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Ophthalmology Chapter 14 Retinopathy
About Chapter 14 of Ophthalmology Retinopathy, including retinal vascular disease, macular disease, retinal detachment, etc.
Edited at 2023-11-25 18:27:23
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Chapter 14 Retinopathy
Section 1 Overview
In addition to neurons and glial cells, the neurosensory layer also contains the retinal vasculature.
1. Retinal anatomical structure characteristics The retina develops from the neuroectoderm, which forms the optic cup in the early embryonic stage. The inner and outer layers of the optic cup develop and differentiate to form the retinal sensory layer (neuroepithelial layer) and the retinal pigment epithelium (RPE) layer respectively.
2. Characteristics of retinopathy
(1) Manifestations of blood-retina barrier disruption
1. Retinal exudation: Lipids or lipoproteins in the plasma leak out from the retinal blood vessels and are deposited in the retina, appearing yellow. Granules or patches are called hard exudates. Its appearance usually occurs during chronic retinal edema. After the water is gradually absorbed, its shape can be diffuse or localized (annular or semi-annular). In the macular area, it can be arranged in a starburst or fan-shape along the Henle fibers, and thicker plaques can also be formed. deposition.
2. Retinal hemorrhage: ① Deep hemorrhage: comes from the deep capillaries of the retina, and the hemorrhage is located in the outer plexiform layer and inner nuclear layer In between, they are in the shape of small dark red dots. More common in venous damage. ② Superficial bleeding: located in the nerve fiber layer. Blood is arranged along the direction of nerve fibers, mostly in lines Shapes, strips and flames, bright red in color. ③ Preretinal hemorrhage: It is mostly half-moon or hemispherical. ④ Vitreous hemorrhage: A small amount of hemorrhage causes vitreous flake or mass opacity, and a large amount of hemorrhage can cause Completely covers the eyes. ⑤Subretinal hemorrhage: When the hemorrhage is located under the RPE, it appears as a black-gray or black-red ridge with clear borders. Start the fire.
Section 2 Retinal Vascular Disease
—Retinal artery occlusion
Central retinal artery occlusion (CRAO)
clinical manifestations
Sudden painless and significant loss of vision in the affected eye. Some cases have a history of paroxysmal melanoma before the onset. The initial visual acuity of 90% of CRAO eyes is between index and light perception. The pupil of the affected eye is dilated, the direct light reflex is extremely slow, and the indirect light reflex is present. The fundus showed diffuse retinal edema and opacity, especially in the posterior pole. The edema and opacity appeared pale or milky white, and the fovea showed cherry red spots. The retinal arteries and veins become thinner, and in severe cases of obstruction, segmental blood columns can be seen in the retinal arteries and veins.
After a few weeks, the retinal edema and opacity subsided; after 2 weeks, the visual acuity of 80% of the affected eyes improved to above 0.4.
2. Retinal vein occlusion
(1) Central retinal vein occlusion (CRVO)
Clinical manifestations: Most cases occur in one eye, with vision loss to varying degrees. Fundus manifestations are characterized by retinal veins in each quadrant The intraretinal hemorrhage is tortuous and flame-like, distributed along the retinal veins. Optic disc and retinal edema, It is particularly obvious in the macular area, and over time, cystoid macular edema (CME) often forms. According to clinical manifestations And prognosis can be divided into non-ischemic type and ischemic type. Ischemic CRVO is often accompanied by CME, with an incidence of 3 to 4 cases. Iris neovascularization and neovascular glaucoma are prone to occur within a month, and the prognosis is poor.
3. Retinal periphlebitis
Retinal periphlebitis also known as Eales disease
Clinical manifestations: Idiopathic peripheral retinal vaso-occlusive disease.
4. Coats disease
Coats disease is also called retinal telangiectasia.
Clinical manifestations: Large amounts of fluid exudation can cause exudative retinal detachment.
5. Diabetic retinopathy
Diabetic retinopathy (DR) is the most common retinal vascular disease and one of the major causes of blindness in people over 40 years old. There are no conscious symptoms in the early stage. After the lesions develop to the macula, varying degrees of vision loss begin. Retinal microvasculopathy is the basic pathological process of DR:
Treatment: For severe NPDR and PDR, panretinal photocoagulation (PRP) is used. If you have macular edema, For local macular edema, local photocoagulation can be used, and for diffuse and cystoid macular edema, macular grid photocoagulation can be used. Congeal.
Section 3 Macular Disease
1. Central serous chorioretinopathy
1. Cause and pathogenesis: The pathogenesis is currently believed to be serous disease caused by increased choriocapillaris permeability. RPE detachment, which further induces RPE barrier function damage, leading to RPE leakage and Posterior serous retinal detachment.
2.Clinical manifestations
The visual acuity of the affected eye decreases, and the visual objects become darker, deformed, smaller, and farther away, accompanied by a relatively dark area in the center; the foveal reflection disappears.
Most cases heal on their own within 3 to 6 months and their vision recovers, but the distortion and shrinkage of visual objects can last for more than a year.
3. Treatment: No special drug treatment. Glucocorticoids and vasodilators should be contraindicated.
3. Age-related macular degeneration
Most patients with age-related macular degeneration (ARMD) are over 50 years old. The disease occurs in both eyes one after another or at the same time, and the vision is progressively damaged. The disease is the leading cause of irreversible visual impairment in people over 60 years old.
clinical manifestations
(1) Dry ARMD: also known as atrophic or non-neovascular ARMD.
(2) Wet ARMD: also known as exudative or neovascular ARMD. There is yellowish white hardness in the lesion area or at the edge Exudation and drusen. In case of massive bleeding, the bleeding can break through the retina and enter the vitreous body. Produces vitreous hemorrhage.
6. Macular hole
Stage IV is a large hole with posterior vitreous detachment, and the Weiss ring can be seen.
Section 4 Retinal Detachment
rhegmatogenous retinal detachment
Etiology and pathogenesis: There are two major factors in the occurrence of retinal detachment. The most common denaturation that forms pores is lattice like degeneration.
2. Clinical manifestations: In the early stage of the disease, there are floating objects in front of the eyes, flashing lights and curtain-like black shadow (corresponding to the RD area)
3. Treatment principle: seal the hole and reset the retina.
Section 5 Retinitis Pigmentosa
Primary retinitis pigmentosa (RP) is a group of genetic eye diseases that are dystrophic degenerative diseases of photoreceptor cells and pigment epithelium (RPE). Clinically, it is characterized by night blindness, progressive visual field narrowing, pigmentary retinopathy, and photoreceptor dysfunction (ERC examination). It usually occurs in both eyes, but rarely in one eye.
Clinical manifestations: ① Night blindness is the earliest manifestation and becomes progressively worse. ②Fundus: The optic disc is waxy yellow and the retinal blood vessels become thin. The retina is blue-grey, and the equatorial retina There is membranous juxtavascular pigmentation, typically osteocyte-like. Pigmentation changes toward the posterior pole and the development of the serrated edge. ③Affected eyes often have pancake-like opacity under the posterior lens capsule.
Diagnosis: Visual field examination: Late stage formation of tubular visual fields.
Section 6 Retinoblastoma
Retinoblastoma (RB) is the most common intraocular malignant tumor in infants and young children.
Clinical manifestations: Fundus examination shows round or oval gray-white solid raised masses with unclear boundaries on the retina, which can bulge toward the vitreous body or grow flat along the choroid.