Ọrịa ịrịa ọrịa mamịrị: mgbaàmà, nkebi, ọgwụgwọ

Ọrịa mamịrị Retinopathy - Nnukwu ọrịa angiopathy, na - emetụta arịa nke retina nke anya ma na - etolite na nzụlite nke ọrịa shuga ogologo. Ọrịa ịrịa ọrịa mamịrị nwere usoro na-aga n'ihu: na mbido mbụ, ọhụụ na-acha nzuzu, a na-ahụkarị ihe mkpuchi na ntụpọ n'ihu anya, na ọkwa nke ikpeazụ enwere nnukwu mbelata ma ọ bụ mfu nke ọhụụ. Nchọpụta nyocha gụnyere nyocha ya na dibia ophthalmologist na diabetologist, ophthalmoscopy, biomicroscopy, visometry na perimetry, retinal vaskụla angiography, na nyocha ọbara ọbara. Treatmentgwọ ọrịa mamịrị retinopathy nke ọrịa mamịrị chọrọ nhazi nke ọrịa shuga, mmezi nke nsogbu nke metabolic, yana n'ọnọdụ nsogbu, nchịkwa intravitreal nke ọgwụ, laser coinallation laser, ma ọ bụ vitrectomy.

Ozi izugbe

Ọrịa mamịrị retinopathy bụ ọrịa shuga dị iche iche na - egbu oge ọrịa ọrịa shuga na-arịa insulin na-abụghị insulin. Na ophthalmology, retinopathy na-arịa ọrịa shuga na-akpata nkwarụ ọhụụ na ndị ọrịa nwere ọrịa shuga na 80-90% nke ikpe. N'ime ndị nwere ọrịa shuga, ìsì na-etolite ugboro 25 karịa karịa na ndị nnọchite anya ndị ọzọ n'ozuzu ha. Yana ọrịa ọrịa obi na-arịa ọrịa mamịrị, ndị na-arịa ọrịa shuga nwere ohere dị ukwuu nke ọrịa akwara obi, ọrịa shuga, nephropathy na polyneuropathy, cataracts, glaucoma, occlusion nke usoro ụjọ na akwara dị n’etiti, ọrịa shuga na ọrịa nke ọrịa. Ya mere, ọgwụgwọ nke ọrịa shuga chọrọ usoro ọmụmụ, gụnyere ntinye ndị ọkachamara si na endocrinologists (diabetologists), ophthalmologists, cardiologists, podologists.

Ihe Ndị Na-akpata Esemokwu

Usoro mmepe nke ọrịa mamịrị retinopathy na-emetụta mmebi nke arịa azụ (akwara ọbara nke retina): ike ha na-abawanye, nnuku nke isi ọwụwa, ọdịdị nke arịa ndị a kpụrụ ọhụrụ na mmepe nke anụ ahụ proliferative (scar).

Imirikiti ndị ọrịa nwere ogologo oge nke ọrịa mellitus nwere ụfọdụ ma ọ bụ akara ndị ọzọ nke mmebi na fundus. N’ime oge ịrịa ọrịa shuga ruo afọ abụọ, a chọpụtara ọrịa retinopathy nke ọrịa shuga n’otu ogo ma ọ bụ ọzọ na 15% nke ndị ọrịa, ruo afọ 5 na 28% nke ndị ọrịa, ruo afọ 10-15 n’ime 44-50%, ihe dị ka afọ 20-30 90-100%.

Ihe ndị dị mkpa na-emetụta ugboro ugboro na ọrịa shuga na-arịa ọrịa shuga gụnyere oge nke ọrịa shuga, hyperglycemia, ọbara mgbali, ọdịda akụrụ na-adịghị ala ala, dyslipidemia, syndrome metabolic, na oke ibu. Mmepe na mmepe nke retinopathy nwere ike iso kpata oge uto, ịtụrụ ime, ịkọ mkpụrụ ndụ ihe nketa, na ise anwụrụ.

