What is macular edema? Macular edema of the retina. Synthetic analogues of glucocorticosteroids

The macula is the central part of the retina on which the light beam is focused. It is in it that the photoreceptors are located, providing clear perception. In some diseases, as well as after injury or surgery, swelling of the macula of the eye may occur. How to recognize its symptoms and what treatment is used in this case?

The macula is also called the macula. It is 5.5 mm in diameter, and its yellowish color is given by pigments - lutein and zeaxanthin, which are extremely important for eye health. The central part of the macula of the eye - the fovea - allows us to see clearly and with contrast. The fovea is the most sensitive area of the macula.

The cones located in it are responsible for the ability to distinguish colors and small details. Another part of the light-sensitive cells - rods - is located on the periphery. Their function is to provide twilight vision, light perception, and a wide field of view. The macula is a very important part of the visual apparatus; its damage is at risk dangerous consequences. So, with cystoid macular edema, timely measures must be taken to eliminate it. How to recognize such swelling?

What causes macular edema: causes

Edema of the macula of the eye develops due to the accumulation of fluid in its layers, and the quality of vision may decrease. Macular edema is not a separate disease, but only a symptom that occurs under certain circumstances:

At various injuries organs of vision;
. due to eye diseases;
. after surgery.

This pathology was first described in 1953 by Dr. S.R. Irwin, when he diagnosed macular edema after cataract surgery. And today it can manifest itself as a complication after cataract extraction.

Often, macular edema can also develop in diabetic retinopathy due to impaired thinning of the vascular walls and increased permeability of the capillary network. The fluid penetrates the vascular wall and accumulates in the retina. In such cases, edema has two types:

Diffuse - extends to the fovea, the retina thickens to 2 disc diameters optic nerve and more;
. focal - the amount of edema is up to 2 disc diameters and does not involve the fovea.

With thrombosis of the central vein, the vulnerability of the vessel walls increases, and the fluid overflows, causing macular edema. It is often diagnosed with vascular and inflammatory diseases- the vitreous body begins to put pressure on the retina, which often leads to its rupture.

Swelling of the macula of the eye can also occur with other eye diseases: retinitis pigmentosa, collagenosis, aphakic glaucoma, tumor choroid, retinal detachment, chronic uveitis. How can you understand that macular edema is developing on the retina, and what should you pay attention to?

Macular edema: main symptoms

So, what manifestations indicate the presence of macular edema? These may be the following symptoms:

Central vision decreases in clarity and images become blurry.
. The contours of objects are distorted - straight lines look slightly curved, wavy.
. The outlines of objects may be edged with a pinkish haze.
. Photophobia often occurs - increased sensitivity to light.
. At certain times of the day (for example, in the morning), there may be a slight decrease in visibility.

Much less often, color perception may be impaired. As a rule, swelling of the retina does not lead to loss of vision - when the cause is eliminated, it is restored. However, in advanced cases, when a person delays visiting an ophthalmologist, the likelihood of irreversible changes becomes higher.

Diagnostics

Modern methods of ophthalmological examinations make it possible to detect the slightest changes in the structure of the retina. There are situations when swelling is not expressed, so it can be difficult to diagnose.

Using a slit lamp, a characteristic bend of the macular vessels is determined, indicating retinal pathology. Optical coherence tomography- one of the most effective ways to diagnose macular edema and possible reasons appearance. Based on the results of this study, the thickness is determined retina in microns, volume in cubic millimeters, and in two- and three-dimensional projection.

A method such as Heidelberg retinal laser tomography can detect changes in the neural layer of the retina, as well as obtain data on the size, contour and shape of the optic nerve head.

Fluorescein angiography is another way to detect hidden macular edema. This study allows you to examine the retinal vessels and determine swelling by the area of contrast dispersion without clear boundaries. With the help of FA, you can also understand where the fluid is accumulating from.

Methods for treating macular edema

Modern ophthalmology offers several treatment options for macular edema:

Conservative;
. surgical;
. laser surgery.

The choice of treatment method depends on the reasons that caused the swelling and the duration of its presence on the eye. Conservative treatment consists in the use of anti-inflammatory drugs (tablets, drops, and injections). As a result of many years of practice, it was found that the most effective drugs To eliminate macular edema, synthetic substitutes for glucocorticosteroids are used - these are hormones produced in the human adrenal cortex. To achieve maximum effect, they are injected directly into the vitreous body - intravitreal.

However, this method has its drawback - the duration of the therapeutic effect remains low due to rapid absorption active substance.

In case of pronounced changes in the vitreous body (tractions, the appearance of epiretinal membranes), vitrectomy is prescribed - partial or complete removal vitreous. After this operation, intraocular pressure stabilizes and swelling disappears. The removed part is replaced with a special transparent hypoallergenic substance, a kind of prosthesis that will last for many years.

