Blocked or narrowed arteries with retinopathy
Introduction
Introduction to arterial occlusion or stenotic retinopathy Carotid artery occlusion or stenosis can result in insufficient blood supply to the brain and eyes to produce a range of brain and eye symptoms. Studies have now shown that this fundus change is not due to venous stasis, but retinopathy caused by chronic perfusion of the ophthalmic artery due to carotid artery occlusion or stenosis is called hypoperfusion retinopathy. Carotid artery occlusion can also cause anterior ischemic ischemia, which together with fundus changes is called ocular ischemic syndrome. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific people Mode of infection: non-infectious Complications: optic atrophy glaucoma
Cause
Causes of arterial occlusion or stenotic retinopathy
(1) Causes of the disease
Defects in the fundus caused by chronic perfusion of the ophthalmic artery due to obstruction or stenosis of the carotid artery.
(two) pathogenesis
The mechanism of the disease is still controversial, and there are several views:
1 micro-emboli movement: micro-emboli from the atherosclerotic plaque of the internal carotid artery enters the larger arteries of the retina, and its flow is visible. When moving to the distal end, vision and visual field recover.
2 vasospasm: not easy to find, check the fundus retina and blood vessels are often normal,
3 Insufficient blood flow: due to carotid stenosis or obstruction, blood flow is insufficient, causing the retinal arterial pressure to decrease, and the retinal artery is lightly compressed, that is, there is no blood flow. If the blood pressure is lower than the intraocular pressure, the artery collapses without blood column, and the blood flow stops. Retinal arterial pressure can not be measured by retinal vasculature. The cause of insufficient blood flow is not only due to changes in systemic blood pressure, but also due to arterial spasm in the distal extremity of the thrombus, or temporary thrombosis or atheroma on the atheromatous plaque. Bleeding causes atheroma to bulge, causing further narrowing of blood vessels, resulting in insufficient blood flow. Patients with transient darkness may have brain symptoms, which are reported to account for 2/3, of which 26% are associated with temporary cerebral ischemia. 37% were associated with stroke.
Prevention
Arterial obstruction or stenosis prevention of retinopathy
Lowering blood pressure is the most important measure to prevent and treat hypertensive retinopathy. Secondly, it is to evaluate the severity of retinopathy. Sometimes special examinations such as fundus fluorescein angiography and optical coherence tomography are needed to confirm the diagnosis. For patients with severe ischemic lesions and macular edema, laser treatment is necessary to reduce oxygen and edema in the retina, prevent retinal neovascularization, and avoid more serious complications.
The damage caused by hypertension to the eyes is concentrated in the retina. The common saying of the retina is the "backplane", which is equivalent to the camera's negative film, and is responsible for the collection of visual information. Retinal blood vessels are the only living blood vessels in the whole body that can be "looking straight". The degree of hardening indirectly reflects the degree of systemic arteriosclerosis. Therefore, for patients who have been diagnosed with hypertension, a fundus examination is usually required to evaluate the condition of retinal arteriosclerosis.
Because of the long or short course of hypertension, high or low blood pressure, the retinal artery will change accordingly, and the performance of the fundus will be different. At the onset of the disease, the blood pressure is slightly elevated or fluctuating. The changes in the retinal blood vessels are mainly the enhancement of arterial reflection, the narrowing of the tube diameter, and the full or distorted veins. This change can often be detected by people over the age of 50. No special treatment is required, it is usually recommended to keep the diet light, often measure blood pressure, and adjust antihypertensive drugs in a timely manner.
In the second stage, if the blood pressure is not well controlled, the condition will further develop and enter the period of dynamic and venous incision. The vein is almost crushed by the artery. This period is a precursor to severe retinopathy, and the patient has no symptoms of discomfort. Regularly checking the fundus can prevent it from happening.
The third stage progressed to retinal hemorrhage, sometimes combined with retinal venous and venous obstruction, and the visual acuity was severely affected. When the diastolic blood pressure continues to be above 130 mm Hg, it is called acute or malignant hypertension. In addition to the above retinopathy, it is mainly characterized by optic nerve edema. It is more common in young people, often with heart enlargement, renal insufficiency, and mortality. 50%, treatment is tricky.
Complication
Arterial obstruction or stenotic retinopathy complications Complications, optic atrophy, glaucoma
Optic atrophy, corneal blistering and erosion, and neovascular glaucoma can cause eyeball atrophy.
Symptom
Symptoms of arterial occlusion or stenotic retinopathy Common symptoms Lens opacity Carotid pulsation weakened or disappeared Light reflex disappeared Spotted bleeding Corneal erosion eccentricity
According to carotid artery occlusion or stenosis, there are different clinical manifestations for unilateral or bilateral and the severity of obstruction.
