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Fundus bleeding

LI YAN
L/O/G/O

retinal anatomy the most common diseases in the fundus bleeding traditional Chinese medicine in treatment of fundus bleeding.

Retinal blood vessels is the only small blood vessels that can directly see from the body. eyeground change is the performance of systemic disease and intraocular disease, therefore, We are often judged systemic disease by eyeground changes, especially for hardening of the arteries, the diagnosis and treatment of hypertension and diabetes and so on, has more clinical significance.

Blood retinal barrier Retina inner barrier: the tightly connection between the retinal capillary endothelial cells and perithelial cells constitute the blood retina barrier. retina external barrier: RPE(retinal pigment epithelium) and during the close small band

blood supply of the retinal retinal artery supply in five layers. Belong to terminal blood vessels, when main branch or branches artery occlusion, the supply of retinal inner organization will immediately oxygen poor, will cause degeneration necrosis.

short posterior ciliary arteries supply outside five layer, belonging to the ciliary vascular system.

normal fundus

The TCM recognition of retinopathy


Retinopathy is to neizhang" category. Ophthalmology of TCM expert professor Chen Dafu in 1959 founded the first "inner eye tissue and relatedness of zang-fu organs and meridians" theory. Chen Dafu professor consider nervus opticus and retinal belong to The Liver Channel of Foot-Jueyin, choroid belong to The Heart Channel of Hand-Shaoyin, macular belong to The Spleen Channel of Foot-Taiyin, vitreous belong to The Lung Channel of Hand-Taiyin, aqueous belong to The Gall Bladder Channel of Foot-Shaoyang, eyes all pigment belong to The Kidney Channel of Foot-Shaoyin.

Diabetic retinopathy,DRP
The most common retinal vascular disease . there are 1% of people with diabetes in our country, after 5-9 years about 10% can occur retinal pathological changes, after 1 5 years about 50% of the people, after 25 years with 80-90% develop retinopathy. About a quarter of people with diabetes have diabetic retinopathy.

Cause: hyperglycemia cause a variety of biochemical and physiological changes, one after another the capillaries endothelial cell damage. Retinal capillary pathological changes including pericyte decreased, basement membrane thickening, blood capillary lumen decreases, and the capillaries endothelial barrier decompensation.

Microvascular cells damage

capillaries vasodilatation Microaneurysm

Microvascular occlusion

nonperfusion

Retinal ischemia hypoxia

proliferation

the occurrence of DR developt not only depends on the degree of metabolic disorders,but also depends on the age, course of disease, genetic factors and the control diabetes.

clinical manifestation
in the early days ,there is no symptoms,with pathological changes, can cause visual impairment. If macular involvement, can have view the shadow, dysmorphopsia If a small blood vessels of retina is broken, and a small amount of bleeding into the vitreous, will feel black shadow flap in the front, when large Numbers of new blood vessels are bleeding into the vitreous, eyesight can be severe loss, the only light.

complication
tractional detachment of retina new vessels on the iris neovascular glaucoma

drug treatment
1.No specific drug. Reduce the DRP capillaries easy leakage, reduce high blood viscosity and platelet cohesive force. Such as, aspirin, etc. Positive control blood suga.r, blood pressure, fundus examination on a regular basis. 2. surgical treatment: used in hyperplastic DRP complications, such as the new blood vessels caused by vitreous hemorrhage, tractional retinal detachment and vitreous proliferation rhegmatogenous retinal detachment and so on, using vitrectomy, intraoperative whole retinal photocoagulation (PRP)

3.photocoagulation treatment to reduce vascular proliferation factor release, mitigate or remove edema, retinal ischemia and disease occurrence and development of new blood vessels.

Retinal vein occlusion,RVO


The disease caused by a branch or central retinal vein occlusion, the main clinical features is retinal vein to circuity and expand circuity, along the affected vein bleeding, exudation and edema, as. Retinal vein obstruction, due to central retinal vein or branch caused by thrombus

Pathogeny:
1.the oppression from outside the Blood vessels: due to the junction of the retinal artery and vein harden , neighboring vein is oppressed. Oppression makes the blood flow is blocked, endothelial injury, thrombosis. much more in hypertension and atherosclerosis in elderly patients.