For swelling caused by diabetic retinopathy, laser coagulation of the retina is prescribed. The effectiveness of this operation is especially high on early stages. It is used only for focal macular edema, while for diffuse it does not bring the desired result. The essence of the method is the coagulation of damaged vessels through which fluid leaks. This prevents its accumulation and stabilizes blood flow.

Folk remedies

If the macula of the eye is swollen, you can also use additional agents to help stabilize intraocular pressure and slightly reduce the swelling of the eye. So, an infusion of sweet clover and propolis will help prevent the appearance of blood clots. To strengthen the walls of blood vessels and increase their elasticity, boiled or raw beets with honey help. A decoction of rowan and hawthorn fruits will help reduce pressure inside the blood vessels. Of course these traditional methods are not a solution to the problem, but will not hurt as an aid.

S.Yu. Astakhov, M.V. Gobedgishvili

Department of Ophthalmology
State Medical University named after acad. I.P. Pavlov,
St. Petersburg
Purpose: to improve functional results of efficacy of phacoemulsification surgery and results of postoperative rehabilitation after phacoemulsification.
Materials and methods: 90 patients (50 males and 40 females) with diagnosed senile cataract and/or POAG after phacoemulsification, phacotrabeculotomy or nonpenetrating deep sclerectomy were included in the study.
Results: Keratopathy was diagnosed in all patients in the first day after surgery.It reduced by 2-3 days of postoperative period. Visual acuity of 0.7-1.0 was detected in the first day after surgery in patients with diagnosis of senile cataract.
In 10 patients after phacotrabeculotomy ciliochoroid detachment was found. In 5% of patients macular edema was diagnosed in 2 months after surgery. In case of macular edema of the size more then 500 micrometers, triamcinolone injections were made intravitreally and NSAIDs were prescribed until complete disappearance of edema.
Conclusion: There was found a necessity of forming of clinical groups according to associated internal and ophthalmologic diseases. These may allow detecting possible complications in each group in the postoperative period and giving the recommendation of their prophylaxis.