1. amaurosis fugax Many eye diseases can produce transient black montmorillonia, but this is the most common symptom of carotid artery occlusion or stenosis. Hollenhorst reported 50 out of 124 cases, which reported its incidence 30% to 40% of carotid occlusion, and even reported that all patients with transient hemoptysis have carotid occlusion and stenosis. The clinical features are sudden and painless monocular vision loss, starting with a black veil covering the front. Suddenly blind from top to bottom or from bottom to top, lasting for a few seconds or 1 minute, there are also up to several minutes, usually after the onset of vision to return to normal, the frequency of attacks, starting 1 or 2 times a month, after frequent episodes, can be daily 10 to 20 times.
2. Low-perfusion retinopathy, also known as hypotensive retinopathy, is a long-term chronic perfusion of the ophthalmic artery, causing retinopathy of long-term reduction of retinal arterial pressure, the incidence of which accounts for 5% to 12 of carotid artery occlusion or stenosis. %, the initial decline in visual acuity, the visual acuity of the late or complicated complications decreased significantly, the ipsilateral hemianopia may appear in the visual field, the b wave decreased in the ERG examination, and the fundus examination was normal: the initial optic disc was normal, and the optic nerve was atrophied in the late stage due to insufficient blood supply, and the optic disc was pale. The normal or central light reflex of the macula disappears. In severe cases, the capillary permeability around the macula is increased due to hypoxia, and the retinal edema of the macula is thickened. The retinal artery is normal or slightly dilated at the beginning, and the end is thinned. The central arterial pressure of the retina is reduced. The blood flow in the arteries can be completely disappeared by gently pressing the eyeball. The central artery pressure of both eyes can be measured. The affected eye can be 25% to 50% lower than the healthy eye. The varicose veins are dilated and the color is darkened. In severe cases, the venous blood column is segmental, and the red blood cells are visible. Intravascular flow, telangiectasia forms microangioma, and the posterior pole retina has cotton-like plaques. Flaming spotting and bleeding, severe cases lead to lack of oxygen and increased capillary permeability around the macula is formed macular retinal edema and thickening, severe ischemia who may have advanced optic disc or retinal neovascularization.
Examine
Examination of arterial occlusion or stenotic retinopathy
1. Fluorescence angiography arm - retinal circulation time and retinal circulation time are prolonged, optic disc is normal or strong fluorescence, macular fluorescein leakage, microangioma, retinal artery, vein and small blood vessels in the posterior pole and equatorial region, Capillary blood vessels can have fluorescein leakage, the veins are beaded, and in some cases there may be capillary non-perfusion areas and arteriovenous traffic.
2. The ERG check indicates that the b wave is reduced.
3. Peripheral visual field examination can suggest ipsilateral hemianopia.
4. B-ultrasound and CDI can understand the diameter and blood flow of bilateral carotid arteries. Carotid angiography is helpful for diagnosis if necessary, but it is dangerous.
Diagnosis
Diagnosis and diagnosis of arterial occlusion or stenotic retinopathy
Diagnostic criteria
In addition to the symptoms of the fundus and anterior segment of the eye, patients with carotid artery occlusion or stenosis may have other ocular symptoms, such as eye and eyelid pain, ocular protrusion, or ptosis and pupil dilation in the case of Horner syndrome. Systemic symptoms may have weakened or disappeared carotid pulsation. Carotid murmurs may be heard in 72% of patients, and brain symptoms such as paroxysmal dizziness, recurrent episodes of hemiplegia, decreased sensory function, temporary language may occur. Disorders, cerebral vascular abnormalities or the development of mental symptoms similar to Alzheimer's disease, these patients often have high blood pressure, coronary heart disease, diabetes or increased blood viscosity and increased blood lipids.
According to medical history, eye examination and carotid examination, such as transient erythema, hypobaric retinopathy, contralateral hemiplegia, weakened carotid pulsation and auscultation, the diagnosis is not difficult, but should be noted, high carotid stenosis Obviously, the noise disappears when it is completely blocked.
Differential diagnosis
Low perfusion retinopathy should be differentiated from the following fundus diseases:
1. Early diabetic retinopathy Most of the diabetic retinopathy is binocular. The fundus hemorrhage and microangioma often invade the posterior pole, and there is an increase in blood glucose. Most of the carotid artery obstruction is monocular, and the lesion is often in the middle part.
2. Central retinal vein occlusion is similar to non-ischemic early fundus lesions, but there is no arterial pressure reduction in the venous obstruction, no carotid pulsation reduction and murmur, and the fundus hemorrhage will gradually increase.
3. Avascular disease fundus lesions can also produce hypotensive retinopathy, but the symptoms are more typical and mostly for both eyes, and the disappearance of the radial artery beat can be identified.
