Fundus manifestations of medical diseases
Nov 28, 2019
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Retinal microvessels are the only microvessels in the whole body that can be observed without damage, and their changes are closely related to many medical diseases. Therefore, changes in the fundus, including retinal microvasculature, can reveal medical diseases for us and become an important indicator for monitoring health conditions. Fundus photography has become a simple, fast and effective screening method to provide doctors with pictures of fundus lesions. Below, let us learn the fundus changes caused by several medical diseases through the following pictures.

DIABETES


Non-proliferative retinopathy with yellow-white hard exudation and bleeding spots.



Diabetes can cause a variety of ophthalmic complications, including diabetic retinopathy (DR), cataracts, and cilitis. DR is one of the most common and serious complications.

Clinically, there are various changes in the fundus of diabetes. The basic changes include microaneurysms, bleeding, exudation, macular edema, and proliferative lesions. According to the presence of retinal neovascularization or vitreous hemorrhage, diabetic retinopathy can be divided into non-proliferative (NPDR) and proliferative (PDR).



Proliferative retinopathy, scattered retina scattered with hard exudation in the macular area, preretinal hemorrhage can be seen under the lower vascular arch.



Clinically, the fundus examination can not only indicate the progress of retinopathy, but also indirectly reflect the microvascular condition of the whole body. Therefore, it is very important for patients with diabetes to check the fundus at least once a year. For patients with severe NPDR and PDR, not only blood glucose should be controlled, but also ophthalmology should be treated as early as possible. Proliferative lesions should be controlled by means of photocoagulation and anti-new blood vessels to avoid vision loss.


HYPERTENSION



Chronic hypertension retinopathy



Hypertensive retinopathy can also be divided into two types, chronic and aggressive, according to the progression of hypertension. Among them, chronic hypertensive retinopathy is the most common, initially manifested by the impact of hypertension on the retinal arteries, such as vasospasm, narrowing, changes in the vessel wall, and exudation, bleeding, and cotton wool spots when severe. The picture shows grade III hypertensive retinopathy, showing changes in arteriosclerosis, retinal arteries generally narrowed, copper filaments, and scattered cotton wool spots and flame-like bleeding.





Radical hypertension retinopathy



Optic disc edema includes non-inflammatory and inflammatory, with increased intracranial pressure being the most common cause of non-inflammatory disc edema. In patients with malignant hypertension, blood pressure rises sharply in a short period of time, which can involve multiple target organs such as the brain, eyes, and kidneys, causing optic disc edema and ischemic optic neuropathy, and acute blindness can occur. Fundus examination showed that the optic disc was swollen and raised, and the edges were unclear.


INFECTIVE ENDOCARDITIS



Infective endocarditis fundus Roth spot


Some patients with infective endocarditis may show decreased vision, and typical findings such as Roth spots can be seen on the fundus. Roth's spot is a central white spot formed by platelet-fibrin agglutination after bleeding from the center of the retina. In addition to infective endocarditis, many other systemic diseases can also cause fundus Roth spots, such as leukemia, anemia, diabetes, and hypertension.

LEUKEMIA


Fundus changes in acute leukemia


Acute leukemia involves the eye more often than chronic leukemia. Acute leukemia with ocular infiltrating lesions is relatively rare, and more common are secondary fundus changes caused by bleeding, thrombosis, and anemia. Retinal hemorrhage is a common manifestation of acute leukemia involving the fundus.



Fundus infiltration of chronic leukemia



Chronic leukemia can cause ocular infiltration, peripheral microretinal hemangiomas, new blood vessels, and sometimes manifested as post uveitis, which is one of the conditions of "camouflage syndrome". The picture shows the "leopard-like" changes caused by choroidal infiltration caused by chronic leukemia. Fundus infiltration is one of the signs of poor prognosis of leukemia. In addition to fundus changes, various tissues of the eye can be affected by leukemia, including orbital infiltration and anterior segment lesions.


TEMPORAL ARTERITIS

Temporal arteritis causes ischemic optic neuropathy


Temporal arteritis, also known as giant cell arteritis(GCA), is a chronic systemic angiogranulomatous inflammation whose cause is unknown.

GCA mainly involves the middle and large arteries, including the aorta and its branches, the external carotid artery, and blindness can be caused when the ophthalmic artery and its branches are involved. The main goal of GCA treatment is to prevent vision loss and systemic vasculitis complications in the healthy eye (tongue necrosis, aortic aneurysm, stroke, myocardial infarction, etc.). Temporal arteritis when it invades the eye is mainly manifested as ischemic optic neuropathy. If not treated as soon as possible, it can quickly cause optic nerve atrophy.

GCA-induced anterior ischemic optic neuropathy appears as painless, non-progressive severe visual loss, and fundus examination reveals localized edema of the papillae and peripheral linear bleeding (Figure 9). Early diagnosis and timely hormonal shock are extremely important for saving vision.





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