Операция близорукости

механизм

Близорукость чаще всего из-за слишком длинного глаза. Фокусировка изображения удаленного объекта формируется таким образом в передней части сетчатки и дальнего видения размыто. К минусам, зрение вблизи ясна. Это позволяет читать без очков. Чем сильнее она больше текста следует сравнивать. В нормальном глазу дальней точке (которая является дальняя точка глаза можно увидеть нетто) находится на бесконечности. Для близорукого глаза близка с точностью до 5 метров. Это расстояние чистое воспроизведение обратно пропорциональна близорукости. Например, до -3 диоптрий составляет 0,33 м до – 5 диоптрий дальней точке составляет 0,20 м.

эволюция

Близорукость обычно появляется в детском возрасте до 6-8 лет и прогрессирует до возраста 20-25 лет, а затем стабилизируется. Однако иногда это может появиться раньше (неонатальный или врожденный близорукость) или, вернее, позже, через 20 лет или стабилизации ранее. Чем больше она начинается в ближайшее время он будет более прогрессивным и важным. Различают две формы близорукости существуют: один, который развивается постепенно 30 лет, другой постоянный рост до 60 лет. Обычно встречаются близорукость не является болезнью. Только высокая близорукость является реальным “близорукость болезнь”, которая сопровождается постепенным ростом размера глаз на протяжении всей жизни и основных изменений зрительной сетчатки.
Близорукость не сохраняет пресбиопии. Близоруким страдает от дальнозоркости затуманенное зрение при ношении очки для чтения с расстояния. К минусам, когда он уйдет, он может играть на различном расстоянии в зависимости от тяжести миопии рекомендуемом становится дальнозоркостью после другого или, ложно, что близорукость становится лучше с возрастом.

знаки

Близорукость слово происходит от сокращения двух греческих слов muein (Закрыть) и OPS (глаз). Взрослый раздражением в далеком видении красноречив. Низкий уровень близоруких может улучшить зрение вдаль, щурясь. В диагностике ребенок может быть более сложным, большинство детей не жалуются этого дефекта. Поэтому важно проводить регулярные осмотры глаз. Близорукость можно обнаружить с помощью учителей, которые находят трудности зрения вдаль к столу. Будучи ближе к своим книгам или телевизор может также вызвать. Это также может произойти позже в студента, который до сих пор хорошее зрение.
mekhanizm

Blizorukost’ chashche vsego iz-za slishkom dlinnogo glaza. Fokusirovka izobrazheniya udalennogo ob”yekta formiruyetsya takim obrazom v peredney chasti setchatki i dal’nego videniya razmyto. K minusam, zreniye vblizi yasna. Eto pozvolyayet chitat’ bez ochkov. Chem sil’neye ona bol’she teksta sleduyet sravnivat’. V normal’nom glazu dal’ney tochke (kotoraya yavlyayetsya dal’nyaya tochka glaza mozhno uvidet’ netto) nakhoditsya na beskonechnosti. Dlya blizorukogo glaza blizka s tochnost’yu do 5 metrov. Eto rasstoyaniye chistoye vosproizvedeniye obratno proportsional’na blizorukosti. Naprimer, do -3 dioptriy sostavlyayet 0,33 m do – 5 dioptriy dal’ney tochke sostavlyayet 0,20 m.

evolyutsiya

Blizorukost’ obychno poyavlyayetsya v detskom vozraste do 6-8 let i progressiruyet do vozrasta 20-25 let, a zatem stabiliziruyetsya. Odnako inogda eto mozhet poyavit’sya ran’she (neonatal’nyy ili vrozhdennyy blizorukost’) ili, verneye, pozzhe, cherez 20 let ili stabilizatsii raneye. Chem bol’she ona nachinayetsya v blizhaysheye vremya on budet boleye progressivnym i vazhnym. Razlichayut dve formy blizorukosti sushchestvuyut: odin, kotoryy razvivayetsya postepenno 30 let, drugoy postoyannyy rost do 60 let. Obychno vstrechayutsya blizorukost’ ne yavlyayetsya bolezn’yu. Tol’ko vysokaya blizorukost’ yavlyayetsya real’nym “blizorukost’ bolezn'”, kotoraya soprovozhdayetsya postepennym rostom razmera glaz na protyazhenii vsey zhizni i osnovnykh izmeneniy zritel’noy setchatki.
Blizorukost’ ne sokhranyayet presbiopii. Blizorukim stradayet ot dal’nozorkosti zatumanennoye zreniye pri noshenii ochki dlya chteniya s rasstoyaniya. K minusam, kogda on uydet, on mozhet igrat’ na razlichnom rasstoyanii v zavisimosti ot tyazhesti miopii rekomenduyemom stanovitsya dal’nozorkost’yu posle drugogo ili, lozhno, chto blizorukost’ stanovitsya luchshe s vozrastom.

