It happens that some of us had to deal with the diagnosis of retinal angiopathy. What does this mean, how serious is this violation and is it possible to cure this ailment? In any case, there is no need to panic, it is better to study as much information as possible on this issue and determine a program of action for yourself.
Retinal angiopathy - what is it?
The term "angiopathy" is composed of two words: "angio" - a vessel and "pathia" - a disease. With angiopathy, for some reason, the normal functioning of its vessels is disrupted. In this case, the retina receives less blood supply due to the impaired function of the vessels of the fundus.
Angiopathy is not an independent diagnosis, but a consequence of other pathologies.
With retinal angiopathy, the blood supply of the arteries and veins of the posterior wall of the eyeball changes, which leads to progressive visual impairment.
Causes
Any angiopathy appears as a result of any long-term failure in the body. Most often, this pathology is observed in patients whose health is impaired due to:
- pressure disorders (arterial hypertension, dystonia or hypotension);
- increased intracranial pressure of various origins (congenital pathology, in old age, due to diseases);
- systemic vasculitis;
- juvenile angiopathy (Eales disease);
- diabetes mellitus;
- vascular atherosclerosis;
- arteritis (more often in the head area);
- glaucoma;
- injuries (usually of the head, neck, face);
- perinatal pathology (injuries or abnormalities in newborns);
- infectious brain lesions (including congenital);
- general intoxication (for external or internal reasons);
- thrombosis;
- serious nervous shocks;
- work in hazardous industries;
- radiation injury;
- smoking;
- high scoliosis;
- over 70 years of age.
Views
Usually, the patient is diagnosed with an indication of the type of angiopathy. The type of ailment indicates the disease that caused the appearance of this eye pathology.
There are retinal angiopathy of the following types:
- traumatic;
- diabetic;
- hypertensive;
- hypotonic;
- youthful.
Disease manifestations
The main danger of retinal angiopathy lies in its asymptomatic course.
Often, retinal angiopathy is accidentally detected during examination of the fundus by an ophthalmologist. When the symptoms of angiopathy are already clearly visible, then this stage of the disease already requires long and expensive treatment.
In what case is it extremely necessary to see a doctor?
This must be done immediately if a person suddenly begins to notice changes in himself in the form:
- A sharp decrease in vision. In this case, the patient has a "blur" of distant objects or he is unable to read the small print.
- Frequent redness of the eyes with streaks of burst blood vessels.
- The appearance of "flies" or a veil before the eyes.
- Narrowing of the visual field and peripheral vision. In this case, the patient may poorly see what is happening to the side of him: a car leaving, an approaching person, etc.
- Feelings of throbbing in the eyes.
- Frequent eye pains with minimal exertion (working at the computer, short reading or handicraft).
The first symptoms of angiopathy are rarely taken into account, so the disease develops further.
The most common symptoms of this disease in the mature stage are:
- decrease in visual acuity and clarity;
- deterioration or loss of color sensitivity;
- narrowing of the field of vision or its clouding;
- the appearance of lightning, dots or white lines in front of the eyes.
In systemic diseases, retinal angiopathy is a consequence of the general fragility of blood vessels in the body. In this case, the patient may have minor bleeding or hemorrhages (skin, nasal, streaks of blood in the feces, etc.)
The degree of angiopathy in hypertension
In hypertension, angiopathy is associated with an overflow of the bloodstream. Depending on the severity of symptoms, the disease in hypertensive patients can have different severity: 1, 2 or 3 degrees. With hypertension, the vessels of the fundus dilate and wriggle, and small hemorrhages form in the eye veins. Subsequently, the retina becomes cloudy, and hemorrhages become a constant companion of hypertensive patients.
1st degree
This is the stage when the painful process is still reversible. If you start at the same time to seriously fight the underlying disease, then the changes in the eyes can be eliminated.
Retinal angiopathies in the initial stage are characterized by ophthalmic disorders of the type:
- dilated veins;
- narrowing of the arteries;
- increasing the tortuosity of blood vessels;
- discrepancy between the width of the vessels and their length.
Grade 2 (moderate)
This stage occurs if there was no timely treatment at the onset of the disease. At this stage, there are already organic changes in the vessels.
The second stage is characterized by manifestations:
- intensification of inconsistencies in the size of blood vessels and their tortuosity;
- vasoconstriction with impaired blood circulation through them;
- the phenomena of thrombosis and vascular hemorrhage;
- the appearance of microaneurysms and growths in the optic nerve region;
- narrowing of the field of vision and its fogging;
- decrease in visual acuity and the appearance of myopia.
Grade 3
At this degree, organic vascular damage is maximally expressed, and visual impairment can reach complete blindness.
Stage 3 angiopathy is characterized by symptoms:
- edema of the retina and optic nerve:
- hemorrhages in the retina;
- foci of white color:
- severe impairment of visual acuity and blurred vision (up to loss).
Types of ailment
After visiting a specialist, not only the diagnosis is established, but also the type of angiopathy. Among the types of this ailment there are angiopathies of the types:
- hypertensive;
- hypotonic;
- mixed;
- dystonic;
- diabetic;
- background;
- venous;
- traumatic.
Consider the features of each type of these types of angiopathy.
Hypertensive type
It occurs with prolonged hypertension and is caused by blood vessels overflowing with blood. This leads to degenerative changes in the retinal vascular bundle. At the same time, visual acuity often decreases and a feeling of blurredness arises. The condition may worsen if the hypertension continues to progress.
By hypotonic type
It occurs due to decreased vascular tone and stagnation of blood in the vessels. This stagnation causes capillary thrombosis. In this case, hemorrhages appear in the eyeball and retina. Vision with these changes is seriously affected.
