroid, etc. Conditions of this kind cause the presence of pathological changes in the immune and vascular systems, violations metabolic processes in the body.
In diabetes, diffuse retinal edema is associated with impaired capillary permeability. These pathological changes are associated with the aggressive effect of surgical stress factors (CS) on the macular retina. Timely identification and treatment of stress-induced macular changes, when the retina still retains the adaptive reserves for restoring metabolic disorders, is the optimal way to obtain high visual acuity at the end of the operation (Egorov V.V. et al., 2008).
Macular edema caused by vitreoretinal traction is often diagnosed. The epiretinal membrane forms in the vitreous cavity. Its development is associated with age-related changes on the fundus. Often found with vascular, inflammatory diseases and eye injuries.
As the progression progresses, the epiretinal film begins to pull on the retina in the central region, which causes edema and further retinal rupture.
If certain risk factors are identified in predicting the development of various types of macular response to cholesterol, it is necessary to carry out their prevention.
Despite the fact that there are currently different opinions regarding the role of vitreous traction and inflammatory mediators in the pathogenesis of macular edema, most researchers believe that inflammation is the most important factor in the development of this condition (Yannuzzi L.A., 1984). Prostaglandins play the main role in the formation of the inflammatory reaction, therefore, treatment is mainly associated with a decrease in their activity.
Today, there are several methods for treating macular edema: conservative, laser and surgical.
Topical corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used for drug treatment.
Corticosteroids are often used as part of traditional treatment for several weeks after surgery to ease the inflammatory response. However, well known side effects corticosteroids: increased IOP, development of cataracts, decreased local immunity, inhibition of wound healing processes, ulceration of de-epithelialized areas of the cornea.
The main advantage when prescribing NSAIDs is the absence of undesirable effects that occur during treatment with corticosteroids.
The preoperative use of NSAIDs significantly increases the effectiveness of cataract surgery. Instillation of NSAIDs should be started three days before surgery. For macular edema, NSAIDs are prescribed according to the standard scheme: 1 drop 4 times / day.
In a study examining the effect of steroid and non-steroidal anti-inflammatory therapy on the incidence of macular edema during cataract extraction with IOL implantation, it was found that when dexamethasone was used, the incidence of this complication was 32.2%, and in patients receiving indomethacin - 12.4% ( Solomon LD et al. 1995).
In the case of vitreoretinal traction syndrome, only surgical treatment is indicated.
At the department of St. Petersburg State Medical University named after acad. Pavlova, a study is being conducted, the purpose of which is to increase the functional results of surgical intervention and the effectiveness of postoperative rehabilitation of patients who have undergone phacoemulsification.
The study was conducted in 90 patients (50 men, 40 women) with age-related cataracts and / or primary open-angle glaucoma (POAG) who underwent phacoemulsification, phacotrabeculectomy, or non-penetrating deep sclerectomy.
Results. On the first day after the operation, the patients had a slight keratopathy (corneal edema, folds of the Descemet's membrane), which was stopped mainly on the 2-3rd day after the operation. All patients with age-related cataracts without other concomitant eye pathologies had high visual functions on the first day after the operation (from 0.7 to 1.0). In half of the patients, slight opalescence of moisture in the anterior chamber was revealed, the disappearance of which was noted by the 5th day after the start of standard anti-inflammatory treatment. In patients after facotrabeculectomy (10 eyes), as a result of a sharp drop in IOP, a ciliochoroidal detachment appeared. Postoperative macular edema was diagnosed in 5% of patients 2 months after surgical treatment. When prescribing topical NSAIDs without a combination with other drugs, the edema decreased to 100 microns. In the case of macular edema greater than 500 μm, intravitreal injections of Kenalog 40 (triamcinolone) were performed; after one injection, the edema was significantly reduced. Then, the patients received topical NPVN until the macular edema completely disappeared. In 50% of patients who received topical NSAIDs in the pre- and postoperative period, there was an increase in retinal thickness, which returned to normal after 3 weeks. after operation.
Analysis of the clinical and functional results of the studied patients revealed the need for systematization of patients by clinical groups, taking into account the accompanying common diseases and ophthalmopathology, which will determine possible complications in each group in the postoperative period and give recommendations for their prevention.

