macular disease
Introduction
Introduction to maculopathy The macular area is an important area of the retina, located in the posterior pole of the eye, mainly related to visual functions such as fine vision and color vision. Once there is a lesion in the macula, vision loss, eye shadow or visual distortion often occur. Macular disease, long-term smoking or passive smoking, smoke stimulation can cause senile retinal maculopathy, eventually leading to blindness, but its pathogenesis has been unknown. Once there is a lesion in the macula, vision loss, eye shadow or visual distortion often occur. Macular disease can be caused by hereditary lesions, senile changes, inflammatory lesions, and other fundus lesions. The macula is 0.35 cm above the temporal side of the optic disc and is slightly below. It is rich in lutein, a yellowish area called the macula. The depression in the center of the macula is called the fovea and is the most sensitive place for vision. basic knowledge The proportion of illness: 0.03%--0.05% Susceptible people: good for the elderly aged 60-80 Mode of infection: non-infectious Complications: cystoid macular edema
Cause
Cause of macular disease
Age-related macular degeneration is divided into dry and wet types. It is related to long-term photodamage, genetics, metabolism, nutrition and other factors of the macula. History of trauma and history of eye disease (retinal vein occlusion, uveitis, diabetic retinopathy, etc.).
The macular degeneration is mainly in the elderly aged 60-80 years, and the female is 2-3 times higher than the male. The reason for the true occurrence of the lesion is not very clear, but it may be related to the retina being involved in the vitreous and causing the hole. The diseases that cause macular degeneration include age-related macular degeneration, high myopia, diabetes, etc. Among them, age-related macular degeneration is the most common, and it is the biggest killer of visual impairment in middle-aged and elderly people.
1. Central serous chorioretinopathy, more common in young and middle-aged men, mostly monocular, with self-healing and recurrence tendencies.
2. Central exudative chorioretinopathy is also known as Rieger central retinitis, young hemorrhagic macular degeneration. The disease is an arcuate exudative chorioretinal lesion that occurs in and around the macula, accompanied by subretinal neovascularization and hemorrhage. It is not uncommon in clinical practice. It is usually caused by monocular disease and is more than 50 years old. The main symptoms are vision loss, central dark spots and visual distortion. The course of disease is half a year to one year, and it is relieved by itself within half a year.
3. Age-related macular degeneration: one of the main causes of blindness in the elderly, occurs in the 60-year-old or older, often in the eyes of both eyes. Without gender orientation, central vision loss is very serious.
Prevention
Macular disease prevention
For the presence of a non-essential macular hole with a clear cause, the occurrence of macular hole can be prevented by treating the primary disease and closely following the examination. There is currently no effective prevention method for idiopathic macular hole.
1, patients should prevent long-term exposure to radiation, especially long-wave UV, may cause chronic lens damage, can lead to age-related macular degeneration to accelerate the development of lesions. Therefore, patients should not be exposed to strong sunlight, light, and a variety of other radiation. When doing activities outside, wear sunglasses or a sun visor to prevent radiation from reaching your eyes.
2, patients should not be overworked, especially should avoid using too much eye. When you work and study, you can take a break every two hours to prevent excessive fatigue. Also pay attention to the eye distance, posture, and whether the light source is sufficient. Relaxing the eyes can be done in the following ways, such as looking at green plants, watching the distance, closing your eyes, and avoiding long-term dim work and learning environments.
3, the patient should regularly do eye massage exercises such as eye exercises, through the massage of scorpion bone, temple, eye point, Hengzhu point, etc., can make blood circulation faster, but also improve eye immunity. In addition, patients should maintain a happy mood, which is the common sense of care for all diseases, because good mood can make the body's blood and blood smooth, thereby improving disease resistance.
Complication
Macular disease complications Complications cystoid edema
Cystic edema around the macular hole and formation of the anterior membrane of the retina, but there is little chance of retinal detachment. If repeated episodes, permanent visual impairment can be left behind.
