Umbono ophansi utholakala cishe ezi-85% zeziguli ezinesifo sikashukela sohlobo 1. I-retinopathy yesifo sikashukela ihlanganisa inkambo yesifo sikashukela ngemuva kweminyaka engu-15-20 yokugula. Uma kutholakala isifo sikashukela sohlobo 2 esegugile, khona-ke isigamu seziguli sitholwa ngasikhathi sinye ngomonakalo emikhunjini ephakela amehlo.
Njengomthetho, i-retinopathy kwisifo sikashukela ihlanganiswe nokuphazamiseka kokujikeleza kwe-systemic, ukubonakaliswa konyawo lwesifo sikashukela kanye nephropathy.
Ubukhulu bokulimala kwamehlo kuhlobene nezinga lokukhuphuka kwe-glucose egazini, izinga lomfutho wegazi, kanye nokwanda kwe-cholesterol kanye nokuphazamiseka kwegazi
Ukuboniswa kwe-retinopathy kushukela
Isici esiyinhloko esithinta ukuncishiswa kwe-acuity ebonakalayo ezigulini ezinesifo sikashukela yi-diemaic macular edema. Kulokhu, uketshezi luqongelela enkabeni ye-retina, lapho kukhona khona indawo ophuzi (macula), omangqamuzana akhe abhekene nombono ophakathi.
Indlela yokuthuthukiswa kwe-edema ihambisana neqiniso lokuthi ngezinga elikhulayo le-glucose, izindonga zemikhumbi emincane ziyachithwa. Izinguquko ezinjalo zibizwa ngama-microaneurysms. Kujuluka uketshezi ngemikhumbi entekenteke, bese inqwabelana e-retina.
Ucwaningo olusebenzisa ukuhlangana kokuhlangana kwe-eyeography luveze izinhlobo eziningana ze-maculopathy yesifo sikashukela: i-spongy retinal edema, i-cystic edema kanye ne-retinal detachment.
Ngaphezu kwe-retinopathy yesifo sikashukela, i-edema ingadala izimo ezinjalo zokugula:
- I-retinal vein thrombosis.
- I-Uveitis, lapho i-choroid yeso lamehlo ikhanyiswa khona.
- Ukulimala kabuhlungu.
- Izinkinga zokwelashwa okuhlinzwa.
I-edema yesifo sikashukela se-macula ihambisana nokuncipha kwensimu yokubukwa okuphakathi nendawo, isithombe siba mnyama, imigqa ifiphazwe, imigqa eqondile ibukeka igobile noma i-wavy.
Ukushintsha kombala kuyashintsha, kuphuma umbala opinki ezintweni. Ukuzwela kokukhanya okukhanyayo kuyanda. Ekuseni, i-acuity ebonakalayo ingaba yimbi kakhulu kunasemini, umehluko wokuphikiswa ungasukela ku-0.25 diopters.
Uma lesi sifo sitholwa kusukela ekuqaleni, kuze kube yilapho sekuqala ukwakha imikhumbi emisha, khona-ke ukwehla kombono kungabuye kubuye kabusha. Kepha isikhathi sokuthola isikhathi eside futhi sisukela ezinsukwini ezingama-90 kuya kwezinyanga eziyi-15.
Ukuvuvukala isikhathi eside kwe-macula kungaholela ekufeni kweseli nokuqothuka ngokuphelele kombono. Futhi kuncike ekwandeni kwenqubo. Uma i-lesion ithwebula yonke ingxenye ephakathi, khona-ke ukuvezwa kwalesi sifo akulungile. Izinguquko zamaphoyinti zivame ukwelapheka.
Ngokuhlolwa okujwayelekile kwe-fundus, kutholakala kuphela i-edema ebanzi. Ngosayizi abancane, ingasolwa ngombala obuthuntu nangokuqina kwengxenye ephakathi. Okunye futhi ukugoba kwemithambo yegazi ku-macula. Izindlela zanamuhla zokuxilonga ezisetshenzisiwe:
- I-Optical cohere yokubambelela (ukuqina kwe-retinal, ivolumu, isakhiwo kufundwa).
