Ординатура / Офтальмология / Английские материалы / Manual for Eye Examination and Diagnosis_Leitman_2007

Retinopathy of prematurity (ROP)

This disease of newborns occurs in premature infants weighing less than 2000 grams or having a gestational age of 28 weeks or less. It occurs more often when oxygen was administered.

Normal vascularization of the retina progresses peripherally and is not normally completed until 1 month after birth. Oxygen given to newborns stops this normal vascularization process. When the oxygen is discontinued, the avascular peripheral retina stimulates new vessel growth (Fig. 363). These new vessels, however, are now abnormal and may bleed, resulting in vitreous hemorrhage with fibrous proliferation. It could drag the retina (Fig. 364), sometimes causing a retinal detachment. The ideal therapy is comprehensive prenatal care to reduce the number of premature births and careful monitoring of oxygen in the nursery.

Unfortunately, ROP is becoming more prevalent because of advances in neonatal intensive care units causing an improvement in survival for very low birthweight infants. An eye doctor should check the peripheral retina at 6 weeks of chronological age or 32 weeks gestational age, whichever was earlier. Transscleral cryotherapy or laser photocoagulation may be used to scar the avascular retina in stage 3 when the demarcation line is elevated with fibrovascular proliferation. Rigid examination and treatment guidelines and frequent poor visual outcomes are causing a shortage of doctors willing to follow these infants and be exposed to high cost litigation.

A

B

Fig. 363 (a) Stage 3 retinopathy of prematurity with vascularized ridge demarcating normal from avascular retina. Note laser photocoagulation spots. (b) Scarred peripheral retinal two weeks post-laser. Photos taken by Leslie Mackeen, Toronto, Canada, with wide-angle RetCam camera. Masse Research Lab, Inc.

Fig. 364 Late stage of retinopathy of prematurity with disk and retinal vessels dragged peripherally on left side.

Abducen’s nerve (CN VI) 24,31,44,48,59 Acne Rosacea 56, 57

AIDS (Acquired Immune Deficiency

Syndrome) 49, 72, 89, 107 Albinism 120

Amblyopia 25, 26 Amsler grid 39, 117 Aneurysms 47, 48 Ankylosing spondylitis 87

Anterior chamber 74, 75, 87 Arcus senilis 68

Asteroid hyalosis 92, 93 Astigmatism 8, 17, 19

Band keratopathy 89 Basal cell carcinoma 56 Behçet’s disease 89 Bell’s palsy 32 Blepharitis 56 Blepharospasm 32, 33

Blow-out fracture of orbit 62 Bowman’s membrane 19, 20, 63 Brain 30, 42–47

Bruch’s membrane 106, 107, 115, 116

Carotid artery 36, 44–48, 113 Carotid-cavernous fistula 47, 48 Cataract 1, 4, 94–99

Cavernous hemangioma 56 Cavernous sinus 44, 46–48 Cavernous sinus thrombosis 47, 61 Central serous retinopathy 117 Chalazion 56, 57

Choroid 84, 85, 89–91, 102, 113, 115–117 Choroiditis (see Uveitis)

Ciliary body (processes and muscle) 80, 83, 84–90

Circulation to visual centers 45–48, 100, 106–115

Color vision 42, 43

Computerized axial tomography (CT Scan) 4, 61, 62

Conjunctiva 14, 68–72 Chemosis (edema) 60, 69 Follicles 70

Hemorrhage 69

Papillae 14, 70

Conjunctivitis (Red, inflamed eye) 70, 72, 88

Allergic 71

Bacterial 71 Blepharoconjunctivitis 71 Inclusion 70

Papillary or Vernal 14, 70 Trachoma 70

Viral 68, 72

Contact lens fitting 12–18 Cornea 63

Abrasion 14, 64, 66 Curvature 13, 16 Edema 66, 67, 82 Endothelium 63, 67 Epithelium 14, 64–68

Inflammation (keratitis) 65–68 In contact lens wear 12–21

In refractive surgery 19–21 Keratitis (inflammation) 65–68 Transplantation 64–65 Ulceration 65

