Matenda a shuga a retinopathy: Zizindikiro, magawo, chithandizo

Matenda a shuga a retinopathy - Angiopathy yapadera, yomwe imakhudza ziwiya za m'maso ndikukula motsutsana ndi maziko a shuga. Matenda a shuga a retinopathy ali ndi njira yopitilira patsogolo: m'magawo oyambawa, masomphenya osasunthika, chophimba ndi malo oyandama pamaso pa maso amadziwika, m'magawo apambuyo pamakhala kuchepa kapena kuwonongeka kwamaso. Diagnostics imaphatikizapo kufunsira kwa ophthalmologist ndi katswiri wa matenda ashuga, ophthalmoscopy, biomicroscopy, visometry ndi perimetry, retinal vascular angiography, komanso kuyesa kwamwazi wamagazi. Chithandizo cha matenda ashuga retinopathy chimafuna kayendetsedwe ka matenda ashuga, kukonza matenda a kagayidwe kachakudya, komanso vuto, zovuta zamkati mwa mankhwala, laser retinal coagulation, kapena vitrumomy.

Zambiri

Diabetesic retinopathy ndi vuto lakumapeto kwenikweni kwa matenda ashuga, onse omwe amadalira insulin komanso osadalira insulini. Mu ophthalmology, matenda ashuga retinopathy amachititsa kuwonongeka kwa odwala omwe ali ndi matenda ashuga a 80-90% milandu. Mwa anthu omwe ali ndi matenda ashuga, khungu limakula ka 25 kawiri kuposa oyimira ambiri. Pamodzi ndi matenda ashuga a retinopathy, anthu omwe ali ndi matenda ashuga ali ndi chiopsezo chachikulu cha matenda a m'matumbo, matenda a shuga, polyphary, nephropathy, matenda am'mimba Chifukwa chake, mankhwalawa a matenda a shuga amafunika njira zingapo, kuphatikizapo kutenga nawo mbali kuchokera kwa akatswiri kuchokera ku endocrinologists (a diabetes), ophthalmologists, cardiologists, podologists.

Zoyambitsa ndi Zoopsa

Kupanga kwa chitukuko cha matenda ashuga retinopathy kumalumikizidwa ndi kuwonongeka kwa mitsempha yamitsempha yamagazi (ma cell a retina): kuchuluka kwawo kwachulukidwe, kuchuluka kwa capillaries, mawonekedwe a ziwiya zatsopano komanso kukula kwa minofu yowonjezereka.

Odwala ambiri omwe ali ndi nthawi yayitali matenda a shuga amakhala ndi zizindikiro kapena zina zowonongeka ku fundus. Ndi nthawi yayitali ya matenda a shuga mpaka zaka ziwiri, matenda a shuga a retinopathy amapezeka pamlingo wina kapena wina mu 15% ya odwala, mpaka zaka 5 - mu 28% ya odwala, mpaka zaka 10-15 - mu 44-50%, pafupifupi zaka 20-30 - mu 90-100%.

Zowopsa zomwe zimakhudza pafupipafupi komanso kukula kwa matenda ashuga retinopathy zimaphatikizapo kutalika kwa matenda ashuga, hyperglycemia, matenda oopsa, kulephera kwa impso, dyslipidemia, metabolic syndrome, ndi kunenepa kwambiri. Kukula ndi kupitilira kwa retinopathy kumatha kuthandizira kutha msinkhu, kutenga pakati, chibadwa chamtsogolo, komanso kusuta.

Gulu

Popeza kusintha komwe kumachitika mu fundus, kusakhudzana, kuchuluka kwa odwala komanso odwala matenda ashuga retinopathy kumasiyanitsidwa.

Mankhwala okweza, osayendetsedwa bwino m'magazi amayambitsa kuwonongeka kwa mitsempha yamagazi ya ziwalo zosiyanasiyana, kuphatikizapo retina. Mu gawo losakulitsa la matenda ashuga retinopathy, makoma amitsempha ya m'mimba amathandizika ndipo amakhala osakhazikika, komwe kumayambitsa hemorrhages, mapangidwe a micaneurysms - kuchepa kwamitsempha yam'mimba. Magazi ochepa amanjoya kudzera m'mitsempha yolowera m'matumbo kupita mu retina, zomwe zimapangitsa kuti akhale ndi edema. Pankhani yokhudzana ndi gawo la chapakati pa retina, macular edema amakula, zomwe zimapangitsa kuti masomphenyawo athe kuchepa.

Mu gawo la prroliferative, ischemia yopita patsogolo imayamba chifukwa cha kuchepa kwa matenda a arterioles, kugunda kwamtima kwa hemorrhagic, matenda a venous.

Preproliferative diabetesic retinopathy imayamba gawo lotsatira, lomwe limapezeka mu 5-10% ya odwala matenda a shuga. Zomwe zimapangitsa kuti pakhale kuchuluka kwa odwala matenda ashuga retinopathy akuphatikizika ndi myopia yayikulu, kuchuluka kwa mitsempha ya carotid, patterior vitreous detachment, optic atrophy. Pakadali pano, chifukwa cha kuchepa kwa mpweya wa okosijeni wa retina, zotengera zatsopano zimayamba kupangika kuti zikhale ndi mpweya wokwanira. Mchitidwe wa neovascularization wa retina umabweretsa kubwerezabwereza kwa preretinal ndi retrovitreal hemorrhages.

Nthawi zambiri, kutaya magazi pang'ono m'magawo a retina ndi vitreous thupi kumadziyimira palokha. Komabe, ndimatumbo akulu am'magazi am'maso (hemophthalmus), kuchuluka kosasintha kwa microus mu thupi lotakasuka kumachitika, kodziwika ndi kuphatikizika kwa fupa komanso kumangika, komwe pamapeto pake kumayambitsa kukokoloka kwamatumbo. Mukatseka njira ya HPV, glaucoma yachiwiri imayamba.

Zizindikiro za matenda a shuga a retinopathy

Matendawa amakula ndipo amapita patsogolo osapweteka komanso asymptomatic - uku ndiko kunyenga kwake kwakukulu. Mchigawo chosakulira, kuchepa kwa masomphenya sikumvedwa kwenikweni. Macular edema imatha kuyambitsa kusakanikirana kwa zinthu zooneka, kuvuta kuwerenga kapena kugwira ntchito pafupi.

Mu gawo la kuchuluka kwa matenda ashuga retinopathy, pakachitika zotupa m'mitsempha, malo akuda ndi chophimba amawonekera patsogolo pa maso, omwe patapita kanthawi amawonekera okha. Ndi zotupa zazikulu mu thupi la vitreous, kuchepa kwambiri kapena kuwonongeka kwathunthu kwa masomphenya kumachitika.

Kupewa

Hyperglycemia yomwe yakhalapo kwa nthawi yayitali. Pali malingaliro pa kufunikira kwa chitetezo cha mthupi pazomwe zimayambira retinopathy.

Pathogenesis

Pathogenesis ya diabetesic retinopathy ndi yovuta. Maulalo omwe akutitsogolera ndi vuto la microcirculation lomwe limakhudzana ndi mapangidwe a ziwalo zam'mimba komanso kusintha kwa metabolic komwe kumayenderana ndi matenda a shuga.

Mu shuga mellitus, chotchinga chamagazi, chomwe chimalepheretsa kulowa kwa mamolekyu akuluakulu m'mitsempha yamagazi kulowa m'matumbo am'mimba, chimakhala chovomerezeka, chomwe chimayambitsa zinthu zosafunikira kulowa mu retina.

Pakukula kwa zizindikiridwe, kuphatikizika kwina kumadziwika: kusintha kwa magazi mosiyanasiyana… .kuwonongeka kwa magazi end Kupweteketsa kotsekemera kotsekemera kotsekemera → kuchuluka kolimba kwachulukidwe → mapangidwe a masinthidwe amizere yamagazi ndi kuchepa kwa misempha.

