Vikova macular degeneration: causes and diseases. Vikova macular degeneration, as a threat to the loss of pensioners Vikova macular degeneration of a volog

9-04-2012, 14:04

to describe

ICD-10:

H35.3 Macular and posterior pole degeneration.

abbreviation: VMD - viral macular degeneration, PEM - pigment epithelium of the sieve, Slo - scanning laser ophthalmoscope, TTT - transpupillary thermotherapy. FAG - fluorescent angiography, PDT - photodynamic therapy, EG - electroretinography. ETDRS - Early Treatment Diabetic Retinopathy Study Research Group.

Epidemiology

In Russia, the incidence of macular degeneration (AMD) is more than 15 per 1000 population.

According to the WHO data, by 2050 r the number of people over 60 years of age in the whole world will increase approximately three times (in 2000 r - about 606 million people). A small part of the population of the older group in economically developed regions is close to 20% in a given hour, and up to 2050 it grows, ymovirno, up to 33%. Apparently, it is clear that there is a greater improvement in AMD ailments.

? Zagalny population a lot of pathological improvement with the help of:

Early manifestation of AMD is observed in 15% of people at 65-74 years old, 25% - in patients 75-84 years old, 30% - in people 85 years old and older;

If AMD is manifested, 1% of people develop age 65-74 years, 5% - people age 75-84 years old, 13% - people age 85 years old and older.

VMD is developed more often in people older than 65 years. Overvolving pidloga is a woman, and moreover, women who are older than 75 years of VMD develop 2 times more often.

VMD can be produced up to a swivel decrease in the state of the field and up to the release of the central dylanok of the field. The most significant functional impairment is characteristic of sub-retinal neovascularization with the onset atrophy of PES, especially the pathological process of swelling of the fovea.

In the presence of manifestations new stage VMD on one assessment pathological changes on іnshomu іtsі to become from 4 to 15%.

Riziku factories

There is a clear-cut link between arterial hypertension and AMD, atherosclerotic lesions of the sudins (especially sleepy arteries), blood cholesterol, diabetes mellitus, overwhelming body mass.

It is clear that there is a direct accumulation of deposits between the houses and the VMD.

Є Requests for a potent connection between the overworld inflow of sleepy light and vіkovy urezhennym maculi.

The importance of postmenopausal females' performance is explained by the second stage of estrogen, which is corrected against advanced atherosclerosis. With a lot of evidence of a sympathetic injection of hormone replacement therapy, there was no bulo.

In the present hour, the development of AMD (sprouting, identification of the type of geni ARMD1, FBLN6, ARMD3) is being continued.

Prevention. Patients with VMD should be advised to see them as fatty ones, less than to give themselves a stream of straight sleepy exchanges. If there is evidence of a supine pathology, it is necessary to come in, direct to the correctness. Nutritional therapy and recommended doses of microelements will be shown below. In the last few years, it is necessary to discuss prophylactic laser coagulation of a sieve in the presence of multiple druses.

screening

It is a sign of suspicion of AMD in a summer patient with the presence of skarg for a decrease in health, difficult when reading, especially in the minds of a decrease in illumination. Innocent illnesses will help vipadannya okremikh letters when reading, Metamorphoses. Significantly earlier, skargi are created for the winter of the colorah, the destruction of the daylight. Prosecution includes the assessment of the state of health, carried out by the microscopy (as there can be any reason for the appearance of symptoms - for example, the manifestation of cataract), ophthalmoscopy (including the wide range of lamps in the area) You can also recommend the dosage of colorovidchuttya (monocular), the Amsler test.

It is necessary to remember about the IMD immobility in patients, for those who have a viconious unsettled cataract extrac-

Patients over 55 years of age need to maintain the macular zone of the medical examiners(To include ophthalmoscopy with a wide window in the plan).

diagnosis

Diagnosis of AMD is established in the presence of such signs(One abo decilkoh): the appearance of hard druses; the appearance of soft druses; making it stronger or weakening the PES pigmentation; atrophy in the macula (geographic atrophy); neovascular macular degeneration - neovascularization of good health, serous or hemorrhagic appearance of PES and further establishment of scar tissue in the macular zone.

? friends- after the attachment of eosinophilic material between the inner ball of Bruch's membrane and the basal membrane of the PES. Cei material - products for the metabolism of clitin PES. Identification of friends can be indicative of the development of a larger swirling AMD in a small one. As a rule, patients, who do not conceal the manifestations of AMD, do not mean a decrease in the central vision. Friends grow up on hard, meats and spills.

? solid friends slurry not overlap 50 microns in diameter; on a day-to-day basis, one can see yak dribni, zhovtuvati, clearly okresleni vognischa. With biomicroscopy, the hyaline structure of the drusen is visible. Solid friends are admittedly friendly to the process, but (if you can see the possibility of progress in terms of up to 10 years), the appearance of a large number of hard friends (over 8) can be added to the presence of some important friends.

? my friends more for the sizes, between the smudges. Rizik їkh progress is significant. The stench can be angry і viclikati vіdsharuvannya PES. As friends know, it is most often to inform about the development in the central zone of atrophy of the new spheres of the net (including the VEZ) and the choriocapillary sphere. In case of small druses, the ophthalmologist is guilty of recommending that the patient conduct self-control of the Amsler lattice and turn up to the ophthalmologist if any new symptoms appear, so as the type of friends may be susceptible to a high risk due to a decrease in geography.

? angry friends the most important can lead to the release of PES and atrophic changes or to tighten up to the development of subretinal neovascularization.

? Friends in dynamism can accept such snakes:

Solid friends can grow in size and transform into meat; my friends can also grow up and make angry friends; all the middle friends can be shaped like calcifications (with ophthalmoscopy, they look like bright crystals); Druses may regress spontaneously, if friends are often sick to progress.

? pererozpodіl pіgment... The appearance of hyperpigmentation in the macular zone is linked to the changes that occur in PES: proliferation of clitins, accumulated melanin in them, or migration of melanin-containing clitins in the subretinal space. Focal hyperpigmentation should be inserted with one of three factors, which should be tightened until subretinal non-ovascularization appears. Local hypopigmentation often leads to rosetting of druses (the ball of the PES groans over them), or it can appear on non-stale types of atrophy of the cells of the PES, or lowering the melanin in them by the snake.

? Geographic atrophy of PES- the form of dry sclerotic macular degeneration has gone far. On the face of it, geographic atrophies appear at the clear-cut zones of depigmentation with the kindly great, good-looking vessels. With a whole lot of people, not only PES, but the first ball of the sieve and choriocapillary ball in the central zone. Geographic atrophy can be not only an independent manifestation of AMD, but a history of myriad druses, a flattening of the appearance of PES and a regression of the choroidal neovascularization.

? Exudative (serous) appearance of PES- buying a line between Bruch's membrane and PEM - often appear with the presence of friends and other manifestations of AMD. There can be no mothers of different sizes. On the view of the serous view of the sensory part of the screen, the view of the PEM is locally established with clear contours, round, dome-like. Gostrota zoru can zalishatisya to finish with a high, ale to see the ruin of refraction in bik hypermetropia.

Serous appearance of neuroepithelium is often found with the appearance of PES. At the same time, there is more prominence in the fire, it has a disc-shaped shape and less readiness.

There may be a flattening of the cavity due to the formation of local atrophy of the PEM, or the formation of the PES from the formation of the subretinal neovascular membrane may occur.

Hemorrhagic appearance of PES or neuroepithelium, as a rule, is a manifestation of choroidal neovascularization. Vona can come from serous vidsharuvannyam.

? choroidal neovascularization characterized by the growth of new-made sudins through defects in the Bruch's membrane for the PES or for the neuroepithelium. The pathological penetration of the new-made Sudins is caused to the sweat of the birthplace, the purchase in the subretinal expanses, and to the formation of embryos. New judges may cause subretinal hemorrhages, hemorrhages, hemorrhages, and sometimes bleeding into the tissue. At the same time, there can be some significant functional damage.

The risk factors for the development of subretinal neovascularization include zlivny m'yaki druzi, in the presence of hyperpigmentation, the manifestation of extrafoveal geographic atrophy of PES.

Dose for the manifestation of subretinal neovascularization of the ophthalmoscopically show: Sagging in the macular zone, the appearance of solid exudates, the appearance of PES, subretinal hemorrhage and / or hemorrhaging in the tissue of the sieve. Firmly exudate early and call for those who have subretinal neovascularization established for a long time.

The appearance of such signs can serve the indications before the fluorescence angiography is carried out.

? Discoid cicatricial structure- Kintseva stage development of subretinal neovascularization. Ophthalmoscopically, in such vipads, there is a discoid in the light of a syro-white color, often with an attached pigment. The size of the head can be small - from small (less than 1 diameter of the optic nerve disc) to the great head, which can overwhelm the entire macular zone. Growth and localization in recognition of the principles of importance for the preservation of healthy functions.

Classification

? form VMD... Practical ophthalmology has the term “dry” (non-exudative, atrophic) form and “vologa” (exudative, neovascular) form of AMD.

? "Dry" form characterized in the first place in Ukraine by a progressively progressive atrophy of the PES in the macular zone and the growth of good quality, so that it can lead to a local secondary atrophy of the photoreceptor ball of the sieve. In other words, the non-exudative form is characterized by druses in the macular zone of the sieve, defects in the PES, overgrowth of the pigment, atrophying PES and the choriocapillary ball.

? "Vologa" form: Sprouting to take the cob from the inner balls of good new vessels through Bruch's membrane in what is not a normal space between PES and sits. Angiogenesis of superficiality is exudated in the subretinal space, with a lot of blood and blood. In this rank, the following eksudativna form harakterizuєtsya stadіyami: eksudativna vіdsharuvannya PES eksudativna vіdsharuvannya neyroepіtelіya sіtkіvki, neovascularization (pid USP i pid neyroepіtelіya sіtkіvki) eksudativno-gemoragіchny vіdsharuvannya USP i / abo neyroepіtelіya sіtkіvki, stadіya rubtsyuvannya.

? early stage... Characteristics of focal friends and unevenness of PES pigmentation.

? Piznya stadiya. Characteristics of PES emergence, PES development, choroidal neovascularization, discoid (fibrovascular) scar, geographic atrophy of PES.

? Choroidal neovascularization. In clinical prescripts, for the purpose of predicting the prognosis and the tactics of treatment in the presence of choroidal neovascularization and in the presentation of fluorescent-angiographic pictures, they see a classic, prikhovannaya form.

? Classic choroidal neovascularization in AMD. It’s simplest, it’s easy to learn about 20% of patients. This form is clinically manifested in the pigmented viglyad, or the structure of the PES, often subretinal hemorrhage occurs. With FAG, the structure is memorized early, quickly and quickly, and then it is possible to get sweaty.

? primed choroidal neovascularization can be suspected during ophthalmoscopy in the presence of an alternate development of the program with one-hour sweeps of the scent, as there are no clear cordons. Such neovascularization is characterized by sweating during PAH in the middle of the phase, which means that it does not stick out.

? zmіshana choroidal neovascularization. Razrіznyayut such options: "overwhelmingly classic" (if "classic" strikes for the area to become not less than 50% of the total volume) and "minimal classic" (with no “classic” stripes, also є, but not 50% of the total volume).

? Likuvannya method. When vibrating the method of treatment, it is necessary to register the classification of choroidal neovascularization, according to prior to the growth in the macular zone:

? subfoveal- the choroidal neovascular membrane is located under the center of the foveal avascular zone;

? juxtafoveal- the edge of the choroidal neovascular membrane, the zone of fluorescence blocking by the pigment and / or hemorrhagic is located between 1-199 microns towards the center of the foveal avascular zone;

? extrafoveal- the edge of the choroidal neovascular membrane, the zone of fluorescence blockage by the pigment and / or hemorrhagic is located at the height of 200 microns and more towards the center of the foveal avascular zone.

anamnesis

Skargi for a decrease in the quality of life, the appearance of "plumes" in front of the eye, metamorphoses. Most of the time with scargami on gosstro vinyklo a decrease in the state of health and metamorphoses, patients with choroidal neovascularization develop.

? History of ailments. Patients can be a trivial hour not to reduce the decrease in the light in the assessment: how to start the process before the process, or as the decrease in the light will develop as often as possible.

Headaches (especially arterial hypertension, atherosclerosis of the brain).

Stretched downward pressure along the VMD.

Awareness of the explicit medical documentation, including the previous entries in the outpatient card of the patient, the information about the hospitalization and the information. (Perebig sickness).

I will become aware of healthy functions for the quality of life.

rigidity

Viznachennya gorodroti zoru s optimal korektsієyu.

Assessment of the central field zoru.

The assessment of the color for the additional help is the table of Yustova or Rabkin.

Biomicroscopy of the anterior view of the intramural apple, IOP vimir.

Ophthalmoscopic assessment of the face-to-face bottom, including the macular zone of the shedding (for the expansion of the period in short-hourly dialectical ways).

I will document the maculi, especially for the additional color stereo photography of the face-to-face bottom.

Vykonannya fluorescent angiography and / abo angiography with indotsianinzelenim.

In case of suspicion of the appearance of the appearance of the sieve, it is recommended to use optical coherent tomography, or to monitor the macular zone behind the aid of the Heidelberg retinal tomograph (HRT II).

Electrophysiological dosage (ganzfeld-E G, rhythmic EPM, patern-E G, multifocal EPM).

Evaluation of the state of the art and refraction

Gostrota zoru with the optimal correction of the assessment in case of skin penetration. Umovy, in which the follow-up is carried out, are guilty of being standard.