Pathological changes in the central region of the retina often worsen the functional results of cataract surgery.
There are a number of retinal diseases that do not provide the opportunity to obtain high visual acuity after surgery (age-related macular degeneration, retinal tear, diabetic retinopathy, etc.). In cases of severe lens opacification, final postoperative visual function remains unclear. Only after restoration of the transparency of the optical media of the eye does it become possible to obtain full information about the condition of the retina, including using special diagnostic methods.
However, there are pathological changes in the retina associated with surgical treatment. Macular edema is considered one of the late postoperative complications. This condition after cataract extraction was first described by S.R. Irvine in 1953. Today, the above postoperative complication formulated as Irwin-Gass syndrome. Despite numerous clinical and laboratory research For more than half a century, the cause and pathogenesis of this syndrome have remained unclear.
The type of surgery affects the incidence of cystoid macular edema. N.S. Jaffe, H.M. Daymen et al. (1982) showed that extracapsular cataract extraction is much less likely than intracapsular cataract extraction to cause the development of macular edema. After extracapsular cataract extraction, the incidence of its occurrence ranges from 2 to 6.7% (Mentes J. et al., 2003).
Behind last years The technique for removing the lens has changed dramatically. Currently, phacoemulsification (PE) is the main method of cataract extraction in most ophthalmology clinics around the world.
The objective advantage of this method over traditional extracapsular cataract extraction is considered to be a small (1.8-3.0 mm) valve self-sealing incision, which allows to minimize the number of postoperative complications and thereby achieve high visual acuity already in the first day after the intervention.
Despite the constant improvement of surgical techniques for cataract removal, this operation is inevitably accompanied by an inflammatory reaction (Adabashyan S.A., 2000). Surgical trauma to the iris and ciliary body or lens epithelial cells induces the synthesis of prostaglandins and also increases the intensity of oxidative reactions. Free radicals and lipid peroxidation products are among the main damaging factors that cause destruction of eye tissue during inflammation. (Katargina L.A. et al., 2003). Their number may depend on the power and duration of ultrasound exposure during PE and/or different types and models of phacoemulsifiers (Aust S., 2009).
Thus, as a result surgical trauma not only postoperative stress of the organ of vision occurs, but also trauma to the uveal tract, which leads to disruption of microcirculation and increased glycolysis with the subsequent development of hypoxia in the tissues. In turn, hypoxia contributes to disruption of the permeability of cell membranes. The severity of postoperative inflammation depends on the type of surgical intervention and is most pronounced after extracapsular cataract extraction.
However, despite 42 years of experience in using phacoemulsification in clinical practice The problem of studying the functional results of surgical intervention in the early and late postoperative period associated with the impact of ultrasound energy on intraocular structures, in particular on the elements of the outer layers of the retina and the pigment epithelium, remains relevant.
It is known that ultrasound has a damaging effect on the cornea (the development of edema due to the loss of endothelial cells), and the degree of its changes depends on the power and time of exposure of the ultrasound to the eye tissue. The question of the possible effect of ultrasound on the retina during PE still remains unresolved.
With FE, progression of destruction of the vitreous body is also noted. There is evidence that high mobility of the vitreous body, caused by vitreal destruction, increases the contusion-traction effects on the vitreoretinal interface and contributes to the occurrence of retinal pathology (Makhacheva Z.A., 1994). R. Grewing, B. Rao believe that PE does not affect changes in retinal thickness after surgery in the absence of concomitant ocular pathology.
In 2004 N.S. Galoyan proved that the use of ultrasound phacoemulsification leads to changes in the morphological state of the central zone of the retina in eyes without concomitant ocular pathology (the changes are reversible and completely disappear a month after PE).
It has not yet been proven whether YAG laser dissection of secondary cataracts increases the risk of developing macular edema.
The macular area within a radius of 20° from the fixation point responds to surgical impact. Postoperative swelling of the macular region of the retina, expressed to varying degrees, is not always visualized by ophthalmoscopy.
Today, there are modern research methods that make it possible to identify even minimal changes in the morphology of the retina and conduct objective dynamic monitoring of the pathological condition.
Methods that assess retinal thickness can be divided into subjective and objective. Currently, the most used methods that allow subjective assessment of retinal edema (thickening) are retinal biomicroscopy using aspheric or contact lenses, as well as stereo photography of standard retinal fields, which is more common in European countries and the United States (Fig. 1). Of the objective techniques that allow us to assess the thickness of the retina, today we can distinguish several: retinal confocal tomography (HRT), fluorescein angiography (FA) and optical coherence tomography (OCT) (Lobo C., 1999; Verano M., 1999; Yoshi- da A., 2000).
Of the objective methods for diagnosing macular edema, OCT is considered the safest and most informative. The main advantage of this method is the quantitative assessment of retinal thickness; with its help, it is possible to objectively, quickly and accurately diagnose pathological changes in the central zone of the retina. OCT ranks 1st in terms of effectiveness in early diagnosis macular edema.
With OCT, tissue is illuminated (probed) with radiation, the source of which is a superluminescent diode. The use of low-intensity light in the near-infrared range as probing radiation is particularly attractive due to its non-invasiveness and relatively weak absorption of light in the range of 700-1300 nm by biological tissues.
The method is based on determining the degree of reflection of radiation depending on the time of its propagation in the medium. In an OCT image, the contrast between different tissue microstructures arises due to the different scattering properties of its elements.
OCT is a universal method for assessing the structure of tissues with a layered structure, but it is advisable to use it only in cases where the depth of interest is no more than 2 mm. It shows an image of the tissue structure in the same orientation as the histological specimen, cut perpendicular to the tissue surface.
The most widely developed diagnostic capabilities of the method are for pathology of the retina, in particular the macular zone (Fig. 2, 3).
The tomogram visualizes all layers of the retina (from pigment epithelium to the internal limiting membrane) and part of the choroid and vitreous. When mapping the retina healthy person the macula area, the average thickness of which is 200-250 µm, is indicated in green, with natural thinning in the foveal area (blue, average thickness 170 µm).
On the tomogram, areas with a thickness of more than 470 microns are indicated in white, red - 350-470 microns, orange - 320-350 microns, yellow - 270-320 microns, green - 210-270 microns, blue - 150-210 microns.
Recent data on the incidence of macular edema after uncomplicated phacoemulsification indicate that the frequency of subclinical forms of the latter, detected using optical coherence tomography, reaches 41% (Lobo C. L. et al., 2004).
According to a study by I. Perente, an increase in retinal thickness was found by the end of the 1st month after surgery. And by the 3rd month, its return to the original norm is noted (Biro Z. et al., 2006).
The literature notes that an increase in retinal thickness in the central regions (according to OCT data) is a manifestation of subclinical macular edema and can further lead to the development of cystoid macular edema (Biro Z. et al., 2006).
Initial central retinal thickening of 80 µm or more can be considered a prognostic factor for the development of macular edema. To standardize the approach to diagnosing this pathology, it is better to focus on the percentage change in the initial retinal thickness in the center.
The results of the study by S.J. Kim indicate that the initial thickening of the retina in the center by 40% according to OCT data is a reliable and significant criterion for the development of macular edema after surgical treatment.
The risk of developing macular edema increases if there is a history of eye trauma, as well as in a patient with glaucoma, diabetes mellitus, myopia, retinal and vitreous dystrophy, inflammation of the choroid, etc. Conditions of this kind cause the presence of pathological changes in the immune and vascular systems, metabolic disorders in the body.
In diabetes, diffuse retinal edema is associated with impaired permeability of the capillary network. These pathological changes are associated with the aggressive impact of surgical stress factors (CS) on the macular retina. Timely detection and treatment of stress-induced macular changes, when the retina still retains adaptive reserves for the restoration of metabolic disorders, is the optimal way to obtain high visual acuity as a result of surgery (Egorov V.V. et al., 2008).
Macular edema caused by vitreoretinal traction is often diagnosed. The epiretinal membrane is formed in the vitreous cavity. Its development is associated with age-related changes in the fundus. Often found in vascular, inflammatory diseases and injuries of the organ of vision.
As the epiretinal film progresses, it begins to pull back on the retina in the central region, which causes swelling and further retinal rupture.
When certain risk factors are identified in predicting the development of various types of macular response to cholesterol, it is necessary to carry out their prevention.
Despite the fact that currently there are different opinions regarding the role of vitreal traction and inflammatory mediators in the pathogenesis of macular edema, most researchers believe that inflammation is the most important factor, which determines the development of this condition (Yannuzzi L.A., 1984). Prostaglandins play a major role in the formation of the inflammatory response, so treatment is mainly associated with a decrease in their activity.
Today, there are several methods for treating macular edema: conservative, laser and surgical.
For drug treatment Topical corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are most often used.
Corticosteroids are often used as part of traditional treatment for several weeks after surgery to reduce the inflammatory response. However, the side effects of corticosteroids are well known: increased IOP, development of cataracts, decreased local immunity, inhibition of wound healing processes, ulceration of deepithelialized areas of the cornea.
The main advantage of prescribing NSAIDs is the absence of unwanted effects that occur during treatment with corticosteroids.
Preoperative use of NSAIDs significantly increases the effectiveness of cataract surgery. NSAID instillations should begin three days before surgery. For macular edema, NSAIDs are prescribed according to the standard regimen: 1 drop 4 times a day.
In a study examining the effect of steroid and non-steroidal anti-inflammatory therapy on the incidence of macular edema during cataract extraction with IOL implantation, it was found that when using dexamethasone, the incidence of this complication was 32.2%, and in patients receiving indomethacin - 12.4% ( Solomon L.D. et al. 1995).
In the case of vitreoretinal traction syndrome, only surgical treatment is indicated.
At the department of St. Petersburg State Medical University named after. acad. Pavlov is conducting a study, the purpose of which is to improve the functional results of surgical intervention and the effectiveness of postoperative rehabilitation of patients who have undergone phacoemulsification.
The study was conducted in 90 patients (50 men, 40 women) with age-related cataracts and/or primary open-angle glaucoma (POAG) who underwent phacoemulsification, phacotrabeculectomy, or non-penetrating deep sclerectomy.
Results. On the first day after surgery, patients had slight keratopathy (corneal edema, folds of Descemet's membrane), which mostly resolved on the 2-3rd day after surgery. All patients with age-related cataracts without other concomitant ocular pathologies had high visual functions on the first day after surgery (from 0.7 to 1.0). In half of the patients, mild opalescence of the anterior chamber moisture was detected, the disappearance of which was noted by the 5th day after the start of standard anti-inflammatory treatment. In patients after phacotrabeculectomy (10 eyes) as a result sharp drop In IOP, ciliochoroidal detachment appeared. In 5% of patients, postoperative macular edema was diagnosed in the 2nd month after surgical treatment. When NSAIDs were prescribed locally without combination with other drugs, the swelling decreased to 100 microns. In cases of macular edema greater than 500 μm, intravitreal injections of Kenalog 40 (triamcinolone) were performed; after one injection, the edema decreased significantly. Next, patients received topical NPVN until macular edema completely disappeared. In 50% of patients who received topical NSAIDs in the pre- and postoperative period, there was an increase in retinal thickness, which returned to normal after 3 weeks. after operation.
Analysis of the clinical and functional results of the studied patients revealed the need to systematize patients into clinical groups, taking into account concomitant common diseases and ophthalmopathology, which will allow us to determine possible complications in each group in the postoperative period and give recommendations for their prevention.