znaki

Blizorukost’ slovo proiskhodit ot sokrashcheniya dvukh grecheskikh slov muein (Zakryt’) i OPS (glaz). Vzroslyy razdrazheniyem v dalekom videnii krasnorechiv. Nizkiy uroven’ blizorukikh mozhet uluchshit’ zreniye vdal’, shchuryas’. V diagnostike rebenok mozhet byt’ boleye slozhnym, bol’shinstvo detey ne zhaluyutsya etogo defekta. Poetomu vazhno provodit’ regulyarnyye osmotry glaz. Blizorukost’ mozhno obnaruzhit’ s pomoshch’yu uchiteley, kotoryye nakhodyat trudnosti zreniya vdal’ k stolu. Buduchi blizhe k svoim knigam ili televizor mozhet takzhe vyzvat’. Eto takzhe mozhet proizoyti pozzhe v studenta, kotoryy do sikh por khorosheye zreniye.

Измерение близорукость

Это может быть выражено либо путем шифрования необходимой коррекции в диоптриях (число предшествует знак минус для близорукости) или шифровать острота зрения в десятых долях.
– Диоптр представляет мощность корректирующие линзы на месте перед глазами, чтобы он мог видеть, лучше всего. Это соответствует цифрам, отмеченных по рецепту очки. Например, близорукость -1 диоптрии может ясно видеть без очков объектов, расположенных на расстоянии одного метра, но который расположен дальше размыта. Он нуждается в стакан -1 диоптрии, чтобы увидеть сеть.
– Десятый представляют размер букв считывать. Они измеряют остроту зрения. Другие буквы маленькие читать далее десятые увеличение.

Существует приближенное соотношение между диоптрий, измеряющих важность близорукости и десятые, которые измеряют зрение без коррекции:
• Для 0 диоптрий близорукости, острота зрения 10/10 десятые
• To – 0,75 диоптрии, острота зрения составляет от 5 до 7/10 десятые
• To – 1,50 диоптрии, острота зрения от 2 до 4/10 десятые
• To – 2,50 диоптрии, острота зрения 1/10 десятые
• To – 3.00 диоптрии, острота зрения менее 1/10 десятых долей
• To – 6,00 диоптрий, острота зрения менее 1/20

– Близорукость низкая от -1 до -3 диоптрий (около трети близоруких), в среднем от -3 до -6 диоптрии (примерно две трети близоруких), за высокой (5% близоруких), очень редко выше -20 диоптрий.
– Как вы можете видеть, видение не поддается количественному определению в десятые для средней миопии более чем -3 диоптрий.
– К тому же каждый десятый не имеет такое же значение: есть большая разница в видении между 1/10 и 2/10 между 7/10 и 10/10.
– Теоретически это возможно иметь остроту зрения до 10/10, т.е. десятые 12/10 15/10 десятых десятые или 20/10 десятые.
– Даже несмотря на высокую близорукость исправлен редко достигается 10/10 десятые (относительно амблиопии).
– The анизометропия определяется разницей более чем одного диоптрий между глазами. Близорукий анизометропия более 5 диоптрий у детей вызывает амблиопии есть снижение развития остроты зрения по умолчанию корковых зрительных клеток. Это амблиопии считается необратимым, когда она не была исправлена ​​в детстве (обычно в возрасте до 5). Рецептурные очки затем остается неэффективной и ограниченный острота зрения, несмотря на средства коррекции.

