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1、RETINAandVITREOUS XufangSunDepartmentofOphthalmology TongjiHospital2012 5 SUMMARY VitreoussymptomVitreoretinalDiseaseRetinaInstructiondevelopment anatomyandphysiology clinicalsignsRetinalDiseasesAgerelatedmaculardegeneration Retinalvasculardisease Diabeticretinopathy retinalartery veinocclusion ROP
2、Retinaldetachment tumoroftheretina Retinadevelopment Neuralectoderm opticcup innerlayer theneurosensoryretinaouterlayer theretinalpigmentepithelium DIESSECTION photoreceptorbipolarcellsGanglioncellsbrain DIESSECTION Photoreceptors Cones color visualacuitybrightMacularRods motion contrast nightperiph
3、eryretina Physiology Rhodopsin 11 cisretinal opsin enzymephoton11 cisretinal opsinall transretinalEnzymeliver11 cisVitminAall transretinalaproteinandligandamplifiercascadereducedentryofcalciumandsodiumcationsintothephotoreceptorcellhyperpolarizes Physiology 2Nutrition Physiology 2nutrition thechorio
4、capillaries blood ocularbarrier Blood retinabarrier innerblood ocularbarrier comprisesasinglelayerofnonfenestratedendothelialcells whichhavezonulaoccludensChoroid retinabarrier outerblood ocularbarrier RPEandtightjunctionsbetweentheRPE AnatomyandPhysiology Choroid retinabarrierAtightjunctionBRPEDbru
5、chmembranEchoriocapillaris Retinadiseases MaculardiseasesMaculardystrophyAgerelatedmaculardegeneration Best StargardtsdiseaseMacularholeRetinalvasculardisease Diabeticretinopathy retinalartery veinocclusion ROP RetinaldetachmentTumorsoftheretina CLINICALSIGNS 1Edema2Exudatethebreakdownoftheblood ret
6、inalbarrier3Hemorrhage4Neovascularization5retinamembrane6Pigment Proliferativeretinopathy CLINICALSIGNS 1Edemaintracellularedema extracellularedema destructionoftheblood retinabarriersubretinaledema destructionofthechoroid retinabarrier CLINICALSIGNS intracellularedemaCotton woolspot CLINICALSIGNS S
7、ubretinaledema sub sensoryretinaedema CLINICALSIGNS 2ExudateALipidcaused CLINICALSIGNS 3Hemorrhage H ADotandblotHBFlame shapedHCPreretinalHDVitreousHESubretinalHFWhite centredH CLINICALSIGNS RetinalHemorrhagesDotandblotH CLINICALSIGNS Flame shapedH CLINICALSIGNS EpiretinalH CLINICALSIGNS Vitreoushem
8、orrhageRetinalbreaksProliferativediabeticretinopathyTraumaValsalvaretinopathyAnycauseneovasculariztion CLINICALSIGNS hemorrhageSub RPEH choroidalH CLINICALSIGNS 5NeovascularizationARetinalneovasculaiation RNV Bchoroidalneovasculaiation CNV RNV CLINICALSIGNS Neovascularization Retinaneovascularizatio
9、n choroidneovascularization CNV thegrowthofabnormalbloodvesselsinthechoroidlayeroftheeye Seenin wetagerelatedmaculardegeneration CLINICALSIGNS Subretinalneovascularization CLINICALSIGNS CLINICALSIGNS 5EpiretinalmembraneSub retinamembrane CLINICALSIGNS 6Pigmentisaresultofdisturbanceofthepigmentepithe
10、liumRetinitispigmentosaPatterndystrophies CLINICALSIGNS pigment EXAMATION OphthalmoscopyDirectophthalmoscopeIndirectophthalmoscopeFundusphotographyFluoresceinangiography FFA indocyaninegreenangiography ICGA Opticcoherencetomography OCT Autofluorescence Opticcoherencetomography FFA MicroaneurysmsNon
11、perfusionarea VitreoretinalDisease SymptomFlashinglightsandfloaters Photopsia Diseases RetinalbreaksandRhegmatogenousretinaldetachmentdiabeticretinopathyTrauma RETINALVASCULARDISEASES 1OcclusionRetinalarteryocclusionRetinalveinocclusion2Inflammationretinalperiphlebitis3Diabeticretinopathy4Hypertensi
12、onretinopathy Centralretinalarteryocclusion Clinicalfeatures1d1wClinicalfeatures anacutepainlesscompletelossofvision Afovelred cherryspot poorprognosis Branchretinalarteryocclusion BranchretinalarteryocclusionisembolicVisualfieldlossVAreduced fovealinvolvement TREAMENT Centralretinalarteryocclusion
13、CRAO isanemergency Iftreatmentbeginswithinanhour thepatienthasthehighestpossibilityofregainingvisionintheaffectedeye althoughcompleterestorationisunlikely Acommontreatmentisinhalationofcarbondioxidesoastodilatetheretinalvesselsandmovetheocclusionfromthecentralretinalarterytoabranchartery Thismovemen
14、treducestheareaoftheretinaaffectedandmayrestoreacertainamountofvision Eyeballmassagemayalsobeperformed alsoinanefforttoremovetheocclusion Thephysicianmayalsoconsiderpuncturingtheeyeball Drugtherapyincludestheuseofcarbonicanhydraseinhibitorstoreducetheinternaleyepressureandenhancemovementoftheocclusi
15、on Bothofthetreatmentswouldbeusedwithinthefirst24hoursofnoticeablevisionloss Alternativetreatment Retinalveinocclusion Clinicalfeatures 1middleaged olderindividualswithsystemicdiseases2acute subacute3painless severevisionloss4severecomplication5poorprognose CausesandRiskFactors age hypertension athe
16、roscleroticvasculardisease anddiabetesmellitus Certainriskfactorsassociatedwithatheroscleroticdisease suchascigarettesmokingandhyperlipidemiaalsoarethoughttoincreasetheriskofretinalveinocclusion vasculitis hyperviscositysyndromesandchronicglaucoma signs retinaledema superficialhemorrhages flame shapedhemorrhagediscswellingcotton woolspotstortuousanddilatedretinalveinsMacularedemairis retinaneovascularization Retinalveinocclusion CentralretinalveinocclusionBranchretinalveinocclusion Ischemicandno