Literature
1. Evgrafov V.Yu., Batmanov Yu.E. Cataract. M.: Medicine, 2005. P. 310-318
2. Egorov V.V., Egorova A.V., Smolyakova G.P. and others. Clinical and morphological features of changes in the macula in patients with diabetes mellitus after phacoemulsification of cataracts // Bulletin of Ophthalmology. 2008. No. 4. P. 22-25
3. Shadrichev F.E., Astakhov Yu.S., Grigorieva N.N. etc. Comparative assessment various methods diagnosis of diabetic macular edema // Bulletin of Ophthalmology. 2008. No. 4. P. 25-28
4. Takhchidi Kh.P., Egorova E.V., Tolchinskaya A.I. and others. Intra-ocular correction in complicated cataract surgery // M., 2004. 170 p.
5. Jaffe S. Thirty years of intraocular lens implantation: The way it was and the way it is. // Journal of Cataract and Refractive Surgery. 1999. Vol. 25. No. 4. P. 455-459.
6. Mentes J., Erakgun T., Afrashi F., Kerci G. Incident of cystic macular edema after uncomplicated phacoemulsification. Ophthalmologica. 2003; 217(6):408-412.
7. Gehring J. R: Macular edema following cataract extraction. Arch. Ophthalmol. 1968; 80: 626-631.
8. Sourdille P, Santiago PY. Optical coherence tomography of macular thickness after cataract surgery. J. Cataract Refract. Surg. 1999; 25 (2): 256-261.
9. Lobo C.L., Faria P.m., Soares M.A., Bernardes R.C., Cunda - Vaz J.G. Macular alterations after small-incision cataract surgery. J. Cataract Refract. Surg. 2004; 30: 752-760.
10. Parente I., Ozturker C. et al. Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical tomography // Curr Eye Res. - 2007 Mar; 32 - (3): 241
11. Biro Z., Balla Z., Kovach B. Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implant // Eye - 2006. - Jun 2.
12. Solomon L.D. Efficacy of topical flurbiprofen and indomethacini preventing pseudophakic cystoids macular edema // J. Cataract Refract. Surg. 1995. Vol. 21. P. Surg. 1995. Vol. 21. P. 73-81.