Nkewa

Nyere mgbanwe ndi a na etolite etolite etolite, ndi n’enweghi proliferative, preroligerative na protinerative diabetic retinopathy bu ndi di iche.

Ọbara shuga dị elu, nke a na-achịkwa nke ọma, na - ebute mbibi arịa ọbara nke akụkụ dị iche iche, gụnyere retina. N'ime ọkwa nke ọrịa mamịrị nke ọrịa mamịrị, mgbidi nke arịa azụ nwere ike ịbụ ihe zuru oke na nke na-emebi emebi, nke na-eduga n'ọbara isi okwu, izụ microaneurysms - mpaghara ọgbụgba akwara nke mpaghara akwara. Mpekere mmiri nke mmiri na-abanye n'ime mgbidi site na obere akụkụ site na arịa n'ime retina, na-eduga na azụ azụ. N'ihe banyere itinye aka na mpaghara mpaghara mpaghara retina, oke mkpụrụ akwụkwọ na-etolite, nke nwere ike ibute ọhụhụ ụzọ.

N'ime usoro Preproliferative, ischemia na-aga n'ihu na-eto n'ihi mgbaze nke arterioles, nkụchi obi ọbara, ọrịa obi.

Ọrịa retinepathy nke ịrịa ọrịa Preproliferative na-aga n'ihu usoro proliferative na-esote, nke a chọpụtara na 5-10% nke ndị ọrịa nwere ọrịa mellitus. Ihe na - enye aka na mmepe nke ọrịa retinopathy na-abawanye ibu gụnyere myopia dị elu, mwepu nke akwara carotid, mkpochapụ nke na-esote akwara, optic atrophy. N'oge a, n'ihi ụkọ oxygen nke retina na-enwe, arịa ndị ọhụrụ na-amalite na-etolite n'ime ya iji nọgide na-enwe ọkwa oxygen zuru ezu. Usoro nke neovascularization nke retina na-eduga n'ọbara preretinal na retrovitreal ugboro ugboro.

N'ọnọdụ ụfọdụ, obere ọbara ọgbụgba dị na mkpo ahụ retina na akụkụ ahụ na-edozi onwe ha. Agbanyeghị, n'ọbara na - adị n'anya oghere (hemophthalmus), ihe na - emegharị ahụ na - emegharị ahụ na - eme ka ọnya na - adịghị ala ala, na - emesia ọ na - eduga na mkpụkọ mkpụkpụ azụ. Mgbe ị na-egbochi ụzọ HPV, glaucoma neovascular nke abụọ na-amalite.

Mgbaàmà nke Ọrịa mamịrị Retinopathy

Ọrịa ahụ na-etolite ma na-aga n'ihu na-egbu mgbu na enweghị asymptomatally - nke a bụ isi mkpuchi ya. Na ọkwa na-abụghị nke na-aba ụba, a na-ahụ anya mbelata nke ọhụụ. Ọrịa ụbụrụ nwere ike ibute ihe ndị a na-ahụ anya, ịgụ akwụkwọ ma ọ bụ ịrụ ọrụ dị nso.

N’ime usoro ịria ọria nke ọrịa mamịrị, mgbe ọbara ọgbụgba na - adị n’iru, ntụpọ gbara ọchịchịrị na mkpuchi na - apụta n’ihu anya, nke na - apụ n’anya oge ụfọdụ. N’inwe nnukwu ọbara ọgbụgba n’arụ ahụ, mbelata nke ọma ma ọ bụ ọhụụ zuru oke na-apụta.

Mgbochi

Ọrịa hyperglycemia nke dịteworo aka. Enwere echiche banyere mkpa ihe dị na mgbochi ọrịa na ebido retinopathy.

Pathogenesis

Pathogenesis ọrịa retinopathy na-arịa ọrịa dị mgbagwoju anya. Njikọ na-eduga bụ nkwarụ microcirculation metụtara ya na njiri mara ihe akụkụ akwara nke arịa azụ na mgbanwe mgbanwe metabolism so na ọrịa shuga mellitus.