Literature
1. Evgrafov V.Yu., Batmanov Yu.E. Cataract. M .: Medicine, 2005.S. 310-318
2. Egorov V.V., Egorova A.V., Smolyakova G.P. and other Clinical and morphological features of changes in the macula in patients with diabetes mellitus after phacoemulsification of cataract // Bulletin of Ophthalmology. 2008. No. 4. P. 22-25
3. Shadrichev F.E., Astakhov Yu.S., Grigorieva N.N. et al. Comparative evaluation of various diagnostic methods for diabetic macular edema // Bulletin of Ophthalmology. 2008. No. 4. P. 25-28
4. Takhchidi Kh.P., Egorova E.V., Tolchinskaya A.I. et al. Intra-ocular correction in surgery of complicated cataract // M., 2004. 170 p.
5. Jaffe S. Thirty years of intraocular lens implantation: The way it was and the way it is. // Journal of Cataract and Refractive Surgery. 1999. Vol. 25. No. 4. P. 455-459.
6. Mentes J., Erakgun T., Afrashi F., Kerci G. Incidenc of cys..toid macular edema after uncomplicated phacoemulsification. Ophthalmologica. 2003; 217 (6): 408-412.
7. Gehring J. R: Macular edema following cataract extraction. Arch. Ophthalmol. 1968; 80: 626-631.
8. Sourdille P, Santiago PY. Optical coherence tomography of macular thickness after cataract surgery. J. Cataract Refract. Surg. 1999; 25 (2): 256-261.
9. Lobo C.L., Faria P.m., Soares M. A., Bernardes R.C., Cunda-Vaz J. G. Macular alterations after small-incision cataract surgery. J. Cataract Refract. Surg. 2004; 30: 752-760.
10. Parente I., Ozturker C. et al. Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical tomography // Curr Eye Res. - 2007 Mar; 32 - (3): 241
11. Biro Z., Balla Z., Kovach B. Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implant // Eye - 2006. - Jun 2.
12. Solomon L.D. Efficacy of topical flurbiprofen and indomethacini preventing pseudophakic cystoids macular edema // J. Cataract Refract. Surg. 1995. Vol. 21. P. Surg. 1995. Vol. 21. P. 73-81.

When fluid accumulates in the central area of \u200b\u200bthe retina, edema forms. It resembles a macula and is called macular. The edema affects the light-sensitive cells, resulting in reduced vision.

The causes of macular edema

Macular edema is expressed as a symptom that accompanies such disorders in the body:

• Cataract. In this case, edema can provoke surgery.
• Vascular lesion in diabetes mellitus.
• Blockage of the central vein or its branches located in the retina.
• Chronic inflammatory processes of the vessels of the eyeball.
• Pathologies in the immune system.
• Glaucoma, which is treated with adrenaline.
• Tumors on the vascular membranes.
• Detachment of the retina from the choroid.
• Degenerative disease of the visual organs of a hereditary type (retinitis pigmentosa).
• Contact with toxins in the eyes.

Cystic edema stands out separately. It can be caused by inflammatory or hypoxic processes. At the same time, fluid accumulates in the macula region, as a result of which the central vision deteriorates several times.

Macular edema symptoms

First, consider clinical picture macular edema in diabetes. If the edema has captured the central zone of the macula and spread to an area larger than the two optic discs, it is called diffuse edema. In the absence of damage to the center of the macula and small size of edema, its focal type is revealed.

Macular edema of any type destroys the retinal tissue, due to which there is a gradual decrease in visual performance. This process is accompanied by the following symptoms:

• Central vision blurred. The clarity of the resulting pictures is lost.
• Lines that were once broadcast as straight bend and appear like waves.
• Images are saturated with a pink palette.
• The eyes become sensitive to light.
• Deterioration of vision depending on the time of day. In most cases, it is lower in the morning.
• Very rarely, there may be a change in the perception of colors, depending on the time of day.

