retinal detachment
Introduction
Introduction to retinal detachment Retinal detachment is the separation between the retinal neuroepithelial layer and the pigment epithelial layer. Primary retinal detachment is a common clinical disease. The number of male patients is more than 3:2 for males. Most of them are adults over 30 years old. Children under 10 years old are rare. The difference between left and right eyes is about the total number of patients. 15%. Occurs in myopia. Especially high myopia. Embryology, the neuroepithelial layer and the pigment epithelial layer of the retina are developed from the inner and outer layers of the optic cup, respectively. Normally, except for the tight connection between the two layers at the edge of the optic disc and the serrated edge, the rest depends on the pigment epithelial cell microfilamental epithelial cell (villiofthepigmentepithelialcell) surrounding the photoreceptor cell outer segment, and the adhesion of the mucopolysaccharide material is loose. When the ground is attached, the retina can exert its physiological functions. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: choroidal detachment glaucoma cataract
Cause
Cause of retinal detachment
Retinal degeneration (30%):
Due to the complex structure of the retina, the blood supply is unique and it is easy to cause degeneration due to various reasons. The peripheral part and the macula are well-denatured parts. Retinal degeneration is the basis of retinal tear formation.
Split hole formation (25%):
Before the occurrence of a hole, the following changes are common: (1) lattice-like degeneration; (2) cystic degeneration; (3) frosty degeneration; (4) paving stone degeneration; (5) retinal compression whitish and non-stressed hair White; (6) dry retinal longitudinal folds.
Vitreous degeneration (20%):
Under normal circumstances, the vitreous is a transparent gel-like structure, which is filled in the cavity of the posterior 4/5 of the eyeball, and has a supporting effect on the retinal neuroepithelial layer attached to the pigment epithelial layer. Except for the flat part of the ciliary body to the serrated edge and the adhesion around the optic disc and the retina, the other parts are only closely attached to the inner limiting membrane of the retina, but there is no adhesion.
Before retinal detachment occurs (15%):
Common changes in vitreous degeneration include (1) vitreous detachment; (2) vitreous liquefaction; (3) vitreous opacity and concentration; and (4) vitreous membrane formation.
Risk factors (10%):
(1) relationship with myopia; (2) the effect of extraocular muscle movement; (3) the relationship with ocular trauma; (4) the relationship with heredity.
Prevention
Retinal detachment prevention
A hole found in the peripheral portion is condensed on the corresponding scleral surface. If there is no retinal detachment in the vicinity of the hole and the vicinity (so-called dry hole), laser photocoagulation is feasible. Macular hole, as long as the vitreous has no obvious abnormalities, or although there is detachment of the vitreous, but there is no adhesion at the edge of the hole, and still maintain a good visual acuity, whether surgical treatment or laser photocoagulation should be cautious.
1. It is not advisable to use excessive fatigue.
2. Lift heavy objects.
3. Prevent the occurrence of myopia.
4. Do less intense activities.
5. Patients with myopia should go to the hospital regularly, especially those with poor fundus.
6. Prevent eye injuries.
Complication
Retinal detachment complications Complications choroidal detachment glaucoma cataract
There are usually complications during retinal detachment surgery. Common complications are:
1 ball wall perforation: can occur when breaking and releasing water. If the perforation occurs in the detachment area of the omentum, it can be treated as a drainage hole; if it occurs in the non-retinal detachment area, suture repair, local condensation and external compression should be performed.
2 water release complications: in addition to the perforation of the ball wall, such as the incision is too large, the liquid outflows too fast, the sudden drop in intraocular pressure, can cause choroidal exudation, hemorrhage, once found, immediately cut the sclera, release the choroidal fluid or Blood, rapid ligation of scleral sutures and cerclage strips. Excessive compression of the eyeball during release of water can invade the retina and vitreous wall, forming a fibrous vascular membrane after surgery, causing repeated bleeding and traction.
3 elevated intraocular pressure: occurs when the choroidal detachment. It is advisable to give mannitol intravenously and, if necessary, anterior chamber puncture. Unsurgical or surgical failure cases progress to full retinal detachment, and there are successive uveitis, glaucoma, and complicated cataracts, which can also cause low intraocular pressure and even eyeball atrophy.
Symptom
Symptoms of retinal detachment common symptoms anterior ocular retinal detachment visual impairment visual distortion ocular edema pigmentation dehydration hallucinations uveitis
Symptoms: Most cases are sudden onset, with decreased vision or dark shadows in front of the eyes. Many cases have prodromal symptoms such as flying mosquitoes and flashing sensations.
Retinal detachment is the detachment of the neuroepithelial layer. Because of the nutritional supply problem, the cells are first damaged, and the visual cell damage first affects the blue sensation. The blue field of the normal eye is larger than the red field of view, and the visual field is inspected by the white, blue, and red optotypes in the retinal detachment. Not only the tangible visual field defect is deviated from the corresponding area, but also the blue and red visual fields are found to intersect.
