Terrible consequences for vision! Background retinopathy and retinal vascular changes: what is it. Background retinopathy of the eyes Background retinopathy drops treatment

Retinopathy is a disease of the organs of vision that affects blood vessels. Its blood supply is disrupted, which causes retinal dysfunction. Ultimately, pathological processes lead to degeneration of retinal tissue, as well as damage to the optic nerve and complete blindness. Retinopathy is not characterized by pronounced symptoms. With this disease there is no pain, only occasionally “blind spots” () and floating spots may be noted in the field of vision. The disease progresses over time. In this case, obvious visual impairment appears.

Diagnosis of the disease is complex. It includes a number of instrumental studies and consultations with various specialists. In order to cure a patient of retinopathy, it is necessary to correct the underlying pathology and take medications such as anticoagulants, vasodilators and vitamin complexes.

Types of retinopathy

There are 2 types of disease: primary and secondary retinopathy. Primary retinopathy is not associated with an inflammatory process, while secondary retinopathy develops against the background of various diseases.

The following types of primary retinopathy are distinguished:

• central serous;
• external exudative;
• acute posterior multifocal.

Secondary forms of the disease are represented by the following retinopathy:

• diabetic retinopathy;
• traumatic retinopathy;
• retinopathy due to blood diseases;
• atherosclerotic and hypertensive retinopathy.

A separate type of disease is.

Background retinopathy

Secondary or background retinopathy develops as a result of pathological processes in the human body that occur with arterial hypertension, atherosclerosis, chronic renal failure and toxicosis of pregnancy.

Hypertensive retinopathy

In hypertensive retinopathy, arteriolar spasms occur. Then hyalinosis and elastofibrosis of the walls of these vessels develop. The severity of the symptoms of the disease is directly dependent on the severity of hypertension and its duration.

In the development of hypertensive retinopathy, four stages of the pathological process are distinguished:

• Hypertensive. It is characterized by a reversible dysfunction of the retina, which affects the activity of arterioles and venules.
• Hypertensive angiosclerosis. The vascular walls become thickened with atherosclerotic plaques, and their transparency decreases.
• Actually hypertensive retinopathy. Foci of pathological changes are formed in the tissues - areas of plasmorrhagia and hemorrhage, fatty inclusions. Protein fluid is released, and oxygen starvation occurs in certain areas of the retina. Partial may develop. Subjective signs of the third stage of retinopathy are decreased visual acuity and the formation of scotomas in the visual field. After adequate antihypertensive therapy, these signs of the disease may regress.
• Hypertensive neuroretinopathy. The previous changes in the retina are accompanied by swelling of the optic nerve head, exudate is released, and local retinal damage occurs. These signs are characteristic of malignant arterial hypertension, which develops in the presence of chronic renal failure. This stage of hypertensive retinopathy requires emergency treatment, otherwise complete loss of vision may occur.

To identify and determine the stage of hypertensive retinopathy, the following research methods are used:

• examination by an ophthalmologist;
• consultation with a cardiologist;
• fluorescent

During an examination of the fundus, the ophthalmologist records changes in the size of the retinal vessels, their obliteration, as well as Salus-Gunn syndrome (veins are displaced into the deeper layers of the retina against the background of pronounced pressure from the thickened artery at the intersection of the vessels). Retinopathy and oxygen barotherapy are used to treat hypertensive retinopathy. Adequate antihypertensive therapy is carried out, vitamin complexes and anticoagulants are prescribed.

In the later stages of arterial retinopathy, complications such as hemophthalmos or retinal vein thrombosis may develop. The high risk of these complications makes the prognosis very serious: a significant decrease in visual acuity may occur, up to complete blindness. With the development of hypertensive retinopathy in pregnant women, it is often necessary to raise the question of terminating the pregnancy.

Atherosclerotic retinopathy

With systemic damage by atherosclerotic plaques, atherosclerotic retinopathy may develop. The pathogenesis of changes in the retina of the eye in this type of disease is similar to those in hypertensive retinopathy. A special feature is that at a late stage of the pathological process, capillary hemorrhages occur, and microcrystals of frozen exudate are deposited along the vessels. There is also pallor of the optic disc.

To diagnose the disease, direct and indirect ophthalmoscopy, as well as ophthalmoscopy, are used. Treatment comes down to therapy of the underlying disease and antisclerotic, diuretic and vasodilating drugs, as well as angioprotectors and vitamins. At the fourth stage of the pathological process, electrophoresis of proteolytic enzymes is performed. This pathology is often complicated by blockage of the retinal artery and atrophic processes of the optic nerve.