Причины близорукости

• генетические факторы.
Близорукость частично генетические и часто появляется в семьях, где есть близоруким иногда поколение скачок. Ребенок больше риск, если один из родителей является близоруким (риск около 3), и даже если оба родителя близоруки (риск 2), половина из близоруким близоруким есть брат или сестра. Исследования, проведенные на наборах монозиготных близнецов (которые, следовательно, одни и те же генетические) также установили генетическое влияние. Это менее важно в дизиготных близнецов, они разделяют ту же среду. Режим генетической передачи до сих пор неясно, но были обнаружены несколько генов, связанных с миопией. Ген идентифицирован в 2010 году имеет решающее значение для функции сетчатки глаза и визуальной консолидации памяти. Это открытие генетического происхождения особенно интересен тем, что глаз является органом выбора для генной терапии. Действительно, тот факт, что она имеет малый объем, и она замкнута позволяет обрабатывать по-прежнему находится в пределах в сильно концентрированном объеме. Другим затруднением была подчеркнута в популяциях японской и китайской близоруких.
Остается определить фактор, ответственный за структурные изменения в близоруких глаз трудно разработать эффективную профилактическое лечение по отношению visde ухудшая близорукости и ее слепящие осложнений.

• Экологические факторы.
Увеличение распространенности близорукости в последние десятилетия, кажется, в первую очередь связано с факторами окружающей среды: сокращение времени, затрачиваемого на открытом воздухе деятельности и активизировать деятельность в ближайшем зрения при искусственном освещении. Генетические факторы, вовлеченные в близорукости не являются, по сути, может вызвать такое быстрое изменение распространенности. Постепенное увеличение в инструкции и деятельности в ближайшем зрения искать жилье с одной стороны, а с другой majorise воздействием искусственного света. Там появляется информация петля обратной связи визуально-рост глаза “, что приведет к тому глаз модулировать рост в зависимости от качества получаемого изображения. Таким образом, в случае зрения вблизи отливки осевую длину глаза возрастает. У животных в период роста экспериментальной близорукость может быть создано путем лишения изображения закупоркой глазом. Это явление может быть частично обратимыми в зависимости от продолжительности эксперимента. Изменение размера глаза сопровождается изменением структуры склеры.
– Первое предположение состоит в том, что вероятность стать близоруким пропорционально отработанному времени или сосредоточиться на близких объектах (чтение, компьютер, телевизор, видеоигры). Близорукость растет в промышленно развитых странах, с уровнем экономической, социальной и образовательной, количество лет учебы и работы в ближайшем зрения. Она пропорциональна средней суточной продолжительности этого видения гораздо ближе, добивается чтения, точность работы или на экранах компьютеров. Близорукие, как правило, более образованные, более интеллектуальным, умнее, согласно некоторым исследованиям IQ в близорукости. Является ли это следствием близорукости, возбуждающие чтение или плотно работать, а не спортом на открытом воздухе или фактором, способствующим увеличению спроса на жилье во время чтения? Обе гипотезы были выдвинуты. Во втором случае, противоядие будет смотреть в сторону, на открытом воздухе.
Роль расфокусировки было предложено: чтобы компенсировать фокусировку зрения на центральной сетчатки при близорукости, есть расфокусировки в периферической сетчатки, склеры фактор роста глазного яблока.
Под-коррекции близорукости может привести к удлинению глазного яблока.
• В недавней статье (Lancet, 2012) подчеркивает еще один фактор риска: отсутствие естественного света. Нейротрансмиттер производится в сетчатке в ответ на свет, допамин играет роль избежать чрезмерного роста глаз в детском возрасте. Если расходы часов читать, играть или работать на компьютере или смартфоне способствует близорукости, это было бы, потому что мы тогда тратить гораздо меньше времени на открытом воздухе при естественном освещении. Профилактика тогда, попросить детей, чтобы провести больше времени на открытом воздухе при естественном освещении. От 2 до 3 часов в день достаточно. См: http://www.ophtalmologie.fr/le-figaro-4mai2012.html
• Еще ​​одно недавнее эпидемиологическое исследование 300000 человек показывает, что дети, рожденные в июне и июле имеют 24% риск в дополнение к развитию близорукости, чем те, кто родился в декабре и январе. Ребенок, родившийся в зимний период будет иметь меньшую тенденцию стать близоруким, что ребенок родился летомГоворили, что из-за воздействия с первых дней жизни от воздействия повышенного естественного света. Тот же вывод был сделан в детей, которые спят с ночью в возрасте до двух лет чаще, чем те, кто спит в темноте. • Близорукость может быть связано с пространственным ограничениям, связанным с закрытой среде, происходящих в тюрьмах или в экипажей подводных лодок. • недавнее австралийское исследование тысяч детей в возрасте от шести до двенадцати лет, что спортивная деятельность на открытом воздухе сопровождалось снижением близорукости; • недавнее исследование показало повышенную распространенность миопии в случае пожилой матери внутриутробной задержки роста и курения во время беременности. • другие причины • кривизна близорукости может быть связано с деформацией кристалла или роговица (кератоконус). • индекс поздним началом близорукость в связи с увеличением показателя преломления линзы, а затем отражает существование катаракте (ядерная катаракта). • близорукость ночь из-за избытка размещения в условиях низкой освещенности. Спазм аккомодации может также привести к ложной близорукости. В этих случаях превышение конвергенции линзы, что создает близорукость. • близорукость иногда из-за лекарства или диабета. В этих случаях réversible.Compte вид этих факторов, испытаний эффективности лечения было предложено, чтобы попытаться замедлить развитие атропин инстилляции, общая оптическая коррекция или с положительными очками, чтобы подавлять рост склеры периферийный порт жестких линз, на открытом воздухе, высокая яркость. Никто не добился убедительного результата, кроме атропина будет лучшим ингибитором роста в мире, но это вызывает неприемлемые побочные эффекты и его эффективность равна нулю по истечении трех лет.

