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….)