Retinal pigmented degeneration. Retinal dystrophic changes

Despite high level technological development, in modern world not all ophthalmic diseases are treatable. Retinal pigmentary degeneration is one such pathology. This disease usually manifests itself at an early age, periods of deterioration and improvement of the state of vision alternate with each other throughout life, and closer to the age of 50, complete blindness most often occurs. Retinal dystrophy most often occurs in men, and for the first time it can manifest itself both in childhood and in adulthood.

To date, the causes of the appearance of retinal pigmentary dystrophy have not yet been identified.

Causes and course of retinal pigment degeneration

Why retinal dystrophy appears is still not fully understood. Ophthalmologists are considering several versions. Pigmented retinal degeneration was named so because of the changes that occur in the fundus, pigment spots appear on the eyes. They are formed along the vessels located on the retina and come in different sizes and shapes. Gradually, the retinal pigment epithelium becomes discolored, as a result of which the fundus of the eye appears as a cobweb of orange-red vessels.

Over time, the disease only progresses, and age spots in the eye spread more and more. Densely dotting the retina, they pass into central part eyes arise in the iris. The vessels become very narrow and practically invisible, and the disc of the nerve turns pale, later atrophying. Retinal pigmentary degeneration usually occurs in both eyes at the same time.

Many are discussing that the pigment epithelium is formed against the background of diseases in endocrine pathologies and vitamin deficiency, in particular, with a significant lack of vitamin A. Some experts are inclined to believe that infections and toxins are negative. It is believed that retinal dystrophy can be inherited from relatives.

Retinal pigmentary degeneration is dangerous with loss of vision in a patient.

If the disease manifests itself at an early age, then by the age of 25 the sick person may lose their ability to work. But there are exceptions here too. Sometimes dystrophy is observed only in one eye, or only a separate fragment of the retina is damaged. People who have age spots in the eyes are at risk for other ophthalmic diseases: cataracts, glaucoma, lens opacity.

Symptoms of the problem

Due to the process of retinal pigment degeneration, patients see a somewhat distorted image. Retinal spots make it difficult to clearly see the outlines of surrounding objects. People often suffer from color perception disorders. Pigmentation causes blurred vision, especially in low light. Due to damage to the rods (components of the retina), the so-called night blindness or hemeralopia is formed. Orientation skills in the twilight disappear. The retina consists of rods at the edges and cones in the center. First, the rods are affected, in connection with which the patient's peripheral vision is narrowed, but a "clean" area remains in the center. Degradation of the cones aggravates the situation and gradually provokes blindness.

Diagnostic procedures

When examining a patient, the doctor first examines the quality of peripheral vision. Retinal pigment abiotrophy can be seen during a fundus examination. Spider-like patches on the iris will become the main feature of dystrophy. To make an accurate diagnosis, electrophysiological study is used, it is considered the most objective in assessing the state and functionality of the retina.

Treatment of the disease

Pigmentary dystrophy should be treated in a complex manner. To get rid of age spots, the doctor prescribes a complex of various vitamins and medications to the patient to nourish the retinal pigment epithelium. In addition to pills and injections, drops are also used. Treatment is aimed at restoring the natural functionality of the retina. Additionally, therapeutic methods are used that are aimed at improving the supply of blood to the eye. This can really slow down the pathological process, and even start remission.

For home use were developed "glasses Sidorenko" - a simulator for the muscles of the eyes, combining several methods of exposure and is especially effective at the initial stages.

Features in children

In the early stages, retinal pigment abiotrophy in children is especially difficult to diagnose, and up to 6 years old it is almost impossible. Later, you can detect the presence of visual dystrophy, noting the presence of difficulties in the child with orientation in space at night. Children do not do their usual things at such a time, they stop playing. Without seeing the periphery of the visual field, the child can bump into surrounding objects, since only the center of the eye works efficiently. If a child has a pigmented spot on the eye, experts recommend that direct relatives be examined by a doctor to detect eye dystrophy on early stage and prescribe treatment.

Pediatric retinal pigmentary dystrophy implies the selection of implants.