Mixed type
Caused by disorders of vascular regulation of the autonomic nervous system. This pathology is preceded by any systemic ailments affecting the vascular network of the body. And the capillaries of the eye day suffer in the first place.
Although systemic diseases can occur at any age, the mixed form is more common in patients over 30 years of age. Such pathologies can lead to serious deterioration or loss of vision. The main manifestations of vascular disorder are the manifestations of "flashes", veils or pain in the eyes, hemorrhage in the retina.
Treatment of mixed angiopathy is closely related to the establishment of blood circulation throughout the body. Complex treatment of the underlying disease can improve the condition of the eyes.
Diabetic
Occurs in diabetics. Lack of insulin in diabetes causes glucose metabolism disorders. However, the disease does not end with this: if the insulin hormone is insufficient, all metabolic processes (carbohydrate, protein, fat, mineral) are disturbed in the body.
In diabetes, the vessels throughout the body are narrowed and affected, starting with the capillaries and ending with the large main vessels. In this case, the blood flows more slowly, and the vessels are clogged. The lack of blood circulation creates problems in the tissues, depriving them of normal nutrition. In this case, the eyes are among the first to be affected, manifesting themselves as a high degree of myopia or even blindness.
Background angiopathy
Appears against the background of other diseases. With this type of angiopathy, dystrophy processes develop in the retina. This type of pathology is a consequence of a number of diseases or conditions: vascular ailments, blood diseases, autoimmune vasculitis, traumatic lesions of the neck or head, intoxication, diabetes mellitus, hypertension, high intracranial pressure, work with constant eye strain.
With background angiopathy, a change in the vascular walls disrupts their functioning. Persistent eye dysfunction leads to irreversible visual impairment, up to and including loss of vision.
Venous
It arises as a complication of pathologies associated with impaired blood flow. In this case, the blood flows more slowly and forms stagnation, which leads to the formation of blood clots or hemorrhages in the eyeball. The veins then become tortuous and dilated throughout. Often, such a violation occurs in hypertensive patients with experience.
Venous angiopathy can lead to multiple disorders such as blurred vision or progressive myopia. Improvement of the condition with this ailment is closely related to the therapy of the underlying disease.
Traumatic
It happens that the most insignificant injuries entail a sharp deterioration or drop in vision. Often this is caused by injuries to the neck, brain, chest compression. Swelling after contusions, for example, leads to retinal opacities.
In traumatic angiopathy, the vessels of the cervical spine are compressed, while the eye vessels are narrowed. As a result, intracranial pressure increases, which can be stably high in this type of angiopathy. From this, the tone of the retinal vessels suffers, which is expressed by constantly aggravating visual disturbances, manifested by increasing myopia.
The mechanism of complications in traumatic angiopathy is associated with the fact that sudden compression of blood vessels during trauma spasms the vessels of the eyes, which causes retinal hypoxia with the release of fluid from it. Subsequently, the trauma leads to organic changes in the retina and hemorrhages in it. With this ailment, the optic nerve is also affected, which leads to severe visual impairment or loss.
In newborns
This is a special type of angiopathy that is often viewed as a normal variant. Often, such a diagnosis is made even at the birth of a baby. But sometimes angiopathy in babies can be a harbinger of congenital neurological problems.
Often, angiopathy in infants occurs after head injuries due to difficult childbirth. At the same time, reddening of the eyes and the appearance of a vascular network are noticeable. Usually these manifestations pass quickly.
However, consultation with a neurologist for angiopathy of newborns is in any case required.
The retina of babies very quickly reacts to various loads (emotional, physical), changes in body position. At the same time, specialists should be alarmed by the phenomena of any venous congestion or vasoconstriction in the eyes of children.
Often, retinal angiopathy speaks of some existing pathology in the baby. Its identification and correct treatment leads to a decrease in pathological changes in the vessels of the eyes.
Provoking factors
In addition to the causes that lead to angiopathy, it is known about the factors that provoke and aggravate the course of the disease. Factors can often serve as such "shocks":
- smoking;
- old age;
- chronic intoxication (including alcoholic);
- hematological diseases with a tendency to blood clots;
- diseases with severe disorders of neurovascular regulation (due to osteochondrosis, increased cranial pressure, head injuries);
- anatomical features of the arteries.
Why is retinal angiopathy dangerous?
Angiopathy is also called a "time bomb" in the body. Impaired vascular functions can lead to degenerative changes in the retina. In addition to visual impairment or myopia, the pathological process can reach its complete loss.
If you do not take retinal angiopathy seriously, this can, over time, lead to serious disorders in the form of:
- progressive deterioration of vision;
- hemorrhages in the vitreous body and retina or their degeneration;
- narrowing of the visual field;
- the progression of myopia;
- optic atrophy;
- glaucoma;
- cataracts;
- detachment of the retina;
- complete blindness.
In addition, angiopathy should not be triggered. Untimely treatment of this ailment may be ineffective. It is important to catch the ailment in the phase of functional disorders, until irreparable organic changes in the retina occur.
Principles of therapy for angiopathy
Treatment for angiopathy may differ for different forms of this ailment. The main principle in the treatment of any type of angiopathy is to find out the cause of the disease and treat the primary diagnosis.
That is, in case of hypertension, it is necessary to closely deal with its effective treatment, choosing drugs and constantly measuring blood pressure. And with diabetes, it is important to regularly take anti-hypoglycemic drugs and measure blood glucose.
