Macular rupture is a disease accompanied by the formation of a defect in the macular region of the retina. In the initial stages, it is asymptomatic. Clinical manifestations are found only at late stages in the form of a sharp decrease in visual acuity, the formation of a dark spot in the central part of the visual field and the appearance of metamorphopsies. Both standard examinations (visometry, tonometry, biomicroscopy) and additional techniques (ultrasound of the eye, fluorescence angiography, optical coherence tomography) are used for diagnosis. Treatment is only surgical, various vitreoectomy techniques are used.
Macular rupture is a pathological condition of the retina of the eye, in which the tension of the preretinal layers of the vitreous body forms a defect in the macular region, leading to a sharp decrease in vision. The macula is the central part of the retinal membrane of the eye responsible for central vision. It is visualized as a yellow spot with a diameter of no more than 2 mm. A gap in the macula is considered a common cause of persistent and irreversible vision loss among people over 60 years of age. For the first time in ophthalmology, this pathology was described in Germany in 1869. Prevalence in the general population: 0.07 0.2% — among people over 40 years old, and 0.8% of cases — among people over 75 years old. It occurs mainly in women. The process flow is two-way. The disease is disabling and significantly reduces the quality of life of patients.
The leading role in the pathogenesis of macular rupture is played by traction occurring on the posterior surface of the vitreous body (CT). At the initial stages of the formation of the macular rupture, a partial detachment of the CT is formed, in which the attachment of the vitreal cord to the exit site of the optic nerve and in the foveolar region is preserved. This condition of the vitreous body causes a direct traction effect on the macular part of the retina and is the main cause of the formation of a defect in the macula.
Risk factors for the development of macular rupture include old age (age-related changes in the structure of the vitreous body occur), eye and head injuries (may cause the formation of a macular defect as a result of the separation of the vitreal cord), high-grade degenerative myopia, heavy physical exertion, the presence of hypertension and particular stressful situations.
Depending on the pathological changes in the macula , the following stages are distinguished:
- The stage of pre-rupture. It is the initial phase of the formation of a defect in the macula, when the foveolar retina is stretched under the action of traction from the posterior boundary membrane of the vitreous body. The so-called intraretinal cyst is formed.
- The stage of lamellar rupture. There is a further lesion of the macular region of the retina of the eye with the preservation of the photoreceptor layer. Lamellar ruptures are formed in 2 stages: first, an interstitial cyst is formed between the layers of the retina of the eye (the inner nuclear and outer layer of Henle fibers), then, under the influence of traction, one of the walls of the cyst is torn off, a non-penetrating tear occurs in the macular region.
- The stage of macular rupture (through defect). It is determined by the presence of a hole in the macular region of the retina of a rounded shape, most often accompanied by the formation of subretinal edema around the macular defect.
Symptoms and diagnosis
Clinical manifestations of macular rupture depend on the stage of the disease. At the stage of pre-rupture, the patient usually does not make any complaints. Pathology is detected by chance and is more often found in patients with a defect in the macula in the other eye. At the stage of lamellar rupture, there is a slight decrease in visual acuity, metamorphopsias appear (violation of the perception of shapes and sizes of objects in space). Patients, as a rule, turn to an ophthalmologist at the end-to-end rupture stage, when visual acuity is persistently reduced to hundredths or light projection, or when an absolute scotoma appears in the center of the visual field (the absence of vision in a certain area is perceived as a black spot).
Standard examination methods are used for diagnosis: visometry, tonography, ophthalmoscopy, biomicroscopy using a slit lamp. Of the additional methods, computer perimetry is used (to determine defects in the field of vision) and ultrasound of the eye (to diagnose changes in the vitreous body). Fluorescence angiography reveals the affected area of hyperfluorescence and the site of rupture. Optical coherence tomography of the macula is the gold standard for this pathology. Allows you to accurately visualize changes in the thickness of the macular region of the retina and determine the size of the macular tear.
Treatment and prevention
Treatment is only surgical. Vitreoretinal interventions are used in combination with removal of the internal hyaloid membrane of the retina and subsequent filling of the vitreal cavity with air or gas. Traditional vitrectomy is characterized by the removal of several layers of the vitreous body and the internal hyaloid plate, followed by the introduction of a special gas. With ruptures in the macula of more than 500 microns, silicone tamponade of the vitreoretinal cavity is recommended. In the postoperative period, the patient must be in a downward position. With successful surgery, a significant increase in vision is observed in 70% of patients. Complications with macular ruptures may occur as a result of vitrectomy. They manifest themselves in the form of total retinal detachment, the formation of defects in the field of vision or the development of cataracts.
Prevention of macular ruptures consists in regular visits to an ophthalmologist, especially after 60 years. In the presence of high-grade myopia, heavy physical exertion, stressful situations at work and at home should be excluded as much as possible. With an increase in blood pressure, it is recommended to take medications to stabilize it. Eye and head injuries should be avoided. After successful treatment of a macular rupture, it is necessary to be regularly monitored by an ophthalmologist for the timely detection of possible new ruptures.