Diabetic retinopathy

Diabetic retinopathy develops in the case of diabetes mellitus of the first or second type. But this disease does not occur in every patient suffering from diabetes.

Risk factors for diabetic background retinopathy:

• significant hyperglycemia;
• long course of the disease;
• arterial hypertension;
• kidney vascular damage;
• excess body weight;
• anemia.

There are four stages of diabetic retinopathy. The first three stages are the same as in previous types of the disease. At the stage of proliferating diabetic retinopathy, the retina becomes vascularized and newly formed vessels appear. Subsequently, they grow into, periodically burst, and then glial tissue is formed. Due to the gradual excessive tension of the fibers of the vitreous body, retinas and partial or complete blindness develop.

Even in the early stages of diabetic retinopathy, visual acuity sharply decreases, a veil and floating whitish spots appear before the eyes. Near vision gradually deteriorates. In the later stages of the disease, vision is completely lost.

Diabetic retinopathy can be complicated by hemophthalmos, the formation of opacities and scars on the vitreous body, and retinal detachment.

Diagnosis of the disease is carried out using the following examination methods:

• ophthalmoscopy after instillation of dilating drugs;
• ultrasonography;
• electroretinography;
• MRI of the eye;
• retinal angiography;
• Diaphanoscopy of the eyeball.

The endocrinologist prescribes treatment that helps maintain blood glucose levels at a stable level. Improvement in the condition of the retina occurs when taking the following drugs:

• vitamins;
• drugs that improve blood microcirculation;
• antiplatelet agents.

When symptoms of retinal detachment appear, laser coagulation is urgently performed. In case of hemophthalmos and scar formation on the vitreous body, surgery or vitreoretinal intervention is indicated.

Retinopathy in blood diseases

Background retinopathy may be one of the manifestations of blood pathologies. Secondary retinopathy is characteristic of the following diseases of the hematopoietic organs and blood:

• multiple myeloma;
• polycythemia;
• various types of anemia;
• leukemia.

The signs of retinopathy are not the same in these diseases. So, for example, if the pathological process develops against the background of polycythemia, brightly colored veins are noted in the fundus of the eye, which acquire a rich red color. The fundus of the eye has a cyanotic tint. Papilledema and vascular thrombosis also develop.

With anemia, the fundus of the eye becomes pale, the vessels dilate pathologically. Hemorrhage may develop under the retina and into the vitreous body. Retinal detachment of the “wet” type is possible.

If the cause of retinopathy is leukemia, the vessels become tortuous, the retina and optic nerve head swell, exudate accumulates under the retinal tissue, and small hemorrhages occur.

Waldenström's macroglobulinemia and melloma disease are accompanied by dilation of the veins and arteries of the retina, which occur due to blood thickening, the appearance of microaneurysms, blockage of the veins and hemorrhages in the retina.

Treatment of diseases of this type requires correction of the underlying pathology and laser coagulation of the retina. With this type of retinopathy, the prognosis in most cases is unfavorable.

Traumatic retinopathy

Traumatic retinopathy is also called “Berlin retinal opacification.” At the moment of sharp compression of the chest, vasospasm occurs. The retina suffers from a lack of oxygen, edematous transudate enters it and retinopathy develops. After injury, hemorrhages develop and organic damage to the retina occurs. Optic nerve atrophy may develop. Subchoroidal hemorrhage develops, swelling of the lower layers of the retina, fluid flows into the space between the retina and the vascular network. Vitamins are prescribed, and in order to eliminate hypoxia, hyperbaric oxygenation is performed.

Retinopathy of prematurity

This pathology develops only in premature infants. Its cause is the underdevelopment of the retina in prematurely born children. Retinopathy of prematurity is most often observed in children weighing less than 1.5 kg and born before 31 weeks. The pathology can also be caused by blood transfusion and oxygen therapy.

Children who are at risk are examined by an ophthalmologist a month after birth. He examines them every 2 weeks until all the structures of the eye are formed. This is the prevention of late complications (primary and retinal detachment).

Premature babies with retinopathy most often do not need treatment, since the signs of the disease go away on their own over time. Sometimes ophthalmologists perform laser coagulation or cryoretinopexy, and in rare cases they resort to surgery to remove the vitreous.

Prevention of retinopathy

The development of retinopathy in adults can be prevented by regular monitoring and examination of patients at risk. In order to prevent the development of retinopathy in premature babies, pregnant women who have a high risk of premature birth are recommended to be hospitalized in an obstetric hospital in a timely manner so that the newborn can be provided with early ophthalmological care. All children with neonatal retinopathy require observation by an ophthalmologist until age 18.