Na ọrịa shuga mellitus, ihe mgbochi azụ nke ọbara, nke na - egbochi ịbanye n'ime irighiri akwara ndị nnukwu irighiri akwara ndị ahụ n’akwara ọbara n’ime akwara azụ, na - abịa n’ihu karịa, nke na - eduga n’ihe ndị a na-achọghị.

Na mmepe nke mgbaàmà, amaara usoro ụfọdụ: vasodilation → ụba ọbara na -efe efe → mmebi ọgbụgba → mkpuchi akpịrị → na -emekarị ihe → na –emepụta akwara arteriovenous na microaneurysms → neovascularization → ọbara ọgbụgba na mwepu na nhazi.

Nkewa

N'afọ 1992, Kohner E. na Porta M. tụpụtara usoro ịrịa ọrịa mamịrị nke ọrịa shuga, nke a nabatara ugbu a:

• Retinopathy na-enweghị ọgwụ (ọrịa mamịrị retinopathy I) - nke a na-egosipụta na ọnụnọ dị na retina nke anya nke mgbanwe pathological n'ụdị microaneurysms, ọbara ọgbụgba (n'ụdị obere ntụpọ ma ọ bụ ntụpọ gbara okirikiri (enwerekwa ndị nwere agba)), agba ọchịchịrị na agba, dị na mpaghara etiti nke fundus ma ọ bụ na nnukwu veins na miri n'ọkpụkpụ azụ), ihe eji achọ ibu (nke etinyere na etiti akụkụ ego, odo na-acha ọcha ma ọ bụ nke nwere oke ma ọ bụ nke edoghị anya) na edema nke retina. Ime nwa ebu n’ara n’etiti (macular) mpaghara ma ọ bụ n’akụkụ nnukwu arịa bụ akụkụ dị mkpa nke ọrịa retinopathy na-enweghị protinerative na-aba ụba.
• Ederede preproliferative retinopathy (ọrịa mamịrị retinopathy II) - ọnụnọ nke ọnụnọ nke anụ ọhịa (nkọ, ntaramahụhụ, ọnụnọ nke ube, okpukpu abụọ na / ma ọ bụ ngbanwe nke ọnya ọbara), ọnụ ọgụgụ buru ibu na "owu" exudates, intraretinal microvascular anomalies (IRMA), ọtụtụ nnukwu mbufụt azụ.
• Mmegharị nke protinerative (ọrịa mamịrị retinopathy III) - nke a na - egosipụta neovascularization nke optic diski na / ma ọ bụ akụkụ ndị ọzọ nke retina, oke ọbara ọbara, nguzobe anụ ahụ na mpaghara ọnya ụbụrụ. Arịa ndị mepụtara ọhụrụ dị gịrịgịrị ma na-emebi emebi - ọbara ọgbụgba ugboro ugboro na-abụkarị, na-eso akpata mkpụkọ azụ. Azụ nke ohuru nke anya (rubeosis) na-edugakarị na mmepe nke glaucoma nke abụọ (rubeous).

Foto nyocha

A na-egosipụta mbido mbụ nke ọnya ahụ site na enweghị mgbaàmà anya (belata ncha anya, ihe mgbu, na ndị ọzọ). Ọnwụ ma ọ bụ ibelata nhụjuanya anya bụ ihe mgbaàmà na-egbu oge na - egosi na ọ ga - aga n'ihu, usoro a na - agbanwe agbanwe (echefula nyocha ọhụụ nke ophthalmological).

