Glaucomatous atrophy (excavation) of the visual nerve. What is excavation of the disc of the optic nerve, what are the types of pathology that cause the development of Medicinal methods for changing the excavation of the ophthalmic fundus?
Excavation of the disc of the visual nerve (EDN) is a loss of various shapes and sizes at its center, which can be the norm or the result of pathological changes.
- physiological.
- glaucomatous.
Physiological EDZN
For a more accurate observation of the changes that occur at the disc of the visual nerve, use ophthalmoscopy with the anterior methods, so that the area is expanded hourly. In a light cleft lamp, normal excavation of the visual nerve is recorded. There is a small hole at this center. This physiological picture is recorded by approximately 75% of healthy people. About 25% of such decay is missing.
The shape of the physiological EDZN in most cases is regularly rounded, occasionally there are patients with sharply sharpened edges, in which the disappearance suggests the appearance of an “oblique” disc. The size of the recess also varies, and there are flat and deep shapes. However, it is normal that the excavation does not stick to the edges of the disc of the visual nerve, but is located exclusively in the center.
Glaucomatous EDZN
The clinical picture of the fundus in glaucoma is characterized by the presence of glaucomatous excavation. The disk has a pale color, and the debris is localized at the cob stage at the crown and central part, and then covers the entire disk, up to its edges. This differential sign of marginal excavation is not specific for glaucomatous changes.
Types of glaucomatous excavation
- flask-shaped.
- temporal.
- buried due to overlap.
- excavation with a hole at the lower and upper top.
The flask-shaped appearance marks the late stage of glaucoma. The hole covers the entire surface, its edges are steep and pitted. The temporal form is characterized by an increase in normal absorption in all directions, and is more temporal. The shape is regular, rounded, which is most often difficult to distinguish from the physiological, the edges of the notches can be flat or steep.
Excavation from a hole means widening the excavation plot to the upper or lower parts, sometimes up to two at a time. Perishing due to the overlap of the permanently dying changes at the disc of the visual nerve. In this case, the atrophy of the clay balls stops, and the internal cordonal membrane retains its integrity. The openings of the central blood vessels of the mesh overlap the area of the retrieval.
Most often, when the internal pressure is moved, the excavation progresses behind the temporal type, and when the internal pressure is decreased, the excavation progresses through the fossa.
Another classification of glaucomatous changes in connection with the topography of the gland sees three types of changes.
- Disk made from underground excavation.
The recess covers the entire area of the disc of the visual nerve, so there is no doubt about making a diagnosis of glaucoma. - Disk with subtotal losses.
The viimanna does not spread over the entire surface of the disk, but rather sticks out at either the lower or upper pole. It is believed that previously there was normal excavation of larger sizes, but pathological processes led to the disintegration of disc tissue in the younger areas. - Subgroup of pathological EDZN.
What is important for diagnosing a variety of tissues is that the fragments of debris do not reach the edge or around the intact tissue. However, this pathology may be flexible before it progresses and is considered to be a transitional form from normal to glaucomatous excavation.
Glaucoma is a group of diseases that is often characterized by displacements of the internal ocular pressure (IOP), and not immediately, changes in the visual field and pathology of the disc of the visual nerve (excavation right up to atrophy).
So to tell people with glaucoma:
Cause glaucoma
Factory riziku rozvitku sickness:
- Increased IOP (ophthalmic hypertension)
- age over 50 years
- Ethnicity (in the Negroid race, glaucoma is more common)
- chronic eye diseases (iridocyclitis, chorioretinitis, cataracts)
- history of eye injuries
- underlying illness (atherosclerosis, hypertensive disease, obesity, blood diabetes)
- Stress
- travail of stagnation of active drugs (antidepressants, psychotropic drugs, antihistamines, etc.)
— slumpiness (in families, some of whom have relatives with glaucoma, and are at risk of developing illness)
Glaucoma is congenital and onset. The first type of ties is caused by damaged development of the eye during the embryonic development period. Often these are intrauterine infections - rubella, influenza, toxoplasmosis, mumps, or maternal illness and the influx of harmful factors (important endocrine pathologies, high temperatures and promenovy viprominyuvannya).
The main types of full-blown glaucoma are primary (videocutaneous, zakritokutove, mixed) and secondary (ignition, phacogenic, vascular, traumatic, postoperative).
Signs of subcutaneous glaucoma include ophthalmic hypertension (periodic or constant pressure displacement), loss of visual field (in which a person should avoid touching some unnecessary objects).
Subcutaneous glaucoma
Subcutaneous glaucoma is divided into stages (behind the development of clinical signs) and behind the level of the internal eye pressure.
Stages of primary glaucoma:
Stage I (cob) - changes in the peripheral part of the day, but small in the central part (paracentral scotomas, in the Bjerrum zone, widening of the blind spots), excavation of the nipple of the visual nerve, so as not to reach its edge.
Stage II (argued) - sounding of the peripheral visual field is more than 10 degrees from the nasal side or more concentric sounding, which does not reach 15 degrees from the point of fixation, excavation of the optic disc (local region)
Stage III (which has gone far) - characterized by concentric sound fields of vision and in one or several segments more than 15 degrees from the point of fixation, excavation of the optic disc.
