第九章视网膜与视神经疾病课件

第九章 视网膜与视神经疾病
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
总论
n 分类：1.视网膜疾病
2.视神经疾病
n 眼底血管是全身唯一能借助检眼镜直接观察到的 血管，为诊治全身性疾病提供价值依据
n 该病与全身性疾病有着密切的关系
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
n [体征]
1.瞳孔直接对光反射消失，间接对光反射存在。 2.视网膜混浊苍白水肿，周边轻后极部重 3.樱桃红斑 4.视乳头界稍模糊，色淡 5.动脉变细，呈白色线条状 6.少见出血点 7.两周后，水肿消退，视网膜苍白萎缩
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
在颞上
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
糖尿病视网膜病变
Diabetic Retinopathy,DR
n 概述 Diabetic 发病率：3.2% 约4千万人 DR发病率：美国 25％ 我国 44～58% 约 2千万人 糖尿病类型、病程、合并高血压和／或高 脂血症，眼底病变发病率增高。
三、高血压性视网膜病变
n [定义]：由于高血压导致视网膜损害的总称
n [病因]：长期高血压作用于动脉壁引起管壁的
平滑肌肥厚、玻璃样变、血管硬化，引起视网膜 失代偿，表现为视网膜水肿、渗出、出血
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
n [治疗]：病因治疗
n 非缺血型：缓解黄斑水肿 n 缺血型：广泛光凝
糖皮质激素 阿司匹林
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
n 血管扩张剂 亚硝酸异戊酯0.2ml吸入 硝酸甘油0.3~0.6mg舌下含服 罂粟碱60~90mg/500ml生理盐水静滴 3日
n 抗血小板药 阿司匹林50mg口服1~2次/天
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
高血压性视网膜病变
Hypertensive Retinopathy
高血压的眼底改变根据其病因、病程和严重程 度不同而有不同的表现。
n 高血压视网膜病变的分级： 1级：视网膜小动脉轻度普遍变细，小动脉管径
均匀， 无局部缩窄。
2级：明显小动脉狭窄及局部管径不规则。
3级：弥漫小动脉明显狭窄及管径不规则，合并 视网膜出血、渗出和棉絮状斑。
n [治疗]
90min 完全缺血后，视网膜不可逆性损害应 作为眼科急重症，积极治疗 n 降眼压
(1)醋氮酰胺：500mg口服(首次) 250mg/6hp配 NAHCO3 (2)球后注射：阿托品1mg 妥拉苏林12.5mg (3)前房穿刺 (4)吸入95%氧气和5%二氧化碳混合气体1次/ h 10 min/次 晚上4h/次
全视网膜激光光凝
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
n [临床表现]
n [症状] 一眼突然发生无痛性完全失明或相应
区域视野缺损发作前有阵发性黑朦
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
4级：在3级基础上加上视乳头水肿和视网膜水 肿。
治疗：病因治疗
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
二、视网膜静脉阻塞
n [特点]：中老年多见，多单眼发病，起病急，
病程长，有自限性
n [病因]：血液动力学因素：
1.血流停滞 2.血流迟缓 n 引起静脉出血，视网膜水肿，渗出
Hale Waihona Puke Baidu
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
视网膜分支静脉阻塞
branch retinal vein occlusion
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
n [实验室检查]：眼底荧光造影
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
视网膜中央静脉阻塞
缺血型 ischemic type
非缺血型 nonischemic type
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
视网膜半侧静脉阻塞
hemicentral retinal vein occlusion
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
治疗
n 病因治疗
1.眼底病变随原发病的改善而减轻 2.VitC、路丁、碘剂、扩血管剂、促进视网膜水 肿、渗出、出血吸收
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
第一节
视网膜疾病
一、视网膜动脉阻塞
n [特点]：眼科急症单眼发病，以中老年多见，
预后差
n [分类]：视网膜中央动脉阻塞
视网膜分支动脉阻塞
n [病因]：1.血管粥样硬化
2.血栓形成或栓塞（分支）
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
视网膜中央静脉阻塞
central retinal vein occlusion
A physical blockage at the level of the lamina cribrosa
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
n [临床表现]：
n [症状]： 视力突然下降，严重者视力降至眼前
手动
n [体征]：1.缺血型(出血性视网膜病变)
2.非缺血型( 静脉淤滞性视网膜病变)
n 眼底早期：视盘水肿静脉迂曲怒张、视网膜广
泛出血、后极多，棉絮斑 n 晚期：新生血管 n 轻型：视盘轻度水肿、少量血管出血 n 分支静脉：阻塞区可见出血、渗出，棉絮斑，常
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee