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? ? ? ? DISEASE OF THE UVEA

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Title: ? ? ? ? DISEASE OF THE UVEA


1
? ? ? ? DISEASE OF THE UVEA
  • ??????????????????
  • EYE HOSPITAL OF THE 1ST CLINICAL MEDICAL COLLEGE,
    HMU

2
  • ????????,?????,????,???????,??????????????????????
    ,?????????????????
  • ??????????,????????????,?????????????,??????????,?
    ????,?????
  • ?????????????????????????????,????????????,???????
    ???????????,??????????????????????????????????????
    ?????

3
????
  • ????(uveitis)???????,?????,????????????
  • ?????,??????????????
  • (?)??????
  • ????(anterior uveitis)
  • ????(posterior uveitis)?????(choroiditis)
  • ??????(peripheral uveitis)????????(pars
    planitis)
  • ?????(panuveitis)?

4
  • (?)???????
  • ???????(tuberculous uveitis)
  • ???????(syphilitic uveitis)
  • ???????(leprosic uveitis)?

5
  • (?)????
  • ??????(acute uveitis)
  • ???????(sub-acute uveitis)
  • ??????(chronic uveitis)?

6
  • (?)???????
  • ???????(suppurative uveitis)
  • ???????(effusion uveitis)
  • (1)???????(serous anterior uveitis)
  • (2)???????(filainous uveitis)

7
  • (?)????
  • ????????(granulomatous uveitis)????????,??????
  • ?????????(non-granulomatous uveitis)?

8
  • (?)????
  • ???????????????????????????????
  • ?????????
  • ?????????????????????,??????????
  • ??????? ???????????????????

9
?.??????(Iridocyclitis)
  • ???(iritis)????????????,????????????,???????(anter
    ior uveitis)?????????,??????(?????????????????)???
    ?????????????????????????,HLA-B27?????????????????
    60(??????????6)?

10
  • Besides the factors of injury, operation,
    infection, the cause of almost all iridocyclitis
    belongs to endogenous. By carefully taking
    history, some correlated systemic disorders may
    be found out, for example, rheumatic disease
    (ankylosing spondylitis, juvenile rheumatoid
    arthritis), ulcerative colitis, tuberculosis,
    sarcoidosis, urethrits as well as venereal
    disease and so on. In recent years, it is
    discovered that the occurrence rate of HLA-27 in
    acute iridocyclitis may get as high as 60.

11
????(clinical findings)
  • 1.????1)???,??,??,?? 2)?????
  • 2.???????????(ciliary injection or mixed
    injection)????(aqueous flare)??????(keratic
    precipitates),??KP

12
  • ?????????????????????????,????????????,????????(p
    eripheral anterior synechia of the
    iris)???????????(goniosynechia)???????????????????
    ????????????Koeppe??,??????????????Busacca????????
    ????,????????
  • ????,??????????

13
  • 3.?????
  • ???????????? ???????????????????????(Secondar
    y glaucoma)??????(Complicated cataract) ???(Low
    IOP and atrophy )??????????

14
  • ??
  • 1. ??????(mydriasis) ,???????
  • 2. ??????????(corticosteroid)
  • ?????
  • 3.?????????(systemic treatment )
  • 4.??????
  • 5.???????

15
??????(Intermediate uveitis)
  • ?????? ??????????????????????????????????????????
    ????????????????????????????????????????
    ???????,???????????????????????????30???????,????
    ?,??????????????????????,?????????,????,??????????
    ??,???11?

16
????(?????)
  • ????(choroiditis),???????(posterior
    uveitis),?????????????????????????????????????????
    ???????,??????????????????,??????????????????,??,?
    ??????,????????????????,???????????,?????????????
    (???????)?

17
???????????
  • ?. ?????(sympathetic ophthalmia)
  • ?????????????????(????????,exciting
    eye),????????????(????)??????,????????????????(???
    ?,sympathizing eye)???????????????????????????2??2
    ???(????10?,????50????),?????2????????????????????
    ???????,?????????????????????????

18
Some specific types of uveitis
  • Sympathetic ophthalmia
  • It indicates that the eye which got perforating
    injury or intraocular operation (called exciting
    eye) undergoes a period of granulomatous
    panuveitis, then the panuveitis with the same
    character takes place in another eye (called
    sympathizing eye). The interval from ocular
    injury or operation to appearance of inflammation
    in healthy eye is from tow weeks to two years
    (the earliest is in 10 days, the longest is after
    50 years). But most have attack within 2 months,
    the probability of onset over 2 years decreases
    with the time going.