This refers to a group of diseases characterized by damage to the vessels of the retina. With this pathological condition, the blood supply to the retina is disrupted, resulting in atrophy of the optic nerve head, which leads to loss of vision. Depending on its origin, retinopathy can be primary or secondary (background). Background retinopathy occurs due to other diseases. Most often it is a consequence of diabetes, hypertension or injury.

Background retinopathy – what is it? These are pathological changes in the retinal vessels that occur against the background of other pathological processes. Secondary damage to retinal vessels occurs most often as a result of the following diseases:

• diabetes;
• atherosclerosis;
• eyeball injury;
• damage to the cranium or chest;
• anemia;
• blood cancer;
• arterial hypertension.

In some cases, underlying retinopathy develops as a result of central retinal vein thrombosis, autoimmune disorders, or radiation exposure.

The likelihood of pathology occurring increases in the presence of renal failure, toxicosis during pregnancy, as well as in newborns born prematurely.

Symptoms

Each type of secondary retinopathy has its own mechanism of origin, clinical picture and treatment tactics. However, regardless of the form of the disease, background retinopathy is manifested by the following symptoms:

• decreased visual acuity;
• reduction of the visual field;
• formation of dark dots and spots before the eyes;
• flickering sparks, light flashes;
• color vision impairment;
• decreased clarity of the visible image;
• formation (blind spot).

Damage to the vessels of the retina may be accompanied, resulting in protein hyperemia. If the damage is severe, the pupil can completely change color. With background retinopathy, temporary blindness, blurred vision, and micropsia may occur. Sometimes painful sensations occur, accompanied by migraines, dizziness, and nausea. The exact clinical picture depends on the cause of the pathology.

Types of background retinopathy

Depending on the underlying disease, there are the following main types of background retinopathy.

Diabetic retinopathy

This is one of the most common forms, which is a complication of diabetes mellitus type 1 or 2. develops in the presence of the following risk factors:

• long course of pathology;
• increased blood pressure;
• lipid metabolism disorder;
• overweight;
• anemia;
• renal dysfunction.

The development of this form of the disease occurs in 3 stages:

1. Diabetic angiopathy. Microscopic aneurysms of the retinal vessels are formed, looking like small red dots.
2. Preproliferative stage. Retinal vascular changes, small hemorrhages, swelling and lipid deposits appear on the retina. The changes are reversible.
3. Proliferating. Deformed vessels with aneurysms grow into the eyeball, causing disruption of its structure.

If treatment is not started in a timely manner, complete loss of vision occurs, and other ophthalmological pathologies may develop.

Hypertensive

This type of pathology develops against the background of high blood pressure and renal dysfunction as a result of vascular spasms of the fundus. The clinical picture and severity of changes depend on the stage of hypertension. The pathological process occurs in 4 stages:

1. Hypertensive angiopathy. It manifests itself as spasms of small vessels and is functional and reversible.
2. Angiosclerosis. The vascular walls become denser, sclerotic changes begin, and the arterial lumen narrows. Organic changes provoke disruption of retinal nutrition and are completely eliminated even with complex treatment.
3. Retinopathy. Pathological changes destroy the structure of the retina, swelling, small hemorrhages develop, and pockets of lipid deposits form. Oxygen starvation begins, accompanied by significant deterioration of vision and loss of visual fields.
4. Neuroretinopathy. The optic disc swells, and exudate begins to appear. At this stage, chronic renal failure is usually observed. Lack of emergency treatment leads to vision loss.

Traumatic

As a result of damage to the chest, skull or organs of vision, a sharp spasm of the arterioles occurs, as a result of which oxygen starvation and swelling develop. This is how traumatic retinopathy arises, which is otherwise called “Berlin’s opacities”. This form of pathology leads to atrophy of the optic nerve.

Atherosclerotic

It occurs against the background of vascular atherosclerosis and develops in the same progression as the hypertensive form. Atherosclerotic retinopathy is accompanied by accumulation of exudate in the veins and blanching of the optic disc. Complications such as optic nerve atrophy and vascular thrombosis are possible.

Retinopathy due to blood pathologies

Background retinopathy can develop as a complication of various blood diseases. Most often, the pathology occurs due to anemia, leukemia or myeloma. In this case, the following clinical picture may be observed:

• swelling of the optic disc;
• bright red color of the eye veins;
• vascular thrombosis;
• minor hemorrhages.

Sometimes retinal detachment, pallor of the fundus and vasodilation are observed. Retinal hemorrhages, microaneurysms, and venous occlusion may occur. Has a poor prognosis.

Diagnostic methods

To diagnose underlying retinopathy, the following studies are most often prescribed:

• ophthalmoscopy;
• biomicroscopy;
• tonometry;
• visometry;
• perimetry;
• angiography.

