Ophthalmology: destruction of the vitreous body of the eye

The vitreous humor is a transparent gel that fills the cavity of the eyeball and is located behind the lens. Outside it is surrounded by a membrane, inside it is divided into channels (tracts). If there is liquefaction, wrinkling or detachment of this gel, then talk about DST eyes.

What it is?

The appearance of various in form, size or degree of turbidity in the vitreous body indicates degenerative processes. The most common diagnoses are pathologies in which the properties of a given medium change.

Normally it is transparent, but contains special filaments - fibrils. With age-related changes or due to certain diseases, they become less elastic and may break, which leads to poor eyesight. At the same time, the destruction of the vitreous body of the eye develops. It should be noted that such violations are not amenable to therapy, and destructive changes in old age are practically not treated (with appropriate therapy they can only be slowed down).

Etiology

Typically, the destruction of the vitreous of the eye, the causes of which can be very diverse, is the result of mechanical eye damage, smoking, drug use or individual medications. There are also pathological changes associated with the natural process of aging. In addition, in the presence of myopia, under the influence of prolonged and frequent loads on the organs of vision, nervous shocks, the destruction of the vitreous body of the eye can also develop.

If you indicate the etiological factors, it should also mention dystrophy or inflammation in the retina, physical exhaustion, retinopathy, vascular lesions, metabolic changes in the eyeball.

It is important to remember that severe destructive changes can be harbingers of retinal detachment, in which there is complete and irreversible loss of vision, therefore timely consultation of an ophthalmologist is mandatory.

Characteristic of destructive changes of vitreous body

When its liquefaction develops, then, as a rule, pathological changes are observed in the central areas. The periphery of the vitreous does not change. In most cases, voids are formed, which are filled with fiber particles and coagulation products. Also, strands or films that float freely in the diluted medium or attach to the fundus can be observed, which leads to abrupt pathological changes in vision.

The destruction of the vitreous of the eye in the most severe manifestation is its wrinkling. It is accompanied by a tension of vitreoretinal compounds, which, in severe cases, leads to photopsy, rupture of the retina, and the appearance of hemorrhages in the vitreous.

It should be noted that such destructive changes are easier to detect on microscopic preparations. Diagnosing the problem with the help of clinical research methods is very difficult and requires a lot of medical experience.

Clinical manifestations

When the destruction of the vitreous body develops, the symptoms of this disorder can include the appearance in front of the eyes of various kinds of floating elements that become more noticeable when considering monochrome space - a white wall, snow or sky. Patients may also note turbidity. It arises from the changes in the refraction of light passing through the optical system of the eye and is associated with the casting of the shadow on the retina, which reduces the quality of vision and may indicate more serious damage to the eyes. Untimely treatment of a doctor can lead to a complete loss of vision.

The destroyed vitreous fibrils appear to the patient as granules, spots, filaments, or films that significantly impair visibility and move after eye movements.

It should be noted that one of the most frequent reasons for turning to an ophthalmologist is a complaint about the appearance of "flying flies" in front of the eyes, which can not be got rid of. After the corresponding examinations, it is the destruction of the vitreous body.

Symptom of "golden rain"

Sometimes patients who turn to an oculist doctor complain of the appearance of golden sparks during eye movements. Where do they come from?

Functional pathologies of various organs (for example, kidneys, liver or endocrine glands) lead to disruption of metabolic processes and cause changes in the colloidal environments of the organism and their mineral composition. This also applies to the vitreous humor, in which abnormal local changes develop and processes of precipitation and coagulation are proceeding, and crystals are deposited, the dimensions of which are insignificant - not more than 0.05 mm.

Such deposits are called synchisis scinlillans. They consist mainly of cholesterol or tyrosine, accumulate in a diluted vitreous in a significant amount, and when the eye movements pendulum, they begin to shimmer and glow, which predetermines the symptom of the "golden rain", which is a rare form of destruction and causes the patient to seek medical attention Help.

Diagnostics

The destruction of the vitreous body of the eye is detected with the help of technically simple manipulation - ophthalmoscopy. In filamentous destructive changes, optically empty cavities are identified, which have the appearance of vertical slits or various figures. The anterior border plate of the vitreous without specific changes, but immediately after it you can see gray-white fibers. They can have different thicknesses and sag in the form of garlands.

If the pathological process progresses, then the mentioned voids merge, forming a single cavity. This is accompanied by the destruction of the structure of the vitreous. At an ophthalmoscopy it is possible to notice scraps of filaments-fibrils. If the cloudiness is located near the retina, it is difficult to see (even with large dimensions).

I must say that such changes are most often found in elderly people, as well as in patients who are simultaneously diagnosed with high degree of myopia or dystrophic lesions of the inner membranes of the eye.

Pharmacological therapy

Despite the fact that medicine (ophthalmology including) at a sufficiently high level, today there are no effective means that would prevent the destruction of fibrils of the vitreous body or contributed to the disappearance of the already destroyed. Most of the pharmacological drugs that are prescribed for destruction only prevent the progression of pathological changes. That is why it is necessary to be cautious about medicines, the producers of which claim that their products can cure DST.

As a rule, instillations of 2% potassium iodide or 3% "Emoksipin", which is administered parabulbarically, are topically applied. For oral administration, resorptive preparations are prescribed, for example, "Wobenzym" or "Traumeel C". In addition, patients are advised to take a course of vitamin therapy. So, treatment of DST of the eye should include the intake of ascorbic acid and B vitamins.

If necessary, physiotherapeutic procedures - electrophoresis with lidase and ultrasound therapy - can be prescribed.

Laser treatment

To date, more and more popular are laser manipulations, which, with DST, are the most effective for destroying floating turbidity. Such treatment is minimally invasive, but requires high qualification and professionalism of the doctor. It involves the destruction by the laser of opaque fragments in the vitreous, which break up into smaller particles that do not affect vision.

Laser intervention on the vitreous is called vitreolysis. It may include the dissection of vitreous joints. If local hernia of the vitreous body develops, which cause the pupillus deformation and improper placement of the intraocular lens, the corresponding part of the CT is excised. In this case, an IAG laser is used. The pulse energy is selected individually (from 1.5 to 8.0 mJ). The success of the operation depends on the viscosity and transparency of the vitreous humor, as well as on the size of the opacities.

Operative treatment

Treatment of destruction of the vitreous body of the eye by a surgical method is called vitrectomy. Such therapy involves partial or complete removal of CT, which is carried out with the help of a vitrectomy system consisting of vitreotom (cutting tool) and endo-illuminator.

In what cases do vitrectomy? As a rule, it is carried out with damage to the vitreous body due to open trauma, with its turbidity, as well as with hemorrhages and retinopathy.

The duration of the operation is 30 to 90 minutes. It is performed under local or general anesthesia, may have one or more stages, depending on the stage and type of pathology.

To replace the vitreous humor, artificial polymers are used, as well as balanced saline solutions. Often, liquid perfluororganic substances, gases or silicone oil are taken. Any substitute for the vitreous must be as transparent as possible, with the appropriate viscosity and refractive power. It also should not be resorbed or cause a toxic, inflammatory or allergic reaction.

After the operation, patients are advised to follow up with an ophthalmologist, limit physical and visual loads, and sudden temperature changes. Otherwise, the risk of inflammatory complications, repeated hemorrhages, cataracts, high intraocular pressure or occlusion of the retinal vessels increases.