Matenda a shuga a retinopathy

Diabetesic retinopathy ndi amodzi mwa mitundu ya microangiopathy yomwe imayamba motsutsana ndi maziko a matenda oopsa a shuga komanso amakhudza mitsempha yamagazi ya retina. Izi ndizomwe zimapangitsa kuti anthu azidwala matenda ashuga.

Matenda a shuga a retinopathy nthawi zambiri amakhudza maso onse awiri, koma kuwonongeka kwake kumakhala kosiyana.

Zoyambitsa ndi Zoopsa

Ndi nthawi yayitali ya matenda ashuga, kusokonekera kwa dysmetabolic kumayambitsa mitsempha yamagazi ya retina (retina). Izi zikuwonetsedwa:

kuphwanya patency (chidziwitso) cha capillaries,
kuchuluka kwa khoma lamitsempha,
kukulitsa kwa minofu yocheperako (yowonjezera),
kapangidwe kazinthu kakang'ono ka magazi.

Zowopsa zazikulu zomwe zimapangitsa kuti odwala matenda ashuga akhale ndi matenda ashuga ndi:

kutalika kwa matenda ashuga
kunenepa
mulingo wa hyperglycemia,
kusuta
ochepa matenda oopsa
chibadwa
aakulu aimpso kulephera
mimba
dyslipidemia,
kutha,
kagayidwe kachakudya matenda.

Mitundu ya matenda

Mitundu yotsatira ya matenda ashuga retinopathy imasiyanitsidwa malinga ndi zomwe zasintha patsiku la ocular:

Zosakondweretsa. The permeability and fragility of the retinal shipping kuongezeka, zomwe zimapangitsa kuti pakhale micaneurysms komanso mawonekedwe a hemorrhages, chitukuko cha retinal edema. Ndi chitukuko cha macular edema (m'chigawo chapakati cha retina), masomphenya amachepa.
Preproliferative. Kubwera kwa arterioles kumachitika, komwe kumabweretsa pang'onopang'ono retinal ischemia ndi hypoxia, kumachitika kwa venous kusokonezeka ndi hemorrhagic mtima kugunda.
Kuchulukitsa. Matenda a retinal hypoxia amachititsa kuti dongosolo la neovascularization liyambe, ndiye kuti, mapangidwe amitsempha yatsopano yamagazi. Izi zimaphatikizidwa ndimatumbo amitsempha yamagazi ambiri. Zotsatira zake, kuphatikizika kwa michere kumapangika pang'onopang'ono, komwe kumayambitsa kukokoloka kwamtundu, mawonekedwe a yachiwiri ya neovascular glaucoma.

Mitundu ikulu ya matendawa, makamaka kuphatikiza ndi atherosulinosis ndi matenda oopsa, nthawi zambiri imayambitsa kusawona bwino.

Matenda a shuga a retinopathy amakhala kwa nthawi yayitali. Mu magawo oyamba, matendawa amakhala asymptomatic komanso osapweteka. Palibenso zochitika zam'munsi zomwe zimapangitsa kuti chidwi chizikhala chochepa kwambiri. Ndi chitukuko cha macular edema, odwala amatha kudandaula kuti samawona bwino patali kapenanso kuwoneka kwamaso, zinthu zopanda pake zimawonedwa.

Mukukula kwa matendawa, chophimba chimawonekera nthawi ndi nthawi pamaso pa malo, malo okhala. Kupezeka kwawo kumalumikizidwa ndi intraocular hemorrhage. Zitatha kutulutsa magazi, mawonekedwewo amadzimiririka okha. Ndi kukhathamiritsa kwamkati kwamatumbo, kuwonongeka kwathunthu kwamatha kumachitika.

Zizindikiro

Pozindikira koyambirira kwa matenda ashuga retinopathy, odwala matenda a shuga ayenera kupendedwa pafupipafupi ndi ophthalmologist. Njira zotsatirazi zimagwiritsidwa ntchito ngati njira yosanthula kuti muwone kusintha kwa diso:

zoyipa
Ma Visometry
diso biomicroscopy ndi nyali yoyenda,
ophthalmoscopy ndi mankhwala oyamba osakaniza ndi ana
diaphanoscopy ya mawonekedwe a maso,
muyeso wa intraocular anzawo (tonometry).

Ngati thupi la mandala ndi mandala latuluka, kuyezetsa maso ndi maso kumachitika m'malo mwa ophthalmoscopy.

Kuyesa ntchito za mitsempha ya optic ndi retina, njira zamagetsi zamagetsi zimagwiritsidwa ntchito, makamaka zamagetsi, electroretinography. Ngati glaucoma ya neovascular ikukayikira, gonioscopy imasonyezedwa.