Gulu

Mu 1992, Kohner E. ndi Porta M. adaganiza za gulu la WHO la matenda ashuga a retinopathy, omwe tsopano amavomerezedwa:

• Nonproliferative Retinopathy (diabetesic retinopathy I) - yodziwika ndi kukhalapo kwa maso a masinthidwe am'magazi mwa ma micaneurysms, hemorrhages (mwanjira ya madontho ang'onoang'ono kapena mawanga a mawonekedwe ozungulira (palinso otayika), amtundu wakuda, amtundu wapakatikati mwa fundus kapena m'mitsempha yayikulu yakuya zigawo za retinal), zigawo za exudative (zozikika pakati pa fundus, zachikaso kapena zoyera ndi malire omveka kapena osamveka bwino) ndi edema ya retina. Retinal edema yodziwika pakati (macular) dera kapena m'matima akuluakulu ndi chinthu chofunikira kwambiri pakukula kwa matenda ashuga a retinopathy.
• Preproliferative retinopathy .
• Proliferative retinopathy (diabetesic retinopathy III) - imadziwika ndi neovascularization ya optic disc ndi / kapena mbali zina za retina, vitreous hemorrhages, ndi mapangidwe a minofu ya fibrous m'dera la preretinal hemorrhages. Zombo zatsopano zomwe zimapangidwa ndizowonda kwambiri komanso zosalimba - zotupa zobwerezabwereza zimachitika kawirikawiri, zimathandizira kuyambiranso. Zombo zatsopano zopangidwa ndi Iris of eye (rubeosis) nthawi zambiri zimabweretsa kukula kwa sekondale (rubeous) glaucoma.

Chithunzi cha kuchipatala

Magawo oyamba a chotupa amadziwika ndi kusowa kwa zizindikiro zamaso (kuchepa kwa maonedwe owoneka, kupweteka, ndi ena). Kuwonongeka kapena kuchepa kwa maonedwe acuity ndi chizindikiro chakumapeto chomwe chimayimira njira yofikira patali, yosasinthika (musanyalanyaze kuyesedwa kwamakono kwa ophthalmological).

Choyambitsa chachikulu cha kutayika kwamaso ndi matenda ashuga retinopathy, mawonekedwe osiyanasiyana omwe amapezeka mwa odwala 80-90%. Malinga ndi Pulofesa A. Efimov, mu kafukufuku wa ophthalmological wa anthu 5,334 omwe ali ndi matenda a shuga, retinopathy yamatenda osiyanasiyananso adapezeka mu 55.2% ya odwala (gawo I - 17.6%, gawo II - 28.1%, gawo lachitatu - mu 9.5%). Kuwonongeka kwathunthu kwa masomphenya pakati pa onse omwe adawayeza kunali pafupifupi 2%.

Retinopathy - kuwonongeka kwa ziwiya za retina. "Zolinga" zazikulu pakusintha kwamachitidwe mu retina:

1. arterioles - lipogaline arteriosulinosis ("plasma vasculosis"), omwe amakhudzidwa kwambiri ndi arterioles osakhazikika komanso capillaries m'dera lotsatira la fundus,
2. mitsempha - kukulira ndi kusinthika,
3. capillaries - kuchepa, kuchuluka kwachulukidwe, kufalikira kwa capillaries, kuchititsa kupweteka kwa mtima, kupindika kwa kwapakati pa khoma ndi mapindikidwe a endothelial, kukula kwa zigawo zam'munsi, mapangidwe a micaneurysms, hemorrhages, arteriovenous shunts, neovascularization,
4. kutupa kwa striatum opticum ulusi, wowoneka ngati imvi malo ndi mawanga ngati mitambo, kutchulidwa exudates, edema ya optic disc, atrophy ndi retinal detachment.

Zizindikiro

Osachepera 1 pachaka, anthu odwala matenda a shuga amayeza mayeso, kuphatikizapo kufunsa mafunso, kuyeza kupenyerera ndi kupenya (atatha kufinya) kuti apeze zotuluka, zotupa zodontha, ma michereurysms ndi kuchuluka kwa ziwiya zatsopano. Zoyenera, kuyeserera kumachitika ndi ophthalmologist wodziwa bwino chipatala cha matenda ashuga.

Chithandizo

Chithandizo cha matenda ashuga retinopathy ndichovuta, chochitika ndi endocrinologist ndi ophthalmologist. Zofunikanso monga kuphatikiza zakudya zoyenera ndi insulin. Ndikofunikira kuchepetsa mafuta muzakudya, m'malo mwa mafuta a nyama ndi mafuta am'masamba, osapatula chakudya chambiri (shuga, maswiti, zoteteza), komanso kugwiritsa ntchito zinthu zambiri zomwe zimakhala ndi lipotropic (tchizi tchizi, nsomba, oatmeal), zipatso, masamba (kupatula mbatata). Mankhwala othandizira a Vitamini ndilofunikira kwambiri, makamaka gulu B (B₁, B₂, B₆, B₁₂, B₁₅) mkati ndi makolo. Vitamini C, P, E amakhala ndi zoteteza kukhoma la mtima (3-4 pachaka, maphunziro a mwezi umodzi). Angioprotectors akuphatikizapo anginin (prodectin), dicinone, doxium. Mankhwalawa amatengedwa monga adanenera dokotala.

• Mu gawo ine matenda ashuga retinopathy (sanali proliferative retinopathy), mayeso obwereza pafupipafupi akuwonetsedwa. Dokotala amayenera kuwunika momwe wodwalayo amalamulirira kuchuluka kwa shuga m'magazi.
• Mu diabetesic retinopathy ya II kapena III siteji (prroliferative and proliferative retinopathy, motero), laser Photocoagulation ikuwonetsedwa.

Kafukufuku waposachedwa wa DS adayang'ana kugwiritsidwa ntchito kwa blockesartan renin-angiotensin receptor (RAS) blocker of Type 1 and Type 2abetes. Kugwiritsa ntchito kwa candesartan sikunachepetse kupita patsogolo kwa retinopathy. Phunziroli, panali chikhalidwe chakuchepa kwa kukula kwa retinopathy. Pakufufuza kochulukirapo kwa RASS, zidawonetsedwa kuti kukulitsa kwa retinopathy mu mtundu 1 wa matenda a shuga kumachepetsa ndi ASD kutsekeka ndi losartan ndi angiotensin-kutembenuza enzyme enalapril inhibitor. Chifukwa chake, kugwiritsidwa ntchito kwa ASD blockers kungakhale koyenera kwa odwala omwe ali ndi matenda amtundu wa 1 komanso retinopathy, koma osati ndi matenda a shuga 2.

Diabetesic retinopathy imalumikizidwa ndi zovuta zingapo za epigenetic, kuphatikizapo methylation ya Sod2 ndi MMP-9 genes ndikulemba kwambiri mtundu wa LSD1 en gene. Kuthekera kwa kugwiritsa ntchito mankhwala a epigenetic kuwongolera pakali pano kuli kulingaliridwa.

Ziwonetsero

Muzochitika zapamwamba komanso kuphatikiza kwa matenda osokoneza bongo a shuga ndi matenda oopsa, atherosulinosis ndi yoopsa kwambiri.

Kupewa

Mukukula ndi kupitiliza kwa retinopathy yamitundu yonse ya matenda a shuga, ntchito yofunika imaperekedwa pamlingo wolipirira pazomwe zimayambitsa matenda. Kukula kwa ochepa matenda oopsa ndi matenda ashuga nephropathy, omwe amaphatikizidwa ndi retinopathy, kukulitsa njira ya retinopathy mu matenda a shuga. Atherosulinosis imapita patsogolo kwambiri pakati pa anthu omwe ali ndi matenda osokoneza bongo aang'ono ndipo amakhala ovuta kwambiri - chifukwa cha kukhalapo kwa microangiopathy, mwayi wopanga kufalikira koyenda umachepetsedwa. Kuti mupeze vuto la panthawi yake, wodwala aliyense yemwe ali ndi matenda ashuga amayenera kuwunikidwa ndi ophthalmologist osachepera 1 pachaka ndipo ngati kudandaula komwe kumachitika.

Popewa zotupa zam'maso kwambiri, kupezeka kwawo koyambirira ndikofunikira - achinyamata omwe ali ndi matenda ashuga amayenera kuwunikidwa ndi ophthalmologist osachepera nthawi 1 m'miyezi 6. Chidwi chachikulu chiyenera kuperekedwa kwa mawonekedwe a odwala omwe ali ndi matenda osokoneza bongo a nthawi yayitali - ndi kuwonjezereka kwa nthawi ya matenda osokoneza bongo, kuchuluka kwa kudziwika kwa matenda ashuga retinopathy kumawonjezereka.

