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 know about such ocular pathology as diseases of the vascular tunic and cataracts. Often it is a local manifestation of many common diseases of the body: rheumatism, diabetes, tuberculosis, chronic and acute infectious disease, thyroid disease, etc. Doctors should be able to diagnose and treat patients with this pathology. It is also necessary to be able to carry out prevention of possible complications arising at these diseases.

• Deepen knowledge on the clinical course of iridocyclitis and chorioretinitis and cataracts. • Develop the ability to select the correct algorithm of actions at iridocyclitis and cataracts. • Criteria for the diagnosis of complications of iridocyclitis and cataracts. • Tactics of GPs in acute iridocyclitis • MPedagogical objectives:odern methods of treatment of cataract

The student should know: • Clinical features of iridocyclitis, chorioretinitis and cataracts • Develop the ability to select the correct algorithm of actions at iridotsiklitah and cataract • diagnostic criteria for complications of iridocyclitis, 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 and cataracts • Conduct clinical examination with laboratory and instrumental methods. • Disclose the criteria for diagnosis • Make his/her own decisions and determine admission criteria in RMC (rural medical center). The student should be able to:

Diabetes – the disease which develops due to insufficient amount of or low efficiency of endogenous insulin. It is characterized with its long lasting course and hyperglycemia. There are 2 types of diabetes: Type I or insulin dependent diabetes which develops in ages between 10 and 20 Type II or insulin independent diabetes which develops in ages between 50 and 70.

Diabetic retinopathy has higher prevalence among patients with type I diabetes (40%) than type II (20%). Diabetic retinopathy is the most frequent cause of blindness among patients aged 20-65. Risk factors of diabetic retinopathy: period of the disease, effective treatment of metabolic changes, pregnancy, arterial hypertension, kidney diseases.

Changes in the retina seen in diabetes Stage I. Non-proliferative diabetic retinopathy. Stage II. Pre-proliferative diabetic retinopathy. Stage III. Proliferative diabetic retinopathy. 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 of arterioles, cotton wool spots, hemorrhages, intraretinal microvascular pathology. Stage II. Pre-proliferative diabetic retinopathy

Pre-proliferative diabetic retinopathy The amount of microanurysms, intraretinal and small preretinal hemorrhages with different calibers is increased, the amount 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 angiopathy Constriction of arteries, expansion of veins, Salus-Gun I and Gvist’s symptoms are seen Сужение артериальных и расширение венозных сосудов, симптом Салюса I на нижне-височных сосудах, извитость мелких венул у больного с гипертонической ангиопатией сетчатки

Stage II – Hypertonic angiosclerosis Arterio-venous ratio is 1/3 – ¼ Stage II – Hypertonic angiosclerosis Arterio-venous ratio is 1/3 – ¼. Salus-Gun 2-3, Copper and silver wiring symptoms, hard exudates and hemorrhages Гипертоническая ангиопатия сетчатки: сужение артериол (стрелки) и симптом Салюса I на верхне-височных ветвях центральных ретинальных сосудов

Stage III – Hypertonic retinopathy Unclear borders of the optic disc, hard exudates, retinal edema, enlargement of veins. Гипертонический ангиосклероз: выраженная неравномерность калибра артерий и вен, двухконтурные полосы вдоль артерий, симптомы медной и серебрянной проволоки, повышенная извитость сосудов.

Симптомы перекреста ретинальных сосудов (симптомы Салюса): I - сужение просвета вены под артерией, II - симптом венозной дуги, III - передавливание просвета вены под артерией. 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 and appearance of relative defects in the visual field Clinical representation: Flame-shaped, petechial and spot like hemorrhages in the background of arterial 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 detachmentТ. White-yellow spots on the pigment epithelium (Elshning’s spots)

Absolute indicators for termination of pregnancy: If hypertonic retinopathy is seen in pregnant 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 the eye with better visual acuity Absolute indicators for termination of pregnancy:

Relative indicators for termination of pregnancy: Early signs of hypertonic retinopathy in pregnant woman with gestosis Partially atrophy of the optic nerve Retinal detachment and hypertonic retinopathy in the anamnesis Retinal myopic degeneration on both eyes of pregnant woman Low visual acuity but not less than 0,5; narrow visual 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 На глазном дне видны размытость границ диска зрительного нерва и его отечность. 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 of patients. 9. Conservative and surgical treatment of cataract. 10. Swelling cataract, cataract with common diseases. 11. Complicated cataract, cataract correction methods.