Additionally, there may be a need for ultrasound, CT, and MRI. To make the correct diagnosis and select adequate treatment, not only an ophthalmologist, but also doctors from other fields: a cardiologist, a neurologist, an endocrinologist, and so on, should participate in diagnosing the problem.

Drug treatment

Regardless of the cause of the pathology, drug therapy is prescribed aimed at strengthening the eye vessels and eliminating retinal swelling. The most commonly prescribed topical medications are:

• glucocorticosteroids: Dexamethasone, Prednisolone;
• antioxidants: Sevitin, Skulachev;
• antiplatelet agents: Kratal. Emoxy optic;
• vasodilators: Octilia, Visin;
• vitamin eye drops: Quinax, Taufon;
• medications to improve microcirculation: Vasobral.

Vitamin eye drops.

Good medications for background retinopathy of any form are eye drops Emoxipin, Vasobral, Lidaza and Gemaza. In addition to these medications, medications are prescribed aimed at eliminating the underlying cause of the disease. For diabetes mellitus, medications are prescribed to normalize glucose and cholesterol levels, and in severe cases, insulin injections. For hypertension, it is necessary to take diuretics and beta blockers. Atherosclerosis is treated with diuretics and antisclerotic agents.

Surgical intervention

In severe cases, when complications develop and drug therapy is ineffective, surgical intervention is performed, which can be of several types:

• vitrectomy;
• vitreoretinal intervention;
• laser coagulation;
• cryosurgery;
• radiosurgery.

The type of surgical intervention is selected individually and depends on many factors: the age and health status of the patient, the type of pathology, the severity of the disease, and so on.

Other treatments

Other treatments for background retinopathy include the following procedures:

• electrophoresis with proteolytic enzymes – promotes the resorption of connective tissue;
• hyperbaric oxygenation – saturation of eye tissues with oxygen.

Hyperbaric oxygenation.

Background retinopathy is accompanied by a decrease in the quality of vision and can lead to blindness. Children may develop other vision abnormalities.

Prevention

You can prevent the occurrence of background retinopathy if you follow the following recommendations throughout your life:

• prevent injuries;
• avoid stressful situations;
• eat properly, balanced;
• add copper, zinc, chromium and other beneficial substances to the diet;
• get rid of bad habits;
• to live an active lifestyle;
• control blood pressure, sugar and cholesterol levels.

Background retinopathy is a complication of other diseases, so it is necessary to promptly consult a doctor when the first signs of a particular ailment appear, properly treat existing diseases and regularly go to the hospital for a preventive medical examination.

Retinopathy– pathological changes in the vessels of the retina of a non-inflammatory nature, leading to disruption of the blood supply in its tissue and the occurrence of degenerative processes, which entails atrophy of the optic nerve and irreversible blindness. Background are pathological changes that occur against the background of any systemic diseases.

Types of retinopathy

In ophthalmology, retinopathy is usually divided into primary and secondary. Both are caused by pathological changes in the retina of a non-inflammatory nature. Experts include primary retinopathy:

• Central serous retinopathy
• Acute posterior multifocal retinopathy
• External exudative retinopathy

Secondary retinopathy that occurs against the background of a disease or pathological condition of the body is divided into:

• Diabetic
• Hypertensive
• Traumatic
• Retinopathy blood diseases

In addition, there is a completely separate type of disease - retinopathy of prematurity.

Causes of retinopathy

The etiology of primary retinopathy is unknown, so they are called idiopathic. The appearance of secondary retinopathy can be caused by a systemic disease of the body, intoxication, or serious injuries.

Secondary retinopathy is often a complication of hypertension, diabetes mellitus, renal failure, systemic atherosclerosis, diseases of the blood system, toxicosis during pregnancy, injuries to the chest, head, face, and eyeball.

Retinopathy of prematurity is a special form of the disease that is associated with intrauterine underdevelopment of the retina. It is detected only in newborns born prematurely, with a low body weight (up to 1500 g) and the need for subsequent nursing in oxygen incubators.

How does retinopathy manifest?

A common symptom of all types of retinopathy is visual impairment. This can be either a decrease in visual acuity and a reduction in its fields, or the appearance of dark spots or dots before the eyes. In some cases, due to retinal detachment, “sparks” and “lightning” may appear before the eyes. Visual impairment due to retinopathy is often accompanied by hemorrhages inside the eye or proliferation of blood vessels, which causes redness of the protein (diffuse or local). Severe degrees of retinal vascular changes lead to changes in the color of the pupil and disruption of its reaction to light. The pathological process is often accompanied by pain and the addition of general symptoms: headache, nausea, dizziness.

