Matenda a shuga a retinopathy

Matenda a shuga a retinopathy ndi microangionathia omwe ali ndi vuto loyambira la arterioles, capillaries ndi postcapillary venological ndi kuthekera kwokhudzana ndi ziwiya zamphamvu zazikulu. Retinopathy imawonetsedwa ndi microvascular occlusion ndi kutayikira. Makamaka, matenda a shuga a retinopathy akhoza kukhala:

• maziko (osachirikiza), momwe zamomwe zimakhalira zam'thupi zimakhala zochepa,
• kuchuluka, momwe matenda amafalikira pang'onopang'ono kumbuyo kwa retina kapena kupitirira apo,
• prroliferative, yodziwika ndi mawonekedwe osagonjetseka owonjezereka.

Matenda a shuga ndi matenda oopsa a metabolism omwe amadziwika chifukwa cha kuchuluka kwa nthawi yayitali kwa hyperglycemia, komwe kumachitika nthawi yachiwiri poyankha kuchepa kwa ndende komanso / kapena zochita za insulin. Matenda a shuga amatha kudalira insulin kapena osadalira insulini, omwe amatchulidwa monga mtundu 1 kapena mtundu 2 wa shuga. Matenda a shuga a retinopathy ndiofala kwambiri ndi matenda amtundu 1 shuga (40%) kuposa okhala ndi matenda a shuga 2 (20%) ndipo ndi chimodzi mwazomwe zimayambitsa khungu kwa anthu azaka zapakati pa 20 mpaka 65.

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Zomwe Zimayambitsa Matenda A shuga a retinopathy

Kutalika kwa matenda ashuga ndikofunikira. shuga Mukamazindikira odwala omwe ali ndi zaka zosakwana 30, mwayi wokhala ndi matenda ashuga pambuyo zaka 10 ndi 50% ndipo pambuyo pa zaka 30 - 90% ya milandu. Matenda a shuga a retinopathy samapezeka kwambiri pazaka zisanu zoyambirira za matenda ashuga komanso kutha msinkhu, koma amapezeka mwa 5% ya odwala omwe ali ndi matenda a shuga 2.

Kulephera kuwongolera kagayidwe kachakudya mthupi ndi chifukwa chachikulu chomwe chimapangitsa kuti matenda ashuga asinthe. Mimba nthawi zambiri imathandizira kukula kwa matenda ashuga retinopathy. Zomwe zimapangidwiratu zimaphatikizaponso kusakwanira koteteza matenda oyambitsidwa musanatenge pathupi, mwadzidzidzi khalani ndi chithandizo chamankhwala poyambira kutenga pakati, komanso kukula kwa preeclampia ndi kusalinganika kwamadzi. Matenda oopsa a arterial ndi osakwanira kuwongolera kupititsa patsogolo kwa matenda ashuga a retinopathy komanso kukulira kwa mitundu yambiri ya matenda ashuga retinopathy a mitundu 1 ndi 2. Pachimake nephropathy kumabweretsa kukulira njira ya matenda ashuga retinopathy. Momwemonso, chithandizo cha matenda a impso (mwachitsanzo, kupatsirana kwa impso) chimatha kutsagana ndi kusintha kwa mkhalidwewo ndi zotsatira zabwino pambuyo pa Photocoagulation. Zina zomwe zili pachiwopsezo cha matenda a shuga a retinopathy ndi kusuta, kunenepa kwambiri, hyperlipidemia.

Ubwino wa Kutanthauzira Kwambiri kwa Metabolic

• Kuchedwa chitukuko cha matenda ashuga retinopathy, koma kupewa.
• Kuchepetsa makulidwe a matenda a shuga a latentic retinopathy.
• Kuchepa kwa kuchuluka kwa kusintha kwa matenda a shuga a retinopathy.
• Kuchepetsa macular edema.
• Kuchepetsa kuchepa kwa laser.

Pathogenesis wa matenda ashuga retinopathy

Pathogenesis ya retinopathy imakhazikika pamayendedwe a m'magazi a retina.

