Snm ophthalmology. Chorioretinal dystrophy of the retina
AGO - antiglaucoma surgery
AK - accommodative convergence
AKA - the ratio of accommodative convergence to accommodation
AKC - abnormal correspondence of retinas (pathological PRKK)
AWP - autorefractometry
IOP - intraocular pressure
VGZH - intraocular fluid
IBD - moisture in the posterior chamber of the eye
VMD - age-related macular degeneration
WOF - vertical volume (goropter) fusion (vertical)
MIC - moisture in the anterior chamber of the eye
VPM - internal border membrane (retina)
congenital - congenital
GRP - vitreoretinal proliferation
HRV - 1) vitreoretinal adhesions; 2) vertical alignment reserve (vertical)
ART - vitreoretinal traction
GAKS - harmonious AKC
GAO - hydroactivation of outflow (antiglaucoma procedure)
DG - hydrogel drainage
ch. - ocular
GNSS - harmonious NCC
GONE - hemorrhagic ONE
GOPE - hemorrhagic OPE
GTS - hernia of the vitreous body
GSE - deep sclerectomy
YES- long-term atropinization
BPH - descemetogoniopuncture
Dda - divergent disaccomodation
DDT - dedystrophic therapy
DZK - discision of the posterior capsule
Optic nerve disc - optic disc
DLK - diffuse lamellar keratitis
DM - diabetic maculopathy
DMO - diabetic macular edema
DOF - divergent volume (goropter) fusion
diopters. - diopter
DR - diabetic retinopathy
DRS - divergent combining reserve
DTK - diode laser thermokeratoplasty
DTCK - diode laser trans-scleral cyclocoagulation. It can be contact and non-contact. She is also laser cyclodestruction, transscleral laser cyclodestruction. It is usually used for terminal glaucoma.
ZhKL - hard contact lenses
BEHIND - stock of accommodation
SGP - visual evoked potentials
ZGM - posterior hyaloid membrane
ZKL - posterior chamber lens
ZKH - posterior lens capsule
ZOA - stock of relative accommodation
ZOST - posterior detachment of the vitreous body
ZPH - replacement of a transparent lens
SAM - posterior radial keratotomy
Zug - angle-closure glaucoma
ZF - visual fixation of the eye
ZER - posterior corneal epithelium
IACS - intropic AKC (adapted to convergent strabismus)
IVVK - intravitreal introduction of kenalog
IVGD - true intraocular pressure
IVVL - intravitreal injection of Lucentis
ICL - iris-clip-lens
IMR - idiopathic macular rupture
IOL - intraocular lens
IRT - acupuncture
ISP - intrascleral cavity
ISU - sclero-strengthening injection
IHD - irido-lens diaphragm
IEK - intracapsular cataract extraction
CA - convergent accommodation
AS - the ratio of convergent accommodation to convergence
CD - collagen drainage
QC - keratoconus
KMO - cystic macular edema
AMG - pterygopalatine ganglion
Kon-va - conjunctiva
KOF - convergent volume (horopter) fusion
Cattle - convergent combining reserve
CT scan - keratotopography
LASEK - laser subepithelial keratomileusis
LASIK - laser in situ keratomileusis
LH - Goldman lens
Lda - therapeutic long-term atropinization
LDVK - laserdiscision of secondary cataract
LDZK - laserdiscision of the posterior capsule
LIKA - laser in-situ keratomileusis by aberrometry
LIE - laser iridectomy (antiglaucoma procedure - a hole in the iris)
LKS, LK - laser coagulation of the retina
LTK
LTP - laser trabeculoplasty
LCC - laser cyclocoagulation (against glaucoma)
MVS - high myopia
MH - micro-fogging (training method according to A.I.Dashevsky)
MH - macular zone
MILK - micropulse laser coagulation