Stage IV (terminal) - continued lack of vision or light perception due to incorrect projection, possible excess vision in the temporal division. If the middle of the eye is clear and the bottom is clearly visible, then there is atrophy of the visual nerve.
Stages of glaucoma
Behind the level of the internal pressure there are 3 stages:
A-normal IOP (up to 27 mm Hg)
Pomirne IOP (28-32 mm Hg)
C-temporal IOP (over 33 mm Hg)
Glaucoma is clearly visible from normal intraocular pressure. When there is a characteristic loss of the visual field, excavation develops with further atrophy of the visual nerve nipple, or IOP is normal.
Postcutaneous glaucoma
Closed cuta glaucoma occurs due to the formation of a permanent or partial block of the iridocorneal cuta, through which the aqueous drainage is released. Provoking factors: small eyes (farsightedness often develops), a narrow anterior chamber, supramiral distortion of the internal ocular spine, the great crystalline lens, a narrow iridocorneal cuta (ICC). It manifests itself as periodic shifts in IOP, the most extreme manifestation of which is acute attack of glaucoma, which can be caused by too much sleep in a dark room or during the day, a large amount of drunken juice, and emotional stress. There is severe pain in the eye, which appears on the other half of the head, red and rainbow circles when looking at the head of the light.
Hostile attack of glaucoma
This country will require great celebration.
It is also seen depending on the stage of progression of stabilized and unstabilized glaucoma (behind the acuity and visual field).
Depending on the level of compensation, glaucoma can be compensated (no negative dynamics), subcompensated (negative dynamics) or decompensated (acute attack of glaucoma with a sharp decrease in visual functions).
Glaucoma long time ago It is possible that mothers are asymptomatic and patients seek help if their visual functions are already irrevocably lost.
Symptoms for which symptoms should be referred to a doctor in order to correct the development of the disease:
- Visibility of the field of vision (no visible objects)
- rainbow cola at a glance is bright
- Clouding the dawn
- Change eyepieces frequently
pain in the eyebrow area
1. Ophthalmic closure:
- Visometry (with tubular vision, visual acuity can be 100%)
- Perimetry, incl. computer The smallest changes are revealed in the field of view.
- Camimetry - tracking of the blind spot (area in the field of view, which is not normally visible to a person) - normally 10?12 cm
- biomicroscopy (visible dilation of the vessels of the conjunctiva, the symptom of the emisarium (presumed by the pigment of the anterior ciliary vessels), the cobra symptom (dilation of the episcleral veins in the vicinity of the eyelid before their perforation of the sclera), dystrophy iris and pigmented precipitates)
- gonioscopy - examination of the iridocorneal cuta with the help of a goniolensis (indicate the size of the cutta of the anterior chamber)
- tonometry for Maklakov (norm 16-26 mm Hg), non-contact tonometry (not an accurate method, used for mass tracking)
- Tonography - Tonometry stretching 4 hours with the help of an electronic tonograph. Normal performance:
P0 = 10-19 mm Hg. (Reference internal eye pressure)
F=1.1-4.0 mm3/xv (internal volume of the internal eye area)
W=0.14-0.56 mm3/xv/mmHg. (Easy inflow coefficient)
KB = 30-100 (Becker coefficient = P0 / C)
- ophthalmoscopy (indicates excavation of the disc of the visual nerve) and examination with a Goldmann lens
Excavation of the zocal nerve disc
- Optical coherence tomography of the network (indicates the smallest changes in the optic nerve disc)
- Heidelberg retinotomography
- Rheoophthalmography (indicates the stage of ischemia or hypervolemia of the skin eye)
- Vantage tests (assist in the diagnosis of closed-cut glaucoma - dark, orthoclinostatic, with mydriatics). When the area of the anterior chamber expands, it closes and symptoms of an acute attack appear.
2. Observation - clinical blood tests for cancer, biochemical blood tests, consultations with a therapist, cardiologist, neurologist, endocrinologist to identify concomitant pathologies that can trigger the ear because the development of the development is worse in patients with glaucoma.
Glaucoma treatment
You cannot improve with glaucoma; you can only slow down the progress of the disease. Treatment means only a doctor.
Types of treatment to treat glaucoma:
1. Local medical treatment:
- Release of prostaglandins (increase the flow of intraorbital fluid) - Travatan, Xalatan - bury 1 drop in each eye before bedtime
- ?-adrenergic blockers - change the vibration of aqueous blood - (non-selective (do not cause side effects on the heart and bronchi, contraindicated in people with bronchospasm) and selective) - Timolol (Arutimol, Kusimolol 0.25% or 0.5%), Betoptik and Bet opik S. Bury the skin for 12 years.
- Miotics - pilocarpine 1% - used in case of closed-cuta glaucoma (sound, the root of the iris comes out from the cut of the anterior chamber, thereby opening it) - 1 drop up to 3 times for a day.
- Carbonic anhydrase inhibitors reduce the vibration of internal ocular fluid (Azopt, Trusopt) - 1 drop 2 times a day.
The kidney is prescribed 1 drug (usually a combination of prostaglandins). If there is no effect, other drops are added, for example, adrenergic blockers. The treatment selects only the doctor, because These drugs are toxic and may be highly contraindicated.
