Ophthalmology

retinal desease Anatomy and physiology of retina

Fundus of eye • 10 layers,4 quadrants • Fovea, macular • Optic disc

Anotomy of retina Retina A thin ,semitranparent,multilayered sheet of neural tissue that lines the inner aspect of the posterior two-thirds of the wall of the globe.ending at a point,the ora serrata.there are two parts: 1 Senory retina 2 Retinal pigment epithelium But at the optic disk and the ora serrata,the retina and retinal pigment epithelium are bound together

Sensory retina

Neuron

Horizontal cell Bipolar cell

vascular

anatomy of sensory retina • • • • • • • • • •

Rods and cones External limiting membrance Outer nuclear layer Outer plexiform layer Inner nuclear layer Inner plexiform layer Ganglion cell layer Capillary Nerve fiber layer Internal limiting membrane

Physiology of retina • the light inject into the ocular,the Rods and cones in the photoreceptor layer transforming light stimulus into nerve impulse,that is conducted by the nerve fiber layer,through the optic nerve and ultimately to the occipital visual cortex. • the macular is responsible for the best visual acuity and for color vision ,and most cell are cones.

Cones in macular

Normal fundus

Vessels of retina( two sources) • Choriocapillaris supply out one third of retina:rods ,cones ,outer plexiform and retina pigment epithelium • The branch of Central retinal artery supply inner 2/3 of retina • Central retinal vein

Pathiology of retina 1,Vascular change 2,nerve degeneration 3,retinal pigment epithelium change

vascular change and nerve tissue degeneration • • • • •

1 retinal edema 2 hemorrhage 3 exudation and microculation 4 vascular itself change 5 neuvascular

1 retinal edema • Cellular retinal edema • Extracellular edema

Cellular retinal edema

extracellular Retinal edema

Central serous chorioretinopathy(FA)

Another patient

Macular edema(extracellular) optic coherent tomography

2 hemorrhage 1,Retinal hemorrhage spot hemorrhage in cell layer splinter hemorrhage in nerve fiber layer 2,Preretinal hemorrhage half moon like hemorrhage 3,Vitreous hemorrhage

3 Exudation • Hard exudation : tissue ischemy, apoptosis or necrosis ,lipd get together • Soft exudation/cotton-wool spot

hard1

hard2

soft1

soft2

Vascular itself change Artery 1 Occlusion 2 microaneurysm 3 inflamation 4 hemorrhage and so on Vein 1 occlusion 2 beeding 3 bleeding and so on

neuvascular

neuvascular

Retinal pigment epitheliun change 1,Pigmental change 2,RPE proliferation

degeneration

Proliferation of Pigment Epithelium

Central retinal artery occlusion

cause • • • •

1 vascular lasting depression 2 thrombus formation 3 embolism (embolus block ) 4 hypertension, injury,blood coagulational failure operation and so on

Clinical apperance • Painless ,suddenly,completely acuity vision loss • derect light reflection loss,inderect light reflection is sensetive • Retina ischemy edema with macular cherry-like red

Sex and age • Main are older than 50 ages • The young also happen • No sex diffrentiation

treatment • No effective management • the follow ways can be tried : 1 High depression oxygen 2 decrease tonometery(depress eyeball,surgery or other ways) 3 anticoagulant, fiberinolitycs