Isifo sikashukela i-retinopathy

I-Diabetesic retinopathy (ikhodi ye-ICD-10 - H36 noma i-E10-E14 k. 3) iyinkinga engapheli yesifo sikashukela, esibangela ukuncipha okukhulu noma ukulahleka ngokuphelele kombono ezigulini zeminyaka yokusebenza. Amathuba okukhulisa isimo esinjalo kuncike ohlotsheni lwesifo, ukwelashwa nokunxeshezelwa.

Izici zobungozi

Ukuthuthukiswa kwe-pathology ye-analyzer ebonakalayo kuthuthukiswa ngu:

• Isikhathi sesifo esiyisisekelo. I-retinopathy yesifo sikashukela ayivelakancane kakhulu eminyakeni yokuqala engama-6-7, kanye nangesikhathi sokuthomba, kodwa-ke, iyatholakala emaphesheni ayi-5% ezigulini ezinesifo sikashukela esingaxhomekeki kwi-insulin ngesikhathi sokuxhumana nochwepheshe.
• Ukuntuleka kokulawula ushukela wegazi kahle kubangela ukuvela kokunciphiswa kwangoko.
• Isikhathi sokuzala ingane. Okubaluleke kakhulu ukukhula kwe-gestosis sekwephuzile (preeclampsia).
• Umfutho wegazi ophakeme. Lesi simo sikhinyabeza ukuqhubeka kwesifo sikashukela.
• Izinkinga zezinso (nephropathy). Ososayensi bafakazele ukuthi ukwelashwa kwe-renal pathology kuhlangene ne-Photocoagulation kungasenza ngcono isimo sesiguli.
• Ukhuluphele.
• Imikhuba emibi.

Indlela yokuthuthukisa

I-diabetes mellitus yisifo lapho zonke izinhlobo zemetabolism ziphazamiseka. Okokuqala, izikebhe zamakhalori amakhulu namancane ahlushwa yilokhu.

I-glycemia ephezulu iyimbangela yokwakhiwa kwe-pathology ye-visual analyzer

I-pathogenesis ye-retinopathy yesifo sikashukela isuselwa ekushintsheni kwe-metabolic kuwo wonke amazinga, kanye nokwanda kokuqina kwegazi, i-hypoxia namaprotheni aphezulu we-glycated. Izibalo ezibalulekile ze-glucose ziholela ekungalingani, ngokumelene nesizinda solo izinguquko ezenzeka emzimbeni, isimilo sokuntuleka kwe-oxygen kwezicubu namangqamuzana. Ezigabeni zokuqala, izindlela zokucindezela ziyenziwa, kepha uma umuntu eqhubeka nesifo sikashukela, kwehla isibani semikhumbi kuvela ngenxa yephimbo eliphakeme lezindonga zawo.

Ukwakheka kwamaprotheni e-glycosylated (ama-glucose molecule ahlangana ne-molecule yamaprotheni) kuhambisana nokukhululwa kwemikhiqizo yokuphela, amanani aphezulu okuvusa ukuphazamiseka kokudla kwamaprotheni, kanye nokuqina kwama membrane amaseli. Ngokuphikisana nesizinda sezinguquko ezinjalo, ukwakheka kwezinto ezinamaprotheni angaphandle kwenzeka, umzimba uzama ukukuqeda, uqala ukuphendula kwe- "bonding". Umphumela ulimaza odongeni lwama-capillaries, ukuqina kwawo okuphezulu.

I-pathology ye-fat metabolism icasule ukuhlanganiswa okubalulekile kwe-cholesterol, triglycerides nezinye izinto ezifanayo ezingavala i-lumen yemikhumbi ye-retinal. Lokhu kuholela ekugxilwe okusha kokungondleki kanye ne-microcirculation yegazi.

I-retinal hypoxia iboniswa ngokwakhiwa kwenethiwekhi entsha ye-pathological vascular (neovascularization) kanye nokuvela kwama-arteriovenous shunts (ama-workarounds egazini).

Ukuhlukaniswa

Kunenombolo enkulu yokuhlukaniswa kwe-retinopathy kushukela. Lokhu kuhlotshaniswa nokuboniswa okuningi kwe-pathology. Enye esetshenziswa kabanzi:

• isigaba esingesona esandayo;
• isigaba sokuqala
• isigaba esandayo.

