Transcript Proliferative DR

Systemic diseases
and Eye diseases
The 4th Affilitated Hospital of China
Medical University
Eye Hospital of China Medical University
Object
1.To understand that difficult ocular diseases may
correlate to systemic diseases.
2.To understand ocular manifestations of common
systemic diseases.
Internal diseases
AS
retinopathy
leukemia
hypertension
eye
diabetes
Vitamin
deficiency
tuberculosis
Thyroid related
eye diseases
Retinal Arteriosclerosis
• Senile degenerative sclerosis and arteriolar
sclerosis
• Reflecting systemic arteriosclerosis to
certain extent
Arteriosclerotic retinopathy
Fundus:
A vessel course
B caliber、color、arteriolar light reflex；
C arterio-venous nicking；
D retinal hemorrhage, exudates
Grading of chronic hypertensive retinopathy
Ⅳ retinal hemorrhage,edema,
hard exudates,cotton-wool spot,
disc swelling
Ⅲ retinal hemorrhage,
edema,hard exudates, cotton-wool spot
Ⅱ silverwire arteriole 、hemorrhage、
hard exudates
Ⅰarterial narrowing、wider arteriolar light reflex
Significance: different prognosis Ⅰ70% Ⅳ1%
Grade 1
Grade 2
Grade 4
Acute hypertensive retinopathy
Acute hypertensive
retinopathy
Pregnancy-induced
Hypertension
syndrome
Malignant
hypertension
Chromaffin cell
tumor
nephritis
Diabetic retinopathy (DR)
• DR is a serious complication of diabetes and a frequent
cause of blindness
• 50% of diabetic patients suffer from DR
Classification and grading of DR
• Nonproliferative DR
I.
Red hemorrhage (microaneurysm、small bleeding spot)
II. Yellow exudates (hard exudate、 small bleeding spot )
III. White cotton-wool spot (cotton-wool spot 、hard exudate)
• Proliferative DR
IV. Neovascularization and/or vitreous hemorrhage
V. Neovascularization , fibrotic proliferation
VI. Neovascularization, tractional retinal detachment
Nonproliferative diabetic retinopathy
Nonproliferative DR Grading
GradeⅠ
Grade Ⅱ
Grade Ⅲ
Proliferative Diabetic retinopathy
Proliferative DR
Grade Ⅳ
Grade Ⅵ
Grade Ⅴ
Diagnosis
• 1.history of diabetes: more than 5 yrs；
• 2.visual acuity decreased or not；
• 3.ocular signs ： microaneurysm, hemorrhage,
exudates, neovascularization, fibrotic proliferation,
tractional retinal detachment
• 4.FFA：leakage，telangiectasia；
• 5.clincal staging :non-proliferative，proliferative
Treatment
Drug,
Laser,
surgery
1.Blood glucose control
2.Blood pressure control
3.Thrombosis prevention
4.Improving capillary permeability
5.Improving axial transport, repairing neural fibers
6.Vitreous hemorrhage treatment
7.Laser
Tyroid related immune orbitopathy
• TAO
• Graves ophthalmopathy
• Immune disease
TRIO
Eye:
upper lid lag and retraction
proptosis
diplopia、restricted extraocular movement
conjunctival injection
optic neuropathy
urgent proptosis :
Acute orbital
hypertension
TRIO
Treatment:
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Correction of thyroid status
Corticosteroid
Immunosupression
Botox A injection
Radiation of pituitary gland
Supportive therapy
orbital decompression
Brian trauma
• Optic nerve duct fracture（pupil reflex）
• epidural hemotoma（hippocampal hernia-oculomotor
palsy、pupil reflex）
• Subdural hemotoma（intracranial pressure increases、
papillary edema）
• Skull-base fracture（bilateral eyelid,conjunctival
,subdermal bruise）
• Brain trauma（visual field、nerve palsy）
Purtscher retinopathy
Retinopathy of prematurity
• Long time oxygen inspire, premature child
• Fibrovascular proliferation of avascular retina
• Retinal hemorrhage, vitreous hemorrhage
• Tractional retinal detachment
• Secondary glaucoma
• Eyeball growth retardation、atrophy
Syphilis
Required：
I stage---eyelid、conjunctival chancre
II stage---acute iridocylitis
syphilitic roseola
chorioretinitis
stromal keratitis
III stage---Argyll Robertson pupil（90%）
optic atrophy （20%）
oculomotor palsy
Syphilis
congenital
Stromal keratitis
chorioretinitis
（peppersalt fudus）
optic atrophy
Neurological disorders
myasthenia gravis :
autoimmune disease（striated muscle ）
Ach insufficiency
neuromuscular conducting disorder
clinical manifestation：
sudden or slow onset
symptoms alleviation in the morning or after rest
aggravated when continuous and repeated excerise
0.5-1 mg neostigmine im
20-40yrs，female
Neurological disorders
Brain tumor:
tumor mass：papillary edema (high intracranial pressure)
tumor compression ：visual field defect
Pupillary edema
Corticosteroid
cataract
keratitis
Papillary /
Macular
edema
Ballous
Retinal
detachment
Secondary
glaucoma
corticosteroid
Central
serous
chorioretinopathy
Mild optosis
Delayed
Wound
healing
Reoccurrence
Of
Primary lesion