RETINAL DISEASESmed.mui.ac.ir/clinical/ophthalmology/Retina.pdf · 2011-07-09 · RETINAL DISEASES...
Transcript of RETINAL DISEASESmed.mui.ac.ir/clinical/ophthalmology/Retina.pdf · 2011-07-09 · RETINAL DISEASES...
RETINAL DISEASESRETINAL DISEASES
DEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.ADEHGHANI.A
Retinal vascular diseaseRetinal vascular disease
�� Venous occlusive diseaseVenous occlusive disease
�� Arterial occlusive diseaseArterial occlusive disease
�� Retinopathy of prematurityRetinopathy of prematurity
Vasculitis Vasculitis �� Vasculitis Vasculitis
�� Coats diseaseCoats disease
�� Arterial macroaneurism Arterial macroaneurism
�� Retinal hemangiomasRetinal hemangiomas
occlusive diseaseocclusive disease
�� Central retinal artery occlusion (CRAO)Central retinal artery occlusion (CRAO)
�� Branch retinal artery occlusion (BRAO)Branch retinal artery occlusion (BRAO)
�� Central retinal vein occlusion (CRVO)Central retinal vein occlusion (CRVO)
))�� Branch retinal vein occlusion (BRVOBranch retinal vein occlusion (BRVO))
BRVOBRVOBRVOBRVOBRVOBRVOBRVOBRVO�� HemorrhageHemorrhage
�� EdemaEdema
Cotton wool spotCotton wool spot�� Cotton wool spotCotton wool spot
�� Dilated and tortuous vein in a sector of retina Dilated and tortuous vein in a sector of retina
�� Mostly in AMostly in A--V crossingV crossing
Risk factors:Risk factors:�� HypertensionHypertension
�� Cardiovascular diseaseCardiovascular disease�� Cardiovascular diseaseCardiovascular disease
�� High BMIHigh BMI
�� History of glaucomaHistory of glaucoma
Treatment:Treatment:�� Laser therapy(PRP)Laser therapy(PRP)
�� Laser after 3monthsLaser after 3months�� Laser after 3monthsLaser after 3months
CRVOCRVOCRVOCRVOCRVOCRVOCRVOCRVO�� Nonischemic CRVONonischemic CRVO
�� Ischemic CRVOIschemic CRVO
Risk factors:Risk factors:�� Arterial hypertension Arterial hypertension
�� Diabetes mellitusDiabetes mellitus�� Diabetes mellitusDiabetes mellitus
�� Open angle glaucomaOpen angle glaucoma
�� Measurement of IOPMeasurement of IOP
�� Treatment of associated risk factorsTreatment of associated risk factors
�� Laser if NVI or retinal neovascularizationLaser if NVI or retinal neovascularization
CRAOCRAOCRAOCRAOCRAOCRAOCRAOCRAO�� Sudden painless loss of visionSudden painless loss of vision
�� Opaque edematous retinalOpaque edematous retinal
�� CherryCherry--red spotred spot
Treatment:Treatment:�� Reduction of IOPReduction of IOP
�� Inhalation of 95%oxygenInhalation of 95%oxygen--5%co25%co2�� Inhalation of 95%oxygenInhalation of 95%oxygen--5%co25%co2
�� Oral acetezolamide and aspirinOral acetezolamide and aspirin
BRAOBRAOBRAOBRAOBRAOBRAOBRAOBRAO
�� Visual field defectVisual field defect
�� Opaque edematous retina in distribution of Opaque edematous retina in distribution of �� Opaque edematous retina in distribution of Opaque edematous retina in distribution of
affected vesselsaffected vessels
Retinopathy Of PrematurityRetinopathy Of Prematurity
(ROP)(ROP)
Normal retinal vascularization from optic disc to Normal retinal vascularization from optic disc to
nasal periphery at nasal periphery at 36 36 week and in temporal in week and in temporal in 4040 weekweek
�� Arrest of vascular developmentArrest of vascular development
�� ischemia neovascularizationischemia neovascularization
�� Tractional retina detachmentTractional retina detachment
Risk factors:Risk factors:�� Less than 36 weekLess than 36 week
�� Birth weight less than 2000 gramBirth weight less than 2000 gram�� Birth weight less than 2000 gramBirth weight less than 2000 gram
�� Oxygen therapyOxygen therapy
Complications:Complications:
�� CATARACTCATARACT
�� StrabismusStrabismus
�� Glaucoma Glaucoma
�� Retinal detachmentRetinal detachment
�� Myopia and astigmatismMyopia and astigmatism
Treatment:Treatment:�� PreventionPrevention
�� CryotherapyCryotherapy�� CryotherapyCryotherapy
�� Laser therapyLaser therapy
RETINAL DETACHMENTRETINAL DETACHMENT
(RD)(RD)
