Thrombosis of the retina
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What is a thrombosis of the retina?
Thrombosis of the retina is the eye disease caused by acute disruption of blood flow in the Central retinal vein (PCV). Synonyms of tsvs thrombosis: venous stasis retinopathy, hemorrhagic retinopathy.
Depending on the localization of thrombosis of the retinal veins is divided into the occlusion (blockage) of the Central vein and occlusion of its branches. Occlusion of the branches in the pathological process involves only the peripheral portion of the retina, which supplied the blood of the affected limb, and the occlusion of the Central vein – a large part of the retina, as in this case, the blood clot is located at the level of the optic nerve. Therefore, the symptoms and prognosis in these two cases are somewhat different.
The frequency of thrombosis of the tsvs is 2.14 per 1,000 people, and among glaucoma patients and 17.3 per 1000 people. The disease occurs mainly in people over the age of 40 years, the average age of the patients 51-65 years. Occlusion of the branches of the tsvs is more common (67% of cases). Thrombosis DCS and its branches is the second largest after the prevalence of diabetic retinopathy among the vascular diseases of the retina.
The causes of thrombosis of the retinaIsolated retinal vein thrombosis is uncommon.
It usually develops under the influence of other diseases, primarily the following:
Systemic vasculitis (connective tissue disease affecting blood vessels);
- Malignant diseases of the blood and organs of hematopoiesis (macroglobulinemia, polycythemia Vera, multiple myeloma), characterized by hypercoagulability and thrombophilia.
In most diseases, the artery wall thickens, thickens and compresses the adjacent vein, causing the blood flow in Vienna and slows down blood clot. Blood stasis in Vienna, increases vascular permeability, causes reverse blood flow in the capillariesretina, its release in megasuite space and increased intraocular pressure, the consequence of which may be haemorrhage in the retina and its swelling.
Also, the cause of the thrombosis may be the following diseases and conditions:
- Infectious diseases (influenza, sepsis, sinusitis, infections of the oral cavity);
- Ocular hypertension;
Swelling of the optic nerve;
- Thyroid ophthalmopathy (go).
Additional risk factors are:
The symptoms of thrombosis of the retinaThere are two types of thrombosis DCS and its branches:
- Ischemic (complete occlusion, covering an area of no less than 10 disc diameters of the optic nerve) characterized by severe lesions of the blood flow, extensive hemorrhages in the retina, a significant reduction of visual acuity, high risk of complications;
- Non-ischemic (partial occlusion) of the lesion of the retina are less pronounced, deterioration of visual acuity slightly.
The safety of vision depends on the degree of ischemia. Thrombosis of the Central vein may develop within a few hours and manifests as sudden painless deterioration or complete loss of vision in one eye. Frequent complaints thrombosis of branches of a vein – fog or dark spots before the eyes, distortion of objects. However, if the macula (Central part) of the retina is not affected, and can be maintained normal visual acuity. In this case, the thrombosis often is found incidentally during preventive examination.
In the development of the disease there are several stages:
Retromboz – veins are tortuous, irregularly dilated, blood flow is slowed in the fundus are diagnosed venous stasis, there is a single hemorrhage. Visual acuity reduced slightly from occasional misting, complaints may be absent;
Directly thrombosis – veins dark, broad, irregular, arteries are narrowed, hemorrhage throughout the retina (with the defeat of tsvs) and in the vitreous bodythe border of the optic disc are blurred, there is swelling of the macular zone. Symptoms: deterioration of visual acuity, blurring of vision, limitation of field of vision;
Post-thrombotic retinopathy – within a few months in the fundus are defined by signs of hemorrhage, pathological tumor vessels on the optic disc. Vision returns slowly.
Diagnosis of thrombosis of the retina
When collecting history revealed the presence of concomitant diseases.
Used physical methods of research:
- The visual acuity testing – check of visual acuity using table or counting fingers;
- Tonometry – measurement of intraocular pressure;
- Perimetry – the definition of the Central or peripheral scotoma (visual field restriction);
- Biomicroscopy – identify opacities of the vitreous, defects of the iris and pupil, etc.;
- Ophthalmoscopy – fundus examination for signs of hemorrhage. The clinical picture usually resembles a squashed tomato.
Laboratory methods include General and biochemical blood analysis. To determine the type of thrombosis and the exact wording of the diagnosis is performed fluorescein angiography.
Treatment of the retinaTreatment of thrombosis DCS and its branches should be initiated as early as possible.
Its main tasks are:
- Resorption of hemorrhages;
- Restoration of blood flow in the affected vein;
- Removal of edema of the retina;
- Improving the trophic (feeding) the retina.
To restore blood flow apply fibrinolytic (plasminogen injection streptodekaza, gamasy). After they are assigned to anticoagulants of direct action (heparin).
To lower blood pressure take nifedipine, fenigidin, intramuscularly lasix, which also reduces swelling of the retina. In the eye to reduce intraocular pressure bury timolol (Arutimol, Cusimolol).
Antiplatelet agents are used to improve microcirculation and prevention of recurrent thrombosis: clopidogrel (plavix), pentoxifylline (Trental).
For the symptomatic treatment of inflammation and edema of the retina used local and systemic hormonal preparations: injectionthe glucocorticoid Dexamethasone, Diprospan.
Additionally appointed antispasmodics, vitamins C and group B.