Macular edema is swelling of the central area of the retina, called the macula or macula. It is this area of the retina that is responsible for central vision.

Macular edema is not an independent disease, but a symptom observed in some eye diseases: diabetic retinopathy, retinal vein thrombosis, uveitis. Macular edema can occur due to eye injury or after surgery.

How and when does macular edema occur?

The cause of macular edema is the accumulation of fluid in the layers of the macula, which reduces visual acuity. The mechanism of fluid accumulation may be different.

In 1953 S.R. Irvine first described macular edema following cataract surgery. Today, this postoperative complication is called Irvine–Gass syndrome. The cause and pathogenesis of this syndrome are still controversial. It has been established that the type of surgical intervention affects the incidence of macular edema. For example, after extracapsular cataract extraction, the frequency of its occurrence is statistically significantly higher than with intracapsular extraction, ranging from 2 to 6.7%.

In diabetic retinopathy, swelling of the retina, including the macula, is associated with impaired permeability of the capillary network. The fluid sweats through the defective vascular wall and accumulates in the layers of the retina.

With thrombosis of the central retinal vein or its branches, the permeability of the vascular wall also increases and fluid leaks into the perivascular space with the formation of retinal edema.

Macular edema is often observed with vitreoretinal tractions - cords between the vitreous body and the retina. Often found in vascular, inflammatory diseases and injuries of the organ of vision. The vitreous body begins to pull the retina along with it, which causes swelling and, if the process develops unfavorably, retinal rupture.

Clinical manifestations of macular edema

Symptoms of macular edema

blurred central vision
image distortion - straight lines look wavy, curved
a pinkish tint appears in the image
increased sensitivity to light.
There may be a cyclical decrease in visual acuity at certain times of the day (usually in the morning). Changes in refraction are often within 0.25 diopters.

Differences in color perception during the day are observed very rarely.

In uncomplicated cases, such as after surgery, macular edema usually does not lead to permanent vision loss, but vision recovery is usually slow, ranging from 2 to 15 months. However, long-term macular edema can cause irreversible changes in the structure of the retina and, as a result, irreparable deterioration of vision.

In diabetes mellitus, focal and diffuse macular edema are distinguished. Macular edema is considered diffuse if the retinal thickening reaches an area of 2 or more optic disc diameters and extends to the center of the macula, and focal if it does not involve the center of the macula and does not exceed 2 optic disc diameters. It is diffuse edema that, when present for a long time, is often accompanied by a significant decrease in visual acuity and can lead to complications such as degeneration of the retinal pigment epithelium, macular hole, and epiretinal membrane.

Diagnostics

When performing ophthalmoscopy (examination of the fundus of the eye), it is usually possible to detect only severe macular edema. If the swelling is not pronounced, it is quite difficult to detect it.

IN initial stage Retinal edema in the central region can be suspected by the dullness of the edematous area. Also a sign of edema is prominence (bulging) of the macular area, which can be identified by the characteristic bending of the macular vessels when examining the fundus under a slit lamp. The foveal reflex often disappears, indicating flattening of the fovea.

There are modern research methods that can detect even minimal changes in the morphology of the retina.

One of the most effective methods diagnostics of macular edema - optical coherence tomography (OCT). According to this study, it is possible to quantify the thickness of the retina in microns, volume in cubic millimeters, its structure, and vitreoretinal ratios.

Heidelberg retinal tomography (HRT) can also detect macular edema and quantification retinal thickness (edema index), but HRT cannot provide data assessing retinal structure.

Another way to confirm macular edema is retinal fluorescein angiography (FAG), a contrast study of retinal vessels. Edema is determined by the area of contrast dispersion without clear boundaries. Using FA, you can determine the source of fluid sweating.

Treatment

There are several methods for treating macular edema: conservative, laser and surgical. Patient management tactics depend on the cause of macular edema and the duration of its existence.

Conservative treatment of macular edema involves the use of anti-inflammatory drugs in drops, injections and tablets. Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed. The main advantage of prescribing NSAIDs is the absence of undesirable effects that occur during treatment with corticosteroids: increased IOP, decreased local immunity, ulceration of deepithelialized areas of the cornea. Preoperative use of NSAIDs improves the effectiveness of cataract surgery. NSAID instillations should begin several days before surgery. NSAIDs and corticosteroids are typically used postoperatively as anti-inflammatory therapy. Their use can be considered as a prevention of postoperative macular edema or treatment of its subclinical forms.

