The vitreous body is a transparent gel that fills the cavity of the eyeball and is placed behind the lens. Outside, it is surrounded by a membrane, inside it is divided into channels (tracts). If liquefaction, wrinkling or detachment of this gel is observed, then they speak of DST of the eye.
What is this?
The appearance of different in shape, size or degree of opacities in the vitreous indicates degenerative processes. Most often, pathologies are diagnosed in which the properties of this environment change.
Normally it is transparent, but contains special threads - fibrils. With age-related changes or due to certain diseases, they become less elastic and can break, which leads to visual impairment. In this case, the destruction of the vitreous body of the eye develops. It should be noted that such disorders are difficult to treat, and destructive changes in old age are practically not treated (with appropriate therapy, they can only be slowed down).
Etiology
As a rule, the destruction of the vitreous body of the eye, the causes of which can be very diverse, is the result of mechanical damage to the eyes,smoking, drug use or certain medications. There are also pathological changes associated with the natural aging process of the body. In addition, in the presence of myopia, when exposed to prolonged and frequent stress on the organs of vision, nervous shocks, destruction of the vitreous body of the eye can also develop.
If etiological factors are indicated, then dystrophy or inflammation in the retina, physical exhaustion, retinopathy, choroid lesions, metabolic changes in the eyeball should also be mentioned.
It is important to remember that abrupt destructive changes can be precursors of retinal detachment, in which there is a complete and irreversible loss of vision, so timely consultation with an ophthalmologist is mandatory.
Characteristics of destructive changes in the vitreous body
When its liquefaction develops, then, as a rule, pathological changes are observed in the central areas. The periphery of the vitreous body does not change. In most cases, voids are formed, which are filled with fiber particles and coagulation products. There may also be strands or films that float freely in a liquefied medium or attach to the fundus of the eye, leading to dramatic pathological changes in vision.
Destruction of the vitreous body of the eye in the most severe manifestation is its wrinkling. It is accompanied by tension of the vitreoretinal joints, which in severe cases leads to photopsy, retinal rupture,the appearance of hemorrhages in the vitreous body.
It should be noted that such destructive changes are easier to detect on microscopic preparations. Diagnosing a problem using 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 violation may include the appearance before the eyes of various kinds of floating elements, which become more noticeable when considering a monochrome space - a white wall, snow or sky. Patients may also notice cloudiness. It occurs due to changes in the refraction of light passing through the optical system of the eye and is associated with shadow casting on the retina, which reduces the quality of vision and may indicate more serious eye damage. Untimely access to a doctor can lead to complete loss of vision.
Destroyed fibrils of the vitreous body appear to the patient as grains, spots, threads or films that significantly impair visibility and move following eye movements.
It should be noted that one of the most common reasons for visiting an ophthalmologist is a complaint about the appearance of "flying flies" before the eyes, which cannot be eliminated. After appropriate examinations, it is the destruction of the vitreous that is detected.
Golden rain symptom
Sometimes patients who go to the ophthalmologist complain about the appearance of golden sparks when moving their eyes. 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 body's colloidal media and their mineral composition. This also applies to the vitreous body, in which pathological local changes develop and the processes of precipitation and coagulation take place, as well as the deposition of crystals, the dimensions of which are insignificant - no more than 0.05 mm.
Such deposits are called synchisis scinlillans. They consist mainly of cholesterol or tyrosine, accumulate in a liquefied vitreous body in a significant amount, and when the eyes move, they swing like a pendulum, begin to shimmer and glow, which predetermines the symptom of "golden rain", which is a rare form of destruction and makes the patient seek medical attention. help.
Diagnosis
Destruction of the vitreous body of the eye is detected using a technically simple manipulation - ophthalmoscopy. With filamentous destructive changes, optically empty cavities are revealed, which look like vertical slits or various shapes. The anterior border plate of the vitreous body is without specific changes, but gray-white fibers can be seen immediately behind it. 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 body. Atophthalmoscopy, fragments of fibril threads can be seen. If the opacity is located near the retina, then it is quite difficult to see (even at large sizes).
I must say that such changes are most often found in the elderly, as well as in patients who are simultaneously diagnosed with high myopia or dystrophic lesions of the inner membranes of the eye.
Pharmacological therapy
Despite the fact that medicine (including ophthalmology) is at a fairly high level, today there are no effective means that would prevent the destruction of vitreous body fibrils or contribute to the disappearance of already destroyed ones. Most pharmacological drugs that are prescribed for destruction only prevent the progression of pathological changes. That is why you should be wary of medicines whose manufacturers claim that their products can cure CTD.
As a rule, instillations of 2% potassium iodide or 3% "Emoxipin", which is administered parabulbarno, are applied topically. For oral administration, absorbable drugs are prescribed, for example, Wobenzym or Traumeel S. In addition, patients are advised to take a course of vitamin therapy. So, the treatment of DST of the eye should include the intake of ascorbic acid and B vitamins.
If necessary, physiotherapy procedures can be prescribed - electrophoresis with lidase and ultrasound therapy.
Laser treatment
Today everythinglaser manipulations are becoming very popular, which, with DST, are the most effective for the destruction of floating opacities. Such treatment is minimally invasive, but requires high qualification and professionalism of the doctor. It involves laser destruction of opaque fragments in the vitreous body, which break up into smaller particles that do not affect vision.
Laser intervention on the vitreous is called vitreolysis. It may include dissection of vitreo-corneal adhesions. If local hernias of the vitreous body develop, which cause deformation of the pupil and incorrect placement of the intraocular lens, the corresponding part of the ST is excised. In this case, a YAG 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 body, as well as on the size of the opacities.
Surgical treatment
Treatment of the destruction of the vitreous body of the eye by a surgical method is called vitrectomy. Such therapy involves partial or complete removal of the CT, which is carried out using a vitrectomy system consisting of a vitreotome (cutting instrument) and an endo-illuminator.
When is vitrectomy used? As a rule, it is carried out with damage to the vitreous body due to open injuries, with its clouding, as well as with hemorrhages and retinopathy.
The duration of the operation is from 30 to90 minutes. It is carried out under local or general anesthesia, it can have one or more stages, depending on the stage and type of pathology.
To replace the vitreous, artificial polymers are used, as well as balanced s alt solutions. Most often, liquid perfluoroorganic substances, gases or silicone oil are taken. Any vitreous substitute should be as transparent as possible, with appropriate viscosity and refractive power. It must also not be resorbable or cause a toxic, inflammatory or allergic reaction.
After the operation, patients are advised to observe an ophthalmologist, limit physical and visual stress, and sudden changes in temperature. Otherwise, the risk of inflammatory complications, rebleeding, cataracts, high intraocular pressure or retinal vascular occlusion increases.
