Retinopathy has many categories and is complex. The common ones are retinal detachment, macular disease, eye trauma, diabetic retinopathy, endophthalmitis, intraocular foreign bodies, congenital eye diseases, such as retinopathy of newborn (ROP), endoparasites. Take the most common retinal detachment as an example.
TCM disease name
Retinopathy
Visiting department
Ophthalmology Department
Common diseases
retina
Common causes
Primary retinal detachment is caused by high myopia and old age, and secondary retinal detachment is caused by other eye diseases or some systemic diseases
common symptom
The retina is partially detached, and there is fixed cloud like shadow in the field of vision on the opposite side of detachment;The macular area is detached, and the central visual acuity drops sharply;Complete separation, complete loss of light perception
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The certification expert of this term is
Bi Hongsheng|Chief physician
Department of Ophthalmology, Eye Hospital Affiliated to Shandong University of Traditional Chinese Medicinecompose
Primary retinal detachment is caused by high myopia and old age, and secondary retinal detachment is caused by other eye diseases or some systemic diseases
common symptom
The retina is partially detached, and there is fixed cloud like shadow in the field of vision on the opposite side of detachment;The macular area is detached, and the central visual acuity drops sharply;Complete separation, complete loss of light perception
pathogeny
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According to the pathogenesis, it can be divided into rhegmatogenous retinal detachment, tractive retinal detachment and exudative retinal detachment.According to the scope of retinal detachment, it can be divided into partial and complete types. According to its etiology, it can be divided into primary and secondary types.
Primary retinal detachment, also known as rhegmatogenous retinal detachment, is the fluid in the vitreous cavity enters the retina through the retinal hole, causing the separation of neural epithelium and pigment epithelium.Such patients often have retinal degeneration, atrophy, thinning, or high myopia, vitreous liquefaction, detachment, concentration, and retinal adhesion due to certain factors such as high myopia and advanced age.
The cause of secondary retinal detachment is relatively clear, which is caused by other eye diseases or some systemic diseases, such as exudative retinitis, acute diffuse choroiditis, hypertensive retinopathy in pregnancy, etc. A large amount of exudate accumulates under the retina, causing retinal detachment.After vitreous hemorrhage due to some eye injuries or periretinal phlebitis, the organizationally proliferating vitreous cords pull down the retina.There are also some choroidal tumors or subretinal parasites that can jack up the retina and form retinal detachment.Systemic diseases such as diabetic vitreoretinopathy, due to vitreous proliferation traction retinal detachment.
clinical manifestation
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Before separation, there are often premonitory symptoms, which flash when the eyes move.Because the vitreous body is turbid, there are often dark shadows floating in the field of vision.When the retina is partially detached, the patient shows fixed cloud like shadow in the field of vision opposite to the detachment.If the macular detachment occurs, the central visual acuity will drop sharply.If the retina is completely detached, the vision will be reduced to light perception or completely lost.Before vision loss, there is often deformation of visual objects. When the eyes move, there is a feeling of object image tremor. Because the intraocular fluid enters the choroid more through the pigment epithelium, the intraocular pressure is low.
inspect
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Under the condition of sufficient mydriasis, the situation around the omentum can be checked with slit lamp and anterior lens, so that indirect ophthalmoscope can be combined with scleral indentation or peripheral holes may be found.Fundus examination showed that the retina in the detachment area lost its normal red reflection and became gray or greenish gray.
B-ultrasound examination helps to find some hidden retinal detachment and confirm retinal detachment.
diagnosis
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Diagnosis is not difficult. Symptoms+fundus examination+auxiliary examination can diagnose retinal detachment.
In clinical practice, we often encounter rhegmatogenous retinal detachment with relatively hidden holes. For example, the hole is located near the serrated edge, which is difficult to find. After excluding the other two types of retinal detachment, rhegmatogenous retinal detachment can still be diagnosed.
Exudative retinal detachment and tractive retinal detachment often have primary diseases, so diagnosis is not difficult.The former is common in diabetic retinopathy, while the latter is more common in tumors of retina and choroid, posterior scleritis, and posterior uveitis.
differential diagnosis
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Once retinal detachment is diagnosed, it is often clear. The differential diagnosis needs to be clear about the type of retinal detachment. Careful exploration of the hole and finding the primary disease is the key.
treatment
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1. External scleral buckling
For retinal detachment with a single hole, scleral buckling can be selected, and multiple retinal holes can be selected, but the distance between the holes and the serrated edge is equal, so scleral buckling can be considered.
2. Vitrectomy and retinal reposition
Resect or cut off the anterior proliferative membrane of the vitreous retina, remove the centripetal and tangential traction of the vitreous body on the retina, suck out the subretinal fluid, and promote retinal reposition.