Распространенность миопии

Он растет в последние десятилетия, особенно у детей и подростков. Это явление наблюдается в некоторых регионах (Юго-Восточной Азии, особенно в Японии, Южной Корее и особенно Китай), будут найдены в Северной и Южной Америке, Австралии и даже в Европе. Распространенность миопии в два раза выше среди issuees населения Дальнего Востока, чем на Западе. Близорукость в Азии достигли рекордных уровней: почти 80% населения в некоторых районах в 2012 году явление имеет решающее значение на этом континенте, где мы говорим с точки зрения эпидемий. Число детей растет с Азии, близорукость начинает моложе и мощность выше. На сегодняшний день патогенез не идентифицирован. Генетические и экологические факторы участвуют. Близорукость также выше в городских районах, по результатам исследования, проведенного в Тайване в 1983 и 2000 годах, распространенность в возрасте 12 лет увеличилось там в течение 20 лет с 37% до 61%; было установлено, что число детей с повышенным, а близорукость началось раньше и был сильнее; Кроме того, она встретилась 3 раза в высоко урбанизированных районах, чем в сельской местности.
Последние статистические данные показывают, Соединенным Штатам скорость миопии составила 25% в 1970 году увеличилась до 42% в начале 2000-х во Франции миопии оценивается в 39% населения (данные Национального союза офтальмологи Франции), с преимущественно женскими фигурами видели в других европейских странах и Соединенных Штатах.

Осложнения близорукости

Высокая близорукость делает слабее глаз, чем обычный глаз. Это 4-й причиной нарушения зрения в Европе. Это составляет 5% от близорукости в США и в Западной Европе, 10% в некоторых азиатских странах. Высокая близорукость является дегенеративным заболеванием, прогрессирующее заболевание, близорукость определяется номерами больше -8 диоптрий и длиной осевой (расстояние роговица-сетчатка) больше 26 мм (23 мм для нормального глаза), до 35 мм чрезвычайно высокая близорукость. Удлинение земного шара за счет задней части глаза.
Высокая близорукость является тяжелым заболеванием, поскольку она отражает гораздо больше и, следовательно, глаз, из-за удлинения глазного яблока, сетчатка растягивается, растягивается, поредели, вероятно, рвать. Это плохо орошаемые, питатель слоя, choriocapillaris, в результате чего ему меньше кровотока.