MIOL - multifocal intraocular lens
MCL - soft contact lenses
MCOZ - maximally corrected visual acuity
MO - macular edema
MSlSt - mild myopia
MSrSt - moderate myopia
MTKL - soft toric contact lens
IEWG - multifocal electroretinography
observation - observation
NAKS - inharmonious AKC
NGSE - non-penetrating deep sclerectomy
NCOZ - uncorrected visual acuity
NCC - normal correspondence of retinas (normal PRKK)
NNKS - inharmonious NCC
NPDR - non-proliferative diabetic retinopathy
IUU or neuroretinal girdle \u003d area Optic nerve disc - ED. (an important part in evaluating Optic nerve disc and its excavation)
NE - neuroepithelium (retina)
OAA - the volume (strength) of the absolute accommodation of the eye
OZ, about. sp. - visual acuity
OKT - optical coherence tomography (retina)
HE TO - acute circulatory disorders (for example, PMC CAC)
ONE - detachment of neuroepithelium
OOA - the volume of relative accommodation of the eye
opera. - operated, operating
OPE - detachment of pigment epithelium (retina)
OS - retinal disinsertion
CCA - detachment of the choroid
OU - objective angle (strabismus)
OUG - open-angle glaucoma
OF - volume (goropter) fusion
OFPS - edematous fibroplastic syndrome
PAX - variable AKC (then GAKSthen NAKS)
PVCRD - peripheral vitreochorioretinal dystrophy
PDR - proliferative diabetic retinopathy
PZO - front-rear axle
PIN - anterior ischemic neuropathy
PINA- Habitual Excessive Stress of Accommodation (syn: prespasm and spasm of accommodation, non-rigid and rigid functional myopia)
PCT - pachikeratotopographer
PKH - anterior lens capsule
PNKS - variable NCC (then GNSSthen NNKS)
POAG - primary open-angle glaucoma
PPLC - peripheral prophylactic laser coagulation
PPO - positive consistent images
prePDR - preproliferative diabetic retinopathy
PRLK - panretinal laser coagulation
PRK - anterior radial keratotomy
trans. - transparent
PTS - Syndrome of an empty Turkish saddle (or vehicle passport
PFOS - perfluoroorganic compounds; substances used in the surgical treatment of retinal detachment.
PCRD - peripheral chorioretinal dystrophy (not to be confused with PVCRD)
PEC - density of endothelial cells
PES - pseudoexfoliation syndrome
PES, PE
RA - accommodation reserve
Rek-but - recommended
RK, RKT - radial keratotomy (Sato incisions)
RTKT - radial tangential keratotomy
ROS - retinal visual acuity
RPE - retinal pigment epithelium
RS - combination reserve
SGA - complex hyperopic astigmatism
UPC - penetrating keratoplasty
SCS - mixed PRKK (combination NCC and AKC)
SLG - silicone hydrogel lenses
SLT - selective laser trabeculoplasty
CM - silicone oil
SMA - complex myopic astigmatism
Mixed. ast. - mixed astigmatism
SNM (KhNV) - subretinal neovascular membrane (choroidal neovascularization)
SONE - serous ONE
SOPE - serous OPE
SP - scleroplasty
SRJ - subretinal fluid
SSG - dry eye syndrome
ST - vitreous
STVE - subtotal vitrectomy
STE - sinustrabeculectomy
SU - subjective angle (strabismus)
TVGD - tonometric intraocular pressure or intraocular pressure tonometer
TVGD-5.0 - tonometric intraocular pressure, measured with a load of 5.0 g.
TVGD-7.5 - tonometric intraocular pressure, measured with a weight of 7.5 g.
TVGD-10.0 - tonometric intraocular pressure, measured according to Maklakov, i.e. with a load of 10.0 g.
TVGD-15.0 - tonometric intraocular pressure, measured with a load of 15.0 g.