Cotton-wool spots 105–109, 114 Cutaneous horn 56

Cyclitis (See Uveitis)

Dacryocystitis 53, 54 Dacryocystorhinostomy 54 Dermatochalasis 54 Dermoid tumor 68

Descemet’s membrane 63, 64, 67 Diabetes 1, 3, 113–115

Diabetic retinopathy 1, 113–115

Diplopia 2, 26, 29–31

Drusen (2 different meanings)

Optic disk 101, 104

Retinal 106, 107, 115, 117

Dry eye 50, 51

Ectropion 52, 57

Endophthalmitis 65

Enophthalmos 60, 62

Entropion 57

Enucleation 90

Epidermoid inclusion cyst 55

Episcleritis 73

Esophoria 25

Esotropia 25, 27, 28

Exophoria 25

Exophthalmos 3, 47, 60, 61

Exotropia 25, 28, 29

Facial nerve 24, 32 Floater 1, 118

Fluorescein angiography 103, 105, 114, 116, 117

Fusion 26

Ganglion cells 33, 34, 76, 79, 100, 110 Giant cell arteritis 2, 35

Glaucoma 1, 67, 74–84 Angle-closure 81, 82, 88 Infantile 83 Inflammatory 83, 87 Open angle 75–81 Pigmentary 83 Pseudoexfoliation 83 Rubeosis iridis 83, 86

Sturge-Weber syndrome 84 Traumatic iris recession 83, 84

Gonioscopy 84

Graves’ disease 3, 5, 15, 61

Headache 2, 31, 47, 105

Herpes simplex keratitis 65, 66, 89 Herpes zoster dermatitis (Shingles) 32, 89 Homonymous hemianopsia 42

Horner’s syndrome 36

Hyperopia (farsightedness) 7, 17, 19, 22, 82

Hyphema 83

Hypopyon 65

Hypotropia 29

Inferior oblique muscle 24, 30 Inferior ophthalmic vein 46, 47, 48 Inferior orbital fissure 60

Inferior rectus muscle 24, 62 Infraorbital nerve 62

Internal carotid artery 44–48, 113 Iritis and Iridocyclitis (see Uveitis)

Kaposi’s sarcoma 71, 72

Keratitic precipitates 87, 88

Keratitis (see Cornea)

Keratoconus 9, 12, 20, 21, 64

Keratoacanthoma 55, 56

Keratometry 13

Lacrimal gland 50, 51 Lagophthalmos 4, 66, 67

Lateral rectus muscle 4, 24, 27, 31 Levator palpebral muscle 30, 39 Lice on eyelashes 58

Lid cellulitis 57

Limbus 16, 63, 68, 80, 93 Lymph nodes 49

Macula 4, 100, 120

Macular degeneration 1, 39, 41, 107, 110, 111, 115–117

Macular edema 109, 111, 112, 114 Macular pucker 118

Magnetic resonance imaging (MRI) 35, 48

Marcus Gunn pupil 34, 105 Meibomian glands 49, 56 Melanoma 73, 85, 86 Migraine 2, 5, 45

Müller’s muscle 3, 24, 36 Multiple sclerosis 35

Muscles (Extraocular) 23, 24, 27, 29–31

Myasthenia gravis 39

Myelinated nerve fibers 34, 102, 105 Myopia (nearsightedness) 8, 17, 19, 21,

101

Nasolacrimal duct 50, 52, 53 Near point of convergence 26

Nerves (extraocular) 24, 29–36, 39, 47, 48, 59

Nevi 55, 72, 86 Nystagmus 43, 45, 120

Oculomotor nerve 30

OCT (optical coherence tomography) 111, 112, 119

Ophthalmic artery 48 Ophthalmodynamometry 46, 47 Ophthalmoplegia 60 Ophthalmoscopy 102