Njira yokhayo yodalirika yopewera matenda ashuga retinopathy ndiyomwe imapangitsa chithandizo cha magawo ake onse ndi chindapusa chokwanira pa matenda a shuga mellitus (mulingo wa glycated hemoglobin HbA_1C .

Pathogenesis ndi zoyambitsa

Pathogenesis ya matenda ashuga retinopathy ndi ovuta. Zina mwazomwe zimayambitsa ndikuwonongeka kwa mitsempha ya magazi ya retina: kupezeka kwawo mopitirira muyeso, kufalikira kwa ma capillaries, mawonekedwe a minofu yowonjezereka (bala) ndi ziwiya zatsopano. Kusintha koteroko kumachitika chifukwa cha majini a kapangidwe ka retina.

Osati gawo lofunikira kwambiri pakukula kwa matendawa limaseweredwa ndi kusintha kwa metabolic komwe kumachitika ndi shuga m'magazi. Pamaso pa matenda a shuga mpaka zaka 2, odwala matenda ashuga retinopathy amapezeka 15% ya odwala, mpaka zaka 5 - mu 28%, mpaka zaka 10-15 - mu 44-50%, kuyambira 20 mpaka 30 - - 90-100%.

Zowopsa zomwe zimakhudza kuthamanga ndi pafupipafupi pakupita patsogolo kwa matenda zikuphatikiza:

• mulingo wa hyperglycemia,
• kutalika kwa matenda ashuga
• aakulu aimpso kulephera
• ochepa matenda oopsa
• kunenepa kwambiri (kunenepa kwambiri),
• kagayidwe kachakudya matenda
• dyslipidemia.

Komanso kukula, kupita patsogolo kwa matenda ashuga retinopathy kumathandizira kutenga pakati, kutha msinkhu, zizolowezi zoyipa.

Chithunzi cha kuchipatala

Matenda a shuga a retinopathy amakula ndipo amapita patsogolo popanda kukhala ndi zikhalidwe. Kuchepa kwa masomphenya m'malo osatukuka sikuwonekeratu. Kuphatikizika kwa zinthu zowoneka kumatha kupangitsa kuti macular edema. Mavuto akuwerenga pafupi kwambiri amadziwikanso. Kuphatikiza apo, maonekedwe akuwoneka bwino amayang'ana kuchuluka kwa shuga m'magazi.

Mukukula kwa matendawa, chophimba ndi chovunda choyandama chikuwonekera pamaso (chifukwa cha kukoka kwamitsempha yamagazi). Pakapita kanthawi, amadzionekera okha.Ndi kuvulala kwakukulu, kuwonongeka kowopsa kapena kuwonongeka kwathunthu kumachitika mu thupi lamphamvu.

Zizindikiro

Kuwona matenda a shuga a retinopathy, wodwalayo amamuika ophthalmoscopy pansi pa mydriasis, masikono, biomicroscopy wa gawo lakunja la diso, maonekedwe oyipa, biomicroscopy wa diso ndi mandala a Goldman, Maklakov tonometry, diaphanoscopy wa mawonekedwe amaso.

Chithunzi cha ophthalmoscopic ndichofunika kwambiri kukhazikitsa gawo la matendawa. Gawo lomwe silikukula, ma micaneurysms, zotupa, ndi zolimba komanso zopepuka komanso zofewa amapezeka. Mchigawo chokulirapo, chithunzi cha fundus chimadziwika ndi kubisala kwamitsempha yama cellular (kukwezedwa ndi kukula kwa mitsempha, kukokana kwamkati), endovascular and preretinal hemorrhages, kuchuluka kwa fibrous, retinal neovascularization, ndi matenda a optic nerve disc. Kuti alembe zosintha pa retina, zithunzi zingapo zachinsinsi zimatengedwa ndi kamera ya fundus.

Ndi ma opacities a mandala a vitreous ndi crystalline, ultrasound ya maso imayikidwa m'malo mwa ophthalmoscopy. Kuti muwone kuphwanya kapena kusunga ntchito za mitsempha ya optic ndi retina, maphunziro amagetsi amachitika: electrooculography, kutsimikiza kwa CSFM, electroretinography. Kuti mupeze khungu la neovascular glaucoma, gonioscopy imachitika.

Njira yofunikira kwambiri yoyeserera ziwiya za retinal ndi fluorescence angiography. Imawerengera magazi mu mitsempha yam'mimba. Ngati ndi kotheka, angiography imasinthidwa ndi laser ndi kuwala koyanjana kwa retinal tomography.

Kuti mupeze zoopsa pazotsatira za matenda ashuga retinopathy, mkodzo ndi shuga wamagazi, glycosylated hemoglobin, insulin, mbiri ya lipid ndi zizindikiro zina zimayesedwa. Palibenso njira zophunzitsira zodziwikiratu momwe mungagwiritsire ntchito impso, kuwunika magazi tsiku lililonse, ECG ndi echocardiography.

Mankhwala othandizira

Mu magawo oyamba a matendawa, njira yayikulu yochizira ndiyothandiza. Wodwalayo akuwonetsedwa kugwiritsa ntchito kwakanthawi mankhwala omwe amachepetsa kuwonongeka kwa capillaries - angioprotectors (Doxyum, Parmidin, Dicinon, Predian). Zimafunikanso kukhala ndi shuga wokwanira m'magazi.

Pochiza komanso kupewa mitsempha yam'mimba, Sulodexide, ascorbic acid, vitamini P ndi E. Amayikidwa Antioxidants (mwachitsanzo, Strix). Kukonzekera uku kumakhala ndi beta-carotene ndi mabulosi abulu. Zinthu zofunikira izi zimathandizira kuwona, kulimbitsa ma network, kuteteza motsutsana ndi zotsatira zoyipa zamagetsi.

A malo apadera pa matenda a shuga a retinopathy ndi matenda a kagayidwe kazinthu. Izi zimachitika pomwa mankhwala ochepetsa shuga. Conservative mankhwala imaphatikizanso matenda a wodwalayo.

Anthu omwe akudwala matendawa amayenera kukayezetsa kuchipatala. Kutengera kuzunzika kwa maphunziro a shuga, nthawi za kulumala zimatsimikizika. Wodwalayo amakhala ataphatikizidwa pantchito yokhudzana ndi katundu wambiri, kugwedezeka, kuwongola mutu ndi thupi, kukweza zolemetsa. Ndikoletsedwa kugwira ntchito zoyendera ndi m'masitolo otentha.

Mankhwala othandizira

Ngati kupezeka kwa matenda ashuga retinopathy kuwulula zakusokonekera: hemorrhages mu retina, edema yake chapakati zone, mapangidwe zatsopano zotengera, ndiye wodwala akuwonetsedwa laser mankhwala. Mwazovuta kwambiri - opaleshoni yam'mimba.

Mitsempha yatsopano yotulutsa magazi ndi ma edular a macular ikawoneka, coagulation ya laser imafunikira. Munthawi imeneyi, mphamvu za laser zimaperekedwa kumalo owonongeka a retina. Imalowa mkati mwa ziphuphu, nthabwala zotsekemera, chinyezi cha chipinda chamkati ndi mandala popanda mawonekedwe.

Ma laser amagwiritsidwanso ntchito kunja kwa gawo loyang'ana pakati kuti azigwiritsa ntchito mphamvu za mpweya zomwe zikusowa mpweya. Ndi chithandizo chake, njira ya ischemic imawonongedwa mu retina. Zotsatira zake, zombo zatsopano zimasiya kuwonekera. Njirayi imachotsanso kale zopanga ma neoplasms. Izi zimabweretsa kuchepa kwa edema.

Cholinga chachikulu cha laser coagulation ndikuletsa kupitirira kwa matendawa. Kuti mukwaniritse, pafupifupi magawo 3-4 amafunikira. Zimatha mphindi 30 mpaka 40 ndipo zimachitika masiku angapo. Pakati pa njirayi, kupweteka kumatha kuchitika. Chifukwa chake, mankhwala othandizira pakhungu amachitidwa mu minofu yowzungulira diso. Miyezi yowerengeka atamaliza kulandira chithandizo, katswiri amawunika mkhalidwe wa retina. Chifukwa chaichi, fluorescence angiography amalembedwa.