Hypotensive drops should be infused gradually to improve the development of glaucoma.
2. Neuroprotectors are necessary, because glaucoma affects nerve tissue. There are direct and indirect effects (reducing microcirculation and indirectly affecting neurons). Direct vitamins include vitamins C, A, group B, emoxypin, mexidol, histochrome, neuropeptides (retinalamine, cortexin), indirect theophylline, vinpocetine, pentoxyphylline, nootropics, hypocholesterolemic drugs. The patient undergoes a course of drug therapy at a hospital 1-2 times a day.
3. Physiotherapeutic treatment includes a variety of methods such as electrical stimulation of the visual nerve, magnetotherapy, and laser therapy.
4. It is shown that drug therapy is ineffective surgical treatment(laser or traditional).
Glaucoma attack
A severe attack of glaucoma will require a lot of healing. There may be pain that bursts, radiating from the adjacent area, nausea and vomiting, which may be oculocardial syndrome. On examination, there is a mixed effect, a swollen cornea, the anterior chamber is friable, the anus is widened, the bombardment (vipiration) of the iris is visible, the fundus is not clearly visible, the visual nerve is hemorrhaged. The eye swells with stone thickness.
Before asking the patient, if the blood has been emptied and drained, arterial pressure (AT) is observed. These will relieve the displacement of the arterial pressure. When the intestines are empty, the spasm of the vessels is relieved and there is a high probability that the IOP will decrease rapidly.
Obov'yazkovo often take pilocarpine 1% and timolol 2 times a day. Internal anesthetic (promedol, analgin). Stick to extensive therapy (for example, mustard plasters for the face). Take diacarb with asparkam, internal lasix under the control of arterial pressure. After the attack has died down, prompt treatment is recommended.
Operative treatment of glaucoma
Main types of laser treatment: laser irectomy(to form an opening at the raiduzhtsi), trabeculoplasty(Reduce trabecular penetration).
Iridectomy
There are many methods of microsurgical debridement. The most widely used method is sinustrabeculectomy. When a new line is formed, watery water flows under the conjunctiva, and the raw material is soaked in the tissue to leave. Other operations are also possible. Iridocycloretraction(expand the cut of the anterior chamber), sinusotomy(Polypschenya vdtoku), cyclocoagulation(Aqueous water production is changing).
People's methods are ineffective. Patients are no longer spending valuable hours on their care, as their illness progresses.
Deterioration of glaucoma
Complications due to inopportune or irrational treatment: blindness, terminal glaucoma, what is wrong, lead to the end of the eye.
Prevention of glaucoma
Prevention is recommended for early-diagnosed illness. If risk factors are evident, it is necessary to regularly visit an ophthalmologist to examine and correct the internal eye pressure.
Sickness with glaucoma must be followed by a treatment regimen, dosage of physical exercise is not contraindicated, turn off the alarms, you can’t drink too much liquid, wear clothes that can cause bleeding Ik the head of the dilyant (tight beds, comiers).
Doctor ophthalmologist Letyuk T.Z.
Excavation
The classification of physiological excavation of the optic nerve is based on its size, shape, depth, and parameters of the crown edge. The remaining one can be steep, gentle, sloping. In approximately 99% of cases, the physiological excavation is round or sometimes oval, while in only 1% of cases there is a sharp skewness of the scleral canal, which clinically appears as an oblique disc. In this type, the excavation itself is represented by an irregularly shaped figure, which is widened at the back of the crown and sounds in the nasal area. The edges of the excavation also vary: the crown edge is flat, and the nasal edge, however, is flat. Due to the presence of a flat physiological excavation of the disk, the illumination size is not large, whereas with any deep excavation, it can reach large sizes.
In glaucoma, excavation of the disc of the visual nerve can be of several types:
With temporal EDZN there is an expansion of primary physiological excavation in all directions, but it is important that expansion occurs in the temporal direction. The edges of the lighting can be flat or steep. With flat edges of the entrapment in the disc of the optic nerve, two equal parts can be formed, which is called a saucer (saucer-like excavation). Sometimes the temporal EDZN is round in shape, sometimes it is oval. This fact complicates differential diagnosis with physiological excavation.
As the EDZN makes a notch in the area of the lower and upper poles, it appears that it is breaking through the burial zone. In this case, changes in the visual field in these parts are characteristic of glaucoma.
It appears that with high internal pressure, the EDZN is most often represented by the temporal type, just as with normal pressure, patients with glaucoma tend to develop excavation with a groove.
To add a rare type, there is excavation with overlaps, and diagnosis requires the use of stereoscopic methods. With this type, atrophic changes occur in the depth of the disc, as the inner cordonal membrane becomes intact. Make sure that the central parts of the mesh and their legs overlap the excavation zone. At later stages, the vessels are displaced to the bottom and side walls of the EDZN.
Flask-shaped excavation can be detected in patients with glaucoma in the terminal stages of illness. When the disk is lost, it can take up almost the entire surface. The edges of the excavation are cool and dry.
