AMOTIO OF THE RETINA (ablatio retinae) — morbid condition, at Krom the retina of an eye loses contact with a choroid and departs from it.
Normal the retina keeps at a choroid (horioidea) due to connection of shoots of cells of a pigmental epithelium of a retina with outside joints of sticks and flasks of a retina, and also pressure from a vitreous.
The pigmental epithelium embryological represents a part of a retina, but anatomically is more closely connected with a choroid therefore at O. of page there is a peeling of a neuroepithelial layer of a retina from a pigmental epithelium. Stratification internal (nuclear) and outside (plexiform) layers of a retina carries the name «reti-noshizis» and represents rare pathology.
It is necessary to distinguish primary (idiopathic) O. of page when the retina is separated from a choroid by subretinal liquid, from the secondary amotio caused by more dense education (e.g., a tumor, exudate, hemorrhage).
Primary amotio of a retina
Primary amotio of a retina meets approximately in 1 case on 10 000 population and without treatment leads to a blindness of an eye. Degenerative ischemic changes of the periphery of a retina, especially in combination with stretching of an eye can be the contributing factors at axial short-sightedness, wrinkling of a vitreous, hereditary weakening of communication between a pigmental epithelium and a bacillary layer. The lake of page can result from an indirect injury (falling, bruises of the head, a sharp raising of weights, concussion of a body); at the same time O.'s development by page is promoted by a rupture of a retina with the subsequent penetration of liquid under it.
At O. of page there are subjective feelings of photopsias in the form of sparks, lightnings, curvatures, fluctuations of objects, there is a dark veil under review, the progressing restriction of a field of vision and falloff of subject sight. The difference in visual acuity and a field of vision in morning and evening hours is symptomatic, edges is explained by the shift and a partial rassasyvaniye of subretinal liquid during sleep.
Oftalmoskopicheski a reflex from an eyeground becomes gray, folds of a retina are defined; because of hypostasis and loss of transparency of a retina its vessels look dark; at the movement of an eye fluctuation of a retina is noted.
At the complicated oftalmoskopiya the ultrasonic ekhografiya helps with O.'s diagnosis by the village (see. Ultrasonic diagnosis ).
Simple diagnostic reception is the research of safety of a phenomenon of mechanophosphene. During the pressing through eyelids on a sclera a glass rod, otstupya from a limb on 12 — 14 mm, normal investigated notes emergence of a hull with a light rim (result of mechanical irritation of a retina). During the pressing on a sclera in the place of an otsloyenny retina this phenomenon is not observed or the spot becomes indistinct. Besides, the patient feels «trembling» or «vibration» before an eye during pressing. At O. the page is absent also such entoptichesky effect as an autooftalmoskopiya, or the phenomenon of a retinal vascular tree of Purkinye (inspected sees vessels of own retina at transscleral raying diafanoskopy or the electric ophtalmoscope).
After diagnosis of primary O. of page it is necessary to establish localization of ruptures of a retina. Finding of gaps is made generally before operation with the help of the return or direct oftalmoskopiya, biomicroscopy with Goldmann's lens at inspection of the extreme periphery of a retina at the most mydriatic pupil.
Peeling of a retina on an eyeground submits to a certain pattern. The liquid from a vitreous getting through a rupture of a retina causes its amotio in the field of a gap in the beginning, then spreads to the gear line and, falling (at the upper provision of a gap) in gravity down, flows round an optic disk and gets on an opposite half of an eyeground. Level of peeling of a retina almost always depends on localization of a gap. The configuration of an otsloyenny retina, gaps and other changes of an eyeground are applied on the special scheme. There is the international color code for a sketch of a condition of an eyeground.
The direct way of establishment of localization of a rupture of a retina is more and more widely applied during operation by cave-in of covers of an eye against a gap by a curved forceps or a thick syringe needle with the blunted end and simultaneous observation of the place of a local compression by means of the electric direct ophtalmoscope or the indirect binocular ophtalmoscope of Skepens (fig. 1).
The perimetric way of calculation of a projection of ruptures of a retina to a sclera described in many managements is labor-consuming and insufficiently exact.
O.'s elimination by the village is reached by calling of an adhesive inflammation around a gap and rapprochement of an otsloyenny retina with a choroid.
From numerous ways of calling of an adhesive inflammation diathermocoagulation, a kriopeksiya are most common (see. the Cryosurgery, in ophthalmology ), photocoagulation (see. Photocoagulation of an eye ) and a lazerkoagulyation (see. the Laser, in ophthalmology ). D the iatermokoagulya-tion (thermo-cauterization across Gonen) presents a peculiar electric welding of a retina with a choroid through a sclera in the classical form current of the high frequency (fig. 2). In the point of fracture make through cauterization by a needle electrode. Through the microopening which arose at the same time subretinal liquid follows, the retina adjoins to a choroid and is fixed as a result of development of an adhesive inflammation, and then the formed hem.
In modern Ophthalmolum, practice use more sparing method — a kriopeksiya the special tips cooled with carbonic acid or liquid nitrogen. Subretinal liquid at the same time, as a rule, is not produced. Control of degree of a primorazhivaniye is carried out by oftalmoskopichesk by training of a white ochazhk.