- I-Heidelberg retinal tomography (kuphela ukuqina kwe-retinal kanye ne-edema index).
- I-Fluorescence angiography - ucwaningo lwemikhumbi ye-retinal isebenzisa i-Medi ephakathi.
Imithi ye-macular edema
Lapho kutholakala i-edema ye-macular edema, ukwelashwa kuqala ngokuncipha koshukela wegazi ophakeme. Kufakazelwa ukuthi lapho udlulisela iziguli ohlelweni olunamandla lwe-insulin therapy, ubungozi bokuvela nokuqhubeka kombono ophansi ku-retinopathy yesifo sikashukela kuyancishiswa.
Ngokuya ngesikhathi se-macular edema kanye nesigaba senqubo, kukhethwa indlela yokwelapha: i-conservative, i-laser coagulation noma ukuhlinzwa. Ukuze uthole ukwelashwa okuqinisa imvelo, kusetshenziswa imishanguzo elwa nokuvuvukala kanye nokufakwa kwezidakamizwa ezikhethekile ku-vitreous cavity.
Ukususwa kwenqubo yokuvuvukala kwenziwa kusetshenziswa izidakamizwa ezingezona ze-steroidal ngendlela yamaconsi wamehlo, amaphilisi noma imijovo. Leli qembu lemithi linethuba elingaphezu kwe-corticosteroids, ngoba libangela imiphumela emibi emincane (ukunyuka kwengcindezi ye-intraocular, ukunciphisa ukuvikelwa kwasendaweni kanye nokubonakala kwezilonda ezi-corneal).
Ukwethulwa kwi-vitreous cavity, kusetshenziswa okulandelayo:
- I-Corticosteroids - i-Kenalog ne-Dexamethasone.
- Ama-Vascular endothelial ukukhula factor factor blockers.
Ukwethulwa kwe-corticosteroids, noma ngabe kunciphisa i-edema ye-retinal, kukhulisa i-acuity ebonakalayo. Isikhathi salo mphumela singafinyelela ezinyangeni eziyisithupha, kepha lapho umuthi uxazulula, umphumela uyancipha futhi i-edema yesifo sikashukela inokuphinda futhi. Ngakho-ke, ngokuhamba kwesikhathi, imijovo ephindaphindwe iyenziwa.
Imiphumela emibi yezidakamizwa ze-steroid ukuthuthukiswa kokugcwala kwe-lens nokukhula kwengcindezi ye-intraocular.
Isici sokukhula kwemithambo sithinta ukukhula nokukhula (okujwayelekile nokwenzeka emzimbeni wakho) embhedeni wonke we-vascular. Ukuxineka kwayo ezithweni zamehlo kukhombisa ubulukhuni be-pathology. I-retinopathy yesifo sikashukela ingalashwa kusetshenziswa abamelene ne-vascular endothelial grow factor.
Kusetshenziswa izidakamizwa ezintathu: Avastin, Macugen noLucentis. Isingeniso sabo sisiza ukunciphisa ijubane inqubo yokulahleka okungaphendukiyo kombono, kepha futhi idinga ukuphathwa ngokuqhubekayo ngenxa yokwehla komsebenzi nokuxineka kwezicubu zamehlo.
Ukwelashwa kwe-macema edema nge-laser coagulation
Naphezu kwemiphumela emihle yomuntu ngamunye yokusebenzisa izidakamizwa emzimbeni we-vitreous, imiphumela yesikhathi eside ikhombisa ukuthi ayikho yezidakamizwa engavimbela ngokuphelele ukulimala kwe-edema yesifo sikashukela.
Ngezinhloso zokwelapha, kusetshenziswa indlela ye-laser coagulation yemikhumbi ebhujiswe kakhulu, engenacala. Kulesi simo, kuyadingeka ukubheka isithombe somtholampilo wesiguli ngasinye, ngoba uma i-edema yesifo sikashukela ithinta indawo enomkhawulo noma ingasongelisi umbono, itholakala ngaphandle kwesikhungo, khona-ke ukwelashwa kwe-laser akuqhutshwa.