With the cleverness in the minds of the polyclinic, or the stationary, hesitate to cite Sivtsev's tables or projectors of viprobubal signs. I will look at the effect of the "recognition" of alphabetic symbols, docilely cries out with Landolt's fingers.

Bazhano with skin tightening of the meaning is also good for the closeness of the normal correction.

With a change in refraction (destruction in the context of hypermetropia), it is possible to see a squeeze (it is possible, for example, when a PES is seen).

Assessment of the central field zoru

The assessment of the central field behind the additional grid of Amsler is the most simple and quick, but only sub'-active until it is allowed to estimate up to 20 ° from the point of fixation.

In the minds of the ophthalmological office, bazhano cries out with standard images, prepared in a drukarsky way Amsler sieve... It’s good to get the results of the test that the patient has passed before the original documentation: it’s possible to allow me to quilt for the dynamism of change.

? Amsler test There are a lot of recommendations for patients and for self-control, for early detection of metamorphoses or scotomy. Patient slid a report to instruct about the rules of the test (it is most important for the patients to change the skin's eye okremo, curling another eye) and recommend to you, when you see some new snakes that are not successful. Assessment will become a field zoru. Її bazhano to spend for help computer static perimeter from the inclusion in the strategy of testing the assessment of the foveal threshold of lightness. However, with a low state of the art, the perimeter of the computer can be seen undisturbed. In such vypadkami vikoristovuyut a specific kinetic perimeter, albeit with a variable vibration, the size and quality of the object.

The assessment of the appearance of the color is carried out according to the additional table of Yustova or Rabkin according to the standard method.

Ophthalmoscopic assessment of the face-to-face

Ophthalmoscopic assessment of the face-to-face bottom, including the macular zone of the sieve, is carried out for the expansion of the period in short-hourly dynamic ways. For the achievement of good mydriasis, one must use the same LZ, for example, tropikamid 0.5% and phenylephrine 10%. (It is necessary to remember about the possibility of a systemic side-by-side action of adrenergic mediators!)

For inspecting the central zone of the shedding and the appearance of a young man in the macular zone, the best manual biomicroscopy of the face-to-face bottom in vicarians aspherical lenses 60 and / or 90 diopters, as well as the lynzi Gruba and the children contact lines(Linzy Goldman, Meinster i n.). Nybilsh is often victorious about Goldman's three-mirror lens.

It is possible to speed up the same way directly with an ophthalmoscope, even at a time when the binocular can be transformed into a macular block.

Dokumentuvannya become makuli It is possible to work in different ways, fixing it from the simple hiding of the changes and ending with the most beautiful color stereo photography of the face-to-face bottom. Nowadays, digital photography systems allow not only unique problems of old video images (for example, they were previously displayed by polarized systems), but they were able to re-display images, overlay them one on one, transfer It is necessary to see the signs of the face-to-face bottom of both eyes, since the VMD is often double-sided, to navigate when there is a decrease in the state of health and the other functional manifestations only at one point.

fluorescent angiography

In general, the diagnosis of AMD can be delivered at the presentation of the clinical conditions. However, fluorescence angiography (FAG) є in case of a lot of disease, it is a valuable pre-diagnostic method, as it allows more accurate initiation of structural changes and assessment of the dynamics of the pathological process. Zokrema, won’t have the initial meaning when you receive food about the tactics of treatment. Bazhano viconati її 3 dib I will first look at the patient at adolescence for the manifestation of subretinal neovascularization, as the membrane over the area grows rapidly (at least 5-10 microns per day). I will look at the possibility of the transition of the "dry" form at the "vologu", with dynamic caution of patients with drusen (especially with the presence of "soft" druses), FAG is recommended to be carried out with a 6-month interval.

? FAG plan... Before the patient's development is complete, the meta angiography of the face-to-face bottom becomes clear, bitter appearances(Announcement of boredom in 5% of patients in the course of a pre-session, read the training of children and others throughout the coming day), clarify the allergological anamnesis.

The patient has been signed and informed about the year.

An internal test for fluorescein is carried out.

In this day, in most of the ophthalmological centers, the FAG is carried out for additional fundus cameras with a digital re-establishment of information. However, it is also possible to use a wide range of photographic fundus cameras and a scanning laser ophthalmoscope.

Until the end of the day, you can see the color photographs of the bottom, and then in the row of photographs in the redless light (with green light filter).

Intra-intravenously inject 5 ml of 10% fluorescein.

Photographer zajsnyuєt for the adopted methodology.

If there is a sign of subretinal neovascularization at one point, the assessment of the photograph of the person in the middle and the beginning of the phase for the appearance of a possible neovascularization

? Assessment of results in fluorescence angiography

friends

Firm friends give you points, give early hyperfluorescence, start instantly, and light up quickly. Serving with friends is dumb.

Some friends can demonstrate early accumulation of fluorescein during the daytime, but they can also be hypofluorescent for accumulation of lipids and neutral fats.

Fluorescein is absorbed by drusen from choriocapillaries.

? Geographic atrophy of PES... On FAG, the atrophy zones show a defect in the viglyad "vikna". Chordal fluorescence is clearly visible even in the early phase through the appearance of the pigment in the outer zones of the PES. Oscillations of the structure, which could have absorbed the fluorescein, in the daytime, the defect in the viglyad "vikna" at once from the background fluorescence of the good idea in the intermediate phase. Even with friends, fluorescein is here along the way to not accumulate and not to go beyond the borders of the atrophic world.

Vidsharuvannya PES. It is characteristic of this type of fluid accumulation of fluorescein in clear localized rounded dome-like statements, so you can start to see it in the early (arterial) phase. Fluorescein is absorbed in the middle of the intermediate phases and in the recirculation phase. Prophecy of barvnik in navkolishnє sіtkіvku is dumb.

? subretinal neovascularization

For the fluorescent-angiographic picture of the classical choroidal neovascular membrane characteristically offensive:

The news of the subretinalnaya judge was triggered earlier, below the judgment of the stench (in the prearterial phase). Tsi judges quickly mend brightly and are similar to the hems of the viglyadi "fancy" or "cartwheels". Slid vrahovuvati, which is blood-borne, the stench can partially mask subretinal neovascularization.

It is possible to accept it during the progress of the fluorescein sweating from the newly developed vessels.

on пізніх stage FAG fluorescein accumulates in the middle of serous shedding, rostia over choroidal neovascularization.

When choroidal neovascularization is involved, step by step, after 2-5 minutes of fluorescein, the fluorescence becomes visible. Hyperfluorescence becomes significant when it is received, it means to move the purchased barvnik in the subretinal space, but not to miss the clear cordons. The re-assessment of the same day of the face-to-face bottom in the early phases of the FAG does not allow to know the dilemma.

Angiography with indocyaninzelenim gained popularity for digital fundus cameras. Indocyaningreening of absorption and fluorescence near the red spectrum. Light absorbed at 766 nm and light at 826 nm (sodium fluorescein absorbed light at 485 nm and light at 520 nm). Great dovzhini hvil, when victorian endocyanin green, penetrate more beautifully into the PES, or into the subretinal rostasovan roof, or serous ridina. The choroid judging is more beautifully visible when it is preliminarily with endocyaninzelenium, below it with fluorescein. In addition, on the basis of fluorescein, endocyaningeneration is practically used to call the bottles, and this does not allow the normal vascularization of chorioid and choroidal neovascularization. Barvnik gets lost in subretinal neovascularization of the nadovgo. Striking is often seen as local zones and hyperfluorescence on hypofluorescent aphids. Angiography with indocyaninzelenim hand for subretinal neovascularization in the presence of the appearance of PES, obscuration of the subretinal line or hemorrhages. It is a pity that the endocyaningeneration until now isn’t going through the restoration in the Ministry of Health and Social Development of Russia, and it isn’t in our country allowed for a legal victory. Slide to respect that in vapoids, if there is no hope for saving the health in case of any kind of liquid infusions (for example, with the presence of fibrovascular cicatricial infusion in the fovea), angiography is not displayed.

Differential diagnosis

Differential diagnosis is carried out:

? With "dry form" AMD with peripheral growth of drusen, as well as degeneration with high accelerated short growth. In the last drop of the range of changes to the macula, there are characteristic atrophic changes near the optic nerve disc, and friends are visible.

? With the "vologo form"

With a high accelerated myopia (meaning anomalies of refraction, varnishes in the posterior pole, myopic changes in the optic nerve disc);

With traumatic opening of the sieve (as a rule, on one assessment; eye trauma in anamnesis, most often it is concentric to the optic nerve disc);

With angioid swears, when on both eyes from the optic nerve disc subretinal, a curved line of red-brown or gray color is spreading;

With the syndrome of transmission of gistoplasmosis of the eyes, in case of any in the middle periphery and in the posterior pole of the sieve, there are other jovtuvato-bile horioretinal cicatrices, as well as middles of cicatrisation in the optic nerve disc;

And also with DZN druzi; puffins хоріоіиді; cicatricial vognisches for laser coagulation; from fiery horioretinal pathology.

lykuvannya

laser surgery

Meta laser treatment- change the price of the forgiveness of the state property lower than that, which is already at the patient's. For the whole subretinal neovascular membrane will increase in the boundaries of healthy tissues, producing intense coagulation. It is recommended for coagulation of stripes, extravagantly rosted, vikoristovuvaty argon laser with a little bit in the green part of the spectrum, and for rosted juxtafoveally - krypton chervonia.

? Patient preparation. Before the cob of laser treatment, it is necessary to conduct a conversation with the patient (informed during the year for the laser engagement).

Answers about the problem of getting overwhelmed, the prognosis, taking into account the involvement, the dignity and the risk of alternative methods of treatment.

As soon as the patient has a certificate for laser coagulation, then he is guilty of explaining that from the point of view of the pre-production forecast, the price is more friendly, but not just being careful about the other way of talking.

To the patient it is necessary to explain, that, for a newer, for the new one to be careful of the peripheral vision, for the child, for the abundant patients with the swiveling second central vision on both eyes, they can independently cope with the baggage at the same time.

In advance, when the risk of a laser treatment is often lost, there is a high risk of recurrence of subretinal neovascularization (in 30-40%), and it can happen before treatment.

The patient in the nearest days was sent to the institute to take care of the problems of additional help with a weak eye; It is possible, it will be necessary to recommend passing medical and social expertise for the establishment of a group of invalids.

Call them fundamentally important to vvazhayut the results and look at the next day when involved, if the increase and decrease in the speed in the result of treatment is maximum. Patients will be told that they will not go down the road for another day. As soon as it goes down, it’s getting worse, the illness is guilty, it’s not okay, it’s going to turn to the ophthalmologist.

? Shown. Lazerné lіkuvannya zmenshu rizik swivel lowering zoru in the context of the visual at the onset of groups of patients.

Patients with extrafoveolar choroidal neovascularization (200 μm or more from the geometric center of the foveolar avascular zone).

Patients with juxtafoveolar choroidal neovascularization (close to 200 microns, not near the center of the foveolar avascular zone).

Patients with subfoveolar choroidal neovascularization from the center of the fovea (laser has not been treated before) or recurrent subfoveolar choroidal neovascularization (earlier than viconuvania by the center of the fovea) (In the last few days, we recommend not laser coagulation, but photodynamic therapy.)

? Etapi involved. When the laser is activated, it is necessary to take care of it when the laser is activated:

1. Get a retrobulbar anesthesia for the sake of non-dexterity for an hour or so.

2. Bezposeredno in front of the involvement of the surgeons I know to look at the FAG, at which it is exactly the beginning of the flow.

3. The entire zone of choroidal neovascularization is covered with intensive coagulates.

4. Between the healthy ones in the pouring out of the openings on the FAG. Iakshcho vikonane vruchaniya viglyadє is inadequate, perhaps it was added secretly.

5. Let's take a look at the bottom of the photo.

6. A bandage is put on the eye, the patients should be recommended to take the bandage after 4 years, or if there is a period of time in the form of a vicious anesthetic.

? Folding. The most frequent acceleration of laser treatment is hemorrhage, either from the subretinal neovascular membrane, or from the perforation of Bruch's membrane. As soon as I got bloodstained for an hour, I need to put a lens on my eye, so that IOP can be adjusted and I bleed all at once. Naykrashche prodovzhuvati fix the grip on the eye with a linse stretching 15-30 seconds after the bleeding. If you are bloody, it is important not to overreach the love. When there is no bleeding, the pressure of the laser is reduced and continued.

? pislyaoperatsіyne beware

For early detection of persistent or recurrent subretinal neovascular membranes, control fluorescent angiography was followed after 2 months of viral laser coagulation.

look in during the operational period Continue writing in 1.5, 3 and 6 m / s from the moment of engagement, and then 1 time in 6 m / s.

In case of suspicion for the recurrence of the subretinal neovascular membrane.

? Relapse. Even with PAH, there is an excessive activity of the choroidal neovascular membrane, for example, early fluorescence due to sweating in the center, or along the edges of the cavity, then I will repeat laser coagulation. Risk factors for recurrence of subretinal neovascularization: arterial hypertension, palynia, the manifestation of choriodal neovascularization of an abnormal discoid cicatrix in the first place, the appearance of small friends and the purchase of a pigment.

