Eye diseases. Types of vascular pathologies of the retina (the most important)

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Eye diseases. Types of vascular pathologies of the retina (the most important)

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31. Types of vascular pathologies of the retina

External exudative hemorrhagic retinitis, or Coates' disease. The disease is characterized by varicose veins in the central zone of the fundus. Exudative and hemorrhagic foci of white, gray or yellowish (golden) color with fuzzy contours, bumpy or smooth surface are found near the optic nerve head. The retina prominates in these places.

The vessels “climb” onto the lesions, make bends, form loops, aneurysms, resembling the picture of angiomatosis. Exudation can be so pronounced that it appears as if there is a retinal detachment, as in retinoblastoma. Exudate accumulates between the choroid and the retina and penetrates the vitreous body. The fundus becomes poorly visible due to exudate and repeated hemorrhages. Gradually, the vitreous body takes on the appearance of a homogeneous grayish mass with hemorrhagic inclusions. Over time, the exudate is replaced by connective tissue, powerful moorings are formed that extend from the retina into the vitreous body and lead to retinal detachment. Gradually, starting from the posterior sections, the lens becomes cloudy. Visual functions decrease depending on the severity of the process.

Treatment. The etiology of the disease is not yet known, so treatment is usually ineffective. Given the similarity of the process with retinal tuberculosis, specific anti-tuberculosis therapy is often used in combination with non-specific anti-inflammatory and resolving agents (corticosteroids and enzymes).

Acute obstruction of the central retinal artery. Patients complain of a sudden sharp deterioration in vision, a typical picture is determined in the fundus: against the background of an ischemic retina of a milky white color, the central fovea stands out in the form of a cherry-red spot (the “cherry pit” symptom), the arteries are sharply narrowed, intermittency of blood flow is determined in the narrow arteries of the retina . Gradually, the optic disc becomes pale and atrophies, and the patient becomes blind.

In adults, the causes of embolism are hypertension, rheumatism, endarteritis.

Thrombosis of the central retinal vein. The disease develops more often in older people on the basis of sclerotic changes, vascular changes in hypertension, in children with blood diseases.

Patients complain of a rapid decrease in vision in one eye, the appearance of fiery flashes, fog before the eyes. The picture of the fundus: the optic disc and retina are edematous, the size of the disc is enlarged, it is red, protrudes into the vitreous body, the vessels are lost in the edematous tissue, the veins are dilated, tortuous, reminiscent of leeches. Therapy of the main suffering, the appointment of heparin, fibrinolysin, antispasmodics and vasodilators, and later absorbable drugs, physiotherapy.

Author: Shilnikov L.V.

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