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Pathological changes of the fundus in general diseases .
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Transcript of Pathological changes of the fundus in general diseases .
Pathological changes of the fundus in general diseases .
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 knowabout such
ocular pathology as diseasesof the vascular tunic and cataracts.
Oftenit is a local manifestation of manycommon diseases of the
body:rheumatism, diabetes, tuberculosis,chronic and acute
infectious disease,thyroid disease, etc. Doctors should beable to
diagnose and treat patients withthis pathology. It is also
necessary to beable to carry out prevention of
possiblecomplications arising at these diseases. Deepen knowledge
on the clinical courseof iridocyclitis and chorioretinitis
andcataracts. Develop the ability to select the correctalgorithm of
actions at iridocyclitis andcataracts. Criteria for the diagnosis
ofcomplications of iridocyclitis andcataracts. Tactics of GPs in
acute iridocyclitisMPedagogical objectives:odernmethods of
treatment of cataract The student should know: Clinical features of
iridocyclitis,chorioretinitis and cataracts Develop the ability to
select the correctalgorithm of actions at iridotsiklitah
andcataract diagnostic criteria for complications ofiridocyclitis,
chorioretinitis, and cataracts. GPs tactics in acute iridocyclitis
Modern methods of cataract treatment Learning outcomes: The student
should be able to:
Identify risk factors at iridocyclitis andcataracts Conduct
clinical examination withlaboratory and instrumental methods.
Disclose the criteria for diagnosis Make his/her own decisions
anddetermine admission criteria in RMC (ruralmedical center). The
student should be able to: Diabetes the disease which developsdue
to insufficient amount of or lowefficiency of endogenous insulin.
It ischaracterized with its long lasting courseand hyperglycemia.
There are 2 types of diabetes: Type I or insulin dependent diabetes
whichdevelops in ages between 10 and 20 Type II or insulin
independent diabeteswhich develops in ages between 50 and70.
Diabetic retinopathy has higher prevalenceamong patients with type
I diabetes(40%) than type II (20%). Diabetic retinopathy is the
most frequentcause of blindness among patients aged Risk factors of
diabetic retinopathy: periodof the disease, effective treatment
ofmetabolic changes, pregnancy, arterialhypertension, kidney
diseases. Changes in the retina seen in diabetes
Stage I. Non-proliferative diabeticretinopathy. Stage II.
Pre-proliferative diabeticretinopathy. Stage III. Proliferative
diabeticretinopathy. 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.
Stage II. Pre-proliferative diabetic retinopathy
Veins are segmented, constriction and occlusion ofarterioles,
cotton wool spots, hemorrhages, intraretinalmicrovascular
pathology. Stage II. Pre-proliferative diabetic retinopathy
Pre-proliferative diabetic retinopathy
The amount of microanurysms, intraretinal and smallpreretinal
hemorrhages with different calibers is increased, theamount 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
angiopathyConstriction of arteries, expansion of veins, Salus-Gun I
and Gvists symptoms are seen , I - , Stage II Hypertonic
angiosclerosis Arterio-venous ratio is 1/3
Stage II Hypertonic angiosclerosis Arterio-venous ratio is 1/3 .
Salus-Gun 2-3, Copper and silver wiring symptoms, hard exudates and
hemorrhages : () I - Stage III Hypertonic retinopathy Unclear
borders of the optic disc, hard exudates, retinal edema,
enlargement of veins. : , , , . ( ): I - , II - , III - . 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.
Thrombosis of the central retinal vein. Factors: AH, diabetes,
blood diseases. Sudden decrease in visual acuity andappearance of
relative defects in the visual field Clinical representation:
Flame-shaped, petechial and spot like hemorrhages in the background
ofarterial 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
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 detachment.
White-yellow spots on the pigment epithelium (Elshnings spots)
Absolute indicators for termination of pregnancy:
If hypertonic retinopathy is seen inpregnant 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 theeye with better visual
acuity Absolute indicators for termination of pregnancy: Relative
indicators for termination of pregnancy:
Early signs of hypertonic retinopathy in pregnantwoman with
gestosis Partially atrophy of the optic nerve Retinal detachment
and hypertonic retinopathy inthe anamnesis Retinal myopic
degeneration on both eyes ofpregnant woman Low visual acuity but
not less than 0,5; narrowvisual 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 Syphilis The fundus is seen with
various retinal changes Tuberculosis After treatment
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
. INFLAMMATION OF THE OPTIC NERVE 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 ofpatients.9.
Conservative and surgical treatment of cataract Swelling cataract,
cataract with common diseases Complicated cataract, cataract
correction methods.