Ngati nonproliferative diabetesic retinopathy imayambitsa kukoka kwamatumbo, wodwala amafunikira vitrumomy. Panthawi yonseyi, adotolo amachotsa magazi ophatikizidwa, ndipo thupi lamphamvu limasinthidwa ndimafuta a silicone (kapena saline). Nthawi yomweyo, mabala omwe amachititsa kuti khungu lisungunuke komanso kubowoleza khungu la m'mimba amadzinyamula ndi laser, ndipo zotulutsa magazi zimatupa. Kuchita mankhwalawa kumalimbikitsidwa kumayambiriro kwa matendawa. Izi zimachepetsa kwambiri zovuta zamavuto.

Ngati wodwala wasintha kwambiri mu fundus, pali zotengera zambiri zatsopano ndi zotupa zatsopano, kuwonongeka kwa retina kumachitika. Zimafunikanso ngati vitollomy kapena laser coagulation sizingatheke.

Mavuto omwe angakhalepo

Zotsatira zoyipa za matenda ashuga retinopathy:

• mphira
• sekondale yachiwiri yamkati,
• kuchepa kwakukulu kwa masomphenya
• hemophthalmus,
• retinal traction
• khungu lathunthu.

Izi zimafunikira kuwunikidwa kosalekeza ndi katswiri wa zamankhwala, neuropathologist, ophthalmologist ndi endocrinologist. Mavuto ena amathetsedwa ndikupanga opaleshoni.

Chithandizo chothandiza kwambiri cha matenda ashuga retinopathy ndikuchepetsa kuchuluka kwa shuga wamagazi ndikukhalabe ndi chikhalidwe chawo. Idyani kumanja ndikumapita kwa ophthalmologist wanu pafupipafupi. Kamodzi pa sabata, madzulo, kuyeza kukakamiza kwa intraocular. Ndi kuzindikira kwakanthawi komanso njira zovuta zochizira, pamakhala mwayi uliwonse wokhala ndi mawonekedwe.

Magawo a shuga a retinopathy

Matenda a shuga a retinopathy amakhala ndi magawo angapo. Gawo loyamba la retinopathy limatchedwa osatukuka, ndipo amadziwika ndi maonekedwe michereamene amachepetsa mitsempha ya m'maso ndi zotupa m'maso mu mawonekedwe a mawanga amdima kapena kumaso owongoka, maonekedwe a ischemic a retina, edema ya retinal m'chigawo cha macular, komanso kuwonjezeka kwa kuchuluka ndi kuwonongeka kwa makoma amitsempha yamagazi. Mwanjira imeneyi, kudzera mu ziwiya zowonda, gawo lamadzi limalowa mu retina, zomwe zimatsogolera pakupanga edema. Ndipo ngati gawo lapakati la retina likuchita nawo izi, ndiye kuti limawonedwa kuchepa kwa masomphenya.

Tiyenera kudziwa kuti matenda amtunduwu a shuga amatha kuchitika pagawo lililonse la matendawa, ndipo akuimira gawo loyambirira la retinopathy. Ngati sichichiritsidwa, ndiye kuti nthenda yachiwiri ya matendawa imachitika.

Gawo lachiwiri la retinopathy ndi kuchuluka, yomwe imayenderana ndi zovuta m'magazi a retina, zomwe zimayambitsa kuchepa kwa okosijeni mu retina (kusowa kwa mpweya, ischemia) Kubwezeretsa kuchuluka kwa oksijeni, thupi limapanga ziwiya zatsopano (njirayi imatchedwa kukopa) Zombo zongopangidwazo zimawonongeka ndikuyamba kutuluka, chifukwa cha chomwe magaziwo amalowera Thupi la Vitreouszigawo za retinal. Zotsatira zake, mawonekedwe osayenda akuwoneka m'maso motsutsana ndi maziko am'maso akuchepa.

M'masiku omaliza a retinopathy ndi kukula kwa ziwiya zatsopano komanso minyewa yochepa, zimatha kuyambitsa kuzungulira kwina komanso kukula glaucoma.

Chifukwa chachikulu cha kukhazikitsidwa kwa matenda ashuga retinopathy sikokwanira insulinkumabweretsa kudzikundikira fructose ndi sorbitolzomwe zimapangitsa kuti zikhale zowonjezereka, kuthina kwa makoma a capillaries komanso kuchepa kwa mipata yawo.

Kukula ndi magawo a matendawa

Ndi kuwonjezeka kwa shuga wamagazi, pali makulidwe amitseko ya mitsempha yamagazi. Zotsatira zake, kupsinjika mwa iwo kumakwera, zotengera zimawonongeka, kukulitsidwa (ma micaneurysms), ndi mawonekedwe ang'ono a hemorrhages.

Kukula kwa magazi kumachitikanso. Fomu ya Microthrombi, kutsekereza lumen ya ziwiya. Pali mpweya wa m'mimba wa retina (hypoxia).

Popewa hypoxia, zikopa ndi mitsempha yamagazi zimapangidwa, kudutsa malo omwe akhudzidwa. Zomangira zimamanga mitsempha ndi mitsempha, koma kusokoneza kayendedwe ka magazi m'magulu ang'onoang'ono ndipo potero kumawonjezera hypoxia.

Mtsogolo, zombo zatsopano zimamera mu retina, m'malo mwa zowonongeka. Koma ndi owonda kwambiri komanso osalimba, chifukwa chake amawonongeka mwachangu, zotupa zimachitika. Zombo zomwezo zimatha kumera mu kuwala kwa mitsempha yotulutsa maso, thupi lotulutsa thupi, kuyambitsa glaucoma, kusokoneza kutuluka kwamadzi kuchokera kumaso.

Kusintha konseku kumatha kuyambitsa zovuta zobweretsa khungu.

Magawo atatu a matenda a shuga a retinopathy (DR) ali ndi matenda osiyanasiyana:

1. Nonproliferative retinopathy (DR I).
2. Preproliferative retinopathy (DR II).
3. Proliferative retinopathy (DR III).

Gawo la retinopathy limakhazikitsidwa ndi ophthalmologist mukamayang'ana ndalama kudzera mwa wophunzirayo, kapena pogwiritsa ntchito njira zapadera zofufuzira.

Ndi retinopathy wosapindika ma micaneurysms amapangidwa, zotupa zazing'onoting'ono m'mitsempha yam'mimba, zimayang'ana kutuluka (thukuta la gawo lamwazi), zimasiyana pakati pamitsempha ndi mitsempha. Ngakhale edema ndiyotheka.

Mu gawo lachiwonetsero kuchuluka kwa zotupa, ma exudates amawonjezeka, amakula kwambiri. Mitsempha ya retinal ikukula. Optic edema imatha kuchitika.

Pa gawo lochulukirachulukira pali kuchuluka (kuchuluka) kwamitsempha yamagazi mu retina, mitsempha yam'maso, kuchuluka kwa zotupa m'mimba ya retina ndi vitreous. Mitundu yocheperako yamkaka, imakulitsa njala ya okosijeni ndikupangitsa kuti minye izitulutsidwa.

Matenda a shuga a retinopathy

Pamodzi ndi mfundo zambiri zochizira retinopathies, mankhwalawa amaphatikiza kukonza kwa kagayidwe kachakudya, kukhathamiritsa kwa kayendetsedwe ka glycemia, kuthamanga kwa magazi, kagayidwe ka lipid. Chifukwa chake, panthawiyi, chithandizo chachikulu chimadziwika ndi endocrinologist-diabetesologist ndi mtima.

Kuwunikira mosamala kuchuluka kwa glycemia ndi glucosuria, kusankha kwa insulin yokwanira kwa matenda a shuga kumachitika, angioprotectors, antihypertensive mankhwala, antiplatelet othandizira, etc. amatumizidwa. Intravitreal jakisoni wa mankhwala am'madzi amathandizira kuchitira macular edema.

Odwala omwe ali ndi matenda ashuga apamwamba a retinopathy amawonetsedwa chifukwa cha laser retinal coagulation. Kuphatikizika kwa laser kumakupatsani mwayi woponderezera njira ya neovascularization, kuti mukwaniritse kuthana ndi mitsempha yamagazi ndi kuwonjezereka kwa fragility ndi kupenyerera, kuti mupewe chiopsezo cha kufinya.

