creeping choroiditis
Introduction
Introduction to choroidal choroiditis Serotic choroidal retinitis (serpiginous choroidoretinitis) is a rare bilateral chronic progressive recurrent inflammatory disease involving the retinal pigment epithelium, choroidal capillaries and choroid, often secondary to retinal involvement. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: cystoid macular edema retinitis
Cause
Cause of choroidal choroiditis
(1) Causes of the disease
The cause is unclear and may be related to the inflammatory response.
(two) pathogenesis
The pathogenesis involves the following three theories:
1. Infection theory: A variety of infections such as Mycobacterium tuberculosis infection, streptococcal infection, influenza virus infection, etc. play a certain role in its pathogenesis, but these reports are scattered, there is no more research evidence to support this view.
2. Inflammation theory: Inflammation causes destruction of the Bruch membrane and causes neovascularization under the retina.
3. Immunological vasculitis theory: Some factors cause retinal or choroidal concealed antigen exposure, through type III, type IV (some people think there may be type II) allergic reaction caused by local immune vasculitis, and cause choroidal capillaries Occlusion, which leads to inflammatory diseases of the choroid and retinal pigment epithelium, has recently been found to be associated with inflammatory bowel disease, suggesting that they have similar or identical immunological pathogenesis.
Prevention
Claudication choroiditis prevention 1. Maintain an optimistic and happy mood. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood. 2, life restraint pay attention to rest, work and rest, life orderly, maintain an optimistic, positive, upward attitude towards life has a great help to prevent disease. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.
Complication
Complications of choroidal choroiditis Complications cystic edema retinitis
The complications of purulent choroidal retinitis are mainly the subretinal neovascular membrane (choroidal neovascular membrane), the incidence rate is 10% to 25%. In very few patients, the subretinal neovascular membrane can spontaneously resolve, some patients may be accompanied Bleeding and exudation, a small number of patients may have shallow serous retinal detachment in the acute phase of inflammation. With the regression of the lesion, retinal detachment can be completely restored. In some patients, retinal pigment epithelial detachment and cystoid macular edema can occur.
Symptom
Claudication choroiditis symptoms common symptoms pigmentation retinal detachment
In the acute phase, 1/3 of the patients have inflammatory cells in the vitreous, usually around the optic disc, visible gray-white map-like canine staggered lesions, deep lesions, invading the choroidal lining and retinal pigment epithelium, lesions from the optic disc to the macular area or even the peripheral part Chronic lameness progression, continuous edge, most lesions from the periphery of the optic disc, but also can appear first in the macula and called "macular choroidal choroiditis", and occasionally there are areas that first appear outside the macula, and even in the peripheral part Retina, acute lesions begin to heal after months or weeks, leaving scars with pigmentation, hyperplasia, pigment epithelial atrophy and fibrosis, the disease can recur, and new inflammatory lesions appear on the edge of the healed lesion, but Rare retinal detachment occurs, although lesions tend to fuse with each other, but isolated lesions are also quite common. The presence of multiple isolated lesions in the posterior pole needs to be differentiated from AMPPPE disease, although both are often bilaterally ill. However, there are great differences in the degree of scar formation and comorbidities between the two eyes at the time of illness; the latter optic disc and retina The blood vessels are usually normal.
The disease may also be accompanied by vitreitis, optic discitis, retinal vasculitis or phlebitis, branch retinal vein occlusion, optic disc neovascularization and retinal neovascularization, 25% of patients may develop choroidal neovascularization, neovascularization often occurs in chorioretinal atrophy The edge is also an important cause of vision loss in advanced patients, most patients are not associated with systemic disease.
Examine
Examination of choroidal choroiditis
Blood tests routinely identify the nature of infection and infection.
1. Fluorescein fundus angiography: active lesions show weak fluorescence in the early stage of angiography, which may be due to swelling of the retinal pigment epithelium and/or non-perfusion of choroidal capillaries; followed by strong fluorescence at the edge of the lesion, which may be Caused by leakage of surrounding choroidal capillary fluorescein; fluorescent staining at the end of the angiography, spotted strong fluorescence in the lesion.
Inactive lesions show weak fluorescence early in the angiography due to choroidal capillary occlusion; subsequent strong fluorescence occurs at the edge of the atrophic lesion due to fluorescein diffusion from adjacent normal choroidal capillaries; Fibrosis scars and sclera staining, because the patient's old lesions and fresh lesions often coexist, angiography usually shows the presence of fluorescein leakage of fresh lesions and fluorescein staining of old lesions.
2. Indocyanine green angiography: Acute phase lesions show weak fluorescence in the early stage of angiography, and staining is shown in the later stage. The lesions found in this examination are larger than the range of lesions observed under fluorescein fundus angiography or ophthalmoscope, suggesting this The disease has extensive changes in ischemia and inflammation; inactive lesions show scar and fibrous tissue staining.
3. Visual field examination: During the active period of the disease, a dense dark spot corresponding to the location of the lesion appears. In the inactive period, the dark spot becomes looser, and a central visual field defect may occur. As the disease progresses, The patient's field of vision can be gradually reduced.
4. Electrophysiological examination: Early retinal current map and electro-oculogram can be changed without abnormality. With the progress of the disease and the expansion of the lesion range, the amplitude of the electroretinogram and the ratio of the ocular electroencephalogram to the dark valley may be abnormal.
Diagnosis
Diagnosis and diagnosis of choroidal choroiditis
The diagnosis of this disease is mainly based on its typical clinical manifestations. Fluorescein fundus angiography and indocyanine green angiography are helpful for diagnosis. Visual field and electrophysiological examination can provide useful information for diagnosis.
The posterior pole of the choroidal choroiditis is differentiated from the AMPPPE. The AMPPPE lesion is limited to the posterior pole, which is round or oval, and the distribution is irregular. After 1 to 2 weeks, the lesion begins to absorb, not chronic. Progressive progression, mild choroidal damage, good visual prognosis, cyclops type need to identify with idiopathic choroidal neovascularization, age-related macular degeneration, angiography found that new blood vessels are helpful for diagnosis, macular type should also be yellow spot Identification of neovascularization.
