vitreous hemorrhage symptoms
Vitreous hemorrhage disease name: vitreous hemorrhage (vitreous hemorrhage) owned sites: the eye doctor Section: ENT ophthalmic signs and symptoms: visual disturbances, corneal opacity, exophthalmos, eye pain, vitreous hemorrhage Introduction
Vitreous hemorrhage eye injury is a vascular disease or retinal damage caused by a common complication of vision, on the one hand, bleeding not only the refractive media opacity, obstruct the light reach the retina, and can seriously undermine the role of eye tissue; the other hand, , the body''s response to the hemorrhage of blood can be removed gradually. In different cases, vitreous hemorrhage is very different consequences, should be based on the primary injury, the amount of work the body bleeding, bleeding and ocular absorption of the performance conditions such as timely to the appropriate clinical treatment. Vitreous hemorrhage, vitreous hemorrhage in the cause of knowledge: for any reason or retinal neovascularization of uveal tissue proliferation of vascular conditions such as vitreous hemorrhage, the symptoms of .: ultrasound examination of the vitreous hemorrhage had greater diagnostic value, especially in the vitreous can not . Check bleeding: ultrasound examination of the vitreous hemorrhage had greater diagnostic value, especially in the not . the differential diagnosis of vitreous hemorrhage: vitreous hemorrhage caused by posterior vitreous detachment, should be in the ultrasound image diagnosis of vitreous hemorrha
ge and the prevention of . : Prevention of common sense: vitreous hemorrhage occurred, we must first identify the cause of the complications of plot . vitreous hemorrhage: the amount of bleeding, there may be black, red, as the disease, bleeding can seriously affect a large number of vitreous hemorrhage as . Treatment: In most cases, spontaneous absorption of vitreous hemorrhage in 4 ~ 6 months .
Vitreous hemorrhage and vitreous hemorrhage basic knowledge of clinical treatment of vitreous hemorrhage and vitreous hemorrhage treatment of eye trauma in general preventive health check 1. History taking cause of injury, location, time, with or without treatment, previous history of eye conditions and eye, with or without systemic disease and so on. 2. General condition, especially in a car accident, blast injury, war injuries and other injuries are complex injuries of the situation in many symptoms of vitreous hemorrhage or vitreous hemorrhage in an eye injury caused by retinal vascular diseases, a common complication of eye damage. On the one hand, bleeding not only the refractive media opacity, obstruct the light reach the retina, and can seriously undermine the role of eye tissue; the other hand, vitreous hemorrhage in which performance and how to diagnose . ultrasound on the diagnosis of vitreous hemorrhage greater value, especially when the can not directly see. Few diffuse bleeding with B-ultrasonic examination may be negative results, it is because the body lacks sufficient in the glass echo interface. The vitreous hemorrhage A type ultrasound scan which checks should be done? Ultrasound examination in the diagnosis of vitreous hemorrhage greater value, particularly when the can not directly see. Few diffuse bleeding with B-ultrasonic examination may be negative results, it is because the body lacks sufficient in the glass echo interface. The A-mode ultrasound scan can be complicated by the diseases of vitreous hemorrhage? Vitreous hemorrhage is ocular trauma or retinal vascular diseases, a common complication of eye damage. On the one hand, bleeding not only the refractive media opacity, obstruct the light reach the retina, and can seriously undermine the role of eye tissue; the other hand, vitreous hemorrhage and the diseases easily confused? Vitreous hemorrhage is ocular trauma or retinal vascular diseases, a common complication of eye damage. On the one hand, bleeding not only the refractive media opacity, obstruct the light reach the retina, and can seriously undermine the role of eye tissue; the other hand, vitreous hemorrhage vitreous hemorrhage clinical symptoms, signs, prognosis and complications depending on bleeding caused by the primary disease and the amount of bleeding, bleeding in the number of other factors. Spontaneous bleeding usually sudden onset, can be a very small amount of bleeding, blood clots and more are forming dense. A small amount of a total of 8 articles 7 articles / page Go to page
Vitreous hemorrhage is ocular trauma or retinal vascular diseases, a common complication of eye damage. On the one hand, bleeding not only the refractive media opacity, obstruct the light reach the retina, and can seriously undermine the role of eye tissue; the other hand, the body''s response to the hemorrhage of blood can be removed gradually. In different cases, vitreous hemorrhage is very different consequences, should be based on the primary injury, the amount of work the body bleeding, bleeding and ocular absorption of the performance conditions such as timely to the appropriate clinical treatment. Etiology and pathology
Any reason or retinal neovascularization of uveal vascular tissue such cases, intravitreal neovascularization may occur. Ocular trauma and retinal vascular diseases, is caused by clinically the most common cause of vitreous hemorrhage.