Depending on the type of retinopathy, symptoms may vary slightly.

Diagnostics

Detection of retinopathy and pathological changes in the retinal vessels requires the following ophthalmological examinations:

• Ophthalmoscopy
• Perimetry
• Tonometry
• Ultrasound of the eyes
• Retinal electrical potential measurements
• Fluorescein retinal angiography

The list of necessary research methods is approved by the attending physician. For patients with diabetes, examination is required twice a year. For pregnant women - once every trimester of pregnancy.

Infants must undergo a mandatory preventive ophthalmological examination no later than the second month of life. Newborns at risk for retinopathy are first screened at three weeks of age and should then be screened every two weeks while the retina is developing.

For retinopathy of prematurity, after treatment, examinations should be repeated every 2-3 weeks. In case of reverse development of the disease after completion of the retinal formation process, preventive examinations are necessary for the child every six months until he reaches the age of 18 years.

Treatment of retinopathy

The main thing in the treatment of secondary retinopathy is compensation for the disease that caused it. In parallel, direct treatment of retinal vascular changes is carried out using conservative and surgical methods. Their choice remains at the discretion of the doctor after diagnostic studies, in accordance with the type and stage of the identified disease.

In conservative treatment of retinopathy, treatment consists of instilling certain eye drops. These are, as a rule, solutions of vitamin complexes and hormonal preparations.

Widely used surgical treatment methods are laser and cryosurgical coagulation of the retina. If necessary, vitrectomy surgery may be prescribed.

In the case of retinopathy of prematurity, spontaneous recovery is possible in the early stages of the disease, which does not negate the mandatory observation of an ophthalmologist and pediatrician. In the absence of a spontaneous positive outcome of the disease, young patients may undergo laser photocoagulation of the retina, cryoretinopexy, scleroplasty or vitrectomy.

Of the physiotherapeutic methods of influence, the greatest effect in the treatment of certain types of retinopathy (diabetic, including) is shown by hyperbaric oxygenation - the effect of oxygen under high pressure on retinal tissue.

Complications of retinopathy

Complications of diabetic retinopathy, as a rule, include vascular proliferation, leading to frequent hemorrhages into the vitreous body, the occurrence of secondary glaucoma, retinal detachment, opacification and scarring of the vitreous body, and, finally, blindness.

Hypertensive retinopathy can be complicated by recurrent hemophthalmos and retinal vein thrombosis, which significantly reduces the quality of vision and can threaten complete loss of vision.

Retinopathy is a threat to pregnancy and sometimes causes abortion.

With atherosclerotic retinopathy, retinal vein occlusions, which can lead to optic nerve atrophy, become frequent complications.

Among the late complications of retinopathy of prematurity, experts name myopia, amblyopia, strabismus, low vision, glaucoma, and retinal detachment.

Disease prevention

Prevention of retinopathy often becomes a concern for doctors of various specialties. So, to prevent the occurrence of this disease, people suffering from diabetes, atherosclerosis, hypertension, kidney disease and blood diseases must undergo a course of treatment for these pathologies and be constantly monitored by an ophthalmologist. If signs of retinopathy appear, such as decreased visual acuity or narrowing of its fields, floating spots or blurred vision, you should immediately seek medical help.

Prevention of retinopathy of prematurity, for the most part, consists of educating pregnant women at risk, increased attention to the management of their pregnancies, and improving the conditions for caring for infants born before term. Children with retinopathy of prematurity, even in the case of a successful outcome of the disease, should undergo annual ophthalmological examinations until the age of 18.

Retinopathy is a disease of the retina of the eye, which is based on a violation of its blood supply. Quite often, ophthalmologists formulate the diagnosis as “background retinopathy and retinal vascular changes” in order to emphasize the significance of vascular pathology in the development of the pathological process.

The disease is called background, because in 99.8% of cases it develops against the background of some other, no less serious disease. Retinal pathology can develop against the background of:

In 82% of cases, the direct cause of retinopathy is diabetes mellitus or hypertension. In the presence of diabetes mellitus, the retinal vessels are affected by the phenomenon of diabetic microangiopathy. And in the case of hypertension, the retinal vessels are subject to fibrinoid necrosis with their subsequent sclerosis.

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Special mention should be made about neonatal retinopathy. This disease can also develop in a small child, but there must be good reasons for this.

The triggering factor may be:

• significant prematurity of the child;
• low body weight;
• birth injury.

According to the etiological factors of the disease, its separate types are distinguished.

Classification and clinical picture of the disease

Among the most common types of retinal pathology in adults are:

Separate identification of the pathological process in young children is due to the fact that this variant of the disease requires a special approach. The treatment tactics, as well as the prognosis, are somewhat different, which we will discuss below.