TDM - trabeculo-descemet membrane
ter. - therapeutic
TC - tangential keratotomy
TC, TKP - thermokeratoplasty
TKK - thermokeratocoagulation
injuries. - traumatic
TSNV - the thickness of the layer of nerve fibers
TSP - Tenoscleroplasty - an operation on the eye muscle to reduce its rotational effect on the eye in strabismus, nystagmus
TSP-I - 1st version of the TSP according to M. B. Vurgaft and V.A. Smirnov (not applied for cosmetic reasons)
TSP-II- 2nd version of the TSP according to M. B. Vurgaft and V.A. Smirnov (not applied for cosmetic reasons)
TSP-III - 3rd version of TSP according to M. B. Vurgaft and V.A. Smirnov (not used due to low efficiency)
TSP-III-o - 3rd, basic version of the TSP according to V.I. Pospelov
TSP-III-d - 3rd, two-flap version of the TSP according to V.I. Pospelov
TSP-III-y- 3rd, narrow-patch version of TSP according to V.I. Pospelov
TSP-IV- 4th version of the TSP according to V.I. Pospelov (analogue of TSP-II, performed on a previously recessive muscle)
TTT - transpupillary thermotherapy
TFV - gaze fixation point
TCVS - thrombosis of the central retinal vein
UZBM - ultrasonic biomicroscopy
UZDG - ultrasound dopplerography
CPC - anterior chamber angle
FAG - fluorescence angiography (retinal)
Fako
PDT - photodynamic therapy
FZK - fibrosis of the posterior capsule
FIOL - phakic intraocular lens
FP - filtration cushion
PRK - photorefractive keratectomy
PRKK - functional retino-cortical correspondence
FSP - functional scotoma (prolapse, suppression of part of the visual field)
FSP-A NCC
FSP-V - functional scotoma, suppressing AKC
FEK - phacoemulsification of cataract
FEPH - phacoemulsification of the transparent lens
CKD - choroidal biological spring. It consists of the choroid, suprachoroidal plates, subscleral trunks of the vorticose veins, tightly connected with the choroid of the retina and the cortical layer of the vitreous body fused with it (A.I. Gorban, 2002).
hir. - surgical
KhNV, SNM - choroidal (subretinal) neovascularization (choroidal neovascular membrane)
HRPDS - chorioretinal pigment retinal degeneration
CAC - central retinal artery
TsVS - central retinal vein
TsVHRD - central vitreochorioretinal dystrophy
CDK - color Doppler mapping
CPF - central ZF
Cost center - central optical zone
TsSR, TsSKh, TsSHRP - central serous chorioretinopathy
CFK - cyclophotocoagulation
CHRD - central chorioretinal dystrophy
PRACTICE - partial atrophy of the optic nerve
CHSMT - Partial median myotomy with longitudinal muscle stratification - V.I. Pospelova, is designed to enhance muscle extensibility and reduce its contractile ability.
EAX - exotic AKC (adapted to divergent strabismus)
ED - excavation of the optic nerve head
EZF - eccentric (not central) ZF
ELK - endolaser coagulation
EOG - electrooculography
ERG - electroretinography
ERM - epiretinal membrane
ESP - episcleral filling
EFI - electrophysiological research
EED - epithelial-endothelial corneal dystrophy
EEC- extracapsular cataract extraction
b / l - sick leave (sheet of temporary disability)
i / v - intravenously
in / m - intramuscularly
in - with glasses
d / b - for near
d / d - for distance
behind - stock of accommodation
c / a glaucoma - angle-closure glaucoma
k / cor - contact correction
k / l - contact lens
n / eyelid, i / eyelid - lower / upper eyelid
n / nar, in / nar, n / v, n / nar - bottom-outer, top-outer, bottom-inner, bottom-outer
n / a - does not correct
nar / vn / top / bottom pr. m-tsa - external / internal / upper / lower rectus muscle
o / u glaucoma - open-angle glaucoma
p / b - parabulbar
pC - front camera
n / a-woo - under the conjunctiva
p / oper - after operation
by m / f - at the place of residence
r / b - retrobulbar
s / k - subconjunctival
s / k - with correction
at / at - narrow-angle (glaucoma)
e / d - ratio of excavation to diameter Optic nerve disc
English abbreviations
Alt (alternatio) - alternates (non-permanent)
ARMD - age-related macular degeneration
AREDS - age – related eye disease study
oh - letters. per. "by", the position of the axis of the cylinder correcting astigmatism (example: ax 90 degrees \u003d 90 degrees each)
BCVA - best corrected visual acuity (the best corrected visual acuity)