Macular edema does not heal until the moment when vision is completely lost. Most often, vision simply falls for a period from two months to one and a half years. Its condition depends on the duration of the edema, which can cause irreversible changes in the retina.

Diagnostics of the macular edema

Visual examinations and fundus examination with an alkaline lamp are not effective methods for making a diagnosis in this case. These methods reveal only the late stages of macular edema. Therefore, in the diagnosis of this pathology, more modern studies are used.:

• OCT - optical coherence tomography. Helps determine the volume, thickness and structure of the retina.
• HRT - Heidelberg Retinal Tomography. The same effect as from OCT, only without data on the structure of the retina.
• FAG - fluorescence angiography. This method is aimed at examining blood vessels using contrasts in the retinal image. It allows you to identify where the liquid is leaking from.

When it comes to identifying initial stage deviations by visual inspection, then the following signs indicate macular edema:

• Dullness of the swollen area.
• Swelling of the macula.
• Flattening of the central fossa.

Timely detection of macular edema will ensure that vision can be restored. Therefore, during the research, all possible diagnostic methods are used.

Here is a possible course of the disease:

Here we see the manifestation of symptoms in macular edema and methods for its diagnosis.

Macular edema ICD-10 code

H35.8 Other specified retinal disorders

Macular edema treatment

Macular edema is treated with medication, surgical and laser methods. The treatment is carried out in this way:

• Anti-inflammatory drugs are prescribed. They are discharged to recover from surgery. In this case, the preference is non-steroidal drugs... These drugs have practically no side effects... Whereas corticosteroids cause an increase in intraocular pressure, a decrease in local immunity and the formation of corneal ulcers.
• If medications do not help, the effect is made directly on the vitreous body. All drugs are injected into its cavity.
• If the vitreous body is severely damaged, it is removed. The operation is called a vitrectomy.
• Diabetic macular edema can only be cured by laser photocoagulation. The pronounced effect of this method is achieved in the case of a focal type of edema. The diffuse type of the disease is difficult to treat, even if extreme measures are taken.

One of the treatment options for macular edema can be traced here:

The result of treatment depends on how long the edema has existed and on the reasons that led to it. If you seek help from an ophthalmologist in time, the macular edema will resolve rather quickly and there will be no complications. Vision will also return to normal.

Rumyantseva Anna Grigorievna

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The human eye is a complex organ that includes a large number of various structures. And each of these structures is responsible for a particular visual function.

In particular, yellow spot (macula) -small element with a diameter of about 5 mm - responsible for central visual perception.

Know! Various kinds of diseases and eye injuries can lead to a malfunction of this structure, as a result of which excess fluid accumulates in it, and edema develops.

Macula - the visual structure of the eye located in central department retina.

This element has a small size, a specific yellowish color, because of which it is usually called a yellow spot in ophthalmology.

Macula responsible for the presence andnormal central visual perception functioning.

In some cases, such a fairly common phenomenon as macular edema occurs. Puffiness is formed as a result of the accumulation of fluid in this area.

This pathology is not an independent disease, arises as a result of other ailments, striking the eyes, or with traumatic injuries of certain parts of the eye.

Pathological accumulation of fluid in the macular region leads to a violation of its functions, and, as a result, to the development of edema and a decrease in central visual acuity.

The disease, as a rule, is reversible, the prognosis for recovery, in most cases, is favorable.

Note! With the right treatment, central vision is fully restored, although this may take a different period of time (from 2 months to 1 year).

In the absence of treatment, pathology often leads to very unfavorable consequences., such as a persistent decrease in visual acuity, up to its complete disappearance.

The causes of the disease

Various external and internal adverse factors can lead to the development of macular edema of the retina, which include:

Clinical manifestations of pathology

At the initial stage of the development of the disease, any of its symptoms may be absent, the patient feels short-term loss of central visual acuity.

This is a phenomenon that only lasts for a few seconds.

As a rule, a person does not pay to this problem special attention.

Over time clinical manifestations ailments become more pronounced.