It is necessary to recall the radically new experimental techniques of influencing the pigment layer of the retina, in particular, gene therapy. With its help, you can restore damaged genes, which means you can find hope for better vision. Specific eye implants have also been developed. Their task is to work similarly to the natural retina. Indeed, people with such implants gradually begin to orient themselves more freely not only within the walls of the room, but also on the street.

Retinal pigmentosa is a rare disease. It occurs in 1 person in 5000, and in the world there are approximately 100 million carriers of the defective gene that causes retinitis pigmentosa. With the development of this pathology, the eye, which was originally a light-absorbing structure, turns into a light-reflecting structure, which inevitably becomes the cause of blindness. Men are more susceptible to the development of retinitis pigmentosa, and the disease can occur both in childhood and in adulthood. According to statistics, most patients with retinal pigmentary dystrophy at the age of 20 years retain their visual acuity above 0.1 and the ability to read, and in 45-50-year-old patients, visual acuity decreases to a value below 0.1, and they can no longer read.

For retinitis pigmentosa or, in other words, retinal pigmentary degeneration, degeneration of photoreceptors and pigment epithelium, as a result of which the ability to transmit signals from the retina to the cerebral cortex is lost. With this pathology, a characteristic accumulation of pigment substance is also clearly observed in the picture of the fundus. The degenerative process with the deposition of pigment causes the disappearance of photo-receptive cells and receptors, which is why the retina loses its sensitivity to light signals. As a result, a person loses his sight.

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

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

Signs

Retinitis pigmentosa often occurs in childhood, it has three symptoms:

• Small accumulation of pigment in the fundus;
• Disk optic nerve has a waxy pallor;
• Narrowing of arterioles.

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

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

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

On last stage diseases, a person loses not only peripheral, but also central vision. Blindness sets in.

Retinitis pigmentosa treatment

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

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

Video of our specialist about the disease

Retinal pigment degeneration (PDS, abiotrophy, dystrophy, pigment retinitis) can cause complete loss of vision. In most cases, the pathology proceeds without pronounced signs, which reduces the chances of a favorable prognosis. What is PDS in medicine, and how to avoid complications, we will tell further.

PDS in medicine is a rare genetic pathology. Its development is associated with ongoing changes in the pigment epithelium, as well as in the retinal neuroepithelium. If someone in the family suffered from this ailment, then there is a high probability that the child will also face a similar problem.

First, violations are noted in the neuroepithelium. After some time, the outer vitreous plate of the retina touches the pigment epithelium, as a result of which it gradually becomes overgrown with gliosis tissues and cells. In some areas, it becomes two- and even three-layer. Against this background, the process of pigment distribution is disrupted inside the cells: in some cells its amount increases, and in others it reaches an extremely low indicator. Both the central and peripheral parts of the visual analyzer are in a similar state.

Retinal pigmentosa degeneration is rare genetic disease.

Symptoms

At an early stage of development, the disease does not manifest itself in any way. However, later, a person may notice a decrease in the quality of vision in the dark. This condition is called night blindness. The deterioration of twilight vision is accompanied by difficulties in orientation. Congenital pathology in a child can go completely unnoticed.

2-4 years after the onset of the problem, peripheral retinal dystrophy is noted. This condition manifests itself in the form of a deterioration in the work of the lateral visual analyzer. Also, the patient narrows the boundaries of vision.

During ophthalmoscopy, pigmentation foci are observed. Their number is gradually increasing, and they confidently approach the center. At the same time, a part of the retina is simply discolored, and the vessels become visible. The optic nerve head becomes pale and takes on a waxy hue. But the central vision remains normal.

Characteristic symptom PDS - "night blindness".

Forms

A neglected form of the disease or PDS in both eyes can provoke cataracts or glaucoma. In this case, the quality of central vision deteriorates greatly. Along with this, atrophy of the optic nerve head is noted, which entails reflex fixation of the pupils. Moreover, peripheral vision may be completely absent. This state is called tunnel vision, when a person sees objects as if through a thin tube.