Opaleshoni ya laser retina ya matenda ashuga retinopathy amagwiritsa ntchito njira zingapo zingapo. Kuletsa kwa laser kukondoweza kwa retina kumakhudzanso kugwiritsa ntchito mitundu ina ya "latisi", m'mizere ingapo, ndipo akuwonetsedwa mwanjira ina yopanda retinopathy ya macular edema. Focal laser coagulation imagwiritsidwa ntchito pouterize micaneurysms, exudates, ndi zotupa zazing'ono zowululidwa nthawi ya angiography. Mukukonzekera kwa panretinal laser coagulation, ma coagulates amawagwiritsa ntchito mu retina, kupatula dera la macular, njirayi imagwiritsidwa ntchito makamaka pa siteji ya prolliferative kuti isapitirire.

Ndi mawonedwe ophatikizika amaso, njira yina ya kuwala kwa laser ndi transscleral cryoretinopexy, kutengera kuzizira kwa ziwalo zam'mimba za retina.

Panthawi yakukwera kwambiri kwa matenda ashuga retinopathy ophatikizika ndi hemophthalmus, macular traction kapena retinal detachment, vitrectomy amatengedwa, pomwe magazi, thupi lamphamvu palokha limachotsedwa, minyewa yolumikizira minofu imadulidwa, mitsempha yotulutsa magazi imatenthedwa.

Zotsogola ndi kupewa

Zovuta zingapo za matenda ashuga retinopathy amatha kukhala glaucoma yachiwiri, matenda amkati, kuchepa kwa khungu, hemophthalmus, kuchepa kwakukulu kwa masomphenya, khungu lathunthu. Zonsezi zimafunikira kuyang'anira odwala omwe ali ndi matenda ashuga ndi endocrinologist ndi ophthalmologist.

Ntchito yofunikira kwambiri yoletsa kupitirira kwa matenda ashuga retinopathy imaseweredwa ndikuwongolera moyenera shuga ndi kuthamanga kwa magazi, kudya kwa hypoglycemic komanso mankhwala a antihypertensive. Kuchita kwakanthawi kwa njira zopangira laser zimathandizira kuyimitsidwa ndi kusinthidwa kwa kusintha kwa ndalama.

Ndani amakula pafupipafupi?

Pali zinthu zina zomwe zimawonjezera mwayi wokhala ndi matenda ashuga a retinopathy. Izi zikuphatikiza:

• Kutalika kwa matenda ashuga (zaka 15 pambuyo pa kuyambika kwa matenda ashuga theka la odwala omwe salandila insulin, ndipo 80-90% ya omwe adalandira kale ali ndi retinopathy).
• Mitsempha yayikulu yamagazi ndipo pafupipafupi imadumphadumpha kuchokera pamwamba kwambiri mpaka pamiyeso yotsika kwambiri.
• Matenda oopsa.
• Kukweza mafuta m'thupi.
• Mimba
• Matenda ashuga nephropathy (kuwonongeka kwa impso).

Ndi ziti zomwe zikuwonetsa kukula kwa matendawa?

M'magawo oyamba, matenda ashuga retinopathy samadziwonetsa mwanjira iliyonse. Wodwala alibe nkhawa. Ichi ndichifukwa chake ndikofunikira kwambiri kwa odwala omwe ali ndi matenda ashuga, mosasamala madandaulo, kukaonana ndi ophthalmologist nthawi zonse.

Mtsogolomo, kumverera kowoneka bwino, kowoneka bwino, ntchentche zosinthika kapena mphezi patsogolo pa maso, ndi pamaso pa zotupa, kumayang'ana malo amdima. M'magawo apambuyo, kuwona kwakumaso kumachepa, mpaka kutsimikiza kwathunthu.

Zovuta zake ndi ziti?

Pakakhala chithandizo choyenera cha matenda a shuga komanso matenda ashuga retinopathy, zovuta zawo zimayamba, zomwe zimapangitsa khungu.

• Kutengeka kwapang'onopang'ono. Zimachitika chifukwa cha zipsera m'thupi lamatumbo lomwe limamangidwa ndi retina ndikulikoka pamene diso likuyenda. Zotsatira zake, misozi imapangidwa ndikuwonongeka kwamawonedwe kumachitika.
• Rubeosis wa Iris - kumera kwa mitsempha yamagazi mu iris. Nthawi zambiri zoterezi zimapindika, zimayambitsa zotupa m'chipinda cham'maso cha munthu.

Chithandizo cha matenda ashuga retinopathy, komanso zovuta zina za shuga, ziyenera kuyamba ndi matenda a glycemia, kuthamanga kwa magazi ndi mafuta m'thupi. Ndi kuchuluka kwambiri kwa shuga m'magazi, akuyenera kuchepetsedwa pang'onopang'ono kupewa ischemia ya retinal.

Chithandizo chachikulu cha matenda a shuga a retinopathy ndi laser. Izi zimapangitsa kuti retina ikhale ndi mtanda wa laser, chifukwa chomwe chimakhala ngati chogulitsidwa kumaso amaso. Kuphatikiza kwa laser kumakupatsani mwayi kuti "mutatseketsa" zombo zomwe zangopangidwa kumene kuti zizigwira ntchito, kupewa edema ndi kuchotsetsanso kwa retine, ndikuchepetsa ischemia yake. Imachitidwa ndi proliferative ndipo nthawi zina prrolifative retinopathy.

Ngati sikungatheke kuchita laser coagulation, vitlimomy imagwiritsidwa ntchito - kuchotsa thupi la vitreous palimodzi ndimisempha yamagazi ndi zipsera.

Poletsa kupanikizika kwamitsempha, mankhwala omwe amatchinga njirayi, mwachitsanzo, ranibizumab, amagwira ntchito. Amalowetsedwa mu thupi lamphamvu kangapo pachaka pafupifupi zaka ziwiri. Kafukufuku wasayansi awonetsa kuchuluka kwakukulu kwa kusintha kwamawonedwe pakugwiritsa ntchito gulu ili la mankhwalawa.

Komanso, pochiza matenda a shuga a retinopathy, mankhwalawa amagwiritsidwa ntchito omwe amachepetsa hypoxia, magazi ochepa m'magazi (makamaka mafupa), mankhwala a mahomoni otsogolera thupi la vitreous.

Chifukwa chiyani nthendayi ndiyowopsa kwa diso?

Mulimonsemo, hyperglycemia, ndiko kuti, kuchuluka kwa shuga m'magazi, kumakhudza maselo, kuphatikizapo khoma lamitsempha.

Imakhala yochepa kwambiri - magazi ndi madzi a m'magazi amalowa momasuka m'malo opanga ma cell, magazi amawoneka mosavuta pa endothelium yowonongeka. Poyamba, matenda ashuga amakhudza ziwiya zazing'ono, motero mitsempha ya m'mimba ndi mitsempha ndiyanso iwonso.

Kodi izi zimakhudza bwanji masomphenya?

Mu magawo oyamba, kugwa kwa ntchito zowoneka sikungachitike. Inde, retina - minyewa yocheperako - imakhudzika ndikusokonezeka kwa magazi, koma njira zowonjezera, komanso mawonekedwe osakhalitsa apakati, macular dera, amapereka malingaliro ovomerezeka.

Magazi akatuluka m'mitsempha yosinthika, mbali zina za retina zimapumira m'matumbo kapena kutaya chakudya (gawo la thrombosis).

Pomwepo, zizindikiro zoyambirira za matendawo ziziwoneka:

• "Ntchentche" pamaso,
• chithunzi blur
• kupindika kwa mizere.

Zizindikiro zowopsa ndizakuchepa kwamaso, maonekedwe akuwala (mphezi), kusowa kwofananira kwa gawo lina m'munda wamasomphenya (kukhazikitsidwa kwa "shroud"). Nthawi zina zochitika zotere zimasonyeza kukula kwa kufalikira kwa retinal

Zowopsa

Ndi zolakwika zilizonse zomwe zingachitike, ndibwino kusamalira kupewa komanso kuchiza matenda obwera ndi nkhawa. Kuopsa kowonera kumawonjezeka ngati zinthu zowonjezera zilipo.

Zomwe zimawonjezera mwayi wa mawonetseredwe a matendawa:

1. Osasunthika spikes m'magazi a magazi
2. Kuthamanga kwa magazi
3. Kusuta ndi zizolowezi zina zoyipa,
4. Matenda a impso ndi chiwindi
5. Mimba komanso nthawi yodyetsa mwana,
6. Zosintha zokhudzana ndi ukalamba mthupi,
7. Makamaka.