Njira imodzi yayikulu yodziwira matenda ashuga retinopathy ndi fluorescence angiography, yomwe imakupatsani mwayi wowunika mawonekedwe amomwe magazi amayendera m'mitsempha yam'mimba.

Matenda a shuga a retinopathy nthawi zambiri amakhudza maso onse awiri, koma kuwonongeka kwake kumakhala kosiyana.

Chithandizo cha matenda ashuga retinopathy umalimbana ndi kukonza kwakukulu kwamatenda amthupi, kuchuluka kwa kuthamanga kwa magazi, komanso kusintha kwa ma microcirculation.

Ndi macular edema, jekeseni wa intravitreal wa corticosteroids amatha kuchiritsa.

Progressive diabetesic retinopathy ndiye maziko othandizira a laser a retina, omwe amachepetsa kulimba kwa machitidwe a neovascularization ndikuchepetsa chiopsezo cha kufalikira kwa retinal.

Mukudwala matenda ashuga retinopathy, ophatikizika ndi retinal detachment kapena macular traction, vitrectomy amachitidwa. Pa opaleshoni, vitreous imachotsedwa, zotupa zamkati za magazi, zotulutsa zingwe zolumikizana.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Kukula kwa matenda ashuga retinopathy kumabweretsa zovuta zotsatirazi:

kuyamwa
sekondale yachiwiri
kuchepa kwakukulu kwa malo owoneka,
mphira
khungu lathunthu.

Pozindikira koyambirira kwa matenda ashuga retinopathy, odwala matenda a shuga ayenera kupendedwa pafupipafupi ndi ophthalmologist.

Kukula kwa matenda ashuga a retinopathy a zooneka ndi ntchito nthawi zonse amakhala akulu. Mitundu ikulu ya matendawa, makamaka kuphatikiza ndi atherosulinosis ndi matenda oopsa, nthawi zambiri imayambitsa kusawona bwino.

Kupewa

Njira zopewera zomwe zimalepheretsa kusakhazikika kapena kupitirira kwa matenda a shuga a shuga:

kuyang'anira pafupipafupi glycemia,
kutsatira mosamalitsa njira ya insulin kapena kuperekera mankhwala ochepetsa shuga,
kudya (tebulo Na. 9 malinga ndi Pevzner),
matenda a kuthamanga kwa magazi,
munthawi ya laser retinal coagulation.

Mankhwala

Shuga wambiri amakhudza mitsempha yomwe imadyetsa maso, kusokoneza kutuluka kwa magazi kudzera mwa iwo. Tiziwalo timamaso timakumana ndi kuchepa kwa mpweya. Amabisalira zinthu zina zotchedwa kukula zomwe zimapangitsa kuti ziwiya zija zikulire komanso kuti magazi azituluka. Tsoka ilo, zombo zatsopano zimakhala zopanda mphamvu. Mwa izi, zotupa m'mimba nthawi zambiri zimachitika. Zotsatira za kutaya magazi pakapita nthawi zimatha kubweretsa kukanidwa kwina (khungu) komanso khungu.

Mankhwala otchedwa grow factor inhibitors (anti-VEGFs) amalepheretsa mawonekedwe amitsempha yatsopano yamagazi. Kuyambira 2012, m'maiko olankhula Chirasha, mankhwalawa Lucentis (ranibizumab) ndi Zaltrap (aflibercept) agwiritsidwa ntchito. Awa si mapiritsi. Amayikidwa mu vitreous (intravitreal). Kuti mupeze jakisoni, muyenera katswiri woyenera. Mankhwalawa ndiokwera mtengo kwambiri. Amatetezedwa ndi ma Patenti motero alibe zofananira zomwe zimakhala zotsika mtengo kwambiri. Kuphatikiza pa othandizira awa, adokotala atha kukulembani mankhwala okhala ndi dexamethasone omwe amatha nthawi yayitali kuti athandize odwala matenda ashuga a macular edema. Mankhwalawa amatchedwa Ozurdeks.

Lucentis (runibizumab)

Palibe madontho amaso ndi wowerengeka azithandizo za matenda ashuga retinopathy. Odwala nthawi zambiri amawonetsa chidwi ndi madontho a maso a Taufon. Mankhwalawa alibe ngakhale diabetesic retinopathy pamndandanda wovomerezeka wazomwe ungagwiritse ntchito. Zomwe zimagwira ndi taurine. Mwina ndizothandiza kwa edema, ngati gawo limodzi la zovuta zochizira matenda ochepa komanso kulephera kwa mtima. Werengani za izi apa mwatsatanetsatane. Ndikwabwino kuti uzitenga pakamwa, osati mawonekedwe amaso. Monga riboflavin ndi mavitamini ena a gulu B. Musagwiritse ntchito ndalama pakutsitsa kwamaso ndi wowerengeka azitsamba. Osataya nthawi yamtengo wapatali, koma yambani kuthandizidwa m'njira zopewera khungu.

