vitreous hemorrhage
Introduction
Introduction to Vitreous Blood Vitreous hemorrhage health search is a common complication of visual impairment caused by ocular trauma or fundus vascular disease. One area of blood makes the refractive interstitial turbid, hinders the light from reaching the retina, and has certain influence on the vitreous structure and adjacent tissues. On the other hand, the health search, the body's reaction to the blood can gradually clear the blood in different cases, glass The consequences of volumetric blood are different from those of a large health search. The clinical treatment should be appropriate and appropriate according to the primary injury, the amount of blood in the glass, the condition of bleeding absorption, and the performance of the eye reaction. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific people Mode of infection: non-infectious Complications: retinopathy, retinal detachment, open angle glaucoma
Cause
Vitreous blood cause
(1) Causes of the disease
Any cause of rupture of the retinal vascular blood vessels or new blood vessels, blood outflow and accumulation in the vitreous cavity, can form vitreous hemorrhage, normal human vitreous avascular, but retinal neovascularization can grow into the vitreous, or vitreous fibrous vascular tissue Hyperplasia, ocular trauma, and fundus vascular disease are common causes of vitreous hemorrhage in the clinic.
Eye trauma or surgery (45%)
Eyeglass injury or blunt trauma caused by ocular trauma or surgery can cause traumatic vitreous hemorrhage. In the corneoscleral penetrating injury, scleral perforation and foreign body injury in the posterior segment of the eye, the incidence of vitreous hemorrhage is very high. The instantaneous deformation of the eye caused by eyeball contusion can cause rupture of the choroid of the retina and hemorrhage; the anterior vitreous hemorrhage can be caused by damage to the ciliary body. Surgical vitreous hemorrhage can be seen in cataract surgery, retinal detachment repair surgery, vitreous surgery, etc.
Spontaneous vitreous hemorrhage (40%)
Including more diseases, mainly retinal vascular disease, such as diabetic retinopathy, retinal vein occlusion, Eales disease, retinal aortic aneurysm, etc.; posterior vitreous detachment or retinal tear formation; wet age-related macular degeneration; retinal choroidal inflammation, degeneration Or tumor, some people with diabetes, ocular trauma and other 151 cases of monocular vitreous hemorrhage clinical analysis found that the main cause of bleeding is retinal tear formation accounted for 42%; retinal vein branch obstruction accounted for 37%, some blood system Diseases such as leukemia, retinoschisis can also cause vitreous hemorrhage, but it is rare. In diabetic patients, retinal neovascularization is a precursor to vitreous hemorrhage. If no treatment is done, about 27% of vitreous hemorrhage occurs within 5 years. The visual acuity caused by bleeding is reduced, and about 60% of patients cannot recover by blood self-absorption.
(two) pathogenesis
Vitreous blood can come from the posterior retina, optic disc and choroid, but also from the iris in the anterior segment of the eye, ciliary body. For aphakic eyes, bleeding is more likely to enter the vitreous backwards. A small amount of bleeding is easy to absorb, and there are no sequelae. More bleeding is difficult to absorb, there may be cholesterol deposition, hemoglobin deposition, partial liquefaction of the vitreous, partial concentration and detachment, etc., a large number of bleeding can also lead to red blood cell degeneration to form a ghost cell, blood cell or hemolytic Glaucoma, and repeated massive bleeding can stimulate the proliferative response of the eye, forming a dense fibrous proliferative membrane with neovascularization. The neovascularization of the membrane is easily broken and causes repeated bleeding, and it can contract to produce retinal tears and traction retina. Disengagement, long-term formation of complicated cataracts and even eyeball atrophy.
Prevention
Vitreous blood prevention
Pay attention to your health and don't stay up late for a long time. Eat more fresh vegetables and fruits in life, especially rich in vitamin A, vitamin C, vitamin D, vitamin E and other fruits and vegetables and B vitamins. To improve eye immune function and prevent vision loss.
Complication
Vitreous blood complication Complications retinopathy retinal detachment open angle glaucoma
1. Vitreous condensing: Vitreous blood can destroy the vitreous state of the vitreous, decompose the mucopolysaccharide, accumulate collagen, liquefy and condense, causing or aggravating the vitreous detachment, and the density of the condensed vitreous is increased by microscopy of the slit lamp. After the vitreous detachment, there is a clear boundary between the membrane and the liquefied vitreous of the water sample. It can be seen that the condensed vitreous interface hangs like a scorpion from above.
