I-RETINOPATHY YESIFO SIKASHUKELA - IZIMBANGELA, IZIMPAWU, UKWELASHWA, I-PROGNOSIS

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I-retinopathy yesifo sikashukela ingenye yezinkinga zesifo sikashukela, esiholela ekulimaleni kokubonakalayo.

Kungani futhi kwenzeka kanjani konke, ubani osengozini ye-retinopathy yesifo sikashukela nokuthi yini i-prognosis yale pathology nokuthi inqubo yokubhubhisa ingamiswa yini - lokhu kuzoxoxwa ngakho ngokuhamba kwesikhathi.

Kuyini i-retinopathy?

I-retinopathy inguquko ebhubhisayo emithanjeni yamehlo, ngenxa yokuthi ukugeleza kwegazi ku-retina kuphazamiseka.

Lokhu kuqala kudala i-dystrophy, bese kuthi ukufa kwe-opic nerve, okugcina kuholele ebumpumputhe.

Igama elithi "retinopathy" lisho izinguquko ze-pathological e-retina, ze-etiologies ezahlukahlukene.

Kungaba:

ama-retinopathies ayisisekelo abangelwa izinqubo zokuvuvukala;
ama-retinopathies wesibili avele ngenxa yezinye i-pathologies.

Ukuhlaziya i-pathology eyenzeka ngokumelene nesizinda sikashukela, kubalulekile ukuqaphela ukuthi kuyinkinga enkulu futhi evamile yesimo sikashukela, okuholela ekulahlekelweni ngokuphelele kombono, futhi kubhekisa ohlotsheni lwesibili lwe-retinopathy.

Ukuthuthuka esikhathini sokuqala, kuba yi-asymptomatic, kwenzeka kuma-85% eziguli ezinesifo sikashukela sohlobo 1, “umuzwa” wakhe kulesi sikhundla iminyaka engaphezu kwengu-20.

Indlela ye-retinopathy

Ngokuqondene nesifo sikashukela sohlobo lwe-2 pathology, engxenyeni yezimo kubantu asebekhulile nabadala, kanye nesifo sikashukela, isigaxa esijwayelekile semithambo yamehlo sitholakele.

I-retinopathy iboniswa inkambo engenabuhlungu kanye nokwehla okuqhubekayo kwekhwalithi yombono.

Ikhodi ye-ICD-10

I-retinopathy yesifo sikashukela ihlukaniswa ngokwe-ICD-10 kanje:

isigaba VII "Izifo zeso ne-adnexa (H00-H59)";
isigaba "Izifo ze-choroid ne-retina (H30-H36)";
ikhodi ye-pathology "H36.0";
ukuxilongwa "I-Diabetesic retinopathy" kusuka ku-E10 kuya ku-E14, kuya ngohlobo lwesifo sikashukela, enophawu lwesine olufanayo "."

Izimbangela zokwenzeka

I-retina yeso yinhlangano eyinkimbinkimbi, kufaka phakathi inani elikhulu lama-receptors athola ukukhanya futhi akuguqule kube umfutho wesimo sikagesi.

Sizungezwe inethiwekhi yama-capillaries enikeza ukugcwala kwegazi okugcwele.

I-retinopathy yesifo sikashukela iba ngu:

Izinkinga ze-metabolic;
ukuphazamiseka kwe-microcirculatory;
khuphula izinga lokuqina kwesithiyo se-hematoretinal (HBG), okuthi esimweni esejwayelekile singavumeli ama-molecule amakhulu ukungena kwi-retina emgudleni wegazi. Esikhathini sikashukela, iyeka ukuba yisithiyo ngokuphelele, okuholela ekwakhiweni kwama-deposits.

Odokotela bakholelwa ukuthi iqembu elisengozini enkulu ye-retinopathy yesifo sikashukela lifaka phakathi abantu abahlushwa:

umfutho wegazi ophakeme
Ama-pathologies wezinso okungamahlalakhona;
izinkinga zebhalansi ze-lipid;
ngokweqile.