CE, CE Mark - certificate of compliance with European safety standards
CLR - clear lens replacement - replacement of a transparent lens
CNV - choroidal neovascularization (choroidal neovascularization)
Conv (Convergens) - convergence (convergence)
cyl - cylindrical lens
D - diopter
DD - disc diameter (diameter of the optic nerve head)
Dev. (Deviatio) - deviation (for example, Dev \u003d 0 or Dev = 10 conv alt)
Div (Divergens) - divergence (divergence)
Dp, Dpp
FDA - food and drug administration
Gl. - glaucoma
LTK - laser thermokeratoplasty
ML - macula lutea - macula, central region of the retina
MZ - macular area of \u200b\u200bthe retina
N - norm
NSAID - Non-steroidal anti-inflammatory drug (non-steroidal anti-inflammatory drugs)
OCT - optical coherence tomography
OD - right eye (oculus dexter)
OS - left eye (oculus sinister)
OU - both eyes (oculi utriusque)
PD - pupillary distance (interpupillary distance)
RPE - retinal pigment epithelium (retinal pigment epithelium)
sph - spherical lens
UCVA - uncorrected visual acuity (visual acuity without correction)
VD - vertex distance (the distance between the front surface of the cornea and the back surface of the corrective spectacle lens; usually about 12 mm)
VEGF - vascular endothelial growth factor (vascular endothelial growth factor)
Vis - (from Visus) - vision - visual acuity
In the exudative form of age-related macular degeneration (AMD), at first the patient may complain of acute sensitivity to light, decreased contrast sensitivity, impaired color perception, photopsy, blurred vision.
With the progression of pathology, a person notes a decrease in visual acuity, the appearance of metamorphopsias (curvature of straight lines, distortion of the image, "jumping" letters when reading).
The disease progresses rapidly, with possible loss of central vision within 6 months. The patient may lose the ability to read and write. Patients with unilateral development of the exudative form of age-related macular degeneration are at risk of developing choroidal neovascularization in the other eye for 3-5 years.
With ophthalmoscopy, soft drainage drusen, local detachment of the retinal neuroepithelium, accumulations of hard exudates around the subretinal neovascular complex can be detected. Rupture of newly formed vessels in this form can lead to hemorrhage into the subretinal space or into the vitreous body (rarely).
Ophthalmoscopically, predominantly classical SUI is visualized as a gray-green lesion, which is localized under the retinal neuroepithelium.
The main ophthalmoscopic signs at this stage of the existence of the subretinal neovascular complex are characterized by the presence of a disc-shaped focus of gray or white color with clear contours, pigment deposition, and possibly the presence of choreretinal shunts and anastomoses.
Subretinal neovascularization
Subretinal neovascular membrane (SNM) is a fairly frequent exacerbation of various fundus anomalies, primarily VDM, complicated by myopia, angioid retinal stripes, central chorioretinitis.
CHM, associated with high myopia and especially age-related macular degeneration, is a pathology with a burdened prognosis. The pathogenesis of this process has not been studied at all; therapeutic options are very limited. The main diagnostic methods are biomicroscopy and fluorescence angiography, additional ones are optical coherence tomography and angiography with indocyanine green, long-wave fundusgraphy. The fluorescein-angiographic picture at the initial phases looks like lace, at the neglected - continuous hyperfluorescence, which merges, this is determined by the extravasal departure of fluorescein through the wall of the newly formed vessels. On optical coherence tomogram, SUI looks like a subretinally placed optically dense formation with the presence of retinal neuroepithelium detachment and / or retinal pigment epithelium.
SNM, given its anatomical localization by foveoli, is divided into three main groups:
- Extrafoveal - the boundaries of the SUI are removed from the geometric center of the foveal avascular zone;
- Yukstafovealnaya - SNM borders are removed from the center;
- Subfoveal - located under the geometric center of the FAZ.
