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"code": "H33",
"name": "Отслойка и разрывы сетчатки",
"icd_name": "Отслойка и разрывы сетчатки",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
1
],
"periodicity": 1,
"slug": "h33_otsloyka_i_razryvy_setchatki",
"lead": "Нарушение здоровья, относящееся к группе болезни сосудистой оболочки и сетчатки",
"description": "Отслойка сетчатки – патология сетчатой оболочки глаза, при которой происходит ее отделение от подлежащей сосудистой оболочки. \r\n\r\nРазрыв сетчатки – это приобретенная патология органа зрения, которая сопровождается нарушением целостности сетчатой оболочки с высоким риском ее дальнейшей отслойки.",
"etiology": "<p>Причиной отслоения считаются разрывы сетчатой оболочки. Сетчатка не сдвигается со своего места, если она герметична и в ней нет разрыва. Если разрыв образовался, то через него жидкость из стекловидного тела проникает под сетчатку и отслаивает её от сосудистой оболочки. </p>\r\n<p>Основная причина формирования разрыва сетчатки — тракции стекловидного тела при изменении его нормального состояния. При наличии заболеваний стекловидное тело изменяется, становится мутным, с уплотненными волокнами, которые связаны с сетчаткой. При движении глаза тяжи (волокна) тянут сетчатку за собой, что может привести к её разрыву. </p>\r\n<p>Разрывы сетчатки могут возникать также при её дистрофии (истончении). Большие разрывы часто возникают при травмах глаза. </p>\r\n<p>Другими более редкими причинами отслойки сетчатки являются тракции со стороны видоизмененного стекловидного тела без формирования разрывов сетчатки. Такое часто бывает при диабетической ретинопатии, опухолях, скоплении жидкости. </p>\r\n<p>Факторами, увеличивающими риск отслойки сетчатки, служат близорукость, астигматизм, дегенеративные изменения глазного дна, хирургические вмешательства на глазах, сахарный диабет, сосудистая патология, беременность, случаи аналогичной патологии у близких родственников и др. </p>",
"pathogenesis": "<p>Образование дырчатого разрыва может быть обусловлено периферической дистрофией сетчатки. При этом в зоне истончения формируются сращения между внутренней оболочкой глазного яблока и стекловидным телом. Данные сращения также могут провоцировать клапанные разрывы. В основе патогенеза лежит попадание коллоидных масс из полости стекловидного тела в пространство между ним и сетчаткой. При этом выраженные сращения являются причиной разрыва и последующей отслойки. </p>\r\n<p>Макулярный разрыв сетчатки травматического генеза возникает при прохождении ударной волны по продольному размеру глазного яблока. </p>\r\n<p>По механизму формирования отслойки сетчатки различают регматогенную (первичную), травматическую и вторичную (экссудативную и тракционную) разновидности. </p>\r\n<ul>\r\n<li>Развитие регматогенной отслойки сетчатки связано с разрывом сетчатой оболочки и попаданием под нее жидкости из стекловидного тела. Данное состояние развивается при истончении сетчатой оболочки в зонах периферических дистрофий. При различных видах дистрофий сетчатки разрыв в дегенеративно измененной области может быть спровоцирован резкими движениями, чрезмерным физическим напряжением, черепно-мозговой травмой, падениями или возникать спонтанно. </li>\r\n<li>Отслойка сетчатки травматического генеза обусловлена травмами глаза (в т. ч. операционными). При этом отслоение сетчатой оболочки может произойти в любое время: непосредственно в момент травмы, стразу после нее или спустя несколько лет. </li>\r\n<li>Возникновение вторичной отслойки сетчатки наблюдается на фоне различных патологических процессов глаза: опухолевых, воспалительных, диабетической ретинопатии, серповидно-клеточной анемии, токсикозах беременности, гипертонической болезни и т. д. </li>\r\n<li>К вторичной экссудативной (серозной) отслойке сетчатки приводит скопление жидкости под сетчаткой. Тракционный механизм отслойки обусловлен натяжением (тракцией) сетчатки фибринозными тяжами или новообразованными сосудами, врастающими в стекловидное тело. </li>\r\n</ul>",
"diagnostics": "<p>Диагностика разрыва и отслоения сетчатки требует следующих исследований: </p>\r\n<ul>\r\n<li>проверка остроты зрения определяет состояние центральной области сетчатки; </li>\r\n<li>исследование бокового зрения (периметрия) для оценки состояния сетчатки на её периферии; </li>\r\n<li>измерение внутриглазного давления (тонометрия); при отслоении сетчатки оно может быть ниже нормы (норма — 16–25 мм ртутного столба); </li>\r\n<li>электрофизиологическое исследование помогает определить жизнеспособность нервных клеток сетчатки и зрительного нерва; </li>\r\n<li>осмотр глазного дна (офтальмоскопия) позволяет точно определить места разрывов сетчатки и их количество, выявить истонченные участки, которые могут привести к возникновению новых очагов болезни; </li>\r\n<li>исследование с помощью ультразвука помогает получить информацию о размерах отслоившейся сетчатки и состоянии стекловидного тела. Это исследование особенно важно при помутнениях роговицы, хрусталика или стекловидного тела, когда увидеть сетчатку невозможно. </li>\r\n</ul>",
