choroidal detachment retinal detachment
Introduction
Introduction to choroidal detachment retinal detachment Rhegmatogenous retinal detachment with ciliary body, choroidal detachment, is a special type and more complicated retinal detachment, called choroidal detachment retinal detachment, the disease is acute, rapid development, severe uveitis and low intraocular pressure. If the treatment is not timely, it can quickly lead to hyperplasia of the vitreous and retina, and the prognosis is poor. Low intraocular pressure caused by choroidal dysfunction is the basic factor in the occurrence of this disease. In addition, advanced age and high myopia are also one of the triggering factors. basic knowledge The proportion of illness: the incidence rate is about 0.004% - 0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: proliferative vitreoretinopathy vitreous opacity
Cause
The cause of choroidal detachment retinal detachment
(1) Causes of the disease
Low intraocular pressure caused by choroidal dysfunction is the basic factor in the occurrence of this disease. In addition, advanced age and high myopia are also one of the triggering factors.
(two) pathogenesis
The basic process is retinal tears retinal detachment, choroidal detachment, low intraocular pressure, liquefied vitreous into the subretinal space through the hiatus, stimulate choroidal vasodilation, increased vascular permeability, fluid oozing out into the choroid and ciliary body, and detachment occurs. At the same time, ciliary body edema caused a decrease in aqueous humor production, causing significant low intraocular pressure. Low intraocular pressure aggravated choroidal vasodilation, increased fluid exudation, and choroidal detachment developed, forming a vicious circle. Uveitis reaction is generally considered to be due to The liquefied vitreous under the retina stimulates the pigment epithelium, the choroid, causing it to exude, and the toxic reaction caused by histamine contained in the subretinal and suprachoroidal fluid.
Prevention
Choroidal detachment prevention of retinal detachment
(1) Patients with high myopia should avoid strenuous exercise and avoid heavy physical labor, and do not use excessive eyes.
(2) Avoid eye trauma and head turbulence.
(3) If there is flash and spark in front of the eyes, or if there is a curtain-like black shadow in a certain position, you should go to the hospital immediately and ask the ophthalmologist to check.
(4) If the fundus examination only finds a simple retinal tear without retinal detachment, the laser can be used to close the hole.
Complication
Complications of choroidal detachment retinal detachment Complications proliferative vitreoretinopathy vitreous opacity
Proliferative vitreoretinopathy: Insufficient understanding of the disease in the early stage, often failed to be actively treated in time, can rapidly develop into proliferative vitreoretinopathy, manifested as vitreous opacity, concentration, proliferation of membrane formation, extensive proliferation of the retina, forming a large number of Fixed wrinkles, etc., the occurrence of proliferative vitreoretinopathy is associated with uveitis and low intraocular pressure. Due to choroidal telangiectasia, exudation, growth factors in exudate cells stimulate cell proliferation, promote peri-proliferation and vitreous Membrane formation, obvious proliferative vitreoretinopathy is one of the characteristics of this disease, but also the main reason for treatment difficulties and surgical failure.
Symptom
Choroidal detachment retinal detachment symptoms common symptoms eye pain tremor ciliary congestion uveitis
1. Characteristics of retinal detachment and tear
Retinal detachment is generally larger, more than 3 quadrants, although the range of detachment is large, when accompanied by choroidal detachment, retinal detachment is shallow detachment, accompanied by small wrinkles, which are often hidden, difficult to find, some authors explained Choroidal detachment is like a plug or buckle to seal the retinal tears, so that it does not develop to a higher position. After treatment with glucocorticoids, the choroidal detachment is improved, and the retinal bulge is also increased. In the advanced cases, the retina is widely fixed. Wrinkles, retinal stiffness and other manifestations, retinal tears are mostly located in the posterior pole, with macular holes and horseshoe-shaped holes more common.
2. Uveitis
It is one of the important features of this disease. Patients can complain of eye pain. When they are examined, they may have eyeball tenderness, ciliary congestion, strong positive flash of aqueous humor, and adhesion after extensive pupil. The vitreous may have opacity and membrane formation, often misdiagnosed as Uveitis and delayed surgery, sometimes a small pigment particles can be seen on the posterior wall of the cornea, but there is no grayish white corneal deposition, no choroidal inflammation or retinitis in the fundus can be differentiated from primary uveitis.
3. Low intraocular pressure
Low intraocular pressure is also one of the main features of this disease. The intraocular pressure is mostly below 3.92mmHg. The three-mirror examination of the fundus often affects the examination due to the wrinkles of the cornea. The anterior chamber is deepened, the iris has concentric wrinkles, iris tremor and lens shaking. Because of the detachment of the ciliary body, not only the secretion of aqueous humor is reduced, the intraocular pressure is reduced, but also the Zinn zonule is relaxed, and the lens and iris are moved backward.
4. Ciliary body and choroidal detachment
Ciliary body and choroidal detachment may occur after 1 to 3 weeks or more of retinal detachment, and the two may not exist at the same time. Ciliary body detachment is generally seen when the pupil is sufficiently scattered, and sometimes there is no need to compress the sclera. The structure of the serrated edge of the ridge can be clearly seen. The morphology and range of the choroidal detachment can be expressed as a flat detachment of the periphery, or a spherical bulge occupying multiple quadrants. The forward development and the detachment of the ciliary body continue, and the bulge portion It is brownish gray, sexy, and looks like choroidal melanoma. If there is a vortex vein or a long ciliary nerve, it has multiple spheres.
Examine
Examination of choroidal detachment retinal detachment
Eye B-ultrasound or eye CT examination can find localized bulges of the fundus, pay attention to the identification of solid tumors.
Diagnosis
Diagnosis and diagnosis of choroidal detachment retinal detachment
diagnosis
According to the low intraocular pressure condition and the fundus performance, the diagnosis can be confirmed by the auxiliary examination to exclude other diseases.
Differential diagnosis
Uveitis
Typical uveitis in addition to eye pain, congestion, positive flash of water, dilated pupils and gray corneal deposition, as well as vitreous opacity and fundus changes, although the disease has obvious uveitis changes, but very few There are gray corneal posterior sediments, no choroidal examination of the fundus, and retinal inflammation. If the medical history is detailed, the general high myopia is followed by flashing, the black screen is blocked, and the inflammation appears later. The retinal detachment can be found after careful examination of the fundus. Separation from the choroid.
2. Idiopathic uveal leak syndrome
There may be retinal detachment and choroidal detachment, but the subretinal fluid is clear and transparent and changes with body position, there may be mild cell infiltration in the vitreous, but no proliferative vitreoretinopathy, normal intraocular pressure, anterior uveitis is extremely mild or absent , often for the onset of both eyes, cerebrospinal fluid pressure and protein content can be increased.
3. Choroidal melanoma
Generally in the posterior pole or other quadrants have a single, localized solid bulge, the surface may have pigmentation hyperplasia, transillumination examination opaque, secondary retinal detachment, generally no uveitis reaction, B-ultrasound and CT examination have substance Mass.