Based on the data of fluorescence angiography, two main components of SUI are distinguished - classical and hidden (occult). The classical component of SUI is determined in the early phases of PAH and is characterized by clearly defined boundaries of the neovascular complex. In late-stage imaging, there is a progressive leakage of the dye into the surrounding subneuroepithelial space.
The latent component of SUI is characterized by a neovascular complex that does not correspond to the angiographic picture of classical SUI. The category of latent SUI includes fibrovascular detachment and late leakage from an unknown source, with the appearance of hyperfluorescence in the late phases of PAH; the limits of latent SUI are difficult to determine because it is located under the retinal pigment epithelium.
These angiographic differences are important for determining in which group of patients there is a possibility of a beneficial effect from laser coagulation or photodynamic therapy.
More often, SUI in WDM is of a mixed nature, when the classical (mainly classical) or latent (minimally classical) component prevails. Some authors distinguish a special form of exudative VDM - retinal angiomatous proliferation - the formation of anastomoses between the retinal and choroidal circulation, as well as polypoid choriovasculopathy.
It has long been known that maintaining the macular pigment, xanthophil, which suffers from AMD is important to preserve the protective function of the macula. The three carotenoids we get from food - lutein, zeaxanthin and mesoseaxanthin - accumulate in the macula and together are involved in creating macular pigment. The importance of macular pigment is due to its antioxidant activity and its ability to trap the blue light spectrum while protecting the macula. To preserve the protective function of the macula and maintain macular pigment, preparations containing lutein and zeaxanthin, such as lutein forte, are recommended.
Laser treatment
There are two fundamental approaches to the preventive treatment of age-related maculopathy in the world: direct and indirect coagulation of druses. Direct laser coagulation (LC) involves direct damage to druses by laser radiation. Indirect laser coagulation is carried out indirectly in the nearby undamaged areas of the retina.
Considering the great importance of early treatment of AMD, a new method of indirect selective LA was developed for the treatment of patients with age-related maculopathy. Indirect selective LA was performed using a specific laser with a radiation wavelength of 532 nm. The technique consists in the fact that coagulates are applied in a series of pulses in an amount from 8 to 12 in each series in 4 rows in the form of concentric circles along the macular area at a distance of 750 μm from the center of the fovea. Beam diameter - 50 microns, exposure - 0.01 s, power - from 0.04 to 0.09 W. The pulse energy is selected for each patient individually.
Indication for indirect selective laser coagulation is the beginning of discharge of soft druses. OCT reveals how the drusen change the relief of the inner layers of the retina. In patients with this, visual acuity is more than 0.7.
The effectiveness of treatment was determined on the basis of the functional parameters of the visual analyzer, OCT, as well as the frequency of formation of subretinal neovascular membranes.
And pigment epithelium. AMD in ophthalmology in different periods was designated by different terms: central involutional macular dystrophy, senile, Kunta-Junius dystrophy, age-related maculopathy and others. Currently, there is a consensus that these are manifestations of the same pathology.
Age-related macular degeneration is the main cause of poor vision and blindness in patients over 50 years of age in Europe and the United States, and in Southeast Asia. The number of those who have lost their sight increases with age. In our country, this pathology occurs in 15 people out of 1000. At the same time, the average age of patients ranges from 55-80 years.
Age-related macular degeneration (AMD) is characterized by bilateral lesions, central localization of the pathological process, long-term slow course, and steady progression. The disease can be asymptomatic for a long time, patients seek qualified help late, which leads to loss of vision and disability. In the structure of disability by AMD, 21% are persons of working age.
Risk factors for AMD
- Age (over 50);
- ethnicity and race;
- heredity;
- white skin color;
- arterial hypertension;
- smoking;
- oxidative stress;
- low content of carotenoids in the macula;
- lack of antioxidants, vitamins, trace elements;
- high level of solar radiation.
