Download - Diseases of Retina
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DISEASES OF RETINADISEASES OF RETINA
Zhong xin
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Anatomy of Retina:Anatomy of Retina:
Thin, semitransparent, inner layer
of the wall of the eyeball.
Anterior magin: ora serrata
ciliary bodyPosterio magin: round the optic
disc
outside: closely neighbors with the
choroid
inside: vitreous
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Anatomy of Retina (Histology):Anatomy of Retina (Histology):
10 layers, Retina pigment epithelium(RPE) are
firmly bound to Bruchs menbrane(basement
membrane of the RPE, its outside is choroid),
RPE : tidy arranged, hexagonal cells, transportnourishment from the choroid to the external layer
of the retina(5 layer)
Photoreceptor layer ( rod and cone) separate from
the RPE layer --Retina detechment.
Visual message visual never pulse.transmittedby 3 neurons: Photoreceptor - bipolar cell
ganglion cell.
Photoreceptor cells : Rods (function)dark vision
Conesstrong light and color
vision
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Anatomy of Retina:Anatomy of Retina:
Macula: the center of the posterior retina
no blood vessel
Fovea: the center of the macula
only cones
Optic disc: 4mm lateral to the fovea
no photoreceptor cells
The central retinal artery: from ocular
artery The central retinal vein
Peripheral retina:
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Examine the Retina:Examine the Retina: Direct ophthalmoscopy
Indirect ophthalmoscopy
Goldman three-mirror lens
Fundus photography
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Examine the Retina:Examine the Retina:
Fundus Fluorescen
Angiography(FFA)take pictures
Idocyanine green angiography(ICG)
Electrophysiologic testing
ERGF-ERG :reflect various
retinopathies
--P-ERG :reflect never ganglion
cell layer
EOGreflect the diseases of RPE
VEPabove the ganglion cells
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Diseases of the Retina:Diseases of the Retina: Retinal vascular diseases:
Retinal artery occlusion (Central , CRAO; Branch BRAO)
Retinal vein occlusion (CRVO; BRVO)
Diabetic retinopathy (DR)
Diseases of the macula:
Age- related macular degeneration ( AMD)
Diseases of the peripheral retina:Retina detachment (RD)
Tumors of the retina:
Retinoblastoma(RB)
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Retinal artery occlusion:Retinal artery occlusion:Pathogeny: Narrow blood vessel and spasm
vascular inflammation
Operation of RD or intraorbital
operation(sometimes)
Arteriosclerosis
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Retinal artery occlusion clinical finding:Retinal artery occlusion clinical finding:
Not common but very seriousprognosis
Two types:
Central, branch
History: Painless catastrophic visual loss occurring over a
period of seconds for one eye
Antecedent transient visual loss
Examination: Visual acuity :
between counting fingers and light perception
(no light perception)
Light reflex of pupil:
direct: ill eyedisappears
indirect: ill eyeexists
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Retinal artery occlusion clinical finding:Retinal artery occlusion clinical finding:
Examination: Fundus: (Ophthalmoscopically)
1. The superficial retina becomes opacitied(The
inner layer loses transparence to become grayish-
white edema due to ischemia).2. Cherry-red spot: in the foveola
Because the retina in macular area is
thinnerand without inner layer,so the edema is no
obvious.The choroidal red background
3. BARO: The retina in distributed area of theartery is in grayish(retina edema)
4. Retinal artery becomes narrow, with segmental
fluxion of the blood
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Retinal artery occlusion clinical finding:Retinal artery occlusion clinical finding:
FFA The filling time of retinal artery is prolonged
The fluorecein is no filling in obstructed blood
vessel or filling peak prolonged than the others
A few cases: see doctor quite lateIn FFA, the sign of artery occlusion may not
be seen,but the fundus change is very typical
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Retinal artery occlusion clinical finding:Retinal artery occlusion clinical finding:
After few weeks: The function of the retina lost almost at all.
The retina restores to transparency, but the
ganglions and nerve fibers at occlusion area are
dead. Optic atrophy and pale of the disk may be
appeared in the trunk occlusion(CRAO)
FFA: Artery blood flow had been restored to
unobstructed, but the filling peak prolong than
the other eye or other branch Some fundus are normal
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Retinal artery occlusion Treatment:Retinal artery occlusion Treatment:
Retina ischemia is longer than 90 minutes:
retina damage is irreversible (photoreceptordie)
When diagnosis is clear:
1. Massage eyeball by himself at once: Close the
eye--use the finger --press the eyeball forseconds--than loose finger for seconds--repeat.
2. Anterior chamber paracentesis(puncture)
3. Inhalation with mixed gas(95%oxygen+5%carbon),10 minutes every hour
4. Or inhalation of isoamyl nitrite5. Retrobubar injection:
drugs:Tolazoline, papaverine(with the use ofpromote angiectasis )
6. Treat systemic disorder:carotid and heartsystem(risk of cerebral infarction)
7. It must performed within 8 hours
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Retinal vein occlusion:Retinal vein occlusion: Common fundus disease
Pathogeny: Extravascular compression: retina arterycompress the neighbor vein at the
arteriobenous crossing
Insufficient perfusion pressure or increased
intraocular pressure or high blood viscosity.1.Olds with hypertension and arteriosclerosis is
commonly seen
2. Often complicated by insufficient blood
erythrocytosis, glaucoma,diabetes,etc.
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Retinal vein occlusion clinical finding:Retinal vein occlusion clinical finding:
Two types:BRVO is much commonthan CRVO
Clinical finding Depend on
the types
Easily diagnose
With potentially blinding
complication
History:sudden painless loss ofvision,often at about 0.1
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Retinal vein occlusion clinical finding:Retinal vein occlusion clinical finding:
FundusVaries from a few small scattered retinal
hemorrhages and cotton-wool sports to a
marked hemorrhagic appearance with bothdeep and break through into vitreous cavity.