Izici zobungozi

Kunezici zokuba khona kwazo okwandisa amathuba okuthola i-retinopathy:

isikhathi sikashukela kanye nezinga lokulawulwa kwesimo se-glycemic. Isifo sikashukela esinde sihlala isikhathi eside, izingozi ziyanda;
ukuvumelanisa okusheshayo kwezibalo ze-carbohydrate metabolism. Lokhu kwenzeka ngokwelashwa okunamandla kwe-insulin kubantu abasha abanesifo sikashukela esinganxephezeli kahle. Noma uma ngohlobo 2 kukhona ukuguquka kusuka kumatafula anciphisa ushukela kuya ku-insulin;
uhlobo lokwelashwa sikashukela. Nge-insulin, amathuba we-retinopathy aphezulu;
umfutho wegazi ophakeme;
isisu-visceral uhlobo lokukhuluphala;
i-nephropathy yemvelaphi yesifo sikashukela;
isakhi sofuzo sokulimaza ama-microvessels kushukela.

Izigaba

Ukuhlukaniswa kwe-retinopathy, okusebenzayo manje, kwamukelwa ngo-1991. Ilula futhi iyaqondakala, eyenza kube lula kakhulu ukuyisebenzisa. Ngokuhambisana nezinhlinzeko zalo mbhalo, kunezigaba ezintathu (amafomu) we-retinopathy yesifo sikashukela.

Okungahambi kahle

Okungahambisani (ingemuva). Ihlukaniswa ngokubonakala kwe-retina (retina):

ama-micaneurysms (ukopha okuqhamuka emithanjeni);
izicucu ze-hemorrhage. Zichazwa njengamachashazi, imivimbo, noma amabala amnyama afanayo, okukhona endaweni maphakathi ne-fundus noma emithanjeni emikhulu elele e-retina;
i-retema edema engxenyeni ye-macular (maphakathi) noma emikhunjini enkulu;
gxila ngokuxhunyaniswa. Lezi yizindawo ezinamafutha ne-cholesterol ezakhiwa ngenxa yokopha. Okumhlophe noma okuphuzi, ziqoqwa kaningi futhi enkabeni yaphansi kwamehlo. Kungaba nemingcele yamazinga ahlukahlukene wokucaca.

I-Preproliferative

I-preproliferative diabetesic retinopathy.

Uyaphawuleka:

ukubukeka kwezinguquko ezingejwayelekile emithanjeni nama-microvessels;
ivolumu ebonakalayo yokuqhuma okuqinile noma kotini;
inani elikhulu lezingcezu ze-hemorrhagic.

Izinga lobufakazi balezi zinguquko lihlobene kakhulu nokuthuthuka okulandelayo kwezinqubo zokwanda.

Iyanda

I-retinopathy ekhulayo ibonakala ngokwanda okuhambelana kwezinhlobo ezimbili:

umsipha;
i-fibrotic.

Imikhumbi emisha eyakhiwe yakha odongeni lwangemuva lwasemuva. Ngenxa yokwehluleka kwabo, ukuphuma kwegazi kuvame ukuvela. Ngokuhamba kwesikhathi, ukudilika odongeni kungenzeka.

I-retinopathy eyandayo

I-retinopathy ekhulayo ingakhula ngamanani ahlukene - kusuka ezinyangeni ezi-3 kuye eminyakeni eminingana. Inqubo ngokwayo ayimisi futhi ayithinti i-visual acuity ekuqaleni. I-Pathology ithinta amehlo womabili.

Izimpawu

Izinhlobonhlobo zezimpawu nobukhali bazo kuncike esigabeni se-retinopathy.

Imvamisa le pathology iqhubeka kancane kancane.

Ekuqaleni, lapho ukwelashwa kwakulula futhi kusebenza, cishe akukho okubonakalisiwe kliniki.

Esikhathini esingandisi kakhulu, abantu abanesifo sikashukela abaziboni izinkinga zokubona.

I-retina edema ikhonjiswa yihaba le "sithombe", elenza ukufunda noma ukukhohlisa izinto ezincane kube nzima.