Changes in the disc of the visual nerve in patients with glaucoma may be represented not only by excavation, mild to progression, but by the formation of a glaucoma halo. It remains associated with atrophic lesions in the peripapillary part of the vessel membrane and the suprapapillary part of the mesh. As a result, the radial structure is destroyed and a large number of small linear hemorrhages are created, growing between the nerve fibers.
What is excavation of the disc of the zocal nerve, what types of pathology are identified that cause the development
EDZN is a shortened name for the pathology, which is called excavation of the disc of the visual nerve. Under this name, there is a concern for the mild-like loss of the visual nerve, which may Different sizes and forms, but the destruction may be within the limits of what is permissible, or else it may be pathological. Clinical examination may show damage to the optic nerve, which may lead to the diagnosis of singing and indicate the need for treatment.
Brief description of illness
When I am examined by an ophthalmologist, the doctor will always carry out a report examination of the visual nerve, which itself means its size and shape. clay, as well as parameters of the crown edge. As a result of extensive research, it was established that the physiological type of excavation occurs in a quarter of the population every day, especially in those people who are over 40 years old. In other people, this pathology occurs in different ways.
Excavation of the zocal nerve disc
It is important to know at least a little about the skin from the species, so that after diagnosis you know how to act.
Causes of development of pathological excavation, diagnosis
The development of pathological loss of the visual nerve is caused by illness, for example, swelling. vizka zoral disk, nerve damage, neuropathy, vein blockage and others.
To identify the main cause, special diagnostics are carried out. Today the following methods are used:
- ophthalmoscopy
- coherent optical tomography
- HRT procedure
Glaucomatous excavation
With this pathology, it is possible to develop loss of several types:
- Pogliblenya, which leads to the cessation of the network.
- Flask type.
- Temporal atrophy
- Lost in the vim near the sphere of both poles.
- The central location is of insignificant character.
- The excavation of the central disk has been expanded.
- Pogliblennya, as if suprovodzhuvalos temporal sawing.
The skin type has its own structure, classification and characteristics.
With temporal excavation of the optic nerve, an expansion of a physiological nature occurs. There appears to be a loss in the temporal direction, hence the name. The edges of the extension often have a steep or gently sloping structure. With a flat structure, the nerve carries a sliver of rays and a culm, the name of the saucer is guessing. The shape of the temporal type is oval or round. Therefore, when diagnosing the kidney, it is important to note any damage. The reason for the development of such excavation is a pressure on the eyes.
Glaucomatous excavation
At the moment of excavation from the hole at the lower and upper poles, the loss of the auricular zone is avoided. There are characteristic glaucoma changes in crop fields and plots. The development of this pathology can occur in a healthy patient with normal tension.
Excavation and destruction from overlaps develops extremely rarely. To diagnose Danish species pathologies, stereoscopic techniques are carried out. The species is subject to profound atrophic changes in the disc of peepers. In this case, the inner membrane of the eye remains intact. At the remaining stage of development of this form of excavation, the lateral walls of the visual nerve gradually shift and the vessel moves to the bottom.
Flask-shaped excavation develops in patients with end-stage glaucoma. The collapse of the disk becomes so large that it covers the entire base and surface of the mesh. The edges of the sunken area are covered and rounded.
Physiological EDZN
Physiological excavation is considered normal and is divided into several types:
To accurately diagnose these types of changes, ophthalmoscopy is performed. The process of the procedure will involve the expansion of the zone. A brightening lamp is directed at the site, and the shape of the fossa at the center of the visual nerve is seen, then the appearance of excavation is established. All people with normal vision experience slight loss of vision, as this is the name of the hole, but in 25% such a hole can last a day. The norm is a hole of the correct shape, rounded, expanded in the center of the hole.
Therefore, there are two main types of excavation of the visual nerve: glaucomatous and physiological. Skin types have their own subtypes, which are classified according to classification. form and parameters. With proper diagnosis, it is possible to identify the shape and defects of the coating.
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Glaucoma
Glaucoma is one of the worst eye diseases that can lead to loss of vision. According to obvious data, about 3% of the population suffers from glaucoma, and glaucoma causes blindness in 15% of blind people around the world. In the risk group, the development of glaucoma occurs in people over 40 years of age; in ophthalmology, such forms of illness as juvenile and congenital glaucoma are becoming more common. The incidence of illness increases significantly with age: thus, native glaucoma is diagnosed in 1 in 10-20 thousand. newlywed; in the group of 40-45-year-old people – in 0.1% of cases; in 50-60 year olds – 1.5% caution; after 75 fatalities – more than 3% of fatalities.
Understanding under glaucoma chronic illness eyes, which occurs with periodic or constant shifts in the IOP (internal ocular pressure), disorders of the IOP flow (internal ocular pressure), trophic disorders in the retina and visual nerve, which accompanies This is a development of defects in the visual field and marginal excavation of the optic nerve disc (disk of the optic nerve). Today, the concept of “glaucoma” is associated with approximately 60 different illnesses, which may include specific features.
Cause the development of glaucoma
The development of the mechanisms of glaucoma development allows us to talk about the multifactorial nature of the disease and the role of the threshold effect in its culprit. To blame for glaucoma, it is necessary to identify low-ranking officials who are susceptible to illness.
