Central scotoma and diopter changes

Introduction The central dark spot and the change of diopter, the malicment melanoma of uvea, is the most common malignant intraocular tumor in adults. Its incidence in foreign countries accounts for the first place in the eye, but only in the country. Second to retinoblastoma, the second place in the intraocular tumor. The tumor has a high degree of malignancy and is easily metastasized to blood flow. It is more common in adults and is easily confused with many fundus diseases in clinical work. Therefore, it should be given full attention in the clinical work of ophthalmology. The disease is more than middle-aged patients. The posterior pole of the eye is a good site, and the incidence rate is decreasing in the forward direction.

Cause

Uveal melanoma is a malignant tumor with no obvious cause.

an examination

Related inspection

Vision eye examination

1. Choroidal malignant melanoma, early symptoms such as visual distortion, small, central dark spots and changes in diopter (continuous increase in hyperopia), is also an important clinical manifestation, enough to prove that a substantial mass under the retina continues to increase . There is no obvious symptom in the early stage of choroidal melanoma in the margin. After retinal detachment, the corresponding visual field defect appears. A special feature of melanoma at the upper edge is the combination of macular flat retinal detachment early in the course of the disease. If you do not expand the details of the peripheral fundus, it is easy to misdiagnose.

2, because choroidal melanoma originates from the ciliary nerve, fundus lesions can be combined with pupillary abnormalities (the corresponding pupil of the pupil does not respond, not easy to be scattered or not in a perfect circle), or a fan-shaped sensation loss zone appears in the corresponding part of the cornea.

3, blood flow reflux disorder or local tumor necrosis caused by scleritis, manifested as localized scleral congestion. There is granulation tissue hyperplasia inside and outside the sclera.

4, eye pain. The cause of pain can be caused by secondary glaucoma or tumor necrosis-induced ophthalmia (uveitis or endophthalmitis), and a small number is caused by tumor infiltration or compression of the ciliary ganglia.

5, anterior chamber or vitreous hemorrhage caused by tumor necrosis.

6. The eyeball is prominent and the tumor is caused by the spread of the ball.

7, scleral transillumination test: a greater use value in differential diagnosis. In inflammatory lesions, macular degeneration, choroidal metastasis or choroidal hemangioma, all can transmit light; in choroidal melanoma, it is generally opaque.

8, B-type ultrasound diagnostic instrument scanning: B-type ultrasound examination has important reference value, more helpful for turbidity of refractive medium. The tumor showed a smooth mushroom-like appearance; the ultrasound of the tumor was followed by an echo-negative area (acoustic shadow) and a choroidal depression.

9, fluorescent fundus angiography:

(1) The retinal blood vessels and the tumor blood vessels simultaneously have a double circulation.

(2) Early non-fluorescent development, increased late fluorescence, and high and low fluorescence mixed mottled morphology.

10. The isotope 32 phosphorus absorption test is positive.

11, CT, phosphorus resonance check is also helpful for diagnosis.

Differential diagnosis

1, choroidal fistula: choroidal fistula is a benign tumor. The vast majority are stable without development. Occasionally, it can affect its neighboring tissue, but it is rare and malignant.

2. Choroidal hemangioma: Choroidal hemangioma is a benign tumor that usually occurs between the ages of 10 and 20. It can exist alone or as part of a craniofacial hemangioma, often with glaucoma. Histologically, these tumors are spongy, with up to 90% of the retinal detachment under the microscope. Clinical manifestations: poor visual acuity, can be a part of craniofacial hemangioma, often combined with glaucoma.

3. Choroidal metastases.

4. Wet age-related macular degeneration.

5, choroidal hemorrhage: choroidal hemorrhage has important clinical significance. No matter how much bleeding, due to damage to the retina, it can cause permanent visual impairment, especially in the macula. Local choroidal hemorrhage is limited to the choroid, which is characterized by dark red, nodular or round masses of varying sizes. The surface has retinal blood vessels passing through it, and the retina is smoky gray or white, and the visual field appears at the corresponding position. dark spot. If the bleeding causes the macular area to be affected, the central vision is significantly reduced. The process of bleeding absorption is slow and generally lasts for several months. The remaining permanent scar is slightly smaller than the original bleeding group, and residual choroidal white fibers and irregular pigment blocks are visible, showing a blind spot in the corresponding position in the field of view.

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