高血压性视网膜病变课件

高血压性视网膜病变(hypertensiveretinopathy)分类 根据发病原因分为：原发性高血压视网膜病变　　　　　　　　　　继发性高血压视网膜病变 根据发病快慢分为：慢性高血压视网膜病变 　　　　　　　　　　急进性高血压视网膜病变原发性高血压眼部表现１．血管改变　　　　早期高血压为动脉普遍狭窄，或局部狭窄（为功能性－痉挛），动静脉比例由２：３减至１：２，１：３或１：４，血压恢复正常后，动脉管径恢复正常．　　　　长期高血压使小动脉管壁发生非炎性增厚及玻璃样变性（器质性－动脉硬化），管径狭窄，反光增强可为铜丝状，再进一步病变，看不到血柱如银丝状．动静脉交叉处可见动静脉交叉征（动脉过静脉处静脉隐蔽，两端静脉血柱变尖，静脉远端扩张，静脉移位．），黄斑区小血管迂曲呈螺旋状．原发性高血压２．视网膜病变　　　视网膜屏障破坏，视网膜水肿以视乳头附近明显，视网膜浅层出血呈火焰状或条状，深层出血呈圆形或不规则形，棉绒斑呈孤立或融合，硬性渗出在黄斑部可呈星芒状．视乳头水肿出现在急进型或缓进型病情加重时．继发性高血压１．肾性高血压　　　发生于慢性肾小球肾炎，肾盂肾炎，先天性肾病．　　　眼底表现：视网膜水肿，棉絮状或硬性渗出，在黄斑区呈星芒状渗出，视网膜动脉硬化，因贫血视网膜色淡．２．妊娠高血压　　多在分娩前三个月．　　　眼底表现：早期视网膜血管痉挛，血压持续高严重动脉缩窄使血－视网膜屏障受损，视网膜出现水肿，出血，渗出，重症者出现浆液性视网膜脱离．也可有视网膜动脉硬化．慢性高血压视网膜病变视网膜动脉对高血压的反应是血管痉挛，变窄，血管壁增厚，严重时出现渗出，出血和棉绒斑．高血压视网膜病变分级急进性高血压视网膜病变多见于４０岁以下青年．最主要的改变是视盘水肿和视网膜水肿，同时可见火焰状出血，棉绒斑，硬性渗出及脉络膜梗塞灶． 双眼高血压性视网膜病变视盘荧光：双眼视盘呈高荧光，网膜血管：动脉细，黄斑：囊样水肿Arteriosclerosis(#1),ofRetinalVesselsComment: Sclerosisofarterialvesselsisshownwiththickeningofthewallanddisappearingvisibilityofthebloodcolumn.Veinsappeardilated,andthereisedemaofthemacularareaArteriosclerosis(#2),ofRetinalVesselsComment: OpaqueandthickenedwallofarterialvesselArteriosclerosis(#3),ofRetinalVesselsComment: Ensheathedarterialvesselsareseennearthedisc.Othersignsofhypertensionaresmallintraretinalhemorrhages,someexudates,slightedemaoftheinferiordiscmargin,andcongestedveins.HypertensiveRetinopathy(#1,1),Cotton-WoolSpotComment: Thecaliberoftheveinsisincreasedinrelationtothearteries.Severalcotton-woolspotsareseenandalittlebitofexudate.HypertensiveRetinopathy(#1,2),Cotton-WoolSpot,HistologyComment: Thehistologicalcytoidbodycorrespondstotheclinicalcotton-woolspot.Itiscomposedofswollenaxonsofthenervefiberlayeroftheretinacausedbyclosureofsmallvessels.HypertensiveRetinopathy(#2,1)Comment: Thinnedstraightarteries,increasedcaliberoftheveins,smallintraretinalhemorrhages,exudatesHypertensiveRetinopathy(#2,2)Comment: Additionalfeaturesofhypertensionareablurreddiscandexudatesinthemacula(starshaped)HypertensiveRetinopathy(#2,3),HistologyComment: Largecystoidspacesintheouterplexiformlayerarefilledwithaproteinaceousmaterialcorrespondingtothehardexudatesvisibleclinically.HypertensiveRetinopathy,IntraRetinalHemorrhage(#3,1)Comment: Sharplydefinedhemorrhageunderneaththeinternallimitingmembrane.(Notethereflexes).Littleglobsofbloodareseenwherethebloodislocatedwhenthepatientisinproneposition.Theprominentwhitecircumferentiallinemayrepresenttheedgeofvitreousdetachment.Proteinaceousmaterialisdepositedintheretinaoutsidethisring.Thisphotowastakenwhenthepatientwaslyingonhisrightsidetoshowthemobilityoftheblood;thediscisabove.HypertensiveRetinopathy,IntraRetinalHemorrhage(#3,2)Comment: Samepatientinuprightposition.Thebloodisdisappearing,thevitreousremainsclear.Thestilldetachedinternallimitinglaminashowsfinefolds.HypertensiveRetinopathy,IntraRetinalHemorrhage(#3,3)Comment: Samepatient.Thebloodhascompletelyabsorbed.Thefoldsintheinternallimitinglaminaandtheproteinoutsidetheringhavedisappeared,HypertensiveRetinopathy,IntraretinalHemorrhage(#1,1)Comment: Centrallythereisawell-definedaccumulationofbloodunderdetachedinternallimitinglamina.Asecondringofbloodhaslesswell-definedbordersandrepresentspreretinalbloodwherethevitreousisdetachedfromtheretina.HypertensiveRetinopathy,IntraretinalHemorrhage(#1,2),HistologyComment: Thehemorrhageisunderneaththeinternallimitingmembraneandthereforeanintraretinalhemorrhage.高血压型肾炎（右眼）高血压型肾炎（右眼）病情进展高血压型肾炎（左眼）视乳头水肿，边缘不清；视网膜有水肿，有渗出棉絮斑及线状出血；动脉细，静脉粗大妊娠高血压综合征（右眼）视盘色淡，边界欠清，视网膜动、静脉变细。黄斑区散在硬性渗出斑。视网膜色素上皮片状萎缩妊娠高血压综合征（左眼）视网膜无水肿，动脉细，静脉扩张