NMD retina eye clinical recommendations. Age Macular Degeneration: Causes and Treatment

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Save good vision to old age is very difficult. Often in the elderly the ability to see gradually loses. This is due to the fact that all human bodies eventually begin to "wear out". One of the first suffers fabric eyes. It is believed that vision is deteriorating from 40-45 years. This is happening even in cases where a person has not previously had problems with vision during life. Impairment of vision occurs gradually. Most of the people are disturbed by "long-poiffness", that is, the inability to see objects located close. Sometimes more serious problems are developing. These include such pathologies as cataracts, glaucoma, etc. Another common disease is considered to be age macular degeneration. Such actions are dangerous in what can lead to loss of vision.

Age macular degeneration (NMD) is a pathology that develops due to dystrophic processes in the mesh eye sheath. This area is directly related to the brain (it is a peripheral analyzer). Using the retina, perception of information and transform it into visual images is formed. On the surface of the peripheral analyzer, there is a zone that contains many receptors - sticks and colodes. It is called Makula (yellow stain). The receptors of which consists of the retina center provide color vision in humans. In addition, it is in Makula that focusing lights. Thanks to this function, human vision is clear and clarity. The age macular degeneration of the retina leads to a yellow spot tissue dystrophy. Not only the pigment layer, but also the vessels that feed this area are exposed. Despite the fact that the disease is called "age macular degeneration", it can develop not only among the elderly. Often the first symptoms of pathological changes in the eye are beginning to be felt by 55 years. To the elderly and old age, the disease progresses to such an extent that a person can fully lose the ability to see.

The age-related macular degeneration of the retina refers to a common illness. Often, this pathology is caused by the loss of disability and disability. It is widespread in America, Asia and Europe. Unfortunately, the disease is often diagnosed in late stages. In these cases, you have to resort to surgical treatment. However, with timely therapeutic treatment, as well as the implementation of preventive measures, it is possible to avoid surgery and complications of pathology (blindness).

Like all degenerative processes, this disease tends to slow and progressive flow. The causes of dystrophic changes in the yellow stain of the mesh shell may be different. The main of them is considered the involution of eye tissues. Nevertheless, some people have dystrophic changes faster, and others are slower. Therefore, it is believed that age macular degeneration is transmitted by inheritance (genetically), and also prevails among people of European nationality. Other risk factors include: smoking, arterial hypertension, frequent stay in the sun. Based on this, the causes of macular degeneration can be distinguished. These include:

1. Vascular lesions. Atherosclerosis of small arteries is considered one of the risk factors. Disruption of oxygen delivery to eye tissues is one of the main mechanisms for the development of degeneration.
2. Excess body weight.
3. Lack of vitamins and some trace elements. Among the substances needed to maintain retinal tissues, you can highlight: Lutein and Zeaxanthine.
4. The presence of a large number of "free radicals". They increase the risk of developing the degeneration of organs several times.
5. Ethnic features. The disease is more often found in people with bright color eyes. The fact is that representatives of the European-divided race, the pigment density contained in the retina is low. For this reason, dystrophic processes are developing faster, as well as symptoms of the disease.
6. Incorrect meals
7. Finding under direct sunlight without protective glasses.

Pathology more often develops in people with a burdened hereditary history (the presence of a disease among parents, grandmothers). In most cases, diseases are diagnosed in the female population.

Like all degenerative changes, this disease has a complex development mechanism. In addition, the pathogenesis of dystrophic processes is still not fully learned. It is known that under the action of adverse factors, the Makula fabric is exposed to irreversible damage. Most often, pathology begins to develop in people suffering from vascular diseases (atherosclerosis, diabetes mellitus), obesity. Also, paragraph is almost always detected among the smoking population. Because of the blockage of the vascular channel and insufficient nutritional food, age macular degeneration develops. The pathogenesis of the disease is based on violation of the redox balance. The main role in this process is played by free radicals. These substances are formed in Maculy for several reasons. First, oxygen and light are constantly affected by the yellow stain of the retina. In addition, in this area there is an accumulation of fatty acids that tend to oxidation. Another factor of the pathogenesis of the development of pathology is considered the origin of the retina. After all, this shell is considered an peripheral analyzer and is directly related to the brain. Therefore, it is particularly sensitive to "oxygen starvation".

All listed factors predispose to the fact that the Makula fabric gradually thinned. As a result of the effects of radicals, cell membranes are destroyed. The retina becomes even more sensitive to the light. Under the influence of ultraviolet and infrared radiation, NMD develops even faster. All these processes lead to the fact that the epithelium of the yellow stain begins to "lose" pigment receptors, exposed atrophy. If you do not stop the destruction of the macula on time, the fabric is detaching. The end stage is the appearance of scars and the development of blindness.

3 forms of macular degeneration are isolated. This classification is based on morphological changes occurring in retinal tissue. Such a division is necessary to determine the tactics of negligence.

Morphological types of the disease:

1. Age macular degeneration is a wet form: characterized by the presence of exudate. This option is rarely found in 20% of cases. It is distinguished by fast-horror flow. If a person has a rapid eyesight (within a few days), it is necessary to suspect such a disease as age macular degeneration. The wet form develops due to non-disconnection, that is, the appearance of a large number of new vessels on the retina. Given the damage in cell membranes, their permeability increases. As a result, edema and hemorrhage develops.
2. Age macular degeneration - dry shape: characterized by a slow flow. In a different way, this type of pathology is called atrophy. Dry age-related macular degeneration develops in 90% of patients. During the inspection, the dresses are noted - bright foci of atrophy, deficiency of the pigment layer, defects on the epithelium.
3. Scar shape of macular degeneration. It is considered the final stage of the NMD. It is characterized by detachment of the epithelium and the formation of the connective tissue (scar). At the same time there is a complete loss of vision.

In some cases, the dry form of NMD enters an exudative version of the disease. Most often this happens in vascular lesions, a in particular - diabetic retinopathy. Such changes indicate a worsening of the forecast and are a signal to provide urgent measures.

Depending on the form of the NMD, the symptoms of the disease can develop both slowly and quickly. Often, for a long time, macular degeneration does not make itself felt for several years. Dry form on the retinal surface, dresses appear on the retinal surface - the atrophy areas. As a result, the vision gradually worsens. A pigment layer suffers to greater extent, because of which the brightness of the colors is somewhat lost. The acuity of vision can be changed, but negligible. The wet form of macular degeneration develops quickly. In a few days, vision can deteriorate significantly, up to full blindness. Because of the edema and increasing the permeability of membranes, hemorrhages may occur, which are noticeable to the naked eye. Symptoms observed with NMD:

1. Changing the contrast and brightness of the image.
2. Reducing visual acuity.
3. Curvature, distortion of objects.
4. Bulk image.
5. The emergence of loss of fields.
6. Impossibility to read, despite wearing glasses.

With the gradual development of pathology, signs of the disease may be absent for a long time. Then there is a gradual deterioration in central vision. When looking forward most of the image becomes blurred. Nevertheless, peripheral (side) vision is saved. Gradually the lesion zone increases.

With wet and scar form, the VMD blindness comes quickly. Unlike dry type of degeneration, peripheral vision is rarely removed. With timely treatment of the ISD, the development of blindness can be stopped.

Age macular degeneration can be diagnosed in the early stages. Therefore, people suffering from vascular defeats must be examined from an ophthalmologist 1-2 times a year. The diagnosis of NMD is based on the history of the history and a special examination. Older people most often complain about the appearance of "stains" before the eyes resembling fog. The diagnosis of "Macular degeneration" is most often set with worsening of vision in women, especially if there is a diabetes mellitus 2, atherosclerosis of vessels. In addition to the survey, a number of ophthalmic surveys are performed. Among them is the measurement of visual acuity, perimetry, stereoscopic biomicroscopy.

To evaluate the state of the vessels, the fluorescent angiography of the Eye DNA is carried out. Thanks to this study, you can detect the epithelium detachment zones, atrophic dresses, neovascularization. However, such a method of instrumental diagnosis has contraindications and risks. Therefore, before you decide on the examination, it is worth visiting an ophthalmologist and get it advice.

When confirming the diagnosis, it is necessary to immediately begin the treatment of age-related macular degeneration. The dry form of the disease is less aggressive, so it gives care of medication therapy. It will not help get rid of pathology in full, but will suspend (slow down) the process for several months or years. First of all, when ISD must be observed a diet. Considering the fact that atrophic processes are developing due to the lack of carotenoids and blockage of the vascular bottoms, the patient should eliminate animal fats. To prevent atherosclerotic changes in small arteries, the retina should eat a large number of fruits, greenery, vegetables. In addition, a similar diet will help to fill the lack of vitamins and trace elements.

To cope with free radicals, it is recommended to spend less time in the sun. Also, patients should use antioxidants. These include vitamin E and C. To improve the blood supply to the eye, it is recommended to use antiagregants, vasodilating drugs.

With a humid form of macular degeneration, not only medication therapy is carried out, but also surgical treatment. The drugs restoring the retina pigment layer include the Lutein and Zeaxantine medicines. These drugs belong to the group of antioxidants. In addition, it is recommended to eat products containing zinc. If the disease developed as a result of diabetic retinopathy, it is necessary to carry out sugar-based therapy under the control of the glycemic profile.

One drug therapy is not enough if the patient is diagnosed with age macular degeneration. Treatment of pathology should be combined with surgical correction. This is especially true of the wet form of NMD. Currently, in almost every ophthalmologic clinic, laser treatment of macular degeneration is carried out. It may be different. The choice of the method depends on the stage of NMD and manifestations of pathology. The following methods of surgical correction are distinguished:

1. Laser coagulation of the neovascular membrane.
2. Photodynamic therapy with preparation "Vodidin".
3. Transpital laser thermal correction.

With the ability and absence of contraindications, the transplantation of pigment epithelium, winctomy (with hemorrhages in the vitreous body of the eye).

Preventive measures include: diet observance, loss of body weight. With vascular lesions, it is recommended to refuse smoking. You should also avoid direct sunlight to people having a light color of the eyes. In addition, the prevention includes the use of vitamins for strengthening vision and trace elements.

Time can not be stopped, as can not be avoided by the aging of the human body. With age, many problems begin to occur. Including problems with vision.

Recall a little structure of our eyes. Makula is wearing a second name - yellow spot. This is the most retinal center of the eye where the light beam focuses. It provides central sight, as well as the color perception of the visual image. The damage to Makula, which arises in patients of the older age group, testifies to the start of such pathology as age-related maculodystrophia (abbreviated - NMD).

With macular dystrophy, the diameter of blood vessels that feed the retina decreases. As a result, her fabric cease to fully obtain the necessary substances. Distrophic changes are developing on one or both (left and right) eyes. Often the NMD is the cause of disabilities and disability.

Of course, when we are talking about age maculodystrophy, we understand that the main cause of this disease is just age degenerative changes in the retina. But some patients develop the disease, and others have no, one progresses rapidly, and others are extremely slow. Until the end, the reasons for such a situation have not been studied, but histology helps to understand the mechanism of the development of the pathological process and identify a number of risk factors:

• Genetic predisposition and heredity (inheritance occurs as an autosomal dominant, an autosomal recessive or a clutch with a X-chromosome).
• Smoking. It significantly increases the risk of NMD.
• Arterial hypertension.
• Diabetes.
• Myopia or hyperopia.
• Prolonged exposure to sunlights in unprotected with sunglasses of eyes.
• Excess body weight. Scientific research indicate the relationship between obesity and the progression of the NMD.
• Incorrect meals, as a result of which the patient's body is not allowed for the nutrients necessary for the proper functioning of the visual apparatus (in particular, carotenoids).
• Race. White age changes have more often than African Americans.
• Vegeth-vascular dystonia or briefly - IT.
• It should also be noted the sexuality - representatives of the weak gender of this disease are diagnosed more often.
• Eye pathology. For example, chronic blepharitis or endocrine ophthalmopathy (pseudotumorous or thyrotoxic form).
• Transferred eye injuries.

Age maculodystrophy is more often diagnosed in women and representatives of the White race.

Classification of maculodystrophia

Okulists Pathology is classified according to the forms of CFID flow:

1. Dry (other names are non-assessive, atrophic). Develops slowly.
2. Wet (other names are exudative, neovascular). Develops rapidly.
3. Scar. The last stage of the NMD. Develops rapidly.

The dry form of NMD is noted in 85% of cases than other forms of pathology. With objection, a person has a change in metabolism. As a result of this, in the field of Makula, yellowish stains called druses. This is the foci of atrophy. Druses are divided into solid and soft. Solid - small and clearly defined; Soft - large, with blurry edges, can merge among themselves. The patient loses visual sharpness gradually. This is one of the differences of this form of pathology from other. Cases are registered when the dry form gradually passed into the last one - the scar stage.