• capillaries. Kusintha kwawo kumayimiriridwa ndi kutayika kwa ma perisonte, kuwonda kwa membrane wapansi, kuwonongeka ndi kuchuluka kwa maselo a endothelial. zovuta zapakati pa hematological zimayimiriridwa ndi kukonzanso ndikuwonjezereka kwa chizindikiritso cha "zipilala za ndalama", kuchepa kwa kusintha kwa maselo ndi kuphatikiza, zomwe zimapangitsa kuchepa kwa kayendedwe ka okosijeni.

Zotsatira zakusowa kwa mafuta a retinal capillaries ake ndi ischemia, yomwe poyamba imawonekera pakatikati kwapakati. Mawonetsero awiri akuluakulu a retinal hypoxia ndi awa:

• arteriovenular shunts, limodzi ndi zovuta ma occlusion ("kutali") a capillaries motsogozedwa ndi arterioles kupita kwa venums. Sizikudziwika ngati kusintha kumeneku kumaimiridwa ndi zotengera zatsopano kapena kutsegulidwa kwa njira zomwe zilipo zam'mimba, chifukwa chake zimatchedwa kuti intraretinal micvascular abnormalities.
• neovascularization imadziwika kuti ndiyomwe imayambitsa zochita za angiopoietic zinthu (kukula kwa zinthu) zomwe zimapangidwa mu hypoxic minofu ya retina ikayesedwa kuti isinthe. Zinthu izi zimathandizira kukomoka kwa retina ndi optic disc, ndipo nthawi zambiri iris (iris rubeosis). Zambiri zomwe zimakula sizimadzipatula, koma chofunikira kwambiri ndi kukula kwamphamvu ya mtima.

Kulephera kwa chotchinga chamkati kumabweretsa kutsekeka kwa zinthu za m'madzi mu retina. Kutopa kwakuthupi kwa makoma a capillaries kumabweretsa kutuluka kwa khoma kwakanthawi, komwe kumatanthauza kuti ma micaneurysms, kutuluka thukuta kapena kutulutsa mawu.

Chowonetsera cha kuchuluka kwa mtima wam'mimba ndikupangika kwa mitsempha yamatumbo ndi edema, yomwe ikhoza kusokoneza kapena yam'deralo.

• kusokoneza edema ndizotsatira zakukulitsa kwodziwika kwa capillaries ndi masamba,
• Local retinal edema ndi chifukwa chakuthambo kwachangu kuchokera ku micaneurysms ndikukulitsa magawo a capillaries.

Matenda am'mbuyo am'malo amtunduwu amachititsa kuti azisungika chifukwa cha kusintha kwa retina ndi edema yathanzi. Zopangika zopangidwa ndi lipoproteins ndi macrophages odzazidwa ndi lipids zimazungulira dera lachiwonetsero cha microvascular mawonekedwe a mphete. Atamaliza kutaya, amatha kumizidwa mwaulere m'magawo ozungulira, kapena atayika, ndipo amatha miyezi yambiri ngakhale zaka. Kutha kwa nthawi yayitali kumapangitsa kuti mafuta azikulirakulira komanso kuwonjezereka kwa mafuta m'thupi.

Nonproliferative Diabetesic Retinopathy

Ma Microaneurysms amapezeka mkati mwa nyukiliya yamkati ndipo ali m'gulu la matenda oyamba kupezeka.

• Madontho ofowoka, ozungulira, ofiira, makamaka owonekera kwakanthawi kochokera ku fovea. Ngati azunguliridwa ndi magazi, ndiye kuti sangasiyane ndi kutulutsa magazi pakhungu.
• retinal assay wa trypsin mu matenda ashuga retinopathy ndi parifocal microaneurysms:
• ma micaneurysms okhala ndi ma cell pakukweza kwakukulu,
• FAG imawulula mfundo zapamwamba kwambiri, zomwe ndi nontrombiric microaneurysms, kuchuluka kwake komwe kumakhala kwakukulu poyerekeza ndi ophthalmoscopically kuwoneka. M'magawo apambuyo, kusokoneza Hyperfluorescence chifukwa cha tsamba lamadzi.

Ma exudates olimba amapezeka kunja kwa wosanjikiza.

• zotupa zofiirira, zachikaso zowoneka bwino m'mphepete, ndikupanga masango ndi / kapena mphete zapakhomo. Pakati pa mphete ya solid exudate (annular exudate), ma micaneurysms nthawi zambiri amatsimikiza. Popita nthawi, kuchuluka kwawo ndi kukula kwake, komwe kumabweretsa chiwopsezo ku fovea ndi kuthekera kwakutenga nawo gawo pazochitika za pathological,
• Phage akuwonetsa hypofluorescence chifukwa chakutseka kwa maziko a choroid.

