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Central retinal dystrophy
Medical expert of the article
Last reviewed: 07.07.2025
Involutional macular dystrophy of the retina (synonyms: age-related, senile, central chorioretinal dystrophy, macular dystrophy associated with age; English Age-related macular dystrophy - AMD) is the main cause of vision loss in people over 50 years of age. This is a genetically determined disease with the primary localization of the pathological process in the retinal pigment epithelium, Bruch's membrane and choriocapillaries of the macular region.
Ophthalmoscopically, the following signs are distinguished: drusen (nodular thickening of the basement membrane of the retinal pigment epithelium), pigment (geographical) epithelial atrophy or hyperpigmentation, detachment of the pigment epithelium, subretinal exudates (yellow exudative detachment), hemorrhages, fibrovascular scars, choroidal neovascular membrane, hemorrhages into the vitreous body.
[ Symptoms of Central Retinal Dystrophy
According to pathoanatomical signs, three main forms of dystrophy are distinguished: dominant drusen of Bruch's membrane, non-exudative and exudative forms.
Clinical symptoms include gradual loss of central vision, metamorphopsia, and central scotoma. Drusen are an early clinical manifestation of the disease. Visual impairment occurs with the development of macular dystrophy. Visual acuity correlates with changes in local ERG, while general ERG remains normal. The most common is the dry, or atrophic, form, which is characterized by atrophy of the pigment epithelium. Less common is the exudative, "wet" form, which is characterized by rapid deterioration in visual acuity associated with the development of neovascular membranes, fibrovascular scars, and hemorrhages in the retina and vitreous body. Detachment of the pigment epithelium is often combined with a neovascular membrane and is a sign of the exudative form of age-related central retinal dystrophy.
Dominant drusen of Bruch's membrane is a bilateral disease with an autosomal dominant type of examination, which is asymptomatic. Drusen are located in the macular region peripapillary, rarely - on the periphery of the fundus. They have different shapes, sizes and colors (from yellow to white), and can be surrounded by pigment.
Typical multiple focal areas of limited fine-point late hyperfluorescence are noted on FAG. The question of whether drusen always precede age-related macular degeneration or can be an independent disease remains unclear.
In the non-exudative form of central retinal dystrophy, drusen are found in the macular region and various manifestations of pathology of the retinal pigment epithelium.
Geographic atrophy of the pigment epithelium is represented by separate large depigmented zones through which large choroidal vessels are visible, forming a horseshoe-shaped ring around the foveal area, where xanthophyllic pigment is preserved until the last stage. The risk of neovascular membrane formation is low. Geographic atrophy can develop against the background of medium and large drusen with unclear borders, disappearing, disintegrating or exfoliated retinal pigment epithelium; mineralization of drusen is noted, which in this case resemble shiny bright yellow inclusions.
Non-geographic atrophy has no clear boundaries and appears as fine-point hypopigmentation combined with hyperpigmentation of the pigment epithelium.
Focal hyperpigmentation can be an independent pathology or combined with drusen or adjacent areas of pigment epithelium atrophy and its detachment during neovascularization of the choroid (formation of a neovascular membrane). Ruptures of the pigment epithelium are a complication of retinal detachment and are caused by the resulting tissue tension.
The exudative form of age-related macular degeneration is manifested by exudative detachment of the sensory retina with subretinal hemorrhages and lipid exudation, dirty gray or yellow macular edema (cystoid macular edema), choroidal folds, pigment epithelium detachment, and subretinal fibrosis. Subretinal exudate is usually opaque due to the high concentration of proteins, lipids, blood products, and the presence of fibrin. Thickening and serous detachment of the retinal pigment epithelium occur due to the formation of neovascularization under the pigment epithelium.
Choroidal neovascularization is the growth of blood vessels through Bruch's membrane into the pigment epithelium. Blood, lipids, and plasma leak beneath the neuro- and pigment epithelium. They stimulate fibrosis, which destroys the pigment epithelium and the outer layers of the retina. Lipid peroxidation in the pigment epithelium is thought to induce intraocular neovascularization by releasing cytokines and other growth factors. FAG is helpful in diagnosing choroidal neovascularization.
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Treatment of central retinal dystrophy
Treatment is aimed at slowing down the pathological process. Antioxidants are used primarily for this purpose. Clinical observations show that the use of a- and b-carotene, cryptoxanthin, selenium and other drugs with antioxidant properties slows down the course of central chorioretinal dystrophy. The effect of vitamins E and C is similar. Since zinc, involved in many enzymatic processes of protein and nucleic acid metabolism, is contained in large quantities in the retinal pigment epithelium - choroid complex, it is assumed that taking zinc-containing drugs should also slow down the development of macular dystrophy. A diet rich in fruits and vegetables is recommended.
To prevent destructive processes in the retina, it is necessary to use optical and pharmacological means of protection and prevention, therefore, patients with age-related macular dystrophy are recommended to be prescribed, in addition to antioxidants, vascular drugs and lipotropic agents, and to wear light-protective glasses.
In the exudative form of the disease, laser photocoagulation is performed, based on the results of FAG diagnostics.
Choroidal neovascular membranes and subretinal hemorrhages are removed surgically. Currently, operations for transplantation of pigment epithelium and photoreceptor layer of the retina are being developed. Positive results of photodynamic therapy have been obtained in patients with subfoveal choroidal neovascularization. The disease is chronic, progresses slowly and leads to a decrease in visual acuity.