Keep in mind! Symptoms such as:

1. Blurred central vision, loss of image clarity.
   This phenomenon persists for a longer period of time. Most often, this problem can be seen in the morning;
2. Impaired perception of straight linesthey appear curved and wavy;
3. The color of the image changes, the picture is increasingly taking on a pinkish tint.
   Color perception can change during the day;
4. Rising sensitivity to bright light.

Retinal edema classification

Depending on the cause that led to the swelling of the macula, the course of the disease and the totality of its symptoms, it is customary to distinguish the following types of this pathology:

Diabetic

This form of pathology occurs as a result of a complicated course of diabetes mellitus, accompanied by the presence of diabetic retinopathy.

With a prolonged course of diabetes mellitus, the smallest vessels of the eyes are damaged, as a result of which their permeability increases, and plasma can penetrate into the macular region, provoking its swelling.

You should know! Depending on the area of \u200b\u200bmacular lesion, 2 forms of this type of disease are distinguished:

1. Focal edema has a relatively small lesion area, does not affect central part retina of the eye;
2. Diffuse edema affects the central region, has a larger lesion area.
   This form is considered the most difficult, since puffiness provokes a violation of metabolic processes in the visual structures, leading to their dystrophy.

Cystic

With cystic macular edema specific cavities are formed in the affected area, which over time are filled with fluid.

As a result pressure is broken in the area of \u200b\u200bthe retina and choroid, which leads to the development of the inflammatory process and the accumulation of infiltrate in the macula.

Dystrophic

This form occurs in as a result of degenerative processes affecting the retina.

Remember! As a rule, these processes are associated with age-related changes, therefore, the dystrophic form of edema occurs in the elderly.

In the area of \u200b\u200bthe retina, new vessels are formed, which, growing under it, violate the integrity of this structure (pathological membranes are formed in the retina, through which fluid enters its central part and accumulates there.

Diagnostics

For an accurate diagnosis the doctor interviews the patient for concerns about his complaints, and instrumental examination of the eye.

Today such methods are known. instrumental research as:

Treatment methods

Need to know! There are 3 treatment options for macular edema. The choice of one or another of them is carried out by the doctor, depending on the severity of the disease.

So, to eliminate the disease at the initial stage its development, apply conservative treatment, i.e using medications different directions. The patient is prescribed:

It is possible to cure an ailment with the help of medicines only at the initial stage of its development, when the affected area is still relatively small.

With no expected therapeutic effect these drugs are injected directly into the affected area of \u200b\u200bthe eye.

With the help of a laser, all the affected vessels through which the liquid penetrates into the macular area are soldered together, preventing the penetration of the infiltrate. At the same time, no effect is exerted on the center of the macula itself.

Treatment of a severe form of the disease involves surgical intervention ... So, if there are irreversible violations in the vitreous body of the eye, it must be completely removed.

Useful video

This video details macular edema of the retina:

Vision is one of essential organs feelings for a person. Violation and decrease in its severity leads to significant problems in everyday life.

These violations can be caused by various diseases eyes and other organs. One ofsuch diseases are considered macular edema of the retina.

This problem leads to impairment of central vision, loss of clarity and color of the image.

Pathology is accompanied by a whole set characteristic symptoms, having found which, it is necessary to consult an ophthalmologist

The doctor will conduct an examination and prescribe treatment. And the sooner it is started, the more likely it is that vision will be restored in short periods of time.

In contact with

The retina of the eye performs the function of visual perception of images, converting the light flux into nerve impulses. Pathological processes in the retina will inevitably lead to loss of vision. Retinal edema is a dangerous disease that can be caused by damage blood vessels eye sockets. Consider the symptoms of pathology and methods of treating the disease.

Edema symptoms

The retina is located at the periphery of the visual center and is a thin membrane of the fundus in the immediate vicinity of the vascular network. Any pathology of the fundus vessels immediately has a negative impact on the health of the retina. The quality of human vision depends on the retina, since the maximum acuity of perception of visual images is focused in the macula (its central part).

Edema forms due to the accumulation of excess moisture and protein mass inside the orbit. This is due to damage to the vessels in the fundus, the walls of which lose their elasticity and become inflamed. The liquid fills the eye socket, the white membrane of the eye is deformed. A person loses full vision, the outlines of objects become blurred and are seen in pink.