Ukungathandeki kokuhlangana kwe-laser ukuthi ayibuyiseli umbono olahlekile, kepha kuvimbela kuphela ukulahleka kwayo okuqhubekayo. Ushintsho olungaphenduki ku-retina kushukela lubangelwa ukufa kwama-neurons athile.
Njengoba amaseli we-retinal acaciswe kakhulu, ukululama kwabo akwenzeki.
Izimpawu zokuthuthuka kwe-retinopathy kushukela
I-prognosis yokusebenza ngempumelelo yokwelashwa incike esigabeni sesifo. Ukubonakala kwe-macular edema kuyisigaba sokuqala se-retinopathy yesifo sikashukela.
Uma ukuxilongwa kungekenziwa ngendlela yesikhathi, khona-ke ekuphenduleni kwehle ekuhlinzekeni kwegazi, ukwakheka nokukhula kwemithambo yegazi kuqala ukubuyisa labo abonakele.
Imikhumbi emisha ikhula ngaphakathi kwe-retina futhi kwesinye isikhathi ingena nge-vitreous. Zintekenteke futhi zivame ukuklebheka, amafomu wegazi. Kancane kancane, kulezi zindawo izicubu ezihlangene zikhula.
Isigaba esandayo se-retinopathy yeswekile sikhonjiswa yizimpawu ezinjalo:
- Yelula i-retina bese uyikhipha esweni.
- Ukungezelela kwengcindezi ngaphakathi kwehlo.
- Ukulahleka kombono.
- Ukuwohloka kombono wasebusuku.
- Ukuhlanekezela okuphambili kwezinto.
Kulesi sigaba, ukwelashwa kwe-laser nokwelashwa okuhlinzwa kukhonjisiwe. Ngezinguquko eziphawuliwe, ukulahleka okuphelele kombono kwenzeka ku-mellitus yesifo sikashukela.
Ukususwa kwe-vitreous kwenziwa nini?
Ngemuva kokuqubuka kwe-laser, umbono ungancipha, insimu yokubuka ibe yincane kanye namandla okubona ebumnyameni ayancipha. Ngemuva kwalokho, ngemuva kwesikhathi sokululama, ukuqina kwesikhathi eside kuvame ukwenzeka.
Uma ama-hemorrhages emzimbeni we-vitreous engavumi, isiguli singabekwa ukuhlinzwa kokususa umzimba we-vitreous - vitrectomy. Ngesikhathi sokuhlinzwa, ama-liginal angama-retinal asikwa futhi i-vitreous isuswe, kuthi kuthathwe isisombululo esiyinyumba endaweni yaso. Uma kunezimpawu zokwenqatshwa kwe-retinal, bese ibuyiselwa esimweni sayo esejwayelekile.
Ngemuva kokuhlinzwa, kungenzeka ukubuyisela umbono ezigulini eziningi, ikakhulukazi uma kungekho ukukhipha i-retina. Ezimweni ezinjalo, amacala aphumelelayo anokuxoshwa kwesikhashana esifinyelela ku-50%.
Izinkomba zokususwa kwe-vitreous yizinguquko eziqinisekisiwe ze-tomography ezicindezela i-retina futhi zisekela i-macema edema. Ukuboniswa okunjalo kufaka phakathi:
- Umaki we-vitreous hemorrhage, okhona izinyanga ezingaphezu kweziyisithupha.
- Ukudonswa kwethoni yokuxosha.
- Izinguquko eziqhubekayo ze-fibrotic ku-vitreous.
Imisebenzi yenziwa nge-microsuction, indlela engahlaseli kangako.
Nge-retina evinjelwe, ukungenelela okuphelele kokuhlinzwa kwenziwa ngaphansi kwe-anesthesia ejwayelekile.
I-Diabetesic Retinopathy Prevention
Ukuze uvikele ukulimala kwe-retina, udinga ukusondeza umsoco we-carbohydrate eduze kokujwayelekile futhi uzuze isinxephezelo sikashukela. Ngale njongo, ukwelashwa ngezidakamizwa nge-insulin kusetshenziswa ohlotsheni lokuqala lwesifo sikashukela. Uma izinga le-glycemia liphezulu, khona-ke imvamisa yemijovo iyanda bese umthamo ulungiswa.