2.The venous blood flow stasis: retinal artery perfusion pressure is insufficient, increased intraocular pressure, and patients with increased the blood viscosity . often occurs in the carotid artery blood supply insufficiency, the massive blood loss, low blood pressure, glaucoma, erythrocytosis, diabetes, and so on.

. damage Caused by the intine of blood vessels: retinal vasculitis, tube wall edema, endothelial cell proliferation narrowed or blocked blood flow. More common inYoung people.

clinical manifestation
Central vein occlusion:Visual acuity decreased significantly. The fundus characteristics: retinal vein dilatation, tortuosity of each quadrant, retinal hemorrhage, edema, optic disc edem

If the obstruction is the branch vein, showed hemorrhage, retinal surface area affected vein retinal edema and cotton wool spots, obstruction of the venous dilation, bending. A concomitant artery narrowing, a sheath. Superior temporal branch vein occlusion of the most common nasal obstruction is rare.

Prognosis:
extensive ischemia can cause retinal neovascularization and macular edema. Macular edema caused by ischemia, with hard exudates, cystoid edema, or pigment disorder and subretinal fibrosis; retinal neovascularization induced by vitreous hemorrhage, traction or rhegmatogenous retinal detachment, macular hole often occurred in the adjacent neovascularization area. About 1% of the BRVO eye iris neovascularization.

Treatment principle:
from the etiology and antithrombotic therapy. 1. etiological treatment there is no special and effective drug treatment. Should be actively looking for the cause, treat of the primary disease. for retinal vascular inflammation, can use corticosteroid treatment; high intraocular pressure, should be reduce the intraocular pressure; hypertension, arteriosclerosis, diabetes should be treated in medical treatment

2 antithrombotic therapy :vasodilator and fibrinolytic therapy.

3 laser therapy: reduce capillary leakage, and form a barrier to prevent diffusion into the macular edema; closed non perfusion area, make the neovascularization atrophy to prevent the occurrence of vitreous hemorrhage and neovascular glaucoma.

For traditional Chinese Medicine understanding of the fundus bleeding .


1.cause and pathogenesis

2.tcm treatment

1.cause and pathogenesis


1.1the main cause Qi fire stagnant blood injury

1.1.1 QI excess, deficiency of QI QI excess abnormal rising of qi , stagnant of qi. Inverse qi because of rage driving qi upward, upward invasion of liver-QI, Qi and blood stasis, or qi blood disorder, the blood is breaking complex out.

Qi stagnation due to pyrophlegm, dyspeptic retention, emotional discomfort .qi stagnation and then blood stasis. Then, blood breaking complex out, or upward invasion of liver-QI, blood vessels are damaged, blood fails to circulate in the vessels and bleeding.

deficiency of qi Due to the age and infirmity, macronosia or overwork, qi is impaired, Qi deficiency failure of blood, blood loss of control, blood fails to circulate in the vessels and bleeding.

1.1.2 sthenia fire, deficient fire.


sthenia fire due to catching pathogenic heat or viscera heat invasion of blood, blood suffered heat stress, abnormal circulation of blood, overflow in the veins cause bleeding, the ancients saidKnow the blood is disturbed, mostly by the fire disturbance, excessive qi inducing heat , retinal bleeding caused by fire burning.

deficient fire
the liver and kidney yin deficiency, yin deficiency and internal heat, deficient fire burn the vessels. blood fails to circulate in the vessels and bleeding.

1.1.3 blood stasis


Blood stasis or qi stagnation can not run the blood, or deficiency qi cannot promote blood circulation, or cold coagulation lag, make vein stasis barrier and then bleeding.

1.1.4 external injury


Because the corpus alienum directly or indirectly damage eyes, blood breaking out, such as "xuezhenglun" "has been falling down, extravasated blood stay inside..

