Panuveitis
Introduction
Introduction to total uveitis Whole uveitis refers to inflammation of the entire uvea. The inner layer of the retina is a film that lining the inner surface of the vascular membrane and has a sensitizing effect. There is an optic nerve head in the back. Inflammation can involve the retina and the vitreous. When uveitis is caused by an infectious agent, it is called endophthalmitis. The common common uveitis in China is Vogt-Koyanagihara disease, Behcet's disease, uveitis and so on. It is basically the same as the medical treatment of sympathetic ophthalmia. Immediately after the diagnosis is confirmed, the glucocorticoid is injected in a large dose, and the dose is decreased after the inflammation is controlled. After the quiescence, the maintenance dose is still required for 3 to 6 months. If the inflammation is severe and the glucocorticoid is difficult to work, add an immunosuppressive drug such as cyclosporin A or cyclophosphamide. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: subretinal neovascular membrane optic atrophy neovascular glaucoma
Cause
Total uveitis etiology
Infection factor (55%):
It refers to infection caused by pathogens such as bacteria, fungi, spirochetes, viruses, and parasites. They invade the local tissue and systemic inflammatory reactions caused by the human body. All pathogens that produce an inflammatory response are said to be infectious.
Other factors (40%):
It is not inflammation caused by pathogenic microorganisms (trauma, high temperature, ultraviolet rays, etc.) and is called "non-infectious inflammation". Inflammatory tissue manifestations: red, swollen, hot, painful. Normal organizations do not have these performances. Including idiopathic, autoimmune, rheumatic diseases, traumatic, camouflage syndrome, etc. can cause this disease.
Pathogenesis
The etiology and pathogenesis of uveitis is mainly due to the invasion of external evils or internal heat; it is related to the dysfunction of liver, kidney and spleen. The liver is more spleen and bloody, the liver is vented, the liver is open to the eye, the liver is heated by the wind or the liver is stagnation, the heat is disturbed, the eye is burned, or the fat is sweet and fragrant, resulting in spleen and stomach dampness. Heat evil on the eyes, smoked and burned glutinous rice, or yin deficiency, long-term yin, liver and kidney yin deficiency, virtual fire on the inflammation, eye damage, or the adjacent tissue lesions in the eye and the intraocular veins cause blood Hoarding. Blood circulation disorder causes disease.
Prevention
Total uveitis prevention
1. The disease occurs mostly in young and middle-aged people, and can also occur in infants and the elderly.
2, pay attention to facial cleanliness.
3, preoperative, postoperative systemic and local use of glucocorticoids, can prevent the recurrence of anterior uveitis.
4, the amount of medication should be sufficient, the course of treatment should be long, in order to consolidate the efficacy and prevent recurrence. Pay attention to changes in blood during medication.
Complication
Total uveitis complications Complications, subretinal neovascular membrane, optic atrophy, neovascular glaucoma
The most common complication is the subretinal neovascular membrane, the incidence rate is as high as 32% to 46%, mostly occurs in the retinal atrophic lesion or new subretinal lesions, the neovascular membrane can occur in the fovea and other fundus Part. It can occur in a single or multiple appearances; about one-third of patients have optic disc congestion and swelling; 14% to 41% of patients have cystoid macular edema. In addition, complications such as the anterior membrane of the retina, optic atrophy, neovascular glaucoma, and subretinal fibrosis may occur.
Symptom
Total uveal inflammation symptoms common symptoms uveitis iris inflammation ciliary congestion
Total uveitis: It is the presence of anterior uveitis and posterior uveitis, but its symptoms often focus on anterior uveitis, and later on the uveal. A few start with posterior uveitis, which later affects the anterior uveal.
Anterior uveal inflammation:
Conjunctiva: ciliary congestion or mixed congestion.
Water: flash, cells.
Anterior chamber: empyema, hemorrhage, fiber flocculation.
KP: size, shape, color, quantity, distribution.
Iris: edema, adhesions, nodules, atrophy, bulging, and neovascularization.
Pupil: Shrink, lock, and close.
Vitreous: turbid.
Post-uveal inflammation:
The vitreous is turbid.
Fundus lesions: localized, disseminated, diffuse.
Different performances in different stages.
Different tissue injuries have different performances.
Examine
Whole uveitis check
Fundus fluorescein angiography: Fluorescein fundus angiography is of great value in the diagnosis of Vogt-Koyanagihara disease. The changes in angiography can be very different at different stages of the disease.
(1) Fluorescein angiographic changes in the acute phase of uveitis: during the period of uveitis, usually called the acute phase of inflammation (actually including the posterior uveitis and anterior uveal age), Fluorescein fundus angiography is characterized by multiple punctate strong fluorescence at the level of retinal pigment epithelium, which gradually enlarges and causes fluorescein to enter the subretinal fluid and retinal pigment epithelial fluid. The strong fluorescent site is located in the choroidal inflammation site, the dye comes from the choroidal capillaries, and enters the subretinal space, delineating the contour of the multifocal retinal neuroepithelial detachment. Another feature of the uveitis period is the appearance of radial choroidal vaginal dark bands and bright bands, which are caused by swollen choroidal wrinkles; in addition, optic disc leakage is a common change, occasionally seeing macular edema, focal retina Vasodilation and leakage.
(2) fluorescein fundus angiography changes in the recurrence of anterior uveitis: in the recurrence of anterior uveitis, inflammation in the posterior segment of the eye, generally chronic inflammation and mild inflammation, inflammatory exudation can be absorbed, this Typical angiographic changes were worm-like fluorescence appearance and window-like defects, and diffuse retinal pigment epithelial lesions showed a strong or weak fluorescence change. In addition, spot-like staining, optic disc strong fluorescence, hemorrhagic masking fluorescence, and macular edema caused by petal-like strong fluorescence were observed, and occasionally, strong local fluorescence caused by pigment epithelial detachment was observed.
Diagnosis
Diagnosis and identification of total uveitis
The diagnosis of total uveitis needs to be diagnosed according to clinical symptoms and examinations. Whole uveitis refers to the inflammation of the entire uveal membrane, often accompanied by inflammation of the retina and vitreous. When uveitis is caused by an infectious agent, it is called endophthalmitis. The common common uveitis in China is Vogt-Koyanagihara disease, Behcet's disease, uveitis and so on.
