acquired large retinal aneurysm
Introduction
Introduction to acquired retinal aortic aneurysm Acquired retinal aortic aneurysm is a localized expansion of the retinal arteriole that occurs in the third-degree bifurcation of the retinal artery and is acquired acquired. May be associated with hypertension and thrombosis, the clinical manifestations of large aneurysms vary widely, mainly hemorrhagic and exudative type 2. At present, a relatively common treatment plan for patients with large aneurysms with vitreous hemorrhage is observed for several months, waiting for spontaneous absorption. basic knowledge The proportion of illness: the incidence rate is about 0.003%-0.009% Susceptible people: no specific population Mode of infection: non-infectious Complications: hypertension, vitreous hemorrhage
Cause
Acquired retinal aortic aneurysm
(1) Causes of the disease
May be associated with high blood pressure and thrombosis.
(two) pathogenesis
The exact pathogenesis is still unclear. In the analysis of cerebral aneurysms, the majority of patients were found to be female, over 50 years old, and the aneurysm diameter was 100-300 m. It is speculated that chronic hypertension and age-related changes lead to arterial wall smooth muscle collagen changes, making Local expansion occurs in the thin wall of the tube. Lavin et al. often occur in the arteriovenous cross-compression site according to the large aneurysm. It is speculated that the lack of the outer membrane layer in the compression site leads to the lack of support structure of the wall, and there are also theories that the formation of the embolus destroys the wall. ,
The difference between large aneurysm hemorrhage type and combined lipid exudation type is that the blood pressure of patients with hemorrhage is often higher than 200mmHg. This type of cystic aortic aneurysm is close to the optic disc, and the perfusion pressure is prone to hemorrhage. The aneurysms with tapered ends are easier. Exudation, often accompanied by embolization of the vein, hypertension may be closely related to the aneurysm that causes bleeding, and the aneurysm that causes exudation is mostly related to local vascular factors.
Prevention
Acquired retinal aortic aneurysm prevention
The clinical manifestations of large aneurysms vary widely, mainly hemorrhagic and exudative. Hemorrhagic large aneurysms often have an acute decline in visual acuity. Retinal hemorrhage can be subretinal, intraretinal or preretinal. Hemorrhage can cover large aneurysms. When subretinal or preretinal hemorrhage occurs on the main arteries of the retina, large aneurysms should be considered. Caused.
Complication
Acquired retinal aneurysm complications Complications, hypertension, vitreous hemorrhage
Hypertension, arterial lesions and ocular retinal hemorrhage, vitreous hemorrhage, etc.
Symptom
Acquired retinal aortic aneurysm symptoms Common symptoms Retinal hemorrhage
The clinical manifestations of large aneurysms vary widely, mainly hemorrhagic and exudative type 2. Hemorrhagic large aneurysms often have an acute decline in visual acuity. Retinal hemorrhage can be under the retina, in the retina or in front of the retina. Hemorrhage can cover large aneurysms. When subretinal or preretinal hemorrhage occurs on the main arteries of the retina, large aneurysms should be considered. When the amount of subretinal hemorrhage is large, blood can enter the vitreous. There is no explanation for the vitreous hemorrhage, such as choroidal neovascular membrane. After the vitreous detachment, venous obstruction, etc., the possibility of a large aneurysm should be considered.
Exudative aortic aneurysms often occur in the iliac crest side, and the visual acuity is gradual. It can be caused by the accumulation of exudate in the macular area and the exudation of fluid. The large aneurysm rarely occurs in the optic disc, the retinal ciliary artery and the nose. On the side of the blood vessels, but if it occurs, it also shows exudation.
Retinal aortic aneurysms can also occur in patients with venous obstruction (8% to 26%) and small arteries associated with obstructed veins. Large aneurysms have also been reported in patients with congenital arteriovenous traffic.
Examine
Acquired retinal aortic aneurysm
1. Hemorheological examination
Defining blood viscosity.
2. Pathological examination
Retinal aortic aneurysm occurs in the retinal arteriovenous junction compression, peripheral telangiectasia, collagen, hemosiderin, accumulation of fibrous platelet agglutination, deposition of lipids outside the macula, suggesting expansion around the large aneurysm The capillary network may be the source of lipids entering the macula.
Fluorescence angiography: It can show the presence of retinal aortic aneurysm. The early aortic aneurysm is filled rapidly. Sometimes the filling of the aneurysm can be incomplete. The proximal and distal aortic stenosis can usually be seen. Many patients may have microvascular abnormalities around large aneurysms, such as telangiectasia, capillary perfusion and collateral circulation between small arteries. When there is a lot of retinal hemorrhage, ICG can better show the presence of large aneurysms.
Diagnosis
Diagnosis and diagnosis of acquired retinal aortic aneurysm
It is not difficult to make a diagnosis based on fundus findings and angiographic findings.
Differential diagnosis
Retinal vein occlusion
Large aneurysms secondary to venous obstruction occur mostly on the venous side of the capillary bed, causing macular edema and ring-like lipid exudation, and can also occur on the arterial side of the venous obstruction, the capillary bed and the collateral circulation.
2.Coats disease
The diagnosis of Coats disease is based on the age of onset, gender characteristics, mainly in the aneurysm-like dilation of veins and capillaries, and the number is large, with a large amount of lipid exudation, fluorescent angiography shows a wide range of vasodilation, adulthood Human Coats disease and foveal telangiectasia syndrome also have more diametrically dilated capillaries that appear on the macula.
3. Retinal capillary hemangioma
Usually combined with retinal edema, exudation and hemorrhagic aortic aneurysms, mostly in the peripheral part of the retina, with large expansion and deformation of the input and output vessels, retinal capillary hemangioma can also occur on the optic disc, retinal hemangioma on the optic disc It is difficult to distinguish from retinal aneurysm. Retinal capillary hemangioma is usually hereditary and is one of the clinical features of von Hippel-Lindau disease. von Hippel-Lindau disease also includes cerebrovascular tumor, renal cell carcinoma and pheochromocytoma. Family history acquired capillary hemangioma often lacks dilated blood vessels and is easily confused with retinal aortic aneurysms. This acquired lesion, also known as primary or idiopathic lesion, occurs in uveitis and retinitis pigmentosa. The patient, who has long-term observation and found that it grows slowly, may be a vascular proliferative tumor.
Choroidal neovascular membrane
It is a common cause of subretinal hemorrhage in the macular area. When the drusen and pigment changes in the macular area are combined, the choroidal neovascular membrane with senile macular degeneration should be considered. Fluorescence angiography and choroidal angiography can show the fluorescence leakage of the neovascular membrane. The artery near the hemorrhage did not show a large aneurysm-like dilation.
