? ? ? ? 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. ??????????????