Transcript changes in fundus+

TASHKENT MEDICAL ACADEMY
Department of ophthalmology
Pathological changes of the
fundus in general diseases
.

The purpose of the training session:
Doctors of any specialties need to know
about such ocular pathology as diseases
of the vascular tunic and cataracts. Often
it is a local manifestation of many
common diseases of the body:
rheumatism, diabetes, tuberculosis,
chronic and acute infectious disease,
thyroid disease, etc. Doctors should be
able to diagnose and treat patients with
this pathology. It is also necessary to be
able to carry out prevention of possible
complications arising at these diseases.

• Deepen knowledge on the clinical course
of iridocyclitis and chorioretinitis and
cataracts.
• Develop the ability to select the correct
algorithm of actions at iridocyclitis and
cataracts.
• Criteria for the diagnosis of
complications of iridocyclitis and
cataracts.
• Tactics of GPs in acute iridocyclitis
• MPedagogical objectives:odern
methods of treatment of cataract
The student should know:
• Clinical features of iridocyclitis,
chorioretinitis and cataracts
• Develop the ability to select the correct
algorithm of actions at iridotsiklitah and
cataract
• diagnostic criteria for complications of
iridocyclitis, chorioretinitis, and cataracts.
• GPs tactics in acute iridocyclitis
• Modern methods of cataract treatment
Learning outcomes:
• Identify risk factors at iridocyclitis and
cataracts
• Conduct clinical examination with
laboratory and instrumental methods.
• Disclose the criteria for diagnosis
 • Make his/her own decisions and
determine admission criteria in RMC (rural
medical center).

The student should be able to:
Diabetes – the disease which develops
due to insufficient amount of or low
efficiency of endogenous insulin. It is
characterized with its long lasting course
and hyperglycemia.
 There are 2 types of diabetes:
 Type I or insulin dependent diabetes which
develops in ages between 10 and 20
 Type II or insulin independent diabetes
which develops in ages between 50 and
70.

Diabetic retinopathy has higher prevalence
among patients with type I diabetes
(40%) than type II (20%).
 Diabetic retinopathy is the most frequent
cause of blindness among patients aged
20-65.
 Risk factors of diabetic retinopathy: period
of the disease, effective treatment of
metabolic changes, pregnancy, arterial
hypertension, kidney diseases.

Stage I. Non-proliferative diabetic
retinopathy.
 Stage II. Pre-proliferative diabetic
retinopathy.
 Stage III. Proliferative diabetic
retinopathy.

Changes in the retina seen in
diabetes
Stage I. Non-proliferative diabetic
retinopathy

Veins are enlarged, microaneurysms, hard exudates,
intraretinal hemorrhage and retinal edema are seen.
Sometimes diabetic maculopathy is accompanied

Non-proliferative diabetic retinopathy
In the fundus petechial and flame shaped
hemorrhages. Cotton wool spots (soft
exudate), and many microaneurysms are
seen. Moreover, macular edema and oval
exudates surrounding macula can be seen.

Veins are segmented, constriction and occlusion of
arterioles, cotton wool spots, hemorrhages, intraretinal
microvascular pathology.
Stage II. Pre-proliferative diabetic
retinopathy
Pre-proliferative diabetic retinopathy
The amount of microanurysms, intraretinal and small
preretinal
hemorrhages with different calibers is increased, the
amount of hard
exudates exceeds.

III. Proliferative diabetic retinopathy
Formation of new vessels and gliotic lesions (proliferation)
and
hemorrhages in the vitreous body is seen.

Stage III. Proliferative diabetic
retinopathy
Neovascularization of the retina, hemorrhagic
lesions, formation of fibrovascular tissue (gliosis).
Retinal changes in arterial
hypertension (classification of
professor Krasnov M.M.)