Among the early symptoms that suggest the development of background retinopathy and retinal vascular changes in adults are:

• gradual decrease in visual acuity;
• decreased clarity of vision, so-called “fogging”;
• disorders of perception of colors, as well as their individual shades;
• the appearance of photopsia - individual flashes of light in the visual fields.

Since symptoms appear and increase gradually, patients quite often miss the moment when the disease begins to develop. Patients often seek help later, when more severe violations occur:

Often, other vessels of the eyeball also react to the pathology of the retinal vessels. Patients suffering from underlying retinal pathology complain of frequent hemorrhages in the eyes, as well as diffuse redness of the whites of the eyes.

Symptoms that appear during the newborn period are similar to those for adults. The only difference is that a small child cannot talk about existing problems, moreover, he is not even able to fully understand them. Consequently, diagnosing this disease in young children is significantly difficult.

Diagnosis and treatment methods for pathology

The diagnosis of “background retinopathy” is made by an ophthalmologist based on the patient’s medical history, as well as on the basis of data obtained during special ophthalmological examinations. It is mandatory to:

If possible, and in the absence of contraindications, patients undergo laser scanning of the retina and fluorescein retinal angiography. These studies provide the most objective information regarding the structure and function of the retina, as well as its vascular bed.

To observe the process over time, examination data must be repeated at least once every 6 months. This recommendation is especially relevant for patients suffering from diabetes.

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A pediatric ophthalmologist is usually involved in examining a newborn. The list of recommended studies remains the same as for adult patients.

Children diagnosed with retinopathy are monitored by a pediatrician and pediatric ophthalmologist.

Principles of therapy

There are two main treatment options for the disease:

• conservative (medicines);
• surgical (using surgery).

If retinopathy was identified at an early stage of development, then taking appropriate medications will be sufficient. At the same time, the main condition for successful treatment remains therapy of the disease that led to damage to the retinal vessels.

Most medications prescribed for retinopathy come in the form of eye drops. As a rule, these are drugs from the following groups:

When there are already pronounced symptoms of retinopathy, surgical intervention is indicated. In this case, one of the following operations can be performed:

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• laser coagulation of the retina;
• cryosurgical coagulation of the retina;
• vitrectomy (removal of the vitreous body).

In cases where retinopathy is detected in a newborn, doctors prefer to maintain a wait-and-see approach. After all, there are often cases when, subject to adequate care, the disease in young children spontaneously regresses. If this does not happen, then it is recommended to decide on surgical treatment. The list of possible surgical interventions is similar to that for adult patients.

Retinopathy is a severe pathology that can lead to blindness. Therefore, it is better to engage in timely prevention rather than treatment. Patients suffering from one (or more) of those diseases that can lead to the development of background retinopathy should be registered with a dispensary and regularly examined. And with regard to the prevention of retinopathy in newborns, the key role is played by the management of the pregnant woman at the stage of antenatal consultation.

Those children who suffer retinal pathology in the neonatal period, regardless of the outcome, are registered at the dispensary until the age of eighteen.

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The term “retinopathy” in ophthalmology combines diseases of the retinal vessels (retina) that are not associated with inflammation. “Background” refers to changes that occur against the background of various systemic diseases. In the general classification they are also called secondary.

Background retinopathy and retinal vascular changes occur without pain, but can not only accompany the disease, but lead to serious complications. Therefore, the participation of an eye doctor in the diagnosis of vascular pathology is so important.

Changes are observed in both children and adults, regardless of the person’s gender. In ICD-10, the pathology is classified in the group of other retinal diseases under code H35.0.

Types of background retinal vascular disorders

The types of background retinopathy are determined by the underlying disease. The reasons may vary. According to the clinical classification, retinopathy is identified when:

• hypertension;
• injury;
• diabetes mellitus;
• blood diseases;
• atherosclerosis.

Some clinicians also add:

• autoimmune type;
• retinopathy due to radiation injury;
• as a consequence of thrombosis in the central retinal vein.

Let us consider the features of the pathogenesis, clinical picture and treatment of this pathology.

Hypertensive retinopathy

The characteristic change in blood vessels in the body during hypertension is completely reflected in the eyes: spasm of small arteries in the fundus occurs. The changes are more pronounced the more persistently high blood pressure persists, and depend on the duration of the disease.