Laser coagulation with prophylactic treatment for soft friends

Laser coagulation near the fovea, vikonuvana behind the type of "lattice" because of the low-energy inflow, make a druze... Buv testimony with a friendly effect is not just a familiarity of the friends, but in the plan of greater immobility, the protection of hospitality by reaching out to fate. However, by stretching the first rock in the flow, the number of drops in the development of subretinal neovascular membranes in the zones of injections increased. In addition, the method of vimagining the forged implantation and modification of the criteria and parameters of the laser injection.

photodynamic therapy

An alternative to laser coagulation has appeared in the rest of the rock photodynamic therapy(PDT). When benzoporphyrin is lost - verteporphin (visudin) - photosensitive (to be activated by light infusion), the flow with the addition of light energy absorption is 680 and 695 nm. Verteporphin, when administered internally, quickly comes up to the end of the battle and selectively begins to endotherm of the newly developed vessels. Oppression of neovascularization Use the aid of a diode laser with a minimum of 689 nm, so that the laser energy can easily pass through the roof, melanin and fibrous tissue. This gives you the ability to vibrate into the fabric-target, without giving away the nasal fabrics and unpleasant injections. From the beginning of the non-thermal laser vyprominuvannya verteporphin generates radicals, as well as to endothelial new solutions. As a result, thrombosis and obliteration of subretinal neovascularization sudin are observed.

results

Likuvalnaya dіya maє buti zdіysnene in the modern term for the display of fluorescent angiography, for which a decision was taken about the need for participation.

In case of a poor group, in the course of treatment it was carried out according to the standard method (verteporfin), in case of ailments, when a placebo was removed, it was revealed that a decrease in guest satisfaction after 12 minutes was carried out in the first 45 - 67% of groups in 39%. Even after 1 rіk, the tendency became evident.

Oscillations from occlusion of the vessels can be recanalized, patients need 5-6 PDT sessions in the middle of 5-6 sessions (more than half of them went down with a stretch of the first rock for a cob of alcohol). First re-look From the angiographic endorsements, to carry out the call in 3 m / s. When you show up sweating, you see again when you get involved. As the ophthalmoscopic picture and the result of the angiography become too large, and the sweating during the day, then it was followed by dynamic warnings, indicating a repeated look after 3 msec.

Subfoveally rosted classic subretinal neovascular membrane, with a state of 0.1 and visceral growth (such patients become no more than 20% of all ailments, as they suffer from AMD);

AMD in case of "overly classic" (if "classic" strikes become 50% of the total volume), or in case of "pricked" subfoveal rosted choroidal neovascularization;

Yukstafovealny urazhennі, roztashovany so, when vikonanny laser coagulation, the center of the foveal avascular zone is torn down;

? "Prikhovannoy" choroidal neovascularization in the size of the head is more than 4 areas of the optic nerve disc; photodynamic therapy is recommended to carry out only at a very low level of energy (even if the diameter of the glass is 5400 microns, the patient will be able to grow, but with the help of likuvannya to deprive the field of protection);

As soon as possible to get rid of the progress of the battle, as well as on the way to the ground without licking, it can be lowered down to the bottom of the “cinnamon” (to allow the patients to get around without outside help).

side reactions tied in the main with incorrect LZ insertions (right up to tissue necrosis). Approximately 3% of the patients who were fed in with a stretch saw the decrease in power consumption. In order to avoid phototoxic reactions, patients are advised not to overwhelm them directly from sleepy exchanges and bright light and wear dark eyepieces.

Efficiency. As a result of the assessment of the effectiveness of photodynamic therapy, it was found that the method was found in one of the most effective: out of 3.6% of patients with ailments, one of them was given a chance to turn around without a decrease in hospitality. However, lіkuvannya maє visoku vartіst.

PDT and corticosteroids. It will remain an hour to see more about the reduction of the results of treatment when two methods are used - PDT and intravitreal administration of a corticosteroid (triamcinolone). However, such techniques have not yet been approved by great classics. In addition, in Russia, there is no GCS, which are allowed to be introduced into the environment.

transpupillary thermotherapy

Proposed on the ear of the 90s for the treatment of choroid melanomas transpupillary thermotherapy(TTT) - laser coagulation, when the energy of the infrared part of the spectrum (810 nm) is delivered to the tissue target through the window behind the auxiliary diode laser. Injection parameters: pressure 262-267 mW / mm2, exposure 60-90 s, diameter 500-3000 microns. Thermal vipromynuvannya spry out in the main melanin PES and choroid. The exact mechanism of the injection with AMD is unclear. You can, inject into the choroidal bloodstream. The method is simple in stasis and very cheap.

show: chorioidal neovascularization is primed or subretinal neovascular membrane primed with minimal classical component. In such a rank, TTT can be stagnant among ailments, for whom it is practically not considered a positive effect of PDT. The results of those who are already getting ready are encouraged (when I will die, I will change more than 2 times).

accelerating tied in the first place in Ukraine due to overdosing of laser energy (in the norm, the infusion is less than threshold): descriptions of infarction in the macular zone, occlusion of heart disease, development of PES, subretinal hemorrhage and atrophy. They also indicated the development of cataracts and the formation of posterior synechia.

Surgical treatment of macular degeneration

Visualization of subretinal neovascular membranes

Shown for surgery is the manifestation of classical choroidal neovascularization with clear cordons.

? A selection of viroblyayut vіtrectomyu for the standard technique, then paramacularly, from the frontal side to show the retinotomy. Through the retinotomic opening, introduce the balancing of physiological problems, and the results are obtained. While looking behind the additional horizontally curved peak, one can see the membrane mobilization, the membrane is seen with a horizontally curved pincer. What is the bleeding? infusion and by adjusting the IOP itself. Carry out a part-time change of day for a turn. In the period of operative period, the patient is guilty after the removal of the incriminating indictment down to the full extent of the death of the mihura povitrya.

? may you expedite from an hour to a time when involved: subretinal hemorrhage (from the smallest to the most laborious, which is a mechanical visualization); iatrogenic development of the links on the periphery of the її; form the macular opening;

Formation of pre-retinal membranes; unrepaired or recurrent subretinal neovascularization.

so much allow changing metamorphoses, Bezpechuyut more permanent eccentric fixation, so often roztinuєtya patients as a sub'active polishhennya zoru. At the same time, through a small retinotomic opening, one can penetrate through a small retinotomic opening and push through a large membrane. The main shortcoming is the visibility of the poll rate as a result of the engagement (in most cases, I do not change 0.1).

Vividness of massive subretinal hemorrhages... Massive subretinal hemorrhage can be evacuated through the retinotomic opening. Once a clot has been formed, it is recommended to inject a subretinal recombinant tissue plasminogen activator (TAP) for an hour beforehand. If necessary, the replacement of blood from the macular and subretinal zones, the introduction of TAP can be successfully combined with the injected gas (C3F8) into the empty space of the bed. In the period of the operational period, the patient will see the position of the incriminating face down.

Transplantation of blood cells... Experimental dosage of the transplantation of the patient's blood cells is carried out. With a lot of non-virulent pooks, the nutrition of the fabric of the nutty will become overwhelming.

maculi translocation

Maculi translocation - Possible alternative to photodynamic therapy or laser coagulation s drive of subfoveal neovascular membranes. In the elderly, in about 1/3 of the range, it was not only stability, but a little more hospitality that reached the limit. The main idea of ​​such an involvement in the field is that there is a possibility of swelling over the choroidal neovascular membrane of the neuroepithelium of the foveal zone and of the shedding so that in the new position there were no signs of bad luck.

? See some subtotal vіtrectomy, And then more or less they peel off the sieve. The operation can be carried out by means of a retinotomy along the whole stake (360 °) with a further turn or a reduction of the sieve, as well as a path to form folds (to shorten) the sclera. Let the sieve "lock" in a new position behind the auxiliary endolaser, and the neovascular membrane is cut behind the auxiliary laser coagulation. To carry out pneumoretinopexy, when the patient is guilty of pretrimuvatisya vimushenya by stretching the dob.

? may you expedite: Proliferative vitreoretinopathy (in 19% of cases), appearance of stenosis (12-23%), formation of macular opening (9%), as well as acceleration, which can be observed during the course of vitrektomіy ​​for those. At the same time, it is possible to lose not only the central, but the peripheral vision.

Radio therapy. Uninvolved in the success of experimental studies, has not yet rejected a wide range of clinical expansion of radio therapy. Clinical presenters did not demonstrate the ability to transcutaneous teletherapy (perhaps, through low doses of percutaneous optimization).

drug therapy

In the Danish hour not іnu therapeutic infusions with improved efficiency in AMD. With "dry form" lykarska therapy It is directed to the prevention of the formation of druses and the introduction of lipofuscin, and in the case of an exudative form, it is poklikana of the transition of pathological angiogenesis.

antioxidant

It’s important that sleepy light is infused with the appearance of radicals, polyunsaturated fatty acids in the new balls of the sieve, in the PES and Bruch’s membranes. At the connection from the cymbal bully, the zrobleni with a path introduced into the ratsion of patients antioxidant activity Reduce injecting oxide stress. Until the best antioxidants are given vitamins C and E, beta-carotene, flavonoids, polyphenols. Uvaga fakhivtsiv screwing also zinc, which is a coenzyme of carbonic anhydrazi, alcohol dehydrogenases and free lysosomal enzymes (including in PES).

paciєnti accepted high doses of vitamins-antioxidants(Vitamin C - 500 mg; betacarotene - 15 mg; Vitamin E - 400 IU) and zinc (80 mg zinc per day 2 mg mid). Vyavilosya, scho implantation of additives did not show any positive effect on the interruption of the AMD.

Vvazayut, the intake of vitamins antioxidant, lutein, zeaxanthin and zinc can serve as a prophylactic development and / or progression of AMD. The application of such a complex LZ can serve Okuwaite Lutein You should take 6 mg of lutein, 0.5 mg of zeaxanthin, 60 mg of vitamin C, 8.8 mg of vitamin E, 20 μg of selenium, 5 mg of zinc. Yogo priznachayut 1 tablet 2 times a day in courses of 1 ms. LZ not revenge? -Carotene.

? Lutein complex To take revenge not only lutein, zinc, honey, vitamins E and C, selenium, but the extract of chornytsi, vitamin A ,? -carotene, taurine. Yogo priznachayut 1-3 tablets per day for 2 m / s courses. I will look at, what LZ take revenge? Carotene, we do not slіd signify we reduce the ailment.

Stagnant is also the drug that revenge blackberry extract("Martalini Forte").

іngіbіtorі angіogenesis

Experimental and clinical preliminaries have brought about the greatest value in the development of neovascularization in AMD growth factor VEGF (vascular endothelial growth factor). Until the present hour, for clinical practice, pegaptanib and ranibitsumab have been propounded, which will be anti-VEGF active.

? Pegaptanib (makuti). By tying VEGF, pegaptan is transformed into the growth of new vascular disease and increased penetration of the vascular disease - two main manifestations of the exudative form of AMD. LZ values ​​for intravitreal introduction. In pre-adolescents, pegaptan was taken in a single dose (0.3, 1.0 and 3.0 mg) for 6 skin types for 48 months. Forward results: the value of the value is less in the case of the use of macutenes (in the case of the control group).

? Ranibitsumab (RhuFabV2)- monoclonal antibodies that vibrate blocking all VEGF isoforms. Intravitreal Inventions LZ are held 1 time per 4 days. In this hour, a clinical trial of the III phase will be held.

corticosteroids

? Anekortav(Retaane company Alcon) - suspension, which opens the depot; it should be injected retrobulbarly behind an additional special curved cannula 1 time in 6 m / s. The most effective in the plan of stabilization of the state of health and the growth of the newly developed Sudin Volodya Anecortav in a dose of 15 mg. In the patients who had their anecortavities cut off, 84% of the patients were welcomed to save their gospel (in the control group - in 50%).

? triamcinolone- another corticosteroid depot is administered intravitreally in a dose of 4 mg. It has been shown that a one-time intravitreal corticosteroid should be produced to a decrease in the size of a given corticosteroid, rather than pouring into the value of a significant decrease.

Combined walk

Nabagato more respect in the Danish hour to come combined treatment - PDT in response to the intravitreal administration of triamcinolone. However, the effectiveness of such a policy is still required by the approval of the previous clinical reports.

Up to the present hour, two have been brought to the effective method of treatment of the subretinal neovascular membrane, which is the main manifestation of the exudative form of AMD. Complete laser coagulation and photodynamic therapy due to the use of verteporfin.

beforehand

Trivayut doslіdzhennya, straightforwardly enough to get involved in all forms of AMD. And also the viconies of the mainstream until the third phase allow the viroblation of the new algorithms. So, a lot of authors vvazhayut, scho:

If subfoveal lesions are evident with "critical classical" choroidal neovascularization, or if neovascularization occurs and the size of the head is not more than 4 areas of the healthy nerve disc, it is recommended to carry out photodynamic therapy;

With the presence of subfoveal lesions with "minimal-classical" choroidal neovascularization, PDT can be preserved, or the angiogenesis of pegaptanib;

In case of juxta-foveal urazhennii, roztashovany so, in case of vikonanny laser coagulation, the center of the foveal Avascular zone will be destroyed, it is also possible to fix PDT;

In case of any localization (juxtafoveal or extra-foveal), laser coagulation is indicated (the number of such ailments does not become more than 13%).

? For prophylaxis, the development of an exudative form of AMD zasosovyut complex food additives (for example, Okuwait Lutein or Lutein-complex).

Retinalamin (polypeptides of the eyes of thinness) is recommended to be used in subconjunctival vigels (5 mg 1 time / day, diluted in 0.5 ml of 0.5% novocaine, course of 10 minutes).

Traditional symptomatic therapy

It should be traditionally vikoristovuvanih LZ for the improvement of regional blood circulation, їх stasosuvannya in the given hour to enter a different plan.

With a "dry" form of AMD, it is possible to stagnate vinpocetine 5 mg 3 times a day in the middle in courses of 2 ms or pentoxifyline 100 mg 3 times a day in courses of 1-2 ms.