Retinal edema makamaka imasanjidwa pakati pamagawo akunja a plexiform ndi zigawo za nyukiliya yamkati. Pambuyo pake, zigawo zam'mimba za plexiform ndi mawonekedwe a ulusi wamanjenje zitha kuphatikizidwa mpaka edema ya retina mpaka kukula konse. Kudzikundikira kwina kwamadzi mu fovea kumabweretsa mapangidwe a cyst (cystic macular edema).

• retema edema imawonedwa bwino mukaonera pa nyali yoyaka pogwiritsa ntchito mandala a Goldmann,
• Phage amawulula mochedwa hyperfluorescence chifukwa chodontha kwa capillaries a retinal.

• mitsempha yotupa ya m'mimba imawonekera kuchokera kumalekezero a capillaries ndipo ili mkati mwa zigawo za retina. Mitsempha iyi ndi kuloza, imakhala ndi utoto wofiira komanso makonzedwe osasintha,
• m'mitsempha yamafupa am'mimba ya retina, zotupa zimatuluka kuchokera ku ma arterioles akuluakulu apamwamba kwambiri, omwe amachititsa mawonekedwe awo kukhala ngati "malilime amoto".

Njira zoyendetsera odwala omwe alibe proliferative diabetesic retinopathy

Odwala omwe alibe proliferative diabetesic retinopathy safuna chithandizo, koma amafunikira pachaka. Kuphatikiza pa kuwongolera kwabwino kwa matenda ashuga, zifukwa zokhudzana ndi (matenda oopsa, kuchepa kwa magazi, komanso matenda a impso) ziyenera kuganiziridwanso.

Preproliferative diabetesic retinopathy

Kuwoneka kwa zizindikiro zakuwopseza kuchulukana kwa osachiritsika odwala matenda ashuga retinopathy kukuwonetsa chitukuko cha prroliferios matenda a shuga. Zizindikiro zamankhwala a prrolopritis diabetesic retinopathy zikuwonetsa pang'onopang'ono retinal ischemia, wopezeka pa FLG mu malo oopsa a hypofluorescence a retina wosagonjetseka (capillary "off"). Chiwopsezo cha kupita patsogolo kuti chiwonjezeke chikugwirizana mwachindunji ndi kuchuluka kwa kusintha kwakukulu.

Zochitika zamankhwala a prrolopative diabetesic retinopathy

Potton-ngati foci ndi magawo am'deralo a vuto la mtima pamtunda wa ulusi wamitsempha yam'mimba chifukwa cha kuphipha kwa arterioles a precapillary. Kulowerera kwa axoplasmic pakadali pano komanso kudzikundikira kwa zinthu zomwe zimatengedwa mu axons (axoplasmic stasis) kumapereka chidwi.

• Zizindikiro: zing'onozing'ono, zoyera, zokhala ngati thonje zomwe zimaphimba mitsempha yamagazi yomwe ili pansipa.
• FAG imawulula hypofluorescence yakumaloko chifukwa chobisa kumbuyo kwa choroid, komwe nthawi zambiri kumatsatiridwa ndi zigawo zina zapafupi zama capillaries osagwiritsidwa ntchito.

Intraretinal microvascular protein imayimiriridwa ndi ma shunts kuchokera ku retter arterioles kupita ku venological, kudutsa bedillary, chifukwa chake, nthawi zambiri amakhala otsimikiza pafupi ndi malo osokoneza magazi a capillary.

• Zizindikiro: mikwingwirima yofiyira yolumikizira ma arterioles ndi ma venass, okhala ndi mawonekedwe am'deralo a zombo zapamwamba zatsopano zopangika. Chomwe chimasiyanitsa zovuta zamtundu wa intraretinal microvascular ndi malo omwe ali mkati mwa retina, kuthekera kwodutsa ziwiya zazikulu komanso kusapezeka kwa thukuta pamtunda.
• Phage akuwonetsa hyperfluorescence yakumalo yomwe imalumikizidwa ndi madera oyandikana ndi kusokonezeka kwa magazi a capillary.