Symptom
Symptoms of maculopathy Symptoms of visual impairment Visual field of vision changes the visual acuity of the macular cystoid edema in front of the eye
The main manifestation is central vision loss, visual distortion, the patient consciously has a shadow in the center of the gaze point, gray or dark red, occasionally purple or green, such as repeated attacks, can leave permanent visual impairment.
Common macular diseases are as follows:
First, the central serous chorioretinopathy: more common in men aged 20 to 45, usually manifested as self-limiting disease. It is characterized by a shadow in front of the eye, deformation of the object, such as getting smaller and farther; the vision is reduced, but often not less than 0.5, and can be partially corrected by the convex lens. There is a round reflective wheel on the fundus, the central concave dark red, the light reflection disappears, there may be gray-white subretinal fibrin deposition, under the binocular indirect ophthalmoscope, the macula is a dome-shaped disc-shaped detachment zone. Fluorescence angiography, in the venous phase, has one or several fluorescein leakage points in the macula, gradually ejecting or ink-like, and expanding into strong fluorescent spots.
Second, age-related macular degeneration: is a common blind eye disease in developed areas over 50 years old. As society ages, the incidence increases. Divided into dry and wet. May be related to long-term chronic photodamage, genetics, metabolism, nutrition and other factors.
Third, cystoid macular edema: not an independent disease, often caused by other diseases. The pathological feature is that intraretinal edema contains a honeycomb-like cyst. FFA showed that the edema came from retinal capillaries with abnormal permeability around the fovea, showing most small leaks, and the accumulation of fluorescence in the cyst, which formed a petal shape due to the radial arrangement of the Henle fibers. It is characterized by decreased vision or visual distortion, or the symptoms are not obvious. The concave light reflection disappeared in the fundus examination center, and the retinal reflection enhancement of the macula was glassy. Sometimes it is difficult to judge under the ophthalmoscope. Under the three-sided mirror, occasionally the retina showed a cystic change. FFA can be diagnosed.
Fourth, macular and pigment epithelial dystrophy: mainly manifested as yellow spots and RPE yellow substance deposition, and the gradual loss of cells.
Five, macular hole: can be caused by trauma, degeneration, long-term CME, high myopia, vitreous traction. The fundus appears as a dark red hole with a clear boundary with a 1/2 to 1/4 PD size and a yellow particle at the bottom of the hole. The central vision decreased significantly. The macular hole in high myopia has a great chance of retinal detachment, requiring retinal detachment surgery or vitreous surgery.
6. The macular epiretinal membrane: occurs on the inner surface of the retina, which is a fibrotic membrane formed by the migration and proliferation of retinal glial cells and RPE. Can occur in a variety of lesions. The macular ERM formed after retinal detachment is thicker and grayish white, affecting vision. Can also be seen in RVO, chronic CME, intraocular inflammation, retinitis pigmentosa and other fundus diseases, ocular trauma and photocoagulation, after condensation. The contraction of the membrane can cause wrinkles, deformation, and macular edema of the macula, causing vision loss and visual distortion. When the ERM is thick and obscures the fovea, and the visual acuity is significantly reduced or deformed, the vitreous surgery can be used to remove the anterior membrane.
Examine
Macular disease examination
Macular cystic edema: sometimes judged under the ophthalmoscope. Under the three-sided mirror, occasionally the retina showed a cystic change. FFA can be diagnosed.
Diagnosis
Diagnosis and differentiation of maculopathy
Diagnostic examination
1. Ask the patient's age, history of trauma and history of eye disease (retinal vein occlusion, uveitis, diabetic retinopathy, etc.), speed of vision loss, visual distortion and incidence of single and double eyes.
2, dilated examination of the fundus, with a three-sided mirror or direct, indirect ophthalmoscopy, pay attention to the presence or absence of vitreous detachment.
3, fluorescent fundus angiography, color vision examination, visual electrophysiological examination.
4, pay attention to the identification of macular hole and pseudo-macular hole.