Isi ihe kpatara ọnwụ anya bụ ọrịa obi ịrịa ọrịa ụbụrụ, ihe ngosipụta dị iche iche nke achọpụtara na 80-90% nke ndị ọrịa. Dabere na Mahadum A. Efimov, n'ọmụmụ ihe ophthalmological nke mmadụ 5,334 nwere ọrịa mellitus, a chọpụtara ọrịa retinopathy nke ịdị iche iche na 55.2% nke ndị ọrịa (ogbo I - 17.6%, ogbo II - 28.1%, ogbo III - in 9.5%). Nhụcha ọhụhụ niile n’etiti nyocha niile dị ihe dịka 2%.

Retinopathy - emebi emebi arịa nke retina. Isi "ebumnuche" bụ isi maka mgbanwe nhazi nke retina:

1. arterioles - lipogaline arteriosclerosis ("plasma vashma"), ihe kachasị emetụta bụ precapillary arterioles na capillaries na mpaghara ụmụazụ nke fundus,
2. veins - mmeba na nrụrụ,
3. capillaries - dilatation, ụba permeability, mgbochi nke mpaghara capillaries, na-akpata pericapillary edema, degeneration nke intra-wall pericytes with proliferation of the endothelium, thickening of the basemb membranes, the form of microaneurysms, hemorrhages, arteriovenous shunts, neovascularization,
4. ọzịza nke eriri ọkụ opticum, nke a na-ahụ anya dị ka ebe isi awọ na ntụ dị ka igwe ojii, akpọrọ exudates, edema nke optic diski, atrophy na retinal detachment.

Ọrịa nyocha

Ọ dịkarịa ala otu oge n'afọ, ndị nwere ọrịa mellitus na-enyocha nyocha nke ophthalmological, gụnyere ajụjụ, ịtụle acuity visual na ophthalmoscopy (mgbe ọ gụsịrị nwa akwụkwọ) iji chọpụta exudates, ọnya isi ọbara, microaneurysms na ịmụba nke arịa ọhụrụ. N’ezie, a na-eme nyocha ahụ site n’aka onye dibia bekee nwere ahụmịhe n’ebe ụlọ ọgwụ na-arịa ọrịa shuga.

Ọgwụgwọ

Ọgwụ nke ọrịa mamịrị retinopathy dị n'ọrịa dị mgbagwoju anya, nke onye na - ahụ maka ọrịa endocrinologist na otu dibịa anya. Otu ihe dị mkpa bụ ezigbo nri nri na ọgwụ insulin. Ọ dị mkpa amachi abụba na nri, jiri abụba dochie abụba anụmanụ, wezuga carbohydrates dị mfe (shuga, ihe ụtọ, ihe nchekwa), na-ejikwa ngwaahịa ndị nwere ihe ndị dị n’ime ala (mkpụrụ obi, azụ, mmanụ oatmeal), mkpụrụ osisi, akwụkwọ nri (ma e wezụga maka poteto). Ọgwụ vitamin dị mkpa karịchaa, otu B (B)₁, B₂, B₆, B₁₂, B₁₅) n'ime na parenteral. Vitamin C, P, E nwere ihe nchebe na mgbidi vaskụla (ugboro atọ n’afọ, agụm ọnwa 1). Angioprotector gụnyere anginin (prodectin), dicinone, doxium. A na-a drugsụ ọgwụ ahụ dị ka dọkịta si kwuo.

• Na ogbo nke ọrịa mamiri retinopathy nke ọrịa mamịrị (nke na-abụghị protinerative retinopathy), a na-egosi nyocha ugboro ugboro nke ophthalmic. Dọkịta kwesịrị ịchọpụta etu onye ọrịa si ejikwa ọkwa glucose dị n'ọbara.
• Na retinopathy nke ọrịa mamịrị nke II ma ọ bụ III (preproliferative na protinerative retinopathy, dị iche iche), lasco photocoagulation gosipụtara.