During the course, there are 4 stages of pathological transformations:

• functional - the spasm is reversible and may disappear without treatment;
• angiosclerosis - hardening of the arterial walls appears, sclerotic lesions narrow the lumen and disrupt the nutrition of the retina, the changes become organic, therapeutic measures can prevent the spread, but it is completely impossible to get rid of them;
• actual hypertensive retinopathy- disrupts the structure of the tissue, small hemorrhages and plasmorrhagia appear (swelling due to the release of plasma), fatty degeneration occurs in the cells, lipids are deposited in the arterioles, zones of ischemia and infarction are formed, requiring constant maintenance treatment;
• neuroretinopathic stage- accompanied by swelling of the optic nerve, vascular hyalinosis, the appearance of foci of exudation and retinal detachment; With optic nerve atrophy, vision is irreversibly lost.

The last stage of hypertensive retinopathy accompanies the malignant course of hypertension, renal failure, and toxicosis during pregnancy.

In hemophthalmia, after the destruction of red blood cells, hemoglobin turns into hemosiderin and settles as grains in the tissues of the vitreous body; they form strands that contribute to retinal detachment

Ophthalmoscopy reveals the following picture:

• sharp narrowing of retinal vessels to complete obstruction;
• displacement of veins at the intersection with arteries deeper under the influence of heavy and dense vessels;
• exudation.

Lack of medical care leads to complications such as:

• retinal vein thrombosis;
• relapses of hemophthalmos.

In case of such phenomena in a pregnant patient, termination of pregnancy is recommended to preserve vision and prevent blindness.

Retinopathy due to traumatic injury

Eye injury is possible when:

• direct sudden action on the eyeballs (impact, pressure);
• creating conditions of acute ischemia under the influence of narrowing of the vessels of the chest and spine (especially those in the neck) - the carotid and vertebral arteries, which supply blood to the organs of the head (concussion, fractures, closed and open skull injuries, bleeding from the central vessels).

Post-traumatic cataract occurs when there is a sudden disruption of the blood supply to the eye

In response to ischemia, retinal cells experience oxygen deficiency. Hemorrhages occur, areas of damage appear with fluid effusion.

Most often, swelling of the space between the retina and the choroid occurs, clouding in the lower layers. This variant is called contusion or Prussian opacities. Lack of treatment leads to atrophic damage to the optic nerve.

Retinopathy in diabetes mellitus

Diabetes mellitus is accompanied by an increased concentration of glucose in the blood and metabolic disorders. Retinopathy complicates the course of the disease in patients with:

• overweight;
• anemia;
• hypertension;
• changes in the kidneys;
• high glucose levels and a long period of illness.

The development of retinopathy goes through 3 stages:

• angiopathy;
• retinopathy itself - the first and second stages do not differ from the hypertensive and atherosclerotic forms;
• proliferation - new small capillaries appear that penetrate the vitreous body, accompanied by hemorrhages and hyalinosis, this contributes to the rupture of the connections of the retina with the vitreous body, detachment.

Complications of diabetic retinopathy include:

• hemophthalmos,
• retinal detachment,
• formation of early cataracts.

Retinopathy and blood diseases

Most often, retinopathy occurs with the following blood diseases:

• leukemia,
• polycythemia,
• multiple myeloma,
• different types of anemia.

The peculiarity of morphological changes is:

• overflow of the venous network of the fundus, leading to swelling of the optic nerve;
• thrombotic complications.

With ophthalmoscopy, the veins are bright red against the background of a bluish fundus.

With anemia, the fundus of the eye is paler than normal, the vessels are dilated, and there are areas of hemorrhage in the retina and vitreous body (hemophthalmos). Retinal detachment is possible.

Leukemia is accompanied by increased tortuosity of blood vessels, accumulation of exudate, swelling of the optic nerve head, and pinpoint hemorrhages.

With Waldenström's macroglobulinemia and multiple myeloma, general blood thickening occurs, retinal vein thrombosis occurs, hemorrhages occur, and microaneurysms form.

Atherosclerotic and postthrombotic retinopathy

The systemic disease affecting the retinal vessels in this case is widespread atherosclerosis. The deposition of plaques in the vessels supplying the brain and organ of vision leads to their narrowing.

As a result of a drop in blood flow and subsequent ischemia, the retinal arteries go through the same first 2 stages as with hypertension. But ultimately, in severe cases, frozen microcrystals of exudate are deposited along the vessels.

Areas of hemorrhage are detected in the fundus, and the optic disc is paler than normal.

Complications of atherosclerosis manifest themselves as:

• thrombosis of small arteries;
• atrophy of the retina and optic nerve.

Postthrombotic retinopathy is associated with thrombosis in the area of ​​the central retinal vein, possibly in its other branches. The formation of auxiliary collaterals and shunts in the vessels of the eye occurs slowly, not earlier than three months. At this time, exudative foci of varying density are visible in the fundus.

How does background retinopathy manifest clinically?

