_ optic atrophy neurosurgery 视乳头水肿和视神经萎缩外科手术课件

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1、FundoscopicexaminationFundoscopicExaminationWindowtothebloodvesselsPrerequisites-GoodophthalmoscopeAlargepupilAstillfieldFundoscopicExaminationDiminishilluminationintheroom(toovercomelightreflex)Instructthepttolookatadistantpoint,whichisclearlydefined(toovercomea

2、ccomodationandkeepingtheeyestill)Rteyeforexaminingrtfundus,lteyeforleftfundusFundoscopicExaminationFirstfindtheopticdiscColourEdgesOpticcupNasalblurring,temporalpallor-NormalVesselsCRA-superiorandinferiorbranches,nasal&temporalbr-fourprominentarterialtrunksemanati

3、ngfromthediscVnsarelargeranddarkerArteriesarelighterandnarrowerthanvnsandoftenhaveacentralreflectingline–‘silver-wire’appearancePointofcrossingofarteriesandvnsHaemorrhageandexudatesMacula,PeripheralretinaOpticdiscOpticcupVeinArteriolesFoveaNormalOcularFundusFundos

4、copicExaminationCuptoDiskRatioDiameterofthecuppedregionoftheopticnerveheaddividedbythediameteroftheopticnervehead.Normalis~0.3-0.5.AbnormalvaluesarehigherandareassociatedwithglaucomaC/D=0.6CottonWoolSpotsCottonwoolspotsresultfromocclusionofretinalpre-capillaryarte

5、riolessupplyingthenervefibrelayerwithconcomitantswellingoflocalnervefibreaxons.Alsocalled"softexudates"or"nervefibrelayerinfarctions"theyarewhite,fluffylesionsinthenervefibrelayer.Papilloedema,HTN,PAN,retinalembolism,severeanaemiaHardexudatesHardexudates(Intra-ret

6、inallipidexudates)areyellowdepositsoflipidandproteinwithintheretina.Accumulationsoflipidsleakfromsurroundingcapillariesandmicroaneurysms,theymayformacircinatepattern.Hyperlipidemiamaycorrelatewiththedevelopmentofhardexudates.Papilledema-DefinitionSwellingofopticdi

7、scArbitrarily,thetermhasbeenreservedforthepassivediscswellingassociatedwithraisedICPUsuallybilateral,althoughitmaybeasymmetricalCausesofpapilledema(RaisedICP)ClinicalFeaturesofPapilledemaUsuallybilateralbutmaybeunilateralorasymmetricUsuallypreservedvisualacuityand

8、colorvisionearlyMayhavetransientvisuallosslastingseconds(obscurationsofvision)VisualfielddefectsEnlargedblindspotGeneralizedconstrictionGlaucomatous-lik