In addition to general therapy, with the progression of angiopathy, the most effective methods of restoring the retina are necessarily selected. Most often, the following drug methods are used in therapy:
- Disaggregants - drugs to improve microcirculation and tissue nutrition, strengthen the vascular wall (Actovegin, Pentoxifylline, Trental, Vazonit, etc.)
- Medicines to reduce the permeability of the vascular wall (Ginkgo biloba, Xanthiol nicotinate).
- Tissue metabolism activators (Cocarboxylase, ATP).
- Vitamin therapy (Anthocyanin forte, Lutein complex, Neurorubin, vitamins B, C, E and A, nicotinic acid) to maintain good microcirculation in the eye vessels.
- Drugs to reduce the likelihood of blood clots (Magnikor, Aspirin cardio, Trombonet, Dipyridamole, etc.)
- Local therapy (instillation of drops with corticosteroids, Taufon, Emxi-optic, Emoxipin, Aisotin).
- Control over cholesterol and lowering it (Pravastatin, Atorvastatin, etc.)
- A diet with restriction of high-calorie foods, salt, spices, alcohol to slow down the transformation of the retina.
In addition to the main methods, the following treatment methods have proven themselves well in the treatment of angiopathy:
- Special physiotherapy exercises to improve the work of blood vessels and heart, gymnastics for the eyes, yoga asanas.
- Physiotherapy (magnetotherapy, laser coagulation, acupuncture). The device "Sidorenko's Glasses" has shown itself well in this disease (it combines the effect of phonophoresis, color therapy, pneumomassage and infrasound). Also, in some private clinics, the innovative STIOTRON pulse therapy device is used. It is believed that this new device is able to restore the regeneration of damaged blood vessels and eliminate malfunctions in the eye itself.
- Massage ShVZ (neck-collar zone) to improve blood circulation and better outflow of blood vessels in the eyes.
Forecast
The prognosis for angiopathy closely depends on the correctness and timeliness of treatment of the underlying ailment. Often, with timely diagnosis and competent treatment, pathological processes in the vessels of the eyes can be stopped or complications can be postponed as much as possible.
However, at an advanced stage (for example, an uncorrected high blood sugar or hypertension of a malignant course), angiopathy can lead to partial or absolute loss of vision.
In some cases, with a severe degree of angiopathy, the risk of retinal detachment is high. At the same time, a modern method of surgical treatment of this disease is used - the method of laser coagulation.
Prophylaxis
Retinal angiopathy often occurs at the site of pre-existing health problems. Therefore, in order to maintain eye health, it is important to take care of your body as a whole: pay attention in a timely manner to alarming "bells" in relation to high blood pressure, high blood sugar, progressive osteochondrosis, any head or neck injuries, etc. It is also extremely important not to overload the eyes with prolonged reading, sitting at the computer or TV, handicrafts. In addition to the obligatory pauses, for better functioning of the eye muscles, it is advisable for people of mental labor to do special gymnastics for the eyes 1-2 times a day (according to Zhdanov, Norbekov, etc.).
Knowing about the asymptomaticness of the initial phases of retinal angiopathy, it is important to have an annual preventive examination by an ophthalmologist. The condition of the damaged vessels of the eyes is already irreversible and may result in blindness. That is why it is necessary to regularly visit an eye doctor for people over 40 years old and people with any chronic diseases. The selection of the correct treatment and lifestyle correction often helps to postpone the development of the disease for decades.
Retinal vascular abnormalities cannot be ignored. For any eye problems, you must consult a specialist. Only a qualified doctor should treat angiopathy, since different eye pathologies with completely different methods of treatment can have the same symptoms. Take care of your eyes!
Retinal angiopathy in most cases affects both eyes. Modern diagnostic methods make it possible to identify pathology at an early stage. It is important to notice the first symptoms, which, among other things, we will discuss in this article.
Retinal angiopathy is clearly diagnosed using ophthalmoscopy, the result of which is shown in the picture
Angiopathy is a pathological condition of the vessels located in the fundus, which is characterized by a violation of their tone. The vessels have a convoluted course, they can be simultaneously narrowed and expanded. As a result, there is a failure in blood supply as well as nervous regulation.
Such a picture on the fundus is not something isolated, for example, ICD-10 does not distinguish retinal angiopathy as a separate nosological unit, considering it in the complex of the background disease in which it is observed.
The retina is very thin and well vascularized, therefore it is highly sensitive to metabolic disorders in the body, and in most cases one of the first is affected in some diseases occurring with metabolic failure.
Causes of pathology
This condition is considered polietiologic, since a wide range of diseases can be complicated by damage to the vessels of the fundus. More susceptible to this are those who are over 30 years old, which is explained by the gradual increase in the incidence of general somatic diseases.
The etiological factors are:
- essential or symptomatic arterial hypertension;
- diabetes;
- systemic vasculitis;
- hematological diseases;
- toxic effects;
- disorders of nervous regulation;
- osteochondrosis of the cervical spine;
- bad habits;
- eye and neck injuries;
- conditions with increased intracranial pressure,
- congenital vascular pathologies of the retina.
Types of retinal angiopathy
Due to the important distinctive features of the course of angiopathy in some diseases, it is advisable to separate them into a separate type. Below will be considered the stages, course options and morphological changes in the fundus in certain types of angiopathy.
Hypertensive
The picture shows the anatomy of the retina of the eye, its microscopic structure With this type of angiopathy, its consequence is damage to the vessels of the eye by increased pressure of the arterial bed, which can be a manifestation of both hypertension and symptomatic hypertension due to certain diseases, for example, such as thyrotoxicosis, glomerulonephritis, etc.