Note! Retinal edema is not an independent disease, but a consequence of the development of another pathology in the body.

Edema symptoms:

• fog before the eyes;
• pink haze around objects;
• decreased visual acuity in the morning;

A defect in visual perception distorts the correct shapes of objects: a straight line is seen as a curve or wavy.

With swelling of the nerve disc, the symptoms are not expressed for a long time. Pathology manifests itself as a sudden short-term loss of vision. It happens instantly and unexpectedly. Attacks of sudden blindness may recur several times a day. Characteristic feature edema optic nerve one eye is affected, not both. Pathology is accompanied by a failure of pupillary reflexes.

Causes of retinal edema

• diabetes;
• orbital trauma;
• deformation of the vitreous body;
• surgical intervention;
• inflammatory processes;
• increased vascular permeability;
• venous thrombosis of the fundus.

Retinal edema develops against the background of other dangerous diseases as a complication. These include leukemia and lipid dystrophy.

Why is diabetes mellitus one of the causes of fundus disease? Because when metabolic processes are disturbed, it is damaged circulatory system: the walls of the blood vessels are affected. Violation of fat metabolism in the walls of blood vessels leads to the accumulation of fluid, which begins to seep through them and pour out. This provokes oxygen starvation in the visual tissues (not enough oxygen is supplied) and the growth of new vessels. Often, individual edema on the retina grows together and form a cyst - a neoplasm.

Another pathology of the tissues of the eye day is increased pressure, which provokes premature vascular wear and deformation. The appearance of edema can be seasonal and appear as a result of allergies to plant odor and pollen.

Macular retinal edema can also occur with toxicosis in the last trimester of pregnancy. However, this pathology disappears immediately after the birth of the child.

Swelling after cataract surgery is one of the complications. However, edema is mainly susceptible to patients with existing diseases - glaucoma, diabetes, hematopoietic system, previous trauma of the visual organs.

Diabetes

A typical eye disease in diabetes is macular edema of the retina (its central part) and the accumulation of fluid near the veins of the fundus. It is the deformation of the lumen of the veins that provokes the accumulation of moisture, which seeks out through the walls to the outside.

The appearance of new vessels in the fundus to provide the visual organ with oxygen provokes new edema around them, which activates the proliferation of connective tissue. Multiple foci of fluid accumulation lead to cystic changes in the macula, which causes the formation of cavities filled with excess moisture. The result of this pathology is vision loss.

Vascular pathology

A disease of the hematopoietic system also leads to retinal edema. The accumulation of fluid is caused by an increase in the permeability of the vessel walls and blood pressure. High pressure quickly wears out the vascular walls, they become fragile and prone to deformation. Deformed veins lose elasticity and twist - this contributes to the formation of blood clots. Thrombosis provokes the development of puffiness of the optic nerve, which leads to a decrease in vision.

Pathological tortuosity of the veins of the fundus can be a consequence hypertension, diabetes and atherosclerosis. Thrombosis can also appear with carious teeth, viral infections and sinusitis. Dangerous for vision is the blockage of the central vein of the fundus. This pathology leads to retinal degeneration, macular edema, optic nerve dystrophy and glaucoma.

Pathologies of the hematopoietic system

With this disease, occlusion of the vessels of the fundus appears due to circulatory disorders. Moreover, the puffiness of the membranes of the eye is the result of completely different diseases:

• vegetative-vascular dystonia (vasospasm);
• blood poisoning;
• atherosclerosis;
• rheumatism;
• infections.

Blockage can occur after an injury, and after acute infectious diseases... A characteristic feature of pathology, in contrast to thrombosis, is a rapid loss of visual function.

Diagnostics

What diagnostic methods are used to determine retinal disease? Visual examination and even examination of the fundus does not always give a clear picture of health ocular membrane... Therefore, if a pathology is suspected, they are prescribed:

• fluorescent angiography;
• laser tomography.

Coherent tomography is considered the most accurate diagnosis of fundus problems. The method allows you to determine the layer thickness, structure and volume of the retina. Tomography is completely harmless to health, therefore, with the help of it, the results of treatment are monitored.

