Posterior uveitis
Introduction
Introduction to posterior uveitis Posterior uveitis, also known as choroiditis, is called choroidal retinitis because the choroid and the retina are adjacent to each other. When the choroid is inflamed, it often affects the retina. Choroiditis is characterized by no pain, loss of vision and significant dark shadows. Posterior uveitis is a group of inflammatory diseases involving the choroid, retina, retinal blood vessels and vitreous, clinically including choroiditis, retinitis, chorioretinitis, retinal choroiditis and retinal vasculitis. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: cataract vitreous opacity
Cause
Cause of posterior uveitis
(1) Causes of the disease
According to the etiology and related diseases, posterior uveitis can be divided into two categories, one is infectious and the other is non-infectious. The former can be divided into viral infection, bacterial and spirochete infection, fungal infection and parasitic infection. The latter can be divided into posterior uveitis associated with systemic diseases, simple posterior uveitis and camouflage syndrome.
In the post-infectious uveitis, tuberculosis and syphilis, which were the main causes in the early 20th century, are rare. However, with the increase in the number of human immunodeficiency virus infections, tuberculosis has been re-emphasized as an opportunistic infection. And opportunistic infections such as cytomegalovirus caused by retinitis are also increasing, with the use of immunosuppressive drugs in some specific populations, fungal endophthalmitis also occurs from time to date, compared with European and American countries The incidence is very low. Although there are reports of ocular toxoplasmosis in our literature, these reports are based on serological tests and do not measure intraocular liquid anti-toxoplasma antibodies. Therefore, the diagnosis is very large. doubt.
In non-infectious (full) uveitis, Behcet's disease uveitis, Vogt-Koyanagi field disease are the two most common types in China, and some people have statistical analysis of 1214 cases of uveitis patients. Accounted for 18% and 16.1% of the total number of patients, other types such as Crohn's disease, ulcerative colitis, sympathetic ophthalmia, Fuchs syndrome (although it mainly causes inflammation of the anterior segment of the eye, sometimes can cause posterior uveitis) Choroidal retinitis, acute posterior multifocal squamous pigment epithelial lesions, acute retinal pigment epitheliitis, Eales disease, subretinal fibrosis and uveitis syndrome also occur from time to time.
(two) pathogenesis
Like anterior uveitis, posterior uveitis can be granulomatous inflammation, but also non-granulomatous inflammation; can be manifested as acute inflammation, can also be manifested as chronic inflammation, infection factors or suspected infection factors, more For acute posterior uveitis, patients with acquired immunodeficiency (such as human immunodeficiency virus infection or use of immunosuppressive drugs) are prone to acute posterior uveitis; non-infective factors or autoimmune reactions caused by posterior uveitis Chronic inflammation, low-virulence pathogen infection caused by posterior uveitis (endophthalmitis) can also be manifested as chronic inflammation, infection caused by posterior uveitis in the early stage of infection did not give enough specific anti-infective treatment can also Causes chronic inflammation; acute posterior uveitis caused by some pathogens may induce autoimmune reactions during the disease, while the latter may lead to chronic inflammation in the later stage. The occurrence of posterior uveitis is also closely related to the immunological mechanism.
Prevention
Post-uvitis prevention
1. To master the method of using the eye: First, to ensure the uniformity of illumination, the natural illumination coefficient is not less than 1%, the desktop illumination is at least 50LUX, preferably 100LUX, the lamp is placed on the left side; the second is to read the book every 20 minutes. Take a break and look into the distance for 1 minute, relax your eye muscles, blink your eyes, close your eyes for a few seconds, lubricate the eyeballs; third, read and write the tabletop about 1 foot from the eyes; fourth, dim light, bed, walk, no reading; It is necessary to wear protective equipment to prevent cataracts in strong sunlight. Sixth, it is necessary to pay attention to watching TV for 30-60 minutes, and rest for 10 minutes. The distance from the eyes to the TV screen is generally 5 times that of the diagonal of the TV. Do not slant more than 45 degrees; Seven is to pay attention to diet, eat more fruits and vegetables, fish, goat liver and other calcium-containing foods, scientific research proves that sweets are easy to cause children with myopia; eight is regular inspection, correction of myopia, hyperopia, astigmatism, etc.; It is found that myopia is corrected in time to reduce eye fatigue.
2, chew hard food to protect the eyes. Professor Chiu University of Japan researched: "In the daily diet, chewing is not good, it will cause vision loss." He believes that with the emergence of food softening tendency, the child's jaw will tend to be underdeveloped, the teeth are not arranged neatly and The upper and lower teeth are not well engaged. Although the choroidal tissue is not directly related to the movement of the teeth, the long-term diet does not chew hard food, the muscle strength of the face becomes weak, and the regulation function of the crystal can not work well, which causes the vision to naturally weaken. Therefore, you should eat more hard food, strengthen the squat exercise, especially pay attention to the upper and lower teeth bite, so as not to affect vision.
3, pay attention to diet protection vision. Ophthalmologists believe that to protect your vision, you should pay attention to your diet. Food is closely related to eye health. During World War II, Royal Air Force pilots used carrots, orange juice, and foods rich in carotenoids to improve vision. A 2001 study confirmed the positive effects of anti-aging agents against free radicals, especially those produced by light (light is the main enemy of the human eye). In patients with age-related macular degeneration, these anti-aging agents, such as vitamins C, A, E and trace elements zinc, copper, selenium, etc., can reduce the risk of disease progression by 25%. Eye health also has some new foods, such as w-3 fatty acids (fish oil, walnut oil and vegetable oil). According to a study published in the United States, eating a large amount of animal oil doubles the risk of macular degeneration, and eating foods rich in w-3 fatty acids reduces this risk by half.