The pathogenetic mechanism of glaucoma is associated with damaged inner ocular drainage, which plays a key role in the exchange of fluid in all eye structures and the maintenance of normal IOP levels. Normally, it is excreted by the eternal (ciliary) body, and the rare fiber accumulates in the posterior chamber of the eye - a slit-like space, expanded at the back of the iris. 85-95% of the intraocular fluid flows through the anterior chamber of the eye - the area between the iris and cornea. The drainage of the internal eye is ensured by a special drainage system of the eye, located in the cuta of the anterior chamber and created by a trabecula and the Scholom canal (venous sinus of the sclera). Through this structure, the intraocular fluid flows from the scleral vein. A small part of the aqueous fluid (5-15%) flows from the additional uveoscleral duct, leaking through the vascular body and sclera at the venous collector of the vessel membrane.
To maintain normal IOP (18-26 mmHg) A necessary balance between the flow and flow of aqueous fluid. With glaucoma, this eye level appears damaged, as a result of which an excessive amount of VGZ accumulates in the empty eye, which is accompanied by displacements of the internal eye pressure towards the tolerant level. High IOP, in its turn, leads to hypoxia and ischemia of eye tissue; compression, postural dystrophy and destruction of nerve fibers, breakdown of ganglion cells of the retina and septum - to the development of glaucomatous optic neuropathy and atrophy of the visual nerve.
The development of congenital glaucoma is associated with abnormalities of the eyes in the fetus (dysgenesis of the cut of the anterior chamber), injuries, and swelling of the eyes. People with severe glaucoma are susceptible to developing full-blown glaucoma, especially those who suffer from atherosclerosis and diabetes. arterial hypertension. cervical osteochondrosis. Moreover, secondary glaucoma can develop as a result of other eye diseases: farsightedness. occlusion of the central vein of the mesh. cataracts, scleritis. keratitis. uveitis. Iridocyclitis. progressive atrophy of the iris, hemophthalmos. injury to the eyes. chubby, surgical hand-offs in front of your eyes.
Classification of glaucoma
They are divided into primary glaucoma, which is an independent pathology of the anterior chamber of the eye, the drainage system and optic disc, and secondary glaucoma, which is complicated by intraocular damage.
The mechanism that underlies the IOP shift is consistent with closed-cuta and sub-cuta primary glaucoma. In case of closed cuta glaucoma, there is an internal block near the drainage system of the eye; in the case of the critical cut form, the anterior chamber of the anterior chamber is closed, resulting in damage to the VGR.
Regardless of the level of IOP, glaucoma can occur in the normotensive version (with a tonometric pressure up to 25 mm Hg. Art.) or in the hypertensive version with moderate shifts in the tonometric pressure (26-32 mm Hg. Art.) or high tonometric vice (33 mm Hg and more).
Over time, glaucoma can be stabilized (due to negative dynamics over a period of 6 months) or unstabilized (with a tendency to change the visual field and optic disc with repeated fastenings).
The severity of the glaucomatous process is divided into 4 stages:
Over the years, congenital glaucoma has been seen (in children under 3 years of age), infantile (in children aged 3 to 10 years), juvenile (in children aged 11 to 35 years) and glaucoma. mature (especially over 35 years old). Cream caused by glaucoma, the solution forms are swollen.
Symptoms of glaucoma
Clinical progress in subcutaneous glaucoma. usually asymptomatic. The sound field of the eye develops step by step, sometimes progressing over many years, so patients often suddenly reveal that they have more than one eye. Sometimes there are cloudy eyes, the presence of rays in front of the eyes, headaches and pain in the forehead, decreased vision in the dark. When you have open glaucoma, your eyes will hurt.
In those who have completed the closed cuta form of illness, there is a phase of preglaucoma, acute attack glaucoma and chronic glaucoma.
Preglaucoma is characterized by a variety of symptoms and is indicated by ophthalmic surgery, if a narrow or closed cut of the anterior chamber of the eye is detected. In case of preglaucoma, the disease may affect the light, cause visual discomfort, and short-term loss of vision.
Acute attack of glaucoma behind the cuta of the anterior chamber of the eye. IOP can reach 80 mm. rt. Art. and more. An attack can be provoked by nervous tension, retraining, medicinal dilatation of the sinus, painful experiences in the dark, painful work with a bowed head. When glaucoma attacks, there is a sharp pain in the eye, raptian vision up to the point of lightness, hyperemia of the eyes, darkening of the cornea, widening of the eyes, which produces a green tint. This very typical sign of illness deprived itself of its name: “glaucoma” is translated from walnut as “green water”. An attack of glaucoma can occur with fatigue, vomiting, and confusion. pain in the heart, under the shoulder blade, in the stomach. A stony thickness swells on the back of my eyes.
An acute attack of closed-cuta glaucoma is characterized by a narrow stature and manifests itself, lasting for several years, by reducing IOP with medication or surgery. In other cases, the ill person may be at risk of permanent loss of vision.
Over the years, glaucoma becomes chronic and is characterized by progressive increases in IOP, recurrent acute attacks, and increasing blockade of the anterior chamber of the eye. The result of chronic glaucoma is glaucoma atrophy of the visual nerve and loss of visual function.