�� Separation of RPE from neurosensory retina Separation of RPE from neurosensory retina
RDRD
�� Rhegmatogenous →retinal breakRhegmatogenous →retinal break
�� Tractional RD → Tractional RD → proliferative membraneproliferative membrane
�� Exudative → leakage of fluidExudative → leakage of fluid
Rhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RD
RETINAL BREAKLIQUIFIED VITREOUS
SPACE BETWEEN RPE AND SENSORY
Rhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RDRhegmatogenous RD
�� 9090--97% break97% break
�� floater,flashingfloater,flashing
�� Low IOPLow IOP
tobacco dusttobacco dust�� tobacco dusttobacco dust
�� corrugated retinacorrugated retina
Tractional RDTractional RDTractional RDTractional RDTractional RDTractional RDTractional RDTractional RD�� DiabetesDiabetes
�� CRVOCRVO
�� BRVOBRVO
TraumaTrauma�� TraumaTrauma
�� PVRPVR
Exudative RDExudative RDExudative RDExudative RDExudative RDExudative RDExudative RDExudative RD�� NeoplasiaNeoplasia
�� InflammationInflammation
�� HypertensionHypertension
RPE diseaseRPE disease�� RPE diseaseRPE disease
TumorsTumors
�� retionblastoma retionblastoma
�� Malignant melanomaMalignant melanoma
RetinoblastomaRetinoblastomaRetinoblastomaRetinoblastomaRetinoblastomaRetinoblastomaRetinoblastomaRetinoblastoma
�� Most common intraocular malignancy in childhoodMost common intraocular malignancy in childhood
�� 66% family history% family history
�� 9494% sporadic% sporadic
�� LeukocoriaLeukocoria
�� StrabismusStrabismus
�� red painful glaucomatous eyered painful glaucomatous eye
�� White intraretinal tumorWhite intraretinal tumor
�� vitreous involvementvitreous involvement
�� CalcificationCalcification
�� ChemotherapyChemotherapy
�� RadiotherapyRadiotherapy
�� enucleationenucleation
Malignant melanomaMalignant melanomaMalignant melanomaMalignant melanomaMalignant melanomaMalignant melanomaMalignant melanomaMalignant melanomaMost common intraocular tumor in adultMost common intraocular tumor in adult
Ciliary body or choroidCiliary body or choroid
�� Brown mass in CB Brown mass in CB
�� subretinal areasubretinal area
�� Laser therapyLaser therapy
�� radiotherapy radiotherapy
�� enucleationenucleation
Acquired disease of maculaAcquired disease of macula
�� Central serous chorioretinopathy(CSR)Central serous chorioretinopathy(CSR)
�� Age related macular degeneration(ARMD)Age related macular degeneration(ARMD)
�� Macular holeMacular hole
CSRCSRCSRCSRCSRCSRCSRCSR�� Serous detachment of sensory retinaSerous detachment of sensory retina
�� Healthy men(Healthy men(3030--50 50 years)years)
�� Stress as etiologyStress as etiology
Blurred vision, distorted visionBlurred vision, distorted vision�� Blurred vision, distorted visionBlurred vision, distorted vision
�� Spontaneous recovery(Spontaneous recovery(8080--9090%)%)
�� Photocoagulation is treatmentPhotocoagulation is treatment
ARMDARMDARMDARMDARMDARMDARMDARMD�� Nonneovascular AMDNonneovascular AMD
--DrusenDrusen
--Abnormality of RPEAbnormality of RPE
Neovascular AMDNeovascular AMD�� Neovascular AMDNeovascular AMD
--CNV formationCNV formation
--Scar formationScar formation
Management:Management:
�� EducationEducation
�� MicronutrientsMicronutrients
�� photocoagulationphotocoagulation
Idiopathic Macular HoleIdiopathic Macular HoleIdiopathic Macular HoleIdiopathic Macular HoleIdiopathic Macular HoleIdiopathic Macular HoleIdiopathic Macular HoleIdiopathic Macular Hole�� SixthSixth--eighth decadeeighth decade
�� Women/men :2Women/men :2--3/13/1
�� Loss of visual acuityLoss of visual acuity
25%25%--30% bilateral30% bilateral�� 25%25%--30% bilateral30% bilateral
�� Vitrectomy in fullVitrectomy in full--thickness MHthickness MH
Vitreous hemorrhagemost Vitreous hemorrhagemost
�� Diabetic retinopathy:most common in adultDiabetic retinopathy:most common in adult
�� Trauma :most common in childTrauma :most common in child
�� Retinal breakRetinal break
PVD PVD �� PVD PVD
�� RDRD
�� Retinal neovascularization(CRVO.BRVO….)Retinal neovascularization(CRVO.BRVO….)