Retinal vein dilated tortuous with deep color
Hemorrhages flame-shape
Optic diskedema(severe cases)
Yellowish-white hard lipid exudatescystoid
macular edema(CMD)with long ill course
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Retinal vein occlusion FFA:Retinal vein occlusion FFA:
Ischemia:capillary occlusion in large area
leading to extensive retinal ischemia
Non-ischemia:prognosis is quite good Venous vascular wallsstaining(In later stage of
FFA)
Retinal neovascularizationflourescein leakage
Defilade
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Retinal vein occlusion FFA:Retinal vein occlusion FFA:
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Retinal vein occlusion treatment:Retinal vein occlusion treatment:
*Isnt specific therapy for RVO
*Chinese traditional medicine
*Careful follow-up evaluation is warranted*When develop anterior sgment
neovascularization,than prompt panretinal laser
photocoagulation
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Retinal detechment:Retinal detechment:
Retinal detechment:Separation of thesensory retina(photoreceptors) and
retinal pigment epithelium(RPE)
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Posterior vitreous detechment:Posterior vitreous detechment:
Normal vitreous is bounded by the retina,optic
disk,pars plana, zonule,and lens.
Its firmly attached to the retina and pars plana
near the ora serrata
Support the retina
With age,the center of the vitreous may undergo
syneresis and become filled with liquid.The liquid
contents of the cavity can migrate into the
preretinal space .The heavier vitreous gel
collapses. Vitreous shrinkage:
Vitreoretinal tractionretinal tear
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Retinal detechment:Retinal detechment:
Three main types:
Rhegmatogenous detechment Traction detechment
Serous or hemorrhagic detachment
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Rhegmatogenous retinal detechment:Rhegmatogenous retinal detechment:
Most common of the three types
Tear: full-thickness break in sensory retinahorseshoe tear,round atrophic hole,etc
Variable degrees of vitreous traction
Liquefied vitreous through the sensory retinadefect(tear) into the subretinal space
Usually accompanied by a posterior vitreous
detachment
Myopia,ocular trauma,aphakia associated with
this type
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Rhegmatogenous retinal detachment treatment:Rhegmatogenous retinal detachment treatment:
Close the hole(key)
Cryotherapy
Laser photocoagulation
surgery
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Rhegmatogenous retinal detechment:Rhegmatogenous retinal detechment:
Most common of the three types
Tear: full-thickness break in sensory retinahorseshoe tear,round atrophic hole,etc
Variable degrees of vitreous traction
Liquefied vitreous through the sensory retinadefect(tear) into the subretinal space
Usually accompanied by a posterior vitreous
detachment
Myopia,ocular trauma,aphakia associated with
this type
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Retinoblastoma(RB)Retinoblastoma(RB)
RB is a rare(morbidity rate is 1/15000-1/28000) but life-endangering
tumor of childhood.Two-thirds of cases appear before the end of
third year. Bilateral disease occurs in 30% of cases.
Generally a sign of heritable disease.An allele within chromosomal
band 13q14(band 14of iong arm of chromosome) controls both the
heritable and nonheritablefrms of the tumor. Gene defect orinactivation----tumor happen.
Tumor suppressor genes
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Retinoblastoma(RB) clinical findings:Retinoblastoma(RB) clinical findings:
RB be divided into 4 stages:
Intraocular
Gloucomatous intraocular pressure increase Extraocular-
Metastatic
Early symptom isnt obvious
Tumor has developed to the posterior pole
Yellowish-white reflex at pupil
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Retinoblastoma(RB) clinical findings:Retinoblastoma(RB) clinical findings:
B-scan ultrasonic
MRI
X-ray: show calcific focus in the tumor
CT
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Retinoblastoma(RB) treatment:Retinoblastoma(RB) treatment:
First of all, Rescue the babys life
Then saved the eyeball
Laser photocoagulation or cryotherapysmall tumor, localized at the
retina, early stage, make the tumor necrosis and atrophy
Radiotherapy of sclera60Co, 125I
Enucleationover a quadrant, Operative manipulation should be gentle;cutting of the optic nerve should be as long as can(should not less than 10mm)
Evisceration of orbit combined with radiotherapy orchemotherapy
extraocular stage, prognosis is quit worse
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Retinoblastoma(RB) prevention:Retinoblastoma(RB) prevention:
Not effective prebentive
High-risk family(got RB)for every nweborn baby should examine
the fundus with mydriasis
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Diabetic retinopathy(RD)Diabetic retinopathy(RD)
Diabetic patient
Damage of pericyte and endothelial cell of retinal capillary
One of the leading causes of blindness in the Western world
Two types: nonproliferative diabetic retinopathy
proliferative diabetic retinopathy
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Diabetic retinopathy(RD)Diabetic retinopathy(RD)Microvascularthe capillaries develop tiny dot-like outpouchings,while theretinal veins become dilated and tortuous.
Cotton-wool spot
Hemorrhages
Macular edemamost frequent cause of visual loss among patients withbackground diabetic retinopathy.It caused primarily by a breakdown of the inner
blood-retinal barrier at the level of the retinal capillary endothelium,allowing
leakage of fluid and plasma constituents into the surrounding retina.
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Diabetic retinopathy(RD)Diabetic retinopathy(RD)
Neovascularizationnew vessels bleed,massive vitreous hemorrhage may causesudden visual loss.
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Diabetic retinopathy(RD) treatment:Diabetic retinopathy(RD) treatment:
Argon laser panretinal photocoagulationindicated in proliferative RD
Control the concentration of blood sugar
VitrectomyRD,severe vitreous hemorrhage