Yak stimulating therapy for stasis also Ginkgo biloba leaf extract 1 tablet 3 times a day, in courses of 2 ms; Chornitsa extract (for example, Striks, Martalini forte), 1 tablet 2 times a day, in courses of 2-3 times, Spirulina platensis extract, 2 tablets 3 times a day, in courses of 1 ms.

With a "vologo" form of AMD, for a change in nabrya it is possible to zastosovuvati dexamethaso n 0.5 ml each in the subconjunctival vigels (10 in); acetazolamide 250 mg 1 time per day for one day to three days (in the case of kalium preparations), after a tridenic interruption, the course can be repeated. Also, you can get rid of it before laser coagulation. Besides, we are ailing etamzilat 12.5% ​​2 ml / m 1 time per day 10 іn'єktsіy (or for viglyadі tablets, 250 mg 3 times a day for 15-20 days) і ascorbic acid + rutoside (1 tablet 3 times a day in a stretch of 15-20 days).

Associativity of the stipulated drug therapy until now, not confirmed by the great classy randomized placebo-controlled preliminaries.

further away

Patients with AMD are guilty of being overtaken by a visual therapist, as they often suffer from arterial hypertension, atherosclerosis of coronary and sleepy arteries, obesity.

We are sick with a low state of the sun, we can recommend it so called get some help with a weak eye... Tse attachment, in different ways, to improve the image and provide illumination of the objects. Among such annexes there can be called special eyepieces, loupes with different types of mounting, television systems with a closed circuit, digital cameras with a projection of the image on the screen.

forecast

In the case of ailments with a significant decrease in the state of health during the period from 6 months to 5 years, it is possible to ochikuvati in 60-65% of cases. Often strips are double-sided and can be produced up to іnvalіdnostі by dawn.

By means of liquid infusions with AMD with the presence of chorioid neovascular membranes є reaching the stabilization of the pathological process, And not polіpshennya zoru!

Laser coagulation and transpupillary thermotherapy allow the speed of a number of severe losses I have up to 23-46% of vypadkiv (in the presence of the localization process), photodynamic therapy with verteporphin - in the middle up to 40%, submacular surgery - up to 19%.

If you want to be built, the arkush iz zoshita in the clink of crooked openings, and the shwi between the chilly tiles at the bath rapt have become irregular and lamanims, then it’s time to get stumped: it’s not so with your sight. All in all, you have a feeling of macular degeneration of the eye strain. Well, for the ailment, do you want to see it? About the special features of this ailment is given in the statute.

So tse take?

Macular dystrophy (degeneration) of the eye strain is a chronically progressive disease, in which case the central zone of the eye strain and the vesicular membrane of the eye is affected. At the same time, the cells and the small space are lost, which leads to the deterioration of the function of the central zor.

Macular dystrophy є one of the provincial reasons for the incapacity to waste and sloughing in the middle of the population of the developed lands in the past 50 years. The problem of macular dystrophy is growing more and more relevant in the middle of the population. At the same time, in the rest of the rock, there was a tendency to the "rejuvenation" of this ailment.

manifestation of macular degeneration

cause

The destruction of the central zoru is seen through the degeneration of the macula - the central part of the site. Macula is a very important element . Supervisors and functionaries, people can throw objects, roztasovani at the closest views from the eye, and also you can read and write, develop colors. Macular dystrophy of the blood cell transmission

The exact reason for the development of this disease has not yet been established. Among all the reasons that have been transferred to the first plan of the patient. In addition, a number of factors have been revealed to the risk, such as є, to the thought of the previous ones, by an unprecedented start-up mechanism.

To them are admitted:

• вік (from 55 rocks and older);
• gender (women who are sick are twice as often per person);
• recession (if close relatives suffer from macular degeneration, then there is a chance to get sick);
• oversized oil;
• kurnnya;
• deficiency of vitamins;
• trivial and intensive inflow of straight sleepy exchanges;
• eye injuries;
• bastard ecology.

see macular degeneration

In the world of progressing macular dystrophy can go through the development stages and form. There are two types of illnesses:

• Dry form of macular dystrophy. Tse pochatkova stage of ailments, there are nayposhirenisha (sickness is close to 90% of patients). At this stage, the patient step-by-step consumes the central zir, so it is possible not to pressure the meaning and to help not to mention any special changes. Such changes can be brought to consumption in special lenses, which can also be used to reach the eye. In the course of looking around, there are no difficulties in developing macular dystrophy of the eye and visually significant form.

• Vologa form of macular degeneration. If dry macular dystrophy of the Bula is revealed at the early stage, apparently, it was not liable, then the ailment develops into the so-called form of the vologue. Progression of degeneration will accept the statements of new blood-bearing vessels, even tendency and lame, which lead to the blood-growing and adoption of “friends” (zhovtyh purchases) in the city. Vologa form of macular degeneration develops rapidly, nagato shvidshe dry.

Showing vologo macular degeneration

Read also in detail about the revision of the zoru.

The dry form of macular dystrophy develops more often, not as a doctor, and appears in 85-90% of all types. In the macular area, they are diagnosed with zhovtuvaty plumes.

Proceedings in the central view between the mobility of the patients: the stench cannot degrade other details. The dry form is not a cover of a suvor, like a volog. However, through a few rocky progression of ailments and daily life, the degradation of the disease can also lead to a loss.

Read also about the causes of the sclera of the eyes in.

Vologa form of macular dystrophy is presented in approximately 10-15% of cases.

Ailments in the central form develop quickly and often produce up to a hundred percent of the central zone. In the case of this form, the process of neovascularization is repaired - the growth of new vessels. The walls of such vessels are uncommon and miss the shelter and bed, which accumulate in the open space before the bed. Tsei vitik wiklikє more often the sensitive clientele of the sieve, as they move and set off in slinky beaches in the central dawn.

Spoke zir in the result of the strike

symptoms

Macular dystrophy is easy to get sick, painless and non-reversible. In small cases of slap, it can come rapt and quick.

Early symptoms of macular degeneration є:

• the appearance of dark beaches in the central dawn;
• unclear image;
• creation of objects and images;
• pogirshennya sprynyattya koloru;
• Rizke dawn on the back or in the temrya.

Read also about the village of zir v.

The Amsler test is the simplest test for the manifestation of macular dystrophy. Amsler's net is stored from the intersecting lines of the central black speck in the middle. Patients with manifestations of dystrophy of the sieve can be baciti, but in the case of lines, they can be seen growing, or vigorous, lamanimi, and in the dark beaches.

Likar-oculist can develop signs of this disease before the development of changes in the age of the patient and direct him to additional conditions.

diagnostics

For the diagnosis of macular dystrophy of the eye doctor vikoristovoyt rіznі vidi obsozhennya. Heads from them:

• visometry, Yaka will help you to pay attention to the central zoru.
• ophthalmoscopy, Yaka is allowed to vivchit stan sitskіvka і day of the day.
• Bio-ophthalmoscopy(Zastosovuєtsya for the end of the day).
• Optical coherent tomography(OCT) is the most effective method for diagnosing macular dystrophy, which occurs at the earliest stages.
• Amsler test(The test can be carried out in the home drainage system).

Read also about the day-to-day ophthalmologoscopy.

Amsler test to be carried out in the home mind

lіkuvannya macular degeneration

It's a pity that macular degeneration of the eye strain does not lend itself to absolute liking. Protect, learn the methods that will allow you to achieve significant successes in the fight against ailments.

• . Laser treatment of dystrophies of the eye strain allows the sight of pathological blood-bearing judges and their progress.
• Photodynamic laser therapy. The essence of this method is in the fact that the patient should enter into the roof a special speech, which penetrates into the judgment of the judgment of the eye. Then the laser blast is victorious, which is an asset to the introduction of a speech and immediately hostile to a new solution of pathological judgment.
• Anti-angiogenesis factor. tse koshty last generation, Acceptance of the growth of pathological sudins.
• Attachments for the weak zoru. Oscillations of macular dystrophy of the stenosis relieve people of the ability to function normally, special electronic attachments and lines of communication to waste people, giving rise to improved signs of something new.

The treatment of macular dystrophy can be carried out using experimental techniques, including the following:

• submacular surgery(Pathological judgment is seen);
• translocation of the link, In the course of which one sees the defeat of the judge before the sitkivkoy.

In the treatment of dry forms of macular dystrophy with the method of normalization of metabolic processes in the community, it is recommended to conduct a course of antioxidant therapy.

According to the AREDS report, a good effect in the intake of antioxidants was promoted in patients who went to the industrial or intermediate stage of the development of ailments. Combined therapy with antioxidants, zinc and myddy over five years reduced the frequency of development of the lower stage of macular dystrophy by 25%, and the risk of losing health - by three or more times.

With a trace of intelligence, the therapy for the prevention and treatment of dry form of macular dystrophy cannot be used as a course, and only on a permanent basis.

Likuvannya vologo form macular dystrophy is aimed at stifling the growth of abnormal sudins. There are also a number of medications and techniques registered in Russia, which allow zupiniti or change the manifestation of abnormal neovascularization. Tse took polіpshennyu zora at significant number of people with the vologo form of becoming ill.

If the diagnosis of macular degeneration was successful, macular dystrophy may recur again Periodically cautioned by an ophthalmologist is guilty of being obovasovim for the patient.

First Pigment Drink. AMD in ophthalmology in the early period was initiated by different terms: central involutional macular dystrophy, senile, Kunta-Junius dystrophy, viral maculopathy and іnshі. In the given hour, a single thought was formulated, so that one and the same pathology were manifested.

Vikova macular degeneration is the main cause of the rotten shit and slap in children from 50 years of age and in the countries of Europe and the United States, and in the Pivdenno-Shidniy Asia. The number has been spent from the beginning to grow. In our land, a pathology is given to develop in 15 people from 1000. At the same time, the average age of patients is growing in the boundaries of 55-80 years.

Vikova macular degeneration (AMD) is characterized by bilateral lesions, central localization of the pathological process, recurrent general course, non-weakened progression. It was trivial to get sick, it could be asymptomatic, the patients are prone to persecute for quality help, to produce it to the point of being at a loss. In the structures of the invalidnost according to the VMD, 21% of the stocks are individuals of the original vik.

Riziku AMD factor

• Вік (ponad 50 rockіv);
• ethnic and racial affiliation;
• recession;
• biliy kolir shkiri;
• arterial hypertension;
• kurnnya;
• oxidative stress;
• maliy vm_st in the zhovt_y plyami karotinoidiv;
• lack of antioxidants, vitamins, microelements;
• a high level of sleepy radioactivity.

The development of macular degeneration is clearly tied as well diabet, Atherosclerosis of sleepy arteries, inappropriate consumption, overwhelming mass, loss of carbohydrate and lipid metabolism. Women in the age of 60 years suffer from a pathology twice as often, below the number of people.

Typical macular degeneration

They develop "dry" and "vologue" the form of this ailment, which lies at the stage of ailment.

"Dry" AMD, or non-exudative, becomes close to 90% of the symptoms, characterized by general progress. "Vologa", or an exudative form, is developed in 10% of cases, supervises the development of choroidal neovascularization and a severe second vision.

In the development of AMD, the initial value is maє ischemic factor(Trophic damage). Poisoning can be developed in two options:

• The first option is characterized by drusenia. Friends appear in both eyes symmetrically as zhovtuvati sweating, roztashovani pіd pіgmentіm sіtkіvka. Їх size, form and number, as well as steps of prominence and addition with other changes of the pigment meal are available. With significant sizes and increased numbers of druses, choroidal neovascularization develops. Characteristic is the active production of the endothelial factor in the growth of sudin, which is a straining stimulant of angiogenesis. New judges may be wider and wider, as well as the food and drink. How long will it take to perforate the pigment epithelium and render the neuroepithelium. A choroidal neovascular membrane is formed, distant - fibrous scar.
• Another option is characterized by a great geographic atrophy of macular pigment epithelium, while choroidal neovascularization develops only at different stages.

Symptoms of macular degeneration (AMD)

"Dry" form of AMD, when you get firm and my friends, you start to feel insignificant functional damage... Gostrota zoru at the children beckon to get ready to finish the temple. At the same time, druses are seen as a factor in the development of neovascularization.

"Vologa" form of AMD is characterized by quick progress and is practically dependent on patients with already obvious "dry" form. Symptoms of the "vologo" form of the onset:

• rіzke znizhennya gorodroti zoru;
• clouded zoru;
• weakening of the contrast of the image;
• Difficulty reading in case of ineffectiveness of glasses corrections;
• vikrivlennya rows when reading or vipadannya okremih letters;
• metamorphoses (creation of objects);
• (Appearing to dark beaches in front of the ochima).

More than 90% of all types of growths in case of AMD are associated with an exudative (“vologo”) form of congestion, which is characterized by abnormal growths of new-born vines, when they take an ear in the protruding membranes through the membranes. The situation is given to start in ophthalmology as the formation of the neovascular membrane.

Blood plasma leaks out to the cell of the new Sudins, and the accumulation of cholesterol and lipids accumulates before the eye starts to accumulate. Raising the newly created judges can lead to bloodshed, which can reach significant commitments. Everything should be done to the destruction of the trophism of the sieve, the development of fibrosis. The link over the fibrosis (scar) zone is subject to rough changes and does not have a good function.

Do not produce Nicoli until more drops of AMD. A couple of things get involved, there is an absolute scotoma (dark plyama) in the central part of the field zoru. Oskіlki pathological process of shedding the macula (the central part of the sieve), to be spared. As a result of the process, the state of readiness is most often not more than 0.1, and the patient is deprived of life.