Kubalulekile! Ukuhlukaniswa okunjalo kwezinkinga kuzonquma ngokucacile isikhathi lapho ukwelashwa kwe-laser kudingekile.

Izinguquko ku-choroid - izibonakaliso eziphambili ze-retinopathy ezinesifo sikashukela

Ukuhlukaniswa okulandelayo:

• i-retinopathy yohlobo olulula (isizinda);
• i-maculopathy;
• i-prrolopative retinopathy;
• proliferative retinopathy.

Isigaba esingelona ukwanda

I-retina ye-analyzer ebonakalayo isivele inama-microaneurysms, ama-hemorrhage amancane abukeka njengamachashazi amnyama futhi abonakala lapho ehlola i-fundus. Ama-hemorrhages, njengomthetho, kwenzeka enkabeni ye-choroid yamehlo womabili noma ohlelweni olujulile lwe-venous. Ngasikhathi sinye, i-foci yokuqongelela kwe-exudate ivela (yenziwa endaweni, efana nezindawo ezimhlophe noma eziphuzi ezingenayo imingcele ecacile) nokuvuvukala.

Isigaba sokugcina

Kuvela ama-anomalies wohlelo lwama-venous lwendalo ehlukile. Imithambo iguqulwe, ifane nasendleleni yerosari, kuvela izihibe, isimo semikhumbi siyashintsha. Ulwelwesi lwemithambo lumbozwe inombolo enkulu yokwakheka okudala. Izinzwa ziba mkhulu.

Isigaba esandisayo

Kulesi sigaba, ukwakheka kwe-neovascularization kwenzeka (ukwanda kokuqina kwemithambo yegazi lapho bekungafanele kube). Okokuqala, avela phakathi kwe-choroid ne-posterior vitreous membrane, bese akhula abe yi-vitreous uqobo.

I-Neovascularization ingesinye sezimpawu ze-proliferative retinopathy.

Uma i-neovascularization ithinta i-iris, ubungozi be-glaucoma yesibili bukhuphuka kaningana. Ngaphezu kwalokho, i-hemorrhage ithathelwa indawo ngamathishu e-fibrous, angavusa ukubukeka kokuqunjelwa kwe-retinal.

Izimpawu ze-pathology

I-retinopathy yokuqala yesifo sikashukela ingaba yi-asymptomatic noma iveze okulandelayo:

• kwehlise i-acuity ebonakalayo;
• umgubuzelo noma izindawo ezimnyama ezintantayo phambi kwamehlo - izimpawu zokumpompela;
• ukungakwazi ukubona izinto ezincane;
• izindawo ezimhlophe ezintantayo - uphawu lwe-edema;
• ukungahambi kahle endaweni yeso.

Ukwehla noma ukulahleka kombono kuyizimpawu ezifika sekwephuzile kwesifo sikashukela. Ukuthuthuka kwabo kukhombisa ukuphindeka kwenqubo. Ngokwezibalo, ukungaboni ngokuphelele kuphuma ku-2% yabanesifo sikashukela.

Umehluko phakathi kombono womuntu ophilile nomuntu onesifo sikashukela nge-pathology ye-visual analyzer

Okuningi ezibukweni

Ama-Microaneurysms yi-dilation yezindonga zemikhumbi emincane emincane. Ukwenza kwabo kwasendaweni kungumngcele walezo zindawo ezingenalo igazi. I-vasodilation ezigabeni zokuqala kuwuphawu lokufakwa kwezindlela zokuncindezela.

Uma ama-micaneurysms akhona ngaphandle kokuboniswa okunye kokuhlaziya komcwaningi, awathathi noma iyiphi ingozi, kepha aveza ukuqala kokuthuthuka kwezinkinga. Kodwa-ke, lapho lesi sifo siqhubeka, yilapho anda khona. Umphumela ovela njalo wama-micaneurysms engxenyeni ephakathi ye-retina ukubukeka kokugobeka.

Ukuphefumula

Zingavela ezingqekweni ezahlukahlukene ze-choroid, zibe nobume obuhlukile. Uma izingqimba ezijulile zithintekile, ama-hemorrhages ayizichashazi noma amabala we-oval or mawonekedwe oyindilinga. Lapho kwenziwa okwasendaweni ethe xaxa, afana nomugqa ophahlazekile.

