choroidal ischemia
Introduction
Introduction to choroidal ischemia With the wide application of fundus fluorescein angiography and the gradual popularization and application of indocyanine green angiography, the understanding of choroidal vascular diseases has been deepened, and more choroidal ischemia has been reported. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: vitreous opacity optic discitis retinitis edema
Cause
Choroidal ischemic cause
(1) Causes of the disease
The etiology of this disease is not clear, many cases of clinical reports combined with body and eye inflammation, such as cerebral vasculitis, viral meningitis, nodular erythema, microvascular nephropathy, abnormal platelet aggregation, acute thyroiditis, sarcoidosis, Respiratory infections, etc., there are facial nerve spasm, sinusitis, OT test positive and ocular uveitis, scleritis and optic discitis, this disease may be a non-specific inflammatory response to different causes of choroidal capillary anterior arterioles, Can be part of the vascular response of the body.
(two) pathogenesis
Gass believes that the retinal pigment epithelium is the earliest affected tissue in this disease. With the in-depth study of the choroidal circulation, it is found that the primary lesion of this disease is in the choroidal capillaries, which is a choroidal ischemic lesion due to the choroidal arterioles. It is caused by obstruction and is therefore called "acute multifocal ischemic choroidal lesion".
Prevention
Choroidal ischemia prevention
Early detection, early diagnosis, early treatment, pay attention to improve their own immunity, eat more foods rich in vitamin C, such as: vegetables, fruits. Vitamin C increases blood vessel elasticity and protects blood vessels. Control the quality and quantity of fat intake. Saturated fatty acids can raise blood cholesterol, while polyunsaturated fatty acids can lower cholesterol. Therefore, it is necessary to control the intake of saturated fatty acids such as lard and tallow in the diet.
Complication
Choroidal ischemic complications Complications vitreous opacity optic discitis retinitis edema
Can be combined with vitreous opacity, optic discitis, retinitis, and may have retinal edema and bleeding.
Symptom
Choroidal ischemia symptoms common symptoms edema
In patients with acute choroidal ischemia, often due to decreased vision or even blindness, the fundus performance depends on the size, number and duration of the obstructed blood vessels. Fresh lesions in the blocked blood vessel branch supply area, grayish white edema in the outer layer of the retina and under the retina If a trunk of the ciliary artery (the temporal or nasal posterior ciliary artery) is obstructed, edema and opacity appear on the side of the fundus on the side of the supply. If both branches are blocked, the entire fundus is grayish white and edematous. After the branch of the artery was blocked, the fluorescein angiography showed that there was no fluorescein filling in the corresponding area, and the ischemic condition improved after 1 week. Most of the recovery occurred after 2 to 3 weeks, but a few patients still showed slow filling after several weeks, usually in 3 weeks. After 1 month, the fluorescein angiography showed normal, with the ash edema gradually absorbed, local formation of choroidal retinitis pigmentosa lesions, and gradually appeared pigment particles, typically appearing as a triangular pigmented scar region, whose apex points to the optic disc, the bottom edge is oriented The peripheral part is called the triangle syndrome.
Clinically, many patients with choroidal ischemia often have central retinal artery occlusion or ischemic optic disc disease. These patients often pay attention to their retinal and optic disc lesions while ignoring the simultaneous presence of choroidal ischemia.
Examine
Choroidal ischemia
Corresponding laboratory tests can be performed for systemic diseases in some cases.
Fluorescein fundus angiography, the early acute phase lesions are irregular weak fluorescence, the mid-term shows that the inflammatory lesions are persistent weak fluorescence, punctate fluorescence, and gradually increase, forming diffuse fluorescence, and strong fluorescence appears in the lesion at the end The edge of the lesion is window-like defect fluorescence, the lesion is patchy, irregular distribution suggests choroidal filling defect, fluorescein leaks due to damage of choroid-retinal barrier, strong fluorescence in the late stage, strong fluorescence in the central part of the lesion shows active lesion The window-like defect fluorescence showed inactive edge of the lesion, the late stage lesion pigmentation was the early visible fluorescence of the window-like defect, and the pigment proliferation was the pigment blocking fluorescence.
Diagnosis
Diagnosis of choroidal ischemia
Diagnostic criteria
Various acute choroidal ischemic lesions that are clinically visible are:
1. Elschnig plaque: It represents a localized choroidal obstruction that results from the obstruction of the terminal choroidal arterioles supplying a single choroidal capillary lobules, as seen in various systemic diseases as described above.
2. Acute multifocal ischemic choroidal lesion: Gass was first reported as acute post-polar multifocal discoid pigment epithelial lesion, also known as acute posterior squamous pigment epithelial lesion, the onset of this disease Urgent, visual acuity drops sharply, mostly in young adults, usually in both eyes, also seen in monocular, most of the scattered small yellow-white round spots in the posterior pole of the acute phase, the boundaries are unclear, the size is different, and sometimes the fusion lesions are visible. It is in the form of a sheet or even a map.
According to the results of FFA examination and typical clinical manifestations, the diagnosis can be confirmed.
Differential diagnosis
This disease is generally not confused with other diseases.
