retinal vasculitis
Introduction
Introduction to retinal vasculitis Retinal vasculitis (retinalvasculitis) is a large class of inflammatory diseases involving retinal blood vessels, which are typically manifested as gray-white vascular sheaths, exudation, hemorrhage, retinal edema, etc., which are a serious type of eye disease that threatens vision. basic knowledge The proportion of illness: 0.012% Susceptible people: no special people Mode of infection: non-infectious Complications: glaucoma retinal detachment retinopathy vitreous hemorrhage
Cause
Cause of retinal vasculitis
(1) Causes of the disease
1. Immune complex: Immune complex deposition is an important mechanism for the development of various retinal vasculitis. It has been found to play a role in the development of systemic lupus erythematosus and nodular polyarteritis, but in most cases, immune complexes The deposition is not specific to the retinal blood vessels. It is unclear whether the deposition of this immune complex is the initiating factor of retinal vasculitis, or the accompanying result. Most people think that retinal vasculitis is often a successor to systemic diseases. Hair performance.
2. Cellular immune response: It has been found that delayed allergic reactions play an important role in the development of some retinal vasculitis. Activated CD4 cells, CD8 cells and macrophages can release some cytokines and cause a series of reactions. Causes vascular damage and inflammatory reactions.
(two) pathogenesis
In addition to retinal vasculitis caused by infections and tumors, whether it is idiopathic retinal vasculitis or retinal vasculitis caused by systemic diseases, it is basically thought to be caused by autoimmune reactions in various vasculitis Cellular immunity and humoral immunity are involved in the occurrence, but some types are mainly humoral immune responses, and some types are mainly cellular immune responses. The self-antigens causing such diseases are not fully understood, and the exact pathogenesis is also relevant. Not completely clear.
Prevention
Retinal vasculitis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Retinal vasculitis complications Complications glaucoma retinal detachment retinopathy vitreous hemorrhage
Retinal vasculitis can cause a variety of complications, the incidence of neovascular membrane formation is 10% to 15%, can occur in the retina or optic disc, but the retinal neovascular membrane is more common in the clinic, the formation of new blood vessels may be related to retinal blood vessels The occlusion is related to retinal ischemia. Some patients may not have vascular occlusion, only diffuse capillary leakage, so the occurrence of new blood vessels may be related to hypoxia, and may also be related to stimulation from inflammation sites or inflammatory cells. Retinal and optic disc neovascularization is prone to retinal hemorrhage and vitreous hemorrhage, macular ischemia, common in patients with occlusion of the foveal around the fovea, fluorescein fundus angiography shows irregular and enlarged foveal avascular area, retinal vasculitis Causes severe retinal ischemia, which causes iris reddening and neovascular glaucoma, a rare complication that is often accompanied by active inflammation and proliferative vitreoretinopathy.
Retinal vasculitis with systemic disease can have corresponding systemic complications. Because retinal vasculitis can occur before systemic disease, these patients are diagnosed with idiopathic retinal vasculitis, so for all idiopathic retinitis Patients should pay attention to whether there is a systemic disease in the future.
Symptom
Retinal vasculitis symptoms Common symptoms Retinal edema Retinal bleeding Eye shadow nodules Herpes deformity Granuloma Vision often foggy
Retinal vasculitis can be divided into three types of arteritis, phlebitis, and capillary vasculitis, and their clinical manifestations are not the same. The characteristics of their respective ocular lesions will be briefly introduced below.
1. Retinal phlebitis and perivenous inflammation
Retinal phlebitis and retinal vein inflammation are common types of retinal vasculitis. The clinical manifestations are mainly the vascular sheath surrounding the blood vessel or the inner sheath lining the inner wall of the venous blood vessel. Any retinal vein from the optic disc to the peripheral retina can be affected. May be involved in segmental involvement, or the whole process is involved, the earliest phlebitis changes finite local retinal vein dilatation or irregular movement, accompanied by blood flow darkening, around the blood vessels began to gather polymorphonuclear leukocytes, after lymphocytes, Giant cells or epithelial cells accumulate around the vein to form a vascular sheath. If the inflammation subsides, the vascular sheath can disappear completely or permanently. If the inflammation persists, secondary changes such as hyalinization of the blood vessel, tube Cavity stenosis or occlusion, thrombosis, vascular wall necrosis or even rupture, which can lead to retinal hemorrhage, edema, exudation, telangiectasia, microaneurysms, retinal neovascularization (Figure 2), such as retinal vascular hemorrhage or Neovascular hemorrhage can lead to proliferative vitreoretinopathy, and traction of proliferative lesions can lead to Retinal detachment.