2. Vitreous inflammation: When a large amount of vitreous hemorrhage, the inflammatory cells in the blood can enter the vitreous body, causing an activation reaction, so that the adjacent tissue blood vessels dilate, and the plasma components ooze out into the eye, resulting in a mild inflammatory reaction. The anterior chamber flashes and the pupils have mild adhesions.
3. Vitrification: There are two reasons for vitrification: one is that a large amount of vitreous blood does not absorb for a long time, and the plasma components and blood inflammatory cells stimulate and transform into fibroblasts, which are mechanically formed into a fibrous membrane in the vitreous body. On the one hand, due to the contraction of the proliferative membrane of the retina, pulling the retinal blood vessels or new blood vessels, causing them to rupture and enter the vitreous, the vitreous blood promotes the proliferation and development, forms or aggravates the vitreous, and eventually leads to proliferative retinopathy. Pulling retinal detachment.
4. Iron yellow pigmentation: The glass volume of blood gradually decomposes, the red blood cells are destroyed, the iron inside is freely released, and it can be deposited in the adjacent tissue, which has a toxic reaction to the retina. Under the microscope of the slit lamp, the brown-yellow particle turbidity in the vitreous body can be seen.
5. Hemolytic glaucoma: The disease is an acute, secondary, open-angle glaucoma, caused by macrophages that phagocytose hemoglobin, hemoglobin, metamorphosis of red blood cells that block the angle of the anterior horn, usually occurring in the blood volume of the glass The clinical characteristics of days or weeks are as follows:
1 increased intraocular pressure;
2 corners are open;
3 filter curtain is red or brownish red;
4 no angle of neovascularization;
5 anterior chamber can be seen red blood cells, first anti-glaucoma drugs are given in the treatment. If the drug can not control high intraocular pressure, surgery such as anterior chamber irrigation and (or) vitrectomy can be considered.
6. Hemophagocytic glaucoma: The red blood cells degenerated by vitreous hemorrhage obstruct the angle of the anterior chamber, causing the drainage of the aqueous humor to be blocked, causing an increase in intraocular pressure. The denatured red blood cells are spherical and concave, containing denatured hemoglobin, often called blood shadow cells. Such cells have poor deformability compared with normal red blood cells, so they cannot pass through the filter curtain, thereby blocking the angle of the anterior chamber, causing an increase in intraocular pressure, and the treatment method is the same as hemolytic glaucoma.
7. Others: including iris redness, cataracts, etc.
Symptom
Symptoms of vitreous hemorrhage Common symptoms No red light reflection at the fundus Repeated hemorrhagic macular disc degeneration
A small amount of bleeding begins to be limited and then spreads out. If the medium is turbid, B-ultrasound should be performed to determine whether there is retinal or choroidal detachment, retinal tears and posterior vitreous detachment. When there is macular damage, choroidal rupture or retinal detachment, it affects vision recovery.
Examine
Examination of vitreous hemorrhage
For some primary diseases that cause vitreous hemorrhage, some necessary laboratory tests, such as blood routine, bleeding, and coagulation parameters, can be performed.
Ultrasound has a great diagnostic value, especially when you can't directly see the fundus:
1 A small amount of diffuse bleeding may result in a negative result with a B-mode ultrasound because there is insufficient echogenic interface in the vitreous, and a type A ultrasound scan may show a low baseline echo.
2 When the volume of blood in the glass is dense, the scattered echoes of low to moderate amplitude can be seen in both type A or B-mode ultrasound examination. When scanning with high sensitivity, the density and distribution of bleeding are more clearly shown; A sensitive scan can cause the echo amplitude to drop and most of the echo points to be removed, thus determining whether there is a simultaneous retinal detachment.
3 Vitreous detachment caused by vitreous hemorrhage should be differentiated from retinal detachment in the diagnosis of ultrasound images.
Diagnosis
Diagnosis of vitreous hemorrhage
Posterior vitreous detachment caused by vitreous hemorrhage should be distinguished 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. Attachment or optic disc, in the traction retinal detachment will show a pulling shape, after the simple vitreous detachment, the posterior vitreous interface has obvious post-movement when the eyeball rotates, and the echo amplitude is weakened when the sensitivity of the machine is reduced. Ultrasound examination can determine the degree of trauma of the posterior segment of the eye and the volume of vitreous hemorrhage. Whether or not there is a lesion such as retinal detachment, the visual prognosis can be judged, and the examination can be repeated if necessary.
