punctate inner choroidopathy
Introduction
Introduction of punctate choroidal lesions Punctateinnerchoroidopathy (punctateinnerchoroidopathy) is a rare multifocal chorioretinal inflammatory disease, typically occurring in young women with myopia, characterized by scattered yellow-white lesions in the posterior pole, located in the retinal pigment epithelium and The level of choroid is a self-limiting process, usually without anterior segment and vitreous inflammation. Most patients have good visual acuity. basic knowledge The proportion of illness: 0.0025% Susceptible population: young women with myopia Mode of infection: non-infectious Complications: retinal detachment
Cause
The cause of punctate choroidal lesions
(1) Causes of the disease
The cause is unclear.
(two) pathogenesis
The pathogenesis is still unclear. Some scholars have carried out tests on various pathogen antibodies, blood routines, serum angiotensin-converting enzymes, antinuclear antibodies, etc., and found no abnormalities. Therefore, it may be a myopia. The resulting degenerative disease, but the patient showed an inflammatory response, it is difficult to explain the patient's clinical manifestations from the point of view of degeneration, the disease may also be an autoimmune disease.
Prevention
Point-like inner choroidal lesion prevention
1, appropriate medication and diet, can shorten the course of disease and prevent recurrence.
2, need to be actively treated when suffering from illness, and need to pay attention to avoid emotional stimuli, overuse of eyesight, overwork and stay up all night.
3, pay attention to conditioning diet, eat less spicy and stimulate the product, to ensure adequate sleep, to reduce the chance of recurrence.
Complication
Pointed choroidal choroidal complications Complications
The most common complication is the formation of subretinal neovascular membrane (choroidal neovascular membrane), which can occur in 17% to 40%. This complication is the main cause of severe vision loss in patients. The subretinal nerve before the pigment epithelium (called type II membrane) is easily exfoliated by surgical methods, and the prognosis is good. Other complications are serous retinal detachment, which occurs in active lesions and can resolve within a few weeks.
Symptom
Symptoms of choroidal choroidal lesions Common symptoms Monocular anterior eye shadow Eye pain Retinal detachment fundus changes
1. Symptoms mainly complained of monocular anterior shadow, flashing, dark spots, blurred vision and decreased vision. Most of the visual acuity decreased slightly (0.5 or more), and some patients may have severe visual loss (can be reduced to 0.04). No redness, eye pain, etc., without systemic disease.
2. The typical change of the signs is multiple yellow and white round lesions in the bilateral fundus, 50 ~ 300m size, located in the retinal pigment epithelium and inner choroid level, mainly concentrated in the posterior pole, some lesions may be accompanied by serous Retinal detachment usually resolves after a few months, leaving a retinal pigment epithelial disorder, or atrophic choroidal retinal scar, which later becomes a scar of a perforated edge.
The patient's anterior segment of the eye usually does not change, unlike many other types of inflammation involving the retinal pigment epithelium and choroid, which does not present intravitreal inflammatory cells.
Examine
Examination of punctate choroidal lesions
Fundus fluorescein angiography showed strong fluorescence in the early stage of active disease, late fluorescein leakage, serous retinal detachment, visible dye leakage to the subretinal, fluorescent defect in the presence of chorioretinal atrophy, it can also show choroid Neovascular membrane, indocyanine green angiography can detect multiple weak fluorescent spots in the posterior pole.
Diagnosis
Diagnosis and differentiation of punctate choroidal lesions
The diagnosis of this disease is mainly based on typical fundus changes, such as scattered multiple yellow and white lesions under the retina, no anterior segment and vitreous inflammatory response, fluorescein fundus angiography and indocyanine green angiography are helpful for diagnosis.
Multiple scattered subretinal yellow-white round lesions in the fundus are common features of choroiditis and retinal pigment epithelial inflammatory disease, but punctate choroidal lesions do not cause anterior chamber and vitreous inflammatory reactions. Types are identified, but this alone is not enough, because other types of inflammatory diseases of the choroidal retinal pigment epithelium do not necessarily have inflammatory reactions in the vitreous and anterior chamber in all patients, so master different types of inflammation. The clinical features, fluorescein fundus angiography, indocyanine green angiography and other changes are necessary for differential diagnosis.
In the differential diagnosis, special attention should be paid to the difference between multifocal choroiditis and total uveitis, subretinal fibrosis and uveitis syndrome. The three diseases have a considerable degree of overlap in clinical practice, such as are likely to occur in young people. Women, mostly myopia, mostly affected by both eyes, fundus lesions appear as subretinal punctate or flaky lesions, can cause subretinal neovascular membrane, but subretinal fibrosis and uveitis syndrome in the subretinal point, On the basis of flaky lesions, it must progress to flaky or banded fibrotic tissue, often with obvious vitreous inflammatory response, while multifocal choroiditis and total uveitis have typical anterior uveitis and vitreous inflammation. It can cause fibrosis under the retina, but this fibrosis is not as significant as subretinal fibrosis and uveitis syndrome. These characteristics contribute to the identification of the three.
The disease should be associated with other diseases that can cause white spots on the fundus (such as acute posterior multifocal squamous pigment epithelial lesions, multiple easily dissipative white spot syndrome, shotgun-like retinal choroidal lesions, ocular tissue Mycoplasmosis, sarcoma-like uveitis, ophthalmic toxoplasmosis, uveitis caused by Lyme disease, Vogt-Koyanagihara disease, etc.