Nnyocha DIRECT mere n'oge na-adịbeghị anya nyochara ojiji nke kandụl renin-angiotensin receptor (RAS) maka ụdị 1 na-arịa ọrịa shuga. Ihe candesartan emebeghi ka enwee udiri akuko. N'oge ọmụmụ ihe a, enwere echiche nke ibelata ogo nke retinopathy. N'ime ihe omumu RASS na-erughi oke, egosiputara na mmepe nke retinopathy na ụdị ọrịa shuga 1 mellitus na-eji nwayọ nwayọ na ASD na-egbochi losartan na angiotensin-na-agbanwe enzyme enalapril inhibitor. Ya mere, iji ihe mgbochi ASD nwere ike ịbụ ihe kwesịrị ekwesị na ndị ọrịa nwere ọrịa shuga 1 na ọrịa retinopathy, mana ọ bụghị ya na ụdị shuga nke 2.

A na - ejikọta ọrịa retinopathy nke ọrịa mamịrị na ọtụtụ nsogbu ọgbụgba, gụnyere methylation nke mkpụrụ ndụ Sod2 na MMP-9 na ntụgharị nke LSD1 en gene nke ukwuu. A na-atụle ugbu a iji ọgwụ epigenetic na-agbazi ha ugbu a.

Amụma

N'okwu ndị dị elu yana yana njikọta ọrịa shuga na ọbara mgbali elu, atherosclerosis dị ezigbo njọ.

Mgbochi

Na mmepe na mmepe nke retinopathy maka ụdị ọrịa shuga niile, a na-enye ọrụ dị mkpa iji kwalite nkwụghachi ụgwọ maka ọrịa na-akpata ọrịa. Mmepe nke ọbara mgbali elu na ọrịa nephropathy, na-ejikọkarị ya na retinopathy, na-eme ka ọrịa retinopathy na mellitus na-arịa ọrịa. Atherosclerosis na-enwe ọganihu dị ukwuu n'etiti ndị nwere ọrịa mellitus nke na-eto eto ma dị njọ karịa - n'ihi ọnụnọ microangiopathy, enwere ike ịmepụta mgbasa njikọ. Maka ebumnuche nke nchọpụta oge, onye ọrịa ọ bụla ga - enyocha onye ọrịa ophthalmologist nyocha ọ dịkarịa ala 1 oge kwa afọ ma ọ bụrụ na mkpesa kwesịrị ekwesị bilitere.

Iji gbochie ọnya ọnya anya, nchọpụta mbụ ha dị mkpa - ndị na - eto eto ga - enyocha onye na - arịa ọrịa shuga ọ dịkarịa ala otu oge n'ime ọnwa isii. Ekwesịrị ị attentiona ntị na ọnọdụ ndị ọrịa nwere ọrịa mellitus ogologo oge - na mmụba na oge ọrịa shuga mellitus, ugboro ole a na-achọpụta ọrịa mamịrị retinopathy na-abawanye.

Naanị otu ihe a pụrụ ịdabere na ya na mgbochi ọrịa shuga na-arịa ọrịa shuga bụ ihe ndabere maka ọgwụgwọ nke ọkwa ya niile bụ ụgwọ kachasị mma maka ọrịa shuga mellitus (ọkwa nke gemoclobin HbA glycated glycated._1C .

Pathogenesis na ihe kpatara

Pathogenesis ọrịa retinopathy na-arịa ọrịa shuga bụ ihe mgbagwoju anya. Otu n'ime ihe ndị kacha akpata ya bụ mmebi na akwara ọbara nke retina: oke ihe oke ha, mgbochi nke oghere anụ ahụ, ọdịdị nke anụ ahụ na - akpụ ụdọ na arịa ndị mepụtara. Mgbanwe ndị a bụ ihe sitere na mkpụrụ ndụ ihe nketa nke ihe dị na retina.

Ọ bụghị ọrụ kachasị dị na mmepe nke ọrịa ahụ bụ site na usoro metabolism nke na-ebilite na ụba glucose n'ọbara. Na ọnụnọ nke ọrịa shuga ruo afọ abụọ, a na-achọpụta ọrịa mamịrị retinopathy na 15% nke ndị ọrịa, ruo afọ 5 - na 28%, ruo afọ 10-15 - na 44-50%, site na afọ 20 ruo 30 - na 90-100%.