Secondary hypertension, as a rule, proceeds more aggressively than essential hypertension, therefore it leads to dystrophic changes in blood vessels faster.
The process is characterized by a staged course. Consider their ophthalmoscopic signs:
- The initial stage of angiopathy proceeds with narrowing of the arteries, which is a compensatory physiological protective response to increased pressure in the capillary, and simultaneous expansion of the veins, which have increased tortuosity.
- In the future, the vessel wall begins to lose its elasticity, due to its ischemia, since oxygen is delivered worse to the spasmodic artery, through its so-called own vessels (vasa vasorum). This activates the process of fibrosis of the middle choroid. The venous bed expands even more and a pronounced stagnation of blood develops in it.
- The progression of the process leads to the transition to the stage. When small hemorrhages appear on the surface of the retina, as a result of which it becomes saturated with blood and gradual destruction.
- The last stage is called neuroretinopathy, since dystrophic changes are transferred to the optic nerve tissue, causing its edema, and subsequently atrophy.
Only if arterial hypertension is relieved at the initial stage of angiopathy, the reverse development of pathological changes in the fundus and natural restoration of vision is possible.
Diabetic
Laser coagulation of the retina is one of the most effective and safe interventions to prevent the progression of angiopathy The most common variant of angiopathy, which often develops within 8-10 years after the onset of the disease, if there is no competent therapy. With this pathology, a complex lesion of the vessels of the microvasculature occurs throughout the body.
In diabetes, processes in the retina of the eye also develop in stages:
- Non-proliferative stage. The retinal vessels are so affected that their walls become thinner and, unable to withstand the blood pressure, burst. At this stage, edema of the macular region already occurs, which is noted when examining the fundus. It is difficult to recognize the disease at this stage, but it is very important, since the treatment will be most effective. The patient may be worried about a slight deterioration in vision and injection of the sclera.
- Preproliferative. Most of all, the veins of the retina are subject to changes, their ducts expand, pathological tortuosity develops. Unable to withstand the tension, the venous vessels rupture, forming small hemorrhages, mixing with the lymphatic fluid, they form infiltrates.
- Proliferation stage. It got its name from the formation of new vessels, which acts as a response to retinal ischemia and is aimed at improving the access of nutrients. The problem is the weakness of the walls of the newly formed capillaries. Hemorrhage is increasingly occurring, affecting the vitreous humor. Retinal tissue nutrition is aggravated up to it, which leads to irreversible loss of vision.
Under the condition of a well-chosen treatment, pathological changes in the retina are partially reversible only at the stage of preproliferation.
Hypotonic
It is characterized by a loss of vascular tone and, as a result, their expansion and tortuosity. In them, the blood flow rate decreases, the permeability of the walls increases.
This impairs microcirculation in the retina and leads to loss of visual function.
Traumatic
It occurs after injury to the head, eyes, cervical spine, chest compression.
These conditions contribute to a sharp increase in intracranial pressure, and so it grows sharply and the vessels are not "accustomed" to such values - they rupture and hemorrhagic saturation of the fundus.
Youthful
One of the rarest forms of angiopathy is called Eales disease. It affects young men, in most cases the process is bilateral. The etiology of the disease has not been studied. According to the latest studies in this area, in 2011, a relationship was found with an increase in the level of interleukins 6 and 10, as well as tumor necrosis factor in persons with this disease.
If you look at the essence of the process, then the primary inflammatory reaction occurs near the venous vessels (periphlebitis), which ultimately leads to infiltration of the retina with white blood cells. This contributes to the aggravation of blood supply and the development of ischemic zones. The last stage in the course of the disease is neovascularization (the appearance of new vessels), as in diabetic angiopathy.
Congenital
This type is due to the underdevelopment of the wall of the vascular bed. Most often occurs in premature babies, or children with a pathological course of embryogenesis.
Under the competent supervision of an ophthalmologist, nothing threatens the baby's vision. However, we note that much depends on the degree of vascular damage in a particular situation.
Retina angiopathy symptoms
It is preferable to conduct a fundus examination with a digital ophthalmoscope, it minimizes the chance of an inaccurate result Despite the diversity of the species composition of angiopathies, all patients present with similar complaints. The only difference is in the degree of their severity and the rate of increase.
Let's consider the main symptoms:
- blurred vision;
- small "flies" before the eyes;
- dropout of image fields;
- flashes, lightning in the eyes;
- decrease in the clarity of the perceived picture.
If you have a risk of developing one of the diseases that contribute to retinal damage, then listen to yourself very sensitively, since this may be one of the first manifestations of the underlying pathology.
Diagnostic methods
Making the correct diagnosis is often straightforward. The set of measures includes the identification of the underlying underlying disease, if it is not idiopathic angiopathy, as well as changes in the fundus.
You can examine the retina using:
- (simple visual inspection after instilling pupil-dilating drops);
- ophthalmochromometry (the method is similar to ophthalmoscopy, however, its essence consists in the reflection of light waves from the retina);
- coherent tomography;
- ultrasound examination;
Tomography and angiography are more complex methods and are used either in cases when it was not possible to accurately establish changes in the fundus by simple methods, or when subsequent surgery is expected.
Treatment of angiopathy
The initial stages are easily treatable with the help of well-chosen medicines. Therapy of this pathology consists of two directions: relief of the background disease, regression of changes in the fundus. Each of them is important in its own way and is impossible without the other.
To improve the condition of the retina, various drugs are used that have a beneficial effect on the vascular wall and microvasculature.
- Trental, Piracetam, Vasonit (effect on microcirculation).
- Parmidin, Calcium Dobezilate (improving vascular health).
- Aspirin, Clopidogrel (prevent blood clots).