4, to develop a good eye-catching habits. Wash your hands frequently, pay attention to the towel and washbasin. Don't touch your eyes casually. Don't go to dusty places. Wear goggles on windy days to prevent your eyes from entering foreign objects. Once your eyes have entered foreign bodies, don't use your hands. Look for the doctor or go to the hospital to take out; there are places that irritate the eyes, do not go to see, such as welding light, etc., to prevent glare from hurting the eyes; bathing, swimming back to pay attention to eye changes, redness, eyelids should be timely, however, Eye drops should not be messed up, must be used under the guidance of a doctor, otherwise, it is easy to cause eye damage; also choose a more scientific and reasonable eye exercises, regular eye care.
Complication
Posterior uveitis complications Complications cataract vitreous opacity
Common complications are:
(1) corneal edema: This is due to inflammation involving the corneal endothelial cells, which destroys the hydration of the cornea. Corneal opacity, more common in children with anterior uveitis, more common in patients with chronic rheumatoid arthritis with chronic iridocyclitis.
(2) Anterior and posterior adhesion of the iris: In severe cases, the pupillary margin is adhered, causing pupillary atresia and iris bulging, and the pupil area is covered by the mechanical membrane to form a pupillary membrane. Iris bulging or anterior chamber exudation is mechanized, so that the iris root can be pulled to the anterior chamber angle to cause pre-iris adhesion. All of the above can cause secondary glaucoma.
(3) secondary glaucoma: due to pupillary atresia, the aqueous humor in the posterior chamber cannot enter the anterior chamber through the pupillary area, causing the posterior chamber pressure to rise and the intraocular pressure to rise sharply. At the same time, there may be a frontal adhesion around the iris to block the angle of the anterior chamber. Decreased filtration function, resulting in increased intraocular pressure; increased viscous water in the anterior chamber of the acute phase, and oozing obstruction of the anterior chamber angle, causing an increase in intraocular pressure.
(4) complicated cataract: due to long-term inflammatory stimulation, affecting the nutrition and metabolism of the crystal, causing turbidity in the posterior and posterior cortex of the crystal. More common in chronic anterior uveitis and intermediate uveitis.
(5) Vitreous opacity: severe iridocyclitis or posterior uveitis, often with vitreous spots, strips or clumps of turbidity, located in the posterior part of the vitreous, fluttering with the rotation of the eyeball, severely affecting vision.
(6) Choroidal detachment: It is exudative and disappears as the inflammation subsides.
(7) retinal and macular edema, degeneration: posterior uveitis often has severe retinal and macular edema, the retina becomes grayish white turbid, the macula can form diffuse or cystic degeneration, such as long duration, can cause severe vision loss .
(8) optic nerve changes: can be complicated by optic neuritis, papilledema and neovascularization of the optic papilla.
(9) Refractive error: ciliary body sputum during inflammatory activity, myopia may occur; macular edema may cause transient hyperopia.
(10) Atrophy of the eyeball: severe inflammation finally forms ciliary membrane traction retinal detachment, ciliary body atrophy, decreased aqueous humor secretion, low intraocular pressure, decreased eyeball atrophy, and complete loss of vision.
Symptom
Post-uveal inflammation symptoms Common symptoms Eye pain Vision deformation Retinal edema Uveitis Oral ulcers Eye shadow vasculitis Retinal hemorrhage Hair loss Retinal detachment
1, the symptoms mainly depend on the type of inflammation, the location and severity of the affected. There may be blurred or decreased dark spots or dark spots, flashes, visual objects, etc., and systemic symptoms are associated with systemic diseases.
2, physical signs depending on the location (level) and severity of inflammation. Common ones are: 1 intravitreal inflammatory cell nuclear turbidity; 2 focal chorioretinal infiltration lesions, size can be inconsistent, late formation of scar lesions; 3 retinal vasculitis, vascular sheath, vascular occlusion and hemorrhage; 4 retinal or macular edema . In addition, exudative retinal detachment, proliferative retinopathy, and vitreous vessels can also occur. Generally, there is no change in the anterior segment of the eye. Occasionally, there may be mild anterior chamber flash and a small amount of anterior chamber inflammatory cells.
Examine
Post-uvitis examination
FFA is helpful in judging the retina and its vasculitis and choroidal pigment epithelial lesions. ICGA helps to determine the lesions of the choroid and its blood vessels. Serological examination, direct smear examination of intraocular fluid pathogens, determination of DNA of infectious agents, pathogen culture, and antibody determination by polymerase chain reaction are helpful for the diagnosis of etiologies.
Diagnosis
Diagnosis and differentiation of posterior uveitis
Diagnosis can be made based on typical clinical manifestations.
Diagnose based on
1. There are black shadows in front of the eyes and decreased vision.
2. Vitreous opacity.
3. Fundus examination revealed an exudative source.
4. Fundus fluorescein angiography shows local or diffuse choroidal leakage.
The most important point in differential diagnosis is that the true inflammatory disease should be differentiated from some ocular tumors (such as retinoblastoma) and systemic tumors (such as lymphoma) that cause inflammation. The prognosis is very different. If misdiagnosed and mistreated, it will lead to serious consequences.
In a large class of diseases of retinal vasculitis, not only should they be distinguished from each other, but also should be distinguished from some non-inflammatory diseases (such as vascular occlusive disease, arteriosclerosis) that cause retinal vascular sheath. Inflammation can also leave this change. The vascular sclerosing changes are different from those caused by active retinal vasculitis and perivascular inflammation. The former does not cause vascular leakage and staining of blood vessel walls, nor is it accompanied by vitreous inflammatory reactions.