The symptoms of background retinopathy of different forms are almost the same. They appear at the border of the second and third stages:

• patients note decreased vision;
• see floating spots (scotomas);
• blood may enter the vitreous body (hemophthalmos).

In patients with diabetes mellitus, the disease begins with:

• disturbances in near visual acuity (farsightedness);
• the appearance of intermittent floating spots, veils before the eyes.

Ultimately, the pathology leads to irreversible blindness.

Early symptoms of background retinopathy are:

• photopsia - flashes of light or sparks in the eyes;
• impaired perception of colors;
• decreased contrast of visible objects.

Methods for identifying underlying circulatory disorders

Diagnosis of retinopathy requires:

• participation of specialists of various profiles (ophthalmologist, endocrinologist, neurologist, pediatrician, cardiologist);
• conducting a complete study of visual acuity and fields (perimetry) - allows us to judge the functional state of retinal cells;
• mandatory ophthalmoscopy (direct and indirect) when dilating the pupil with a special medication;
• Ultrasound of the eyeballs - to determine areas of compaction, hemorrhages, scars, hyalinosis inside the eye.

These methods are used by territorial clinics.

Diaphanoscopy - transillumination of the eyeball with a narrow light beam in order to detect retinal detachment and differential diagnosis with tumors

More subtle ways are:

• fluorescein angiography of the fundus;
• biomicroscopy of the eye;
• electrophysiological techniques (electroretinography) - allows you to assess the viability of retinal tissue;
• angiography;
• magnetic resonance imaging.

They are carried out in specialized centers and departments.

Treatment

To treat secondary retinal pathology, therapy for the underlying disease is necessary.

For hypertension and atherosclerosis, treatment requires:

• correction of blood pressure;
• the use of antispasmodics and arterial dilators;
• administration of anticoagulants to prevent thrombosis.

Prescribed:

• vasodilators;
• diuretics;
• anti-sclerotic drugs;
• antihypertensive.

In case of diabetes mellitus, to maintain normal glucose levels, the necessary optimal dosage of a hypoglycemic agent is selected.

Background retinopathy in blood diseases is difficult to treat and often leads to irreversible blindness.

For any form of retinopathy you need:

• angioprotectors;
• vitamins;
• drugs that improve microcirculation;
• antioxidants that improve tissue resistance to oxygen deficiency.

At the stage of neuroretinopathy, a course of electrophoresis on the eyeballs with proteolytic enzymes can be effective.

The treatment method for detecting signs of retinal detachment is laser coagulation. A beam is used to cauterize the separated flap to its place.

For scars and hemorrhages in the vitreous, operations are performed to remove it - partial, complete or vitreoretinal vitrectomy

To saturate the eye tissues with oxygen, therapy is prescribed in special pressure chambers.

Retinopathy in childhood

In children, manifestations of background retinopathy are possible after injury, with severe diabetes mellitus, and blood diseases. Causes such as hypertension and atherosclerosis are very rare.

But there is a special form that is unique to children - retinopathy of prematurity.

Among babies born prematurely, the greatest risk is:

• born at a gestational age of 31 weeks or less;
• with body weight less than 1.5 kg;
• have had a blood transfusion;
• receiving oxygen for a long time to restore their general condition.

Retinal pathology requires compliance with oxygen-free methods of metabolic processes in the body to complete development. But to nurse babies and ensure the growth of vital organs, oxygen is needed in inhalation, which is supplied to special children's incubators. It turns out that retinopathy is formed as a result of treatment.

In order to timely detect pathology, an ophthalmologist examines newborns from risk groups at the age of three to four weeks, then every 2 weeks until the retina completes maturation.

Types of complications:

• formation of early myopia;
• glaucoma;
• strabismus;
• amblyopia (disorders of the visual function of one of the eyes);
• retinal detachment and blindness.

Amblyopia is called the “lazy eye” disease.

At the initial stage, the child may self-heal. When the consequences appear, ophthalmologists decide which operation is best to use:

• laser coagulation;
• cryoretinopexy (freezing of the detached portion of the retina);
• more serious interventions with lens replacement.

Children diagnosed with retinopathy during the neonatal period should be examined annually by an ophthalmologist.

To prevent the disease, a complex of preventive treatment is carried out for pregnant women with kidney diseases, hypertension, blood pathologies, diabetes mellitus, and those who have suffered injuries.

The conditions for caring for premature infants must be prepared to preserve the health of the child in case of any identified pathology. The effectiveness of treatment of underlying retinal vascular lesions depends entirely on the possibility of compensating for disorders caused by the underlying disease. Therefore, supportive and preventive therapy and periodic consultations with an ophthalmologist are so important.