• Вовлечение макулы
Вовлечение макулы, центральной области сетчатки, особенно боялся, потому что это ставит под угрозу зрительной функции центральной сетчатки глаза, то есть, возможности воспроизведения. В дополнение к потере зрения, знак тревоги может вызвать достижение макулы является существование метаморфопсия (деформации линий). ОКТ (оптическая когерентная томография) является фундаментальным исследование, чтобы выделить и следить за состоянием сетчатки в случаях высокой близорукости.
Высокая близорукость может привести к макулярной бледным, близорукие Стафилома (деформация земного шара назад), ломает визуальные слои сетчатки (разрыв мембраны Бруха), глубокий хориоретинальный атрофию, хориоидальной неоваскуляризации.
Fovéoschisis является распространенным явлением. Это связано с наличием intraretinal кист. Это может сопровождаться Epiretinal мембраны, простирающейся сетчатку вперед в то время как staphylome тянется назад макулярной отслойки, слоистый макулярной отверстие частичное или полное и привести к разделению сетчатка.
Хориоретинальная атрофия является частым осложнением приводит к снижению прогрессивного видения.
Макулярной отверстие может также вызвать плохое зрение чтения с деформациями (метаморфопсия). Хирургическое лечение возможно.
Хориоидеи неоваскуляризации отражают проход судов в хориоидеи через сетчатку, вызывая отек и кровотечение макулы. Их можно лечить с помощью сфокусированного аргоновым лазером, фотодинамическая терапия (PDT) или интравитреальных инъекций анти-VEGF.
Значительный прогресс был достигнут в последнее время в диагностике и лечении этих осложнений сетчатки для фотодинамической терапии, анти-ангиогенных факторов и внутриглазной хирургии.

• Вовлечение периферической сетчатки
Периферия сетчатки глаза близоруких должны регулярно контролироваться путем исследования с помощью стекла или зеркала 3 панорамные линзы. Там может быть на периферии сетчатки глаза ограждений, отверстий и слезы, чтобы иметь дело профилактически с аргоновым лазером, чтобы избежать отслоения сетчатки чаще встречается у близорукости.
Важно подчеркнуть, что это не редкость, чтобы найти эти опасные поражения сетчатки, предрасполагающих к отслоению сетчатки, в близорукой субъекта, не встревожены, поскольку не жалуюсь любого нарушения зрения, нет боль, консультант по тривиальным причинам, таким как рецепт пары очков или контактных линз, и, следовательно, требует обработки аргонового лазера в профилактике отслойки сетчатки. Иногда фосфены существуют, вспышки, поплавки, вуали глаз. Если отслойка сетчатки доказано, лечение может быть только хирургическое.

• Плавающие
Близоруким часто жалуются на «покупать» или поплавки мелкие частицы, которые движутся медленно с позицией взгляда. Это явление происходит из-за сжижения и стекловидного структурных изменений с возрастом, но часто встречающиеся ранее в случае миопии. Там нет причин для беспокойства к восприятию поплавки из поплавки нитей … но их внешний вид требует тщательного изучения сетчатки, особенно если эти поплавки увеличиваются или если появляются молнии фиксируется в определенном месте и сохраняются даже с закрытыми глазами. Если есть повреждения периферии сетчатки может быть, вероятно, будет осложнен отслоения сетчатки они должны быть превентивно, обработанного аргонового лазера.

• Катаракта ранее в случае миопии высокой степени, в среднем на десять лет раньше, чем не-близоруких субъекта. Поэтому необходимо действовать раньше, что есть возможность исправить близорукость одновременно.

• Глаукома является гораздо более распространенным в миопии высокой степени (10%), чем в остальной части населения (2%). Он должен быть обнаружен преждевременно, поскольку он может добиться успеха без симпAlarm женного к ухудшению тяжелой и необратимой видения. Это открытая глаукома ничем не примечательный до 6-8 диоптрий. За 8 диоптрий риск развития или обострения глаукомы значительно увеличивается. Диагноз очень трудно из-за сложности анализа миопией высокой степени в оптических дисков и волокон зрительного нерва и дефектов поля зрения.