Kutalika kwa shuga kumakhudzanso kuwonekera kwa matendawa. Amakhulupirira kuti mavuto amakono amawoneka pafupifupi zaka 15 mpaka 20 atazindikira, koma pali zomwe zingachitike.

Muubwana, pamene vuto la mahomoni limafotokozanso ndi zomwe zimayambitsa matenda ashuga, kusintha kwa matenda ashuga retinopathy kumatha kupezeka m'miyezi ingapo. Ichi ndi chizindikiro choopsa kwambiri, chifukwa ngati zinthu zitakhala choncho, ngakhale pang'onopang'ono pounikira ndikusamalitsa, chiopsezo chakhungu chakula.

Matenda a shuga

Matendawa matenda a shuga ayambanso matenda ofala kwambiri. Matenda a shuga amakhudza onse akulu ndi ana.

Madokotala amayanjana ndi kuchuluka kwa odwala omwe ali ndi matenda ashuga ndikuti masiku ano, makamaka m'mizinda yayikulu, zomwe zimayambitsa matendawa ndizofala kwambiri:

• malo oyipa
• onenepa kwambiri
• kuperewera kwa zakudya m'thupi
• zolimbitsa thupi zochepa
• "Sedentary" moyo
• kupsinjika
• kutopa kwambiri.

Malinga ndi akatswiri, kuchuluka kwa anthu odwala matenda ashuga kumatha kufika pa 2025 - 300 miliyoni, omwe ndi anthu 5% padziko lonse lapansi.

Matenda a shuga amawoneka ndi shuga wambiri. Nthawi zambiri, maselo a pancreatic (ma cell a beta) amatulutsa insulin - timadzi timene timayendetsa kagayidwe, shuga (glucose) m'magazi komanso mafuta ndi mapuloteni.

Mu matenda a shuga mellitus, chifukwa chosakwanira kupanga insulin, zovuta za metabolic zimachitika, ndipo shuga wamagazi amatuluka. Ndipo, monga mukudziwa, ndi shuga yemwe ndi wofunikira pakugwira bwino ntchito kwa maselo a thupi.

Kuperewera kwa insulin m'matenda a shuga sikuti kumangokhala ndi maselo amthupi, komanso kumabweretsa kuwonjezeka kwa shuga osagwirizana ndi magazi. Nawonso, shuga wambiri amachititsa kuti mafuta asamayende bwino komanso kuti mafuta azikundana m'magazi, mapangidwe a ziwongo.

Izi zimatsogolera kuti lumen ya ziwiya zimacheperachepera, ndipo magazi ake m'misempha amachepa mpaka kuthe. Mu shuga mellitus, omwe ali pachiwopsezo chachikulu ndi mtima, maso, zida zowonera, ziwiya zamiyendo, ndi impso.

Matenda a shuga a retinopathy amakhala ndi zaka 5-10 kuchokera ku matenda a shuga kuchokera mwa anthu. Mtundu wa I wa matenda a shuga a mellitus (wodalira insulini), matenda ashuga a shuga amawonjezereka msanga ndipo proliferative matenda ashuga retinopathy amapezeka msanga.

Zoyambitsa matenda ashuga:

1. Kudziletsa
2. Kunenepa kwambiri.
3. Matenda ena omwe amayambitsa kuwonongeka kwa maselo a beta omwe amapanga insulin. Awa ndi matenda a pancreatic - kapamba, khansa ya kapamba, matenda am'minyewa ya endocrine.
4. Matenda a ma virus (rubella, chikuku, mliri wa hepatitis ndi matenda ena, kuphatikiza chimfine). Matendawa amatengera anthu omwe ali pachiwopsezo.
5. Kupsinjika kwa mantha. Anthu omwe ali pachiwopsezo ayenera kupewa nkhawa komanso nkhawa.
6. M'badwo. Ndi kuchuluka kwa zaka khumi zilizonse, mwayi wokhala ndi matenda osokoneza bongo umawonjezereka.

Kuphatikiza pa kumverera kofooka ndi kufooka, kutopa msanga, chizungulire komanso zizindikiro zina, matenda a shuga amawonjezera mwayi wokhala ndi matenda amtundu wamatumbo komanso glaucoma, komanso kuwonongeka kwa retina. Chimodzi mwazomwe zimawonetsa matenda ashuga ndi matenda a shuga.

Zomwe zimayambitsa matenda a shuga a retinopathy

Kufotokozera mwachidule tanthauzo la njira yomwe imatsogolera pakupanga matendawa ndikosavuta kwambiri. Kusintha kwa kagayidwe kachakudya kamene kamayambitsa matenda ashuga kumabweretsa vuto pakagwiritsidwe ka magazi kupita ku zida za ocular. Ma cellvessel amaso ndi otsekeka, zomwe zimabweretsa kuwonjezeka kwa kukakamiza komanso kuwonongeka kwa makoma.

Kuphatikiza apo, zinthu zakunja zochokera m'mitsempha yamagazi zimatha kulowa mu retina, chifukwa zotchingira zachilengedwe zoteteza mu shuga zimayamba kukwaniritsa ntchito yake moyipitsitsa. Makoma amitsempha yamagazi amayamba kuchepa ndipo amatha kutayika, zomwe zimapangitsa kuti magazi azituluka komanso azithanso kuona.

Zowonongeka za matenda ashuga a retina ndi ziphuphu zakumaso zimachitika mwachindunji, zovuta zowoneka mochedwa za matenda a shuga, pafupifupi 90% ya odwala pankhaniyi ali ndi vuto losaona.

Zomwe matendawa amatchulidwa zimasinthidwa nthawi zonse, pomwe kugonja kwa cornea ndi retina m'magawo oyamba kumatha popanda zizindikiro zowoneka. Pang'onopang'ono, wodwalayo amayamba kuwona kuwonekera pang'ono kwa chithunzicho, mawanga ndi chophimba chikuwonekera pamaso pa maso, omwe amayamba chifukwa cha kuphwanya kwamaso kwa diso - ziphuphu.

Popita nthawi, chizindikirocho chimakulirakulira, masomphenya amachepa kwambiri ndipo khungu lonse limayamba kulowa.

Zombo zatsopano za retina ndizosalimba. Amakhala ndimakoma oonda, opangidwa ndi maselo amodzi, amakula mwachangu, amadziwika ndi kusinthasintha kwachangu kwa madzi a m'magazi, kuwonjezeka kwa kufalikira. Ndi kusunthika uku komwe kumatsogolera ku kuwoneka kwa zotupa m'maso osiyanasiyana.

Tsoka ilo, milandu yayikulu ya hemophthalmus sindicho chokhacho chomwe chimapangitsa kuti masomphenyawo asokonezeke. Komanso, kukula kwa khungu kumayambitsidwa ndi zigawo zam'magazi zotuluka m'magazi omwe amapangidwamo kumene, kuphatikiza njira zomwe zimapangitsa kuti khungu lizipindika, komanso kuwonongeka kwa khungu.

Kutalika kosagwirizana kwa mawonekedwe a fibrovascular popangika mu mawonekedwe a mitsempha ya minyewa ndi m'magulu akhungu am'mimba kumayambitsa kuyambika kwa kupambanitsa kwa retina, komwe kumafalikira ku dera la macular ndikukhudza mawonekedwe apakati.

Izi, pamapeto pake, zimatha kukhala chinthu chofunikira kwambiri pakuwonekera kwa regmato native retinal detachment, yomwe imakwiyitsa kukula kwa iris rubeosis. Masewera am'madzi otumphukira kwambiri amasungunuka ndi madzi ochokera kumitsempha, omwe amachititsa kuti khungu lizigwira bwino ntchito.

Chingwe chotere cha pathogenetic chimakhala chokhwima kwambiri ndipo chimangofotokoza mawonekedwe osasangalatsa okha. Zachidziwikire, nthawi yayitali kuchuluka kwa matenda ashuga sikutha nthawi zonse.

Mulimonsemo, kupita patsogolo kwake kungasiye mwadzidzidzi. Ndipo ngakhale pankhani iyi, monga lamulo, kutayika kwa masomphenya kumayamba, njira zowonongeka pazowonera zomwe zatsala zimachepetsedwa kwambiri.

Kodi odwala matenda ashuga atha kupewa khungu?