Diagnosis of glaucoma
Early detection of glaucoma has important prognostic value, which means the effectiveness of treatment and visual function. Conductive value in diagnosing glaucoma is played by the value of IOP. detailed examination of the fundus and optic nerve disc, examination of the visual field, quilting of the cuta of the anterior chamber of the eye.
The main methods of measuring the internal eye pressure are tonometry. Elastotonometry. Doba tonometry. The IOP is shaken with a stretch of the hand. Indicators of internal ocular hydrodynamics are determined using additional electronic tonography of the eye.
An invisible part of the study in glaucoma is perimetry - measurement between the fields of vision using various techniques - isoptoperimetry, campimetry, computer perimetry, etc. Perimetry makes it possible to detect incremental field changes that are not noted by the patient.
With the help of gonioscopy for glaucoma, the ophthalmologist may be able to evaluate the lining of the anterior chamber of the eye and the trabeculae through which the VGR drains. Informative data will help you determine the ultrasound of the eyes.
ONH becomes the most important criterion for assessing the stage of glaucoma. Therefore, the complex of ophthalmological care includes performing ophthalmoscopy - a procedure for examining the fundus of the eye. Glaucoma is characterized by deepening and widening of the optic disc (excavation). At the stage of glaucoma, which is far advanced, there is a marginal excavation and a change in color of the optic nerve disc.
A more accurate, clear and complex analysis of structural changes in the optic disc and retina can be carried out using additional laser scanning ophthalmoscopy, laser polarimetry, optical coherence tomography or Heidelberg laser retrieval. tinotomography.
There are three main approaches to the treatment of glaucoma: conservative (medicinal), surgical and laser. The choice of medical tactics depends on the type of glaucoma. The goals of drug treatment for glaucoma include a decrease in IOP, increased bleeding of the internal ophthalmic nerve, and normalization of metabolism in the tissues of the eye. Anti-glaucoma drops according to their activity are divided into three great groups:
When an acute attack of glaucoma develops, a decrease in IOP is necessary. Reversal of an acute attack of glaucoma begins with the instilation of a miotic - 1% dose of pilocarpine per regimen and dose of timolol, including diuretics (diacarba, furosemide). At the same time, medicinal therapy is carried out in a wide range of ways - cupping, mustard packs, leeches on the crown area (hirudotherapy), hot baths for the legs. To remove the damaged block and renew the flow of the intraocular fluid, it is necessary to perform laser iridectomy (iridotomy) or basal iridectomy using the surgical method.
Methods of laser surgery for glaucoma are numerous. The stinks are differentiated by the type of laser used (argon, neodymium, diode, etc.), the method of infusion (coagulation, destruction), the object of infusion (iridus, trabecula), indications before the procedure, etc. In laser surgery for wide-angle glaucoma Laser iridotomy has begun iridectomy, laser iridoplasty, laser trabeculoplasty. laser goniopuncture. In severe cases of glaucoma, laser cyclocoagulation may be used.
They have not lost their relevance in ophthalmology and antiglaucomatous operations. Among fistulizing (penetrating) operations for glaucoma, the most extensive trabeculectomy and trabeculotomy. Before non-fistulizing hands, a non-penetrating deep sclerectomy is performed. Operations such as iridocycloretraction, iridectomy, etc. are aimed at normalizing the circulation of the intraocular fluid. To reduce the production of intraocular fluid in glaucoma, cyclocryocoagulation is carried out.
Prognosis and prevention of glaucoma
It is important to understand that it is impossible to suffer from glaucoma, but the disease can be controlled. At an early stage of illness, when irreversible changes have not yet occurred, satisfactory functional results from glaucoma treatment can be achieved. The uncontrolled flow of glaucoma leads to irreversible loss of vision.
Prevention of glaucoma involves regular examinations by an ophthalmologist in particular groups of patients with a severe somatic and ophthalmological background and a history of depression over 40 years of age. Patients who suffer from glaucoma must visit a dispensary with an ophthalmologist, regularly see a specialist every 2-3 months, and always follow the recommended treatment.
The most optimal method for identifying changes in the structure of the disc of the visual nerve is stereoscopy:
· Indirect ophthalmoscopy on a long lamp with lenses 60 D or 90 D;
· Direct ophthalmoscopy on a slit lamp through central part Goldmann lenses or Van Beuningen lenses.
Before increasing the effectiveness of the eyes, it is necessary to expand the zones with short-acting midritics (tropicamide, cyclopentolate, phenylephrine). Contraindications for mydriasis include closed cut of the anterior chamber, acute attack of glaucoma or transfer of attacks of the paired eye.
Therefore, the physiological excavation of the disc of the visual nerve has a horizontal oval shape. Increased physiological excavation with a large size of the disc most often has a round shape. Normally, the excavation of both eyes is symmetrical. In 96% of episodes, the E/D ratio is between 0.2 DD.
Glaucoma is characterized by atrophic changes in the ONH. Clinically, stinking appears in the decoloration (pale) of atrophic disc segments, in extended deformation of its excavation. In the early stages of glaucoma, there are no clear differences between physiological and glaucomatous excavation. There is a gradual change in the width of the neuroretinal ring. The refinement can be equal across all stakes, local regional ones or united. Be sure to take into account the shape and overall size of the excavation, its depth, and the nature of the crown edge.
