Fibrosis is a pathological condition caused by an inflammatory process or mechanical damage, in which excessive growth of connective tissue in organs occurs - scarring. It is always the outcome of a previously suffered disease. For example, with pulmonary fibrosis, adhesions form in the alveoli, which are responsible for gas exchange and normally should be filled with oxygen. This does not happen with fibrosis. Thus, the functional vital capacity of the respiratory organ is reduced. Cardiac fibrosis occurs after myocardial infarction and can cause heart failure in the patient in the future.
Fibrosis is a physiologically justified reaction of the body, which is a consequence of damage to healthy tissue, disruption of blood circulation and its innervation. Scar tissue is tougher because it consists of fibrillar collagen protein and amorphous substance. Fibrosis is considered a pathological process, since connective scar tissue differs in its morphology, and its excessive growth in organs leads to disruption of their vital functions.
The causes of fibrosis of organs, ligaments and muscles can be a variety of past diseases (including infectious ones), injuries, surgeries, and allergic reactions. Fibrosis is the outcome of a disease or mechanical damage, so it does not manifest itself immediately, but within 1-2 months. The process can continue for a long time, and pathological changes are almost irreversible. Therefore, it is necessary to first identify the cause of fibrosis and begin timely treatment to reduce the progression of fibrotic changes.
General information
Epimacular fibrosis is a slowly progressive age-related pathology that causes severe visual impairment. A characteristic feature is the presence of an epiretinal membrane (thin film), localized mainly in the central region of the retina. Because of this, the most characteristic symptom is a decrease in visual acuity, but there are other manifestations of the pathology.
The exact cause of the development of epimacular fibrosis is unknown. Risk factors for the development of the disease include previous eye injuries, surgical interventions, pathological systemic changes, etc.
Statistics indicate that epimacular fibrosis develops more often in older people.
Thus, in a sample of patients under the age of 50 years, the incidence of the disease does not exceed 2%. In persons aged 75 years - 20%.
Now the relevance of the issue of timely diagnosis and selection of the most effective treatment method is increasing.
At the moment, only surgical intervention is an adequate treatment tactic with a pronounced positive effect.
Why does fibrosis form after fillers?
After injections, compactions are observed in the first days. This is because the drug has not yet been distributed. But, if the lump appears in the form of a lump and lasts for more than a week, then you need to contact your surgeon.
Causes of fibrosis:
- rejection of a foreign substance.
- vascular damage;
- incorrect technique for administering the drug;
- violation of sanitary standards, etc.
Photos before and after thread lifting.
Photo from the website of D.R. Grishkyan. There are contraindications, specialist consultation is required. You can see more before and after photos in the photo gallery
Fibrosis after fillers: what is the danger? David Rubenovich Grishkyan Plastic Surgery Clinic May 8
Etiology
Epimacular fibrosis is a polyetiological and multifactorial disease. The exact cause of the pathology is unknown. However, there is a clear dependence of the frequency of detection of epimacular fibrosis on the age of patients.
There is a direct relationship: the older the patient, the higher the risk of the formation of a pathological epimacular fibrous membrane.
This is due to physiological changes in the eyeball that occur with age.
The main reason for the development of epimacular fibrosis is the detachment of the vitreous substance from the surface of the retina. This is accompanied by microtraumas, as a result of which the formation of connective tissue at the site of injury is activated.
Statistics also show that hypercholesterolemia is a risk factor for the development of epimacular fibrosis. Increased levels of low- and very low-density lipoproteins in the blood contribute to negative structural changes in the vascular wall, in particular in small-caliber vessels that are located in the retina. This disrupts tissue trophism, promotes the appearance of microtraumas, which causes increased formation of connective tissue.
Epimacular fibrosis has been shown to develop more often in people with systemic diseases, e.g. diabetes (diabetic retinopathy), against the background of ophthalmic pathologies (retinal vein occlusion, retinal detachment), after ophthalmic surgery.
There is also an idiopathic form of the disease, the etiology of which is unknown.
Fibrosis of the liver and kidneys
Most often it is a consequence of chronic liver diseases, such as fatty disease, hepatitis (viral, toxic), or other internal organs (coronary heart disease, diabetes mellitus, cholelithiasis). People who abuse alcohol are also predisposed to liver fibrosis. The process of proliferation of connective tissue and scarring of the organ starts every time the primary disease worsens and the liver is exposed to trauma. Over time, an injured and scarred organ may completely lose its functions, and cirrhosis of the liver develops. A liver CT scan is prescribed in conjunction with other examinations and reliably shows the location, size, and density of fibrosis foci.
