Senile macular degeneration and age-related macular degeneration, occurs mostly in persons over 45 years of age, the prevalence rate increas
Senile macular degeneration and age-related macular degeneration, occurs mostly in persons over 45 years of age, the prevalence rate increased with age, recent research in the above 50 years old the prevalence accounted for 15.5%, is one of the important ocular current in the elderly.
(a) risk factors for age-related macular degeneration
According to the study of the United States, Australia and some famous epidemiological group, the risk factors of senile macular degeneration are the following: age, diet, light, smoking history, family history, history of hypertension, hypercholesterolemia, gender and ethnicity (Caucasian much different), history of cardiovascular disease.
At present, the cause of the disease is not clear, but it is thought to be related to systemic diseases such as heredity, chronic light damage, malnutrition, cardiovascular system and respiratory system and other environmental factors.
1, dry age-related macular degeneration: also known as non exudative age-related macular degeneration or atrophic age-related macular degeneration, macular edema, no bleeding, accounting for about 80%---85%.
2, wet age-related macular degeneration: also known as exudative age-related macular degeneration, refers to the new blood vessels and bleeding, accounting for about 15%.
With the increase of age, the retinal pigment epithelial dysfunction, substance accumulation of retinal pigment epithelial cells, abnormal extracellular matrix in the basement membrane, Bruch membrane between the pigment epithelium and many eosinophilic material accumulation of drusen. The changes of pigment epithelium, Bruch membrane and visual cells in different degrees of degeneration, hyperplasia and atrophy were observed. The change of permeability of Bruch membrane for nutrients, so that the retinal pigment epithelium in response to metabolic disorders, leading to retinal pigment epithelium, Bruch membrane and choroidal capillary atrophy, slow development of atrophic age-related macular degeneration (or macular degeneration; dry type) can also cause Bruch collagen membrane thickening, and elastic layer fracture, resulting in choroidal capillary through the Bruch membrane within pigment epithelium or subcutaneous nerve, choroidal neovascularization. Due to the structural characteristics of the new blood vessels to determine the occurrence of leakage and bleeding, the formation of exudative age-related macular degeneration or wet age-related macular degeneration.
(five) fundus manifestations
1, dry age-related macular degeneration: more than the age of more than 50 years of age, the onset of slow, patients with visual acuity decreased, there may be physical deformation, the degree of similarity between the eyes, can easily be mistaken eyes aging". Because each layer of the outer retina and pigment epithelium, Bruch membrane, choroidal capillary atrophy, etc. gradually, the early course of the posterior pole. The size of the visible yellowish white oval drusen can fusion, pigment epithelial hyperplasia or atrophy, foveal light reflex, posterior pigment disorders, further clear boundary map atrophy region. In the late stage of development, choroidal capillary atrophy in this area can be seen.
2, exudative age-related macular degeneration: clinical manifestations were sudden monocular vision loss, visual distortion or central scotoma, the other eye symptoms may appear in a long time. Fundus retinal hemorrhage, exudation, which sometimes visible yellow lesions will be neovascularization. Located in the subcutaneous nerve or subcutaneous hemorrhage on the pigment, the color dark red or black, slightly red edge, and a shallow bright red bleeding, sometimes visible near the drusen, the lesion can be raised. Fluorescein angiography showed high fluorescence neovascularization form clear boundary in the early stage, called angiogenesis typical, some patients will have no clear realm, called occult neovascularization, rapid leakage of fluorescein angiography, the boundary is not clear, is still relatively late Gao Yingguang. Indocyanine green angiography, more conducive to the display of choroidal neovascularization morphology. Such as a large number of shallow bleeding into the vitreous body, resulting in vitreous hemorrhage, fundus can not be seen. Time machine, macular hemorrhage, discoid scar formation, complete loss of central visual function.
1. There is no specific treatment for atrophic age-related macular degeneration.
2, exudative age-related macular degeneration treatment is aimed at the closure of subretinal choroidal neovascularization, located in the center of the 500um from the outside of the new blood vessels can be laser closed to prevent the continued development. But it can't prevent recurrence, so it is necessary to observe closely after photocoagulation. In 1990s the vitreous body were successfully removed in subretinal neovascularization, but because of the retinal pigment epithelium and optic cell damage, visual function surgery has not improved, compared with the observation group failed to prevent vision loss, and surgical complications was significantly higher.
Photodynamic therapy (PDT) combined with endothelial cell specific choroidal neovascularization by a certain wavelength photosensitizer, light activated photosensitizer, light oxidation, destruction of endothelial cells, so as to achieve the destruction of choroidal neovascularization has been widely used. However, there is still the possibility of recurrence of the disease, there are still long-term clinical follow-up, observation of curative effect.
700-900nm is the essence of thermotherapy (TTT), which is characterized by the use of infrared laser or near infrared laser penetration, and less damage to other tissues, especially neuroepithelial tissue.
Anti -VEGF therapy is mainly used in Ophthalmology (bevacizumab) with bevacizumab and ranibizumab (ranibizumab), this year has been successful in clinical treatment of exudative age-related macular degeneration, is a major achievement.
The occurrence of macular degeneration may be related to the accumulation of toxic effects of light, it should avoid light damage, under the strong light should wear glasses. In recent years, the application of laser in the prevention and treatment of hyaline membrane disease in the prevention and treatment of senile macular degeneration has been reported.
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