The subject of antigiography research is the orbital vessels. In this case, the patient is injected into the vein with a contrasting sparkling substance and high-frequency imaging is performed. The picture clearly shows the vascular pattern, which gives information about the presence of changes and areas of edema.

Laser diagnostics provides comprehensive information about the state of the fundus organs, including the retina.

How to treat retinal edema

How is retinal edema treated? The scheme of therapeutic measures is built depending on the nature and severity of the pathology. In simple cases, anti-inflammatory drugs help to relieve puffiness. With pathology of the lens drug treatment indispensable, surgical correction is required.

In diabetes mellitus, the course of treatment consists in eliminating the cause of the increase in blood sugar levels, correcting fat metabolism and blood pressure in the vessels. The course includes hormonal treatment, the appointment of enzymatic drugs to eliminate the consequences of micro hemorrhages in the tissues of the fundus.

In severe cases, it is removed, laser coagulation is prescribed. After removal of the vitreous, it stabilizes and the puffiness disappears. With laser coagulation, the walls of the vessels that allow moisture to pass through are corrected: this normalizes blood flow and eliminates fluid accumulation.

If the cause of the pathology of the lining of the eye is hypertension, treatment is aimed at stabilizing the blood pressure. With thrombosis, drugs are used to resorb blood clots, drugs to normalize eye pressure.

Allergic retinal edema is treated with antihistamines and anti-inflammatory drugs. Drops and oral medications are prescribed.

Folk remedies

Herbal healing helps quick healing, but does not replace it. Application folk methods helps to prevent the development of puffiness, but does not treat existing pathological processes. When complex therapy herbal infusions help stabilize intraocular pressure.

• With increased blood pressure drink tinctures of hawthorn and rowan fruits.
• To improve visual acuity, use fresh vegetables / fruits.
• Effective folk remedy is a salad of chopped raw carrots with the addition of honey - a monthly course.
• To improve the quality of blood and the elasticity of blood vessels, they use beets with honey in any form - boiled or cheese.
• Beet juice with honey has a good effect on the quality of the visual organs.
• A decoction of horsetail herb has a beneficial effect on the visual organs.
• Infusion of sweet clover and propolis can prevent the appearance of blood clots.

Important! If you decide to apply traditional medicine when treating the retina, notify the ophthalmologist.

Celandine recipe

To prepare a healing broth, pour a couple of tablespoons of dry herbs cold water and bring over low heat until boiling. Remove immediately from the stove and wrap for 20 minutes. The cooled filtered broth (take several layers of gauze) is instilled into the eyes three times a day, 3-4 drops from a pipette. You need to drip every day for a whole month, then take a break for half a month and repeat the procedure.

Nettle lotions

To relieve swelling and relieve the condition, use the following recipe. Mix powdered dry nettle with chopped dry lily of the valley leaves (2 tbsp / l for 1 h / l). Raw materials are steamed with a cup of boiling water and left for 4-5 hours. Add h / l of baking soda to the finished filtered infusion, moisten cotton swabs and apply on closed eyelids. The procedure is repeated three times a day.

Onion peel with needles

This broth is used orally for eye diseases. To do this, you need to take 5 parts of coniferous needles into two parts of rose hips and two parts of onion husks. The raw materials are pounded in a mortar to a state of fine crumbs, steamed with a liter of boiling water and placed on low heat for 8-10 minutes. A day they drink a liter and a half of the finished broth, the healing course is one month.

Decoction of caraway seeds and cornflowers

The drops are made as follows. Cumin seeds (tablespoon) are steamed with a cup of boiling water and kept on low heat for 10-12 minutes. A teaspoon of dried cornflower inflorescences are poured into the finished broth and mixed, allowed to stand for 5 minutes. Thoroughly filtered drug is instilled with a pipette twice a day, two drops in each eye until recovery.

Outcome

In order to prevent the development of pathology, it is necessary to cure existing diseases - diabetes and hypertension. Regular visits to an ophthalmologist for preventive purposes will allow timely identification of the onset of the disease. An annual eye test is the key to healthy eyes.