Matenda oyipa: kukulira, kupangidwa kwa malupu, magawo a mawonekedwe a "bead" kapena "roza".

Zovuta zapamtunda: constriction, chizindikiro cha "siliva waya" ndi kuwonongeka, komwe kumapangitsa kuti zifanane ndi kuphatikizika kwa nthambi ya central repinal artery.

Malo amdima am'matumbo: hemorrhagic retinal infarares ili mkati mwake.

Njira zamakonzedwe a odwala omwe ali ndi prroliferative diabetesic retinopathy

Ndi Prerolopative diabetesic retinopathy, kuwunika kwapadera kumafunikira chifukwa chowopsa chokhala ndi matenda ashuga omwe amapitilira patsogolo.

Matenda a shuga a shuga

Choyambitsa chachikulu cha kuwonongeka kwamawonekedwe kwa odwala omwe ali ndi matenda ashuga, makamaka mtundu wa 2 shuga, ndi fovea edema, mawonekedwe a exudate olimba kapena ischemia (matenda ashuga maculopathy).

Gulu la odwala matenda ashuga Maculopathy

Local exudative matenda ashuga maculopathy

• Zizindikiro: kukulira pang'ono kwa retina, komwe kumayendetsedwa ndi mphete yathunthu kapena yopanda malire ya ma exifoveal solid exudates,
• PHA imawululira mochedwa hyperfluorescence chifukwa chakutuluka thukuta komanso kupukusira kwa ma cell ambiri.

Zovuta zakuda za matenda ashuga maculopathy

• Zizindikiro: kuyambitsa makulidwe a retina, omwe amatha limodzi ndi kusintha kwa cystic. Kugawanika ndi edema kwambiri nthawi zina kumapangitsa kuti zikhale zosatheka kutengera fovea,
• FAG imawulula mfundo zingapo zoopsa zama microanefysoresence komanso kuchedwa kuyambitsa Hyperfluorescence chifukwa cha thukuta, lomwe limatchulidwanso poyerekeza ndi mayeso am'chipatala. Pamaso pa cystic macular edema, malo omwe ali ngati "maluwa petal" amatsimikiziridwa.

Ischemic Diabetesic Maculopathy

• Zizindikiro: kuchepa kowoneka bwino ndi fovea yotetezeka, yomwe nthawi zambiri imakhudzana ndi prinopathy ya matenda a shuga. Malo amdima akhungu atha kupezeka,
• Phage akuwulula ma capillaries osagwiritsidwa ntchito popanga fovea, kuopsa kwake komwe sikugwirizana nthawi zonse ndi kuchepa kwa zowoneka bwino.

Zigawo zina za ma capillaries osagwiritsa ntchito mafuta omwe amapezeka nthawi zambiri amapezeka pachipinda chakumaso ndi kufupi.

Maculopathy osakanikirana ndi matenda ashuga amakhala ndi zizindikiro za ischemia komanso exudation.

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Makamaka edema yama macular

Makamaka edema yofunika kwambiri imadziwika ndi izi:

• Retinal edema mkati mwa 500 μm yapakati pa fovea.
• Chotentha chimachoka mkati mwa 500 μm kuchokera mkati mwa fovea, ngati chikuyenda ndi kukula kwa retina kuzungulira (komwe kumatha kupitirira 500 μm).
• Retinal edema mkati mwa 1 DD (1500 μm) kapena kuposa, i.e. gawo lililonse la edema liyenera kugwera mkati mwa 1 DD kuchokera ku fovea wapakati.

Makamaka edema yofunika kwambiri ya macular imafunikira laser Photocoagulation mosasamala za maonedwe owoneka, popeza chithandizo chimachepetsa chiopsezo chakuwonongeka kwamaso ndi 50%. Kupititsa patsogolo mawonekedwe owoneka ndi kawirikawiri, chifukwa chake chithandizo chimawonetsedwa pofuna kupewa. M'pofunika kuchita phokoso musanayambe chithandizo kuti mudziwe madera komanso kukula kwake thukuta. kuzindikira kwa capillaries osagwira mafuta mu fovea (ischemic maculopathy), komwe ndi chizindikiro chosavomerezeka komanso kuphwanya chithandizo.