Ihe ndị dị egwu na-emetụta ọsọ na ugboro ole ọrịa na-enwe gụnyere:

• larịị nke hyperglycemia,
• oge nke ọrịa shuga
• ụkwara akwara na-adịghị ala ala
• ọbara mgbali ike
• Ibu ibu (oke ibu),
• metabolic syndrome
• dyslipidemia.

Ọzọkwa, mmepe na ọganihu nke ọrịa mamịrị retinopathy na-arịa ụkwara ume na ime ka afọ ime, uto, àgwà ọjọọ.

Foto nyocha

Ọrịa mamịrị retinopathy na-etolite ma na-aga n'ihu n'enweghị akara njirimara. Ọhụhụ ọhụụ na ọkwa na - - amụba amụba anaghị achọpụta nke ọma. Mmecha nke ihe ndị a na-ahụ anya nwere ike ibute ọrịa edere. Achọpụtakwara nsogbu ịgụ ihe na nso. Ọzọkwa, ịdị ọhụụ na-adabere n'ọbara nke glucose n'ọbara.

N'ime ọkwa ọbara nke ọrịa ahụ, opacities na ebili mmiri na-apụta n'ihu anya (nsonaazụ ọbara ọgbụgba). Mgbe oge ụfọdụ gasịrị, ha ga-efu efu n'onwe ha.Site na mmerụ ahụ dị ukwuu, mmebi nke oke ma ọ bụ ọhụụ zuru oke na-apụta na ahụ.

Ọrịa nyocha

Maka nyocha ọrịa mamịrị retinopathy nke ọrịa mamịrị, a na-enye onye ọrịa ọgwụ ophthalmoscopy n'okpuru mydriasis, visometry, biomicroscopy nke akụkụ ihu nke anya, elekere, biomicroscopy nke anya nwere oghere ọla edo, Maklakov tonometry, diaphanoscopy nke anya anya.

Foto ophthalmoscopic bụ ihe kachasị mkpa maka ịtọ ntọala nke ọrịa. N’ime usoro ana - amụba, a na - achọta microaneurysms, hemorrhages, na exudates siri ike ma dị nro. N’ime usoro a na-aga n’ihu, a na-eji esepụta ego nke microvascular intraretinal intriretinal (mmekpa ahu na mgbasawanye nke akwara), endovaskụla na preretinal hemorrhages, mgbasa nke ụbụrụ, azụ neovascularization retinal, na ọrịa optic nerve disc. Iji detuo mgbanwe na retina, a na-ewere kamera fundus foto ọtụtụ.

N'iji oghere nke vitreous na kristal, a na-edenye ultrasound anya kama iji ophthalmoscopy. Iji nyochaa mmebi ma ọ bụ ichebe ọrụ nke akwara optic na retina, a na-eme ọmụmụ ihe electrophysiological: electrooculography, mkpebi siri ike nke CSFM, electroretinography. Iji chọpụta glaucoma neovascular, a na-eme gonioscopy.

Mostzọ kachasị mkpa iji nyochaa akwara azụ bụ fluorescence angiography. Ọ na - edeba oruru ọbara na akwara ozi. Ọ bụrụ na ọ dị mkpa, a na-eji laser na optical coherent scanning retinal tomography dochie angiography.

Iji chọpụta ihe ndị dị ize ndụ maka ọganihu nke ọrịa mamịrị retinopathy mamịrị, mmamịrị na shuga ọbara, a na-enyocha haemoglobin glycosylated, insulin, profaịlụ na-egosi ike na ihe ndị ọzọ. Zọ nchọpụta ọrịa na-adịchaghị mma bụ ultrasound nke arịa akụrụ, nleba anya kwa ụbọchị nke ọbara mgbali, ECG na echocardiography.

