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视网膜色素变性(一)

简介

1、原发性视网膜色素变性在历史上曾称为色素性视网膜炎。中医称为“高风内障”是一种比较常见的毯层-视网膜变性。视网膜色素变性是一种少见的遗传性眼病。本病表现为慢性、进行性视网膜变性,最终可导致失明。 2、部分患者视网膜色素变性为显性遗传,父母双方只要有一方带致病基因,子女就会发病。也有部分患者视网膜色素变性为连锁性遗传,仅仅母亲带致病基因,子女才会发病。另有些病例同时伴有听力减退,这种类型视网膜色素变性多见于男性。 3、视网膜的一些感光细胞(视杆细胞)负责暗光下的视力。若视杆细胞逐渐变性,患者在暗光环境下视力明显减退(夜盲)。夜盲症状常在儿童期即出现,随时间发展,可出现进行性周边视野缺失。在晚期病例中,可仅残存一个小的中心视野(管状视野)和很窄的周边视野。 4、通过检眼镜检查,医生可发现视网膜上有某些具有诊断价值的特殊变化。也有数项检验可帮助进一步诊断。对家庭成员的检查可建立遗传模式。

诱发因素及预防

1、遮光眼镜片之选用 强光可加速视细胞外节变性,所以必须戴用遮光眼镜。镜片的颜色从理论上说,应采用与视红同色调的红紫色,但有碍美容用灰色,阴天或室内用0~1号;晴天或强光下用2~3号灰色镜片。深黑色墨镜并不相宜。绿色镜片禁用。 2、避免精神和肉体的过度紧张 过度紧张时体液内儿茶酚胺(catecholamine)增加,脉络膜血管因此收缩而处于低氧(hypoxia)状态,使视细胞变性加剧。我国传统的气功(静功),能以自己的意志高速大脑皮层及机体各器官的活动,如持之以恒,对防止本病视功能迅速恶化方面可能有益。  

临床表现(症状与功能改变)

1、夜盲:为本病最早出现的症状,常始于儿童或青少年时期,且多发生在眼底有可见改变之前。开始时轻,随年龄增生逐渐加重。极少数患者早期亦可无夜盲主诉。 2、暗适应检查:早期锥细胞功能尚正常,杆细胞功能下降,使杆细胞曲线终未阈值升高,造成光色间差缩小。晚期杆细胞功能丧失,锥细胞阈值亦升高,形成高位的单相曲线。 3、与中心视力:早期有环形暗点,位置与赤道部病变相符。其后环形暗点向中心和周边慢慢扩大而成管状视野。中心视力早期正常或接近正常,随病程发展而逐渐减退,终于完全失明。 4、电生理:ERG无反应,尤其b波消失是本病的典型改变,其改变常早于眼底出现改变。EOG LP/DT明显降低或熄灭,即使在早期,当视野、暗适应、甚至ERG等改变尚不明显时,已可查出。故EOG对本病诊断比ERG更为灵敏。 5、多数患者童年时色觉正常,其后渐显异常。典型改变为蓝色盲,红绿色觉障碍较少。 

眼底检查所见

本病早期虽已有夜盲,眼底可完全正常。俟后随病程进展而渐次出现眼底改变。典型的改变有:1)视网膜色素沉着 2)视网膜血管改变 

特殊临床类型

⑴单眼性原发性视网膜色素变性:非常少见。 ⑵象限性原发性视网膜色素变性:亦甚少见。 ⑶中心性或旁中心性原发性视网膜色素变性 ⑷无色素性视网膜色素变性

鉴别诊断

根据上述病史、症状、视功能及检眼镜检查所见,诊断并无太大困难。但当与一些先天生或后天性脉络膜视网膜炎症后的继发性视网膜色素变性注意鉴别。

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