Paving stone degeneration

Introduction Paving stone-like degeneration: a choroidal retinal atrophy with a small white or elliptical boundary with a blocky pigmentation. The choroidal vessels in the lesion are clearly visible.

Cause

(1) Causes of the disease

It is currently confirmed that myopia is the result of a combination of genetics and environment, and heredity plays a very important role in degenerative myopia.

(two) pathogenesis

The vast majority of degenerative myopia is a congenital disorder. Guggenheim et al. performed a statistical analysis of the prevalence of degenerative myopia and the genetic status between the parents and the offspring. The results were significantly higher than the low myopia, indicating the hereditary pathogenesis of degenerative myopia. It plays a very important role. The genetic mode of degenerative myopia is extremely complicated, and there are many genetic methods such as autosomal dominant inheritance, autosomal recessive inheritance, and sexual linkage inheritance.

In addition, Balacca believes that the pathogenesis of degenerative myopia should include various factors that act on scleral collagen, and certain long-term visual impairments can affect the pituitary system and alter hormone balance. This hormonal balance is associated with a continuous decrease in scleral collagen, which is predisposed to myopia. Fundus microcirculation disorders can cause destruction of scleral collagen fibers, leading to the extension of the sclera and degeneration of myopia. In addition to heredity, the acquired environment such as general health, living environment, personal habits, long-term use of close eye work, etc., can contribute to the deepening of myopia.

an examination

Related inspection

Eye and sacral area CT examination blood routine

1. Genetic examination.

2. Histopathology: The growth of degenerative myopia is enlarged. The lesions are mainly in the equator, especially in the posterior pole. The sclera is thinned and scleral staphyloma is formed in the posterior pole. The choroid is thinned, the matrix pigment is lost, the number of blood vessels is reduced, and small blood vessels and capillaries are lost. The Bruch film becomes thin and can crack. The ciliary body is significantly atrophied, mainly due to hypoplasia of the annular muscle fibers. Choroidal retinal atrophy, RPE in the atrophy area disappeared completely. RPE significantly proliferated to form Fuchs, which were covered with a layer of colloidal, cell-free exudate.

3. Fundus fluorescein angiography: When the diffuse lesion is mild, the posterior pole of the arterial phase is a bit or linear, showing a paint crack. Brightness increases with time, but does not enlarge. After the background fluorescence disappears, it does not disappear for a long time. There is atrophic plaque in the pole after severe lesions. The angiography shows that there are a wide range of punctate, linear or flaky fluorescent spots in the arterial phase. Or a strong fluorescent region and a weak fluorescent region. It indicates that the choroidal capillaries are atrophied and that coarse choroidal vessels are visible.

Differential diagnosis

Peripheral retinal choroidal degeneration:

The peripheral lesions of myopia are divided into:

1 diffuse choroidal degenerative lesions.

2 banded choroidal degenerative lesions.

3 retinal cystic degeneration.

The manifestations of peripheral degeneration are:

1 pigment degeneration:

The increased pigment is spotted or plaque. May be related to vitreous traction, abnormal biochemical stimulation caused by pigment epithelial cell proliferation. The long axis of the eye is obvious, more common in pigmentation spots.

2 The choroidal vessels in the lesion are clearly visible;

3 lattice-like degeneration;

4 does not pressurize and whiten;

5 cystic degeneration and cystic degeneration.

Most lesions have a shallow serous detachment, angiography is strongly fluorescent, sometimes accompanied by leakage in the early stage, scars leave after healing, and pigmentation may increase over time.

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