In the eye trauma, or penetrating eye injury can be caused by ocular blunt traumatic vitreous hemorrhage. In the corneoscleral penetrating injury, scleral perforation and posterior segment of the retention of foreign body, the high incidence of vitreous hemorrhage. Eye caused by ocular blunt transient deformation can cause retinal choroidal rupture and hemorrhage; anterior vitreous hemorrhage caused by injury of the ciliary body parts. According to our observation of a group of patients, traumatic vitreous hemorrhage and can be accounted for mainly involving posterior segment contusion cases 25% to 45%. Juan and other eye injury on 453 cases of patients the statistical results showed that 145 cases of vitreous hemorrhage, accounting for 32%.
More spontaneous vitreous hemorrhage diseases, including retinal choroidal inflammatory, degenerative or malignant diseases. According to a statistical group of patients, diabetic retinopathy, 34.1%; retinal breaks without detachment 22.4%; rhegmatogenous retinal detachment 14.9%; retinal vein occlusion, 13.0%, 84% of the above four diseases. Other diseases such as posterior vitreous detachment, retinal vasculitis, retinal vein inflammation around age-related macular degeneration, intraocular tumors, retinopathy of premature children, the occurrence of vitreous hemorrhage is also a considerable proportion of cases. Anji Fang and other new fields of diabetes, eye trauma, except for the two causes of vitreous hemorrhage in 151 cases of unilateral clinical analysis of cases, mainly caused by hemorrhage, retinal hole formation accounted for 42%; retinal vein occlusion 37%. Some blood diseases such as leukemia, retinoschisis can also lead to vitreous hemorrhage, but more rare.
In diabetic patients, retinal neovascularization occurs is a harbinger of vitreous hemorrhage. Without any treatment, about 27% occurred within 5 years vitreous hemorrhage. Vision loss caused by bleeding can not be restored by the blood of patients self-absorbed about 60%. [Food network]
Surgical bleeding of glass found in cataract surgery, retinal detachment repair surgery, vitreous surgery.
Blood accumulate in the vitreous cavity, will produce vitreous and retina damage; and the body''s reaction will gradually clear the blood and its decomposition products.
Damage to the blood of the vitreous
According to clinical observation and experimental research, a certain amount of blood into the vitreous, the vitreous concentration can gather, liquefaction and detachment, vitreous gel structure and loss of normal support and other functions of the retina, and biochemical characteristics have changed.
To the intravitreal injection of normal rabbit 0.1 ~ 0.2ml of autologous whole blood, 1 week can be observed separation between the vitreous and the retina, vitreous collapse to form tissue-like membrane surrounding the blood clot was false cystic. This pseudomembrane and parts of the vitreous is not completely out of phase attachment.
After 2 weeks, almost completely divorced from the vitreous, and vitreous degeneration and liquefaction.