Ngaphezu kwalokho, lapho ama-heminal hemorrhages ejwayele ukwanda, abanesifo sikashukela bakhuluma ngokubonakala kwezindawo ezimnyama phambi kwamehlo, okuthi, ngokuhamba kwesikhathi, zinyamalale zodwa.

Ezimweni ezimbi kakhulu, i-glaucoma ingahle ikhule futhi kubuye kwenzeke i-retina. Lokhu kusongela ngobumpumputhe.

Ukuxilongwa nokwelashwa

Ukuxilongwa kwe-retinopathy yesifo sikashukela kudinga imishini ekhethekile ngokunemba okuphezulu. Kuyadingeka ukuthi:

khomba izinga lokulahleka kombono kanye nesimo sesikhungo se-retina;
faka indlela ye-computer perimetry (yocwaningo lwensimu ebonakalayo) ukuthola isimo ezingxenyeni ezisondelene ne-retina;
hlola umphambili wesohlo ukubona isimo se-lens ne-iris;
enze i-gonioscopy;
enze tonometry (isilinganiso sokucindezela kwe-intraocular).

Lapho ingcindezi engaphakathi kwamehlo ingaphakathi kwemikhawulo eyamukelekayo, lezi zinhlobo zezifundo ezilandelayo zenzeka kumfundi, zixutshwe ngaphansi kwethonya lamaconsi akhethekile:

I-Biomicroscopy ye-lens kanye ne-vitreous iyenziwa.
Izinketho zokuxilonga ze-electrophysiological zisetshenziswa ezidingekayo ukuhlola ukusebenza kwe-retina ne-nerve (optic).
I-Ophthalmobiomicroscopy iyasetshenziswa, okudingekayo ukuthola ukusebenzisana kokusebenza komzimba we-vitreous ne-retina, kanye nokuthola izinguquko ku-retina, ngokuzimisela kwendawo yabo. Lolu cwaningo lubandakanya ukuthwebula izithombe okuphoqelekile isithombe esiphumela.
Ukuhlolwa kwamehlo kwe-ultrasound kwenziwa ukubona isimo somzimba we-vitreous. Lokhu kwenza umqondo okhethekile ezimweni zezikhalazo ezigcwalayo, lapho kunzima ukubona ngezimpawu zamehlo zesitho sombono.

Ukuxilongwa okugcwele ngokuphelele akuvumeli ukunquma isimo sezitho zombono kuphela, kodwa futhi nokubikezela izinga lokuqhubeka kwe-pathology, kanye nokuhlola isikhathi somphumela ongemuhle. Lokhu kubalulekile ekukhetheni iqoqo lezinyathelo ezingabambezela kakhulu ukuqala kobumpumputhe.

Kubalulekile kuwo wonke umuntu onesifo sikashukela i-mellitus futhi, ngenxa yalokho, i-retinopathy, ukuthi avakashele njalo i-ophthalmologist. Kungale ndlela kuphela lapho umuntu angabamba "inkinga" ngezigaba zokuqala, lapho ukwelashwa kunganikeza umphumela omuhle kakhulu.

Izindlela zokwelapha ze-retinopathy zibandakanya:

I-Laser retina moxibustion, ehlisa ukuthobeka futhi inciphise inani lama-hemorrhages. Ezimweni ezingama-80%, kungenzeka ukumisa inqubo futhi kumise ukuqhubeka kokulimazeka okubukwayo okungafika eminyakeni eyi-12. Ukungenelela okunjalo kungenzeka kunoma yisiphi isigaba, kepha okuhle kunakho konke, kuyazikhombisa kwesesibili.
Isingeniso kwizitho zombono wesidakamizwa iRanibizumab. Lokhu kubuchwepheshe obusha. Ikuvumela ukuthi uyeke ukukhula futhi kuhamba kahle nge-laser coagulation.
Ukususwa kwe-Vitreous (vitrectomy). Le ndlela isetshenziswa uma izinhlaka zemisipha ezisanda kwakhiwa zingena ngaphakathi kwe-vitreous, zibangele ukuphuma kwesibindi okukhulu. Uma isetshenziswa ngaphambi kokuthi i-retinal detachment ivele, i-80% yabanesifo sikashukela ingavimbela ukulahleka kombono.
Ukwelashwa ngezidakamizwa. Ihlose ukuqinisa izicubu ze-vascular kanye nokumisa ama-hemorrhages. Izidakamizwa ezikhethekile ezibhekiswe kwi-retinopathy azikabikho. Njengamanje, i-Tranexamic acid kanye nama-ejenti asuselwe kuyo asetshenziswa ngempumelelo. Kodwa noma kunjalo, izindlela eziphumelela kakhulu zibhekwa njengezikhulu, ezishiwo ngenhla.