Infections in all patients are opposed individually, even if a neovascular chorioretinal membrane is formed, the key role is played by the hour. early diagnosis and an ear of love in the whole period will allow you to unknow it at a loss, to reach the stage of remission.

diagnostics of AMD

Macular dystrophy may be present before development key symptoms... Only promptly ophthalmologic observance allows one to immediately diagnose pathology. For the purpose of enlightenment, it is necessary to use both traditional diagnostic methods (,), as well as computerized and automated - computer, visocontrastometry, fluorescent, color stereophotography, macularity of visibility. When already verified, the diagnosis of AMD is highly informative, the self-control of the patients behind the additional Amsler network. The Danish test allows the symptoms of macular blockage to occur in the presence of choroidal neovascularization.

Treatment of macular degeneration (AMD)

In the case of VMD, the basic principles are an ear of ear, pathogenetic condition, differentiation in the incidence of diseases from the stage of pathology, triviality (only some treatment is carried out by stretching out life), complexity (medication)

Medication therapy for AMD includes the preservation of antioxidant drugs, vitamins of mineral complexes, which include zeaxanthin, lutein, anthocyanin, vitamins A, C, E, selenium, zinc, components, and other substances that are not required

Laser treatment of VMD is based on the implementation of laser coagulation, photodynamic therapy. The surgical treatment of AMD includes such methods as the pigment epithelium of the blood pressure, as seen by the SNM.

The great breadth of the method of intravitreal introduction of the kenalog is important for simplicity and accessibility, which is carried out when filling the macula developmental ethology, Including with "vologom" AMD. The Danish method is less efficient, meaningfully it reduces the swelling component, and the dressing with the risik is faster.

In the last few years, a new progressive method of treating AMD is being practiced - the use of drugs, which is used to adjust the release of the endothelial factor to the growth of sudins. The preparations show the best results in the plan to save time and є by the vibration method.

Video about getting sick

prevention of AMD

All patients with an anamnesis for VMD, as well as a group of skin problems 2-4 undergo a complex ophthalmologic treatment. With the appearance of scarg, characteristic for the given pathology (decrease in gosti zoru, vypadannya litter, metamorphoses and іnshikh), they will inaccurately turn to an ophthalmologist.

clientele of Moscow

The bottom is the TOP-3 ophthalmologic clinics of Moscow, de Vie can undergo diagnostics and treatment of macular degeneration.

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Macular dystrophy - tse termin, yakiy one group of illnesses of sits, when the central zir is destroyed.

The reason for this is in the ischemia of the blood supply (lack of blood filling), as it develops due to different factors.

It is practical to make the visibility of a complex solution to the point of dripping.

Another name for an affliction is vikova macular degeneration of the eye strain, as it develops, as a rule, in people older than 45-50 years. Most often, before the pathological process, an offense of the eye can occur.

The reasons for the diagnosis and development of the disease

Until now, the feast has not been precisely established, but it is the cause of the viral macular degeneration of the bloodstream. On the current day, a number of hypotheses for nutrition have been hung up, but they do not reliably explain the problem.

One of the theories is the lack of a reliable body mineral speech and vitamins: carotene, lutein, ascorbic acid, zinc and tocopherol. You can read more about vitamins in products.

The hypothesis of runtutsya on the ruined regime of rchuvannya is coming. In a number of years, the bulo has been established, which implantation in fatty fats will accelerate the process of macular dystrophy.

Tyutyunopalinnya is not on the last place. If the statistics are correct, then in chickens, macular dystrophy is progressing in the spine of developing shvidshe, Nіzh from non-smokers. The whole fact will be explained by the fact that nikotin reduces normal blood flow in all organs and systems, including in the system.

More than 20% of cases of macular degeneration are genetic in nature

The theory of declining schism has gained the greatest breadth. In the course of the last few days, it was found that 20% of cases of macular degeneration were genetic in nature and were transmitted in declines from one generation to another.

Bullets are suspected of the role of cytomegalovirus and herpes simplex virus in patients with disabilities.

Riziku factor:

• Allowances instead of cholesterol in the blood;
• Вік: repairing from 40-45 years old people get sick more often;
• Become: women suffer from macular dystrophy three times more for the number of people;
• Spadkov's smartness;
• Inappropriate grubbing of food fats;
• the manifestation of such heart-and-heart disease, Atherosclerosis of the brain and arterial hypertension;
• kurnnya;
• Chronic stress;
• Overweight and obesity;
• Trivale oprominennya eyes ultraviolet;
• A shortage of vitamins and antioxidants;
• Unfriendly ecological mind.

See macular dystrophy

It was accepted to divide macular dystrophy into two types:

• Dry macular degeneration, or non-exudative;
• Vologa macular degeneration, abo exudative.

dry form

The whole type of dystrophy does not develop more, less in 10% of cases. On the basis of this lie the destruction of the pigment ball of the diet, as well as the very formation of the intermingled retinal atrophy.

Mechanism of Formation

The pathogenesis of dry form macular dystrophy until the present hour is definitely not inoculations, we go far into the distance to reliably describe the mechanism of the formation of this pathology.

Most often the dystrophy of the scent before the beginning.

At the same time, friends (small puffs of light) grow on the surface of the flaky plate, as they create a pigment-like drink. In cich people, some of the program changes, and sometimes it changes.

One hour at a time, friends see a vitrified Bruch membrane (the inner ball of the sheath), which in some cases is supercharged with calcification.

Klinichny show

Name the non-exudative form of getting sick with minor functional signs. Gostrota zoru at the end of the day will be at 50% or more.

on cob stage An ophthalmologist can identify friends and small defects in the patient's language. Then there are lonely oval or round edges of macular atrophy. For some people, the stinks get angry and look like a geographic map.

At the same time, people will ponder, that in the field there are cattle - tse so called slips. The number and size of each can vary.

Vologa form of macular degeneration

The vologue form of macular dystrophy is characterized by the appearance of more gross changes on the day, as a result of other hemorrhages and fibrosis.

Mechanism of Formation

Until now, the richness of nutrition, tied with the mechanism of the formation of the macular form of the macular degeneration of the eye, has become obscure.

Vidomo, at the very moment coloidal or granular substance is formed between the pigment cells of the sieve and Bruch's membrane.

As a result of the increased penetration of the blood vessels and the sheath, blood plasma leaks out and accumulates under the ball of the pulmonary food.

Years later, yak bi “zagusa” and transformed into a coloid, which consumes lipid and cholesterol, which is evident in the blood plasma. As a result, the neuroepithelium is seen as a result of the blood loss.

At the end of the stage, the compensatory mechanisms are launched, which are adjusted to the growth of new retinal vessels. New judges form a solid membrane on the surface of the sieve, which will become the cause of hemorrhage. All the tses lead to the development of macular dystrophy.

diagnostics

In a large number of diagnostics of macular macular dystrophy, there is no acceleration. Vikoristovuyut ophthalmoscopy and method of fluorescent angiography of the bottom of the vessel.

Amsler test

Obov'yazkovuyu doslidzhennyam є carrying out with a sieve. Win dopomagaє viznachiti, chi is not destroyed in the patient's central zir.

The order of the Amsler test:

1. Detach the eyepieces or linzi (wear it as you please).
2. Sit down by hand and spread the sieve 30 centimeters in front of the eye.
3. Cover one eye with a shield.
4. Focus your gaze on the central point, and do not see from it, assess the field of the grid. Perevirt, where all the squares are of the same size, where there is no sign of the lines, or the delays are clouded, etc.
5. Repeat the procedure with another eye.

Yak evaluate the result

Normally, the patient's central view is not damaged, but the image is clear. On the spot, be it singing and foul play, and all the squares are the same for the size.

The results can be seen like this:

Yak to back the sieve Lyudina is healthy/ Yak to bach the net of lyudin from the ruins of the central zor

The Amsler test is guilty of statistically binding dosages for all patients, which are 45 years old.

Klinichny show

Main symptoms:

Symptoms of illness are trivial hour can be seen from day to day... Naybіlsh parts of the scarg, which represent the children - the appearance of healthy effects in front of the ochima. There can be sleeps, blinks, floating beaches and іnshі.

It is necessary to say that macular dystrophy can rarely be brought to total slack. In connection with this, the pathological process of getting rid of only the central part of the sieve, the peripheral zir begins to take hold. In such a rank, people will have only the presence of a bichesky zir.

Likuvannya macular degeneration of the eye

On the current day, there is no reason for the disease of the macular degeneration of the eye disease. There are three main areas of therapy that can be seen:

1. Laser treatment;
2. Conservative lіkuvannya;
3. Hirurgic methods of correction.

The ophthalmologist's tactics will be found in the fact that he has long been ill.

conservative therapy

For the treatment of dry form macular dystrophy it is recommended to accept lіkarskі zasobi, as normalize the exchange processes of sіtkіvka.

Before them, vitamins are introduced with selenium and zinc (for example, Adruzen), as well as antioxidants (tocopherol,).

A friendly infusion is so self-limiting of preparations on the basis of yagid chornytsi: dfrarel, chornytsya forte, Mirtilom forte and іnshі.

Shcheb polіpshiti blood circulation in the region(Macular area), it is necessary to vicoristovuvati sodinosilovalny zoobi. Smell volodyut new effects:

• Reduce the penetration of blood vessels;
• Muscle blood flow;
• Decreased blood viscosity;
• To galvanize the aggregation (gluing) of the forms of blood elements, which will turn the microcirculation;
• Increase the flow of sourness to fabric;
• To accelerate the glucose uptake, which is necessary for the preparation of an energetic exchange.

Likarsky drugs, which are satisfied with all re-insured vimogs: Cavinton, stugeron, tanakan, trental, picamilon and іnshi.

In the last few years, drugs appeared on the pharmaceutical market, which are used to develop new Sudins in the city. Tse Lucentis and Avastin. More detailed information can be seen.

... The whole drug is applied to the retinal surface. Just one injection to Avastin will often help to cope with the bazhany result.

The bulo is revealed, with more than 50% of the varieties of the cich are tied in the form of renewal of the state.

Lucentis... Molecules of tsyogo koshti can be infused with a very low mass, which allows them to penetrate through all retinal balls and to fill in the object.

In 2006, in the New States of America, Lucentis was hardened in the form of a Vibor preparation for the treatment of exudative forms of macular dystrophy. On the territory of the Russian Federation, the drug appeared in two different ways.

Meta vikoristannya tsyo medication - zupiniti progressing lowering zoru... At the same time, there is no way to see the names of the symptoms, which have disappeared from the dystrophy. Tim hour is a part of the children by definition, which Lucentis is in the world of additional information and news.

Denmark is directly involved in ophthalmological practice in the middle of seventy years of the past century.

The laser promotes the antioxidant activity of the strain, stimulates microcirculation, as well as the process itself of the elimination (vivedennya) of the products in the drop.

Laser treatment of blood vessels is shown in a non-exudative form of macular dystrophy. without the formation of great retinal friends.

However, the best effect of the laser is on eksudative and exudative-hemorrhagic dystrophies. At the same time, there is a change in the embryo in the area of ​​the new beaches and the ruining of the membrane, approved by the new ships.

For practical use of krypton, argon and other lasers. Bagato fakhivtsiv will show the Krypton's ferry exchange itself, so it will be important, as it will be from the smallest shkidlivu.

Surgical methods of treatment

Surgical treatment of macular degeneration of the disease is carried out using the following methods:

• Standard vіtrectomy;
• Retinotomy in the posterior pole zone;
• Zmіna positioning of the macula.

vіtrectomy- partly or outside of the view of the squalid building with the method of rejecting the prompt access to the eye. Here it is necessary to carry out the visualization of subretinal membranes, which is the reason for the destruction of the brain. Nadal from the distance to the fabric of the living room will be replaced by a special type of gas.

Retinotomy is carried out with the visualization of subretinal hemorrhages. In the course of the operation, there are lykar viroblyans on the site, through which one can see the shelter, where the site is. Clots of blood are uncomfortable, therefore, preparations are injected into the zone of degradation, so that a self-sustained dermatitis of hematomas is taken.

The change in the position of the maculi is wobbling in a subtotal direction and circular rotation on the site. The sieve is peeled off and replaced as required. As a variant of the operation, the screening mill can be changed for additional shaping on these folds. With a lot of growth in cola, do not viroblyayut.

People for the treatment of macular dystrophy

Often the patients self-stagnate like this people zasobi for the treatment of macular degeneration of the eye:

I would like to respect that in front of the zasosuvannya of the given methods, I would like to consult you with my eligible doctor.

Way of life with macular degeneration

The cob stage of macular degeneration should not be brought up to the point of being a bit sick. In some cases, there is a need for greater clarity for the visitor of robots, who had not previously been able to do so.

In the world of progression of ailments, a sick person is very sick... Visible reality emerges, and a dark beach appears in the field.

All the trick is to put a person in front of the need to see and from the car, read, visit, and ensure high accuracy and good vision. In general, the manifestation of macular degeneration is to rob the image of a patient's life as passive.

prophylaxis

It is well with the last tributes, that the macular degeneration of the disease is showing a tendency to "rejuvenation", so that the initiative begins to manifest itself in a greater early age. The very fact of prevention of ill health is an even more important role.

• Name the view from the city;
• Be sure to take your eyes from the ultraviolet injected (wear smart eyepieces, headwear, etc.);
• Do not get involved in arterial hypertension, if you have such a thing є;
• See your ophthalmologist regularly (at least once per day);
• Add cholesterol and all products to the minimum in their races, and take in excess fat;
• In case of declining schism before becoming ill, take vitamins with zeaxanthin and lutein. Before the speech, it seems, the meanings of the elements are found in beans, spinach, egg chews, kivi, lettuce, peas, as well as in seaweed (for example, in lamina).