Коррекция близорукости

Для того, чтобы получить четкое представление, изображение удаленных объектов должны быть сосредоточены на сетчатке. Коррекция близорукости, поэтому для изменения пути световых лучей, так что они сходятся на сетчатке.
• Коррекция может быть сделано с помощью очков, чьи вогнутые стекла расходятся толкает изображение на сетчатке. Более коррекция сильна более близоруким восприятие, что окружает меньше, чем в действительности. Более коррекция, тем выше стекло тяжелый, толстый у края и в конце в центре. Этот неприглядный внешний вид снижается за счет использования показателя преломления стекол позволяет их повышенную прореживания. Субъект имеет выбор индекса стеклянных линз более сильные, более тонкие, но тяжелее или легче пластиковые линзы. Выбор небольшого кадра может ограничить толщину на краю линзы. Более стекло высокий показатель, тем больше форм отражения света на их поверхности. Следовательно, интерес антибликовым покрытием для линз разбавлять.

• Коррекция может быть сделано путем одноразового использования мягких контактных линз (ежедневно или ежемесячно) или традиционных или жестких линз. Линзы позволяют retouver нормальный размер изображения для перемещения ближе коррекции роговицу увеличивает изображение сетчатки глаза. Изображение больше очковой линзы, острота зрения часто лучше, если миопией высокой степени до 2/10 близорукости -8 диоптрий. Визуальное поле является более важным, то есть, что периферийное зрение шире, особенно для высокой миопии. С помощью объектива есть лучше ночного видения за счет увеличения освещенности сетчатки глаза по сравнению с очками (25% -10 D миопии). Обратите внимание, что с определенной степенью миопии (-4 диоптрии) сила объектива меньше, чем сила очковой линзы (например, -7 диоптрий очки соответствует -6.50 диоптрий линзы ).
Ношение проницаемые жесткие линзы кислорода у детей способствует визуальной созреванию, улучшает качество жизни и может замедлить прогрессирование по данным некоторых исследований. Их можно носить с возраста 6-7 лет, если ребенок сотрудничает. Иногда раньше, если высокая близорукость может привести к амблиопии или косоглазия. Мы должны выбрать Трансмиссибильность материал высокого кислорода либо с жесткой линзой или мягкой линзы. Подавляющий эффект жестких линз на разработках обсуждался, хотя и не доказано. Было бы из-за коррекции оптических аберраций стимулирующим сетчатку зрительных клеток и угнетает рост глазного яблока. В будущем могут стать полезными оптическими корректировки, основанные на теории расфокусировки и пара-sympathicolytics лечения.
Распространено наблюдается непереносимость контактных линз носить в течение многих лет, что требует периодического порта или оставления.

• Хирургическая коррекция близорукости может быть сделано с помощью операции миопией изменения кривизны роговицы с помощью эксимерного лазера или, для миопии высокой степени, чтобы разработать имплантат внутри глаза.
Различные текущие операции могут быть выполнены путем вычитания или сложения.
Субтрактивно является «Erase» с помощью эксимерного лазера на поверхности роговицы, чтобы сделать его менее сходящимся. Это абляции ткани роговицы может быть поверхностно (PKR, LASEK, Epi-LASIK) или глубже после подъема лоскут роговицы (обычный LASIK или LASIK фемтосекундный).
Качество зрения пациента является важным понятием, отличается острота зрения. Острота может быть 10/10 и видение низкого качества. Поле зрения означает лучшее представление в ночное время, в туман, дождь, сильный солнечный свет. Лучше восприятие расстояния, рельефа местности, скорости, отсутствие побочных эффектов: ночные ореолы, двоение, помутнение, колеблясь вуали блики.
Операция близорукости увеличивается от стандартной операции, которые каждый пациент был обработан одинаково с точки зрения его количества близорукости хирургии к персонализированным, оптимизировано, в зависимости от каждого конкретного случая.
Можно, чтобы соответствовать профилю каждой обработки, чтобы улучшить качество зрения и избежать побочных эффектов.
Один из методов используется обработка оптических аберраций в связи с роговицы или хрусталика переменной от одного человека к другому. Количественное этих аберраций делается путем изучения волнового фронта, которая исследует нерегулярное поведение каждого луча света, проникающего в глаз и, как это происходит на сетчатке.

Аддитивно, в свою очередь, состоит из введения имплантата
– В передней камере глаза перед радужной оболочки (факичной имплантата) или угловые опоры (слева) из-за осложнений с рого

Статья с сайта http://www.ophtalmologie.fr

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