Kuphatikizika kwa laser kwapafupi kumaphatikizapo kugwiritsa ntchito laser coagulation kwa micaneurysms ndi zovuta za microvascular mkati mwa mphete za olimba okhazikika, opangidwira mkati mwa ma microns 500 500,000 kuchokera pakati pa fovea. Kukula kwa coagrate ndi ma 50-100 ma microns okhala ndi masekondi 0,10 ndi mphamvu zokwanira kuti athe kupatsanso kuwala kapena kuzizira kwa ma micaneurysms. Chithandizo cha kuyang'ana mpaka 300 μm kuchokera pakatikati pa fovea chikuwonetsedwa ndi kupangika kwapakati kachulukidwe kachulukidwe kakang'ono, ngakhale chithandizo cham'mbuyomu komanso kupenyerera pansipa 6/12. Zikatero, tikulimbikitsidwa kuti nthawi yochepetsedwa ikhale yafupika kwa masekondi 0,05, b) kugundika kwa laser kugwiritsidwa ntchito pamaso pa malo oyambitsa kutulutsa kwa retina komwe kuli kutali ndi 500 μm kuchokera pakati pa fovea ndi 500 μm kuchokera pamphepete mwa mutu wam'maso. Kukula kwa ma coagulates ndi ma micons a 100-200, nthawi yowonekera ndi 0.1 sec. Ayenera kukhala ndi utoto wowala kwambiri, amaikidwa patali molingana ndi mainchesi 1 akuwundana.

Zotsatira Pafupifupi 70% yamilandu, ndizotheka kukwaniritsa kukhazikika kwa ntchito zowoneka, mu 15% - pali kusintha, ndipo mu 15% ya milandu - kuwonongeka kwotsatira. Kusintha kwa edema kumachitika pakatha miyezi inayi, kotero kukonzanso panthawi imeneyi sikuwonetsedwa.

Zinthu Zakuwonongeratu Wosauka

Yotentha ikuphimba fovea.

• Kutupa kwa macula.
• Cystic edema ya macula.
• Wosakanikirana wachisangalalo-ischemic maculopathy.
• Retinopathy kwambiri panthawi ya mayeso.

A pars plana vit sahihiomy itha kuwonetsedwa kwa macular edema yolumikizana ndi tangential traction yomwe imachokera ku unakhuthala komanso kufinya mawonekedwe a posterior hyaloid. Zikatero, mankhwalawa a laser samathandiza poyerekeza ndi opaleshoni yochotsa ma cellular.

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Kukula kwa matenda a shuga a retinopathy

Amapezeka mu 5-10% ya odwala matenda ashuga. Mtundu woyamba wa matenda ashuga, chiwopsezo ndi chachikulu kwambiri: kuchuluka kwa anthu 60% patatha zaka 30. Zomwe zimathandizira ndizo carotid artery occlusion, posterior vitreousach, high myopia, and optic atrophy.

Zamankhwala zamatenda owonjezereka a shuga a retinopathy

Zizindikiro zakukula kwa matenda ashuga. Neovascularization ndi chizindikiro cha kuchuluka kwa odwala matenda ashuga retinopathy. Kuchulukitsa kwa zombo zatsopano zomwe zimapangidwa kumatha kuchitika pa mtunda wa 1 DD kuchokera ku optic nerve disk (neovascularization in the disk dera) kapena m'mitsinje yayikulu (neovascularization kunja kwa disk). Zonsezi ndizotheka. Kukhazikitsidwa kuti kukulira kwa proliferative diabetesic retinopathy kumayambitsidwa ndi osagwiritsa ntchito gawo limodzi mwa kotala la retina. Kusowa kwa membrane wamkati wamkati mozungulira kuwala kwa mitsempha ya m'mimba kumalongosola gawo la neoplasm m'derali. Zombo zatsopano zimawoneka ngati mawonekedwe a endothelial proliferation, nthawi zambiri kuchokera m'mitsempha, kenako zimadutsa zolakwika za membrane wamkati wamkati, zimagona mu ndege yomwe ingatheke pakati pa retina ndi kumbuyo kwake kwa thupi la vitreous, lomwe limawathandiza.