- Taufon, Vizualon, Oftan-Katakhrom (eye drops, promote proper blood circulation in the vessels of the eye).
The medical method in isolation will only help patients with an early stage of the disease, in other cases the effect will only be in reducing the degree of progression of angiopathy.
Treatment of background pathology is reduced to the field of narrow medical specialists. Briefly, we note that patients with diabetes mellitus need to follow a low-carbohydrate diet and control glucose levels either with hypoglycemic drugs (Metformin, Glibenclamide, Glickvidon, etc.), or subcutaneous insulin injections.
Those who suffer from arterial hypertension are shown a comprehensive examination to exclude a secondary etiology of the disease. Therapy is reduced to constant monitoring of blood pressure levels by taking medications, among which there are several groups of pathogenetic effects. It is also important to follow a special diet.
In no case try to heal yourself. Diseases such as diabetes mellitus and essential arterial hypertension require competently selected and adjusted therapy, which can only be prescribed by a doctor.
The advanced stage of the angiopathy process can be eliminated only with the help of surgical intervention, which implies exposure to argon rays. At the moment, it has no alternative and is widely used to help patients regain their vision.
Prevention of vascular retinopathy
When the process is running, surgery is the only way to preserve vision. The indisputable principle has long been known: "It is easier to prevent a disease than to cure!" Not everyone thinks it is advisable to follow the instructions of doctors before the onset of serious symptoms. But you need to accept the fact that the method has not been developed more effective than prevention, and only it will help preserve your vision without health consequences.
Let's consider its main points:
- People, especially in the category over 35 years old, need to undergo a medical examination annually with the obligatory measurement of blood pressure and glucose levels. For the older age group (after 50 years), an annual fundus examination by an ophthalmologist is also indicated.
- If the patient already has a background disease, the doctor's recommendations for taking prescribed medications and the frequency of visits to control the course of the process should be strictly observed.
- The use of multivitamin complexes for the eyes (Visiomax, Okovit, Focus, etc.) will provide comprehensive support for vision.
- Quitting alcohol, smoking and other bad habits, enriching your diet with vegetables and fruits - all this will have a positive effect not only on the eyes, but on the whole body.
- A healthy lifestyle, increased physical activity, daily exercises for the eyes.
Summing up, it is safe to say that retinal angiopathy is a formidable disease that can lead to complete and irreversible loss of visual function. But there are both medical treatment methods that are effective in the early stages, and operational. Therefore, it is important to watch your eyes, which will allow you to see a specialist in time and preserve the opportunity to see the beauty of our world.
You will learn information about the structure of the retina, its diseases, diagnostic features from the video:
With many diseases that damage the vessels, the vessels of the retina also suffer. The most pronounced changes on the part of the vessels, often leading to visual impairment and blindness, causes diabetes mellitus. This change in veins and arteries is called diabetic retinal angiopathy. These changes are usually noted in both eyes.
In itself, retinal angiopathy is not a disease, but speaks only of the initial changes in the vessels affected by diabetes mellitus. This change is called microangiopathy and is the first complication. A long course of diabetes mellitus, especially in a severe, decompensated form, leads to the development of macroangiopathies, in which the lower extremities, heart, brain and eyes are affected.
The pathological change has an ICD-10 code - H35.0 (background retinal angiopathy).
The mechanism of development of retinal angiopathy
Elevated blood glucose levels cause gradual destruction of the vascular walls, starting with the smallest capillaries. At the site of the damaged endothelium, blood clots appear, and then cholesterol plaques.
Over time, the blood flow in the small capillaries stops completely, the walls of the venules and arterioles become loose and permeable, first for blood plasma, and then for the formed elements. Coming out of the vascular bed, the liquid part of the blood causes retinal edema, "cotton" foci appear. In the case of a release of blood, hemorrhages appear on the fundus from small punctuates to extensive, occupying most of the vitreous body. This stage of changes in the retinal vessels is called non-proliferative diabetic retinopathy (DRP).
Further change leads to the development of newly formed vessels, with damage mainly in the macular zone, destruction of the vitreous body and clouding of the lens. This stage of the disease is called proliferative DR.
Symptoms and manifestations of the disease
For a long time, retinal angiopathy is asymptomatic. Occasionally, with an increase in blood sugar or with a rise in blood pressure, there is a temporary deterioration in vision, double vision, "fog", which disappear when the factors that caused them are eliminated.
With the development of non-proliferative DRP, symptoms are also often absent.
Only half of the patients have the following complaints:
- deterioration of vision, "fog" in the eyes;
- flies, cobweb, floating opacities in the eyes;
- the appearance of narrowing of the visual fields.
Proliferative DRP seriously affects both the vessels and the retina.
At this stage of changes, there are always complaints:
- a significant decrease in vision that is not amenable to correction;
- opacities become more pronounced, which is associated with the destruction of the vitreous body and the development of diabetic cataracts.
Diagnosis of pathology
The complex of examinations for diabetes mellitus includes an annual examination by an ophthalmologist. With already identified changes in the eyes, an examination is carried out every six months.
Diagnosis of angiopathy and other eye changes caused by diabetes mellitus is not difficult in most cases. The examination begins with a check of visual acuity and tonometry.
Next, 1-2 drops of midriacil, a special drug that dilates the pupil, are instilled into the conjunctival sac. After 10-15 minutes, when the pupil has dilated, an examination is performed on a slit lamp using high-dioptric lenses. It is during biomicroscopy under conditions of mydriasis that most of the changes in the retina and its vessels, hemorrhages, edema are revealed.