The dry form of NMD is also called non-appliant or atrophic.

Neovascular form

Ophthalmologists diagnose this type of pathology in just 10-15% of cases. The wet form of NMD is the result of the progression of atrophic form. The disease is developing rapidly. In most cases, central vision is almost completely lost. As the size of the new vessels develops the process of forming new vessels in the sizes and thickening. It is the given process that also neoangiogenesis also, is the difference in a wet form. As a result, the body tries to erroneously compensate for insufficient nutrition of the retina, sending an additional volume of oxygen and necessary for the functioning of substances.

Under the progression of pathology through the walls of new vessels, blood cells and fluid penetrate in the area under the retina. Edema develops, hemorrhages appear. As a result, the retinal cells, particularly sensitive to light, are constantly damaged and dying. So the blind spots in central vision are formed.

Classified on:

1. A classical, affecting subretinal neovascular membrane (SNM).
2. Hidden, called even occult.
3. Mixed.

The wet form is also called exudative or non-disconnect.

Scar shape

When spacing the vessels under the pigment epithelium, a retinal detachment is possible with the subsequent detachment of neuroepithelius and the formation of scar tissue (transition to scars).

This is the final stage of age macular degeneration. Loss of vision is irreversible.

Symptoms directly indicate the form of the disease. In most cases, the disease proceeds asymptomatic.

Symptoms:

1. As a result of the gradual appearance and further increase in friends, impaired vision. With a dry form, a slight and gradual, and with a wet and scar, rapid.
2. Fly flour begins in front of their eyes (especially characteristic of dry shape).
3. The most affected pigment layer suffers because of which the perception of shades and brightness of the picture is reduced, its contrast.
4. Arriving due to hemorrhage edema, which are noticeable to others, indicate a humid form of the disease.
5. Fields of view fall out.
6. Blinds the picture that we see.
7. The surrounding items are distorted, straight lines are twisted.

The development of a dry form in the first time proceeds asymptomatic.

Dry form development:

1. In the initial stages there are no symptoms.
2. Gradually worsens central vision.
3. Then there is a bulk of most of the image.
4. Over time, the affected area increases and darkens, as a result of which the scotoma is formed.
5. Peripheral vision remains saved.

The special second and third shape is as follows:

1. 100% of vision loss comes quickly.
2. Save peripheral vision is possible in very rare cases.

Under the final scar form of the NMD, the degree of loss of vision reaches 100%.

Despite the possibility of a long asymptomatic flow of the disease, age-related maculyodistrophia can be diagnosed thanks to modern eye studies. Faces older than 50 years should regularly pass an inspection of the eyepiece. This will allow you to identify pathology in the early stages and prevent loss of vision.

Dry shape can smoothly go to the most dangerous - scar shape. Therefore, the oculist needs to be visited regularly.

With a long-term development process of pathology, patients coming to an ophthalmologist are most often complaining about the appearance of "stains" before the eyes resembling fog. Gradually, the defect is incremented in size.

Diagnostic methods:

• collection of anamnesis;
• visometry;
• ophthalmoscopy (inspecting the eye bottom);
• optical coherent retinotomography;
• forecrastometry;
• fluorescent angiography;
• computer perimetry;
• color stereo photography.

These methods allow us to conduct timely and high-quality diagnosis of the macular area of \u200b\u200bthe retina.

According to the results of the diagnosis, a course of treatment is appointed.

When ISD is detected, the doctor must clarify the patient what it is, to appoint a course of treatment and conduct training self-diagnosis (relevant for the dry form of pathology).

For those patients who have already been identified by the age macular degeneration of the retina, a good method of diagnosing the disease progression is a test using an amms stew mesh (lattice). This method allows to determine even initial signs of macular edema due to the formation of new vessels on the retina.

The ammster grid is a 40 x 40 cm mesh with square cells with a point in the middle. When diagnosing, the test distance to the amlser lattice is about 50 cm. One eye must be closed with palm, others look at the grid.

If there are pathology, the patient can see non-existent "holes" or "dark spots", curvature of the grid. With this development of events, it is necessary to urgently undergo a survey from an ophthalmologist.

Self-examination in the ammsler grille can be carried out even every day.

Self-diagnosis allows you to track the development process of the NMD.

Treatment of NMD Eyes

Treatment of dry form

Dry form is better to treat compared to wet. It has a more favorable flow.

Damage to this form of the disease is irreversible. Reducing the risk of transition into a wet form is achieved by drug therapy, including reception:

1. Antioxidants.
2. Vitamin Mineral Complexes.
3. Taurina.
4. Lutein / Beto-Carotene / Vitamin A / Zeaxantina (one of the drugs is prescribed or their complex, depending on the clinical picture of the disease) in the amount of 10 mg / 15mg / 28000m / 2mg.
5. Anthocianozide.
6. Vitamins C and E in the volume of 500mg and 400ma, respectively, daily.
7. Copper and zinc in the volume of 2 mg and 80mg, respectively.
8. Selena and other trace elements.
9. Gingko-Biloba.

A physician should be regularly visited to track the course of the disease.

With dry form, the NMD treatment is based on the reception of vitamin complexes.

To improve blood circulation in the retina, patients recommended antiagregants, vasodilatory drugs.

It is worth noting that conservative medicine, which consists in the appointment of dedistrophic tools, immunomodulators and antioxidants (tablets, injections or drops), is ineffective. Taking these drugs, patients, most often, ignore the need to visit an ophthalmologist to control. In this regard, the risk of the transition of the disease is increasing in a more severe stage.

Not so long ago, a laser coagulation remained the only effective method of treatment of the wet form - destruction (destruction) of newly formed vessels with a laser. However, this method did not eliminate the cause of the formation of new vessels. In addition, healthy fabrics can also be destructed with this procedure.

A less aggressive variant of laser therapy of a wet form is photodynamic therapy using the preparation "Vodidin". It is injected intravenously and irradiated with a retina with a laser. The drug has tropiness only to pathological vessels of the retina, is able to accumulate in them and activated when exposed to the laser beam. In the bleeding pathological vessels, swarms are formed, the vessels are "searched". With this procedure, the risk of lesion of healthy tissues is practically absent.

Vodidin is used to treat the wet form of NMD in photodynamic therapy.

But, the more progressive method is considered to be developed in early 2000 VEGF therapy. The second name is "sighting therapy". Treatment of NMD eyes in this case allows not only to stop the progression of the process, but also partially restore the patient's vision. However, this statement is fair only in the case when irreversible scar changes have not yet begun.

With VEGF therapy, the injection of special preparations, stopping the formation of blood vessels, in the vitreous body of the eye. Preparations used for data of injections - Lutnotis, "Makugen", "Avastin" and "Eilea".

With this form of therapy, the following risks are possible: an increase in intraocular pressure, retinal detachment, eye infection, temporary disorder of vision, hemorrhage.

Of the surgical methods of treatment, NMD should be noted such types of operations:

• transplantation of pigment epithelium;
• removing subregular unwasurant membranes with formation of folds sclera;
• remove subretinal hemorrhages.

Lutentis is used to treat the wet form of NMD with VEGF therapy.

Additional measures

For patients who have lost sight of sight, glasses are prescribed. Plus lenses are installed for short-sized, and for far-sighted - minus. Recommended the presence of an anti-reflective coating that allows you to protect your eyes from such a negative impact, like glare from a monitor or TV, reinforced eye load when reading or otherwise.

Use one or another people's method of treatment is permissible only after consulting with the attending physician. Unfortunately, traditional medicine is unable to heal the NMD, but can improve well-being, prevent the development of the disease and to relieve symptoms.

1. In a half-linet bank, soak on the 4th hour washed oats grain. Water to merge, and Oats ship in a saucepan. Pour the 3rd liters of water and on medium fire to cook after boiling 30 minutes. The resulting decoction is fastened and stored in the refrigerator. Take heated to 5 times a day in a glass. It is recommended to add to the decoction of amraged berries of currants, blueberries, black rowan and honey.
2. 1 tablespoon of pharmacy calendula is poured with a glass of boiling water and insistant 15 minutes. Give to stand Then strain and take 3 times a day by ¼ cup. You can still put the eyes of 2 droplets in 1 eye. Take up to 6 months. Then take a break.
3. About the benefits of aloe and mumia know everything. With NMD, they can also help. You need 50 g mumes to dissolve in 100 ml of aloe juice. Insist. There are two use of this infusion. The first is to drink 10 ml 2 times a day. The second is to use as droplets for the eyes: 1k. In every eye. After 10 days of reception, take a break.
4. Onion husks (2 parts), rosehip fruits (2 parts) and needle (5 pieces) need to grind. 1 tablespoon of mixture pour 1 l water and boil 2-3 minutes. Take 1,5l daily.
5. The tablespoon of cumin is poured 250 ml of water. Boil on a small fire for 2-3 minutes. Pour 1 tsp. Flowers cornflower, mix and retain for 5 minutes. Use 1-2 drops to each eye 2 times a day.
6. Celest chop. 1 tsp. Pour 100 ml of water. Heat on fire 10 sec. Let it stand. Infusion is filtered and stored in the refrigerator. Apply 3 drops into each eye 3p. in a day. Course - 1 month.
7. Take 1 part of goat milk and 1 part of boiled water. The resulting mixture is used as droplets - 1 to 1 to each eye. After instillation, you need to learn a dark bandage or special glasses and take 30 minutes. Course - 1 week.
8. In 1/3 glasses of crushed nettles Add 1 tsp. crushed valves and pour ½ cl. soda. Mix. Put in a dark and dry place for 9 hours. From the resulting mass to make compresses.
9. Treatment with leeches is a separate, but very useful area of \u200b\u200btraditional medicine.

Folk medicine can be used as an addition to the main treatment.

It is necessary to consume a sufficient amount of products rich in carotenoids, fresh vegetables, fruits, greens.

It should also be limited to advent of animal feeds provoking atherosclerotic changes in the retina.

Products rich in carotenoids:

• carrot;
• pumpkin;
• potatoes;
• melon;
• spinach;
• cabbage;
• zucchini;
• citrus;
• tomatoes;
• bell pepper;
• corn;
• apricots;
• peaches;
• persimmon.

Products with antioxidants:

• red Ribes;
• blueberries;
• cranberry.

The measures for the prevention of the senile disease - the NMD are:

• adherence to the diet (limiting animal fats; a sufficient amount of fresh vegetables and fruits);
• reducing body weight;
• control of blood pressure;
• wearing sunglasses (especially patients with blond eyes);
• rejection of bad habits (smoking);
• receiving vitamin complexes;
• sports; But from professional sports; For example, triathlon will have to abandon.

And, of course, a regular inspection of an ophthalmologist is needed.

Nov 28, 2017 Anastasia Tabalina

Age macular degeneration, this is a deterioration of vision, up to blindness, people after 40 years. As a rule, it starts to atrophy and modify the retina. In other words, this disease is called maculodystrophy. This pathology is considered chronic, because the macular zone of the retina is amazed irreversibly. If the violations are observed in one body, then after a period of time, another will be involved. In this case, the degree of lesion can be different, that is, degeneration occurs asymmetrically.

The age macular degeneration of the retina is characterized by a progressive course, which begins to develop first gradually, but then acquires a rapid form. For many years, a person may not be aware of the existence of pathology, but when it reaches a certain extent, it begins to progress.

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The main symptoms of the disease is the inability to consider the subject, at any distance. Sometimes in life it happens that the familiar person passes and looks into the eyes, but does not even greet. In fact, the reason is not that he does not want to see you, but that he cannot.

While watching the TV, the patient also does not distinguish the image and the more can not read. The fact is that the picture in the eyes of the patient seems blurry, and the color is incomprehensible. For example, if a person looks at a straight line, he will definitely see the wave. In addition, quite often the patient sees a translucent stain that is fixed in one place. The disease can be two forms: dry and wet. Each of them has its own features.

The age macular degeneration of the dry form is considered simpler and is observed at the majority of patients. As a rule, it proceeds asymptically for many years, only there are some signs of farsightedness. This is a bad vision of objects at close range. But the distant images look clear and peripheral vision is preserved. With this form of pathology, there is a deterioration in the digestibility of nutrients with kolzkov, responsible for this. This is due to the accumulation of druses, that is, products of processing of metabolic processes.

The wet form of pathology occurs quite rarely, only in ten cases from one hundred. It is considered dangerous, as always wears a rapid form of development. If a timely wet type of age-related macular degeneration does not detect, it can lead to full blindness. Consequently, to disability. This form is characterized by the rotation of the vessels of the eye into the retina, as a result of which the blood fluid seeps into the thickness of the organ. Due to this, strong solidity develops, which weakens the function of the visual apparatus.