When examining the GZN, the following signs are recorded:
· The specific size of the excavation (the ratio of the maximum size of the excavation to the diameter of the disk - E/D);
· Glibinu excavation (dribna, middle, deep);
· character of the crown edge (flat, steep, steep);
· color of neuroglia (rozhdish, decoloration, sound of neuroretinal swelling, tendency to vertical extension of excavation);
· Presence of the beta zone (scleral lining peripapillary).
Widening of the excavation of the optic disc is likely to occur in all directions, but is most often observed in the vertical direction behind the rachunca of the neuroretinal ring in the upper and lower sectors, which is associated with the peculiarities of the rachis plate.
A one-time investigation of the ONH does not allow for the development of residual findings to identify or determine the presence of glaucomatous changes due to the great variability of its occurrence and changes over time. However, the size of the excavation from 0 to 0.3 is brought to normal sizes, from 0.4 to 0.6 the size is brought to the group of significant increase between the changes for especially in the amount of 50 rocks, and more than 0.6 – up to the group of advanced rhizi and development of glaucomatous atrophy
When a patient is fastened with increased IOP, the following principle should be followed: the greater the excavation, the greater the tolerance, which is glaucomatous.
Of greater importance is the pale surface of the disc, visible ophthalmoscopic displacement of the vascular bundle, and the presence of peripapillary atrophy of the vascular membrane. It is recommended to pay attention to the relief and picture of the course of nerve fibers on the retina, which in glaucoma appears to be faded and severe. These details look better when using a barless or blue filter.
In patients with glaucoma, there may be atrophy of the choroid in the peripapillary region, atrophic changes in the network in the ball of nerve fibers and the appearance of other linear hemorrhages, often dissolved and along the periphery or along the edge of the disk.
Thus, when examining the optic disc, a clear and complex assessment is carried out.
A clear assessment of the optic disc:
· Contour of the neuroretinal ring, its thickness (kraiova ekskavatsia) or the tendency to its breakthrough to the edge;
· Blood on the surface of the optic disc;
· Peripapillary atrophy;
· Zsuv of the vessel bundle.
Kilkisna assessment of DZN:
· Relation of excavation to the disc (E/D);
· Connection of the neuroretinal ring to the disc.
To document the optic disc, you can manually select color-coded photographs; for the purpose of the camera fundus, you can select schematic little ones.
In addition to clinical methods of suturing the optic nerve disc, methods are increasingly being used today that allow for a clear assessment of the state of nerve structures. These include confocal laser ophthalmoscopy, scanning (Heidelberg retinal tomography - HRT), scanning laser polarimetry (GDX) and optical coherence tomography (OCT). It is necessary to note that the data, taken away from these devices, should not be interpreted as a residual diagnosis. The diagnosis is based on the combination of all clinical data, such as disc size, visual field, IOP, age and family history. At the same time, the improvement of the optic optic disc was confirmed, which is an important prognostic sign of the progression of glaucoma.
Officials riziku rozvitku POAG
· Slackness. The prevalence of glaucoma among blood relatives of patients with POAG is 5-6 times higher than in the general population.
· Vik. POAG rarely occurs in people under 40 years of age, and the incidence of illness increases in older age groups.
· Myopia. Short-sightedness is characterized by a decrease in the rigidity of the fibrous membranes of the eye and internal ocular structures (trabecular and transverse diaphragms) and an increase in the size of the scleral canal of the visual nerve.
· Early development of presbyopia, weakening of the ciliary muscle.
· Increased pigmentation of the trabecular apparatus.
· Pseudoexfoliation syndrome.
· Organic (atherosclerosis) and functional (vascular spasms) disruption of blood flow in the vessels of the cerebral cerebellum and in the ophthalmic artery.
· Peripapillary chorioretinal dystrophy.
· Blame of asymmetry in signs characteristic of the glaucomatous process between male eyes.
Factors against rhizic development of POAG
· Young age (up to 40-45 years).
· Hypermetropia.
· Good function of the ciliary pulp.
· Preservation of pigment and stromal layers of the iris.
· The number of dystrophic changes in the structures of the anterior chamber.
· The reaction of the light is alive.
· The number of symptoms of damage to the internal orbital and cerebral blood flow.
Lie the size, shape, depth, parameters of the crown edge. The remaining one can be steep, gentle, sloping. In approximately 99% of cases, the physiological excavation is round or sometimes oval, in only 1% of cases there is a sharp skewness of the canal, which clinically appears as an oblique disc. In this type, the excavation itself is represented by an irregularly shaped figure, which is widened at the back of the crown and sounds in the nasal area. The edges of the excavation also vary: the crown edge is flat, and the nasal edge, however, is flat. Due to the presence of a flat physiological excavation of the disk, the illumination size is not large, whereas with any deep excavation, it can reach large sizes.
Glaucomatous excavation
When excavating the disc of the zocal nerve, there may also be splint types:
- Excavation due to overlap;
- Temporal EDZN;
- Flask-shaped excavation;
- EDZN with a notch in the area of the lower and upper poles.