If there is no effect of conservative therapy, certain drugs are injected into the vitreous cavity, for example, long-acting corticosteroids or medicines, specially designed for intravitreal administration.

If there are pronounced changes in the vitreous body - tractions, epiretinal membranes, vitrectomy is performed - removal of the vitreous body.

The only treatment for diabetic macular edema is laser photocoagulation of the retina. A fundamentally important condition is that laser treatment. The effectiveness of laser coagulation has been proven for focal macular edema. At the same time, according to many researchers, despite laser treatment of diffuse edema, the prognosis for visual functions is poor.

The essence of laser coagulation of the retina for macular edema comes down to coagulation of all defective vessels through the wall of which fluid leaks. The center of the macula should remain unaffected.

The prognosis for macular edema depends on the pathology against which it arose, on timely diagnosis and early treatment. The most favorable prognosis is in cases of postoperative macular edema - it resolves within several months and visual functions, as a rule, are completely restored.

The key to successful treatment is timely contact with a specialist. Even if you have been seeing an ophthalmologist for a long time about a disease and know your diagnosis, you should not neglect what you think are minor symptoms. Be attentive to your health!

Macular edema is a local accumulation of fluid inside the retina in the area of the macula, or macula, the area that is responsible for clear vision. Thanks to the macula, people cope with sewing, reading, facial recognition and the like. Despite these symptoms, lesions of the macula in one of the eyes may not be noticed immediately, since macular edema of the eyes passes painlessly, and the visual defect in one of the eyes is compensated by the excellent vision of the second. In this regard, you need to be attentive to yourself so as not to miss the time for successful therapy with absolute restoration of vision.

Let's figure out what it is - OCT In what cases is it prescribed?

Description of the disease

In this case, we are talking about swelling of the central region of the retina, which is called the macula or macula. It is this part of the retina that is responsible for human vision. Macular edema is not an independent disease, but a symptom that is observed in a number of eye pathologies. For example, it is observed in retinopathy, and in addition, if the patient has retinal thrombosis. Macular edema can occur due to eye injury or after surgery.

Causes of edema: how does it occur?

The cause of the problem is the increased permeability of the vascular walls. As a result, fluid flows from the bloodstream into the intercellular space. The retinal tissue in the macular area increases in volume, which greatly interferes with the normal functioning of visual receptors.

Diabetes mellitus is a common cause of macular edema. Increased quantity glucose contributes to damage to the vascular walls, and angiopathy develops. Thus, favorable conditions are created for fluid to enter the retinal tissue from the bloodstream. In addition, in diabetes, newly formed vessels can grow into the retina, the walls of which are initially permeable and defective.

Diabetic edema as a complication of diabetes often develops when there is insufficient control over the increase in the amount of glucose in the blood, and the disease lingers at the stage of decompensation. One of the reasons for the development of this disease can be eye infections, namely:

Uveitis, which is different types inflammation of the choroids of the eyes.
The development of cytomegalovirus retinitis, which is an inflammatory process in the retina, which is caused by a viral agent of eye infections.
The appearance of scleritis, that is, inflammation of the outer membrane of the eyes.

Another reason is vascular problems as:

Presence of retinal vein thrombosis.
The presence of a large aneurysm, that is, limited expansion of the central artery.
The presence of vasculitis, that is, a genetically determined inflammatory process in the walls of blood vessels.

Eye surgery as one of the causes of the disease

Swelling of the macula of the eye can occur immediately after extensive and complex manipulations, and also after low-traumatic surgical intervention. The reasons are usually the following:

Cataract surgery followed by installation of an artificial lens.
Carrying out laser coagulation and cryocoagulation of the retina.
Performing laser capsulotomy.
Performing penetrating corneal plastic surgery, also known as keratoplasty.
Carrying out scleroplasty and surgery to improve fluid outflow in the presence of glaucoma.

Postoperative complications that cause pathology often resolve spontaneously and without consequences.

Causes of the disease: injuries and side effects

Against the background of eye contusion, microcirculation disorders in the retina may appear, which lead to the development of edema. Afterwards, swelling can develop against the background of injury, and also as a complication of surgical therapy.

Side effects from taking certain medications also often cause swelling. This condition is also known as toxic maculopathy. For example, medications made with prostaglandins, along with niacin, certain diabetes medications, and immunosuppressants, can cause macular edema. Therefore, you need to remember the medications you have to take in order to later be able to answer the doctor’s questions in detail and quickly determine the causes of the problem. Other intraocular pathologies can also cause the appearance of such edema:

Hereditary diseases, for example
Various acquired pathologies in the form of strands between the macula and the vitreous body, which can provoke edema along with subsequent retinal detachment.
Presence of age-related macular degeneration of the retina.
Presence of central serous chorioretinopathy.
Effect of radiation.
Macular edema is often a complication of radiation treatment for cancer.

