Cornea dystrophy
Contents:
Description:
Dystrophies (degenerations, a keratopathy) corneas — chronic diseases which cornerstone disturbance of the general or local exchange processes is.
Cornea Dystrophy symptoms:
Allocate primary and secondary dystrophies of a cornea.
Primary dystrophies usually bilateral. Among them the main place is taken by heredo-familial degenerations. The disease begins at children's or youthful age, very slowly progresses owing to what during a long span can remain unnoticed. Sensitivity of a cornea gradually decreases, there are no signs of irritation of an eye and inflammatory changes. At biomicroscopic examination at first reveal very gentle opacifications in the central department of a cornea having an appearance of small small knots, spots or strips. Pathological inclusions in a cornea most often are located in stroma blankets, sometimes subepitelialno. The front and back epithelium, and also elastic membranes of a cornea do not change. Peripheral departments of a cornea can remain transparent, there are no neogenic vessels. By 30 — 40 years decrease in sight becomes noticeable, the cornea epithelium begins to change. Periodic exfoliating of an epithelium causes pain, a photophobia, a nictitating spasm.
Different types of hereditary dystrophies of a cornea differ the friend from an arch generally in a form and an arrangement of focal changes in a cornea. The nodular, spotty, trellised and mixed dystrophies are known. The hereditary nature of these diseases is established at the beginning of the last century.
Edematous dystrophy of a cornea (synonyms: эндотели-альная, endothelial and epithelial, violent, deep dystrophy) can be epithelial both primary, and secondary. Long time the reason of this disease remained the unknown. Now at anybody the fact that primary edematous dystrophy of a cornea arises at insolvency of the barrier function of a single-row layer of cells of a back epithelium caused by dystrophic changes in cells, or their critically small quantity does not raise doubts (less than 500 — 700 cells in 1 mm2).
The mirror biomicroscopy allows to reveal thin initial changes when the cornea is still transparent and there is no hypostasis. They can be diagnosed also at usual biomicroscopy if attentively to examine a back surface of a cornea in a thin light cut. Normal cells of a back epithelium of a cornea are not visible as they are very small. When the quantity of cells considerably decreases, the remained cells are flattened and stretch to close all back surface of a cornea. The sizes of cells increase by 2 — 3 times therefore they can already be seen at biomicroscopy. The back surface of a cornea becomes similar to the misted glass. This phenomenon is called a drop cornea (cornea guttata). There are no ways to change considerably this state, however early diagnosis of harbingers of the approaching disease now allows to plan correctly treatment of the accompanying pathology, for example to choose the method of extraction of a cataract which is most sparing a back surface of a cornea to refuse introduction of an artificial crystalline lens (or to find the necessary model) and that is very important, to charge operation performance to the most experienced surgeon. Having excluded or having reduced an injury of cells of a back epithelium of a cornea, it is possible to remove for several months or years development of edematous dystrophy.
Existence of a symptom of a drop cornea does not mean yet the beginning of a disease (the cornea is transparent and is not thickened), but is the certificate that functionality of cells of a back epithelium of a cornea is close to limit. There is enough loss of a small amount of cells that not closed defects were formed. It can be promoted by infectious diseases, contusions, injuries, especially band operations.
Cornea Dystrophy reasons:
The nature of dystrophies of a cornea can be various: heredo-familial factors, autoimmune, biochemical, neurotrophic changes, injury, effects of inflammatory processes, etc. The initial link of defeat can remain the unknown.
Treatment of Dystrophy of a cornea:
Treatment of heredo-familial dystrophies symptomatic. Appoint the vitamin drops and ointments, drugs improving a cornea trophicity: баларпан, тауфон, adge-bosoms, эмоксипин, Etadenum, Retinolum, gel of a solkoseril, Actovegin; inside accept polyvitamins. Conservative treatment does not stop progressing of a disease. At considerable decrease in sight carry out a layer-by-layer or through keratoplasty. The best optical result is yielded by a through keratoplasty. Heredo-familial dystrophy — the only type of pathology of a cornea which renews in a donor transplant. 5 — 7 years later after operation in a transparent transplant on the periphery there are single small knots or stripes of gentle opacifications, same what were in own cornea. The quantity them slowly increases, sight gradually worsens. In 10 — 15 years it is necessary to make a repeated keratoplasty which in most cases well begets, providing high visual acuity.
Treatment of edematous dystrophy of a cornea in the beginning symptomatic. Appoint antiedematous drugs in installations (glucose, glycerin), and also the vitamin drops and means improving a cornea trophicity (баларпан, глекомен, carnosine, тауфон). When puffiness reaches a cornea epithelium, surely add antibacterial agents in the form of drops and ointments, and also tocopherol Solutio oleosa, gel of a solkoseril, Actovegin, the vitamin ointments improving regeneration of an epithelium. Ointment drugs and medical contact lenses serve as a peculiar bandage for a cornea, protect open nerve terminations from external irritations, take off pain.
Good medical effect low-energy laser stimulation of a cornea an out-of-focus beam gives helium - the neon laser.
