Diseases of Retina

8/14/2019 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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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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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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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

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Diseases of Retina