(1) Flying mosquito: seeing vitreous opacity caused by various reasons. When the mosquitoes suddenly increase, attention should be paid to whether they are prodromal symptoms of retinal detachment. The patient complained that there were black shadows in front of the eyes, and the black shadows were smoky or point-like, flake-like, and the shape often changed, which seemed to fly like a bug. The flying mosquito is a sign of posterior vitreous detachment. It may be a glial tissue surrounding the optic disc. It is produced by being torn off and suspended in the posterior cortex of the vitreous after detachment of the vitreous. It may also tear the retinal blood vessels or tear when detached. Broken retinal tissue that has physiological or pathological adhesions to the vitreous and is caused by bleeding. When the symptoms of this mosquito fly suddenly appear in myopic patients, the pupil should be enlarged, and the fundus, especially the peripheral part, should be carefully examined with indirect ophthalmoscope or three-sided mirror to detect retinal tears or early retinal detachment.
(2) Flashing sensation: After the vitreous body breaks out, at the adhesion between the vitreous and the retina, it can pull the irritating retina and produce a flashing sensation; or the detached vitreous body is caused by hitting the retina during eye movement. This symptom may disappear as the vitreous body completely detaches from the retina. The sense of flash may also be a precursor to retinal detachment and should be given the same attention as the mosquito. It is the most important symptom of retinal detachment. It can be a precursor to detachment. The vitreous degeneration and pathological adhesion of the retina can cause a flashing sensation when the vitreous body of the eyeball rotates and stimulates the visual cells. If the sense of flash persists and is fixed in a certain part of the field of view, the retinal detachment should be alert to the recent occurrence. The sensation of flash can also occur in patients with retinal detachment, which is caused by the liquefied vitreous from the ruptured pore into the neuroepithelial stimulating retinal cells.
(3) Visual impairment: Many retinal detachments can be without any aura, and vision loss is the first symptom. The change in vision varies depending on the location and extent of the dissection, and the retinal detachment in the posterior pole has a significant decrease in visual acuity. In addition to visual loss, the shallow detachment of the macula also has visual distortion and minor vision. When the peripheral retinal detachment, there is no self-consciousness, and it only gradually expands in the disengagement range, and the visual acuity is impaired when the posterior pole is affected.
(4) Visual field change: There is a visual field defect at a position corresponding to the extent of retinal detachment. Some patients after retinal detachment perceive that the black shadow gradually expands from a certain direction like a curtain. Cases in which the temporal retina begins to detach are common, and the nasal visual field defect area caused by it is just in the field of view of both eyes, sometimes not easy to detect, and is often found when covering one eye. When the retina is detached as follows, there is a defect in the upper field of view, but the average person has less chance of looking up, and because the upper field of view is covered by the upper eyelid, the upper visual field defect can also be ignored.
(5) Central visual impairment: varies depending on the location and extent of retinal detachment. When the posterior pole is disengaged, the visual acuity suddenly drops significantly, and the peripheral part of the disengagement has no effect or little influence on the central vision. Central visual impairment occurs only when the disengagement range extends to the posterior pole.
(6) Allergies: When the detachment occurs when the peripheral part is detached from the posterior pole and the detachment occurs, in addition to the decrease in central vision, there are symptoms such as deformation and smallness of the object.
Examine
Examination of retinal detachment
Under adequate dilation, indirect ophthalmoscope combined with scleral depression or slit lamp and contact lens can be used to check the appearance of the surrounding of the omentum. Fundus examination showed that the retina of the detached area lost normal red reflection and was gray or blue-gray, with slight tremors and dark red blood vessels crawling on the surface. The uplifted retina is like a hilly undulation, and the wide range of bulges can obscure the optic disc and wrinkle. Flat detachment, often missed diagnosis if not detailed examination. When the macular area is detached, the fovea of the macula has a red dot, which is in sharp contrast with the retina that is grayish-white.
A hole is often found in retinal detachment.
Diagnosis
Diagnosis of retinal detachment
diagnosis
According to clinical findings, the diagnosis is not very difficult, but the shallow detachment in the peripheral area is often easy to miss diagnosis, especially in the peripheral part of the detachment, direct ophthalmoscopy can not be found, must use both eyes indirect ophthalmoscope or three-sided mirror plus sclera The pressure can be determined after repeated and careful inspection.
Differential diagnosis
1, retinoschisis: degenerative retinoschisis is located in the lower peripheral fundus, a hemispherical lobe, developed by cystic degeneration. The inner wall is thin and transparent. Pigmentation can occur near the outer wall edge. If the inner and outer walls are ruptured, it becomes a true hole and a retinal detachment occurs. Congenital retinoschisis is found in school-age children. With a family history, retinal blood vessels are often accompanied by white sheaths. The lesion is located below the fundus or below the sac, with bilateral symmetry. If the inner wall breaks into a large hole, it is similar to the sawtooth edge. But its leading edge is not sawing.
2, central serous chorioretinopathy (referred to as "middle pulp"): "middle pulp" itself is also a shallow detachment of the neuroepithelial layer in or near the macula. It is a self-limiting disease that can resolve on its own. Different from primary retinal detachment. Retinal detachment invades the common plaque and causes visual distortion and small vision, which is the same as the "middle pulp" symptom. The surrounding area should be inspected.
3, uveal leakage (ureal effusion): choroidal effusion (choroidal effusion). Often accompanied by retinal detachment, hemispherical bulge, easy to move with changes in body position, no holes.
4, solid retinal detachment: high vitreous opacity, more easily misdiagnosed. It can be identified by ultrasound or CT scan.
5, vesicular retinal detachment: the detachment surface is smooth, no wave-like wrinkles, the effusion under the neuroepithelial layer is clear, can flow quickly with the change of body position, no rupture, different from this disease.