Зміст [Show]

Save a good spot until the elder is very easy. Most often in the summer time, the quality of Bachiti is steadily consumed. Tse is tied to this, so that all organisms of the people in an hour repair "znoshuvatisya". One of the first people of the suffering will weave the eyes. Vvazhaєya, scho zirshut already from 40-45 years. So you can find yourself in a quiet place, if people have not had any problems with their life before. Pogirshennya zoru vidbuvaєtsya step by step. For a large part of people, turbines are "far-out", so that the lack of a backyard of objects, roztashovani close. In some cases, more serious problems arise. Before them, there are such pathologies as cataracts, glaucoma, etc. Also, one of the widening illnesses is inflicted on macular degeneration. A certain ailment is not a safe team that can lead to waste.

Vikova macular degeneration (AMD) is a whole pathology that develops through degenerative processes in some parts of the world. The given area is tied without the front to the brain (є peripheral analyzer). For the help of the link, the information and re-creation of the image in good health is being formed. On the surface of the peripheral analyzer, there is a zone, which can be used to locate the helpless receptors - a stick and a cone. Vona is called makuli (zhovta plama). Recipes, which are located in the center of the sieve, will provide you with a colorant sir at the people. In addition, the focus of light is in the macula itself. The staff of the tsy function, the view of the people is clear and clear. Vіkova macular degeneration of the shedding leads to tissue dystrophy and gum dystrophy. It’s not just a pigment ball, but a lot of luck, to live the region. Unimportant to those who become ill, it is called "viral macular degeneration", it may not only develop among young people. Most often, the first symptoms of pathological changes in the assessment are repaired up to 55 years. Until the summer and old age, the ailment has progressed to such a level that people can increase the healthiness of the bacity.

Vikova macular degeneration of the stenosis is carried to the wider ailment. Often the pathology becomes the reason for the loss of protractedness and disability. Vona is widely expanded in America, Asia and Europe. It is a pity that the disease is often diagnosed at different stages. In cich vipadkah it is brought to the level of surgical treatment. However, with a quick therapeutic treatment, as well as preventive visitsє uniqueness prompt engagement and acceleration of pathology (sloughing).

Yak and all degenerative processes, given the incidence of a tendency until the general and progressive interruption. The causes of dystrophic changes in the zhivtіy plyamі sіtkіvki can be debilitating. The main one of them is the innovation of fabrics. For some people, dystrophic changes are more pronounced, and among others, more. In addition, I think that viral macular degeneration is transmitted in recessions (genetically), as well as in particular European nationality. Prior to those of the officials, the risk was brought up to the following: curriculum, arterial hypertension, often being transferred to sleep. Out of the blue it is possible to see the cause of macular degeneration. To them are admitted:

1. Sudden battle. Atherosclerosis of other arteries is one of the factors involved in the risk. Damage to the delivery of sourness to fabrics of the eye є by one of the head mechanisms of the development of degeneration.
2. Nadlishkova masa tila.
3. Lack of vitamins and microelements. A number of words that are necessary for the preparation of fabrics can be seen: lutein and zeaxanthin.
4. The appearance of a great number of "strong radicals". The stench podvischuyut risik development of degeneration of organs in a number of development.
5. Ethnic specialties. Zvoryuvannya is often seen in people with light colored eyes. On the right, in the fact that the representatives of the European race have a scholarship to the program to take revenge in the community, is low. The reasons for dystrophic processes develop more quickly, as symptoms of illness.
6. Wrong eating.
7. Zakhozhennya pіd straight sleepy interchanges without fixed eyepieces.

Pathology often develops in people with a tight, spasmodic anamnesis (the manifestation of illness in fathers, grandmother). Most of the diseases are diagnosed in the female population.

Yak and all degenerative changes, given the disease, the folding mechanism of development. Moreover, the pathogenesis of dystrophic processes does not lead to increased vivity. Seemingly, for some unfriendly officials in macula tissue, there are non-collared ears. The most frequent pathology begins to develop in people who suffer from delinquency (atherosclerosis, diabetes), obesity. It is also practical to develop an ailment in the middle of the population. Through blockages of the vessel bed and inadequate tissue tissue of the eyes, macular degeneration develops. The pathogenesis of the disease of the soil on the damaged oxidative-basic balance. The leading role in the whole process is played by radicals. The speech is established in the macula for several reasons. Perche, on the zhovta of the beach the sits are continuously infused with muslin and light. In addition, in the whole region, the purchase of fatty acids tends to be oxidized. Another factor in the pathogenesis of the development of pathology is the appearance of the sieve. And the shell of the eye is given to be inserted into the peripheral by the analyzer, and it is tied without the middle to the brain. Tom is especially sensitive to "sour hunger."

All pererakhovani factories are produced before the fabrics on the macula step by step groan. As a result, the influx of radicals into the membrane will ruin. Sitkivka grows more sensitive to the light. With the infusion of ultraviolet and infrared vipromynuvannya VMD develop more quickly. All the processes must be produced before the “ingestion” of the pigment receptors is started, until atrophy occurs. It’s not always the time to zupiniti ruinuvannya maculi; Kintsevoyu stadієyu vvazhaєya appearance of scars and development of slit.

See 3 forms of macular degeneration. The given classification is based on morphological changes, which can be seen in the fabric of the text. Such a necessity is necessary, so that the tactics of treating ailments are necessary.

Morphological types of sickness:

1. Vikova macular degeneration - vologic form: characterized by the appearance of exudate. Tsei option is developed rather seldom, in 20% of vypadkiv. Wines appear as a progressed plin. As soon as people start to lose heart (with a stretch of decilkoh days), then they can see it as well, as a macular degeneration. The Vologa form develops through neovascularization, so that a great number of new Sudins appear on the site. I’ll look at the cells in the membrane cells, their penetration is getting better. As a result, a swell and blood is developing.
2. Vikova macular degeneration is a dry form: characterized by an abundant interruption. In a way, the type of pathology is called atrophy. Dry vikova macular degeneration develops in 90% of ailments. When looking around, friends are seen - lights in the atrophy, lack of a pigment ball, defects in the epithelium.
3. Cicatricial form of macular degeneration. Vona vvazhaєtsya kintsevoyu stієyu VMD. Describe the messages of the epithelium and the statements with good fabrics(Scar). When tsomu get a headache, it’s a waste of time.

In some cases, the dry form of AMD is transformed into an exudative version of the disease. Most often it is seen when court battles, And zokrema - diabetic retinopathy. See more information about the failure of the forecast and a signal for more term calls.

Falsely from the form of AMD, symptoms of illness can develop as often as well as quickly. Most often, a trivial hour, macular degeneration does not allow the nobility to hold out decile rockets. With a dry form of AMD, friends appear on the surface of the sieve - atrophy dilens. For a reason, it’s worthwhile to step down. A large world is awestruck by a pigment ball, through which the color of the colorations will be absorbed. Gostrota zoru can be zmіnyuvatisya with tsyom, ale insignificantly. Vologa form of macular degeneration develops quickly. For a few days of zir, it can be lost, right up to more slap. Through the padding and increased penetration of the membranes, there can be a blood-thinning effect, which is dimmed by an unbreakable eye. Symptoms that can be diagnosed with AMD:

1. The change of contrast and brightness of the image.
2. Decrease in the state property for the zoru.
3. Vikrivlennya, created by objects.
4. Blurred image.
5. Appearing vipadannya polіv zoru.
6. Unwillingness to read, unaffected by the wear of the eyepieces.

With the gradual development of pathology, signs of sickness can be found in a trivial hour. Possibility to see the deed of the destruction of the central zoru. When you look ahead, a large part of the image becomes blurred. Protein peripheral (bichny) spills. The step-by-step battle zone is improving.

In case of vologii and cicatricial forms of AMD of slap infusion it is fast. On the basis of a dry type of degeneration, peripheral vision is rarely given protection. In case of a fast lіkuvannі VMD, the development of slips can be zupiniti.

Vikova macular degeneration can be diagnosed at early stages. Those people who are suffering from sufferers need to see an ophthalmologist 1-2 times per day. Diagnostics of AMD is based on anamnesis and special conditions. People who have been kidnapped are most often skarzhashis at the appearance of "plami" in front of the ochim, where there is a fog. The diagnosis of "macular degeneration" is most often used in women with severe disease, especially if they have a history of type 2 diabetes mellitus, atherosclerosis, sudin. Krym opituvannya, vikonuyut a number of ophthalmologic conditions. Among them - vimir state property, perimeter, stereoscopic biomicroscopic.

Schob assess the country of the Sudin, conduct a fluorescent angiography of the face-to-face bottom. The staff of the cims for the last few years, it is possible to evolve the zone and the appearance of the epithelium, atrophic friends, neovascularization. However, a similar method of instrumental diagnostics can be counter-indicative and risky. To that, before tim yak zvazhitsya on the obsozhennya, varto see an ophthalmologist and take out this consultation.

When a diagnosis is confirmed, it is necessary to immediately treat the disease of macular degeneration. The dry form of the disease is aggressive, so drug therapy is needed. It’s not possible to get around the pathology in the general community, protest (co-ordinate) the process for a few miscellaneous or rocky ones. In pershu cherga with AMD, children need to take care of it. I’ll look at those atrophic processes that develop through the failure of carotenoids and blockages of the bottom of the vessel, and the ailment of fatty fats. To increase the atherosclerotic changes in other arteries, there is a great number of fruits, greens, vegetables to live in. Besides, it is also possible to remember the failure of vitamins and microelements.

It is recommended that you spend less than an hour on the sun for less than an hour. Likewise, patients are guilty of living antioxidants. Before them, vitamins E and C are given. For the improvement of blood flow to the bottom, it is recommended to live antiaggreganti, sudinorosilicidal preparations.

In the case of the form of macular degeneration, it is not only medication therapy that is carried out, but the surgical treatment. Before the preparations, when the pigment ball of the sieve is introduced, the medicines "Lutein" and "Zeaxanthin" are introduced. The price of drugs can be applied to a group of antioxidants. In addition, I recommend to live in products to take revenge on zinc. As soon as the disease has developed in cases of diabetic retinopathy, it is necessary to carry out juvenile therapy in order to control the glucose profile.

One drug therapy is lacking, as for the patient of delivering the diagnosis "viral macular degeneration". Likuvannya pathology can be unified with surgical correction. Especially the vologo form of AMD is especially important. In this hour, it is practical to carry out laser treatment of macular degeneration in the ophthalmologic skin clinic. Vono can be smart. Vibir method to lay down at the stage of AMD and manifest pathology. See the advancing methods of surgical correction:

1. Laser coagulation of the neovascular membrane.
2. Photodynamic therapy with the drug "Vizudin".
3. Transpupillary laser thermal correction.

When it is possible and on a daily basis, a contraindication, a transplantation of a pulmonary epithelium, a vitrectomy (if there is blood in the middle of the eyes).

Prior to prophylactic visits, the following should be noted: for a child, for a decrease in mass. In case of court battles, it is recommended to take a walk from the court. It is also a unique feature of the direct hit of sleepy exchanges to people who have light colors of their eyes. Krym, prior to prophylaxis, it is necessary to introduce vitamins for the improvement of the environment and microelements.

An hour is not possible to zupiniti, as it is not possible to unify the old organisms of the people. In a nutshell, fix the problems without any problems. That number has problems in no time.

Zgadaimo Trohi Budova of our eye. I will name a macula for a friend - zhovta plama. The most important center of the eye is shedding, the beam of light is de-focused. Winning the central view, as well as the color of the healthy image. Picking up the macula, scho the winners of the older children in the group, tell us about the ear of such pathology, like the macular degeneration (fast - AMD).

With macular dystrophy, the diameter of the blood-bearing vessels changes, so that the sieve can live. Yak inheritance, fabrics cease in the whole world to trim the necessary speech. Dystrophic changes develop on one or both (livy and right) eyes. Often AMD is the reason for the loss of normalcy and disability.

It’s crazy, since we are talking about the macular macular degeneration, my mind, but the main reason for this illness is because of the degenerative changes in the bloodstream. Alle, some of the children become ill, but in some of them, in some it is progressing, and in some of them it is more common. Until the end of the reason for such a situation not vivchenii, ale histology of additional assistance to the intelligence mechanism of the development of the pathological process and the development of a number of factors in the rizik:

• Genetic tenacity and recession (recession occurs as an autosomal dominant, autosomal recession, or for X-chromosome formation).
• Kurinnya. It is significant to advance the development of AMD.
• Arterial hypertension.
• Diabetes mellitus.
• Short-sight or far-sight.
• Triva diya sleepyhead exchanges on the unprotected sleepy eyepieces of the eyes.
• Nadlishkova masa tila. Advise on the links between obese and advanced AMD.
• Wrong eating, as a result of which the patient's organism is inadequate to lively speech, which is necessary for the correct function of the healthy device (carotenoid sprinkle).
• Race. More often than not, African Americans are more likely to see changes.
• Vegeto-sudinna dystonia or, for short, VSD.
• It is also a sign of belongingness - the representatives of a weak stati of a given disease are diagnosed more often.
• Ochni pathology. For example, chronic blepharitis abo endocrine ophthalmopathy(Pseudotumorous abo thyrotoxic form).
• Suffered from eye injuries.

Vikova macular degeneration is often diagnosed in women and representatives of the white race.

Classification of macular degeneration

Oculists of pathology classify the forms of overturning AMD:

1. Dry (іnshі name - non-exudative, atrophic). Growing up all over the place.
2. Vologa (іnshі name - exudative, neovascular). Grow rapidly.
3. Rubtsov. Ostannya stage of AMD. Grow rapidly.