Kidney fibrosis leads to impaired renal function and chronic renal failure.
Pathogenesis
The bulk of the eyeball is made up of a jelly-like structure - the vitreous body, which is 99% water and occupies 2/3 of the total volume of the eye. Forms the spherical structure of the eye and provides its internal pressure.
With age, the amount of water in the vitreous body gradually decreases. This is a natural physiological process. In this case, a small space may form between the retina and the vitreous body. Often this does not lead to unpleasant consequences and is asymptomatic. But sometimes this leads to microtraumas of the retina.
Damage to the retina activates regeneration processes. Scar tissue is intensively formed, which fits tightly to the retina.
Detachment of the posterior wall of the vitreous contributes to the appearance of microtears in the retina. An epimacular fibrous membrane gradually forms.
Small damage to the internal limiting membrane, which forms after vitreous detachment, provides access for astrocytes to the vitreous cavity. They grow rapidly and also take part in the formation of the epimacular connective tissue membrane.
There is also idiopathic epimacular fibrosis, the origin of which is unclear.
The structure of the epiretinal membrane involves:
- glial cells (in particular fibrous astrocytes);
- macrophages;
- retinal pigment epithelial cells;
Connective tissue structures transmit light rays worse than the transparent media of the eye, so the formed membrane is an obstacle to the passage of light on its way to the retina.
Also, when the shape of the scar tissue changes, the structure of the retina changes (since the connective tissue fits tightly to the retina). This distorts the image projected onto the retinal area of the eye.
If such a connective tissue membrane is formed in the area of the macula, then the acuity of central vision is significantly reduced.
Deterioration in visual acuity depends on the density of fibrous formations and the level of retinal deformation (macular distortion).
Pulmonary fibrosis
Pulmonary fibrosis (pneumofibrosis, pneumosclerosis) is most often the result of pneumonia, tuberculosis, and exposure to allergens, toxic gases and substances in the respiratory tract. The exception is idiopathic pulmonary fibrosis, when it is not possible to determine the cause. Single pulmonary fibrosis, affecting only small areas of the parenchyma, as a rule, does not affect the quality of life, but requires conservative therapy under the supervision of a pulmonologist. Multiple diffuse fibrosis affects several pulmonary lobes and segments, reducing the vital capacity of the lungs. The patient is concerned about shortness of breath, nonproductive cough, and fatigue. For pulmonary fibrosis, dynamic CT monitoring is recommended, especially in the presence of complications.
Symptoms
The nature and severity of pathological symptoms experienced by the patient during the development of epimacular fibrosis mainly depend on:
- Thickness of the connective tissue membrane;
- Deformations of the retina at the site of formation of the fibrous membrane;
- Localization of wrinkling;
- Swelling/detachment of the macula (macula).
Clinical manifestations of the disease develop gradually. The rate of their progression is determined by the time of membrane formation, the frequency of retinal microtraumas, their volume, etc.
The intensity of clinical manifestations varies from a latent or erased course to severe visual impairment.
At the beginning of the development of the disease, a slight deterioration in vision is possible, which is manifested by slight clouding or distortion of the image. Often the initial stage is hidden and asymptomatic, which contributes to the further development of pathology and the increase in pathological manifestations.
Along with the progression of the growth of the epimacular fibrous membrane, visual acuity decreases, the image becomes cloudier, and objects are blurred. However, this happens slowly and the patient practically does not notice the changes. A common complaint is the appearance of slight distortion of objects.
In the case of simultaneous formation of a fibrous membrane and local macular detachment, visual acuity significantly suffers. Even after surgical treatment, complete restoration of visual acuity is rarely observed.
The dynamics of the increase in pathological symptoms are divided into 3 stages:
- Stage 0 membrane. It is characterized by the absence of clinical manifestations or their insignificant intensity due to the translucency of the fibrous epimacular membrane. Such conditions are also called "cellophane maculopathy" due to the cellophane-like reflection from the retina during fundoscopy.
Such a reflection may be the only symptom of the onset of the disease and is diagnosed accidentally during an ophthalmological examination.
- Stage 1 membrane. At this stage, the formation of the fibrous membrane continues and it becomes less transparent. In addition, at the location of the membrane, the inner surface of the retina begins to wrinkle. The twisting of its inner layers in the form of folds resembles the appearance of wrinkled cellophane under ophthalmoscopy. The shrinkage may be severe enough to distort the paramacular vessels. In this case, visual acuity deteriorates significantly.
