RetinalVasculitis英文.ppt

Retinal Vasculitis Dr. Christine Fardeau Department of Ophthalmology Chief of the department : Pr P. LeHoang H?pital Pitié-Salpétrière Paris, France;What are the retinal vasculitis? Inflammation of retinal vessel in the posterior uveitis Leading to 3 questions : Positive diagnosis Etiological diagnosis Therapeutic questions 1 Positive and differential diagnosis 2 Etiological diagnosis based on Initial associated ocular or periocular signs Retinal angiographic features Immunological status of the patient Associated systemic signs ;Biomicroscopic diagnosis of retinal vasculitis Whitish sheathing of vessel血管白鞘 Focal or diffuse, short or long, active or scar In intermediate uveitis : retinal vasculitis are veinous and peripheral 中间葡萄膜炎：网膜血管炎发生在静脉和周边 In posterior uveitis vasculitis may be arterial, veinous or mixed 后葡萄膜炎可为动脉、静脉或混合性 Exsudation along the inflammatory vessel wall is uncommon. Hard exsudates are uncommun. Plamatic exsudation could be organised in macular cyst (cystoid macular edema) 炎症血管壁沿途很少看到渗出。硬性渗出罕见。浆液性渗出会聚集到黄斑形成囊样水肿;Retinal angiography is of interest for many reasons : (1) can show retinal vasculitis nor seen in ophthalmoloscopic examination (2) can show the inflammatory activity of retinal vasculitis (wall staining then leakage from the vessel) (3) can show the arterial, veinous or both lesions (4) can show occlusive vasculitis and neovascular complications (5) can suggest specific etiology (6) can help to assess the therapeutic response (7) OCT (optical coherence tomography) and visual field are systematically made in the initial work-up ? ;Differential diagnosis : Diabetic retinopathy In Diabetic retinopathy : vessel sheathing and irregular vessel diameter can be linked to ischemic lesions due to chronic hypoxia . They are due to a degenerativ ischemic processus糖网：慢性缺氧导致缺血性损害包括血管鞘及血管直径不规则，为进行性过程 In Diabetic retinopathy there is no other inflammatory signs in the aqueous humor, pars plana, or vitreou