Kuchuluka kwa odwala omwe ali ndi matenda a shuga kwa nthawi yayitali amakhala ndi zotupa za m'maso ndi retina, yomwe imatha kukhala osiyanasiyana.

Chifukwa chake, akatswiri adazindikira kuti pafupifupi 15% ya odwala omwe amapezeka ndi matenda osokoneza bongo amakhala ndi zizindikiro zochepa za matenda ashuga retinopathy, omwe amakhala ndi matenda opitirira zaka zisanu, pafupifupi 29% ya odwala ali ndi zizindikiro, 50% ya odwala omwe ali ndi zaka 10 mpaka 15.

Ndiye kuti munthu akadwala matenda ashuga kwambiri, ndiye kuti pamakhala chiwopsezo chachikulu chowonongeka.

Zina, monga:

• kuchuluka kulimbikira kwa kuthamanga kwa magazi ndi ndende ya magazi,
• kuwonongeka kwaimpso,
• kuphwanya kuchuluka kwa magazi lipids,
• kuchuluka kwa mafuta ochulukirapo,
• kagayidwe kachakudya,
• kunenepa kwama degree osiyanasiyana,
• chibadwa
• nthawi yapakati
• zizolowezi zoipa
• zotupa za m'maso.

Komabe, kuyang'anira shuga wamagazi pafupipafupi, kutsatira kadyedwe kena komanso moyo wathanzi, kutenga mavitamini ndi michere yamagetsi m'maso, opangidwa makamaka kwa odwala matenda ashuga (Antotsian Forte ndi ena) kungachepetse vuto la khungu chifukwa cha zovuta za shuga.

Njira yothandiza kwambiri yopewa kutaya kwamaso ndikuwona momwe pafupipafupi amayendera wodwala yemwe ali ndi matenda a shuga ndi ophthalmologist ndi endocrinologist, kutsatira malingaliro awo.

Choopsa chachikulu chomwe matendawa amatenga ndi nthawi yayitali yopanda zizindikiro. Pa gawo loyamba, kuchepa kwa masomphenya sikumveka konse, chinthu chokhacho chomwe wodwala angayang'anire ndi edema ya macular retinal, yomwe imadziwoneka yokha mwanjira yakusowa kwa lakuthwa kwa zithunzi, zomwe zimakonda kuchitika ndi zotupa.

Zimakhala zovuta kwa wodwala kuwerenga ndi kugwira ntchito ndi zinthu zazing'ono, zomwe nthawi zambiri amazitcha kuti atopa kapena kukomoka.

Chizindikiro chachikulu cha kuwonongeka kwa retinal chikuwonekera pokhapokha kukhathamiritsa kwamphamvu mu thupi la vitreous, lomwe kwa wodwala yemwe ali ndi matenda ashuga amamva mu mawonekedwe a kuchepa kwapang'onopang'ono kapena lakuthwa mu kuwona kwa chidwi.

Mitsempha yama cell imakonda kuphatikizidwa ndi mawonekedwe amtambo woyandama ndi chophimba pamaso pa diso, chomwe patapita nthawi chimatha popanda kufufuza. Kutulutsa kwamphamvu kwambiri kumatsogolera pakuwonongeka kwathunthu.

Chizindikiro cha macular edema ndimamvekanso chophimba pamaso pa maso. Kuphatikiza apo, ndizovuta kuwerenga kapena kugwira ntchito pafupi.

Gawo loyambirira la matendawa limadziwika ndi mawonekedwe a asymptomatic, omwe amachititsa kuti azindikire chithandizo chamankhwala komanso chapanthawi yake. Nthawi zambiri madandaulo akuwonongeka kwa ntchito yowonekera amabwera mu gawo lachiwiri kapena lachitatu, chiwonongeko chinafika pamlingo waukulu.

Zizindikiro zazikuluzikulu za retinopathy:

1. Kuwona koperewera, makamaka kudera lakunja,
2. Maonekedwe a "ntchentche" patsogolo pa maso,
3. Vitreous mawanga
4. Kuwerenga zovuta
5. Kutopa kwakukulu ndi kuwawa m'maso,
6. Chophimba kapena mthunzi womwe umasokoneza mawonekedwe abwinobwino.
7. Kukhalapo kwa chizindikiro chimodzi kapena zingapo kungawonetse mavuto akulu amawonedwe.

Pankhaniyi, muyenera kukaonana ndi dokotala - a ophthalmologist. Ngati mukukayikira kukhazikitsidwa kwa matenda ashuga retinopathy, ndibwino kuti musankhe katswiri wopanikizika - ophthalmologist - retinologist. Dokotala wotereyu amakhala ndi odwala omwe amapezeka ndi matenda osokoneza bongo ndipo amathandizira kudziwa molondola zomwe zasintha.

Mankhwala

Kukonzanso odwala omwe ali ndi matenda ashuga retinopathy (DR) amakhalabe amodzi mwa zovuta kwambiri komanso zovuta kuzimitsa maso. DR ndiye amene akutsogolera khungu kwa anthu akuluakulu.

Mayendedwe a Conservative chithandizo cha DR:

• Kulipiritsa kwa matenda ashuga komanso zovuta zokhudzana ndi metabolic:
• chakudya kagayidwe kachakudya
• kuthamanga kwa magazi (BP) (renin - angiotensin - aldosterone system blockers),
• lipid ndi mapuloteni kagayidwe (mavitamini A, B1, B6, B12, B15, fenofibrate, anabolic steroids),
• retinal kagayidwe kachakudya:
• antioxidant mankhwala
• mitsempha ya minyewa yothandizira,
• aldose reductase zoletsa,
• angiogenesis blockers,
• kukonza matenda a mtima dongosolo ndi magazi rheology:
• magazi amathandizira
• vasodilators,
• angioprotectors
• othandizira omwe amasintha mkhalidwe wa endothelium ndi chapansi membrane wa mtima khoma.

Mndandandawu umasinthidwa nthawi zonse ndikusinthidwa. Zimaphatikizapo magulu onse odziwika omwe amaimiridwa ndi magulu osiyanasiyana a mankhwala, komanso madera atsopano, olimbikitsa.

Njira zopanda chithandizo chilichonse cha mankhwala a DR (onse osakhazikika ndikuchita opaleshoni) ndikubwezeretsanso kwa matenda ashuga komanso zovuta zokhudzana ndi metabolic - protein and lipid metabolism.

Chomwe chimapangitsa kupewa ndi kuchiza matenda a DR ndiye chindapusa chokwanira cha kagayidwe kazakudya. Mtundu woyamba wa matenda ashuga, kuchuluka kwa glucose mpaka 7.8 mmol / L amadziwika kuti ndizovomerezeka, ndipo zomwe zili glycosylated hemoglobin HbA1 zafika pa 8.5-9,5%. Mtundu wachiwiri wa matenda ashuga, kuchuluka kwa glycemia kumakhala kokwezeka pang'ono, poganizira momwe wodwalayo alili.

Malinga ndi zotsatira za kafukufuku wa EUCLID, kugwiritsa ntchito kwa ACE inhibitor lisinopril kunachepetsa chiopsezo cha kupitanso patsogolo kwa retinopathy nthawi 2 ndikuchepetsa kuchuluka kwa milandu yatsopano ndi 1/3 mkati mwa zaka 2 zowonedwa.

Kuphatikiza pa kugwiritsa ntchito bwino kwa lisinopril, kugwiritsa ntchito kwa mitundu ina ya ACE inhibitors (Captopril, fosinopril, perindopril, ndi zina zambiri).

Komanso, pakuwongolera kagayidwe ka lipid ndi mapuloteni, olemba angapo amalimbikitsa kugwiritsa ntchito mavitamini A, B1, B6, B12, B15, fenofibrate ndi anabolic steroids.

Amadziwika kuti fenofibrate, kuwonjezera pa kukonza kwa hypertriglyceridemia ndi dyslipidemia, ikhoza kuletsa mawu a VEGF receptors ndi neovascularization, komanso kukhala ndi antioxidant, anti-kutupa ndi neuroprotective.

M'magawo oyambilira a DR, kutchulidwa kwa lipid peroxidation kunadziwika, chifukwa chomwe wolemba adapeza zabwino kuchokera kugwiritsidwa ntchito kwa tocopherol (1200 mg patsiku).