Progressive impairment of vision over time can lead to terrible consequences - from the development of local pathologies up to full blindness. People, sciences of bitter experience, to restore vision use a proven tool that has not been previously known and popular ... Read more »

The risk group can include people with the following violations:

1. Age changes after 50 years.
2. Hereditary factor.
3. Female.
4. Diabetes.
5. Smoking and consumption of alcoholic beverages.
6. Excessively frequent visits to a solarium and a long stay under the open rays of the sun.
7. Obesity.
8. Incorrect meals
9. Vascular diseases.
10. Heart pathology.
11. Hypertension.

When a decrease in visibility is detected, it is necessary to immediately go to an ophthalmologist, especially since symptoms may indicate the availability of other pathologies.

After a thorough study of the eyes, each patient needs to be monitored all the time. This is necessary to clarify the speed of progression. This can be done using the image with which the person faces daily. Looking, for example, on a favorite picture (each time from one distance), you can understand how tightly the image is seen.

There is also a special control technique: an ammster grid that allows us to estimate the vision state. Testing should be carried out exclusively in daylight. The grid must be placed at a distance of 30 cm from your own eye. Consider considering the image you need in the usual state. For example, if you always go to glasses, then the test is carried out in them. So, for the assessment of vision, you need one eye to cover, and the second carefully look at the point, which is located in the center. If everything is in order with vision, then all lines and the point will be viewed without distortion.

This is how the grid will look like a mild form of the disease:

As can be seen, the central part has a slight distortion. The point becomes blurry, and the lines acquire more rounded shape. The next figure indicates a severe form of pathology.

In this case, the image is distorted even more: the lines take the wavy shape, and the point seems to be a solid stain.

Cure the dry form of the disease is much easier, which you will not say about wet. So, age-related macular degeneration is a wet form treatment:

It's important to know! An effective way to effectively restore vision recommended by the leading ophthalmologists of the country! …

1. Surgical intervention.
2. Treatment with a laser.
3. Medical therapy.

Only the attending physician may appoint a treatment course based on the characteristics of the disease. As a rule, with a severe form of pathology, an intravial method of administering drugs is prescribed, the network by injection into the mouth cavity. But, every patient must stick to a certain diet. Alcohol, smoking, fats of animal origin, fast food and other harmful dishes are excluded. But it is necessary to use, as with any illness of the visual apparatus, fresh vitamins. They are contained in carrots, Bulgarian pepper, pumpkin, legumes and grain crops, in the egg, liver, spinach, broccoli. The use of dark berries, grapes, blueberries will not be harmful.

How to restore vision without resorting to the operation

We all know what is bad vision. Myopia and limblessness seriously spoil life limiting in ordinary acts - it is impossible to read something, consider close without glasses and lenses. Especially strongly these problems begin to manifest themselves after 45 years. When one on one in front of physical tenders, panic comes and hellishness is unpleasant. But this does not need to be afraid - you need to act! What a means you need to use and why told ... "

The invention relates to medicine, in particular to ophthalmology, and concerns the treatment of a wet form of age-related macular degeneration (NMD). For this, the introduction of Lutnutis in the form of injection into the vitreous body at a dose of 0.5 mg 1 time per month is carried out. Then the parabulbarno on 1.5 ml of isotonic solution is administered alphaphhetoprotein at a dose of 0.0075 mg in the evening and glutathione-S-transferase at a dose of 0.0000005 g in the morning. Introduction is carried out in each eye daily before the retina visualization with newly formed vessels around the macula. Next, carry out laser coagulation of blood vessels, without damage to the Macula. Then the parabulbarno and retrobulberno, closer to the Makula region, transplan the suspension of autologous mononuclear bone marrow. The number of mononucleararies is 5-40 million. At the same time, the suspension is administered by 1.5 ml "NCTF-135". Introduction is carried out 2-4 times with an interval of 2 months. The method allows you to stop neoagiogenesis, weaken the autoimmune process in the field of eye tissues, i.e. To lead to the blockade of pathogenetic mechanisms for the development of the NMD, which eliminates the recurrence of the disease when creating conditions for the organotipic regeneration of the retina and a pronounced improvement in the visual function. 1 pr.

The invention relates to medicine, in particular to ophthalmology, and can be used to treat a wet form of retinal age-related macular degeneration (NMD).

The incidence of WMD in Russia is more than 15 per 1000 population, and this eye pathology is one of the main reasons leading to a decrease in vision, blindness, disabled and deterioration of the quality of life in the elderly. The age macular degeneration of the retina is a chronic progressive disease, degenerative (dystrophic) process leading to damage to the pigment epithelium cells, photoreceptors, an intercellular substance, the membrane of the bachelor and the choriocapillary layer, as a result of which the visual function of the eye is disturbed. The leading role in the pathogenesis of the NMD is given to the violations of hemodynamics in eye choriocapillars.

The purpose of the invention is a decrease in blindness and weakness with the age-related macular degeneration of the retina.

For the treatment of a wet form of age-related macular degeneration, drug treatment is used. Inhibitors of angiogenesis (Macumen, Lutnotis and Avastin), crystal glucocorticoids are introduced intravitreally introduced. The peptide bioreculator obtained from the retina of the cattle eye is introduced subconjection, is retinalamin. Also carry out laser -ugoagulation and transpatal thermotherapy, photodynamic therapy with vertographinist. Such treatment is aimed at stabilizing the pathological process, improving the sharpness and quality of vision, as a rule, cannot be.

As a prototype, a method for treating a wet form of age-related macular degeneration of retinal is chosen, comprising the introduction of Lutentis in the form of injection into the vitreous body at a dose of 0.5 mg 1 time per month (Egorov E.A. et al. Ranibizumab (Lucentis) in the treatment of patients with " Wet "form of age macular degeneration. Rzhm, 2010, №2, 4 p.) The disadvantages of this method are recurrences of the disease, the need for repeated injections of this expensive drug and gradual (with each subsequent introduction) to the weakening of its effectiveness.

The technical result of the invention is to reduce blindness and weakness in the humid form of age-related macular degeneration of the retina due to improved blood circulation, normalizing the microenvironment of the retinal cells, stimulation of intracellular regeneration of the eye and reversibility of dystrophic changes. Transplanted autologous bone marrow cells induce organotipic regeneration of pathologically modified eye tissues. Normalization of microenvironment is achieved due to the use of an α-fetoprotein drug in the complex treatment, which improves intravascular and tissue hemoperfusion and the stumerizing production of endogenous prostaglandins E1 and E2, removing the vessels of vessels and blocking the development of autoimmune reactions, α-fetoprotein is a transport protein and replaces the lack of transport protein. transstitutein, whose synthesis is reduced during pigment epithelium dystrophy. Introduction from the outside of the transport protein makes it easier to eliminate from the field of retina accumulated deposit metabolic products forming, including dubs, and other high molecular weight substances, are not normal for retinal. When the disintegration zone is normalized in the degeneration zone, the composition of the intercellular medium in the zone of the rear pole of the eyeball is normalized, edema is eliminated, the osmotic pressure and acid-alkaline balance in the tissue rear pole environment, which creates conditions for reversibility of dystrophic changes primarily by the retina pigment epithelium. Not only intracellular and tissue regeneration of the epithelium is initiated, but also restores its function to maintain the difference in osmotic pressure in subretinal space and chorioide. With a decrease in edema, newly formed vessels are visualized that expose laser coagulation. Then the autologous bone marrow cells are introduced, which significantly improves the blood circulation and tissue trophics in the field of the orcate, ensures the synthesis of the required levels of cytokines regulating the rehabilitation processes, they are also a source of regeneration for vessels and connective tissue of the eye and retrobulbar fiber. The introduction of glutathione-S-transferase antioxidant antioxidant administration in a dose of 0.000005 grams to Introduction every other day significantly reduces the damage associated with photocusing stress. As a result, pathogenetic mechanisms for the development of the NMD are blocked, which eliminates the recurrence of the disease, the atypical neoagiogenesis is stopped, which is, in fact, the response of the body to the ischemia of the eye tissue.

The method is carried out in four stages.

First step. The use of lucentis in the form of injection into the vitreous body at a dose of 0.5 mg (0.05 ml) 1 time / month, one-time. Luttis (Ranibizumab) is a human monoclonal antibody fragment to an endothelial growth factor A (VEGF-A) and is expressed by recombinant strain-Escherichia coli. Ranibizumab selectively communicates with the endothelial vessel growth factor, VEGF-A (VEGF110, VEGF121, VEGF165) and prevents the interaction of VEGF-A with its receptors on the endothelium cell surface (VEGR1 and VEGR2), which leads to the suppression of the neovascularization and proliferation of vessels. Suppressing the growth of newly formed vessels of choroids in the retina, Ranibizumab stops the progression of an exudative-hemorrhagic form (wet) age-related macular degeneration (NMD).

Second phase. Daily parabulbar administration of drugs prior to the retina visualization with newly formed vessels around the macula. Antioxidant glutathione-S-transferase is introduced at a dose of 0.0000005 grams to the introduction into each eye on 1 ml of isotonic solution in the morning.

For 1.5 ml of isotonic aqueous solution, Profetal® is introduced at a dose of 75 μg to 1 one introduction to each eye in the evening.

Third stage. Laser budget of newly formed vessels (if necessary).

Fourth stage. In a patient from the wing of the ileum under local anesthesia, an outpatient basis in aseptic conditions produce a bone marrow fence in an amount of 10-60 ml. The aspirate of the bone marrow with the anticoagulant is transmitted to the laboratory of cellular technologies. In the laboratory under aseptic conditions from the bone marrow, a cellular graft is prepared in the form of a bone marrow mononuclear suspension by 1, 5 ml NCTF ("NCTF - 135" - a complex biological preparation containing vitamins, minerals, amino acids, nucleic acids and antioxidants, "Laboratois Filorga" France's production). Part of the cells are frozen in liquid nitrogen and is transferred to a cryobank for possible subsequent use. Suspension of cells in the amount of 5-40 million autologous bone marrow mononuclears per 1.5 ml NCTF solution. The introduction of cellular material is carried out 2-4 times with an interval of 2 months.

Bone marrow stem cells with such a transplantation method show known properties, namely, organotipic angiogenesis is activated, reinforcing blood circulation in the retinal vessels and the eye nerve of the eye, improve the trophy of the fabrics of the soccer, which allows you to effectively restore the impaired visual function.

Clinical examples.

Patient V.M., 78 years old.

Diagnosis: age-related maculodystrophy of the retina of both eyes (wet form). In case of inspection of the fundus, many dystrophic devices were found in the central region of the retina of both eyes, a large amount of pigment, retinal edema.

Before treatment: the acuity of vision of the right eye - 0.05; The acuity of sight of the left eye is 0.07. Correction in both eyes is impossible. Patient with weakness - a significant decrease in central vision. The process of visual perception is difficult and slowed down. The patient notes a pronounced binding of vision, significant difficulties in reading and recognizing persons.

Treatment. It was first introduced in a dose of 0.5 mg (0.05 ml) in a dose of 0.5 mg (0.05 ml), further, then parabulbarly by 1.5 ml of isotonic solution of alphaphhetoprotein, at a dose of 75 μg 12 days in the evening, glutathione-S-transferase, at a dose 0, 0000005 g 12 days in the morning, in each eye daily before the retina visualization with newly formed vessels around Makula, then conducted a laser coagulation of the newly formed vessels (without damage to the macula), then transplanted the suspension of autologous mononuclear bone marrow monomuclears and retrobulbarly, closer to the Macula region. 3 microsurgical cellular transplants of the autologous bone marrow cells were performed at intervals of 60 days.

After treatment: the vision of the left and right eye is 0.2 (without correction). When examining the eye bottom, it was found that the area of \u200b\u200bdystrophic devils and the friends became substantially less, the amount of pigment decreased, no swelling.

The method of treatment of a wet form of age-related macular degeneration of the retina, which includes the introduction of lutentis in the form of injection into the vitreous body at a dose of 0.5 mg 1 time per month, characterized in that the lumotis is administered first, the alfactiphene in the dose is administered to 1.5 ml of isotonic solution 0.0075 mg in the evening, glutathione-S-transferase in a dose of 0.0000005 g in the morning in each eye Daily before visualizing the retina with newly formed vessels around the Macula, then, if necessary, their laser coagulation (without damage to the Macula), then transplan the suspension of autologous mononuclear bone mononuclear Bragulbarno brain and retrobulberno, closer to the Makula region, while using a suspension by 1.5 ml "NCTF-135", the number of mononuclearov is 5-40 million, and the introduction of them is carried out 2-4 times at intervals in 2 months.

9-04-2012, 14:04

Description

- progressive disease characterized by damage to the macular zone (the central zone of the retina in the rear pole of the eyeball). For the designation of this pathology, other terms are used: an involutionary central chorioretinal dystrophy, sclerotic maculodystrophy, age-related macular dystrophy, seenylum macular dystrophy, age-related maculopathy associated with age macular degeneration, etc.