19
?.Vogt-??-?????
  • Vogt-??-?????(Vogt-Koyanagi-Harada
    syndrome)????????????,??????????????????,?????????
    ????????,?????????????????????????????????????????
    ???????????????????????,??????????????(Vogt-?????)
    ,?????????????????????(?????)?

20
  • ?????3050?????,??????,?????????????????,??????,??
    ???????6.89.2,???????????,????????

21
?. Behcet?
  • Behcet????????????????????????????????????????????
    ?,???2040?????,??????,????,???????????????
  • ???????????????

22
?.Fuchs?????????
  • Fuchs?????????(Fuchs heterochromic
    iridocyclitis)????????,?????,????,????,??????????
    ????????????,??????,??????????????KP??????????,??
    ????????????????????????????????????????????????

23
????(Disease of the retina)
  • ?????????????,?????????????????,???????,??????????
    ,????????????????????????????,????????????????????
    ??,???????????????,

24
  • ??????????????????????????????????????,???????????
    ?????????????????????????????????,???????????????
    ???????????????????????????????????????????,??????
    ????????????????????????

25
  • 1.???????
  • ????????????????????,????????????,?????????

26
?????????(central retinal artery occlusion,CRAO)
  • ?????????????
  • ?????
  • ???

27
  • (1)  retinal artery occlusion
  • retinal artery occlusion is not commonly seen in
    clinic, but with very serious prognosis. If there
    is not proper management in time, the results is
    the loss of vision finally. The cause leading to
    retinal central artery or its branch occlusion
    often is the debris exfoliated from
    atherosclerotic plague of the carotid. A few may
    be embolism by exfoliated thrombus on the
    vegetaiton of cardiac valves.

28
  • Or it is due to narrow blood vessel and spasm,
    vascular inflammation, pulseless disease, oral
    administration of contraceptive or caused by fat
    embolus at long bone fracture. Sometimes
    operation of retinal detachment or intraorbital
    operation may cause it. Recently occasionally,
    the cases are seen due to injection of
    prednisolone and other medicines into inferior
    nasal concha or behind the globe that induce
    retinal artery occlusion.

29
  • ??????????????????????????????????????????????,??
    ???,????????????????????????????????????,????????
    ?????????,?????????????,

30
  • ??????????????????FFA?????????????????????ERG?b???
    ???,a?????????,???????,???????????????????,???????
    ????,??????????????????

31
  • ????????????,????????,??????????????????(1)????
    ???????????2)?????????,????????,????????????,???
    ???????,ATP,??A?????
  • ????????????????

32
  • retinal vein occlusion
  • Retinal vein occlusion is a common fundus
    disease its causes are extravascular
    compression, stagnation of venous blood stream as
    well as impairment of venous vascular inner wall.
    Extravascular compression is most caused by
    sclerosis of the central retinal artery or its
    branches within the optic nerve or at the
    arteriovenous crossing to compress its neighbor
    veins. So, it is commonly seen in the elder with
    hypertension and arteriosclerosis. Stagnation of
    venous blood stream is seen in the cases with
    insufficient perfusion pressure or increased
    intraocular pressure or high blood viscosity.

33
  • So it is often complicated by insufficient blood
    supply of the carotid, a large quantity of blood
    loss, lower intraocular pressure,
    glaucoma,erythrocytosis, diabetes, sickle cell
    anemia and abnormal albumen in the blood and
    other diseases. Impairment of vascular inner wall
    is often caused by trtinal vasculitis, so it is
    commonly seen in the young and diabetic patients.

34
?????????(central retinal vein occlusion,CRVO)
  • ?CRAO??????????,??????,???????
  • ?????????????????????????????????????????????,???
    ???????,???????????????????,?????????????????,???
    ???????????????????????????????

35
  • ????(branch retinal vein occlusion)????????,??????
    ?????????????????????
  • ???????CRVO?????????????????????????,??????,??????
    ????????????????????,???????????????????

36
  • Clinicallly, according to the different sites of
    occlusion, it is divided into central retinal
    vein occlusion (CRVO) and branch retinal vein
    occlusion (BRVO).

37
  • ?????????????????????????????????????????????,??
    ????????,??????,?????
  • ????????????????????????
  • ????????
  • ????????????,????????????????????