Phage. Sichifunika pakuwonetsetsa, koma imawululira za m'mitsempha yoyambirira yamagetsi ndikuwonetsa hyperfluorescence m'magawo amtsogolo chifukwa cha thukuta lomwe limatulutsa thukuta.

Zizindikiro za kuchuluka kwa matenda ashuga retinopathy

Kukula kwa proliferative diabetesic retinopathy imatsimikizidwa poyerekeza malo omwe amakhala ndi zombo zomwe zangopangidwa kumene ndi dera la optic disc:

Disk Neovascularization

• Zochepa - kukula zosakwana 1/3 DD.
• Yalengezedwa - kukula kwakukulu pa 1/3 DD.

Off-disk neovascularization

• Zochepa - kukula zosakwana 1/2 DD.
• Yalengezedwa - zazikuluzikulu kuposa 1 / DD.

Zombo zazitali zongopangidwa kumene sizimayanja chithandizo cha laser kuposa zombo zapamwamba.

Fibrosis yolumikizidwa ndi neovascularization ndiwokondweretsedwa chifukwa kuchuluka kwachulukidwe kachulukidwe kakakang'ono, ngakhale kali kochepa kutuluka kwa magazi, pamakhala chiopsezo chachikulu cha kupatsirana kwa minyewa.

Ma hemorrhages, omwe amatha kukhala preretinal (subhialoid) ndi / kapena vitreous mkati mwa vitreous, ndi gawo lofunikira pachiwopsezo chochepetsera kupenyerera kwakumaso.

Makhalidwe a chiwopsezo chowonjezereka cha kuchepa kwakukulu m'masomphenya mzaka 2 zoyambirira pakalibe chithandizo ali motere:

• Kulimbitsa thupi modekha m'dera la diski ndi zotupa ndi 26% ya chiopsezo, chomwe chimachepetsedwa mpaka 4% atalandira chithandizo.
• Kukhazikika mwamphamvu mu dera la disk lopanda kukha magazi ndi 26% ya ngozi, zomwe pambuyo poti chithandizo chatsitsidwa mpaka 9%.

Neovascularization mwamphamvu ya kuwala kwa kuwala

• Kukhazikika mwamphamvu m'dera la diski ndi zotupa ndi 37% ya chiwopsezo, chomwe pambuyo chithandizo chimachepetsedwa mpaka 20%.
• Kukhazikika mwamphamvu kwina kwa hemorrhagic disk kumakhala pangozi ya 30%, yomwe pambuyo chithandizo imachepetsedwa mpaka 7%.

Ngati izi sizikukwaniritsidwa, ndikulimbikitsidwa kukana kujambula ndi kuyesa wodwala miyezi itatu iliyonse. Komabe, kwenikweni, ophthalmologists ambiri amagwiritsa ntchito laser Photocoagulation ngakhale pachiwonetsero choyamba cha neovascularization.

Mavuto a Kukhudzika Kwa Maso A shuga

Mu matenda a shuga a retinopathy, zovuta zowopsa zomwe zimachitika zimawonekera kwa odwala omwe sanalandiridwe mankhwala a laser, kapena omwe zotsatira zake sizinakhutiritse kapena zosakwanira. Mwina chitukuko cha chimodzi kapena zingapo zotsatirazi.

Amatha kukhala mu vitreous kapena malo a retrogyaloid (preretinal hemorrhages) kapena ophatikizidwa. Ma hemorrhages a preretinal ali mu mawonekedwe a crescent, amapanga gawo la demarcation lokhala ndi chakumaso kwakunja kwa vitreous. Nthawi zina zotupa m'mimba zimatha kulowa mu thupi la vitreous. Kubwezeretsanso zotupa zoterezi kumatenga nthawi yayitali kuposa kutaya magazi m'mbuyomu. Nthawi zina, gulu ndi kapangidwe ka magazi limachitika pachinthu chakumaso kwa thupi lachipilidwe ndikupanga "membala wamtundu wa ocher." Odwala ayenera kuchenjezedwa kuti kukha magazi kumatha kuchitika chifukwa cha kupsinjika kwakuthupi kapena kupsinjika, komanso hypoglycemia kapena kuvulala kwamaso mwachindunji. Komabe, maonekedwe a kukhaulitsa nthawi ya kugona nthawi zambiri.