On the mechanism of blood there is no vitreous degeneration caused by exactly the same . long time, people think that after the degradation of blood, hemoglobin released from the iron ions play an important role of vitreous liquefaction. To test this hypothesis, we isolated the iron chloride solution was added to bovine vitreous, the result is equivalent to the blood concentration of ferrous iron soluti0mM 0.1ml, within 20 hours, the vitreous gel structure can be completely destroyed, so that collagen separation of all the condensed fiber. Equivalent to 1% of this concentration of ferrous ions, but also make some collagen cohesion. Iron ions on the specific destructive effect of vitreous and produce hydroxyl free radicals. Rabbit in vivo experiments confirmed that the equivalent of 0.3 ~ ~ 0.7mol / L concentration (16.8 ~ 39.2 g) of iron can make rabbit vitreous liquefaction. In theory, 0.1ml blood containing about 50 g or more of iron, but in fact, vitreous hemorrhage, only a small release of free iron ions. in vitreous hemorrhage, a large number of macrophages invasion in vivo experiments confirmed that the glass of the activity of SOD decreased, indirect proof of macrophages in the phagocytic respiratory burst when the release of surplus oxide anion radical (O Â·) exists. The free radicals on the vitreous matrix and cell components have a strong role in the destruction. from the perspective of enzyme reaction, the blood can activate the inflammatory process caused by lysosomal enzymes, they can occur on the vitreous collagen and hyaluronic acid hydrolysis. Therefore, the vitreous liquefaction degeneration of the role of these three may be a common result.
Vitreous detachment and vitreous condensation and macrophages in the role. The injection of activated macrophages or glass for, the transmission electron microscope examination showed macrophages attached to the vitreoretinal interface, the interface on the loose collagen collapse, which happened in the 8 days after the surface of vitreous separation from the internal limiting membrane to form vitreous space, while the internal limiting membrane integrity and complete within the space, macrophages, after moving away from the posterior vitreous membrane, separation scope. This observation shows that posterior vitreous detachment may be associated with macrophages in the elastic fiber enzyme, collagenase hydrolysis effects. Clinical manifestations
Vitreous hemorrhage symptoms, signs, prognosis and cause bleeding complications depends on the primary disease and the amount of bleeding, bleeding in the number of other factors. Spontaneous bleeding usually sudden onset, can be a very small amount of bleeding, blood clots and more are forming dense. Small amount of bleeding, the patient may not be self-aware, or only "floaters"; more bleeding, the patients found that the immediate shadow flowing, or like red glass block, repeated bleeding of the patient may consciously "smoke" , visual acuity decreased significantly. Eye examination, in less bleeding, will not affect the slit lamp observation, you can see the red blood cell aggregation in the vitreous gel in the holder, was lemon-like dust. Moderate amount of fresh hemorrhage was dense black strip cloudy. No red eyes caused by heavy bleeding reflex, visual acuity decreased to light perception.
Over time, the body''s blood dispersion glass, color fades, the vitreous gradually becomes transparent. More blood absorption takes 6 months or more than a year. In the absence of significant retinopathy, the sight may be fully or largely restored. In the posterior segment trauma with massive vitreous hemorrhage, there may be loss of useful vision half of the patients. Diagnosis and differential
Ultrasound examination in the diagnosis of vitreous hemorrhage greater value, particularly when the can not directly see. Few diffuse bleeding with B-ultrasonic examination may be negative results, it is because the body lacks sufficient in the glass echo interface. The A-mode ultrasound scan may show a low baseline for this echo. Dense vitreous hemorrhage, regardless of type A or B-mode ultrasound examination can be seen low to moderate amplitude of the scattered echo. When scanning with high sensitivity, density and distribution of bleeding is more clearly displayed; reduce the sensitivity of the scan can make the echo amplitudes, most of the echo points are removed, so they can determine whether the simultaneous retinal detachment. Vitreous hemorrhage caused by posterior vitreous detachment, in the ultrasound image diagnosis should be differentiated and retinal detachment. Detachment of the retina often has an echo of high amplitude, changing the sensitivity, the retinal echo little change. Often traceable to a detached retina or optic disc attachment in traction retinal detachment will show a form of traction. In the simple posterior vitreous detachment, vitreous in the eye after the interface has obvious when, after turning movements and reduce the sensitivity of the machine when the echo amplitude decreased. Therefore, ultrasound can determine the eye with vitreous hemorrhage after the section of the degree of trauma, is associated with retinal detachment and other diseases to determine the visual outcome, if necessary, can repeat the examination. [Food network]
The diagnosis of vitreous hemorrhage should include the primary disease (or traumatic); on the amount of bleeding, we propose that the degree of vitreous opacities were divided into four, " " or ,? A very small amount of bleeding does not affect the fundus observation; "" or obvious that fundus red reflex, or the top of the peripheral retinal vessels visible; "" or , that some have red fundus reflex, red reflex in the second half without; "" or , refers to the fundus No red reflex.