Zotsatira zabwino zomwe zidawonetsedwa ndikugwiritsa ntchito mitundu yovuta ya antioxidant - systemic (alpha-tocopherol) ndi mafilimu am'deralo (ophthalmic mankhwala omwe ali ndi emoxipin), ndi mankhwala a mexidol.

Zotsatira zamankhwala zamaphunziro angapo owona kawiri, owongoleredwa ndi placebo ku DR adatsimikizira zovuta zamachitidwe a Tanakan mwa mawonekedwe osintha machitidwe a retina ndikuwonjezera kuwonekera kwamphamvu.

• Mitsempha yamitsempha yama minyewa.

Kuyambira 1983, kafukufuku wambiri komanso wazachipatala adachitidwa pakugwiritsa ntchito ma peptide bioregulators ku DR. Peptide bioregulators amawongolera kagayidwe kachakudya mu retina, ali ndi anti-aggregation ndi hypocoagulation zotsatira, ndi antioxidant ntchito.

Aldose reductase zoletsa.Kugwiritsa ntchito aldose reductase inhibitors, ma enzyme omwe amatenga gawo la glucose metabolism kudzera njira ya polyol ndi kudzikundikira kwa sorbitol m'maselo a insulini odziyimira pawokha, akuwoneka kuti akuwonjeza.

M'maphunziro oyesera a nyama, zidawonetsedwa kuti aldose reductase inhibitors imalepheretsa kuchepa kwa pericyte pa retinopathy.

• Direct inhibitors a mtima endothelial kukula factor (VEGF).

Kugwiritsa ntchito ma inhibitors mwachindunji a vascular endothelial grow factor (VEGF) ndi gawo lina lodalitsika pochiza DR. Monga tikudziwika, chinthu cha VEGF chimayambitsa kukula kwa zombo zapakhomo zopangidwa kumene, kutaya magazi ndi kutulutsa kuchokera mu ziwiya za patina.

Intraocular dongosolo la anti-VEGF factor imatha kukhala yogwira magawo oyambilira a DR ndikuchepetsa macular edema kapena retinal neovascularization. Pakadali pano ma anti 4 a anti-VEGF alipo: pegaptamib sodium, ranibizumab, bevacizumab, aflibercept.

Ma Vasodilator pakali pano amalimbikitsidwa kuti azigwiritsidwa ntchito mosiyanasiyana komanso mosamala. Pali chochitika chabwino chogwiritsa ntchito xanthinol nicotinate pochotsa matenda a hemorheological ku DR ndi mitundu ya hypotonic komanso hypertonic.

Njira zomwe zimalimbitsa khoma lamitsempha, poletsa kuchuluka kwake, ndi gulu lalikulu pakati pa mankhwala omwe amagwiritsidwa ntchito pochiza DR.

Kuchokera pagululi, rutin ndi zotumphukira zake, vitamini E, ascorbic acid, ndi doxium (calcium dobsilate) adagwiritsidwa ntchito. Pogwiritsa ntchito mankhwala a gululi kwa nthawi yayitali (miyezi 4 - 8 kapena kuposerapo), olemba adafufuza kutulutsa kwina kwa retinal.

Kuwongolera mkhalidwe wa endothelium ndi chapansi chotupa cha khoma lamasamba kumawoneka kuti ndi njira imodzi yolimbikitsira pankhani ya chithandizo cha magawo oyambilira a DR komanso kupewa kupewa kwa matendawa.

Zaka zaposachedwa, pakhala pali malipoti ambiri okhudza kugwiritsa ntchito mankhwalawa Sulodexide (Wessel Duet F, Alfa Wassermann) kuchokera pagulu la glycosaminoglycans (GAG), lomwe lili ndi gawo laling'ono la heparin (80%) ndi dermatin-sulfate (20%) pa chithandizo cha DR.

Sulodexide ndi DR imakhala ndi zovuta:

1. angioprotective - kubwezeretsanso kwa magetsi kwa chipinda chapansi komanso kukhulupirika kwa khoma la mtima.
2. antithrombotic,
3. microsolytic,
4. antihypertensive

Njira zopangira opaleshoni

Kuphatikiza kwa laser sikumakhala koopsa komanso kothandiza kwambiri. Pakadali pano pakupanga mankhwala, iyi ndiye njira yabwino kwambiri yowongolera mashuga matenda ashuga retinopathy.

Ndondomeko ikuchitika pogwiritsa ntchito mankhwala oletsa ululu m'malo momwe madontho, safunikira kukonzekera mosamala komanso nthawi yayitali yokonzanso.

Malangizo apadera amafunikira kuyesedwa koyambirira, ngati kuli kotheka, chithandizo chamankhwala pambuyo potsatira njirayi ndi nthawi yopumula mutatha kulowererapo.

Ndondomeko imatenga pafupifupi theka la ola, wodwalayo samamva kupweteka komanso kusapeza bwino. Pankhaniyi, kugonekedwa kwa chipatala kwa wodwala sikufunikanso, chifukwa njirayi imachitika pang'onopang'ono.

Zovuta zokhazokha za laser coagulation ndizofufuza akatswiri wabwino komanso zida zosakwanira zamagulu azachipatala. Si chipatala chilichonse chomwe chimakhala ndi zida zotere, chifukwa chake okhala kumadera akutali ayenera kulingaliranso mtengo wa ulendowu.

Nthawi zina, mphamvu ya laser coagulation ikhoza kukhala yosakwanira, motero njira ina imagwiritsidwa ntchito - opareshoni. Amatchedwa vit sahihiomy ndipo amachitidwa pansi pa opaleshoni yotupa.

Chofunikira chake ndikuchotsa ma membrane owonongeka a retinal, thupi lamatupi oyeserera komanso kukonza kwa mtima. Malo abwinobwino a retina mkati mwa nsidze ndi mawonekedwe a kulumikizana kwamankhwala amatithandizanso.

Nthawi yokonzanso imatenga masabata angapo ndipo imafuna mankhwala othandizira pambuyo pake. Amathandizira kuthetsa kuthekera kotheka, kuteteza chitukuko cha matenda obwera pambuyo pake ndi zovuta.

Kusankhidwa kwa njira yoyenera yowonetsera mashuga retinopathy kumachitika malinga ndi momwe wodwalayo alili. ziyenera kudziwika kuti ndizosatheka kukwaniritsa machiritso athunthu, chifukwa chake, izi zimachepetsa njira za m'maso.

Mwina m'zaka zochepa wodwalayo adzafunikanso kuchitapo kanthu, kotero kuti amapita kwa ophthalmologist atachita bwino opaleshoniyo sanathe.

Kuzindikira kwa odwala

Kutalika kwa moyo ndi kusungidwa kwa mawonekedwe owonekera kumadalira kuchuluka kwa kuwonongeka kwa maso, zaka komanso nthawi yayitali ya matenda ashuga. Ndikovuta kwambiri kuzindikira kuti palibe, chifukwa Zizindikiro za wodwala ziyenera kukumbukiridwa.

Kuphatikiza apo, ndi diabetesic retinopathy, kuwonongeka kwa ziwalo zina ndi machitidwe kumayesedwa pogwiritsa ntchito njira zosiyanasiyana zapadziko lonse lapansi. Pafupifupi, kukula kwa retinopathy kumachitika zaka 10 mpaka 15 pambuyo pa kutsimikiza kwa matenda a shuga, ndipo zotsatira zosasinthika zimapezekanso panthawiyi.

Nthawi zambiri, zovuta za matendawa zimatchedwa kupezeka kwa matenda ophatikizika ndi matenda. Matenda a shuga amakhudza ziwalo zonse zamkati ndi kachitidwe ka thupi, koma ntchito yowoneka imakhala yoyambirira.

Matenda a shuga a retinopathy ndi omwe amachititsa kuti anthu azikhala ndi matenda ashuga kwambiri. Mothandizidwa ndi kusintha kwa kayendetsedwe ka kagayidwe kazinthu, ntchito ya zotengera zomwe zimagwiritsa ntchito zida za ocular zimalephera, zomwe zimayambitsa zotupa m'mimba ndi ma process a maso.

Matendawa samadziwonekeranso kumayambiriro, kotero odwala ambiri amapita kwa dokotala kale ndi njira zosasintha. Kuti izi zisachitike, muyenera kupita kukaonana ndi maso kuti mumayang'ane maso anu ndi ma retina.