"Okuqinile" exudate

Kuqongelela ama-lipids nemikhiqizo yabo yokuqhekeka. Zine-tint ephuzi nokubukeka okucacile. "I-Solid" exudates itholakala ezindaweni zokukhulisa ama-capillaries nasemngceleni we-puffness. Ukufakwa okufana engxenyeni ephakathi ye-choroid kuholela ekunciphiseni okukhulu kwe-acuity ebonakalayo.

Ukuthambisa Okuthambile

Ziyizindawo ezincane ze-ischemia (necrosis) zama-nerve fibers aqhamuka ngenxa ye-capillary occlusion. “Izithambisi” ezithambile zibukeka zinezindawo ezimhlophe ezingenayo imingcele ecacile.

Isifo sikashukela maculopathy

Enye yezinto eziboniswa yi-angioretinopathy, ebonakala ngezilonda ze-macula.

I-maculopathy yesifo sikashukela ivela ngenxa yokwanda kokuvela kwama-capillaries kanye ne-microocclusion yabo yokuqala. Idatha yamanje igcizelela ukuntuleka kokuhlukaniswa okuvame ukwamukelwa kwe-macular lesion, kepha iningi lababhali likhetha ukuyihlukanisa ibe nge-edematous ne-ischemic, okuncike ekwandeni kokubonakala kwendawo.

I-macemopathy ye-Edematous ingaba:

Ukwelashwa kwe-polyneuropathy kushukela

• okwasendaweni (okukhawulelwe) - ukuhlolwa kukhombisa ubukhona bendawo eyodwa noma ngaphezulu bokwenza izinto enkabeni ye-retina;
• faka - i-edema ebalulekile ivela, engenayo imingcele ecacile, ngokuhambisana nokwakhiwa kwama-cysts amancane.

I-Ischemic maculopathy inomphumela omubi kakhulu maqondana nomsebenzi wokuhlaziywa okubukwayo kanye ne-visual acuity. Kunzima kakhulu ukwahlukanisa lapho uhlola i-fundus. Ama-Optometrists, njengomthetho, cabanga ngokuthuthukiswa kwalolu hlobo lwe-pathology nge-mismatch phakathi kokukhanya okuphansi okubonakalayo kanye nezinguquko ezincane ezibukwayo. Ekuxilongeni, i-fluorescence angiography isetshenziswa.

Ukuxilongwa

U-Ophthalmologist uhlola abantu abanesifo sikashukela imvamisa ethile:

• emva kweminyaka emi-5 kusukela kuqalile "isifo esimnandi" esikhonjwe ngohlobo 1 sikashukela;
• lapho uqala ukuxhumana ne-endocrinologist enesifo sohlobo 2;
• Isikhathi esingu-1 ngonyaka ngaphandle kokuba khona kwe-retinopathy;
• njalo ezinyangeni ezi-6 ngokuxilongwa kwe-retinopathy engakhethi;
• isigaba sokuqala - kanye njalo ezinyangeni ezi-3-4;
• "prinopathy retinopathy" emlandweni wezokwelapha - kanye njalo ezinyangeni ezi-2-3.

I-Ophthalmologist - umsizi oyinhloko ekwelapheni nasekuvimbeleni i-pathology

Izindlela zokuxilonga ezisetshenzisiwe:

• Ukunqunywa kwezinkambu ezijwayelekile ze-retinal - kuyenziwa kusetshenziswa ukuthwebula izithombe nge-stereoscopic. Indlela ibonakala ngokuzwela okuphezulu, ukucutshungulwa kwezithombe okusheshayo. Ucwaningo luyabiza.
• I-ophthalmoscopy eqondile - udokotela uqondisa isibani sokukhanya esweni lesiguli, esikuvumela ukuthi uhlole isimo se-fundus.
• I-Biomicroophthalmoscopy - kusetshenziselwa ama-lens okuxhumana nawokucwaninga ocwaningweni.
• I-Fluorescence angiography - into ekhethekile ifakwe emgudwini wegazi wesihloko, okwaziyo ukukhazimula ekuphenduleni ekukhanyiseni ukukhanya. Ikuvumela ukuthi uhlole isimo se-microcirculation, kwasendaweni yemithambo yegazi, ukuba khona kwe-ischemia, hemorrhage.
• I-Optical cohere yokubambelela - ikuvumela ukuthi uhlole isimo sokuvuvukala.
• I-Echography - kusetshenziswa indlela yokuthola ubungako kanye nokwenza kwasekhaya izinto zangaphakathi emzimbeni.
• I-EFI iyinkimbinkimbi efaka izifundo eziningana. Bayasivumela ukuthi sicacisa izinqubo ze-bioelectrogenesis zezingqimba ze-choroid zohlaziyo olubonakalayo.