2.tcm treatment
According to Chengdu University of Traditional Chinese Medicine professor Wang Mingfang's theory puts forward research ideas on the treatment of four period. Divided into hemorrhage, blood stasis, dead blood, dried blood.

2.2.1 Bleeding period appropriate hemostasis and activating blood circulation


time:bleeding within 2 weeks

manifestation Fundus manifestation :the hemorrhage was flame shaped; large, or spot, red color; vitreous hemorrhage manifestation :A large number of blood cells visible vitreous cavity, the pupil area with or without red light reflection, fundus does not be examinated.

treament:hemostasis and activating blood circulation. traditional Chinese drug shengpuhuangtang add or decrease.( pollen typhae, yerbadetajo, Salvia miltiorrhiza, Cortex Moutan rehmannia dride rhizome, herba, Curcuma aromatica,chuanxiong)

If hemorrhage repeatedly, should cool the blood, to stop bleeding, promoting blood flow,such as retinal periphlebitis, central exudative retinopathy, diabetic retinopathy, and age-related macular degeneration (wet bleeding).

2.2.2 promoting blood circulation and removing blood stasis in haemostasis period

Time:bleeding within 2-6 weeks

manifestation haemostasis is purplish red or dark red vitreous hemorrhage :If the vitreous hemorrhage,we can find that vitreous turbid is eticulation,when Bleeding time, the pupil area without red light reflection, observation of a large number of brown or pale floc reticular opacity in the vitreous from the slit lamp. fundus does not be examinated.

treament: when Qi stagnation blood stasis ,promoting blood flow, light use Taohong Siwu decoction, Severity use Xuefu Zhuyu decoction;

Supplementing Qi and activating blood circulation when Qi deficiency and blood stasis expelling, buyanghuanwu decoction; (astragali, adenophorae, tuckahoe, batatatis rhizoma, angelica tail, red peony root, chuanxiong, radix curcumae, safflower, earthworm, peach kernel).

2.2.3 Die blood period appropriate cure phlegm and blood stasis at the same time.
Time:bleeding within 6-10 weeks

Manifestation: Blood is dark or white exudate, blood stasis involve macular,cause cystoid macular edema, or neovascularization on discus opticus, or rubeosis iridis. If the vitreous hemorrhage, note the amount of white floc reticular opacity, or white Organize strap in vitreous beneath

Treament:cure phlegm and blood stasis at the same time. cure liquid and blood at the same time. Phlegm and blood stasis should be broken blood stasis, expectorant and soft firm, with Tongqiao Huoxue Decoction "yilingaicuo" (musk, peach kernel, safflower, red peony root, Chuanxiong Decoction and "erchen Decoction ") (pinellia, epicarpium citri, tuckahoe, licorice) plus leech, Tabanus,.

cure liquid and blood at the same time.,we should break blood and removing stasis, with Xuefu Zhuyu Decoction Combined with wuling Decoction.If the drug is ineffective, can be combined with laser and vitrectomy operation treatment. Suitable for retinal vein occlusion without perfusion condition and ocular trauma of vitreous hemorrhage.

2.2.4 strengthening body resistance, eliminating stagnation in the last period


Time:bleeding within 10-12 weeks

Manifestation: Retinal hemorrhage absorption or most completely absorbed, left a little dead blood clot, or only organize, retinal color is wax yellow or proliferation of retinal detachment.

If the vitreous hemorrhage,we can see a large number of white organization, fundus does not be examinated.

How to cure?Pay attention to strengthen body resistance, replenishqi and blood, nourishing liver and kidney both QI and blood deficient,should nourishing both qi and blood, Decoction of Eight Ingredients

Deficiency of liver and kidney, tonify them, Lycii and Chrysanthemi and Rehmanniae Bolus or zhujingwan (broussonetiae fructus, medlar,dodders,Chinese magnoliavine fruit, leonuri,fructus, isapgol, papaya, notoginseng,radix, placenta hominis, calcitum), At the same time must be used with drugs soften hard lumps and dispel nodes.

Thank You!
L/O/G/O
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