Symptoms of the disease

Symptoms of this disease are the following:

A cloudy spot that makes it difficult to see the details of the image.
Within the limits of vision there may be areas of distortion, and at the same time blurred lines.
The image before your eyes may have a pink tint.
Availability hypersensitivity to the light.
Decreased visual acuity near and far.
The presence of cyclicity in decreased visual acuity, usually the condition worsens in the morning.

Diagnostics

How is fundus examination performed?

The specialist makes a diagnosis immediately after he evaluates the information obtained from interviewing the patient in total and carries out all necessary examinations. The doctor may suspect pathology in the following cases:

If there are characteristic complaints.
In the presence of concomitant diseases that could serve as the basis for the development of such edema, for example, diabetes and so on.
Decreased vision that cannot be corrected with glasses.

As part of the diagnosis, an examination of the fundus of the eye and a visual field test are performed. A feature of the disease is a significant deterioration of central vision while maintaining peripheral vision. There are different techniques your doctor can use to identify central vision problems. The most informative technique is to identify areas of deterioration in visual clarity, which are called central scotomas. The characteristic position of the scotoma may indicate damage to the macula area.

Performing a fundus examination

The condition of the macula can be visually assessed using ophthalmoscopy. This technique allows you to get an idea of general condition retina. Before the examination, the doctor uses drops that dilate the pupil to achieve best review macula.

Performing fluorescein angiography

When using this technique, a special dye is used to identify the area in which fluid flows out of the bloodstream due to increased permeability of the vascular wall. Thanks to this technique, the location of fluid accumulation in the retinal tissue is identified, that is, it is possible to see the swelling with its size and boundaries.

For vision diagnostics, you can contact the Fedorov Clinic. This medical facility is located in many large cities.

Performing optical coherence tomography

This technique (also called eye OCT for short) allows you to scan the retina, determining its thickness, including the ability to examine the macular area. This technique provides the greatest amount of information compared to other diagnostic methods.

Not everyone knows what OCT of the retina is. This latest technology, thanks to which you can study the tissues of the eye thoroughly without causing harm.

In this diagnostic method the effect is non-contact, since only a laser beam or infrared lighting is used during the procedure.

The result of OCT of the eye is a photograph of the fundus, two- or three-dimensional.

Treatment of pathology

The main goal of treating macular edema is to stabilize visual function while eliminating increased vascular permeability. The treatment plan largely depends on the causes of edema and the nature of its severity.

Medicines that are advisable to use in this case are mainly eye drops, and in addition, various tablets. Often, treatment uses drugs with anti-inflammatory effects along with diuretics and agents that improve microcirculation. If macular edema is caused by progression chronic diseases, treatment is prescribed to improve control over the progression of the disease or stop further deterioration. The drug that caused the swelling is discontinued or replaced with another medication.

When a more powerful therapeutic effect is required, doctors resort to bringing the medicine as close to the macula as possible. To do this, an injection is performed medicinal product directly into the eye. This procedure requires sterile conditions, and in addition, good practical training of the doctor, so it is performed by an ophthalmic surgeon in the operating room under anesthesia. Corticosteroids can also be used for treatment. These are drugs that have a powerful anti-inflammatory effect, they are able to relieve tissue swelling.

Laser coagulation of the retina at the Fedorov Clinic is performed to reduce swelling in the macula area. This procedure can be performed, including repeatedly, in order to achieve better control over the processes of fluid accumulation. If swelling in the macular area is present in both eyes, then coagulation is usually performed in one eye, and after a few weeks in the other.

Surgery as an effective treatment option

In cases where edema is difficult to treat, and in addition, vitrectomy is used to prevent complications of this condition. This procedure involves removing the vitreous from the area of the eyeball.

Treatment for macular edema usually takes several months until it completely disappears (usually it takes from two to fifteen months). The only thing a patient can do to speed up his recovery process is to follow absolutely all medical recommendations.

In the presence of uncomplicated macular edema, patients' vision is usually completely restored. But in the case of long-term edema, irreversible structural damage may occur in the area of the macula, which will most likely affect visual acuity. In this regard, if there is any suspicion of macular edema, you should not postpone your visit to the doctor.

The macula is the central zone of the retina, which is the yellow spot, the diameter of which does not exceed 5 mm. It is responsible for the acuity of central vision. The macula is located opposite the pupil, near the optic nerve.

When a pathological accumulation of fluid occurs in the central zone of the retina of the eye, we are talking about. As a rule, such swelling is not an independent disease, but a consequence of an injury or some kind of ophthalmological disease.

As a rule, the following symptoms force a person to see a doctor:

deterioration of central vision, that is, distorted perception of the shape of surrounding objects, for example, straight lines may appear wavy;
periodic disturbance of color perception (often the patient sees the surrounding picture in pinkish tones);
decreased overall visual acuity, objects are seen unclear, with blurry edges. At the same time, you can track the connection with the time of day; in the morning this symptom is more pronounced;
The eyes become sensitive to bright light.