The diagnosis is made by an ophthalmologist after the examination in cases when the expansion and darkening of the walls of the venous bed are visible, and their course changes (becomes tortuous).
In this case, the arterial bed also undergoes changes - the walls of the arterioles become thinner, the lumen narrows. There is often a white stripe along the vessels - the deposition of lymphocytes and plasma blood cells. In the initial stages, such changes often occur on the periphery of the fundus, and can be missed when viewed with a narrow pupil.
There is no direct dependence of the stage of the disease on the level of blood sugar and the duration of the course of diabetes. Some patients with type I diabetes mellitus for more than 20 years, and having an average sugar level in the region of 10-12 mmol / l, do not have pronounced complications. And, on the contrary, in patients with low glucose levels of 7-8 mmol / l and "experience" of the disease for 2-3 years, there may be severe complications. 
In many specialized ophthalmological clinics, photographic registration of the state of the fundus is carried out to further track the dynamics of the disease.
If you suspect the development of diabetic macular edema, retinal detachment or neovascularization, optical coherence tomography (OCT) is recommended.
This method of examination allows you to see the retina in a section, which for a long time was impossible and made it difficult to make a diagnosis, and to determine the tactics of treatment.
Another informative examination method is fluorescent angiography of the retina, which allows you to accurately show the places where blood is sweating from the vessels. This method is recommended after laser coagulation of the retina, as well as in the presence of SUI.
Diabetic lesion treatment
Diabetic retinal angiopathy does not require special treatment. The patient is advised to follow a special diet, monitor sugar levels and blood pressure, glycated hemoglobin. Treatment should be started when complications develop.
Conservative
Most ophthalmologists, when detecting angiopathy or non-proliferative DRP, prescribe Taufon and Emoxipin eye drops. These drugs are dripped into both eyes in courses of 30 days, with a frequency of 3 times a day.
In the presence of glaucoma, which often develops in diabetic retinopathy, hypotensive treatment is mandatory.
When diabetic macular edema is detected, non-steroidal anti-inflammatory drugs are prescribed - Nevanak 1 drop 3 times a day for a month.
Laser coagulation
Surgical treatment for diabetic retinal angiopathy is not indicated. When an ophthalmologist detects hemorrhages along the vessels and in the macular region, laser coagulation of the retina is performed.
The laser is used to cauterize the sites of retinal vascular ruptures to prevent further bleeding. Often this manipulation is carried out 2-3 times, and laser coagulates cover the entire area of the retina.
Surgical treatment is used in the following cases:
- when a subretinal neovascular membrane (SNM) appears in the macular region. This complication leads to retinal detachment, which threatens with irreversible loss of vision;
- in case of destruction of the vitreous body with a high risk of developing tractional retinal detachment, vitrectomy is performed.
Diet for illness
There are a number of specific nutritional requirements for both type I and type II diabetes. These requirements should be met regardless of the presence or absence of complications.
- vegetables: cucumbers, tomatoes, all types of cabbage, peppers, zucchini, eggplants, radishes, radishes;
- fresh and pickled mushrooms;
- greens, spinach, sorrel;
- tea and coffee without sugar and cream;
- mineral water.
The second group includes products, the use of which must be limited according to the principle of "divide by two":
- lean meat: chicken, turkey, beef;
- fish of low-fat varieties: cod, pollock, pike perch, hake.
- boiled sausage without fat.
- milk with a low fat content of 1.5-2%.
- low-fat cottage cheese;
- potato;
- legumes - peas, beans, lentils;
- bread and bakery products;
- pasta;
- eggs.
- oils of animal and vegetable origin;
- lard, margarine and mayonnaise;
- cream, cheese and fat cottage cheese;
- fatty meat: pork and lamb, duck, goose;
- fatty fish: trout, salmon, herring, chum salmon;
- nuts and seeds;
- sugar, honey, preserves, cookies, jams, chocolate, ice cream, sweet drinks;
- alcoholic beverages;
- grapes, bananas, persimmons, dates, figs.
Features of angiopathy in children
In childhood, diabetes develops due to inadequate pancreatic cell function.
The development of diabetic eye complications in children, as well as their examination, has some features:
- due to a weak vascular wall, children are characterized by a rapid manifestation of complications - proliferative DR, diabetic cataract, retinal detachment, secondary neovascular glaucoma;
- preschool children may not make any complaints, even if they have very poor eyesight;
- examination of young children by an ophthalmologist also presents some difficulties;
- children cannot independently monitor their diet, the regularity of insulin injections, and check their blood glucose levels, which also poses a serious threat.
Video material on the diagnosis and treatment of pathologies of the retina:
Preventive measures aimed at preventing the development of diabetic retinal angiopathy and other eye complications include:
- strict adherence to diet;
- regular and correct intake of insulin and sugar-reducing drugs;
- control of sugar levels, glycated hemoglobin and blood pressure;
- regular visits to the endocrinologist and ophthalmologist.
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violation of nervous regulation, which is responsible for the tone of the walls of blood vessels;
blood diseases;
work in hazardous production;
diabetes;
elderly age;
arterial hypertension;
intoxication of the body;
congenital features in the structure of the walls of blood vessels (for example, telangioetasia);
systemic vasculitis of an autoimmune nature.
cervical osteochondrosis
traumatic injury;
increased intracranial pressure
The development of retinal angiopathy can cause congenital features in the structure of the walls of blood vessels (for example, telangietasia), work in hazardous work, smoking, traumatic injuries.
What the doctor sees
Retinal vascular angiopathy is characterized by a violation of the lumen of blood vessels or their course: they can be narrowed, dilated, crimped, full-blooded, etc., depending on the reason that caused their change. Retinal angiopathy usually develops in both eyes at once.