ICD-10:

H35.3 Macula degeneration and rear poles.

Abbreviation: NMD - age macular degeneration, PES - pigment retinal epithelium, layer - scanning laser ophthalmoscope, TTT - transpital thermotherapy. FAG - fluorescent angiography, PDT - photodynamic therapy, erg - electrolytinography. ETDRS - Early Treatment Diabetic Retinopathy Study Research Group (research team on the study of early treatment of diabetic retinopathy).

Epidemiology

In Russia, the incidence of age macular degeneration (NMD) is more than 15 per 1000 population.

According to WHO, by 2050, the number of people over 60 throughout the world will increase approximately three times (in 2000 - about 606 million people). The share of the population of the older age group in economically developed countries is currently about 20%, and by 2050 it will probably increase, up to 33%. Accordingly, a significant increase in patients with NMD is expected.

? General affected by the population This pathology increases with age:

Early manifestations of NMD are found in 15% of people aged 65-74 years, 25% - aged 75-84 years, 30% - aged 85 years and older;

Late manifestations of NMD are found in 1% of people aged 65-74 years, 5% - aged 75-84 years, 13% - aged 85 years and older.

The NMD is occurring more often over the age of 65. The prevailing floor is female, and in women over the age of 75 years old, NMD meets 2 times more often.

The NMD can lead to a pronounced reduction in visual acuity and to fall out of the central sections of the field of view. The most significant functional disorders are characteristic of sub-retinal neovascularization with subsequent atrophy of the PES, especially if the pathological process captures Fovye.

In the presence of the manifestations of the late stage of the NMD on one eye, the risk of significant pathological changes on another eye ranges from 4 to 15%.

Risk factors

There is a clear link between the arterial hypertension and the NMD, atherosclerotic damage to the vessels (especially sleepy arteries), the level of cholesterol in the blood, diabetes, excessive body weight.

There is a direct relationship between smoking and NMD.

There are guidance on the possible connection between the excessive effect of sunlight and the age lesion of the Macula.

The prevailing defeat of women in postmenopausus is explained by the loss of the protective effect of estrogen directed against the common atherosclerosis. In this case, there was no evidence of the favorable effect of hormone-plating therapy.

Currently, studies of the genetic predisposition of the development of the NMD (in particular, the responsible genes of ArmD1, FBLN6, ArmD3 are identified).

Prevention. Patients with NMD should be recommended to abandon smoking, fatty food, less exposed to direct sunlight. In the presence of concomitant vascular pathology, measures are needed aimed at its correction. Questions of vitaminotherapy and recommended doses of trace elements will be discussed below. In recent years, prophylactic laser -ugolation of the retina in the presence of multiple friends is discussed.

Screening

The NMD in an elderly patient should be suspected if there is complaints about the reduction of visual acuity, difficulties in reading, especially under conditions of reduced illumination. Sometimes patients notice loss of individual letters when fluent readingMetamorphopsy. Significantly meet complaints about changing color perception, worsening of twilight vision. The survey includes the determination of visual acuity, conducting biomicroscopy (which can reveal other possible causes of symptoms - say, the presence of age cataracts), ophthalmoscopy (including a slit lamp using aspherical lenses) and perimetry. You can also recommend a study of the color-point (monocular), an amoslera test.

It is necessary to remember the probabilities of the NMD in patients who, after the coaraxcratic extraction performed extraction, cannot achieve high visual acuity.

Patients over 55 years old need to examine the macular zone of the retina during scheduled medical examinations (that is, to include in an inspection plan an ophthalmoscopy with a wide pupil).

Diagnosis

The diagnosis of NMD is set with the following signs (one or more): the presence of solid friends; availability of soft friends; strengthening or weakening PES pigmentation; Atrophic foci in Makula (geographical atrophy); Neovascular macular degeneration - non-uniscovery of choroids, serous or hemorrhagic PES delay and subsequent formation of scar foci in a macular zone.

? Druze - extracellular sediments of eosinophilic material between the inner layer of the membrane of the Bruch and the basement membrane of the PES. This material is the methods of metabolism of PES cells. The presence of friends may indicate the likelihood of a more pronounced NMD in the future. As a rule, patients who do not have other manifestations of NMDs do not note the decline in central vision. Druses are divided into solid, soft and drain.

? Solid dresses usually do not exceed 50 μm in diameter; On the eye day are visible as small, yellowish, clearly defined affairs. With biomicroscopy, a guial structure is visible. Solid dresses are considered a relatively favorable manifestation of the process, but (if we consider the possibility of progression up to 10 years) the presence of a large number of solid friends (more than 8) can predispose the appearance of soft friends and more severe manifestations of NMD.

? Soft dubs More in size, their boundaries are fuzzy. The risk of their progression is significantly higher. They can merge and cause PES pars. If the dubuses disappear, it most often indicates the development in this area of \u200b\u200batrophy of the outer layers of the retina (including PES) and the choriocapillary layer. When detecting soft friends, an ophthalmologist must recommend a patient to conduct a self-control with a grille of the ammsler and contact an ophthalmologist when any new symptoms appear, since this type of friend is accompanied by a high risk of reducing vision (due to the possibility of developing geographic atrophy or choroidal neovascular membrane).

? Drain dresses Most likely can lead to PES details and atrophically change or predispose to the development of subretinal neovascularization.

? Druses in dynamics can be subject to the following changes.:

Solid dresses can increase in size and turn into soft; Soft dubs can also increase and form drain dresses; Calcifications can be formed inside the friends (with ophthalmoscopy look like shiny crystals); A spontaneous regression of the friends is possible, although the dubs are more likely to progress.

? Redistribution of pigment. The appearance of sites of hyperpigmentation in the macular zone is associated with changes occurring in the PES: cell proliferation, accumulation of melanin or migration of melanin-containing cells into subretal space. Focal hyperpigmentation is considered one of the factors predisposing to the appearance of subretinal non-ovascularization. Local hypopigmentation often corresponds to the location of the Friends (layer of the PES on them is thinned), but can be determined by the PES or reduced melanin cell atrophy or reduced melanin content.

? Geographic Atrophy of PES. - Farmed form of dry sclerotic macular degeneration. At the eye, the foci of geographic atrophy is detected in the form of well-defined depigmentation zones with well distinguishable large choroidal vessels. At the same time, not only PES, but also the outer layers of the retina and the choriocapillary layer in this zone. Geographical atrophy may be not only an independent manifestation of the NMD, but also to occur as a consequence of the disappearance of soft friends, compulsion of the PES detachment and even the regression of the hearth choroidal neovascularization.

? Exudative (serous) PES PES - The accumulation of fluid between the membrane of Bruchi and PES is more often detected in the presence of friends and other manifestations of NMD. The detachment may have different sizes. Unlike the serous detachment of the sensor portion of the retina, the PES delay is a localized formation with contours, rounded, dome-shaped. The acuity of vision can remain high enough, but refractive shift towards hypermetropy occurs.

Serous neuroepitheliy dear detachment is often combined with PES detachment. At the same time, there is a greater prominization of the focus, it has a disk shape and less clear boundaries.

A focus may occur with the formation of local PES atrophy, or a PEC rupture can occur with the formation of a subretal neovascular membrane.

Hemorrhagic PES delay or neuroepithelia, as a rule, is a manifestation of choroidal neovascularization. It can be combined with a serous detachment.

? Horioidal neovascularization It is characterized by the rotation of the newly formed vessels through the defects of the membrane of Bruch under PES or under neuroepithelii. The pathological permeability of the newly formed vessels leads to a fluid to rugging, clustering it in subretinal spaces and to the formation of the retinal edema. Newly formed vessels can lead to the appearance of subretinal hemorrhages, hemorrhages in the retina tissue, sometimes break through the vitreous body. In this case, significant functional disorders may occur.

Flusted soft dresses, foci of hyperpigmentation, the presence of extractive geography atrophy of PES are considered factors of the risk of development of subretinal neovascularization.

Suspicion of subretinal neovascularization should cause the following ophthalmoscopic manifestations: The retina edema in the macular zone, the presence of solid exudates, PES detachment, subretinal hemorrhages and / or hemorrhages in the retina tissue. Hard exudates rarely and usually indicate that subretinal neovascularization was formed relatively long.

The identification of such signs should be indicated to carry out fluorescent angiography.

? Discoid scar focus - The final stage of the development of subretinal neovascularization. Ophthalmoscopically, in such cases, the disk-shaped source of gray-white color is determined, often with pigment deposition. The focus can be different - from a small (less than 1 diameter of the DZN) to large foci, which can exceed the entire macular zone. The size and localization of the focus is of fundamental importance for the preservation of visual functions.

Classification

? Forms NMD. In practical ophthalmology, the terms "dry" (non-assessive, atrophic) shape and "wet" (exudative, neovascular) form of NMD are used.

? "Dry" form It is primarily characterized by slowly progressive PES atrophy in the macular zone and the choroids located under it, which leads to local secondary atrophy of the photoreceptor retinal layer. In other words, the non-assessive form is characterized by druses in the macular zone of the retina, defects of the PES, the redistribution of pigment, PES atrophy and the choriocapillary layer.

? "Wet" form: germination originating in the inner layers of choroids of newly formed vessels through the membrane of Bruchi into the absent space between the PES and the retina. Angiogenesis is accompanied by exudation in subretinal space, retinal edema and hemorrhages. Thus, the exudative form is characterized by the following stages: an exudative PES detachment, an exudative retinal neuroepartery detachment, neovascularization (under PES and retinal neuroepitheli), exudative-hemorrhagic PES and / or neuroepithelies retinal, stage of scarring.

? Early stage. Characterized focal dresses and non-uniformity of PES pigmentation.

? Late stage. PPP detachment is characteristic, PES rupture, choroidal neovascularization, disc-shaped (fibrovascular) scar, geographical atrophy of PES.

? Horioidal neovascularization. In clinical studies to determine the forecast and tactics of treatment in the presence of choroidal neovascularization, and on the basis of the fluorescence-angiographic picture, classical, hidden and mixed forms are highlighted.

? Classical Horioidal neovascularization with NMD. It is easiest to recognize it, it occurs approximately 20% of patients. This form is clinically detected as a pigmented or reddish structure under the PES, the subretyal hemorrhages are often found. With phage, the structure is filled early, quickly begins to shine bright and then gives amplifying breathing.

? Hidden Horioidal neovascularization can be suspected with ophthalmoscopy in the presence of focal pigment dispersion with simultaneous rock thickening, which does not have clear boundaries. Such neovascularization is characterized by phage with a peaunting in the late phase, the source of which cannot be determined.

? Mixed Horioidal neovascularization. There are such options: "predominantly classic" (when the "classic" defeat in the area is at least 50% of the entire focus) and "minimally classic" (with it "classic" defeat is also available, but is less than 50% of the entire focus).

? Treatment method. When choosing a treatment method, it is necessary to apply the classification of choroidal neovascularization in accordance with its location in the macular zone:

? subfoveal - the choroidal neovascular membrane is under the center of the Fovaal Avascular Zone;

? yukstafovaneal - the edge of the choroidal neovascular membrane, the area of \u200b\u200bthe blockade of fluorescence by pigment and / or hemorrhage is in the range of 1-199 microns from the center of the foveal avascular zone;

? extrafoal - The edge of the choroidal neovascular membrane, the blockade of fluorescence blockade by pigment and / or hemorrhage is at a distance of 200 microns or more from the center of the foveal avascular zone.

Anamnesis

Complaints of a decrease in visual acuity, the presence of "stains" in front of the eye, metamorphopyia. Most often with complaints about the acute decrease in visual acuity and metamorphopyia, patients with choroidal neovascularization are treated.

? Disease history.Patients can not notice a long time in the eye for a long time: which is involved in the process first, or if the reduction of vision develops slowly.

Common diseases (especially arterial hypertension, atherosclerosis of brain vessels).

Haded heredity on NMD.

Familiarization with existing medical records, including with previous entries in the outpatient map of the patient, certificates of hospitalization, etc. (course of illness).

Acquaintance with the influence of the state of visual functions on the quality of life.

Survey

Determination of visual acuity with optimal correction.

Assessment of the central field of view.

Evaluation of color vessels with the help of tables of youth or slave.

Bomicroscopy of the front department of the eyeball, measurement of the WGD.

Ophthalmoscopic assessment of the condition of the fundus, including the macular zone of the retina (after expanding the pupil with briefly active mydritis).

Documenting the state of the Makula, preferably using the color stereo photography of the eye bottom.

Performing fluorescent angiography and / or angiography with indocyanzene.

In suspected, the presence of a retinal edema is recommended to perform optical coherent tomography or a study of a macular zone with the help of Heidelberg retinal tomograph (HRT II).