Diabetes mellitus, atherosclerosis of the carotid arteries, inappropriate nutrition, overweight, impaired carbohydrate and lipid metabolism are also clearly associated with the development of age-related macular degeneration. Women over the age of 60 suffer from this pathology twice as often as men.
Types of age-related macular degeneration
There are "dry" and "wet" forms of this disease, which depend on the stage of the disease.
"Dry" AMD, or nonexudative, accounts for about 90% of cases and is characterized by slow progression. The "wet", or exudative form, occurs in 10% of cases, accompanied by the development of choroidal neovascularization and rapid loss of vision.
In the development of AMD, the ischemic factor (trophic disorders) is of decisive importance. The disease can develop in two ways:
- The first variant is characterized by drusen formation. Drusen are defined in both eyes symmetrically as yellowish thickenings located under the retinal pigment epithelium. Their size, shape and number, as well as the degree of prominence and combination with other changes in the pigment epithelium, vary. With a significant size and an increase in the number of druses, choroidal neovascularization develops. Active production of vascular endothelial growth factor, which is a powerful stimulant of angiogenesis, is characteristic. Newly formed vessels can spread under the pigment epithelium, causing the retina. Further, there is perforation of the pigment epithelium and detachment of the neuroepithelium. A choroidal neovascular membrane is formed, then a fibrous scar.
- The second variant is characterized by extensive geographic atrophy of the macular pigment epithelium, while choroidal neovascularization develops only in the later stages.
Age-related macular degeneration (AMD) symptoms
The "dry" form of AMD, in which hard and soft drusen are formed, is usually accompanied by minor functional impairments. Visual acuity in patients is usually quite high. In this case, the presence of drusen is considered as a risk factor for the development of neovascularization.
The "wet" form of AMD is characterized by rapid progression and almost always occurs in patients with an already existing "dry" form. The symptoms of the "wet" form are as follows:
- a sharp decrease in visual acuity;
- blurred vision;
- weakening the contrast of the image;
- difficulty reading when spectacle correction is ineffective;
- curved lines when reading or the loss of individual letters;
- metamorphopsies (distortion of objects);
- (the appearance of dark spots before the eyes).
More than 90% of all cases of complete vision loss in AMD are associated with the exudative ("wet") form of the disease, which is characterized by abnormal growth of newly formed vessels originating in the choroid and growing through defects in Bruch's membrane under the layer of retinal pigment epithelium, neuroepithelium. This situation is defined in ophthalmology as the formation of a neovascular membrane.
Blood plasma seeps through the wall of new vessels, and cholesterol and lipid deposits accumulate under the retina. Rupture of newly formed vessels can lead to hemorrhages, which can reach significant volumes. All this leads to a violation of the trophism of the retina, the development of fibrosis. The retina over the area of \u200b\u200bfibrosis (scar) undergoes gross changes and is no longer able to perform its functions.
AMD never leads to complete blindness. Initially, it is lost, an absolute scotoma (dark spot) appears in the central part of the visual field. Since the pathological process affects the macula (the central part of the retina), it remains preserved. At the end of the process, visual acuity is most often no more than 0.1, and the patient sees only with peripheral vision.
The disease in all patients proceeds individually, but when the neovascular chorioretinal membrane is formed, the time factor plays a key role. Early diagnosis and initiation of treatment during this period allows you to avoid loss of vision and achieve stable remission.
AMD diagnostics
Macular degeneration can be detected even before the development of clinical symptoms. Only a timely ophthalmological examination allows diagnosing pathology in time. To determine the disease, both traditional diagnostic methods (,) and computerized and automated methods are used - computer, visocontrastometry, fluorescence, color stereo photography, which make it possible to qualitatively diagnose macular pathology. With the already verified diagnosis of AMD, self-control of patients using the Amsler grid is highly informative. This test detects symptoms of macular edema due to choroidal neovascularization.
Treatment of age-related macular degeneration (AMD)
In the treatment of AMD, the main principles are a timely onset, a pathogenetic approach, differentiation depending on the stage of pathology, duration (sometimes treatment is carried out throughout life), complexity (drug, surgical, laser treatment).