38
????????(retinal periphlebitis)
  • ????2040??????,???????????,??Eales?,?????????????
    ?????????????????,???????????????????,??????,?????
    ???????,????????????,?????????,??????,???????,????
    ????????????

39
  • ????????????????????????????????????????????????,
    ??????????

40
Coats?
  • ?????????,????????,???????,??????,????,???????????
    ???,????????????,????????????????,?????????,??????
    ??,?????????????????????,??????,????????????????,?
    ?????,?????,?????,???????,??????????,?????????????
    ?????????,??????????????????

41
??????
  • ??????????(primary pigmentary degeneration of the
    retina)
  • ????????????,?????????,?????????,??????,?32?

42
  • The sorts of retinal degeneration are varied.
    Clinically the most common one is retinitis
    pigmentosa. The etiology is unclear, as a kind of
    genetic disorders autosomal recessive
    inheritance, dominant inheritance as well as
    sex-linked recessive inheritance may all be seen.
    Among the cases of three kinds of genetic
    defects, sex-linked recessive type is the least,
    but the most severe. The damage of autosomal
    dominant inheritance is less severe, whereas the
    autosomal recessive one is

43
  • between both types above. Clinically there are
    not less sporadic cases without genetic evidence.
    At early stage of ill course, it mainly damages
    the rods and pigment epithelial cells. Whereas at
    advanced stage, all the retinal cells and
    choroidal capillary layer will be impaired.

44
  • ???????????????,?????????????,
  • ?????
  • ?????????,???????????????????????
  • ?????????????,??????????,?????

45
  • ??????????????,?????,????????,??????
  • ????????????,?????????,??????,?????????,?????????
    ??,???????,????????,??????,???????????????????????
    ? ?

46
  • ??????????
  • 1.?????????????,???????
  • 2.?13?????????,??????
  • 3.?50????????

47
  • ????????????????,?????????????,??????????
  • ???????????,???,????,?????30????????????,50??????
    ??

48
The disease of the optic nerve and pathway
  • Optic neuropathy
  • optic neuritis
  • papillitis
  • etiology
  • clinical findingsocular examination
  • fundus
    examination
  • examination
    of visual field
  • treatment

49
????????
  • ????(optic neuritis)
  • ??????????,40?????86,??????,??????????2/3????????
    ???,????????,??????????,??????????????????

50
??????(neuropapillitis)
  • ????,??????????,???,?????????????,??????????????,?
    ?????,????,???????????????,??????,?????????(????)?
    ??????????,?????????????????????????????????VEP???
    ???

51
  • ????,????????????,?????
  • ????????????????,?????????
  • ?????,?????????????,?????????????????

52
??????(retrobulbar neuritis)
  • ?????????????????????????????,????????????????????
    ????????,???????????

53
???????(Papillaedema)
  • ????????????????????????????????????????????????
  • ??1)????
  • 2)????
  • 3)????

54
  • ?????????????????,???????????????????????????????
    ????????????????????

55
  • ????????????????????????,????,????,?????,??,?????
    ?,?3D?????????????????????

56
?????(optic atrophy)
  • ??????????????,??????,??????????????,???????.?????
    ?????????,???????????????????.
  • Optic atrophy is a final end of various severe
    disorders of the retina and optic nerve. Due to
    extensive damage of the retinal photoreceptor,
    gangliocyte as well as its axon, and loss of
    nervous fiber, gliosis, severe disturbance of
    visual function have been induced.

57
  • Main sysmptom of the optic atrophy is
    disturbance of visual function, manifesting as
    decrease of vision, contraction of visual field.
    Total loss of vision at ill eye in severe case.
    Moreover, the pupil may have the corresponding
    changes, for example, disappearance or
    retardation of light reflex. Clinically according
    to fundus manifestationg, it is divided into
    primary, secondary and ascending atrophy, three
    kinds.

58
  • ???????
  • ???????????????????
  • ???????????????,???????,?????????,???????,???????
    ?
  • ????????????????,???????,???????,??????,?????????
    ,???????????????????????????,???????????????????

59
  • ???????,??????
  • 1.???????
  • 2.?????????,
  • 3.????????
  • 4.????????????
  • 5. ???????????????

60
  • ????????????
  • 1.?????????????????
  • 2.?????????????????????????????
  • 3.???????????,????????????????????????????????????
    ?????????????
  • 4. ??????????????
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