Types of retinal angiopathy
1. Hypertensive angiopathy is a consequence of a person's hypertension. With this type of disease, uneven narrowing of the arteries in the fundus, dilated veins (their normal ratio of 2: 3 in the direction of 1: 2 and 1: 4 is disrupted), punctate hemorrhages in different parts of the eyeball, branching of the venous bed are observed. If the stage of angiopathy of this type is neglected, then retinal tissues are modified. In the case of elimination of hypertension, the fundus of the patient again acquires a healthy appearance, if there was an initial stage.
2. Diabetic eye angiopathy occurs in the absence of timely treatment of diabetes mellitus. There are two types: microangiopathy and macroangiopathy. Microangiopathy - thinning of the walls of the capillaries, leading to hemorrhage in the tissues that are nearby, as well as to a violation of the general circulation of blood. With macroangiopathy, the larger vessels of the eye are affected. With the development of diabetic angiopathy, the basement membranes thicken, mucopolysaccharides clog the walls of the vessels, which leads to narrowing of the lumens in them, this is fraught with their complete blockage in the future. Such pathological changes impair blood microcirculation, which can result in tissue hypoxia (lack of oxygen). In advanced cases, multiple hemorrhages are observed, leading to a significant decrease in vision.
3. Hypotonic angiopathy - significant dilation of arteries, pulsation of veins. Vessels appear crimped.
4. Traumatic angiopathy of the retina can occur with sudden compression of the chest or injuries of the cervical spine, brain. This is due to the compression of the vessels in the cervical spine, increased intracranial pressure, etc.
Diagnostics and treatment of retinal vascular angiopathy
A qualified specialist should diagnose and prescribe treatment for retinal angiopathy.
In this case, the doctor can prescribe drugs that improve the microcirculation of blood in the vessels of the eyeball: "", "Trental", "", "Mildronat", etc.
In the course of treatment of angiopathy of a diabetic nature, in addition to drugs, the doctor prescribes the patient to follow a special diet, which excludes all foods rich in carbohydrates from the diet. Moderate exercise is recommended for patients with this diagnosis, which promotes muscle sugar consumption and improves the functioning of the cardiovascular system.
In the treatment of hypertensive angiopathy, an important role is played by the normalization of blood pressure, lowering cholesterol levels. Treatment is usually done by a physician or cardiologist.
It is possible to improve the patient's condition with angiopathy with the help of physiotherapeutic methods (laser irradiation, acupuncture, magnetotherapy).
Treatment of retinal angiopathy requires rejection of bad habits, a responsible attitude to one's health. Retinal angiopathy in both eyes is a disorder that should be treated right away. It is impossible to stay idle - neglected angiopathy of the retina can lead to atrophy of the optic nerve, complete or partial loss of vision. As you can see, not only eye doctors, but also related specialists play an important role in treatment. Treatment of the underlying disease leads to positive results in the treatment of retinal angiopathy.
The ophthalmologist can recommend to the patient vascular preparations in the form of drops, vitamins for the eyes in the form of tablets to improve microcirculation directly in the vessels of the eye and preserve the patient's vision, as well as physiotherapeutic effects.
Speaking about the use of vitamins, it is worth noting the fact that with age, the content in the body of the substances lutein and zeaxanthin, which are necessary for eye health and visual acuity, decreases. These substances are not produced in the intestines, so their content must be replenished regularly. If angiopathy of the retina is detected and complaints of progressive decrease in vision, people after 45 years of age need to follow a diet. In addition to zeaxanthin and lutein, the diet should include vitamin C, tocopherol, selenium and zinc, which nourish, repair and protect eye tissue. In addition to adhering to a diet, to prevent the development of age-related changes in the retina, it is necessary to take special multivitamins. For example, the vitamin and mineral complex "Ocuwaite Lutein Forte" with lutein and zeaxanthin, which protect the eyes from the negative effects of sunlight, vitamins C, E, zinc and selenium. It has been proven that such a composition prevents the development of age-related changes in the retina, allows even the elderly to enjoy sharp vision.
Medical measures taken to treat vascular complications of retinal angiopathy must be comprehensive.
- Drug therapy is important, which is aimed at improving blood flow in the vessels of the eyes. Treatment takes place in courses using the following drugs - Emoxipin, Mildronat, Solcoseryl, Vazonit, Arbiflex, Trenatal. These medicines can improve the processes of microcirculation in the eye vessels. Also, the effect of using these drugs will be an increase in the plasticity of red blood cells, which helps them move better through the capillaries of the eyes.
- The following drugs help prevent thrombus formation - Pentoxifylline and Curantil. It is also good to use medicines to improve the rheology of blood in the vessels - Xanthiol nicotinate and nicotinic acid.
- Reduces vascular permeability preparations of ginkgo biloba and calcium dobesilate.
- The nourishment of the eye tissues is best provided by Actovegin injections, as well as eye drops, which will be discussed below. The metabolism of nutrients in blood vessels and nearby tissues helps to restore the use of cocarboxylase and ATP.
- It is also necessary to take vitamin complexes to improve the condition of the eyes, which are represented by the preparations Lutein Complex, Anthocyan Forte. It is also important to take ascorbic acid and Neurorubin. Such a measure will allow to achieve the effect of improving microcirculation in the eye vessels, and will also support the patient's visual acuity.
- Compliance with a special diet, especially for diabetes mellitus, which will help neutralize the underlying disease, as well as improve blood circulation in the retina. At the same time, it is important to know that one of the requirements of such a diet is the presence of a ban on foods with a rich carbohydrate composition. The same applies to foods with a high number of calories per unit of measurement. Salt restrictions in dishes are also important, as they lead to the normalization of metabolism and improvement of the body's recovery functions.