Optic atrophy 33, 34 Optic chiasm 36, 42 Optic disc 77, 101

Optic nerve 4, 33–36, 41

Optic neuritis 4, 34, 35, 43, 105 Optic tract 36, 42

Ora serrata 100 Orbicularis oculi muscle 32 Orbit 3, 23, 48, 59–62 Orbital cellulitis 47, 60 Orbital fat 54, 60

Orbital septum 54, 60

Papilledema 104–106 Pars plana 81, 93

Phacoemulsification 95, 96 Photophobia (Light sensitivity) 2, 12, 86,

120 Pinguecula 69

Pituitary gland 41, 42 Posterior cerebral artery 44–47 Presbyopia 9, 12, 22

Prism testing 28

Proptosis (see exophthalmos) Pseudostrabismus 28 Pterygium 69

Ptosis 36, 39

Puncta 50–53 Pupil 30, 35, 38

Adie’s pupil 37

Argyll Robertson pupil 37 Constrictor muscle 35 Dilator muscle 35, 36 Light reflex 34, 36, 37 Marcus Gunn pupil 34

Refraction 9–11 Refractive surgery 19–22

Conductive keratoplasty 22 Epi-LASIK 20

Intac 21

LASIK (Laser in situ keratomileusis) 19 Phakic implants 21

PRK (photorefractive keratectomy) 20

Radial keratotomy 19 Reiter’s syndrome 89 Retina 100-122

Retinal artery 41, 48, 101, 104, 106, 108, 111–113

Retinal artery occlusion 113

Retinal blood vessel disease 106–115, 122 Retinal detachment 41, 73, 78, 93, 114,

118–119, 122 Retinal hemorrhages 111

Retinal hole 103, 118, 119

Retinal vein occlusion 105, 109–113 Retinitis pigmentosa 2, 120, 121 Retinoblastoma 121

Retinopathy of prematurity 113, 122 Rheumatoid arthritis 50, 73, 89 Rubeosis iridis 83, 86

Sarcoidosis 89, 111 Sclera 73

Scleral staphyloma 73 Scleritis 73

Scotoma 41, 42, 45 Seborrheic keratosis 55 Shingles 32, 89

Sinus cavities (facial) 2, 60–62 Sjögren’s syndrome 50

Slit lamp 63

Squamous cell carcinoma 56 Strabismus 2, 25–29

Stroke 45–48 Sty 56, 57

Superior oblique muscle 24, 29, 30, 31 Superior ophthalmic vein 46, 47, 48, 60 Superior orbital fissure 60

Superior rectus muscle 24, 30 Surgery

Cataract 94–99

Corneal transplant 20, 64, 67 Enucleation 90

Glaucoma 79–82 Refractive surgery 19–22 Retinal detachment 118 Strabismus 25 Vitrectomy 93, 114, 119

Sympathetic nerve 24, 36, 39, 48 Sympathetic ophthalmia 89, 90 Syphilis 37, 73, 89

Tarsus 54, 60

Tearing (Epiphora) 51–53 Thyroid disease 3, 35 Tonometers 74 Toxoplasmosis 89

Trabecular meshwork 74, 75, 80 Transient ischemic attack (ministroke) 45 Trauma

Anterior uveitis 86–89 Dislocated lens 95 Hyphema 83 Ruptured globe 90

Vitreous hemorrhage 92, 93, 118, 122 Trichiasis 58, 66, 70

Trigeminal nerve 24, 31, 32 Trigeminal neuralgia 32 Trochlear nerve 24, 30, 31

Ultrasound 85, 93

Uvea (iris, ciliary body and choroid) 84

Uveitis 86–92

Anterior (iritis, cyclitis) 86–89

Posterior (choroiditis) 89–92

Vascular endothelial growth factor (VEGF) 109, 112–114, 116

Verruca (warts) 55 Vertebral artery 44–47 Vision testing (central) 6 Visual cortex 45

Visual field testing (peripheral) 39–43 Visual pathway 36, 43

Vitrectomy 93, 114, 119 Vitreous 92, 93

Vitreous detachment 92, 111 Vitreous hemorrhage 92, 93, 118, 122

Wirt stereopsis test 26

Xanthelasma 55