Izimiso zokwelashwa

Okokuqala, kubalulekile ukuguqula izinkomba ze-glucose ejwayelekile futhi uzuze isimo sesinxephezelo sesifo esikhona. Kungcono ukuthi izibalo zegazi elisheshayo zingabi ngaphezulu kuka-6 mmol / L, futhi izinga le-hemoglobin ye-glycated likhuphuka laya ku-6.5%.

Futhi, ukungabikho kwe-hypertension kubhekwa njengephuzu elibalulekile. Inhloso eyinhloko yabanesifo sikashukela ukucindezela kwegazi kungabi ngaphezu kuka-140/90 mm Hg. Ukulungisa izinombolo ngokwejwayelekile, amaqembu alandelayo izidakamizwa asetshenziswa:

• Ama-inhibitors e-ACE - i-Captopril, iLisinopril.
• AmaCalcium Antagonists - uVerapamil, uTiapamil.
• I-Diuretics - Dichlothiazide, Furosemide.

Izinkomba ezijwayelekile ze-BP - isixhumanisi ekuvimbeleni i-retinopathy

Ukulungiswa kwe-cholesterol

Izidakamizwa ezisetshenziselwa le nhloso zenza ukuthi kunxephezelwe isifo sikashukela futhi kwehlise intuthuko nokuqhubeka kwezinkinga. Sebenzisa imali eqenjini lama-statins (Lovastatin, Fluvastatin) kanye ne-fibrate (Fenofibrate, Bezafibrat).

Ukwenza ngcono i-rheology yegazi kanye nesimo sodonga se-vascular

I-retinopathy yesifo sikashukela ihambisana nokwanda kokunamathela kweplatelet. Lokhu kuchaza isidingo sokuqokwa kwemali elandelayo:

• Acetylsalicylic acid;
• IHeparin;
• I-Sulodexide;
• I-Ticlopidine;
• I-Pentoxifylline.

Ukuze ulungise ithoni odongeni lwama-vascular, kukalwa i-Vitamin C, i-Rutozid, iPirikarbat, i-Etamzilat.

Ama-antioxidants kanye nokwenza ngcono kwe-metabolic

Ukusetshenziswa kwe-Vitamin E, i-methylethylpyridinol, ukukhishwa kwe-Ginkgo biloba ezikhathini zamuva nje sekugcwele. Le mishanguzo inomphumela we-antioxidant, ibopha futhi isuse ama-uree radical emzimbeni.

Izindlela ezithuthukisa izinqubo ze-metabolic ku-retina (ezilawulwa ngabazali, ngomlomo nangezinsini):

• I-Dihydroergocriptine;
• I-Inosine;
• ukukhishwa kwezithelo ze-blueberry;
• ukukhipha izithelo ze-blueberry nge-beta-carotene.

I-Laser coagulation

Le ndlela ibhekwa njengenye ephumelela kakhulu ekwelapheni i-retinopathy yesifo sikashukela. Inhloso yawo uku:

• ukuvalwa kwezindawo ze-ischemic;
• ukucindezelwa kokwakhiwa kwemikhumbi emisha ye-pathological;
• ukuvalwa kwe-lumen ye-vasal yalezo capillaries ezikhulise ukuvama kwezindonga;
• ukwakheka kokunamathela, kunciphisa amathuba okuqhekeka.

I-laser retinal coagulation - indlela ephumelelayo yokumisa ukuqhubeka kwesifo

I-coagulation yenziwa yi-lason, solid-state noma i-diode (infrared) laser. Kunezindlela ezimbalwa zokuhlangana kwe-laser, ezihlukile komunye komunye ngenhloso yokufeza, izinkomba, amasu.

I-Panretinal coagulation

Kusetshenziswe ekwelapheni i-prinophathy ye-prroliferative and proliferative ye-etiologies ehlukahlukene. Ama-coagulates asetshenziswa kuyo yonke indawo ye-choroid, ngaphandle kwe-corpus luteum, ukuvimbela noma ukunciphisa ukubukeka kwemikhumbi emisha. Lokhu kusivumela ukuthi sithuthukise ubuqili balezo zindawo ze-retina ezingazange zithintwe yinqubo ye-pathological.