Isimo sezulu

Lapho umuntu onenkinga ye-retinopathic ebonisana nodokotela futhi eqala ukwelashwa ekuqaleni, kunethuba langempela lokunciphisa ukulimaza okubukwayo okungafika eminyakeni eyi-15. Lokhu kuncike ekugcinweni okuzinzile kwamazinga kashukela egazini hhayi ngaphezulu kuka-9 mmol / L.

Kuhlobo lwesifo sikashukela sohlobo 1, ukonakala okubukwayo kukhula ngokushesha, ngokuqhathanisa nezinhlobo zalo zesibili. Inkambo engazinzi (ilebula) ye-retinopathy isheshisa ukukhula kwezinqubo ezingezinhle.

Ukuvimbela

Ngeshwa, azikho izindlela zokuvimbela ukuqeda ngokuphelele ubungozi be-retinopathy ngesifo sikashukela.

Uhlala, umngani kakhulu kulokhu okubalulekile.

Ukwenza ukulahleka kombono kube kuncane futhi kungasheshi, udinga ukubonwa ngudokotela wamehlo ngezikhathi ezithile.

Uma kwenzeka kuba nesifo sikashukela esincike ku-insulin (uhlobo 1), kudingeka ukuthi kuhlolwe iso ngokuphelele ngemuva kweminyaka engu-5 ngemuva kokuxilongwa okuyinhloko. Ngohlobo 2 sikashukela, ukuxilongwa kwesimo sezitho zombono kunqunywa ngokushesha.

Lapho i-retinopathy iqinisekiswa, imvamisa yokuvakasha ku-ophthalmologist inqunywa yisigaba sayo:

Isigaba 1 - Isikhathi esingu-1 phakathi nesigamu sonyaka;
Isigaba 2 - isikhathi esingu-1 ngekota;
Isigaba 3 - amahlandla ama-4 ngonyaka noma ngokwezinkomba.

Izinyathelo ezijwayelekile zokuvimbela izimo ze-retinopathic kushukela zifaka:

ukuqapha okujwayelekile kwamazinga kashukela (okungenani izikhathi ezine ngosuku);
ukugcina isimo sempilo esinjalo ukuthi inkomba kashukela ayidluli i-9 mmol / l isikhathi eside kunazo zonke;
ushintsho olufika ngesikhathi kumithamo ye-insulin;
ukuhambisana nezincomo zikadokotela maqondana nokudla, kanye noku-oda kwemijovo ye-insulin noma ukuphathwa ngomlomo kwezidakamizwa ukwehlisa ushukela;
Ukugwema ukwehluka okungazelelwe ekukhuleni nasekunciphiseni ushukela
ukulandela umfutho wegazi;
ukuvakasha njalo kwe-endocrinologist;
ukulawula isisindo somzimba.

Ukuze unciphise ubungozi bokuxineka kwengqondo ngesikhathi se-retinopathy, musa:

phakamisa futhi uphathe imithwalo esindayo (ngaphezu kwama-5 kg);
Isikwele
uhlobo (isibonelo, ifenisha eshukumayo);
enze ukunyakaza okubukhali.

Abesifazane abakhulelwe abanesimo se-retinopathic baboniswa ukulethwa kwe-caesarean.

I-retinopathy yesifo sikashukela ngokuvamile iyiqiniso elingenakugwenywa. Ukuze ulondoloze umbono oyigugu iminyaka eminingi, kubalulekile ukuthi ungayiqali le nkinga, kodwa uqale uyixazulule ngokushesha okukhulu.