Electrophysiological studies (Ganzfeld Erg, Rhythmic Erg, Pattern Erg, Multifocal ERG).

Assessment of visual acuity and refraction

Sharpness with optimal correction should be assessed at each visit. The conditions in which the study is conducted must be standard.

During the examination under conditions, polyclinic or hospital usually use Sivzian tables or test signs. Given the effect of "recognition" of alphabetic symbols, it is advisable to use Landalt rings.

Preferably, with each survey, there is also visual sharpness for a close to the corresponding correction.

When refraction (shift towards hypertropy), the retinal edema should be suspected (this is possible, for example, with PES pars).

Assessment of the central field of view

Evaluation of the central field of view using the ammster grid is the simplest and more fast, but exceptionally subjective research, which allows to evaluate up to 20 ° from the fixation point.

Under the conditions of an ophthalmic cabinet, it is desirable to use standard, typographic image-made images amslera grids. It is desirable to introduce the results of the test patient to the primary documentation: this will help to visually trace the dynamics of changes.

? Test Assler It can be recommended for patients and for daily self-control to alleviate the early detection of metamorphs or cattle. The patient should instruct in detail about the rules for conducting the test (most importantly teach patients to check each eye separately, closing another eye) and recommend it when identifying any new changes to contact an ophthalmologist. Assessment of the state of sight. It is preferable to carry out using computer static perimetry With the inclusion in the testing strategy of the fusal threshold of photosensitivity. However, with low visual sharpness, computer perimetry may be impracticable. In such cases, the usual kinetic perimetry is used, but with an appropriate choice of size and brightness of the object.

Coloring grade is made using the tables of YUSTOV or Rabkin according to the standard technique.

Ophthalmoscopic evaluation of the state of the eye

Ophthalmoscopic assessment of the state of the fundus, including the macular zone of the retina, is made after expanding the pupil with briefly acting mydritis. To achieve a good mydriasis, sometimes use a combination of drugs, for example, tropiacs 0.5% and phenylephrine 10%. (It is necessary to remember the possibility of the systemic side effect of adrenergic mydriatics!)

For the inspection of the central zone of the retina and detecting a possible edema in the macular zone most convenient to the biomicroscopy of the eye bottom using aspheric lenses 60 and / or 90 diopters, as well as lenses Ground and various contact lenses (Goldman lenses, Mainster, etc.). The most frequently used trotter goldman lens.

You can also use direct ophthalmoscopy, but at the same time consider that the lack of binocularity can prevent the revealing of a macular edema.

Documenting the state of Makula It can be carried out in various ways, starting from simple sketching of the changes and ending with the most preferred color stereo photography of the eye bottom. The currently existing digital photography systems allow not only to avoid the "aging" problems of prints (for example, previously poroidized systems), but also edit the resulting images, impose them to each other, store and transmit information in digital form. It is necessary to take pictures of the eye of both eyes, as NMD is often bilateral, even if there is a decrease in visual acuity and other functional manifestations on one eye.

Fluorescent angiography

In many cases, the diagnosis of NMD can be made on the basis of clinical examination data. However, fluorescent angiography (phage) is the disease with an exceptionally valuable additional diagnostic method, as it makes it possible to more accurately determine the structural changes and evaluate the dynamics of the pathological process. In particular, it has a decisive importance when solving the issue of treatment tactics. It is advisable to perform it for 3 days After the first examination of the patient with suspicion of the presence of subretinal neovascularization, as many membranes in the area are increasing enough (sometimes 5-10 microns per day). Given the possibility of transition of the "dry" forms into the "wet", with dynamic observation of patients with druses (especially in the presence of "soft" friends) FAGs are recommended with a 6-month interval.

? FAG. Before the study, the patient clarifies the purpose of the angiography of the Eye DNA, the procedure for conducting possible side effects (the occurrence of nausea in 5% of patients during the study, yellow skin and urine painting over the next day) is specified by allergic history.

The patient signs informed consent.

An intradermal sample is carried out on fluorescene.

Currently, in most ophthalmological centers, FAG is carried out using the Hazelnus cameras with digital registration of information. However, it is also possible to use conventional photographic huts and scanning laser ophthalmoscope.

The study is performed by color photographs of the eye dove, and then in some cases photographing in a heartless light (with a green light filter).

Intravenously introduced 5 ml of 10% p-ra fluorescein.

Photographing is carried out according to the generally accepted method.

If there are signs of subretinal neovascularization on one eye, photos of another eye in the middle and late phase should also be performed to identify possible non-disclaiming (even if there is no suspicion of its presence on the clinical picture).

? Evaluation of the results of fluorescent angiography

Druze

Solid doubts are usually point, give early hyperfluorescence, filled at the same time, and the glow stops late. There is no breathing out of friends.

Soft dubbers also demonstrate the early accumulation of fluorescein in the absence of its healing, but may also be hypophilyorescent due to the accumulation of lipids and neutral fats.

Fluorescein is absorbed by dresses from choriocapillary.

? Geographic Atrophy of PES.. At the phage of the atrophy zone give a defect in the form of "windows". Horioidal fluorescence is visible already in the early phase due to the lack of pigment in the corresponding PES zones. Since the structures that could be delayed fluorescein are absent, the defect in the form of "windows" pale along with the background fluorescence of choroids in the late phase. As with the druses, the fluorescein here in the course of the study does not accumulate and does not go beyond the boundaries of the atrophic focus.

PES delay. It is characterized by a rapid and uniform accumulation of fluorescein in clearly defined local rounded dome-forming formations, usually occurring in the early (arterial) phase. Fluorescein is delayed in the foci over the late phases and in the recycling phase. There is no peasant dye into the surrounding retina.

? Subretinal neovascularization

For fluorescent angiographic pattern of classical choroidal neovascular membrane characteristic of the following:

Newly formed subretinal vessels are filled earlier than retinal vessels (in the sub-phase). These vessels quickly begin to glow brightly and look like a network in the form of "Lace" or "True Wheels". It should be borne in mind that if there are hemorrhages, they can partially mask subretinal neovascularization.

It may be occupied by the progestion of fluorescein from newly formed vessels.

In the later stages of FAG, fluorescein usually accumulates inside the serous retinal detachment, located above the choroidal neovascularization.

With hidden choroidal neovascularization, gradually, after 2-5 minutes after the injection of fluorescein, becomes the visible "cracked" fluorescence. Hyperfluorescence becomes more significant when attaching the healing, even the colductions of the dye in the subretinal space, which have no clear boundaries. Re-evaluation of the same section of the eye dove in the early phases of the FAG does not allow to find a source of sinking.

Angiography with Indocyanselene Won popularity after the introduction of digital hinds-cameras. Indocyansene has absorption and fluorescence peaks near the red spectrum. It absorbs light at 766 nm and emits at 826 nm (sodium fluorescene absorbs light at 485 nm and emits at 520 nm). Large wavelengths, when using an indocyansene, are better penetrated into the PES or in subretinalized blood or serous fluid. Therefore, the vessels of choroids are better visible in the study with indocyanzene, than with fluorescene. In addition, in contrast to fluorescein, Indocyansene is almost completely associated with proteins and therefore does not give to the ruggling from normal vessels of choroids and choroidal neovascularization. The dye is delayed in subretinal neovascularization for a long time. The lesions are often visible as the local zones of hyperflyluorescence on a hypoofluorescent background. Angiography with Indocyanselene convenient to identify subretinal neovascularization In the presence of PES detachment, opaque subretal liquid or hemorrhage. Unfortunately, Indocyansene has not yet been registered with the Ministry of Health and Social Development of Russia and does not have permission to legal use in our country. It should be noted that in cases where there is no hope for preservation of vision by any of therapeutic effects (for example, in the presence of a fibrovascular scar focus in Fovaa), angiography is not shown.

Differential diagnosis

Differential diagnosis is carried out:

? With a "dry form" NMD with peripherally located druses, as well as with degeneration with highly complicated myopia. In the latter case, in addition to changes in Macula, there are also characteristic atrophic changes around the DZN, and there are no dubs.

? With "wet form"

With high complicated myopia (significant refraction anomaly, lacquer cracks in the rear pole, myopic changes at DZN);

With the traumatic tip of the retina (as a rule, on one eye; eye injury in history, most often concentric ZN);

With angioid stripes, in which on both eyes from the DZN, curved lines of red-brown or gray are subretyrally diverged;

With the syndrome of the alleged histoplasmosis of the eye, in which small yellowish-white chorioretinal scars are revealed on the middle periphery and in the rear pole of the retina, as well as the foci of scarring at ZN;

As well as druses of the DZN; tumors of choroids; by scar foci after laseroagulation; with inflammatory chorioretinal pathology.

Treatment

Laser Surgery

The purpose of laser treatment - Reduce the risk of further decline in visual acuity below that already has a patient. For this, the subretinal neovascular membrane is completely destroyed within the limits of healthy tissues, inflicting intense drain coagulates. It is recommended for coagulation of lesions located extraference, to use the argon laser with wavelengths in the green part of the spectrum, and for the Located YukSTAFOVEAL - Crypton Red.

? Preparation of the patient. Before laser treatment, it is necessary to talk with the patient (informed consent to the laser intervention).

To tell about the likely course of the disease, the forecast, objectives of interventions, the advantages and risks of alternative treatment methods.

If the patient has indications for laseroagulation, then it should be explained that in terms of a long-term forecasting this intervention is more favorable than just observation or other methods of treatment.

The patient needs to be explained that, most likely, he will have peripheral vision, emphasize that many patients with severe loss of central vision on both eyes can independently cope with many tasks of everyday activity.

To warn that the visual acuity after laser treatment often deteriorates that high risk of recurrence of subretinal neovascularization (in 30-40%) and that additional treatment may be required.

The patient in the coming days after the intervention should be sent to the institution dealing with the problems of assistance to the visually impaired; Perhaps it will be necessary to recommend the passage of medical and labor expertise to establish a group of disability.

Usually, it is fundamentally important to consider the results of inspection on the second day after the intervention, when the edema and reduction of vision as a result of treatment is maximal. Patients should be said that the acuity of sight will not decrease after the second day. If the vision deteriorates, and the distortions increase, the patient must, without postponing, turn to an ophthalmologist.

? Indications. Laser treatment reduces the risk of expressed reduction in vision compared with the observation of the following groups of patients.

Patients with extracular choroidal neovascularization (200 microns or more from the geometric center of the Fovoyolar Avascular zone).

Patients with YUKSTAFOVAYAR choroidal neovascularization (closer than 200 microns, but not under the center of the fowolar avascular zone).

Patients with fresh subfove major choroidal neovascularization under the center of Fovaa (laser treatment was not previously applied) or recurrent subfove major choroidal neovascularization (laser treatment was previously carried out, recurrence under the center of Fovaol). (In recently, it is currently recommended not to laser -ugulation, but photodynamic therapy.)

? Stages of intervention.The most important provisions that must be observed when performing laser intervention:

1. Retrobulbar anesthesia is performed to ensure motionlessness of the eye during intervention.

2. Immediately before intervention, the surgeon again looks at the phage, while accurately determines the boundaries of the impact.

3. The entire zone of choroidal neovascularization is covered by intense coagulates.

4. The boundaries of the impact are compared with the benchmarks at the FAG. If the intervention performed is inadequate, it can be supplemented immediately.

5. Then perform photos of the eye bottom.

6. On the eye impose a bandage, patients are recommended to remove the bandage after 4 hours or later, depending on the validity period of the anesthetic used.

? Complications. The most frequent complication of laser treatment is hemorrhage or from subretinal neovascular membrane, or from perforation of the membrane of Bruch. If hemorrhage occurred during the impact, it is necessary to press the eye lens to increase the WFD and immediately stop the bleeding. It is best to continue to put pressure on the eye lens for 15-30 s after stopping bleeding. If hemorrhage occurs, it is important not to interrupt treatment. After stopping bleeding, the laser power reduce and continue treatment.

? Postoperative observation

For the early detection of persistent or recurrent subretal neovascular membranes, control fluorescent angiography should be performed 2 weeks after produced by the laser -ugulation.

The examinations in the postoperative period continue after that 1.5, 3 and 6 months from the moment of intervention, and then 1 time in 6 months.

With suspected the presence of a relapse of the subretinal neovascular membrane.

? Recurney. If the residual activity of the choroidal neovascular membrane is detected at phag, for example, early fluorescence with late peopling in the center or the edges of the lesion focus should be re-laser -ugulation. Risk factors for recurrence of subretinal neovascularization: arterial hypertension, smoking, presence of choriodeal neovascularization or diskhead scar on another eye, the presence of soft friends and pigment clusters.