With temporal EDZN there is an expansion of primary physiological excavation in all directions, but it is important that expansion occurs in the temporal direction. The edges of the lighting can be flat or steep. With flat edges of the entrapment in the disc of the optic nerve, two equal parts can be formed, which is called a saucer (saucer-like excavation). Sometimes the temporal EDZN is round in shape, sometimes it is oval. This fact complicates differential diagnosis with physiological excavation.
As the EDZN makes a notch in the area of the lower and upper poles, it appears that it is breaking through the burial zone. In this case, changes in the visual field in these parts are characteristic of glaucoma.
It appears that with high internal pressure, the EDZN is most often represented by the temporal type, just as with normal pressure, patients with glaucoma tend to develop excavation with a groove.
To add a rare type, there is excavation with overlaps, and diagnosis requires the use of stereoscopic methods. With this type, atrophic changes occur in the depth of the disc, as the inner cordonal membrane becomes intact. Make sure that the central parts of the mesh and their legs overlap the excavation zone. At later stages, the vessels are displaced to the bottom and side walls of the EDZN.
Flask-shaped excavation can be detected in patients with glaucoma in the terminal stages of illness. When the disk is lost, it can take up almost the entire surface. The edges of the excavation are cool and dry.
Changes in the disc of the visual nerve in patients with glaucoma may be represented not only by excavation, mild to progression, but by the formation of a glaucoma halo. It remains associated with atrophic lesions in the peripapillary part of the vessel membrane and the suprapapillary part. As a result, the radial structure is destroyed and a large number of small linear hemorrhages are created, growing between the nerve fibers.
During the day, this is the place where glial fibers exit the skull. The term “excavation of the disc of the zoal nerve” refers to the area not occupied by these fibers in the center of this anatomical light. Expansion of these can indicate the presence of a pathological process. There is a physiological increase in the zone of exit of the visual nerve, which occurs in half of the population and is not a symptom of illness. Examination of the fundus can only be done with a special device - an ophthalmoscope, with the help of which the ophthalmologist determines the severity, stage and type of pathology.
Causes of excavation guilt
The exit zone for glial fibers is present in all people. With ophthalmoscopy, it is indicated as a sick colo different diameters From the vigins of the blood vessels, which distort the disc of the visual nerve. By examining the bottom, the ophthalmologist determines its shape, width, and size. By changing these parameters, the doctor may suspect illness. The size of the area where the nerve fibers exit is midway with the diameter of the disc. Since people are great, the physiological excavation will be wide. Varieties of normal excavation include:
- slightly sunken at the center of the disk;
- centrally expanded;
- excavation with screen traps.
The high pressure of the ear pinches the nerve. Clearly rare causes of disc loss include traumatic injuries (after traumatic brain injury), various neurological disorders, swelling of the zomental nerve papilla, neuroopticopathy, thrombosis or embolism of the central veins of the mesh. In all types, the expansion of the zone where nerve fibers exit is accompanied by other specific symptoms.
Widening between excavations for glaucoma
The main cause of pathological changes in glial tissue is glaucoma. This pathology is characterized by a displacement of the internal ophthalmic pressure (the norm is not more than 24 mm Hg), which adversely affects the ophthalmic nerve. Through sharp cuts of the IOP, the nerve tissue completely dies, which leads to expansion between the disc.
Glaucoma is a serious illness that is characterized by a dramatic change. on Narazi It is the main cause of blindness in the world.
This disease can be suspected during routine ophthalmological examination, focusing on the parameters of the test, which is measured with weights or on a special device (pneumotonometer). However, illness often occurs within normal or threshold levels. This is the same information as soon as illness is evident and changes during the day.
How does widening between the disc of the optic nerve appear?
Without the necessary care, the process becomes irreversible. Damage to the disc of the visual nerve at the cob stages is initially asymptomatic. The main sign is the sound of the fields, people begin to notice the development of illness at later stages. Glaucomatous excavation of the visual nerve comes in several types:
- Skroneva abo Krajowa. Be careful in the early stages of illness. Enlargement and loss of the disc of the visual nerve on the side of the crown.
- The displacement of the fibers burns to the bottom of the disk. Learn about the development of the glaucomatous process. The disappearance of nerve fibers along the lower and upper edges of the disc.
- Excavation from blocking vessels. Be careful with advanced glaucoma. It is characterized by deep changes in the structures of the visual nerve.
- Totally expanded. Diagnosed in the remaining stage of glaucoma. Concentrically wider, saucer-like, slightly sunken.
Methods for diagnosing extended excavation
The investigation will help to establish the state of the mesh and disc of the visual nerve. Ophthalmoscopy should be used before using the simplest methods of quilting. Using a special device or lens, the doctor monitors the very bottom and indicates the presence of changes in the optic nerve disc. In this way, you can determine the shape of the excavation, the presence of its enlargement, its size, the type of pathology and suspect glaucoma. The photorecording method under ophthalmoscopy is important for monitoring the development of illness. To confirm glaucoma, the following diagnostic methods are used:
- Heidelberg retinal tomograph. A close microscope, which allows one to determine the exact size of the pathology, does not show the level of thinning of the glial fibers, and is also useful for monitoring the development of illness.
- Optical coherence tomography. Allows you to follow the deep apertures of the disc, follow the progression of glaucoma, and show the fragments through the nerve tissue.