- Stage 2 membranes. The membranes that develop after surgical interventions for retinal detachment are formed in the form of a thick matte hymen.
In this case, wrinkling of the macula is often accompanied by retinal edema, minor hemorrhages, and rare macular detachments.
Such membranes are called “wrinkled membranes”.
Reasons for the formation of uncontrolled fibrosis:
1. Medical error or poor quality material. This consequence can be eliminated by removing the thread.
2. Wound infection during the rehabilitation period. In this case, antibacterial drugs prescribed by the doctor will help.
3. Formation of hematomas. In this case, the doctor pumps out excess accumulated fluid with a syringe.
Photos before and after thread lifting. Photo from the website of D.R. Grishkyan. There are contraindications, specialist consultation is required
Diagnostics
Optical coherence tomography of the eye
It is carried out to diagnose epimacular fibrosis and determine its stage. It also allows for an objective assessment of the negative effects of the fibrous membrane on the macula, e.g. thickening of the retina in this area, possible traction effects of the vitreous body on the retina.
The method will be used in the postoperative period to monitor the healing and restoration of the architectonics of the retina after surgery.
To carry out treatment, our clinic offers its patients a whole range of modern devices and techniques that guarantee the best results in the shortest possible time.
Endometrial fibrosis, ovarian fibroma
With endometrial fibrosis, the functional uterine mucosa is replaced by connective tissue. Meanwhile, the uterine mucosa plays an important role in the reproductive health and cycle of a woman’s reproductive system. Pathological changes can lead to chronic endometritis with all the consequences.
Ovarian fibroma is a benign neoplasm. When the tumor reaches a large size, it begins to painfully compress surrounding organs and causes bleeding. Large ovarian fibroids are removed surgically, which may subsequently affect reproductive function. However, most often such neoplasms form in women over 40 years of age.
Treatment
Before planning surgical tactics, it is necessary to clearly ensure that epimacular fibrosis is the main cause of visual impairment. To do this, a number of studies are carried out to exclude pathologies with similar manifestations (macular holes, cystoid macular edema, etc.).
Surgical treatment of epimacular fibrosis is not an emergency operation. It is carried out as planned.
There are many surgical methods for treating this disease, but they highlight the main stages:
1. Vitrectomy . At this stage of surgery, the posterior and central regions of the vitreous are removed (if a natural lens is present). If there is an artificial lens, the anterior part of the vitreous is removed.
Advantages of this stage:
- Removing the pressure of the vitreous body on the macula;
- Prevention of vitreous contracture;
- Increased safety of fibrous membrane removal.
Flaws:
- The risk of developing cataracts increases in the first 6 months after surgery.
2. Direct removal of the epiretinal membrane. After finding the outer edge of the fibrous membrane, use thin tweezers to gently lift its edge at an angle. Raising the edge perpendicularly is unacceptable due to the risk of microtears in the retina!
By moving the tweezers in a circle, the surgeon removes it, gradually peeling off the membrane from the periphery to the center.
3. Removal of the internal limiting membrane.
4. Treatment of retinal microtears. After removing the fibrous membrane, the inner surface of the retina is carefully examined to identify any damage or tears. After determining their location, the surgeon performs laser retinopexy or cryoretinopexy (if the ruptures are not burdened by the accumulation of subretinal fluid).
If there is such an accumulation, then internal drainage is performed under gas tamponade or air pressure.
In the postoperative period, a binocular bandage is made, which provides favorable conditions for the healing of surgical wounds.
Periodic examinations and consultations with an ophthalmologist are necessary to monitor retinal recovery and timely diagnosis of complications, if any.
Our prices
The cost of treatment depends on the chosen method (hardware or surgical), the number of recommended procedures, etc. Comprehensive examination in our clinic from 4,000 rubles. Prices for all types of diagnostic tests, procedures using devices and surgical interventions can be found here.
You can find out all the details you are interested in, prices for services and sign up for a consultation with a specialist by calling: 8(800)777-38-81 (toll-free call for all phones in the Russian Federation) and the Moscow number or online, using the appropriate form on the website.
Fibrosis of muscles and ligaments
Muscle fibrosis occurs due to mechanical damage or as a reaction to inflammation. Moreover, any strong spasm or muscle tension can be a prerequisite for the formation of an inflammatory focus. As a result of fibrous compaction, muscle tissue loses the ability to contract, conduct nerve impulses and move.
The ligaments themselves consist of dense fibrous tissue, but its hyperplasia leads to impaired joint mobility, pain, and impaired biomechanics.