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.