2. Retinal arteritis
The manifestations of retinal arteritis vary greatly in clinical practice. The immune complex is deposited in the anterior capillaries of the capillaries, causing microinfarction and cotton plaque. This change can be seen in systemic lupus erythematosus, dermatomyositis and some infectious factors. Caused by retinal arteritis, inflammation of the branches of small arteries can be expressed as nodular leukoplakia around the vascular lumen, but not beyond the arterial wall, this type is seen in ocular toxoplasmosis, syphilis, tuberculosis, herpes zoster viral retinopathy This plaque-like change subsides slowly, leaving no traces, and can leave a slight scar. Arteritis can cause irregular white sheath of the artery. The white sheath can be segmental or full-scale, severe arteritis. Can completely interrupt the blood flow of blood vessels, causing massive retinal necrosis and hemorrhage. This severe retinal arteritis can be seen in nodular arteritis, Wegner granuloma, Churg-Strauss syndrome, giant cell arteritis, Takayasu disease, simple Retinitis or acute retinal necrosis syndrome caused by herpes virus and herpes zoster virus.
3. Retinal capillary vasculitis
Patients with blurred vision, blurred vision, dark shadows and other symptoms, visual acuity is generally not obvious, but there may be significant visual loss when the macula is involved, no obvious bleeding, exudation, vascular sheath, neovascularization Such changes, but patients may have mild retinal edema, cystoid macular edema, long-term chronic inflammation patients may also have proliferative changes, fluorescein fundus angiography found extensive retinal microvascular leakage.
Examine
Retinal vasculitis
1. Check for cardiovascular disease, diabetes, rheumatism, tuberculosis, sarcoidosis and viral infections.
2. Check the visual acuity, dilated eye drops, pay attention to the white sheath and vein occlusion, fundus hemorrhage and neovascular membrane, proliferative lesions.
3. Fluorescein fundus angiography and visual electrophysiological examination. Fluorescent fundus angiography (FFA) can show fluorescence leakage and vascular wall staining of affected vessels.
4. Pathogen examination, blood routine examination, ESR and X-ray chest X-ray.
Diagnosis
Diagnosis and diagnosis of retinal vasculitis
diagnosis
The diagnosis of retinal vasculitis is mainly based on medical history, ocular manifestations, fluorescein fundus angiography and certain laboratory tests. The medical history query can provide a diagnostic basis for obtaining a specific diagnosis, although the vascular sheath and vascular diameter change, fluorescein Fundus angiography revealed retinal vascular dye leakage and vascular wall staining is a common clinical manifestation of vasculitis, but the affected blood vessels, the course of inflammation, accompanied by other ocular inflammation (such as granulomatous or non-granulomatous anterior grapes) Membrane inflammation, vitreous globular turbidity, beaded turbidity, ciliary body flat and vitreous base snow estrous changes, retinitis, retinal choroiditis, choroidal granuloma, etc. and systemic diseases (such as skin lesions, arthritis, Nervous system lesions, digestive system lesions, respiratory diseases, and urinary system lesions may all provide important clues for specific diagnosis. Performing appropriate laboratory and auxiliary tests on some suspicious patients will help to determine a specific diagnosis.
Differential diagnosis
Note that acute retinal necrosis syndrome (ARN) is a kind of necrotizing retinitis caused by herpes zoster virus or herpes simplex virus. It can occur in normal people or in immune function. Inhibited patients, typically manifested as peripheral full-thin retinoic retinitis, retinal vasculitis with occlusive arteritis, moderate vitreous opacity and inflammatory response, retinal detachment is prone to occur later, many patients have Obvious anterior chamber inflammation, retinal vasculitis in this disease is mainly arterial involvement, visible vessel thinning and vascular sheath formation, retinal necrosis lesions have clear boundaries, suggesting an ischemic necrosis, also can be seen Venous vascular sheath and intraretinal hemorrhage correspond to the disappearance of small arteries and microvascular non-perfused areas in fluorescein fundus angiography.
