医学精品课件：08眼底病.ppt

1、视网膜及视神经疾病北京大学第一医院眼科PrefaceEyeball is similar to cameraCornea and lens=vertexRetina=film or CCDEmbryology of Retina视泡outer layer 视网膜色素上皮层（retinal pigment epithelium RPE）视泡inner layer 视网膜神经上皮层Anatomy of Retina视神经Optic nerve黄斑Macula lutea视网膜Retina Photograph of Fundus视盘Optic discMacula lutesFovea centr

2、alisFigure of RetinavRetina血液供应 retina中央血管系统（内6层）choroid血管系统 （外4层）睫状视网膜系统vBRB组成 RPE细胞 外屏障 视网膜血管内皮细胞 内屏障vBRB功能 Contentv视网膜疾病v视神经疾病概述视网膜血管病黄斑疾病视网膜脱离视网膜变性视网膜肿瘤视网膜疾病概述基本病变v血管改变v血视网膜屏障受损的表现血管管径变窄动脉硬化血管扩张和迂曲血管白鞘视网膜出血视网膜渗出视网膜水肿 Preretinal hemorrhagesSuperficial hemorrhagesDeep hemorrhagesSubretinal hemorrh

3、agesHard exudatesRoths spotsCotton-wool spotsSuperficial retinal edema(Star exudates)Deep retinal edema(Cystoid macular edema CME)Cloudy swellingvClassification Central retinal artery occlusion(CRAO)Branch retinal artery occlusion(BRAO)Cilioretinal artery occlusionvEtiology 血管壁受损 血管痉挛 栓子阻塞CRAOClinic

4、al featuresvSymptoms 一过性黑朦 amaurosis fugax 严重视力下降 severe visual lossvSigns 视网膜水肿 retina edema 樱桃红点 cherry-red spotF.F.ACRAODifferential Diagnosisv眼动脉阻塞 Ocular artery occlusionv缺血性视神经病变 ischemic optic neuropathyBRAOClinical featuresvSymptoms 视野缺损 loss of visual field 累及黄斑视力下降 reduction of visual acui

5、ty(if the fovea is involved)vSigns 部分视网膜水肿 retina edema partly Cilioretina Artery OcclusionvAlone vCombine with CRVOvCombine with ischemic optic neuropathyTrentmentv降低眼压 Decrease intraocular pressurev吸氧 Oxygenv血管扩张剂 Vascular dilationv其他 Others ClassificationvAccording to location of occlusion Centra

6、l retinal vein occlusion(CRVO)Hemi-central retinal vein occlusion Branch retinal vein occlusion(BRVO)vAccording to extent of occlusion 缺血型 ischemic type 非缺血型 non-ischemic type Etiologyv血管壁的改变v血液流变性改变v血流动力学的改变v其他CRVOClinical featuresvSymptoms 视力下降 reduction of visual acuity vSigns 视网膜出血 hemorrhages 血

7、管扩张迂曲 dilation and tortuosity of vessle 棉毛斑 cotton-wool spots 新生血管 neovascularizationCRVO缺血型非缺血型Differential DiagnosisvDiabetic retinopathyHemi-CRVOBRVOMacular BRVOComplicationv黄斑囊样水肿 Cystoid macular edemav新生血管形成 Neovascularizationv新生血管性青光眼 Neovascular glaucomaTreament v病因治疗v激光光凝 Laserv中药 Chinese tr

8、aditional medicinev纤溶制剂 Fibrinolytic agentsv抗凝制剂 Anticoagulantsv手术 Surgery分型分期视网膜病变非增生型I微血管瘤或合并小出血点III期+Hard exudatesIIIII期+Cotton-wool spot增生型IV除上述病变外新生血管V新生血管和增生膜形成VIV期并有视网膜脱离backgroudpreproliferativeproliferativeDiabetic RetinopathyTreatment v控制血糖血压 Control of blood sugar and blood pressurev激光光凝

9、Laserv手术 surgeryvEales diseasevUnknown causesvYoung persons,bilateralvRecurrent vitreous hemorrhagesvWhite sheathing of vesslev类型vSenile arteriosclerosisvatherosclerosisvArteriolar sclerosisv后果:-视网膜动脉阻塞v眼底表现:v眼底表现 血管改变 BRB破坏的症状v分级 1级：小动脉普遍变细，管径均匀 2级：明显动脉狭窄及局部管径不规则 3级：2级合并retinal exudates,出血，cotton w

10、ool spots 4级：3级合并papilledema和retinal edema Hypertensive RetinopathyHypertensive retinopathy4级Macular Diseasesv中心性浆液性脉络膜视网膜病变 Central serous chorioretinopathyv年龄相关性黄斑变性 Age-related macular degeneration ARMDCentral Serous Chorioretinopathyv好发于青壮年，常于劳累和紧张后发病v易复发v视物变小、变形v视力下降一般不超过0.5vMacula圆盘状水肿vF.F.A显示

11、macula渗漏OCTF.F.ADifferential Diagnosisv中心性渗出性脉络膜视网膜病变v孔源性视网膜脱离vCystoid macular edemaAge-related Macular Degenerationv干性（非渗出性）v湿性(渗出性)分为特发性和继发性v视力下降，变形v后级部视网膜玻纸样反光vOCTv视力下降v黄斑裂孔形成vDefinition Retina内9层神经上皮层和视网膜色素上皮层分离 孔源性 rhegmatogenous RRDvClassification Non-RRD 牵拉性 traction RD渗出性 exudative RD外伤性trau

12、matic RD RRDSymptoms 闪光感 黑影遮挡Signs 不同程度视力下降 玻璃体混浊 视网膜脱离呈灰白色 视网膜裂孔v遗传性疾病v夜盲v视网膜骨细胞样色素沉着vERG异常v眼内生长期v青光眼期v眼外扩展期v全身转移期Characteristicsv遗传倾向v自发消退v三侧性视网膜母细胞瘤v第2恶性肿瘤Differential DiagnosisvCoats病v早产儿视网膜病变（ROP）v原始玻璃体增生症（PHPV）v转移眼内炎v先天性白内障Treatment v激光光凝 Photocoagulationv光动力学疗法 Photodynamic therapyv经瞳孔温热疗法 Tr

13、anspupillary thermotherapy,TTTv放射治疗 Radiotherapyv冷冻治疗 Cryotherapyv手术 Surgeryv化学治疗 Chemotherapy Anatomy of Optic Nervev球内段 1mmv眶内段 25mmv管内段 6 10mmv颅内段 10 23mm TOTAL 50mmOptic Nerve Diseases临床表现视乳头水肿视神经乳头炎缺血性视乳头病变视力早期正常急性明显减退突然减退视乳头水肿3D 3D 3D眼底出血渗出出血渗出出血视神经萎缩视野生理盲点扩大中心暗点与生理盲点相连的水平或象限视野缺损神经系统检查颅压增高正常正常眼别多双侧多单侧单侧后另眼可发病其他颅内肿瘤眼球转动痛全身血管病papillitisIschemic optic neuropathyPapilloedema全身性疾病眼底病THANKS