In most cases, spontaneous absorption of vitreous hemorrhage requires 4 to 6 months, although retinal hemorrhage in a few days to several weeks of casual dating between. Therefore, before starting treatment, the general observation that should be 3 to 4 months, if not during this period significantly reduced vitreous opacity, indicating complete absorption of spontaneous absorption of the possibility of slow or small.
Drug therapy trying to promote the absorption of blood. However, there is certainly no confirmation of a drug effect. As cases of vitreous hemorrhage vary difficult to randomized controlled clinical trial to evaluate a drug or non-surgical therapy results. Reported in the literature is more intravitreal injection of urokinase. The mechanism of urokinase, the enzyme can activate the blood clots in the plasminogen, so that dissolve blood clots breaking, may also increase the permeability of capillaries in the eye, and promote blood absorption. Intravitreal injection in the dilated, under local anesthesia for two rectus traction suture fixation of the eye, to give 0.5g of preoperative oral acetazolamide to reduce intraocular pressure, anterior chamber before the injection needle is also possible to soften the eye, and then ciliary body level through the Ministry of intravitreal injection of 0.3ml of urokinase 25000ploug units (distilled water). 6 to 8 weeks, if the vitreous is still not transparent, can repeat injection. After intravitreal injection of urokinase often cause hypopyon, takes 3 to 6 days to subside. Intraocular pressure may also have a transient increase, can be 1 to 2 weeks after oral acetazolamide 0.25g, 4 times a day. Campman-Smith for 27 patients (34 eyes), visual acuity improved in 10 eyes, 10 eyes had no change, three deteriorated. Chen Daoyu other by subconjunctival injection, efficacy and the results of approximation. In animal experiments, Koziol, etc. to the monkey intravitreal injection of urokinase 22500CTA units, the results of vitreous blood cleared of no effect. Without rigorous case-control report, the slow absorption of bleeding in patients with urokinase 6000 ~ 10000IU for the ball next to the injection, 1 week, a total of 8 to 10 times, and achieved a certain effect. Other drugs, including the role of blood circulation with a compound Chinese medicine, such as Danshen solution, compound anisodine also clinical application, its efficacy needs further evaluation. [Food network]
Physical therapy with ultrasound treatment has been reported vitreous hemorrhage, but the experiment showed that the full dose of the blood absorption of ultrasonic non-accelerating effect. Coleman so that ultrasound can promote the absorption of the vitreous membrane. Argon laser shot hit the glass also tested in vivo clot, blood clots can gasification, release from the solution, red blood cells rupture, macrophages, vitality, speed up the absorption of blood. But may only have clear blood clot and the surrounding medium transparent cases.
Vitrectomy surgery best suited to ocular trauma (eg contusion, laceration, penetrating injury, or rupture) due to vitreous hemorrhage cases.
1. Vitreous hemorrhage eye injury early vitrectomy experimental and clinical studies have shown that 1 to 2 weeks after injury, surgery is more appropriate, the removal of the eye of a blood clot and inflammatory product, to avoid blood on the wound healing process hyperstimulation to reduce intraocular fibrosis and traction retinal detachment of the opportunity, visual recovery more likely.
2. Intraoperative or postoperative bleeding has been reported that the treatment solution by adding thrombin in perfusion can reduce the incidence of bleeding. 6 - aminocaproic acid on the prevention of postoperative bleeding has a role. Vitreous hemorrhage after surgery for a small amount of special treatment do not generally absorbed quickly; more, can be used suction irrigation method or gas-liquid exchange will suck out the blood clots.
Peripheral retinal cryotherapy has been tested in severe diabetic retinopathy with vitreous hemorrhage, it is not suitable for cases of vitreous surgery, to a certain extent, promote the absorption of vitreous blood, while freezing some of the retinal tissue, there is a certain effect on the control of the disease .
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