As independent methods of treatment apply photocoagulation and laser coagulation at peripheral and central ruptures of a retina with its flat amotio. The gap is delimited by one or two rows of coagulants. Sufficiency of a dosage is determined by emergence of a whitish velvet-like ochazhk without hemorrhages (fig. 3).
At O. the village, the region does not adjoin completely after use of above-mentioned ways, carry out rapprochement of covers by cave-in of a sclera by seals from an autogenous tissue (an ear cartilage, a piece of an Achilles tendon, invagination of own sclera), a gomotkana (a cadaveric tinned sclera and a firm meninx, a catgut), silicone rubber or a sponge from silicone rubber. The seals by the size exceeding a gap on 3 — 4 mm press ekstraskleralno P-shaped seams or in the way of their insertion to a pocket of the stratified sclera and the subsequent sewing together of edges of a pocket.
At the expressed traction changes of a vitreous, a weak raspravleniye of a retina after a bed rest, multiple gaps apply circular impression of covers at the level of gaps thread, a polyethylene tube or a silicone tape — operation of Arrugi, or tsirklyazh (fig. 4). Tsirklyazh often combine with a podkladyvaniye under thread or a tape of a seal in the field of gaps. Subretinal liquid is usually released before tightening of a circular seam through a puncture of a sclera a needle electrode of a diathermocoagulator.
There are ways of treatment of O. of page, at to-rykh rapprochement of a retina with a choroid carry out by means of various implants entered into a vitreous (endovitrealno). For these purposes use sterile air, silicone fluid, luronit, kapron loops, latex bubbles. Endo-vitrealnoye introduction of implants more often is addition to usual scleroplastic surgeries, but sometimes it is applied as an independent method, napr, administration of silicone fluid during the wrinkling of a vitreous and tightening of a retina in the form of a funnel, at huge gaps with torsion of their central region.
Operational treatment demands stay of the patient in a hospital during 1 — 3 week, including 2 — a 6-day bed rest in the postoperative period with use of a binocular bandage.
Patients with the gaps or defects of a retina constituting potential danger of emergence of O. of page are subject to preventive treatment. Valve «mute» gaps, and also the perforated gaps which are combined with photopsias concern to them. If O. of page occurred on one eye, then the eyeground of the second eye is carefully investigated in dynamics and at emergence of «mute» gaps make preventive treatment, a cut consists from photo, lazerkoagulyation (or kriopeksiya) retinas around gaps for the purpose of calling of an adhesive inflammation.
Secondary amotio of a retina
Secondary amotio of a retina arises owing to various diseases of eyes: the inflammatory, getting wounds, new growths, vascular damages of a retina (diabetes, an azotemic retinitis, toxicosis of pregnancy it.). The wedge, picture is characterized by O.'s combination of page to typical manifestations of a basic disease. Unlike primary O. ruptures of a retina often are not defined by page.
After getting O.'s wounds of page is caused by education in a vitreous connecting tyazhy or preretinalny membranes; at inflammatory diseases of an eye — chorioretinites, sclerites — the exudative amotio which is followed by opacifications in a vitreous, precipitated calcium superphosphates and other inflammatory manifestations in a vascular path is sometimes observed; at new growths of an eye the retina exfoliates the growing tumor and is characterized by rigidity, absence or trace amount of folds of a retina, a rarity of gaps; the diabetic retinopathy in a proliferative stage quite often is followed by retraktsionny amotio of a retina against the background of neogenic vessels, hemorrhages.
Secondary O.'s treatment by the village includes therapy of a basic disease: at tumors according to indications — operational treatment or photocoagulation; at posttraumatic and diabetic O. of page — usual scleroplastic surgeries using a vitrectomy for crossing or removal shvart (see. Vitreous ).
Bibliography: V. V wolves. Operations at diseases of a mesh cover, the Guide to eye surgery, under the editorship of M. JI. Krasnova, page 264, M., 1976; Krasnov M. M. System of surgical treatment of amotio of a retina, Vestn, oftalm., No. 1, page 3, 1966; Brewers of H. N and Prokofiev V. N. Mekhanofosfen as indicator of a functional condition of a retina and its diagnostic value, in the same place, No. 4, page 34, 1974; Rozenblyum M. E. Operational treatment of amotio of a retina, M., 1952, bibliogr.; Filatov S. V. Amotio of a retina, M., 1978, bibliogr.; Sh e-valev V. E. and Babanin Yu. D. Operational treatment of amotio of a mesh cover, M., 1965, bibliogr.; And yes-g and N. of Sur la pathogenie et le traitement postoperatoire du decollement retinien, Ann. Oculist-. (Paris), t. 186, p. 507, 1953; G r an e f e A. Zur Lehre von der Netzhaut-ablosung, Arch. Ophthal., Bd 4, S. 235, 1858; Lin with off H. McLean J. M. a. Nano H. Cryosurgical treatment of retinal detachment, Trans. Amer. Acad. Ophthal. Otolaryng., v. 68, p. 412, 1964; Schepens C. A new ophthalmoscope demonstration, ibid., v. 51, p. 298, 1947.
H. H. Pivovarov.