Laser retinal coagulation

Kupanga ndiko moxibustion. Panthawi yogwiritsa ntchito laser ya retina, kuwotcha kwamphamvu kumayikidwa m'matumbo. Izi zikulepheretsa kukula kwa capillaries atsopano, kumachepetsa pafupipafupi komanso kuopsa kwa kutulutsa magazi. Njira yokhazikika ndiyothandiza kwambiri. Zimakuthandizani kukhazikika pang'onopang'ono pamlingo wowonjezera wa matenda ashuga retinopathy mu 80-85% ndi gawo lakukula mu 50-55% ya milandu. Mukuvutikira kwambiri kwa matenda ashuga m'maso, zimapangitsa kupewa khungu mu 60% ya odwala kwa zaka 10-12.

Kambiranani ndi ophthalmologist ngati njira imodzi yotsatsira laser ikukwanira, kapena muyenera kuchita zingapo. Monga lamulo, pambuyo pa njira iliyonse, mawonekedwe a wodwalayo amayamba kufooka pang'ono, kukula kwa munda wake kumachepa, ndipo kuwona kwamadzulo ndikosavutikira. Koma patapita masiku ochepa zinthu zimakhazikika. Pali mwayi waukulu kuti zotsatira zake zitha nthawi yayitali. Kutupa kwa laser kwa retina kungaphatikizidwe ndi kugwiritsa ntchito mankhwala, zoletsa za kukula kwa mtima (anti-VEGF), monga momwe dokotala adasankhira. Vutoli lingachitike ndikubwereza kwamatumbo ambiri, omwe amalepheretsa. Pankhaniyi, vitrectomy ndiyofunikira.

Chikatsika

Vitrectomy ndikuchotsa opaleshoni ya thupi lake lomwe lasintha chifukwa cha kukoka magazi. Dongosolo lochotsedwa limasinthidwa ndi saline wosabala ndi ma polima owumba. Kuti afike ku vitreous, dokotalayo amadula zopindika za retina. Pamaso pa kuundana kwa magazi, amachotsedwanso, limodzi ndi minofu yosinthika ya m'magazi.

Kuchita opareshoni kumachitika pansi pa opaleshoni wamba. Pambuyo pakuwona kwake kuyambiranso. Mwayi wake ndi 80-90% kwa odwala omwe sanakane. Ngati kukanidwa kwina kwachitika, ndiye kuti mu opareshoniyo mubwezeretsedwa kumalo ake. Koma mwayi wochira umachepetsedwa mpaka 50-60%. Vitrectomy nthawi zambiri imatha maola 1-2. Nthawi zina zimakhala zotheka popanda wodwala kuchipatala.

Mawonetseredwe azachipatala

Microaneurysms, hemorrhages, edema, exudative foci mu retina. M'mimba muli mawonekedwe a madontho aang'ono, mikwingwirima kapena mawanga amdima a mawonekedwe ozungulira, opangidwira pakatikati pa fundus kapena m'mitsempha yayikulu m'mitsempha yayitali ya retina. Ma exudates olimba komanso ofewa nthawi zambiri amakhala mkati mwa fundus ndipo amakhala achikasu kapena oyera. Chofunikira pa siteji iyi ndi edema ya retinal, yomwe imapezeka m'deralo kapena mkati mwa sitima zazikulu (mkuyu. 1, a)

Zotsatira zosavomerezeka: lakuthwa, kuzungulira, kuzungulira, kubwereza komanso kutulutsa kusinthasintha kwa mawonekedwe amitsempha yamagazi. Chiwerengero chambiri cha "thonje" yolimba ndikuthamanga. Intraretinal microvascular anomalies, zotupa zazikulu za retinal hemorrhages (mkuyu. 1, b)

Neovascularization of the optic disc ndi magawo ena a retina, vitreous hemorrhage, mapangidwe a minyewa ya fibrous m'dera la preretinal hemorrhages. Zombo zatsopano zomwe zimapangidwa ndizochepa kwambiri komanso zosalimba, chifukwa cha zomwe zimatulutsa pafupipafupi kutulutsa magazi. Vuto la Vitreoretinal limayambitsa kuyamwa. Zombo zatsopano zopangidwa ndi iris (rubeosis) nthawi zambiri zimayambitsa kukula kwa glaucoma yachiwiri (mkuyu. 1, c)