Medication therapy for AMD includes the use of antioxidant drugs, vitamin-mineral complexes, which include zeaxanthin, lutein, anthocyanins, vitamins A, C, E, selenium, zinc, copper and other necessary components, as well as angiogenesis inhibitors and peptide bioregulators.
Laser treatment of AMD involves laser coagulation, photodynamic therapy. Surgical treatment of AMD includes techniques such as retinal pigment epithelium, with removal of SUI.
The method of intravitreal administration of a kenalog has become very widespread due to its simplicity and availability, which is performed for macular edema of various etiologies, including with “wet” AMD. This method is highly effective, significantly reduces the edematous component, but is associated with the risk of complications.
In recent years, a new progressive method of treating AMD has been practiced - the use of drugs that inhibit the production of vascular endothelial growth factor. These drugs show the best results in terms of preserving vision and are the treatment of choice.
Disease video
Prevention of AMD
All patients with a history of AMD, as well as those from risk groups, should undergo a comprehensive ophthalmological examination every 2-4 years. In the event of complaints characteristic of this pathology (decreased visual acuity, loss of letters, metamorphopsias and others), you should immediately contact an ophthalmologist.
Clinics of Moscow
Below are the TOP-3 ophthalmological clinics in Moscow, where you can get diagnostics and treatment of age-related macular degeneration.
Myopic choroidal neovascularization can also be referred to under the names: "subretinal neovascularization in pathological myopia", "Fuchs spot", "retinal Foster-Fuchs spot", "disciform degeneration in pathological myopia".
Myopic choroidal neovascularization is the most common vision-threatening complication of myopic disease. The visual prognosis is better in younger patients, with a smaller size of the focus of choroidal neovascularization, a higher initial visual acuity, and juxtafoveolar localization of choroidal neovascularization.
Pathogenesis... The exact pathogenesis remains unknown. There are several theories of the pathogenesis of myopic choroidal neovascularization, incl. mechanical theory. Degenerative changes in myopic disease are considered secondary. Excessive lengthening of the anteroposterior axis leads to mechanical stress of the tissues and the appearance of ruptures in the complex pigment epithelium - Bruch's membrane - choriocapillaries, which stimulates the secretion of VEGF by the pigment epithelium with the subsequent development of pathological neovascularization.
Symptoms of myopic choroidal neovascularization
Patients with myopic choroidal neovascularization may experience the following symptoms:
- decreased vision;
- metamorphopsias;
- scotomas;
- flashes of light or floaters in the field of view.
Typical changes in the posterior pole of the eye in pathological myopia include "parquet" fundus, "lacquer cracks", patchy or diffuse atrophy of PE, choroidal neovascularization, macular atrophy, posterior staphylloma, straightened and distended vessels, peripapillary atrophy in the temporal and temporal region, hemorrhages Optic nerve disc.
"Parquet" (or "mosaic") fundus is observed when, due to hypopigmentation or hypoplasia of the RPE, the choroidal vessels become visible through the retina. "Lacquer cracks" are ruptures of the elastic plate of Bruch's membrane.
Diagnosis of myopic choroidal neovascularization
Basic diagnostic methods: fundus examination, OCT, fluorescent angiography. Also used autofluorescence, angiography with indocyanine green. Diagnostic and differential diagnostic criteria for myopic choroidal neovascularization.
- Ophthalmoscopic signs: fundus changes characteristic of myopic disease. The subretinal neovascular membrane (SNM) is local and small (no more than one optic disc diameter), occurs mainly along the edge of foci of atrophy or "lacquer cracks"; localization is predominantly subfoveolar or juxtafoveolar. Hemorrhages are not pronounced and are localized around the SUI.
- OCT: the appearance of specific choroidal neovascularization of the 2nd type in the form of SUI, which is located under the neuroepithelium of the retina. Retinal edema is minimal and is often detected only on OCT. Detachment of the PES. not registered. Detachment of the retinal neuroepithelium is not pronounced, it is located perifocally around the SUI or (less often) - above it.