macular degeneration
Introduction
Introduction to macular degeneration Macular degeneration is usually a natural consequence of age-related degeneration. As age increases, retinal tissue degenerates and thins, causing a decrease in macular function. In 10% of patients with macular degeneration, the microvessels responsible for supplying nutrients to the retina will leak and even form scars. Newborn abnormal blood vessels are also common. The fluid leaking from the blood vessels will damage the macula and cause visual distortion. The visual acuity is reduced, and the dense scar causes the central vision to drop significantly, affecting the quality of life and even becoming blind. Macular degeneration Sometimes, macular degeneration can also be caused by trauma, infection or inflammation, and there are certain genetic factors in this disease. Macular degeneration is one of the most difficult eye diseases recognized by the international ophthalmology community. There are currently not many effective treatments for macular degeneration. Nowadays, the United States has adopted Avastin for the treatment of macular degeneration, which has been approved by the US FDA. Currently, only Hong Kong has adopted this drug to treat macular degeneration. basic knowledge The proportion of diseases: the incidence rate of middle-aged and elderly patients over 50 years old is about 0.003%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: retinal detachment retinopathy
Cause
Cause of macular degeneration
Body factor (85%):
When the macular degeneration affects the pigment epithelium and the neuroepithelium causes dissociation, the vision loss or visual distortion can be attributed to visual fainting. When a small amount of bleeding enters the vitreous and causes turbidity, it can be cloud and fog. However, if a large amount of blood enters the vitreous and causes a sudden drop in vision, it can be classified as "blindness."
Age factor (15%):
The disease is mainly due to old and frail, debilitating qi or deficiency of congenital spleen, spleen and kidney deficiency and liver stagnation, phlegm and heat are the main factors. The main spleen of the spleen is transported, and the spleen and qi are not transported, the qi and blood are not enough, and the kidney qi is agitated. The malfunction of the main water and the Tibetan essence leads to the retention of water or dampness.
The pathological products of the drusen of the early stage of the disease were born. , , , , , , , , , , , , , , , , , , , , , , , , , , Excessive in the extravaginal, blood stasis and phlegm and phlegm, phlegm and blood stasis aggravate the condition, resulting in phlegm, liver qi, blood stasis in the middle and late stages of the disease, intricate clinical manifestations of repeated recurrence of the fundus, bleeding and Pathological manifestations such as neovascularization and scar formation are difficult to treat.
Prevention
Macular degeneration prevention
First, prevention-based, early treatment
Age-related macular degeneration, the macular degeneration of the macular area is the earliest stage of the disease, the lesions are the lightest, but the risk of its latent is very large, at this time the most can not be paralyzed. In patients with juvenile macular degeneration, the early central visual acuity decreased, but the fundus changes were not obvious. At this time, it should be discovered in time, early medication, and adherence to treatment. In the course of any disease progression, the earliest course of the disease, as well as the lightest stage of the disease, is the best time to treat, with more opportunities to prevent progression.
Second, acute cases, specimens are treated together to ease the disease
Diagnosis and treatment When there is blood pigmentation epithelial detachment in the macular area, neuroepithelial detachment and hemorrhage into the vitreous and other signs, the disease progresses sharply and the visual function is severely impaired. This case often recurs until the visual impairment is severely damaged or completely lost. . For such serious cases, we must actively and actively treat them. According to the different stages of the disease, we will use different treatment methods to take the blood to stop bleeding, replenish qi and collaterals, clearing heat and cooling blood, and promoting blood circulation to remove blood stasis. There are serous exudates, mainly spleen and phlegm, phlegm and dampness; late hemorrhage absorption is slow, it is suitable for phlegm and gas, soft and firm; for a large number of scar formation, it nourishes liver and kidney, soft and firm For the treatment of the law; for the early decline in visual acuity, the macular pigment disorder is the main change, it is appropriate to adjust the liver and kidney, Yiqi Yangxue Tongluo.
Complication
Macular degeneration complications Complications retinal detachment retinopathy
Macular degeneration is the leading cause of blindness in people over 50 years of age.
Symptom
Symptoms of macular degeneration Common symptoms Visual field of vision changes central dark spots and flexion... Visual impairment retinal detachment
1. Early visual distortion, vision loss, and severe visual impairment in the later stage.
2. Fundus performance: atrophic type: the center is unclear, scattered in the yellow spotted drusen (druscn), pigmentation disorder in the macula, like a salt-like or gold-like appearance. Exudation type: In addition to atrophic performance, exudation and hemorrhage can be seen, forming a yellow-white, gray-black or gray-blue disc-shaped bulge. In the later stage, the pathogen is whiteized scar and pigment group or residual bleeding.