Laser compound with prophylactic purposes with soft druses

Laser buds around Fovaa, performed by the type "Grid" using low-energy impact, leads to disappearance of friends. A favorable effect was shown not only about the disappearance of the friends, but also in terms of more likely to preserve visual acuity during the year. However, during the first years after exposure, the number of cases of the development of subretal neovascular membranes in the areas of influences increased. Therefore, the method requires further study and generation of criteria and laser exposure parameters.

Photodynamic therapy

Alternative to Laser Aagulation has become emerged in recent years. photodynamic therapy (PDT). In the treatment, a benzoporphyrin derivative is used - the verteporphine (visudin) is a photosensive (that is, a light-activated substance with a light energy absorption peak between 680 and 695 nm. The uteritepin in intravenous administration quickly goes to the lesion focus and is selectively captured by the endothelium of the newly formed vessels. The irradiation of the focus of non-uniscovery It is carried out using a diode laser with a wavelength of 689 nm, which allows laser energy to freely pass through blood, melanin and fibrous tissue. This makes it possible to selectively affect the target fabric, without exposing the surrounding tissues to adversely affect. Under the influence of non-coordinated laser radiation, the vertimorfin generates free radicals that damage the endothelium of the newly formed vessels. As a result, thrombosis and obliteration of vessels of subretinal neovascularization occur.

results

Therapeutic effects must be produced within a week after the fulfillment of fluorescent angiography, after which the decision was made on the need for intervention.

When comparing a group in which treatment was carried out according to the standard method (vertimorphine), with patients with a placebo, it was found that a significant decrease in visual acuity after 12 months was absent in the first group in 45-67% of cases, and in the second - in 32-39 %. After another 1 year, the same trend remained.

Since recanalization may occur after the occlusion of vessels, patients were required on average 5-6 FDT sessions (more than half of them were performed during the first year after the start of treatment). The first repeated examination With the performance of angiographic research, usually spend after 3 months. If the height is revealed, re-intervention is performed. If an ophthalmoscopic picture and the result of angiography remain the same, and there is no heighting, it should be limited to dynamic observation, assigning a repeated inspection after another 3 months.

A subfovefully located classical subretal neovascular membrane, with visual sharpness of 0.1 and higher (such patients constitute no more than 20% of all patients suffering from NMD);

NMD with "predominantly classical" (when the "classic" defeat is more than 50% of the entire focus) or under the "hidden" subfovefully located choroidal neovascularization;

Yukstafovyal defeat, located so that during the fulfillment of the laseroagulation, the Center of the Fovyal Avascular Zone would be affected;

? "Hidden" choroidal neovascularization in the sizes of the focus of more than 4 DZN areas; Photodynamic therapy is recommended to be carried out only with very low visual sharpness (if the diameter of the foci exceeds 5400 μm, the patient should clarify that the purpose of treatment is only the preservation of the field of view);

If the rapid progression of the lesion is expected or if visual acuity without treatment may soon decrease below the "useful" (that is, the patient can do without any help).

Adverse reactions Connected mainly with improper introduction of drugs (up to tissue necrosis). Approximately 3% of patients after exposure during the week there was a decrease in visual acuity. In order to avoid phototoxic reactions, patients are recommended not to be under the influence of direct sunlight and bright light and wear dark glasses.

Efficiency. As a result of the evaluation of the effectiveness of photodynamic therapy, it turned out that this method is one of the most effective: from 3.6% of treated patients, one can prevent a pronounced reduction in visual acuity. However, treatment has a high cost.

FDT and corticosteroids. Recently, there are reports of the best results of treatment with a combination of two methods - PDT and intravitreal administration of corticosteroid (triamcinolone). However, the advantages of such a technique are not yet confirmed by major clinical studies. In addition, Russia has no GCS, allowed to introduce into the vitreous body.

Transpatallar thermotherapy

Suggested in the early 1990s for the treatment of melanoma choroid transpatallar thermotherapy (TTT) - Labercoagulation, in which the energy of the waves of the infrared part of the spectrum (810 nm) is delivered to the target tissue through the pupil with a diode laser. Exposure Parameters: Power 262-267 MW / MM2, exposure 60-90 s, Spot diameter 500-3000 μm. The thermal radiation is perceived mainly melanin PES and choroid. The exact mechanism of exposure to the ISD remains unclear. Perhaps the effect on choroidal blood flow occurs. The method is easy to use and relatively cheap.

Indications: Hidden choroidal neovascularization or hidden subretal neovascular membranes with a minimal classic component. Thus, TTT can be used in patients who have practically no positive effect from PDT. The results of pilot studies are encouraged (deterioration of the state managed to reduce more than 2 times).

Complications They are bound primarily with the overdose of laser energy (the impact must be subtracted): infarction in the macular zone, occlusion of retinal vessels, PES breaks, subretinal hemorrhages and atrophic foci in the chorioide are described. The development of cataracts and the formation of the rear synechs are also noted.

Surgical treatment of age macular degeneration

Removal of subretinal neovascular membranes

The indication for the operation is the presence of classical choroidal non-disclaiming with chorid borders.

? First produce vitrectomy According to the standard technique, then paramaacularly, the temporal side is performed by retinotomy. Through the retinotomic hole, a balanced saline solution is administered to delay the retina. After that, with the help of horizontally curved peak, the membrane mobilization is performed, the membrane is removed by horizontally curved tweezers. The resulting bleeding stops, lifting the bottle with an infusion solution and increasing the most VGD. Produce partial replacement fluid into air. In the postoperative period, the patient must comply with the forced position to face down until the air bubble resorption.

? Possible complications During and after intervention: subretal hemorrhage (from minimal to more massive, requiring mechanical removal); Yatrogenian retinal breaks on its periphery; forming a macular opening;

Formation of a preset membrane; Restored or recurrent subretinal neovascularization.

Such interventions allow to reduce metamorphopyia, provide more constant eccentric fixation, which is often regarded by patients as a subjective improvement in vision. At the same time, through a small retinothomic hole, it is possible to remove even enough extensive membranes. The main disadvantage is the lack of improving visual acuity as a result of intervention (in most cases it does not exceed 0.1).

Removal of massive subretinal hemorrhages. Massive subretal hemorrhages can be evacuated through the retinotomic holes. In the case of the formed bunches, it is recommended to introduce a subretyral recombinant fabric activator of plasminogen during the intervention (TAP). If necessary, the displacement of hemorrhages from the macular zone Subretinal administration of TAP is successfully combined with the administration of gas (C3F8) into the cavity of the vitreous body. In the postoperative period, the patient complies with the forced position to face down.

Pigment epithelium cell transplant. Experimental studies on the transplantation of pigment epithelium cells are carried out. In this case, tissue compatibility issues remain unauthorized.

Translocation of Makula

Macula Translocation - possible alternative to photodynamic therapy or laseroagulation Regarding subfoveal uncommon membranes. In pilot studies, approximately 1/3 of the cases managed to achieve not only stabilization, but also some improvement in visual acuity. The basic idea of \u200b\u200bsuch an intervention is to shift the neuroepitheliy-uncommon zone of the neuroepithelius of the fetal zone located above the choroidal neosascular membrane so that in a new position there are unchanged PES and the choriocapillary layer.

? First perform subtotal vitrectomyAnd then completely or partially peel the retina. The operation can be performed with the holding of retinotomy throughout the circle (360 °), followed by turning or displacement of the retina, as well as the formation of folds (that is, shortening) sclera. Then the retina is "fixed" in a new position with the help of an endolaser, and the neovascular membrane is destroyed by laseroagulation. Pneumatretisopyism is produced, after which the patient must comply with the forced position during the day.

? Possible complications: Proliferative Vitreoretinopathy (in 19% of cases), retinal detachment (12-23%), forming a macular hole (9%), as well as complications encountered when conducting vitrectomy for other indications. At the same time, the loss of not only central, but also peripheral vision may occur.

Radiation therapy. Despite successful experimental studies, radiation therapy has not yet received a wide clinical propagation. Clinical studies have not demonstrated the advantages of percutaneous teleterapics (possibly due to low doses of used irradiation).

Medical therapy

Currently there are no therapeutic effects With proven effectiveness with NMD. Under the "dry form", drug therapy is aimed at preventing the formation of friends and deposits of lipofuscin, and with an exudative form - is intended to prevent pathological angiogenesis.

Antioxidants

It is believed that the effect of sunlight contributes to the appearance of free radicals, polyunsaturated fatty acids in the outer layers of the retina, in the PES and the Broha membrane. In this regard, attempts were made by introducing patients to the diet. antioxidant substances Reduce the impact of oxidative stress. The most well-studied antioxidants include vitamins C and E, BETAROTEN, flavonoids, polyphenols. The attention of specialists is also a zinc, which is a coenager of carboangestases, alcoholdhydrogenases and many lysosomal enzymes (including PES).

Patients accepted high doses of vitamins antioxidants (Vitamin C - 500 mg; Betaroten - 15 mg; vitamin E - 400 IU) and zinc (80 mg of zinc in combination with 2 mg of copper). It turned out that the use of additives did not reveal any positive impact on the course of NMD.

It is believed that the reception of vitamins of antioxidant action, lutein, zeaxanthin and zinc can serve as the prevention of development and / or progression of the NMD. An example of such a complex LAN can serve Lyteine \u200b\u200bopvaitecontaining 6 mg of lutein, 0.5 mg of zeaxanthin, 60 mg of vitamin C, 8.8 mg of vitamin E, 20 μg of selenium, 5 mg of zinc. It is prescribed 1 tablet 2 times a day by courses for 1 month. HP does not contain? -Karotina.

? Lutein complex Contains not only lutein, zinc, copper, vitamins E and C, selenium, but also blueberry extract, vitamin A,? -Karotin, Taurine. It is prescribed 1-3 tablets per day for 2 months. Considering that the LAN contains? -Karotin, it should not be prescribed to smoking patients.

Preparations containing also Chernika extract ("Myrtlene Forte").

Angiogenesis inhibitors

Experimental and clinical studies have been proven that the greatest importance in the development of neovascularization at NMD plays endothelium growth factor VASCULAR Endothelial Growth Factor). To date, Pegptanib and Ranibitsumab, which have anti-VEGF activity are proposed for clinical practice.

? Pegapotanib (Makutena). Combining VEGF, Pegapotanib prevents the growth of newly formed vessels and an increased permeability of the vascular wall - two main manifestations of the exudative form of NMD. HP is intended for intravitreal administration. The study used pegaptanib in different dosages (0.3, 1.0 and 3.0 mg) every 6 weeks for 48 weeks. Preliminary results: the probability of considerable loss of visual acuity is less in the treatment of Makutena (compared to the control group).

? Ranobitsumab (Rhufabv2) - Monoclonal antibody, selectively blocking all VEGF isoforms. Intravitreal injections of LS are produced 1 time in 4 weeks. Currently, a clinical study of the III phase is carried out.

Corticosteroids

? Anecortav (RETAANE firms Alcon) - suspension that creates a depot; It is introduced retrobulbarly with the help of a special curved cannula 1 time in 6 months. The greatest efficiency in terms of stabilization of visual acuity and the growth in the growth of newly formed vessels has an anecortion at a dose of 15 mg. In patients who received the anechatav, the preservation of visual acuity was achieved in 84% of cases (in the control group in 50%).

? Triamcinolone - Another Corticosteroid Creating Depot - is introduced intravitreally at a dose of 4 mg. It is shown that the single intravitre injection of this corticosteroid leads to a decrease in the size of the lesion focus, but does not affect the likelihood of a significant reduction in vision.

Combined approaches

Much more attention is currently paid combined treatment - PDT in combination with the intravitreal administration of triamcinolone. However, the effectiveness of such treatment still needs to be confirmed by the relevant clinical studies.

To date, there are two proven effective methods for the treatment of subretinal neovascular membrane, which is the main manifestation of the exudative form of the NMD. These are laser andoagulation and photodynamic therapy with the use of vertospin.

Estimated approaches

Studies continue to search for adequate interventions for all Forms of NMD. And already completed clinical studies of the III phases allow you to develop new algorithms of influences. So, many authors believe that:

In the presence of a subfoveful lesion with the "predominant classical" choroidal non-uniscoversion or with hidden neovascularization and sizes of the hearth, no more than 4 areas of the optic nerve disk are recommended to carry out photo-dynamic therapy;

In the presence of a subfoveful lesion with the "minimum-classical" choroidal neovascularization, the use of PDT or inhibitor of pegapotanib angiogenesis is possible;

Under the YUKSTAFOVAIVER lesion, located in such a way that the center of the Foval Avascular zone will necessarily affect the fulfillment of the laser adoption, the FDT can also be applied;

At any other localization (YUKSTAFOVATIVE or extra-fovaal), lasercoagulation is shown (however, the number of such patients is no more than 13%).

? For the prevention of the development of the exudative form of NMD Complex food additives are used (for example, opaway lutein or lutein complex).