Dry form of AMD is indicated in 85% of cases, lower than any form of pathology. With the rise of the people, people will find a change of speech. As a result, in the region, maculi are called druses. Ce і є in the atrophy. Friends grow up on hard and soft meat. Solid - solid and clean; m'yakі - great, with flowing edges, you can get angry with yourself. The patient consumes the state of the art in a step-by-step manner. There is one reason for the formation of pathology among others. Registered vipadi, if the dry form gradually passed into the remains - scar stage.

The dry form of AMD is also called non-exudative aboatrophic.

neovascular form

Ophthalmologists diagnose this type of pathology in 10-15% of cases. Vologa form of AMD is the result of progression of atrophic form. The ailment grows rapidly. In most cases, it is practical to use the central view. In the world of growing in the scope and growing of druses (like winnies with dry forms), the process of forming new sudins is developing on the ground. The male process, the change is also neoangiogenesis, є form. As a result, the organism will grow pompously to compensate for the lack of grasping of the eye, by supplementing it with a supplementary service, which is necessary for the function of speech.

When pathology progresses through the walls of the new vessels, blood and family cells penetrate, which accumulate in the area before the formation. The bulge is growing, blood is growing. As a result, the clientele is especially sensitive to the light, and they constantly move and move. This is how one is set in slips in the central dawn.

Classify into:

1. Classically, it is the subretinal neovascular membrane (SNM) that is squeezed out.
2. Prihovanu, called the occult.
3. Zmishan.

Vologa form is also called exudative or neovascular.

cicatricial form

With the germination of sudin, the pigment epithelium may appear as a result of the onset of neuropathy and the formation of scar tissue (transition to the scar stage).

Tse kintseva stage of viral macular degeneration. Vrata dawn is non-negotiable.

Symptoms bezposeredno affect the form of the disease. In most cases of ailment, it is asymptomatic.

symptoms:

1. As a result of the step-by-step appearance of the forgiveness, the friends will see the loss of life. With a dry form - slightly і action, and with a vologіy and cicatricial і іs thunder.
2. To fix flies in front of the ochima (especially typical for dry form).
3. The guardian is the greatest pigment ball through the hole and the lowering of the picture, the contrast.
4. Winning through the embankment of blood, as we will feel sick, let us know about the vologue of the form of sickness.
5. Vipadayut fields zoru.
6. The picture is blurred, yaku mi bachimo.
7. Navkolishnі objects are created, direct lines are wicked.

The growth of dry form in the first hour is asymptomatic.

Dry form rollout:

1. On the cob stages, symptoms are visible.
2. The central zirshutsya in steps.
3. There is a chance to see the clouded image of the big picture.
4. During the year, the zone of growth and darkness has been damaged, as a result of which a scotoma has become established.
5. Peripheral zir to be saved.

Particularly different and third forms of the field in the offensive:

1. 100% wasted by Zoru nastaєshvidko.
2. Preserve the peripheral vision to protrude into the arches of the small droplets.

In case of endovian cicatricial form of AMD of the feet, the reach is 100%.

Unimportant to the possibility of a trivial asymptomatic interruption of ailment, a macular degeneration can be diagnosed by a patient in every day. Individuals over 50 years of age are regularly examined by the eye specialist. Do not allow the emergence of pathology in the early stages and at the same time.

The dry form can smoothly go into the most insecure - cicatricial form. This needs to be reviewed regularly.

With the trivial process of developing the pathology of the patient, such as coming to the ophthalmologist, it is more common to skar on the appearance of "beams" in front of the ochima, when there is a fog. The defect gradually increases in size.

Diagnostic methods:

• sbir anamnesis;
• visometry;
• ophthalmoscopy (look around the bottom);
• optically coherent retinotomography;
• visocontrastometry;
• fluorescent angiography;
• computer perimeter;
• color stereo photography.

These methods allow to carry out timely and efficient diagnostics of the macular region of the eye.

For the recognized results of diagnostics, a course of treatment is assigned.

In case of emerging AMD of the eye, the drug is guilty of the patient's diagnosis, so it is necessary to assign a course of treatment and conduct self-diagnostics (relevant for dry form of pathology).

For quiet patients, for those who already have a macular degeneration of the sieve, a good method for diagnosing the progress of sickness is a test for an additional Amsler sieve (lattice). The Danish method allows you to visually draw on the cob signs of the macular embryo after the establishment of new Sudins on the site.

Amsler sieve є a sieve with a size of 40 x 40 cm with square midpoints with a point in the middle. When diagnosing the test, go up to the Amlser grate to become close to 50 cm.

With the manifestation of pathology, the patient can bachiti unsettled "diri" or " dark beaches», Vikryvennya sіtki. With such a development, it is necessary to undergo a periodical examination by an ophthalmologist.

Self-protection according to the decision of Amsler can be spent on a skin day.

Self-diagnosis allows for the development of AMD.

Lіkuvannya VMD ochі

Likuvannya dry form

The dry form is more beautiful to give a taste to in proportion to the vologo. You will find yourself with a more friendly interruption.

Poshkodzhennya at the given form of ill health. Reducing the risk of transition from the vologue to the form is reached by the path of drug therapy, which includes the following:

1. Antioxidants.
2. Vitamin-mineral complexes.
3. Taurine.
4. Lutein / be-carotene / vitamin A / zeaxanthin (one of the drugs is recognized or the complex is fallen from the clinical picture of getting sick) in 10mg / 15mg / 28000ME / 2 mg.
5. Anthocyanosides.
6. Vitamin C and E in total 500mg and 400ME as usual.
7. Mead and zinc in total 2 mg and 80 mg altogether.
8. Selena and other microelements.
9. Gingko Biloba.

Slide regularly to remove the sickness to remove the ailments.

With a dry form of AMD, treatment is based on the reception of vitamin complexes.

Blood circulation in patients, patients with recommendations for antiplatelet drugs, sudinorosilicidal drugs.

Of course, it is conservative medicine, yaka polyagaє in the recognized destructive disorders, immunomodulators and antioxidants (tablets, inn'єktsії abo dots), is ineffective. Prevent the need for an ophthalmologist's advice for monitoring. At the connection with the cym, the risk of the passage of the ailment into a larger stage is improved.

Not so long ago, laser coagulation - destruction (ruining) of newly created vessels behind the aid of a laser - was used by the only effective method of eliminating the volume of AMD. However Danish method did not understand the reason for the establishment of the new Sudins. Until then, the fabrics are healthy, so can be used for ruinous infusion during the whole procedure.

The less aggressive version of laser therapy of vologo form is a photodynamic therapy with a vicious preparation "Vizudin". It is possible to inject internally and optimize the sieve with a laser. The drug can be used only to pathologic stenchs, which accumulate in them and become active when the laser exchange is injected. In bleeding pathologic sudina thrombosis is established, the verdict is "sealed". During the whole procedure, the healthy tissues are practically worn out.

Vizudin vikorystovuyutsya for the treatment of vologo form of AMD in photodynamic therapy.

Ale, with a more progressive method, for this year's day, VEGF therapy has been broken down on the cob. Another name is "Pritcilna therapy". Lіkuvannya VMD ochі in this vypadka allows not only the progress of the process, but the first part of the change of the patient. However, the tsverdzhennya is only fair in this case, if there were no nevorotnye cicatrices of the serpent.

With VEGF therapy, special medications are carried out in order to diagnose Sudin, in spite of the eyes. The drugs that can be used for the given injections are Lucentis, Makugen, Avastin and Eily.

With this type of therapy, the risk of attack is as follows: the adjustment of the internal vise, the introduction of the stench, the internal infection, the timing of the risk, the blood vessels.

s surgical methods Likuvannya VMD next means the following types of operations:

• transplantation of pigment epithelium;
• visualization of subretinal neovascular membranes from the formation of scleral folds;
• vivid subretinal hemorrhages.

Lucentis vikoristovuyutsya for the treatment of vologo form of AMD in VEGF therapy.

dodatkov_ come in

Eyepieces are prescribed for patients who have lost the quality of light. Plus lines stand for short-handed, and for distant-looking - minus. Recommendations for the visibility of anti-blinking, so that it allows you to prevent the eyes of such a negative input, as it appears from the monitor or the TV, which can be installed on the eyes when reading a robot.

Vikoristovuvati toy chi іnshy folk method Likuvannya is permissible only after consultation with a doctor. It's a pity Folk medicine not in the power to vilikuvati AMD, or to improve self-esteem, to prevent the development of ailments and to reduce the symptoms.

1. Soak in a glass jar for the 4th year and rinse the grain of the whole grain. Make the water angry, and sip the oats into a casserole. Pour 3 liters of water into the middle water and cook 30 ghilin to boil. Take away the process and save it in the refrigerator. Take up to 5 times for a do-it-yourself sklent. It is recommended to add grated berries of currant, blackberry, blackberry pea and honey in a batch.
2. 1 tablespoon of pharmacy calendula pour in a bottle of sprinkle and infuse 15 quilins. Let me stand. Use the process and take ¼ flasks 3 times a day. It is possible to presently zapuvat eyes 2 dots in 1 eyes. Take up to 6 months. Let's take a break.
3. About cinnamon scarlet and mumіє know everything. With AMD, the stench can also help. Requires 50 g of mummy roschiniti in 100 ml of aloe juice. Insist. Є two options for the application of the infusion. First - tse piti 10 ml 2 times for doba. Another - vikoristovuvati yak dots for the eyes: 1k each. in the skin the eye. After 10 days I will take a break.
4. Lushpinnya tsibuli (2 parts), fruit of shipshini (2 parts) and needles (5 parts) need to be adjusted. Pour 1 tablespoon of sum_shі into 1 liter of water and prokip'yatiti 2-3 chilini. Take 1.5 liters of food each day.
5. Tablespoon spoon kminu pour 250 ml of water. Prokip'atiti on a small water 2-3 hvilini. Vsipati 1 tsp. Quote of hairs, mix and add to 5 quills. Vikoristovuvati 1-2 dots in the skin of the eye 2 times a day.
6. Cleanliness detail. 1 tsp pour in 100 ml of water. Pidigriti on fire 10 sec. Dati insist. Nastiy process and save in the refrigerator. Zastosovuvati for 3 dots in the skin of the eye 3p. in a day. Course - 1 month.
7. Take 1 part of goat's milk and 1 part of boiled water. Otrimanu sum_sh vikoristovuvati yak krapli - 1 K. In the skin there is an eye. When you apply it, you need to put on a dark bandage on your eyes, or for special eyepieces and lie down for 30 minutes. Course - 1 day.
8. In 1/3 of the bottle, add 1 tsp. additional convoys і vsepati ½ tsp. sodi. Remix. Place in dry and dark place for 9 years. Z otrimanoi masi robiti compressi.
9. Lіkuvannya p'yavkami - tse okrem, ale duzhe korisna area of ​​folk medicine.

Folk medicine can be vikoristovuvatisya, yak added to the main lykuvannya.

It is necessary to live a sufficient number of products rich in carotenoids, fresh vegetables, fruits, greens.

It is also a trail of intertwining the hopefulness of food fat, and provoking atherosclerotic changes in the city.

Products rich in carotenoids:

• carrots;
• garmelon;
• potatoes;
• dinya;
• spinach;
• cabbage;
• zucchini;
• citrus;
• tomachi;
• malt pepper;
• corn;
• apricots;
• peaches;
• persimmon.

Antioxidant products:

• Chervona currant;
• chornitsa;
• crane.

Before entering the prophylaxis of the old malady - VMD, the following should be applied:

• dotrimannya dієti (amalgamation of food fats; abundance of fresh vegetables and fruits);
• decrease in mass tila;
• control of the level of arterial vise;
• the wear of the eye-catching eyepieces (especially for the patients with the eyes);
• vidmova vid shkіdlivyh ringtone(Kurinnya);
• reception of vitamins;
• doing sports; ale of professional sports; for example, a triathlon, to be able to adapt.

I, obviously, a necessary regular examination by an ophthalmologist.

Lis 28, 2017

Vikova macular degeneration, the price of death, right up to sleep, people have 40 years of age. As a rule, fixing the atrophy and appearance of the sieve. In other words, the goal is to be called macular degeneration. Given the pathology to become chronic, the macular area of ​​the shedding is not reversible. As soon as the collapse is observed in one organ, then after an hour, there will be a hitch. With a wide range of steps, the battle can be rather slow, so that the degeneration is asymmetric.

The vicious macular degeneration of the sowing develops into a progressive interruption, as it starts to develop in a step-by-step manner, but instead of swelling the shape. A lot of rocky people may not know about the pathology, but if the world is still singing, then start to progress.

Ophthalmologists are in a hurry: “They tried to show us how to sell ourselves for the night in Europe. For a renewed eye renewal it is necessary ... " »

The main symptoms of sickness are the unwillingness to look at the object, but not at the same time. One day in life to trample, to go through a familiar person and at all to marvel in the eyes, but not to visit. For the sake of reason, the reason is not that guilt does not want to bach you, but that guilt cannot.

For an hour to look at the TV view of ailments, it is not so much the image itself, and you can't read it anymore. On the right, in the one where the picture in the eyes of a sick person is given a sprinkle, and the color is impertinent. For example, if a person marvels at a straight line, then it is necessary to beat a hvilya. In addition, it is often necessary to fill up the ailments on the way to the beach, as it takes place in one moment. Zahvoryuvannya can be of two forms: dry ta vologue. The skin of them has its own specialness.