Degeneration of the retina of the left or right eye of an atypical form is rarely diagnosed, in which the head of the optic nerve suffers, vasoconstriction occurs, and the acuity of twilight vision decreases. Sometimes one-sided degeneration is still found, occurring together with AMD or cataract on the affected organ.
Diagnostics

This disease is very problematic to detect in children, especially at an early stage of development. A child can be diagnosed only after reaching 6 years of age. The presence of pathology may be evidenced by his disorientation in the dark.

During diagnostic measures, peripheral vision and its quality are checked. In addition, the fundus is examined. Depending on the severity of the disease, the changes that have occurred on the part of the retina are determined.

It is very difficult to identify PDS in a child under 6 years old.

To make a more accurate diagnosis, patients are sometimes assigned to undergo an electrophysiological study. This method allows you to more accurately assess the functionality of the retina. Additional research can be aimed at determining a person's dark adaptation, and his ability to navigate in the dark.

Treatment

Not all methods that are used in the treatment of retinal pigmentary degeneration can improve the patient's condition. Most of them simply turn out to be ineffective. With regard to vision, experts give a not very favorable prognosis. In rare cases, the disease can even become a reason for disability. This status threatens patients who have lost the ability to do their job in a working environment.

To improve the condition, it is necessary to minimize the strain on the eyes as much as possible. It is also important to take B vitamins.

B vitamins are prescribed to improve the patient's condition.

The main method of treating this pathology today is vasodilator therapy. The patient may also be prescribed biogenic stimulants. The operation is performed if the medical approach has not brought the desired result.

In addition, experts have come to the conclusion that the use of autologous stem cells contributes to the restoration of the retina. After being introduced into the damaged area, they connect with the patient's cells, which begin to adopt their properties.

Traditional

Restore retinal functionality and expand blood vessels allows taking the following drugs:

• Aloe extract;
• Emoxipin;
• Taufon;
• Alloplant;
• Mildronate.

Enough good result gives complex therapy using nucleic acids. Most often, patients are prescribed Enkad, which can significantly improve the quality of vision. The medicine is meant for intramuscular injection... It can also be used for local applications.

Enkad is prescribed to improve vision.

Massage

To prevent the progression of the disease and relieve eye strain, it is permissible to do simple exercises. To do this, you must alternately close your eyes tightly, and then open your eyes. Repeat the exercise 15 times.

Massage will be equally useful. In this case, you need to lightly press on the eyes with your index fingers, massaging them in a circle. Actions should be fluid. This will relax the eye muscles, relieve puffiness and fatigue.

ethnoscience

Supporters of alternative medicine can use the following recipes:

1. Plantain decoction. For cooking, you need 10 g of dry plantain leaves. The raw material is placed in an enamel container, filled with boiling water in an amount of 250 ml and covered with a lid. The dishes with the future medicine are sent to a water bath for half an hour. The resulting broth is cooled, filtered and taken in half a glass three times a day 10 minutes before the start of the meal.
2. Eyebright infusion. Grass in the amount of 1-2 tsp. flood cold water (250 ml), brought to boiling point and infused for 2 minutes. As soon as the product has cooled down, it is used in the form of eye drops or compresses. This infusion can also be taken orally. Treatment is carried out three times a day for 30 minutes. before meals, 3 tbsp. l.

Any decisions regarding the intake of a particular remedy must be agreed with the attending physician.

Nov 29, 2017 Anastasia Tabalina

Thanks to the development of high technologies, nowadays most of the diseases of the organs of vision are treatable. However, in ophthalmological practice, there are still pathologies that can be very difficult to cope with, sometimes impossible. Such severe ailments with good reason include retinal pigmentary degeneration. Distinctive feature This disease is a long, progressive course, alternating with periods of sharp deterioration in vision and unexpected remissions. As a rule, the disease begins to actively develop in adolescence, by the age of 20 it can already be clearly diagnosed, and by the age of 40 - 50, blindness usually occurs.

