Retinal periphlebitis
| Classification according to ICD-10 | |
|---|---|
| H35.0 | Retinal periphlebitis |
| ICD-10 online (WHO version 2019) | |
When Periphlebitis retinal (synonym: Juvenile recurrent vitreous hemorrhage ) is it is an inflammation-induced wall violation of retinal veins with severe recurrent vitreous hemorrhage, mostly in men.
etiology
A distinction is made between a primary and a secondary form. Often no precise cause can be determined for the primary form. The secondary form is based on a number of diseases, including:
- Giant cell arteritis
- Polyarteritis nodosa
- Granulomatosis with polyangiitis
- Lupus erythematosus
- multiple sclerosis
- Sarcoid
- Behçet's disease
Even infectious diseases such as cytomegalovirus , herpes simplex , herpes zoster or syphilis can be associated with retinal Periphlebitis.
Pathogenesis
The inflammation of the vein wall leads to minor injuries in the further course, which in turn favor the occurrence of cellular infiltration in the vitreous humor . Any new vessel formation ( neovascularization ) can also lead to vitreous hemorrhage or retinal detachment .
Symptoms
The first indication of retinal periphlebitis is a reduction in vision caused by the opacification of the vitreous humor with the subjective impression of a "black wall" or "a dark moving curtain". Retinal hemorrhages or recurrent vitreous hemorrhages may later occur, which severely limit visual acuity and field of vision . If the retina is detached, there is a risk of blindness .
Diagnosis
The diagnosis is made using ophthalmoscopy . The inflammation can be shown in the form of small, whitish invaginations of the retinal veins, which are reminiscent of dripping candle wax ("candle wax exudates"). Vitreous infiltrates are also often found. Fluorescence angiography is the most reliable way to diagnose neovascularizations .
Differential diagnosis
The most important differential diagnosis is Eales' disease . This is an inflammation of the retinal vessels of unknown cause, which always affects both eyes. Men between the ages of 20 and 40 are particularly affected.
therapy
The therapy consists primarily in the treatment of the underlying general illness. An additional steroid therapy often leads to a rapid subside of the inflammation. In the case of ischemic retinal areas, laser coagulation can also be used . In any case, it is very important that before infectious causes are excluded. In the late stage and significant visual loss also may vitrectomy be considered.
forecast
The prognosis is generally good, but depends primarily on the underlying disease.
literature
- M. Sachsenweger: Dual Series: Ophthalmology , 2nd edition; Thieme Verlag, Stuttgart, 2002; ISBN 978-3-13-128312-2 . P. 265ff
- F. Grehn: Ophthalmology , 30th edition; Springer Verlag, Berlin, 2011; ISBN 3-540-75264-1 . P. 241
- Th. Axenfeld, H. Pau: Textbook and Atlas of Ophthalmology . With the collaboration of R. Sachsenweger et al .; Gustav Fischer Verlag, Stuttgart, 1980; ISBN 3-437-00255-4