Vikova macular degeneration of dry form takes over more prostates and is more likely to occur in more people with ailments. As a rule, there is a lot of rock_v against asymptomatic, depriving the presence of deyaki signs of distant growth. Tse nasty things from a nearby city. Then, distant images can be seen clearly and the peripheral vision can be seen. With a given form of pathology, it is possible to prevent the destruction of occupation. living talk flasks, which show for the price. It is received through the accumulation of friends, so that the products of the processing of the exchange processes.

The form of pathology in the pathology is to grow up to a small amount, less than ten times in a hundred. Vona vvazhaєtsya is not safe, so you must wear a stripe shape. As often the type of viral macular degeneration does not appear, then it can lead to more slough. From the same, і to іnvalіdnostі. The form is given to be characterized by the growth of the eyes of the eye into the sieve, in the case of which the blood of the blood seeps into your organ. The staff of the whole grows up strongly to swell, as I will weaken the function of the health apparatus.

Progressively degrading the dawn in an hour can lead to terrible inheritances - in the form of the development of local pathologies as much as more slap. People who are awfully awkward, should be able to change their minds, because they have not seen it before, and it is popular ... Read the lecture "

Before the group riziku, you can include people with the attacked ones:

1. Vіkovі changes from the 50-th rockіv.
2. Slump factor.
3. To become a zhіnoch.
4. Diabetes mellitus.
5. Courinnya and vzhivannya of alcoholic beverages.
6. superciliously often solarium and triviality overwhelmed by open walkways.
7. Obesity.
8. Wrong eating.
9. Zahvoryuvannya Sudin.
10. Heart pathology.
11. Hypertension.

If there is a decrease in the state of health, it is necessary to inform an ophthalmologist, moreover, the symptoms may indicate the manifestation of these pathologies.

It is necessary to carry out monitoring of the vision for the whole hour for the purpose of making the eyes of the skin patient. The price is necessary to clarify the progress. The price can be created for the help of the image, and people can be kept at the same time. If you wonder, for example, you can look at a picture (skinny times from one place) you can see it, and the image may seem unclear.

Also, there is a special control technique: Amsler's net, which allows the assessment of the standard. Testing is guilty carried out on a weekly basis. The sieve needs to be spaced at 30 cm from the eyes of the power. Fuck, look at the image is required in the zvichny camp. For example, if you always use eyepieces, then the test is carried out in them. Otzhe, to carry out the assessment, the zoru needs one eye to close, and the other to respectfully marvel at the point, the yak is roasted in the center. As soon as everything is in order, all the lines and the point will be overlooked without a trace.

The axis will be so visible when easy form getting sick:

Yak can be seen, the central part is not great. The point becomes more frequent, and the lines swell a larger rounded shape. An offensive little one will tell about the importance of the form of pathology.

In this view of the image, there is even more to it: the lines take on a snappy shape, and the point is created by a succinct dance.

The vilikuvati dry form is lighter on the nabagato, which cannot be said about the vologue. Otzhe, vikova macular degeneration in the form of treatment:

Important to the nobility! Divy way of effective renovation of the zone, recommended by the provincial ophthalmologists of the country! …

1. Hirurgic involvement.
2. Lіkuvannya behind the aid of the laser.
3. Drug therapy.

Assign a course of treatment only a few drugs, including the peculiarities of the disease. As a rule, with an important form of pathology, an intravial way of administering the drug is indicated, then I use an additional empty mouth... Ale, a skin ailment is guilty of a singing child. Alcohol, chicken, food, fast food and food and drink. Then it is necessary to live, as if there were any ailments of a healthy appliance, svіzhі vіtamіni. Smell take revenge in carrots, Bulgarian pepper, Garbuz, legumes and cereals, eggs, liver, spinach, broccoli. Chee will not be too awkward to plant dark berries, grapes, blackberries.

Yak vіdnoviti zіr are not available before the operation

We all know that so are the rotten spirits. Myopia and far-sightedness is a serious thought of life, intertwining in the childish acts - it’s hard to read, look at loved ones without eyepieces and lenses. Especially hard to fix problems and to show themselves for 45 years. If one on one in front of a physical nonsense, the insistence of panika and pekelno is unacceptable. It’s not necessary to be afraid of it - it’s necessary for children! Yakim needs to be corrected and what is indicated ... "

Winning is taken to medicine, to ophthalmology, and to taking advantage of the vologo form of macular degeneration (AMD). For a whole lot of time, the introduction of Lucentis in viglyadi in''ktsii in a dose of 0.5 mg 1 time per month is available. Then, parabulbarically, per 1.5 ml of an isotonic solution, inject alpha-fetoprotein at a dose of 0.0075 mg in the evening and glutathione-S-transferase at a dose of 0.0000005 g of vrantz. The introduction should be carried out in the skin of the eye until the visualization of the sieve with the newly created vessels near the macula. let go laser coagulation Sudin, without popping makuli. Then parabulbar and retrobulbar, closer to the macula, transplant a suspension of autologous mononuclear cells cystic brain... The number of mononuclear cells becomes 5-40 million. When the suspension is injected per 1.5 ml of "NCTF-135". Introduced 2-4 times with an interval of 2 months. Ways to allow zupiniti neoangiogenesis, to weaken the autoimmune process in the area of ​​tissue of the eye, in order to bring about the blockade of pathogenetic mechanisms in the development of AMD, as well as a relapse of seizure during the establishment of the brain for the organotypic regenerative regeneration 1 ex.

Winery is used for medicine, for ophthalmology, and it can be used for the treatment of voluntary form and macular degeneration of the cellulite (AMD).

The morbidity of the VMD in Russia becomes 15 per 1000 population, and the full-time pathology is one of the main reasons, which leads to a decrease in the blindness, dullness, invalidization and destruction of the quality of life in people of the abducted age. Vikova macular degeneration of the disease є chronic progressive ailments, degenerative (dystrophic) process, which leads to the development of cells of the membrane of the brain, photoreceptors, destruction of the membrane of speech, zorova function eyes. The role in the pathogenesis of AMD is the introduction of hemodynamic damage in the choriocapillaries of the eye.

Meta vinohodu is a reduction in slush and low vision in case of vikovoy macular degeneration of the strain.

For the elimination of the vologo form of the vikovoy macular degeneration of the stump drug treatment... Intravitably to administer preparations-ingibitorium angiogenesis (Makugen, Lucentis and Avastin), crystalline glucocorticoids. Subconjunctively injecting a peptide bioregulator, retinalamin from the eyes of thinness. Also carry out laser coagulation and transpupillary thermotherapy, photodynamic therapy with verteporphyrin. They are more likely to be attracted to the stabilization of the pathological process, to polish the state of affairs and the quality of the light, as a rule, do not go out.

It is a prototype of the method of treatment of the vologo form of the macular degeneration of the sieve, including the introduction of Lucentis in the viglyadi in the ugly diet at a dose of 0.5 mg 1 time per month (Yygorov E.A. with the "vologo" form of viral macular degeneration. RZhM 2010, No. 2, 4 p.). The shortcomings of this method є recurrence of illness, the need for repeated injections of an expensive drug and actions (with cutaneous offensive injections) of weakening of its effectiveness.

The technical result of the winery is the reduction of lameness and low vision in the case of the vologic form of the malignant macular degeneration of the bloodstream for the improvement of blood circulation, the normalization of the microcopy of the intracellular regeneration, stimulation Transplanted autologous cells of the cystic marrow induce organotypic regeneration of pathologically changing tissues of the eye. Normalization of the microenvironment complex treatment drug α-fetoproteїnu - Profetal scho polіpshuє intravascular i tkaninnu gemoperfuzіyu i stumulіruyuschego viroblennya endogennih prostaglandinіv E1 i E2 scho znіmayut spasm sudin i blokuyuchih rozvitok autoіmunnih reaktsіy, α-fetoproteїn Je VEHICLE bіlkom i zamіschaє nedolіk transport bіlka transthyretin synthesis yakogo znizhuєtsya at distrofії pіgmentnogo epіtelіyu. The introduction of a transport library for the transfer of accumulated deposited products in the metabolism, including friends, and those of high molecular speech, in the norm is not typical for the system. When posilennі vivedennya produktіv rozpadu in zonі degeneratsії normalіzuєtsya warehouse mіzhklіtinnoї seredovischa zonі in the posterior pole of full-time Yabluko, lіkvіduєtsya nabryak, normalіzuєtsya osmotichniytisk i acid Luzhny balance tkaninnoї seredovischі posterior pole, scho stvoryuє Minds for oborotnostі distrofіchnih for Change in Perche Cherga pіgmentnogo epіtelіyu sіtkіvki. It’s not only the inner tissue and tissue regeneration of the diet, but also the new function according to the growth of the osmotic grip in the subretinal space and the choroid. With a decrease in the amount of information, the news of the judge appears, as the result of laser coagulation. It is more possible to inject autologous cells of the cystic marrow, while at the same time it rapidly reduces blood circulation and trophism of tissues in the area of ​​ossification, prevents the synthesis of necessary cytokine cells, and also regulates the regeneration and regeneration of cells for the cells of the vascular system. The introduction of the parabulbar antioxidant glutathione-S-transferase at a dose of 0.000005 grams per injection every other day significantly reduces the amount of money associated with photooxidative stress. As a result, the pathogenetic mechanisms of the development of AMD are blocked, which leads to a relapse of the disease, atypical neoangiogenesis, which, according to the day, appears to the body on the ischemia of the tissue of the eye.

How to stay in the chotiri stage.

First step. Stagnation of Lucentis in viglyadi in''ktsii in a small amount of 0.5 mg (0.05 ml) 1 time / m / s, one time. Lucentis (Ranibizumab) is a human monoclonal fragment of antibodies to endothelial growth factor A (VEGF-A) and is expressed by a recombinant Escherichia coli strain. Ranibizumab vibrates with the isoforms of endothelial factor growth of sudin, VEGF-A (VEGF110, VEGF121, VEGF165) and for the release of VEGF-A from receptors on the surface of the endothelial cell Attracting the growth of newly developed sudin chorioidei into the setting, Ranibizumab zupinia progression of exudative haemorrhagic form (vologo) of the macular macular degeneration (VMD).

Another stage. Schodenne parabulbarne introduction drugs before the visualization of the sowing with the newly created vessels near the maculi. The antioxidant glutathione-S-transferase is administered at a dose of 0.0000005 grams per injection in the skin of the eye per 1 ml of isotonic growth from the wound.

For 1.5 ml of isotonic water gap the drug Profetal® is administered in a dose of 75 mcg per 1 injection in the skin of the eye in the evening.

Third stage. Laser coagulation of new-made vessels (if necessary).

Quarter stage. In a patient with a krill of a club brush under an anesthesia on an outpatient basis, in aseptic minds, the removal of a cystic brain in a bottle of 10-60 ml. The aspirate of the cystic brain with an anticoagulant is transferred to the laboratory of clinical technologies. At the laboratory in aseptic cells from the cystic marrow, a cell transplant is prepared in the cell suspension of mononuclear cells in the cystic marrow for 1.5 ml of NCTF ("NCTF - 135" - complex biological preparation, To take revenge on vitamins, minerals, amino acids, nucleic acids and antioxidants, Laboratoires Filorga (France). Part of the klin is frozen in rare nitrogenі transferred to a cryobank for a quick storage. Suspension of clitin in a quantity of 5-40 mln. Autologous mononuclear cells in the cystic marrow per 1.5 ml of NCTF size. The introduction of critical material will last 2-4 times with an interval of 2 months.

With this method of transplantation, the stem cells of the cystic marrow appear to function as a power, and it activates the organo-genetic angiogenesis, as well as the blood circulation in the vessels of the cyst and the green nerve, reduces the dose, the tissue trophies of the tissue.

Klinichny butt.

Patient V.M., 78 years old.

Diagnosis: Vikova macular degeneration of both eyes (vologic form). When looking at the bottom of the faceless dystrophies were revealed in the central region of both eyes, there is a great number of pigments, a lot of symptoms.

To lіkuvannya: gostrota zoru right eye - 0.05; gostrota zoru livogo oka - 0.07. Korektsiya on both eyes is uncomfortable. Patient with weak vision - significant reductions in the central vision. The process of healthy recovery of difficulties and confidences. The patient is visually obscured, meaning it is difficult to read and interpret particulars.

Likuvannya. A spout was injected with Lucentis at a dose of 0.5 mg (0.05 ml) once a day, in a single dose of 0.5 mg (0.05 ml) of an ultra-tonic alpha-fetoprotein, at a dose of 75 μg, 12 days in a dose of trans-glutate 0, 000 005 g 12 days of war, in the skin of the eye, before the visualization of the macula with the new-produced vessels near the macula, then they carried out laser coagulation of the new-produced vessels (without the reduction of the macula), then transplant the parasitic retinucleus autologous Viconano 3 microsurgical cells of autologous cell transplantation with an interval of 60 days.

Pislya lіkuvannya: zіr lіvogo і right eye - 0.2 (without correction). When the bottom is flattened, it is revealed that the area of ​​dystrophies and druses has become quite smaller, some of the program has changed, the bulge has grown.

The method of eliminating the vologo form of the macular degeneration of the bloodstream, which includes the introduction of Lucentis in the viglyadi in the early stage at a dose of 0.5 mg 1 time per month, when the paralysis begins to develop. injecting alpha-fetoprotein at a dose of 0.0075 mg in the evening, glutathione-S-transferase at a dose of 0.0000005 g in the skin eye before the visualization of a sieve with new-produced vessels near the macula, then carry out laser transplantation if necessary a suspension of autologous mononuclear cells in the cystic marrow parabulbarly and retrobulbarly, closer to the macula region, with a whole vicious suspension of 1.5 ml of "NCTF-135", the number of mononuclear cells becomes 5-40 million, and it is introduced in 2-4 minutes ...