Futhi, ngokwelashwa kwe-insulin, ukuthi kungenzeka ukuthi inkambo yokudla okungenamsoco yesifo sikashukela kufanele icatshangwe. Kuhlobo 2 sikashukela, i-insulin esebenza isikhathi eside ingabekwa njengesijobelelo kumathebhulethi anciphisa ushukela. Uma isinxephezelo singatholakali, khona-ke iziguli zidluliselwa ngokuphelele kumalungiselelo we-insulin.
Nganoma yiluphi uhlobo lwesifo sikashukela, ukudla okunamafutha, ikakhulukazi lokho okuvela ezilwaneni (inyama enamafutha, i-offal, imikhiqizo yobisi yokuqukethwe okunamafutha aphezulu, ibhotela) kunqunyelwe ekudleni kwabo. Uma kungenzeka, udinga ukunciphisa ukusetshenziswa kwenyama bese ushintshela ezitsheni zenhlanzi, imifino kanye nemifino encane.
Kubalulekile ukudla ukudla kwe-lipotropic, okubandakanya i-cottage shizi, i-oatmeal, amantongomane. Ama-carbohydrate alula avinjelwe ngokuphelele:
- Ushukela, yonke imikhiqizo nezitsha nayo.
- Ukubhaka
- Amaswidi, ama-dessert, uju.
- Ujamu nezithelo ezimnandi.
- U-ayisikhilimu.
- Ijusi neziphuzo ezinoshukela wezimboni.
Indlela yokubuyiselwa kwesifo sikashukela i-hemoglobin engaphansi kwe-6.2%. Kubonisa kakhulu ingozi ephansi yokulimala kwemithambo. Ngamanani angenhla kwe-7.5%, amathuba okuthuthuka kwezinkinga zikashukela akhuphuka kakhulu.
Isikhombi sesibili esidinga ukubhekwa njalo yizingcindezi zegazi. Kumele isekelwe ezinombolweni ingadluli ku-130/80. Ukusetshenziswa kwezidakamizwa ze-antihypertensive kukhonjisiwe ukuthi kusebenza ngempumelelo ukuvimba izinguquko ku-retina yeso.
Ukusetshenziswa ukuvimbela izidakamizwa zemithambo yegazi, okubandakanya i-Dicinon, i-Cavinton, i-Prodectin akulethi umphumela wokuvikela ekukhuleni nasekuqhubekeni kwe-retinopathy yesifo sikashukela.
Ukutholwa kwe-retinopathy ezigabeni zokuqala kungenzeka kuphela ngokuvakashela njalo i-Optometrist. Kulokhu, ukuhlolwa kwe-fundus kwenziwa ngaphansi kwezimo zokwanda kwabafundi nokukalwa kwengcindezi ye-intraocular.
Imvamisa yokuhlola yeziguli ezinengozi eyengeziwe ye-retinopathy yesifo sikashukela:
- Ukuntuleka kwezimpawu - isikhathi esingu-1 ngonyaka.
- Isigaba Esingandisi - izikhathi ezi-2 ngonyaka.
- I-edema yesifo sikashukela se-macular edema - okungenani amahlandla ama-3 ngonyaka.
- Lapho kunezimpawu zokuchuma kwemithambo yegazi - okungenani izikhathi ezi-5 ngonyaka (ngokuya izinkomba kaningi)
Basengozini yokuba nesifo sikashukela i-retinopathy yiziguli ezine-hyperglycemia ende ne-hypertension ye-arterial yesigaba sesibili nesesithathu, izimpawu zengozi ye-cerebrovascular, kanye nababhemayo. Okubalulekile futhi kuwukuqagela kwenjongo yokuncipha kokunciphisa umbono noma i-retinal pathology.
Funda ividiyo mayelana ne-macular edema izosiza ividiyo ekule ndatshana.