Retinalamine (retinal retina polypeptides) are recommended to be used in the form of subconjunctive injections (5 mg 1 time / day, in dilution by 0.5 ml of 0.5% plin, course 10 injection).

Traditional symptomatic therapy

As for traditionally used drugs to improve regional blood circulation, their application is currently moving into the background.

With the "dry" form of the NMD, you can apply vinpocetin 5 mg 3 times a day inside courses for 2 months or pentoxifilla per 100 mg 3 times a day inside courses for 1-2 months.

As stimulating therapy also use Ginkgo biloba leaves extract 1 tablet 3 times a day inside courses for 2 months; Blueberry extract (for example, Strick, Myrtylene Forte) 1 tablet 2 times a day inside courses for 2-3 weeks, algae extract SPIRULINA Platensis 2 tablets 3 times a day inside courses 1 month.

With the "wet" form of the NMD to reduce the edema can be applied dexamethaasoh 0.5 ml in the form of subconjunctive injections (10 injections); Acetazolamide 250 mg 1 time per day in the morning for half an hour before eating 3 days (in combination with potassium preparations), then after a three-day break, the course can be repeated. Such treatment can be applied before laser adoption. In addition, patients prescribe ethailate 12.5% \u200b\u200b2 ml in / m 1 time per day 10 injections (or in the form of pills inside 250 mg 3 times a day for 15-20 days) and ascorbic acid + rutoside (1 tablet 3 times a day in For 15-20 days).

The feasibility of applying these drug therapy to date is not confirmed by large clinical randomized placebo-controlled studies.

Further maintenance

Patients with NMD should be under the supervision of the therapist, since they more often suffer from arterial hypertension, atherosclerosis of coronary and carotid arteries, obesity.

Patients with low urgency vision can be recommended so-called assistance means of visually impaired. These are devices, in various ways of increasing images and reinforcing the illumination of objects. Among such devices, special increasing glasses, magnifiers with various types of fastening, television systems with closed contour, various digital cameras with projection of images on the screen can be called.

Forecast

In patients in the absence of therapy, a significant reduction in visual acuity on time from 6 months to 5 years can be expected in 60-65% of cases. Often the defeat is bilateral and can lead to vision disability.

The purpose of therapeutic effects at the ISD in the presence of choroidal neovascular membranes is achieving stabilization of the pathological process, not an improvement in vision!

Laser and transpapallar thermotherapy allow you to reduce the number of cases of severe loss of visioni am up to 23-46% of cases (depending on the localization of the process), photodynamic therapy with the vertimipin - an average of up to 40%, submaacular surgery - up to 19%.

What is NMD?

Age macular degeneration (NMD), or maculyodistrophy - this is a disease that affects the central, the most important area of \u200b\u200bthe retina - maculus, playing a key role in providing vision.

Age macular degeneration is the leading cause of irreversible loss of vision and blindness among the population of developed countries of the world aged 50 years and older. Since people in this group represent an increasing share of the population, the loss of vision from the degeneration of Macula is a growing problem.

According to WHO, the share of the population of the older age group in economically developed countries is about 20%, and by 2050. It will probably increase, up to 33%. Accordingly, due to the expected increase in the life expectancy, the steady growth of atherosclerosis and the concomitant pathology, the problem of the NMD remains the most relevant. In recent years, there has been a clear tendency to "rejuvenation" of this disease.

The reason for the decline in view is the Macula degeneration, the most important retinal zone of the eye responsible for the sharpness and sharpness of the central vision necessary for reading or driving the car, the peripheral vision is practically not suffering. The socio-medical significance of this disease is due to the rapid loss of central vision and loss of overall performance. The severity of the process and the loss of central vision depends on the form of the NMD.

Dry and wet form of NMD

Intensive metabolic metabols leads to the formation of free radicals and other active forms of oxygen, which can cause the development of degenerative processes in case of insufficient operation of the antioxidant system (AOS). Then in the retina, especially in the macule and the paramaacular region, undegraved polymer structures are formed under the action of oxygen and light - dubs, the main component of which is lipofuscin.

With the deposition of friends, atrophy of the adjacent retinal layers occurs and the growth of pathological newly formed vessels in the retina pigment epithelium is noted. In the future, the border processes occur, accompanied by the loss of a large number of retinal photoreceptors.

Ophthalmologists allocate two variants of the flow of this disease - dry (non-assessive, atrophic) and wet (exudative, non-disconnect) form of NMD.

The dry form of NMD occurs more often than wet and revealed in 85% of all cases of NMD. In the macular area, yellowish spots are diagnosed, known as Druz. A gradual loss of central vision limits the possibilities of patients to distinguish small details, but it is not so severe as with a wet form. However, the dry form of NMD in a few years can slowly progress to the late stage of geographic atrophy (ha) - gradual degradation of retinal cells, which can also lead to serious loss of vision.

To date, there is no radical treatment of the dry form of the NMD, although some are now in clinical trials. A huge amount of clinical studies have proven that certain nutrients, such as beta-carotene (vitamin A), vitamins C and E can help prevent or slow down the progression of dry degeneration of yellow spots. Studies show that the reception of large doses of some nutritional additives and eye vitamins can reduce the risk of developing an early NMD stage by 25%. Eye doctors also recommend patients with a dry form of NMD wearing sunglasses with protection from UV.

The wet form of NMD is represented by about 10-15% of cases. The disease is developing rapidly and often leads to significant loss of central vision., Dry AMD moves to more advanced and damage to the form of eye disease. With a humid form, the NMD begins the process of growth of new blood vessels (neovascularization). The wall of such vessels is defective and passes the blood cells and liquids that accumulate in the space under the retina. This leak causes constant damage to the photosensitive cells of the retina, which dying and create blind spots in central vision.

Horioidal neovascularization (CHNV) underlies the process of the development of the wet form of NMD. Anomalous growth of vessels is an erroneous way of the body to create a new network of blood vessels to ensure the flow of the required amount of nutrients and oxygen to the retina. Instead of this process, scars are formed, which leads to a serious loss of central vision.

Causes and Risk Factors Development of NMD

Despite numerous studies on the NMD, the reasons for this disease remain so far not completely clarified. NMD refers to multifactorial diseases.

Age - the main reason. The incidence increases sharply with age. Among middle-aged people, this disease occurs in 2%, between the ages of 65 and 75 is diagnosed in 20%, and in the group from 75 to 84 years old, the signs of NMD are found in each third. A significant part of the population has a congenital predisposition to the NMD, which makes a number of factors that either contribute to the occurrence of the disease or warn it.

A number of risk factors have proven, which adversely affect natural protective mechanisms and therefore contribute to the development of the NMD, are the most significant:

• Rasa - the greatest spread of the NMD is observed in the Europeanid race
• Heredity - family history is an important risk factor in 20% of patients with NMD. A three-time increase in the risk of developing NMDs is established if the disease occurs in relatives in the first generation
• Cardiovascular diseases are a significant role in the development of NMD. It has been established that during atherosclerosis, the risk of damage to the macular region increases 3 times, and in the presence of hypertension - 7 times.
• Smoking cigarettes is the only risk factor, the significance of which was confirmed in all studies. The cessation of smoking reduces the risk of developing NMD.
• Direct exposure to sun rays
• Nutrition - the risk of NMD is higher in people who eat more saturated fats and cholesterol, as well as with increased weight of the body.
• Light iris
• Cataract, especially nuclear, is a risk factor for NMD. Surgical removal of cataracts can contribute to the progression of the disease in patients with already existing changes in the macular zone.

Symptoms of NMD

Age macular degeneration usually causes a slow, painless and irreversible loss of vision. In rare cases, vision loss can be sharp.

Early signs of vision loss from NMD are:

• the appearance of dark spots in central vision
• fucetitude image
• distortion of objects
• decisions of color perception
• sharp impairment of vision with poor illumination and in the dark

The most elementary test to determine the manifestations of the NMD is a test amsel train. The ammster grid consists of intersecting straight lines with a central black point in the middle. Patients with manifestations of NMD can see that some lines look blurred or wavy, and dark spots appear in the field of view.

The ophthalmologist can distinguish the manifestations of this disease before the development of changes in the vision of the patient and send it to additional surveys.

Diagnosis of NMD

The diagnosis of NMD is based on history data, patient complaints, evaluating visual functions and retinal inspection data by various methods. Currently, one of the most informative methods in the detection of retinal pathology is recognized by fluorescent angiography of the Eye DNA (FALD). For the implementation of FALD, various models of cameras and special contrast agents -Fluorescein or Indocyanine are green, which are injected into the patient's vein, and then perform a series of photographic bottom images.

Stereoscopic images can also be used as source for dynamic observation of patients with a pronounced dry foma OTM and patients during treatment.

For a fine estimate of changes in the retina and macule, OKT is used (optical coherent tomography), which allows you to identify structural changes in the earliest stages of retinal degeneration.

Treatment of dry and wet forms of ISD

Despite the enormous successes in the improvement of the methods of diagnosis of the NMD, its treatment remains a rather complex problem. In the treatment of dry forms of ISD and with a high risk of developing the disease in order to normalize exchange processes in the retina, antioxidant therapy courses are recommended.

According to the research of Areds, the useful effect of receiving antioxidants was achieved from those participants who had an intermediate or late stage of the ISD at least one eye. Combined therapy with antioxidants, zinc and copper for 5 years reduced the lateral stage of NMD in 25%, and the risk of visual acuity on 3 and more lines by 19%.

It should be remembered that the replacement therapy for the prevention and treatment of the dry form of NMD cannot be a course, its use is possible only on an ongoing basis. It should be used in persons over 50 years old, and in the presence of risk factors (smoking, overweight, burdened anamnesis, cataract extraction), and earlier.

Treatment of the wet form of NMD is aimed at suppressing the growth of abnormal vessels. To date, there are a number of drugs and techniques registered in Russia, allowing to stop or reduce the manifestations of abnormal neovascularization, which made it possible to improve vision at a significant number of people with a wet form of NMD.

For more information, read our article "Treatment of Vans Maular Degeneration".

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Age macular degeneration is one of the common causes of weakness and blindness in people after 50 years. This disease is associated with the development of pathological processes affecting photoreceptors, the membrane of Bruch and the pigment epithelium of the mesh shell. Consider for which reasons arises and how the macular degeneration of the retina is treated.

After about 45 years in the human body, age changes are inevitably occur. The visual system is no exception. According to statistics, about 300 people per 100 thousand population annually turn to ophthalmologists with the problem of the emergence of age macular degeneration (NMD). This is a serious illness, which in the absence of timely vocational treatment inevitably provokes the appearance of full blindness. Most often it is observed in people of the older age group. Pathology arises due to a slowdown in metabolism in the retinal structure, due to which the cells are affected in its central part (macule), where the light beam is focused. The disease can only be localized on one eye, but in severe cases there is a bilateral defeat of organs of vision. It should be noted that degenerative violations in the work of the macular zone of the mesh shell lead to weakness and complete blindness. Therefore, it is important to receive qualified medical care in a timely manner.

Age Macular Degeneration: Dry Shape

Makula, or a yellow stain, is a central part of the retina consisting of several layers: photoreceptors, a pigment epithelium and a membrane of Bruch, which performs the function of the partition between the upper layers and blood vessels (choriocapillars). Over time, exchange processes slow down in the human body. This leads to the fact that the products of cell vital products accumulate in Makula. As a result, special seals are formed in the layers of the yellow stain - dubs. The presence of a plurality of similar small formations is a sign of an early dry form of NMD. At this stage, there is practically no worsening of vision, especially if pathology is localized on the one hand. This is due to the fact that a healthy eye compensates for the work of the visual system due to more intensive functioning. Over time, age macular degeneration (dry form) progresses to a developed stage. At the same time there is an increase in the size of the friends and their number. In addition, destructive processes in photosensitive cells and tissues surrounding maculi begin to occur. This leads to a significant reduction in visual acuity and contrasting eye sensitivity. Also, many patients in the center of sight appear first vague, and then a dark spot. In this regard, the straight lines are perceived partially durable, and the picture is very distorted, for example, a direct doorway may seem to be overwhelmed. In addition, in the developed stage of the dry form of the NMD, an increased sensitivity of the eyes to the light may be observed, violation of spatial vision and complexity in distinguishing the color scheme. All of the above symptoms impose restrictions on the performance of any work requiring good visibility near and away. In the absence of treatment, the dry shape of the NMD is rapidly progressing and goes into a wet.

Dry Shape NMD: Stages

Early stage. Often proceeds asymptomatic and does not cause a decrease in visual acuity. At this stage, the formation of seals (friends) occurs in the Structural layers of Makula.

Developed stage. It is characterized by an increase in the size and number of friends. At this stage there is a criminaliness and a sharp decrease in visual acuity, as well as other uncomfortable symptoms.

Progressive stage. It is characterized by the transformation of pathology in a wet form.

