vitreous hemorrhage
Introduction
Introduction to Vitreous Bleeding Vitreous hemorrhage is a common complication of visual trauma caused by ocular trauma or retinal vascular disease. On the one hand, bleeding not only makes the refractive medium turbid, but also hinders the light from reaching the retina, and it can cause serious damage to the eye tissue; The body's response to bleeding can gradually clear the blood. In different cases, the consequences of vitreous hemorrhage are very different, according to the primary injury, the amount of bleeding in the off-duty, the absorption of bleeding and the performance of the eye reaction, etc., timely appropriate clinical treatment. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: retinal detachment
Cause
Cause of vitreous hemorrhage
Traumatic (35%):
In ocular trauma, perforation of the eyeball or blunt contusion of the eye can cause traumatic vitreous hemorrhage. In the corneoscleral perforation injury, scleral perforation and residual foreign body injury in the posterior segment of the eye, the incidence of vitreous hemorrhage is very high. The transient deformation of the eye caused by blunt trauma of the eye can cause rupture of the choroid of the retina and hemorrhage; the anterior vitreous hemorrhage can be caused by damage to the ciliary body.
Spontaneity (30%):
Spontaneous vitreous hemorrhage has many diseases, including inflammatory, degenerative or neoplastic diseases of the choroid of the retina. Some blood system diseases such as leukemia and retinoschisis can also cause vitreous hemorrhage, but it is rare.
Diabetes (30%):
In diabetic patients, the appearance of new blood vessels in the fundus is a precursor to vitreous hemorrhage. Due to the decreased vision caused by bleeding, some patients cannot recover by blood absorption.
Prevention
Vitreous hemorrhage prevention
Vitreous hemorrhage occurs, first of all to identify the cause, and actively treat the primary disease, such as less vitreous hemorrhage will absorb it, a large number of bleeding patients are difficult to absorb, drug treatment is often unsatisfactory, there are also laser and ultrasound treatment, efficacy Inaccurate, general conditional hospitals use vitrectomy, the effect is better, some patients have improved vision, but if there are obvious lesions in the fundus, the visual acuity after vitrectomy can not be restored, so the prognosis of this disease depends on the primary The amount of bleeding, the degree of damage to the retina and the complications are different.
Complication
Vitreous hemorrhage complications Complications
There are many bleedings, black spots, red vision, massive bleeding will seriously affect vision, and even light perception disappears. Repeated multiple bleeding can be transformed into a dense membrane, and new blood vessels from the retina grow into the vitreous cavity. Affecting central vision, membrane traction can cause retinal detachment, and cataracts, rupture of new blood vessels will cause re-vitreous hemorrhage, such a vicious circle, eventually resulting in neovascular glaucoma, and even eyeball atrophy, a large number of vitreous hemorrhage, blood-aqueous barrier Destruction, red blood cells degenerated in the vitreous cavity enter the anterior chamber, block the angle of the anterior chamber, further develop into blood-stained cell glaucoma, macrophages phagocytose the dissolved red blood cell debris, block the trabecular bone, denature the trabeculae, may cause cell-soluble glaucoma The trabecular endothelial cells phagocytose the dissolved red blood cells, and the iron of hemoglobin causes rust deposition, which also denatures the trabeculae, affects the outflow of aqueous humor, and produces hemosiderin glaucoma.
Symptom
Vitreous hemorrhage symptoms Common symptoms Vitreous blood has no red light reflection, refractive medium, turbid retinal detachment
The symptoms, signs, prognosis and complications of vitreous hemorrhage mainly depend on the primary disease and the amount of bleeding caused by bleeding, the number of bleeding and other factors. Spontaneous hemorrhage often occurs suddenly, can be a small amount of bleeding, and many form a dense blood clot. When a small amount of bleeding occurs, the patient may not be aware of it, or only "floating mosquitoes"; when more bleeding occurs, the patient may notice that the shadows in front of the eyes are fluttering, or there may be red glass occlusion, and patients with repeated bleeding may consciously "smoke" The visual acuity decreased significantly. Ophthalmic examination, when there is less bleeding and does not affect the observation of the slit lamp, it can be seen that the red blood cells accumulate in the scaffold of the vitreous gel, which is lemon-like dust. A moderate amount of fresh bleeding can be a dense black strip of turbidity. A large amount of bleeding caused no red light reflection at the fundus, and the vision decreased to the light.
Examine
Examination of vitreous hemorrhage
Ultrasound examination has a great diagnostic value for vitreous hemorrhage, especially when it is not directly visible. A small amount of diffuse bleeding may result in a negative result with B-mode ultrasound. This is because there is not enough echo interface in the vitreous, and type A Ultrasound scans may show low baseline echoes. When vitreous hemorrhage is dense, both low- and medium-amplitude scattered echoes can be seen in either type A or B-mode ultrasound, and when scanned with high sensitivity, bleeding Density and distribution are shown more clearly; scanning with reduced sensitivity can reduce echo amplitude, and most echo points are removed, so it can be determined whether retinal detachment is present at the same time. Therefore, ultrasound can determine the posterior segment of the eye and vitreous hemorrhage. Degree, whether there are lesions such as retinal detachment, to determine the prognosis of vision, if necessary, can be repeated.
Diagnosis
Diagnosis of vitreous hemorrhage
Posterior vitreous detachment caused by vitreous hemorrhage should be differentiated from retinal detachment in the diagnosis of ultrasound images. The retinal detachment often has high-amplitude echoes. When the sensitivity is changed, the retinal echo changes little, and the detached retina can often be traced to the attachment. At the site or optic disc, the traction retinal detachment will show a pulling shape, and after the simple vitreous detachment, the posterior vitreous interface has obvious posterior motion when the eyeball rotates, and the echo amplitude is weakened when the sensitivity of the machine is lowered.