Stage I. Hypertonic angiopathy

Stage II. Hypertonic angiosclresosis

Stage III. Hypertonic retinopathy
Stage I. Hypertonic angiopathy
Constriction of arteries, expansion of veins, Salus-Gun I and
Gvist’s symptoms are seen
Stage II – Hypertonic
angiosclerosis
Arterio-venous ratio is 1/3 – ¼. Salus-Gun 2-3, Copper and
silver wiring symptoms, hard exudates and hemorrhages
Stage III – Hypertonic retinopathy
Unclear borders of the optic disc, hard exudates, retinal
edema, enlargement of veins.
SALUS SYMPTOMS
HYPERTONIC NEURORETINOPATHY
In severe cases in hypertension papilledema could be seen. Enlarged
and twisted vessels due to malperfusion with different calibers might
be seen. Cotton wool spots are seen around the disc.
In acute hypertonic attack, small hemorrhages, cotton wool spots, lipid
exudates and macular edema are seen.
The same patient after treatment
Retinal changes in atherosclerosis
of general vessels
Thread-like, straight and constricted arteries, veins are
enlarged, hard and soft exudates.
OCCLUSION OF CENTRAL RETINAL ARTERY
Causes: emboli (cardiogenous, atherosclerotic embols, thrombi), vaso
obliteration.
Retinal blanching due to severe edema, cherry red spot in macular
region
Clinical representation: acute impairment of visual acuity.
Thrombosis is shown on the right
Thrombosis of the central retinal vein.
Factors: AH, diabetes, blood diseases. Sudden decrease in visual
acuity and appearance of relative defects in the visual field
Clinical representation: Flame-shaped, petechial and spot like
hemorrhages in the background of arterial hypertension and diabetes
OCCLUSION OF CENTRAL RETINAL VEIN
Many intraretinal hemorrhages, twisted vessels, papilledema
Thrombosis of central retinal
vein
OCCLUSION OF THE BRANCH OF CENTRAL RETINAL VEIN
PRE-ECLAMPSIA
Sudden constriction of arterioles, arterio-venous ratio is disrupted,
diffuse retinal edema
Pictures of both eyes in pregnancy toxemia. Serosis-exudative, bilateral retinal
detachmentТ. White-yellow spots on the pigment epithelium (Elshning’s spots)
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If hypertonic retinopathy is seen in
pregnant woman with gestosis
Retinal detachment due to gestosis
Thrombosis of the central retinal vein
Inflammation of the optic disc
Edema of the optic nerve
If high degree myopia is present in the
eye with better visual acuity
Absolute indicators for
termination of pregnancy:
Early signs of hypertonic retinopathy in pregnant
woman with gestosis
 Partially atrophy of the optic nerve
 Retinal detachment and hypertonic retinopathy in
the anamnesis
 Retinal myopic degeneration on both eyes of
pregnant woman
 Low visual acuity but not less than 0,5; narrow
visual field but not less than 350

Relative indicators for termination of
pregnancy:
RETINAL DETACHMENT
RETINAL CHANGES IN CHRONIC
HEPATITIS
 Retinal
angiopathy
 Angioretinopathy
Retinal angiopathy
Angioretinopathy
RHEUMATISM
Soft and hard lesions with various calibers, intraretinal and
preretinal hemorrhages in regions of malperfusion.
COAGULOPATHIES AND VASCULOPATHIES
TOXOPLASMOSIS
Different sized scars formed due to fibrotic metaplasia,
vascular changes, blanching of temporal part of the disc.
Syphilis
The fundus is seen with
various retinal changes
Diffuse spread white-yellow
spots
Tuberculosis
After treatment
Choroiretinal and star shaped macular edema due to exudate
CYTOMEGALOVIRIS RETINOPATHY
General vasculitis
RETINAL CHANGES IN HIV INFECTION
INFLAMMATION OF THE OPTIC NERVE
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Questions
1.Uvea, structure, blood supply, innervation, function.
2. The iris, the structure, blood supply, innervation,
function.
3. Iridocyclitis, classification, clinical features, diagnosis,
treatment, complications.
4. Post-traumatic iridocyclitis, clinic, diagnosis, treatment,
complications.
5. Choroiditis, clinic, diagnosis, treatment, complications.
6. The structure of the lens, the disease of the lens.
7. Types of cataracts by localization, etiology.
8. Age-related cataracts. Methods of examination of
patients.
9. Conservative and surgical treatment of cataract.
10. Swelling cataract, cataract with common diseases.
11. Complicated cataract, cataract correction methods.