3. Fundus fluorescein angiography: a window-like defect in pigmented epithelial atrophy. In the exudative type, there is a neovascular membrane under the pigment epithelium, and the resulting fluorescence is blocked by fluorescence and leakage. The vitreous of the drusen is fluorescent or the residual fluorescence in the late stage of contrast.
Examine
Macular degeneration check
Fundus examination:
1 dry type: early visible macular dementia, the fovea is unclear, there are scattered glass sputum. In the late stage of the disease, the macular part may have metal-like reflection, and the retinal pigment epithelium atrophy is map-like, showing cystic degeneration.
2 Wet type: There are many fused glass enamels with dark borders, dark yellow patterns, or irregular lesions. The ridge can range from 1-3 PD, a large number of subretinal hemorrhages, can enter the vitreous, and form vitreous hemorrhage. The late lesions were grayish white scars.
Fundus fluorescein angiography, showing retinal pigment epithelial atrophy when exposed to fluorescence, pigmentation can be masked at the pigmentation, early lace-like or reticular neovascularization, and late fluorescein leakage (wet type).
Diagnosis
Diagnosis and differentiation of macular degeneration
Diagnostic criteria
(1) The age of onset is over 45 years old. The older the age, the higher the incidence rate, and the two eyes have successively become the main eye diseases of the elderly with visual impairment.
(2) The central vision is slowly decreasing, and there may be visual distortion, and there is a gaze shadow in front of the eyes, and finally the central vision is lost. Peripheral vision exists.
(3) Fundus examination:
1 dry type: early visible macular dementia, the fovea is unclear, there are scattered glass sputum. In the late stage of the disease, the macular part may have metal-like reflection, and the retinal pigment epithelium atrophy is map-like, showing cystic degeneration.
2 Wet type: There are many fused glass enamels with dark borders, dark yellow patterns, or irregular lesions. The ridge can range from 1-3 PD, a large number of subretinal hemorrhages, can enter the vitreous, and form vitreous hemorrhage. The late lesions were grayish white scars.
(4) fundus fluorescein angiography, showing retinal pigment epithelial atrophy when showing fluoroscopy, pigmentation at the pigmentation, early lace-like or reticular neovascularization, and late fluorescein leakage (wet type).
Differential diagnosis
First, age-related macular degeneration
It is manifested that the retinal pigment epithelial cells decrease the phagocytosis and digestive function of the outer disc membrane of the visual cells, so that the undigested disc membrane remains in the basal cell original paddle and is discharged to the outside of the cell to form a drusen, thus secondary After pathological changes, macular degeneration occurs, which is mainly related to long-term chronic photodamage in the macula, choroidal vascular sclerosis, and retinal pigment epithelial cell aging. Macular degeneration is divided into atrophic and exudative types according to clinical manifestations:
1 atrophic type - also known as dry or non-exudative: mainly due to choroidal capillary atrophy, thickening of the glass membrane and atrophy of the macular area caused by atrophy of the retinal pigment epithelium.
2 exudative type - also known as wet or discoid macular degeneration: mainly due to destruction of the vitreous membrane, choroidal blood vessels invade the subretinal choroidal neovascularization, macular retinal pigment epithelial or neuroepithelial serous or hemorrhagic discoid The detachment eventually becomes a mechanical scar, and according to clinical observation, the atrophy type can also be converted into an exudation type.
Second, juvenile macular degeneration (Stargarde) also known as congenital macular degeneration.
Most of them start to develop from 8-14 years old and are autosomal recessive hereditary eye diseases. The cause of the disease is related to lipid deposition in the retinal pigment epithelial cells, which cause atrophy of the macular choroid and retina due to degeneration of such cells.
Diagnostic points and clinical manifestations:
(1) In the early stage of the lesion, the fundus is completely normal, but the central visual acuity has been significantly reduced, and it is easy to be misdiagnosed as amblyopia or rickets. The lesion progresses slowly, but is progressive for symmetry, often showing a typical change around the age of 30, with central vision dropping to 0.1 or lower.
(2) Fundus examination: When the visual acuity of the patient is decreased, the macular lesions are not significant, and the two are not proportional; then the foveal fovea disappears, uneven pigment spots appear, grayish reflection, and finally macular degeneration District, there is gold foil reflective. The choroid becomes white, the blood vessels become thinner, and the color of the optic disc is light.
(3) Fluorescence angiography can show high fluorescence in the macular area before the fundus changes.
(4) According to electrophysiology, EOG is slightly reduced, and ERG shows that the cone function is gradually lost.