"treatment": "<p>При незначительном повреждении внутренней оболочки или ламеллярном разрыве пациентам рекомендовано динамическое наблюдение у офтальмолога, т. к. эти дефекты склонны к самостоятельной регрессии. </p>\r\n<p>Цель хирургического лечения при отслоении сетчатки состоит в обнаружении разрыва сетчатки и его закрытия. Для этого вокруг разрыва вызывается воспаление посредством криопексии или лазером) и последующее рубцевание в области разрыва сетчатки. Данная процедура восстанавливает её герметичность. Для улучшения герметизации производится сближение оболочек глазного яблока. В зависимости от конкретного вида отслоения сетчатки проводятся следующие операции: </p>\r\n<ul>\r\n<li>локальное пломбирование в зоне разрыва сетчатки. Проводится в случаях, когда сетчатка отслоилась частично; </li>\r\n<li>круговое пломбирование. Его применяют при полном отслоении сетчатки; </li>\r\n<li>витрэктомия — метод, при котором удаляется изменённое стекловидное тело, вместо него вводится один из препаратов: физиологический раствор, жидкий силикон, перфторуглеродное соединение в виде жидкости или специальный газ, которые изнутри придавливают сетчатку к сосудистой оболочке; </li>\r\n<li>лазерная коагуляция сетчатки для ограничения области разрыва и истонченных участков сетчатки. </li>\r\n</ul>\r\n<p>Комбинация этих вмешательств подбирается индивидуально для каждого пациента и зависит от того, сколько времени прошло с момента появления отслоения сетчатки, какая она по величине, сколько в ней разрывов, где они расположены. </p>\r\n<p>В зависимости от конкретного случая лечение может быть проведено в один или несколько этапов. </p>",
"prevention": "<p>Специфической профилактики разрыва сетчатки не разработано. Неспецифические превентивные меры сводятся к соблюдению правил безопасности на производстве при работе с материалами, требующими ношения защитных очков или каски.</p>\r\n<p>В большинстве случаев отслойку сетчатки возможно предупредить. С этой целью пациентам с миопией, дистрофией сетчатки, сахарным диабетом, травмами головы и глаз необходимо регулярное профилактическое обследование у офтальмолога. Осмотр окулиста входит в стандарт ведения беременностии позволяет предотвратить отслойку сетчатки во время родов. Пациентам групп риска по возникновению отслойки сетчатки противопоказаны тяжелые физические нагрузки, подъем тяжестей, занятия некоторыми видами спорта.</p>",
"clinical_picture": "<p>При полном разрыве сетчатки пациенты предъявляют жалобы на внезапное появление «вспышек света» перед глазами. Данный симптом развивается в связи с натяжением внутренней оболочки глазного яблока или раздражением зрительного нерва. </p>\r\n<p>Частичное повреждение только в редких случаях приводит к развитию фотопсий. При этом они чаще появляются в темном помещении или на фоне эмоционального перенапряжения. В большинстве случаев пациенты не могут указать точное время разрыва сетчатки. В редких случаях заболевание склонно к самостоятельной регрессии с последующим восстановлением зрительных функций. </p>\r\n<p>Для клиники отслойки сетчатки характерно: </p>\r\n<ul>\r\n<li>Появление пелены перед глазом. Пациенты безуспешно пытаются самостоятельно устранить её, промывая глаза чаем или закапывая капли. В этом случае важно запомнить и сказать врачу, с какой стороны первоначально появилась пелена, так как со временем она может увеличиться и занять все поле зрения. </li>\r\n<li>Вспышки в виде искр и молний также являются характерной чертой происходящего отслоения сетчатки. </li>\r\n<li>Искажение рассматриваемых букв, предметов, выпадение из поля зрения их отдельных участков указывает на то, что отслоение захватило центр сетчатки. </li>\r\n</ul>\r\n<p>Иногда пациенты отмечают, что после сна зрение несколько улучшается. Это объясняется тем, что при горизонтальном положении тела сетчатка возвращается на своё место, а когда человек принимает вертикальное положение, она вновь отходит от сосудистой оболочки и дефекты зрения возобновляются. </p>",
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"standard_type": 3,
"danger": 1,
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"parent": null,
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{
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