Ngaphambi kokukhohlisa, isiguli kufanele sijwayelane neqiniso lokuthi inqubo ayenziwa ngenhloso yokubuyisa i-acuity ebonakalayo, kepha ukuvikela ukuqhubeka kwayo kwehle.

Ukwelashwa kwe-antiangiogenic

Indlela izidakamizwa ezifakwa ngayo ngqo kwi-vitreous. Ukuze uvikele i-neovascularization, asetshenziswa blocker angiogeneis. Umphumela ubuye wehla kwe-edema esifundeni se-corpus luteum.

Indlela ayisetshenziswa njengenqubo ehlukile. Ukwelashwa nge-antiangiogenic kubhekwa njengengxenye yokwelapha okuyinkimbinkimbi futhi kuhlanganiswe nokwenziwa i-laser coagulation noma ukuhlinzwa.

I-Vitrectomy

Ukungenelela kokuhlinzwa kuyadingeka ukuvikela ukuqhubeka kwenqubo ye-pathological, kanye nokulungisa isimo sesiguli uma kubhekene nezinkinga. I-Vitrectomy ayenzeki kumacala alandelayo:

• i-rubeosis ye-iris;
• i-glaucoma yesibili ye-neovascular;
• i-optic atrophy;
• i-corneal pathology;
• isigaba esibulalayo sokwanda;
• ukuncipha kwesifo sikashukela nezinye izifo ezinohlelo.

Ngokusho kwe-ophthalmologists, ukuzinza kwemisebenzi yomhlaziyi obonakalayo ngemuva kokuhlinzwa kwenzeka emaphesheni angama-45%, kanti phakathi kweziguli ezingasilandeli izeluleko zodokotela, ziyi-14% kuphela.

Amakhambi esintu

Ukwelashwa ngemishanguzo yabantu kungavumeli kuphela ukugcina imisebenzi yezinsiza ezibonakalayo, kodwa futhi nokugcina ushukela wegazi ngaphakathi kwemikhawulo eyamukelekayo. Ukusebenza kahle kukhombisa i-nettle. Amacembe amasha afohliwe, ethola ujusi. Kuyadingeka ukuphuza ingxenye yesithathu yengilazi kathathu ngosuku. Amahlamvu eNettle angangezwa kumasaladi, izifundo zokuqala.

Ijusi le-Nettle - isitolo sezinto eziwusizo hhayi ezigulini kuphela, kodwa futhi nakubantu abanempilo

Umphumela ofanayo unejusi lamaqabunga we-aloe. Ngaphambi kokukhipha uketshezi lokupholisa, amaqabunga abekwa esiqandisini amahora amaningi. Ngemuva kwalokho bayachotshozwa, ujusi uyatholakala, ubilisiwe kungabikho imizuzu engama-3-4. Sebenzisa i-1 tsp. kathathu ngosuku, ebusuku ungashayela emehlweni (ama-2 ehla ngamunye).

Ungasebenzisa ukumiliselwa kwe-blueberries (uphuze ngezingxenyana ezincane usuku lonke), ujusi we-lingonberry, ama-decoctions amalungiselelo we-herbal.

Izindlela zokuvimbela

Iphuzu elibalulekile ukugcinwa kwezinkomba ezamukelekayo zoshukela wegazi, umfutho wegazi, isisindo somzimba. Lokhu kukuvumela ukuthi ugweme noma ubambezele ukuthuthukiswa kwe-retinopathy hhayi kuphela, kodwa nezinye izinkinga ezinzima futhi ezingamahlalakhona zesifo sikashukela i-mellitus.

Ukuvimbela kungokulandelayo:

• ukunamathela ekudleni okuphansi kwe-carbohydrate;
• ukusebenza komzimba okwanele;
• ukuhlolwa njalo nge-oculist;
• ukwelashwa okufika ngesikhathi kwesifo esiyimbangela kanye nezigaba zokuqala zezinkinga.

Ngeshwa, akunakwenzeka ukwelapha inkinga, ikakhulukazi ezigabeni zakamuva, futhi kungenzeka ukuvikela ukukhula kwayo, ukugcina imisebenzi yokubuka nokuyeka ukuqhubeka. Into esemqoka ukulandela izeluleko nezincomo zochwepheshe futhi sina ngalesi sifo esikhona.