玻璃体疾病课件.ppt

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1、玻璃体疾病李国星概述解剖特点透明胶样粘连不均分区概述分区概述组织特点水99%透明质酸胶原纤维Ⅱ69%Ⅴ24%Ⅸ7%其它：糖、蛋白、氨基酸、VitC、电解质概述玻璃体的作用发育透明屏障支持、减震代谢、转运概述基本病理改变液化浓缩脱离变性积血炎症增生混浊寄生虫渗出ExamnationofthevitreousSlitlampexaminationcontactleneHrubylensVolk-stylelensIndirectophthalmoscopyDirectophthalmoscopyB-scanultrasonography液化病因年龄>60岁，65%近视外伤出血炎症其

2、它液化病理改变玻璃体由凝胶状变为液状，胶原纤维塌陷,出现空腔本质是透明质酸变性、降解、丢失液化临床表现症状：飞蚊症体征：空腔塌陷胶原纤维浓缩玻璃体移动度大玻璃体改变liquefaction玻璃体改变liquefaction玻璃体改变空腔玻璃体改变玻璃体改变液化后果：PVD、出血、裂孔、网脱视神经、视网膜水肿危害视力玻璃体后脱离定义：后皮质从视网膜内表面分离病理基础：liquefactionClinicalFeaturessymptomsFlashinglinghtsFloatersSignsSeparationCavityLiquidWeissring发生率：>65岁，41％玻

3、璃体改变PVD玻璃体改变PVD头部运动与玻璃体牵拉头部运动与玻璃体牵拉玻璃体牵拉格子样变性格子样变性格变＋裂孔VitreousDegenerationAgerelatedvitreousdegenerationAsteroidhyalosisSynchysisscintillansamloidosisAsteroidHyalosisMinitewhiteopacity(occasionallyyellow)Calcium-containingphospholipids1:200inpatientsAge>50,inahealthyeyeUnilateralin75%ofcase

4、sRarelycausesasignificantdecreaseinvisualacuityAsteroidHyalosisAsteroidHyalosisAsteroidHyalosisAsteroidHyalosisCholesterolosis(Synchysisscintillans)SignsYellowishwhite,gold,multicoloredCholesterolcrystalsCausesTraumaSurgeryHemorrhageLateuveitisSynchysisscintillansSynchysisscintillansSynchysi

5、sscintillansSynchysisScintillansDifferentialdiagnosisAsteroidHyalosisthroughoutthecavity“healthy”SSPVDCrystalssettledinferiorlyprimarydiseasesAmyloidosisFamilyhistory,dominantinheritanceBilateralVitreousdeposition,opacitiesGranular,wispyfringes,glass-wool,PVDRetinalhemorrhage,exudates,cotton

6、-woolspots,peripheralretinalneovascularizationFromposteriortoanteriorAbnormolitiesinOthertissueOtherorgansAmyloidosisAmyloidosisAmyloidosisAmyloidosisAmyloidosisVitreousHemorrhageVitreousHemorrhageVitreousHemorrhage３临床表现少量出血：飞蚊征大量出血：视力下降玻璃体可见血液：鲜红色－暗红色－黄白色－恢褐色原发病表现，另一眼VitreousHemorrhageVitre

7、ousHemorrhage病程和预后出血多少部位玻璃体状态原发病巨噬细胞并发症VitreousHemorrhage并发症玻璃体浓缩玻璃体炎症机化含铁血黄素沉着青光眼溶血性血影细胞性VitreousHemorrhageVitreousHemorrhageVitreousHemorrhage３临床表现少量出血：飞蚊征大量出血：视力下降玻璃体可见血液：鲜红色－暗红色－黄白色－恢褐色原发病表现，另一眼VitreousHemorrhageVitreousHemorrhage病程和预后出血多少部位玻璃体