central exudative chorioretinopathy
Introduction
Introduction to central exudative chorioretinopathy Central exudative choroidal retinopathy (central exudative chorioretinopathy) referred to as "intermediate osmosis", multiple monocular onset, fundus similar to age-related macular degeneration, but the lesion is smaller than the age-related macular degeneration, mostly isolated exudate with bleeding . basic knowledge The proportion of sickness: 0.0003%-0.0008% Susceptible people: no specific population Mode of infection: non-infectious Complications: vitreous hemorrhage
Cause
The cause of central exudative chorioretinopathy
(1) Causes of the disease
In the foreign literature, toxoplasma infection is the most common, accounting for more than 1/3 of the total number of cases, the other is tuberculosis, syphilis, histoplasmosis (histoplasmosis), but in China, it is more related to tuberculosis.
(two) pathogenesis
Inflammation originates in the choroid, granulomatous inflammation is easy to induce neovascularization, new blood vessels derived from the choroidal capillary layer, and the damaged Bruch membrane and pigment epithelium invade the retinal neuroepithelial layer to form a neovascular membrane and follow-up A series of pathological changes such as exudation, hemorrhage, and mechanization.
Prevention
Central exudative chorioretinopathy prevention
Emphasis on active treatment of primary disease.
Complication
Central exudative chorioretinopathy complications Complications
Retinal hemorrhage and even vitreous hemorrhage.
Symptom
Symptoms of central exudative chorioretinopathy Common symptoms Visually impaired fundus hemorrhage and exudation of retinal detachment from the fundus to change visual distortion
Most of the patients are young and middle-aged, and the incidence of monocular is mostly, but in a few cases, there are also patients with binocular vision. The center of vision is visually impaired, visual distortion or minor vision. The fundus examination has the following typical symptoms:
1. The center of the lesion is a gray-white deep invasive lesion, slightly rounded, slightly raised, with blurred edges, about 1/4 disk diameter, rarely more than 1 disk diameter.
2. There may be bleeding around, often appearing at the edge of the lesion, in a punctate, flaky, curved or circular shape, surrounded by gray-white infiltration damage.
3. There may be exudate under the retina and there is discoid detachment around the lesion, especially in the acute phase.
4. If the condition persists for a long time, there may be bright white hard fat deposits near the lesion.
Examine
Central exudative chorioretinopathy
Blood examination, tuberculin intradermal test, tissue cytoplasmin intradermal test and Toxoplasma erythrocyte aggregation reaction, syphilis VORL and TPHA and other blood tests are necessary, but in most cases may still be unable to determine the disease and can only be given symptomatic treatment .
1. Chest X-ray film.
2. Fundus and fluorescein angiography can be divided into three phases:
(1) Active period: Slit lamp microscope plus front mirror or contact lens to check the posterior vitreous body. In some cases, after the dark adaptation of the examiner, extremely slight dusty or line-like gray-white opacity can be seen. Under the ophthalmoscope, in the middle of the macula. Or near it, there are gray-white round or round-like exudative lesions, the size is 1/2 ~ 1PD, slightly uplifted, the boundary is not clear, there is a zigzag ring or eyebrow-like hemorrhage around the lesion (Figure 1) , FFA can be seen in the gray-white exudation lesions in the beginning of the arterial phase has been fluorescent, radiation or granular, and rapidly expanded to enhance the strong fluorescent spots, until the end of the angiography continues to retreat, suggesting that there are new blood vessels under the retinal neuroepithelial layer, Fluorescence obscuration at the bleeding around the lesion (Fig. 2A, B).
(2) Recovery period: retinal edema subsided at the exudate lesions, the boundary was slightly clearer than the active period, peripheral bleeding disappeared, pigmentation and pigmentation were observed (Fig. 3), FFA arterial phase appeared and gray-white lesions and their surrounding depigmentation The uniform size of the fluorescence is gradually enhanced and slightly enlarged.
(3) Scar stage: the retinal edema disappeared on the surface of the lesion, and it became a clear gray-white plaque in the boundary. In the FFA arterial phase, there was a fluorescent spot consistent with the scar lesion. The surrounding area was fluorescently concealed due to hyperpigmentation, and there was a wheel-shaped translucent fluorescence. The fluorescence at the lesion gradually increased, but did not expand.
Diagnosis
Diagnosis and diagnosis of central exudative chorioretinopathy
The disease lasts for a long time, often intermittent, often lasts for a year or two, and finally enters the stage of scar formation. At this time, the pigment epithelial cell metaplasia or glial cells are repaired to form a mechanical scar, and the fundus is visible. The lesion has been grayish white, clear boundary, replaced by scars with pigmentation. The patient has a strong central dark spot, and the visual acuity suffers permanent damage. If the lesion is located in the paracentral area, the fovea is not affected, then the patient often A considerable amount of central vision can be preserved. In a very small number of cases, the condition can recur after a few years, and the recurring exudate often appears on the edge of the original scar.
The disease is common in young adults with good general health, most of them are monocular, with characteristic fundus changes, and the diagnosis is relatively easy.
In a small number of patients should be differentiated from exudative age-related macular degeneration, the main difference, the latter is the incidence of both eyes, in the case of exudative lesions at a glance, most of the other macular spots can be seen with drusen and pigmentation disorders, the center The age of onset of serous chorioretinopathy is the same as that of this disease. It is also caused by monocular damage, but the central visual acuity is generally not less than 0.5. The macular is the serous retinal neuroepithelial detachment. The retinal effusion is transparent at the beginning. No bleeding, different from this disease.