Age Macular Degeneration (wet shape)

The most aggressive and serious is the wet (exudative) form of NMD, characterized by the formation of new pathological blood vessels in Makula. As the druses accumulate in the structure of the yellow stain, the retina begin to develop inflammatory processes, accompanied by the production of VEGF protein. It promotes angiogenesis - the growth of new blood vessels, which are abnormal for macula tissues. Over time, they germinate through the membrane of Bruchi and are introduced into the structure of the tissues of the yellow spot of the retina. Further on pathological vessels begins to flow blood and liquid (plasma), which leads to the formation of bubbles. The age macular degeneration (wet form) is dangerous in that the deposit data is stored and accumulated between the membrane of Bruch and the layer of photoreceptors, thereby hitting the vulnerable nerves. If it is not possible to receive medical care in a timely manner, the process of formation of scar tissue and detachals in the area of \u200b\u200bMacula will begin. It threatens irrelevant loss of vision. It should be noted that the wet form of the disease is less common than dry, in 1-2 cases out of 10. However, it is most dangerous because it progresses fast enough.

Diagnosis of NMD

Makulyodistrophia is a serious illness that can cause full blindness. Therefore, between the ages of 45 and 50 years, it is recommended for at least once every 2-3 years to undergo an ophthalmic survey, and after 60 years - at least 1 time per year. Modern computerized methods of retinal diagnostics make it possible to reveal the disease at the earliest stage of the dry form of the NMD. For this, as a rule, a method of optical coherent tomography (Oct) is used. With it, a specialist can obtain detailed information on changes in the tissue structures of Makula.

When symptoms of the disease, for example, the emergence of a blurry spot in the center of the field of view, you can spend a test on the NMD at home. This will require an amsel table that can be easily found on the Internet. This test is designed to identify Makula pathologies, as well as estimating the dynamics of the treatment of a previously diagnosed disease of the central part of the retina. The table must be placed at a distance of 30 cm and cover one eye with hand. Then you should focus on the bold point, which is located in the center of the checkered page. If there are CFD cells that are around the focal point, will begin to be distorted. Ophthalmologists recommend noting these deformations on a sheet (sketch) and take with them to receive. This can be useful in the diagnostic process.

Many are interested in what factors affect the development of the NMD. Currently, doctors determine several reasons that contribute to an increase in the risk of appearance and aggressive progression of this disease.

Factors affecting the appearance of maculyodistrophy:

• Sexual sign. In women, the risk of the appearance of the disease is 2 times higher;
• Age. VBM is often diagnosed in people aged 50;
• Obesity (overweight);
• Smoking;
• Chronic diseases (atherosclerosis, hypertension, diabetes mellitus);
• Negative professional factors (ionizing radiation);
• Bad ecology.

Treatment of NMD (age macular degeneration)

Currently, the treatment of macular degeneration is carried out quite effectively. Previously, a laser coagulation method was used to stop the growth of pathological vessels in Macula. He allowed to partially remove an abnormal tissue, but did not affect the cause of its appearance, namely, the production of VEGF protein. Therefore, such a procedure was only a temporary measure. In the early 2000s, a revolutionary way of struggle with the NMD was developed, which was based on the destruction of VEGF protein with the help of special medical preparations. He has proven its effectiveness, so successfully applies to this day, allowing millions of people around the world to avoid the onset of blindness. However, it should be noted that at the very late stage of the disease, this method of treatment is already ineffective. Anti-VEGF Therapy cannot help when scar tissue appears in the Makula zone. In such a situation, loss of vision is inevitable. In other cases, injections allow you to reduce the progression of NMD and restore the clarity of view. The control of angiogenesis using these drugs is removed edema and prevents further damage to the yellow stain, which stabilizes the visual function.

Treatment of Macular Degeneration: Anti-VEGF Therapy

The drug "Lucentis". This substance includes ranibizumab molecules. The effect of this drug is aimed at reducing excessive stimulation of the growth of pathological vessels at NMD. It reduces the macular swelling swelling, prevents the germination of pathological vessels, new hemorrhages and significantly reduces the location zone of pathology.

Eil. This drug contains an aflybercet - an active substance whose molecules are spliced \u200b\u200bwith pathological cells and destroy them. It is applied only with a humid form of the disease.

These drugs counteract the development of new pathological vessels in the center of the retina. For the most efficient impact, injection is produced directly into the vitreous body of the eye. The procedure takes several minutes and does not require special training. It is carried out in sterile conditions an experienced ophthalmologist. With the penetration of active substances, the level of activity of the VEGF protein is decreased in the Macula tissue, as a result of which the pathological vessels begin to decay. With several injections, an abnormal liquid is also absorbed. The course of treatment is carried out under the strict observation of the ophthalmologist. It is strictly forbidden to try to independently apply these drugs. This may entail irreparable effects, up to full blindness.

Prevention of the disease

In order to prevent the appearance of NMD, it is recommended to systematically undergo an ophthalmic survey, especially after 45 years. Also, experts advise to protect their eyes from the excessive impact of ultraviolet (use sunglasses). It is proved that people spending a lot of time in the sun are 4 times more often diagnosed with maculyodistrophia. Ophthalmologists strongly advise refreshing cigarettes. It has been proven that smoking significantly increases the risk of developing and progressing the NMD (approximately 5 times). In addition, doctors recommend limiting oily food and control cholesterol levels (the increased content of the eye breaks down). It should be introduced into the diet products useful for vision: blueberries, salad, cabbage, spinach, fish, eggs, grapefruit and others. In the fall and in winter it is advisable to take vitamin complexes. In general, specialists advise to conduct an active lifestyle, spend more time in the fresh air and, as far as possible, reduce the visual loads.

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Age macular degeneration is a chronic disease in which the degradation of central vision occurs. The pathological process is based on damage to the Macula - the central part of the retina. The composition of Makula includes a huge number of photosensitive cells that provide acute and detailed central eyesight. Macula is located in the backy of the retina and is the most sensitive part.

What it is?

Experts allocate dry and wet form of NMD. The first type is found quite often and is associated with the appearance of deposits on the retina. The wet form is formed due to blood supply and fluid from blood vessels.

Age macular degeneration significantly worsens the quality of life. Patients worsen vision in the central portion of the field of view, and this area is responsible for many processes, among which reading, recognizing persons, driving a car, sewing.

Most often, degenerative macula changes appear after the fifty-year-old age, although there are cases when the disease occurs in young patients. The NMD can develop slowly, and the vision over the entire period of time does not change. In other cases, pathology quickly progresses and causes a significant impairment of vision on one or both eyes.

Allocate wet and dry form of NMD

Provoking factors

The exact causes of the degenerative changes of the Makula still have not been studied completely, but they arise as eye aging. As a result, it leads to thinning and destruction of the central part of the retina.

Experts identify such etiological theories of the emergence of the NMD:

• anomalous height of blood vessels. The liquid flowing from the anomalous vessels prevents the normal functioning of the retina and leads to the turbidity of the macula. As a result, the items that you see seem curved and deformed;
• the accumulation of fluid in the rear of the eye. This causes a pair of epithelium, which is manifested in the form of a blister under Makula.

The dry form of age macular degeneration can progress and become a wet type. Specialists do not give any guarantees regarding whether such rebirth is possible and when it happens. Some people have a worsening view so progressing that leads to blindness.

Smoking is a provoking factor in the emergence of the pathological process of Makula

The risks of the occurrence of age macular degeneration under the influence of the following factors:

• smoking. According to research, this harmful habit of twice increases the risks of the appearance of NMD;
• genetic predisposition;
• cardiovascular disorders;
• overweight;
• racial affiliation. Europeans are more often diagnosed by NMD;
• age indicators;
• improper nutrition;
• inflammatory processes;
• increased cholesterol;
• operation for clouding lens;
• long stay under an intense light source.

Experts assure that a healthy lifestyle significantly reduces the likelihood of a pathological process. Doctors recommend abandoning smoking, engage in moderate exercise, control blood pressure and cholesterol. An important role is played by the diet, which should include greens, vegetables, fish.

Symptoms

For macular degeneration, the appearance of the following symptoms is characteristic:

• need for a brightest light for reading and working with small objects;
• bad adaptation in conditions of insufficient illumination;
• blurry text;
• the feeling that the colors became faded;
• poor face recognition;
• the appearance of haze before eyes;
• rapid impairment of vision;
• the appearance of the blind spot in sight;
• straight lines seem curved;
• spectative hallucinations. People or geometric shapes can be used.

With macular degeneration, visual hallucinations may appear

What is dangerous maculodystrophy?

As you know, the eyes are a pair body, so a healthy organ of vision takes the function of affected. For a long time, degeneration may remain unnoticed. It is also worth noting the fact that when maculodystrophy may not be painful sensations, so the patient may seem to be that everything is fine.

The disease threatens with full blindness and disability. Reasonable consequences can develop in just a few weeks. That is why as soon as possible, you should contact an ophthalmologist for diagnostics.

The diagnosis is made on the basis of anamnestic data, studies of visual acuity, angiograms and CT. The doctor will necessarily examine the fundamental bottom.

With macular degeneration, macula cells are destroyed

Life with maculodystrophy

If you are diagnosed with age macular degeneration, it means that you have to change lifestyle. This also applies to nutrition. Consider all these recommendations:

• use fruits and vegetables. Incoming antioxidants are extremely important for eye health. Doctors recommend entering spinach, beans, broccoli, leaf cabbage into the diet. These vegetables include not only antioxidants, but also lutein and zeaxanthin, which are so necessary in the fight against maculyodistrophia;
• use fats. We are talking about healthy unsaturated fats, which, for example, are in olive oil. It should limit the use of saturated fats. They are contained in butter, fast foods;
• flour replace whole grain products;
• eat fish. Omega-3 fatty acids included in the product reduce the risks of vision loss.

The following tips will help adapt to changes:

• try to pick up glasses as accurately as possible;
• to work with small objects, use a magnifying glass;
• on electronic devices, select the desired font size and contrast of the image. There are special computer programs designed for visually impaired. You can set a program with which the text will be made in MP3 format;
• make bright house lighting;
• if you are allowed to drive a car, do it with great care;
• do not closure to yourself, look for help from loved ones. Perhaps you will need help a psychologist or psychotherapist.

Spend more time with family, close people will have invaluable support

Wet macular degeneration

The pathological process is based on the growth of pathological vessels under Maculat on the back of the retina. These abnormal blood vessels are quite fragile, which is why blood and liquid penetrates through them, which raise with a natural position. A wet form develops quickly and characterized by rapid impairment of vision.

Important! In the ninety percentage of cases, it is wet maculodystrophy that becomes blind.

Treatment of age-related macular degeneration includes conservative therapy. Patients prescribe dedyatrophic drugs, antioxidants and immunomodulators. Also useful during retinal degeneration are Lutein and Zeaxanthin. Although they cannot return vision, suspend the progression of the pathological process is completely capable.

Currently, techniques are applied, the effectiveness of which is clinically confirmed:

• photodynamic therapy. This is a relatively new method of treatment. The abnormal vessels turns out to be photochemical effects. With the help of a weak laser exposure, a special substance is activated, which is first introduced intravenously. As a result, there is a blockage of abnormal vessels and the removal of swelling;
• angiogenesis inhibitors: Avastin, Eil, Lutnotis. These prepartes quickly stop swelling and return normal indicators of vision. A means of directly in the eye are introduced using the finest needle. This procedure is absolutely painless.

With wet NMD, fluid and blood from pathological vessels occurs

Dry macular degeneration

It is characterized by atrophic changes, as a result of which the macular tissue is thinning. At first, the pathological process affects one eye, after which the second organ of vision is involved in it.

A characteristic symptom of dry form is the education of friends. They are deposits under the retina. Druz themselves are not the cause of impairment.

The disease occurs in three main stages:

• Early stage. It is characterized by the appearance of several small friends. As a rule, clinical manifestations are absent.
• Intermediate stage. There are a large number of medium-sized friends and a few large ones. Symptoms may be absent. In some cases, the central part of the field of view appears. A person needs more time to go into a dark room, and brighter reading lighting.
• Late stage. There are druses of large sizes. Macula cells are destroyed. Significant impaired vision.

Treatment of dry maculodistrophy includes the following:

• timeliness of therapeutic measures;
• impact on the mechanism for the development of the pathological process;
• comparative analysis of NMD with other pathologies;
• lifelong treatment, including lifestyle change;
• the use of a drug, laser and surgical treatment method.

Summary

Age macular degeneration is a serious pathological process, which most often arises from people after fifty years. The disease threatens irreversible changes up to loss of vision. Maculyodistrophy is dry and wet. Depending on the form of illness, appropriate treatment is selected. Early diagnosis, timely appointed treatment and adherence to medical recommendations will help prevent the development of dangerous complications and restore vision.