Symptoms

A typical symptom of this pathology is a severe deterioration of vision, especially when switching from normal light to weaker lighting, for example, with the onset of dusk. And in the dark, “night blindness” arises. Scientifically, this condition is called hemeralopia. At first, peripheral vision falls noticeably, then over time the optic nerves atrophy and central vision narrows concentrically. This is already a harbinger of complete blindness.

Features of the development of the disease

Pigmented dystrophy (degeneration, retinitis) got its name due to the characteristic changes occurring in the fundus. On the retina along the retinal (located at the level of location nerve fibers) vessels form dark brown pigment deposits. They are peculiar bony bodies of various shapes and sizes, resembling heaps of scattered fine coal. Over time, discoloration of pigment epithelial cells occurs. As a result, the fundus of the eye shines through and becomes like a mosaic created by densely intertwining orange-red choroidal vessels converging towards the center of the eye.

As the disease progresses, the number of pigment bone cells increases, their area of \u200b\u200bdistribution expands. Gradually, conglomerates of pigment masses densely cover the entire retina. Then dystrophic changes capture the central part of the eye. The retinal vessels are strongly narrowed, become filiform, and the optic nerve head acquires a waxy pale shade with subsequent atrophy. Pigmented dystrophy most often develops in both eyes, but in rare cases it can also affect one eye.

Development reasons

The origin (etiology) of pigmentary dystrophy has not yet been studied. Ophthalmologists express conflicting opinions. Some believe that the cause of this pathology is the hypofunction of the cerebral appendage. Others lean towards toxicity or polyglandular disorder. Still others argue that the development of the disease is a consequence of vitamin deficiency, endocrine or genetic disorders. A fairly stable hypothesis is that excess light illuminates a special substance in the organs of vision - rhodopsin. As a result, the function of updating the photoreceptors of the retina is upset. Moreover, all experts agree that the root cause of the disease is family-hereditary.

Treatment

Pigmented dystrophy is diagnosed using electroretinographic examination. Unfortunately, the prognosis is poor. The pathological process can only be slowed down. The main direction of treatment is to improve the trophism of the retina, vasodilation, including choroidal ones. For this purpose, apply nicotinic acid, Acetylcholine, as well as heparin-based drugs. In general, the list of drugs that slow down the progression of pigmentary dystrophy is quite extensive. Doctors use thyroid, testicular, ovarian medicines, metabolic steroids (for example, Nerobolil, Retabolil), prescribe vitamin therapy (except for vitamin A).

Ultrasound and radiation therapy to the cervical region stabilize visual functions. Surgical methods treatments are still under development, but the first operations (revascularization) have already been performed. Moreover, the doctors managed to achieve positive results. The essence of the surgical procedure is as follows: a partial segment transplant is performed in the perichoroidal region of the eye oculomotor muscles... This improves blood circulation in the choroid.

Of course, people with diagnosed retinal pigmentary dystrophy cannot be envied. It is scary to realize that blindness will come someday. It remains to be hoped for progress in the field of ophthalmology.

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

Retinal dystrophies can be divided into:

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

Causes of retinal dystrophy

The causes of retinal dystrophy are different, but most of them are common diseases (diabetes mellitus, atherosclerosis, hypertension, kidney disease, adrenal glands) and local (myopia, uveitis), as well as genetic predisposition.

Retinal dystrophy symptoms:

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

How is retinal dystrophy diagnosed?

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

Evaluation of patients with suspected retinal dystrophy includes:

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

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

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

The laser is a unique surgical instrument that has given ophthalmic surgeons completely new possibilities. The principle of treatment is based on the fact that laser exposure leads to a sharp increase in temperature, which causes coagulation (clotting) of the tissue. Thanks to this, the operation is bloodless. The laser is very precise and is used to create splices between mesh and choroid eyes (i.e. strengthening the retina) to prevent retinal detachment. For the operation, a special lens with an anti-reflective coating is put on the patient's eye. It allows the radiation to penetrate completely into the eye. Laser radiation is supplied through special light guides, and the surgeon has the ability to control the course of the operation through a stereomicroscope, direct and focus the laser beam.

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

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