- Inclusion in the daily routine of feasible physical exercises, which give energy to the muscular system, and also improve the condition of the blood vessels and the heart.
- When treating angiopathy caused by hypertension, it is important to lower blood pressure levels as well as cholesterol levels through diet and medication. Such a complex treatment can be carried out by a therapist or cardiologist.
- Application of physiotherapy methods. It is possible to use laser coagulation, as well as course treatment with magnetotherapy and acupuncture.
- At the moment, Sidorenko's Glasses are considered an important method of physiotherapy. This device is a combination of pneumomassage, phonophoresis, infrasound and color therapy. Such a complex has a powerful effect on the retina of the eye, allowing you to achieve a high effect in a short time.
- It is good to take courses of massages of the cervical spine.
Drops for retinal angiopathy
An ophthalmologist may prescribe eye drops to the patient. The purpose of this therapy is to improve metabolic processes in the eyes, as well as to intensify blood circulation in the retinal vessels and to organize the nutritional process of all eye tissues for a long time.
Drops for the eyes are selected as one of the components of complex therapy and are considered an element of symptomatic treatment.
Drops for retinal angiopathy are represented by the following names:
Taufon
- Drops are available in bottles of five and ten milliliters. The active ingredient of the drug is taurine. It is used in the amount of one or two drops three times a day.
- corneal injuries
- moderate retinal angiopathy,
- age-related, radiation and traumatic cataracts,
- dystrophic changes that have affected the retina and cornea,
- open-angle glaucoma.
- stabilization of cell membranes,
- activation of corneal regeneration after trauma,
- stimulation of metabolic processes and energy in the eyes,
- normalization of intraocular pressure.
Emoxipin
It is a synthetic antioxidant used one or two drops two to three times a day. The course of treatment takes place in different ways: for three days and a month. There are contraindications to the use of the medication for pregnant women and people who have hypersensitivity to the components of the drug.
- corneal burns
- circulatory disorders of the brain,
- hemorrhages inside the eyes, which have a different origin,
- angiopathy caused by diabetes,
- complications caused by myopathy and glaucoma.
Effects from the use of the medication:
- promotes the resorption of small hemorrhages that are present on the retina,
- protects the retina from bright rays of light,
- strengthens the blood vessels of the eyes and reduces the fragility and permeability of their walls,
- activates blood flow in the vessels.
Quinax
Effects from the use of the medication:
- regulation of metabolic processes in the tissues of the eye,
- stimulation of antioxidant processes,
- improving the condition of the lens in the form of increasing its transparency.
Aisotin
Allows you to strengthen and restore vision in various eye diseases. Release form - ten milliliters, in vials. It is used three times a day, two drops in a course of treatment for two or more months.
- recovery after eye surgery, various surgical procedures and laser therapy,
- conjunctivitis,
- redness of the sclera of the eyes,
- glaucoma,
- eye burns
- angiopathy of diabetic origin,
- various visual pathologies.
Emoxy Optician
It is produced as a less expensive substitute for Emoxipin.
- corneal burn
- hemorrhage in the sclera of the eye,
- inflammatory processes in the cornea,
- constant progression of myopia.
Effects from the use of the medication:
- strengthening of blood vessels, namely their walls,
- the blood is activated and thinned, which contributes to the resorption of intraocular hemorrhage,
- preventing oxidative processes involving lipids,
- increases the resistance of eye tissues to a lack of oxygen.
Treatment of retinal angiopathy with folk remedies
In the complex therapy of retinal angiopathy, treatment with folk remedies is necessarily present. So, we give an approximate list of methods of folk healing that are recommended by experts. one.
The use of various deposits in the vessels helps
- juice squeezed from fresh parsley,
- infusion of dill seeds,
- infusion of the mixture, which contains caraway seeds and a stem of blue cornflower,
- tea from black currant leaves,
- Rowan tea.
Fees, cleansing vessels:
- take one hundred grams of chamomile, as well as one hundred grams of St. John's wort,
- you can use one hundred grams of yarrow and with the same amount of birch buds and immortelle (sometimes the immortelle is replaced with corn stigmas),
- the selected collection option is taken in the amount of a tablespoon and poured with half a liter of boiling water,
- the drink is infused for fifteen to twenty minutes,
- after which it must be filtered and brought to the initial volume with warm water,
- half of the drink is drunk in the evening, and after drinking it you can neither drink nor eat, and the remaining half is drunk in the morning on an empty stomach,
- the procedure is repeated until the prepared mixture of plants is finished.
Collection that maintains vascular tone:
- valerian rhizome and lemon balm leaves are taken in fifteen grams, and yarrow herb in the amount of fifty grams,
- everything is well mixed and two teaspoons of the mixture are taken,
- this amount of raw materials is poured with a glass of water at room temperature and left to infuse for three hours,
- after which the infusion is boiled with a water bath for fifteen minutes, cooled and filtered,
- then the infusion is brought to a quarter of a liter with water and drunk several times during the day,
- the course of therapy is three weeks.
Collection that maintains the condition of blood vessels:
- horsetail is taken in the amount of twenty grams, bird highlander - in the amount of thirty grams, and hawthorn - in the amount of fifty grams,
- everything is mixed, two teaspoons are taken and poured with a glass of boiling water,
- the drink is left to infuse for half an hour,
- an infusion is taken one tablespoon thirty minutes before a meal three times a day,
- the course of therapy is one month.