The stronger the macular edema, the more the patient is concerned about these disorders.

If you don't apply for medical care and do not start treatment, irreversible damage to the visual receptors may begin after 6 months.

Causes

Macular edema can develop due to the following reasons:

inflammatory eye diseases: – damage to the choroid, – inflammatory process in the iris and ciliary body;
glaucoma – persistent increase in intraocular pressure;
central retinal dystrophy;
benign or malignant tumors eyes;

Factors contributing to the occurrence of edema are infectious diseases, cardiovascular pathologies, concussions.

A particular risk factor is diabetes mellitus.

Classification

Macular edema is divided into several types:

Diabetic, i.e. manifested as a complication of diabetes mellitus. In this case, the swelling is a consequence of impaired blood supply inside the retina;
Dystrophic, associated with age-related changes. It is mainly diagnosed in older patients, statistically more often in women than in men;
Cystic. Develops as a result of inflammatory processes. Cystic edema can also be a reaction to surgical intervention, for example, after surgery to replace the lens with an artificial lens.

To accurately determine the type of edema, you need to collect anamnesis and conduct a diagnosis.

Diagnostics

To diagnose macular edema, the following procedures are performed:

Ophthalmoscopy is an examination of the fundus of the eye. Ophthalmoscopy reveals only severe swelling. Upon examination, the doctor will see that the affected area is slightly bulging;
Optical coherence tomography is a non-invasive study of the retina. Today OCT is the most informative method;
Examination of retinal vessels with contrast or fluorescein angiography. The procedure allows you to determine the size of the swelling.

Based on data obtained from diagnostic studies, your doctor will decide on treatments for macular edema.

Drug treatment

A conservative treatment method is therapy with non-steroidal anti-inflammatory drugs. Their advantages include a minimal amount side effects. Often these drugs are prescribed after ophthalmological operations to prevent the development of complications. For example, if a patient starts taking them after photoemulsification of a cataract, macular edema may not occur at all.

In addition, doctors use long-acting corticosteroids. These medications may be prescribed as injections, eye drops, or ointments. Just like non-steroidal drugs, they suppress inflammatory processes and restore blood circulation.

Laser treatment

For diabetic edema, the most preferred treatment method is laser coagulation.

Using laser beams, the surgeon strengthens damaged vessels through which fluid penetrates. As a result, blood microcirculation is restored, and nutrient exchange inside the eye is improved.

The earlier the correct diagnosis is made, the more effective the treatment will be.

Surgery

Sometimes during drug treatment the need to remove the vitreous becomes obvious. This operation is called vitrectomy. It is performed by a qualified ophthalmic surgeon.

Vitrectomy requires little preparation: you need to determine visual acuity, perform another examination of the fundus, and measure intraocular pressure. If it is elevated, surgery should be postponed until the pressure can be brought back to normal.

Vitrectomy process

During the procedure, the surgeon makes three small incisions, cuts the conjunctiva, and, using special techniques, removes the vitreous humor step by step. At the final stage, sutures are placed and a subconjunctival injection is made. antibacterial drugs to prevent the development of inflammation.

After surgery, it is important to follow the rules rehabilitation period: avoid physical activity, treat eyelids antiseptics, spend as little time as possible on the computer.

Recovery takes 2-3 months; for patients with diabetes, rehabilitation can take up to six months.

Treatment of macular edema with folk remedies

Treatment folk remedies can give results if the swelling is not too severe. The following recipes exist:

To eliminate cystic edema, take calendula internally and externally. Pour 50 g of dried flowers into 180 ml of boiling water and let it brew for 3 hours, then strain. Take 50 ml orally three times a day, at the same time instill the decoction into the eyes, 2 drops 2 times a day. Continue treatment for at least 5 weeks;
Pour 40 g of dry celandine into a glass cold water and bring to a boil, simmer over low heat for 10 minutes. Strain through several layers of gauze, drop 3-4 drops into the eyes three times a day. The course of treatment is 1 month;
Brew fresh nettle in the proportion of 1 tbsp. l. raw materials per glass of boiling water. Leave overnight, strain, dissolve 1 tsp in the broth. baking soda. Use for cold gauze compresses, apply them to your eyelids for 15 minutes;
mix 2 tbsp. l. crushed onion peel and 2 tbsp. l. hawthorn berries, pour 1 liter of boiling water, cook for 10 minutes. Take the decoction daily, 150 ml once a day, for 3 weeks;

Medicinal herbs are known for their anti-inflammatory properties. In high concentrations, they are able to soothe irritated areas, which is why celandine, nettle, calendula and other plants are widely used in folk recipes. Before carrying out any manipulations, you need to thoroughly wash your hands, clean your face and eyelids of decorative cosmetics. Traditional medicine suggests eating as much celery, spinach, fresh herbs and cabbage of any variety as possible.