Retinal traction

Ikuwoneka ndi kupindika kwapang'onopang'ono kwa nembanemba wam'mimba mwa madera akuluakulu a vitreoretinal fusion. Kuchulukitsa kwakumaso kwa odwala omwe ali ndi matenda ashuga kumachitika pang'onopang'ono, nthawi zambiri kumakhala kosakwanira, komwe kumachitika chifukwa champhamvu chomata cham'mbali cham'mimba cham'mimba mwa kuchuluka kwa michere.

Mitundu yotsatirayi ya kusakhazikika kwa ma vitreoretinal imayambitsa kuyamwa kwina:

• kukokomeza kwa anteroposterior kumawonekera pomwe mgwirizano wa fibrovascular membranes, womwe umachokera gawo lam'mbuyo, nthawi zambiri umalumikizidwa ndi network yayikulu yamitsempha, kunja mpaka kumunsi kwa vitreous,
• kutsika kwa mlatho kumachitika chifukwa cha kupindika kwa ziwalo zam'mimba za fibrovascular, zomwe zimasuntha kuchokera hafu imodzi ya gawo lotsatira mpaka gawo lina. Izi zimabweretsa kusamvana m'chigawo cha mfundozi ndipo zitha kupangitsa kuti pakhale kusamvana, komanso kusunthidwa kwa wachibale wa macula ku disk, kapena ayi, kutengera komwe gulu lamphamvu lidayenda.

Zovuta zina za matenda ashuga retinopathy

Makanema okhala ndi mitambo omwe amatha kukhazikika pampando wakunja kwa zigawo zakuluzikulu zomwe zimakoka retina kuchokera kumtunda kupita pansi ku dera laling'ono la arcade. Makanema otere amatha kuphimba kwathunthu macula ndi zowonongeka zamtsogolo.

• Chosunga ndalama sichisintha.
• Olimbitsa thupi odwala matenda ashuga omwe amapezeka m'magazi ang'onoang'ono komanso / kapena olimba amawoneka patali kopitilira 1 DD kuchokera ku fovea.

Kuwongolera komwe kukakonzedwera kwa ophthalmologist

• Osachilikiza odwala matenda ashuga retinopathy okhala ndi mphete zolimba exudate mu mawonekedwe a mphete m'mphepete mwa maphwando oyambira, koma osawopseza fovea.
• Matenda a shuga omwe siwachulukirachulukira popanda maculopathy, koma amachepetsa m'maso kuti adziwe zomwe zimayambitsa.

Kutumizira koyambirira kwa a ophthalmologist

• Matendawa osachiritsika a shuga omwe amapezeka ndi zotupa kapena / kapena kukha magazi mkati mwa 1 DD ya fovea.
• Maculopathy
• Preproliferative diabetesic retinopathy.

Kutumizira mwachangu kwa ophthalmologist

• Kupitilira patsogolo matenda ashuga retinopathy.
• Preorrine kapena vitreous hemorrhages.
• Rubeosis wa Iris.
• Kubwezeretsanso kwina.

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Matenda a shuga a retinopathy

Chithandizo cha panretinal laser coagulation cholinga chake ndikuyambitsa kuphatikizika kwa ziwiya zatsopano zomwe zingapangidwe ndikupewa kutaya kwamaso chifukwa cha kukoka kwamitsempha kapena kukokoloka kwamatumbo. Kuchuluka kwa mankhwalawa kumatengera kuopsa kwa odwala omwe ali ndi matenda ashuga retinopathy. Ndi matendawa pang'ono pamatendawa, ma coagulates amawagwiritsa ntchito mosagwirizana kutali ndi mphamvu yotsika, ndipo pogwiritsa ntchito njira kapena kutchulanso, mtunda pakati pa opangawo uyenera kuchepetsedwa, ndipo mphamvu ziyenera kuchuluka.

Oyamba ophthalmologists bwino kugwiritsa ntchito panfundoscope. kupatsa kukula kokulirapo kuposa mandala atatu a Goldmann. popeza mukamagwiritsa ntchito chomalizachi, kuthekera kwa kujambula kopanda zotsatira zoyipa kumakhala kwakukulu.

