acute retinal pigment epitheliitis
Introduction
Introduction to acute retinal pigment epitheliitis Acute retinal pigment epithelial inflammation (acuteretinalpigmentepithelitis) is a disease characterized by acute inflammation of the retinal pigment epithelium, typically characterized by dark gray clusters of small spotted lesions in the macula, surrounded by yellow-white halos around the lesion, usually accompanied by Vision loss, these lesions disappeared within weeks to months, and vision can return to normal levels. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: edema
Cause
Causes of acute retinal pigment epitheliitis
Cause:
The disease is acute and recoverable. It is presumed to be caused by infection. The cause of the disease is not fully understood. Some people think that its occurrence may be related to viral infection, but more research is needed to determine it.
Pathogenesis
The pathogenesis is still not fully understood. Recently, the experimental autoimmune uveitis model was induced in Lewis rats using the retinal pigment epithelial membrane protein. It was found that this model mainly showed inflammation of the retinal pigment epithelium and histologically showed the retina. The pigment epithelium has plaque-like cell aggregation, in which macrophages are the main cell type, and it is considered that macrophages play an important role in their occurrence.
Prevention
Acute retinitis pigment epithelial prevention
The disease has a self-healing tendency, and the visual prognosis is generally good. Most patients' vision can be restored to the level before the onset of the disease, but if the lesion invades the fovea, the visual recovery is poor. The patient's macular degeneration usually resolves from 6 to 12 weeks, and individual patients may have recurrence but the patient's visual prognosis is good.
Complication
Complications of acute retinal pigment epitheliitis Complications edema
Retinal edema, visual impairment.
Symptom
Acute retinal pigment epitheliitis symptoms Common symptoms Color vision abnormal vision deformation
Symptom
Patients usually have no systemic history, no flu-like performance, and more unilateral vision loss, but the degree of visual decline is very variable, patients have more visual distortion, central dark spots and color vision abnormalities, a few patients can have no symptoms, Patients have mild visual loss, and only 1/4 of those below 20/30, some patients may have color vision abnormalities.
2. Signs
There are usually no signs of inflammation in the anterior segment of the eye; typical dark gray scattered clusters of punctate lesions appear in the macular area, with 1 to 4 point lesions per cluster, yellow-white halo changes around the lesion, all located in the retinal pigment epithelium Level, as the lesion subsides, the color of the dark gray spotted lesion is further deepened, or the lesion is faded. It is difficult to see under the ophthalmoscope, and the ring-shaped change of the yellow-white halo disappears. The above lesion rarely occurs outside the macular area. .
Examine
Examination of acute retinal pigment epitheliitis
Blood routine examination can understand the infection status of the whole body and has reference value for the diagnosis of the disease.
Amsler checklist can detect central dark spots or visual distortions; visual field examination can find corresponding visual field defects; ocular electrocardiogram abnormalities usually occur in the acute phase of the disease, which indicates a wide range of retinal pigment epithelial damage; retinal current map and vision The evoked potentials usually have no change; fluorescein fundus angiography shows weak fluorescence points consistent with dark gray lesions under the ophthalmoscope. The yellow-white halo rings of these lesions show strong fluorescence, and sometimes the vicinity of the optic disc can be affected, and strong fluorescence occurs. Point, suggesting that there may be a slight leak.
Fundus fluorescein angiography is characterized by pigmented epithelial depigmentation, which is characterized by strong fluorescence of the fundus and macular window-like defects. Multiple window-like fluorescence is collected into grape cluster-like fluorescent spots, and pigmentation of pigmented epithelium in lesions is formed. The weak fluorescence of the fluorescent mask is characterized by bright spots in the middle and black. Some people have followed up the patients who have no black-and-white bright fluorescent spots and grape cluster-like fluorescence. It is found that the early grape cluster-like fluorescent spots eventually become Fluorescent spots are bright in the middle and black, so grape cluster-like fluorescent spots are considered to be one of the characteristics of acute retinal pigment epitheliitis.
Diagnosis
Diagnosis and diagnosis of acute retinal pigment epitheliitis
The diagnosis of this disease is mainly based on the patient's clinical manifestations, that is, visual loss or visual distortion, accompanied by typical spotted lesions in the macular area, Amsler checklist, visual field examination, fluorescein fundus angiography and electrophysiology Checking and so on can help with the diagnosis.
Differential diagnosis
1. Acute posterior multifocal squamous pigment epithelial lesions
The disease is mostly bilateral, the sclera of the anterior segment of the eye may appear, iritis, a typical posterior polar flat cream-like plaque lesion at the fundus, located at the level of the retinal pigment epithelium and choroidal capillaries, the lesion is round or Oval, border blurred, 1 / 8 ~ 1/4 optic disc diameter, lesions can be fused into a sheet, late lesions may involve the peripheral retina, usually combined with mild vitreous inflammatory response, a small number of patients may have retinal edema or hemorrhage Retinal vasculitis, optic discitis and serous retinal detachment, posterior plaque lesions disappear within days to weeks, leaving pigmentation or depigmentation scars, a small number of patients may be associated with systemic inflammatory diseases, fluorescein Fundus angiography revealed that the lesions showed weak fluorescence in the early stage of angiography and strong fluorescence in the later stage. These features are easy to distinguish the disease from acute retinal pigment epithelium.
2. Central serous chorioretinopathy
The disease is more common in adults aged 20 to 45 years, more men than women, male to female ratio of 8:1 to 10:1, patients usually complain of decreased vision or blurred vision, visual distortion, paracentral dark spots and color vision Abnormal, visual acuity can be significantly reduced; typical fundus changes are neuroretinal detachment, serous retinal pigment epithelial detachment, subretinal exudate deposition, multiple spherical serous retinal and retinal pigment epithelial detachment and atrophy Fluorescein fundus angiography showed that there was focal retinal pigment epithelial defect in the acute phase, with plaque or punctate strong fluorescence in the early stage, and gradually expanded in the middle, showing ink-like, mushroom-like or diffuse strong fluorescence; Because the neuroepithelial detachment is a large piece of strong fluorescence, and acute retinal pigment epitheliitis due to multifocal pigment epithelial lesions, fluorescein fundus angiography shows multiple sites of fluorescein leakage, dark gray dots are weakly fluorescent, yellow-white ring is strongly fluorescent .
3. Viral retinitis
Viral retinitis (such as rubella viral retinitis) can cause pigmentation changes in the fundus like acute retinal pigment epitheliitis, but it is more common in children. Fundus changes typically show "salt and salt"-like changes, and electro-oculograms are usually absent. Abnormal changes, other viral retinitis often more severe retinitis, retinal vasculitis, causing retinal edema, hemorrhage and other diseases, therefore, in general, acute retinal pigment epitheliitis is not difficult to distinguish from viral retinitis.
4. Acute macular neuroretinopathy
This disease is a rare disease, mainly involving young people, usually bilaterally affected, showing a sudden drop in central or paracentral vision, small superficial retinopathy in the macular area, brown-red petal-like or wedge-shaped, lasting for several weeks Or months, vision can return to normal levels, fluorescein fundus angiography can find telangiectasia near the central fovea, can also find early strong fluorescence of the macula lesions, late staining, these characteristics help to identify the two.
