fundus vascular streaks
Introduction
Introduction to fundus vascular streaks Fundus angioids (Fundusangioidstreaks) is a Bruch membrane disease caused by degeneration of the mesodermal component of the choroidal Bruch membrane, the elastic layer. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia
Cause
Fundus vascular-like streak
(1) Causes of the disease
The cause is unknown.
(two) pathogenesis
The pathogenesis is unknown. At present, most agree with Knapp that it is caused by the rupture of the Bruch membrane elastic fiber layer. The main change is the lack of vitality of collagen fibers. It may be due to the change of enzymes affecting the metabolism of amino acids, and the rupture of the glass membrane can be The thinned and pigmented pigment epithelium spans, and the fibrovascular tissue from the choroid enters the pigment epithelial layer from the crack of the Bruch membrane, which widens the discoloration of the pigmentation line and enters through the thinned pigment epithelium. Under the neuroepithelial layer, it causes localized shallow retinal detachment, hemorrhage and exudation.
Prevention
Fundus vascular streak prevention
Develop good habits and find timely treatment in a timely manner.
Complication
Fundus vascular streak complications Complications anemia
62% of fundus changes can be accompanied by typical elastic pseudo-yellow tumors (pseudoxanthoma), a type of elastic fiber dysplasia that affects the skin, eye, gastrointestinal and cardiovascular systems. The typical performance is in the neck, The inferior skin has a pseudo-yellow tumor and the appearance of the skin is chicken skin. The pseudo-yellow tumor patients are 80% to 87% of the patients. When the disease and the pseudo-yellow tumor coexist, it is Greonblad-Strandberg syndrome. At this time, the patient's skin is loose and thick, and there are many small yellow patches on the skin. At the beginning, it is only 1 to 3 mm in diameter. Later, it can be fused into larger plaques, yellowish and soft, lacking elasticity, often occurring in the neck., elbow, knee, groin, chest and abdomen and other large joints near the skin, this can still occur cardiovascular changes and gastrointestinal and urethral bleeding, in addition to the disease 8% ~ 15% associated with Paget disease (osteitis osteitis, osteoitis deformans ) and 1.5% to 6% of sickle cell sickle (sicklemia), etc., may also have a fundus change of the disease, because the disease involves the Bruch membrane, which can be complicated by retinal pigment epithelial cell serous detachment.
Symptom
Fundus vascular-like streak symptoms Common symptoms Visual impairment Fundus changes macular degeneration retinal hemorrhage
1. There is no self-consciousness in the early changes of visual function. Most of them are found in the fundus examination. The early central vision is normal. The central part of the eyesight is seriously degraded and the recovery is difficult to recover.
2. Fundus changes in the fundus can be changed from mild orange peel to severe posterior vascular streaks. There are irregular lines around the optic disc with reddish-brown or dark brown-like blood vessels. Most of them are emitted from around the optic disc. The equator is thinned and terminated before, the lines are narrow, the length is different, there are branches or staggered, the edges are clear, but the unevenness (Fig. 1), the stripes are located in the deep surface of the retinal blood vessels and the shallow surface of the choroidal blood vessels, the color of the stripes It may vary depending on its pigmentation or the degree of fiber tissue proliferation. It is usually brownish red or grayish white, and the fibrous tissue is gray when visible. When the pigment is long, it may be light brown, taupe or black. The older stripes may have grayish white sides. The accompanying lines indicate fibrous tissue hyperplasia, and the streaks can be static or progressive. Wildi once classified the disease into three stages: the first stage showed pigmentation streaks at the fundus; the second stage showed streak progression. The macular extension, subretinal hemorrhage or exudation; the third stage is the macular organic matter similar to discoid degeneration, but the lesions are slow, from pigmented streaks to macular degeneration, the disease can be reached Ten years.
Pedia's orange can also be seen on the fundus, and the posterior pole of the fundus can have reticular pigment atrophy, focal retinal pigment epithelium (RPE) atrophy and yellow plaque. Due to the thickening of the stratum corneum of the Bruch membrane, focal chorioretinopathy sometimes occurs, which is similar to the punched-out seen in the fundus of the ocular histoplasmosis, and more fundus is seen. Glass sputum can be complicated by macular degeneration and hemorrhage. The incidence of macular degeneration is 50%. Hemorrhage is caused by subretinal neovascularization at the Bruch membrane rupture.
Examine
Examination of fundus vascular streaks
1. Blood routine examination to determine whether there is sickle cell anemia.
2. Histopathological examination The streak of the fundus is thickened by Bruch membrane, formed by calcification and fracture, the edge is serrated, the pigment epithelium at the edge of the crack can be normal, some of the stripe is degenerated, or it is replaced by fibrous vascular tissue. Below the large defect area, the choroidal capillaries are replaced by connective tissue, and the choroidal capillaries and pigment epithelium are less involved in the early stages of the lesion. As the disease progresses, these structures are also secondary to degeneration, and finally choroidal neovascularization occurs through the Bruch membrane. Cracks that cause subretinal hemorrhage, exudation and edema eventually lead to discoid scars.
3. Fundus fluorescein angiography has many manifestations. Due to RPE destruction, vascular-like stripe angiography shows strong fluorescence in the early stage (Fig. 2). The choroidal background fluorescence is seen in the RPE through the atrophy of the stripe surface, and the late high fluorescence is the ruptured Bruch membrane. Caused by the coloration of the edges and choroid.
In the early stage of the streak, due to the atrophy or rupture of choroidal capillaries, weak fluorescence is caused by poor perfusion, the edge is strongly fluorescent, and the coloration is late. The fluorescein angiography of the orange-like lesions seen in the fundus is a weak fluorescent spot, which may represent choroidal capillaries. And local defects of Bruch membrane, but the spots are often strong fluorescence, disappeared later, caused by pigment loss, can see the background fluorescence, indicating that there is a wide range of RPE changes in this disease.
4. Indocyanine green angiography of indocyanine green angiography is mainly characterized by the following manifestations: most of the streaks show strong fluorescence, which is clearer than that seen by fundus examination and fluorescein angiography; retinal pigment epithelium and In cases of complete atrophy of choroidal capillaries, the fringe edge is strongly fluorescent, but the center is linearly weakly fluorescent; due to the complete atrophy of the RPE and choroidal capillaries at the streaks, the hyperpigmentation of the streak hyperplasia makes the contrast weakly fluorescent, and the weak fluorescent fringes can be There is a strong fluorescence point; the clinical appearance of the orange peel-like lesions indocrosal green angiography is characterized by a large number of dot-like strong fluorescences, and on the central concave side, the contrast of the corresponding strong fluorescent point lesions is shown by contrast. The clinical findings are wide, can affect the entire posterior pole, and even extend to the nasal region of the optic disc. Indocyanine green angiography shows that orange peel-like lesions are clearer and more accurate than fluorescent angiography.
Diagnosis
Diagnosis and diagnosis of fundus vascular streaks
The fundus has a special performance and the diagnosis is not difficult.
The different manifestations of the fundus also need to be differentiated from the following diseases:
1. Choroidal sclerotic vascular-like streaks are widened due to RPE degeneration and choroidal capillary degeneration, so that it is difficult to distinguish vascular-like streaks, and fundus changes are difficult to identify choroidal sclerosis, and other clinical manifestations need to be referred to.
2. Age-related macular degeneration mostly occurs in the elderly, and there is no vascular-like streak-like change in the fundus.
3. The ocular histoplasmosis of the ocular cytoplasmic disease is similar to that of the fundus vascular-like streak due to the wear-like lesion and the macular degeneration, but no vascular-like streaks.
