Expert introduction: Zhang Shuhua, Deputy Director, Director of Ophthalmology Center of Provincial Hospital of Traditional Chinese Medicine, Doctor of Medicine, Head of Fundus Group. Study together with Professor Lu Mianmian, a famous ophthalmologist of integrated traditional Chinese and western medicine in China. Mainly engaged in the diagnosis and treatment of common eye diseases, viral keratitis and fundus diseases, such as central serous chorioretinopathy, retinal vein occlusion, diabetic retinopathy, age-related macular degeneration and optic neuropathy, especially good at fundus fluorescein angiography, choroidal angiography and * * * focus laser retinal tomography, OCT, visual electrophysiological examination and fundus laser research. The magazine publishes academic papers and many domestic papers at or above the provincial level.
Author: Is age-related macular degeneration a disease?
Zhang Shuhua: Age-related macular degeneration, also known as age-related macular degeneration (AMD), changes the structure of macular area with age. The main uptake capacity decreased. Due to the disc membrane of the outer disc membrane of the optic cell, the incompletely digested residue remains in the protoplasm of the basal cell, which is discharged from the cell and deposited on the bruch membrane, forming a glass membrane wart of the glass membrane. Because of the particularity of macular structure and function, this change is more obvious. Vitreous warts are also found in the elderly with normal vision, but secondary lesions lead to macular degeneration. The disease mostly occurs over 45 years old, and the prevalence rate increases with age, leading to blindness in the elderly.
Author: What causes age-related macular degeneration?
Zhang Painting and Calligraphy: The cause of the disease is still unclear, which may be related to heredity, congenital defects, chronic light damage, malnutrition, poisoning, drug action, immune abnormality, cardiovascular system, respiratory system and other systemic diseases. Now, most people think that this disease may be the result of a combination of many reasons. The disease can be divided into atrophic type and exudative type according to different clinical manifestations. Atrophy (also known as dry or non-exudative) choroidal atrophy and macular degeneration and atrophy caused by retinal pigment epithelium atrophy. With the destruction of exudative (also called wet or discoid) glass membrane, choroidal vessels invade the retina to form choroidal neovascularization, serous or hemorrhagic discoid macular pigment subcutaneous nerve detachment occurs, and finally it becomes a machine scar. Some observed atrophy forms can also be transformed into exudation forms.
Author: What are the symptoms of age-related macular degeneration?
Chapter painting and calligraphy: patients often complain of decreased central vision, blurred or distorted vision. Atrophic vision loss is slow, even for months. Exudative vision drops sharply, accompanied by bleeding, dark shadows in front of eyes or visual impairment. Fundus manifestations: atrophic type: macular pigment disorder, pigment epithelium atrophy, foveal reflection weakened or disappeared, scattered in vitreous warts. The typical feature of exudative subretinal neovascularization in macula is the irregular round lesion in macular fovea or the next type of macular fovea, which is gray or yellow-white. Located under the nerve. Or the surface around the bleeding focus and anti-halo. Fundus fluorescein angiography: atrophic type: early obvious window defect, high fluorescence macular drusen, accompanied by background fluorescence enhancement, weakening and dissipation of pigment loss. Some contrast staining or small pigment epithelium shedding. The course of the disease is long, and the choroidal capillaries in the atrophic area of macular pigment epithelium are atrophied and occluded. Here, we can see the low fluorescence area and the residual choroidal great vessels. Exudative type: choroidal neovascularization in macula, fluorescein leakage or bleeding, fluorescence blocked. There are two types of typical and occult choroidal neovascularization fluorescein angiography. Typical choroidal neovascularization: the early boundary of angiography is clear and strong fluorescence, and the late fluorescein leaks and accumulates, and the localized strong fluorescence appears in the form of skin or nerve subcutaneous. Concealed choroidal neovascularization can be divided into vascular pigment epithelial detachment and vascular diseases. A small irregular area was separated from the vascular pigment epithelium under the skin, and the fluorescence was stronger than that of the early pigment. In a few minutes, the fluorescence gradually increased the dye staining or leakage of the middle and late retinal tissue. Vascular pigment epithelial lesion: typical choroidal neovascularization with unclear boundary, irregular boundary in the early stage of fluorescence angiography, subcutaneous leakage of pigment and subretinal hemorrhage covered with fluorescence, also known as unknown leakage in the later stage.
Indocyanine green angiography (ICGA): Characteristics of choroidal neovascularization in macular area of exudative macular degeneration and retinopathy. Weak fluorescence, CNV leakage in the late stage of ICGA. ICGA can make up for the deficiency of FFA, but ICGA can not effectively diagnose occult CNV macular hemorrhage. ICGA FFA found CNV more clearly in a wider range, and the diagnostic rate was greatly improved.
Optical coherence tomography (OCT): OCT examination is helpful to know the location of choroidal neovascularization (CNV), such as CNV and retinal pigment epithelial cells (RPE). In the case of RPE, the retinal layer and CNV ooze upward and downward, with or without cystoid macular edema.
Author: How to treat age-related macular degeneration?
Zhang Painting and Calligraphy: There is no effective treatment for this disease, which can be used for the following adjuvant treatment: Trace element zinc: 50 mg each time, zinc gluconate twice a day. Some people think that oral zinc can prevent the development of macular degeneration.
Antioxidant: Take vitamin C and vitamin E orally to prevent free radicals from damaging cells and protect visual cells. It is a nutrient in the retina.
Chinese medicine: Chinese medicine has the functions of anti-aging and improving microcirculation, and has a good effect on atrophic diseases. It also has the function of recurrence, preventing exudative scar, repairing the other eye and preventing the disease from developing. Early disease, fundus drusen, pigment disorder and change, vision loss is not too serious. In this case, in view of the fact that liver and kidney regulate qi and blood, retinal pigment epithelium, serous detachment of neuroepithelium, invigorating spleen and eliminating dampness and phlegm, hemorrhagic detachment, administrative hemostasis, blood stasis, and a lot of scars, whether as nourishing liver and kidney or endometriosis.
Laser therapy: the heat generated by laser destroying abnormal neovascularization in macular area. Laser photocoagulation can not prevent the formation of new blood vessels, which belongs to symptomatic treatment. Unnecessary laser itself will damage choroidal neovascularization and nearby normal tissues, which will be greatly affected according to its function, so we must be vigilant.
Pupillary thermotherapy (TTT): In this method, near-infrared laser with the wavelength of 8 10nm is used to irradiate the retina at 7.5W/cm2, and less power is absorbed through the refractive medium, so that the target tissue is slowly heated to about 10℃. The local temperature is lower than that of traditional laser photocoagulation, and the damage to normal tissues around nonspecific CNV is less. After treatment, CNV is thrombosis, and some or all CNV blocks and promotes the absorption of bleeding and exudation, which also occurs relatively and maintains certain visual function. Therefore, TTT is suitable for the treatment of various CNV, occult and typical CNV.
Photodynamic therapy (PDT): A specific photosensitizer is injected into the patient's blood, and the 689nm laser excites the photosensitizer to circulate to the retina, thus destroying abnormal neovascularization and normal retinal tissue without any damage. Therefore, it is used to treat age-related macular degeneration and CNV, especially CNV in the fovea. The treatment is convenient, safe and effective.
Surgical treatment: removal of subretinal neovascular membrane, macular transposition and retinal transplantation. The treatment of this disease brings hope.