Macular rupture is a condition in which a retinal rupture occurs in the central zone, which is responsible for high vision.
The retina or inner photosensitive shell of the eye consists of 10 layers of nerve cells that provide the perception of light, and hence the vision. The central region of the retina or yellow spot, the macula, consists of densely located cells or photoreceptors, which have the shape of cones, due to which this particular area of the retina provides good central vision.
From the inside it is tightly attached to the retina, the so-called vitreous body. This is normally a transparent gel that takes up almost the entire volume of the eye. The vitreous body intimately adjoins the retina with its thin membrane at the periphery, in the area of the optic nerve head and in the macula.
With age, as well as with various injuries of the eye, a condition arises when the vitreous shell loses its contact with the optic nerve head and the macula and is a good scenario.
However, often under the influence of a number of reasons, the shell of the vitreous body remains fairly tight contact with the central zone, and at the same time the retina stretches into the cavity of the eye, resulting in its rupture at the place of such a dense connection. There is a complete damage to all layers of the retina or rupture of several internal layers.
As a rule, the disease occurs over the age of 50 years, more often in women, for no apparent reason. Such a state can develop rather slowly, so most patients simply do not pay attention to it at first or simply do not notice it.
Reduction of visual acuity in the distance and near (“layering lines of text”, “falling letters out of the word”, difficulty in working with small details) always occurs because exactly that area of the retina that provides good vision is damaged. The degree of reduction of vision may be different. It depends on the duration of the disease, the rate of formation of the gap, the presence of a complete gap or damage only the inner layers of the retina, as well as the size of the gap.
The distortion of objects, “the curvature of the image in question”, the change in the size of the object being examined in comparison with a healthy eye, in which straight lines appear curved, arises due to a change in the surface relief of the retina. This symptom of the disease appears quite early, even before vision loss.
A dark spot in front of the eye - (“gray spot” in the center of the visual field) arises due to a retinal defect. It is the area of the gap, in which there are no sensitive cells left, that the patient looks like a “dark spot”.
Violation of color perception, as the central zone of concentration of color receptors suffers.
To assess the state of the macular zone, several tests are conducted:
visual acuity check
Amsler's test - when looking at the center of the lattice, consisting of vertical, horizontal and diagonal straight lines, the patient can see and mark distorted sections on the tables or some sections fall out. The table is kept at a distance of 30 cm, a study of each eye is conducted separately. You can use reading glasses.
Be sure to conduct a thorough examination of the fundus with a pupil expanded with special eye drops.
OCT-optical coherent tomography of the retina is a high-precision method of research that allows determining the structure of the retina, specifying the diagnosis, tracking the dynamics and determining the effectiveness of the treatment.
Treatment of central retinal tears is only surgical.
The operation is carried out - dosed, sparing vitrectomy, in which a small part of the vitreous body is removed above the central zone of the retina with its internal boundary membrane, which is tightly connected to the macular area. The operation is performed through superthin punctures of the eyeball with a diameter like an insulin needle. As a rule, after such an operation, the prognosis is favorable if it was performed in a timely manner.
The effectiveness of treatment is higher with the timely treatment of the patient.
Often it is possible to completely restore the patient's vision. Therefore, when any signs of this disease appear, or simply suspicions on the part of the patient, an ophthalmologist should immediately see the doctor.
Closed microinvasive vitrectomy with hemophthalmus, vitreous opacities, diabetic vitreoretinopathy
Micro-invasive closed posterior vitrectomy, peeling of VPM and ZGM in the posterior pole during BMT syndrome and (or) macular rupture
Micro-invasive closed, subtotal vitrectomy, phacophragmentation, implantation of IOL MA60MA
Micro-invasive closed, subtotal vitrectomy, phacofragmentation, implantation of IOL IQ
Micro-invasive closed, subtotal vitrectomy, phacophragmentation, implantation of IOL MA60AC
Micro-invasive closed total vitrectomy, retinal smoothing, endolaser coagulation, vitreal cavity tamponade with retinal detachment (gas, silicone)
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Polyachenkov Sergey Vladimirovich
Head Physician, Board Certified in eye surgery, Minsk