• kukula kwa kutengera zimadalira ndi mandala omwe amagwiritsidwa ntchito. Ndili ndi mandala a Goldmann, kukula kwa coagulum kuyenera kukhala ma microns 500, pomwe pali panfundoscope - 300-200 ma microns,
• nthawi yowonekera - masekondi 0,05-0.10 pamphamvu yomwe imakupatsani mwayi kuti mugwiritse ntchito coagulates modekha.

Chithandizo chachikulu cha matenda ashuga retinopathy chikuchitika ndikugwiritsidwa ntchito kwa 2000-3000 coagulates m'malo omwazikana kulowera mbali yakumbuyo, kuphimba zotumphukira za retina mu gawo limodzi kapena awiri, kupanikizika kwa laser, komwe kumangokhala gawo limodzi, kumalumikizidwa ndi chiwopsezo chachikulu cha zovuta.

Kuchuluka kwa mankhwalawa nthawi iliyonse kumatsimikiziridwa ndi kupweteka kwa wodwalayo komanso kuthekera kwake kokumbika. Kwa odwala ambiri, kuponyera kwakanthawi kwa diso kumakhala kokwanira, koma parabulbar kapena subthenon anesthesia ikhoza kukhala yofunikira.

Mndandanda wa zochita uli motere:

• Gawo 1. Pafupi ndi disc, pansi kuchokera pa arcade wochepa kwambiri.
• Gawo 2. Chotchinga chotchinga kuzungulira macula chimapangidwa kuti tipewe kuwonongeka ndi vitreous. Chifukwa chachikulu chokhazikika pakukhazikika kwa mankhwalawa ndikosakwanira kulandira chithandizo.

Zizindikiro zochotseka zimayang'ana kukhudzika kwa ma neovascularization komanso mawonekedwe a ziwiya zosafunikira kapena minyewa yotupa, kuchepa kwamitsempha yotupa, kuyamwa kwa zotupa za m'mimba, komanso kuchepa kwa chikhodzodzo. Nthawi zambiri retinopathy yopanda mphamvu zoyipa, masomphenya okhazikika amakhazikika. Nthawi zina, odwala matenda ashuga retinopathy amabwezanso ngakhale atakhala ndi zotsatirapo zoyenera. Pankhaniyi, kuyesanso kwa odwala omwe ali ndi miyezi 6-12 ndikofunikira.

Panretinal coagulation imakhudza gawo lokhazikika la mtima la fibrovascular process. Pankhani ya kukonzanso kwa ziwiya zatsopano zomwe zimapangidwa ndikupanga minofu ya fibrous, chithandizo chobwerezedwa sichimawonetsedwa.

Kubwezerani chithandizo

• kubwereza laser mobwerezabwereza ndikugwiritsa ntchito coagulates pazikhala pakati pa malo omwe amapangidwa kale,
• cryotherapy kudera lakunja la retina kumawonetsedwa ngati kujambulidwa mobwerezabwereza sikungatheke chifukwa chakuwona bwino kwa fundus chifukwa chofufuza nkhani. Kuphatikiza apo, zimakupatsani mwayi wogwira nawo mbali za retina zomwe sizinapangepozi zamtundu wa laser ..

Ndikofunikira kufotokozera odwala kuti panretinal laser coagulation ikhoza kuyambitsa zolakwika m'munda wamagetsi osiyanasiyana, ndiko kutsutsana koyenera poyendetsa galimoto.

• Gawo 3. Kuchokera pa uta wa diski, kutsiriza kwa kulowererapo m'dera lanyumba.
• Gawo 4 Kusintha kwazotengera kufikira kumapeto.

Ndi odziwika kwambiri odwala matenda a shuga a retinopathy, ndikofunikira kuti athe kuchitapo kanthu m'magawo atatu a retina, chifukwa malo omwe hemorrhage imakhala m'thupi la vitreous, malowa amatsekedwa, zomwe zimapangitsa kuti chithandizo chinale chisamachitike.

Kutsatira njira zoyeserera

Kuwona nthawi zambiri pamatha masabata 4-6. Pankhani ya kuvulala kwamitsempha pafupi ndi disk, magawo angapo angafunike ndi kuchuluka kwa ma coagulates mpaka 5000 kapena kupitirira apo, ngakhale kuti kuchotsa kwathunthu kwa neovascularization kumakhala kovuta kukwaniritsa ndipo kungafunike chithandizo cha opaleshoni choyambirira.