Usoro ọgwụgwọ

N'ime usoro mbụ nke ọrịa ahụ, usoro ọgwụgwọ bụ isi. E gosipụtara onye ọrịa ahụ ogologo oge iji ọgwụ ndị na-ebelata adịghị ike nke capillaries - angioprotector (Doxyum, Parmidin, Dicinon, Predian). Achọkwara ya ka ọ nwee ike inweta glucose dị n'ọbara.

Maka ọgwụgwọ na mgbochi nke nsogbu vaskụla, enyere ọgwụ Sulodexide, ascorbic acid, vitamin P na E. Antioxidants (dịka ọmụmaatụ Strix) na-enye ezigbo mmetụta. Nkwadebe ndị a nwere beta-carotene na wepụ mkpụrụ osisi apụl. Ihe ndị a bara uru na-emezi ọhụụ, na-ewusi network vaskụla ike, na-echebe megide mmetụta nke radicals n'efu.

Ọnọdụ pụrụ iche na ọgwụgwọ ọrịa mamịrị retinopathy na-arịa ọrịa shuga bụ nhazi nke metabolism metabolism. Nke a na - eme site na ị drugsụ ọgwụ shuga dị ala. Usoro ọgwụgwọ uche na-emetụtakwa ịkpa oke na nri onye ọrịa.

Ndi mmadu na - arịa oria bu ndi dibia bekee. Dabere n'ịdị njọ nke ọrịa shuga, a na-ekpebi oge nkwarụ. A na - eme ka onye ọrịa ahụ nwee ọrụ metụtara ibu ihe anya, ịma jijiji, na - agbatị isi na ahụ, na - ebuli ibu. Amachibidoro ya iwu ịrụ ọrụ na mbupụ na ụlọ ahịa na-ekpo ọkụ.

Ọgwụ ịwa ahụ

Ọ bụrụ nchoputa banyere ọrịa mamịrị retinopathy na-egosi mkpamkpa dị ukwuu: ọnya ọbara na retina, edema nke mpaghara etiti ya, nguzobe arịa ọhụrụ, mgbe ahụ, a na-egosi onye ọrịa laser. N'okwu ndị siri ike - ịwa ahụ.

Mgbe arịa ọbara ọgbụgba ọhụrụ na edema ụbụrụ pụtara, a chọrọ lasagu coagulation laser. N'oge usoro a, a na-enye ike laser n'akụkụ mpaghara mebiri emebi nke retina. Ọ banye na cornea, akwa ịkpa ike, mmiri nke ihu ihu ụlọ na oghere na-enweghị incisions.

A na-ejikwa laser na-abụghị mpaghara mpaghara ọhụụ iji wepụta akụkụ nke retina na-enweghị oxygen. Site n'enyemaka ya, a na-emebi usoro ischemic na retina. N’ihi nke a, arịa ọhụrụ na-akwụsị ịpụta. Usoro a na - ewepụkwa usoro neoplasms nke emezilarị. Nke a na - eduga na mbelata nke edema.

Ebumnuche bụ isi nke coagulation laser bụ igbochi mgbasa nke ọrịa. Iji mezuo ya, achọrọ nkezi nke nzukọ 3-4. Ha na - ejikọ nkeji iri atọ na anọ ruo iri anọ, ma ha na-eme ya na etiti oge. N'oge usoro ahụ, mgbu nwere ike ime. Ya mere, a na-eme ọgwụ izizi n'ime anụ ahụ gbara anya. Ọnwa ole na ole ọ gbasasịrị ọgwụ, otu ọkachamara na-enyocha steeti retina. Maka ebumnuche a, a na-enye ọgwụ ikuku fluorescence angiography.

Ọ bụrụ na ọrịa retinopathy na-arịa ọrịa mamịrị na-akpata ọbara ọbara buru oke ibu, onye ọrịa chọrọ vitrectomy. N'ime usoro a, dọkịta na-ewepụ ọbara nke mkpokọ, wee jiri mmanụ silicone (ma ọ bụ saline) dochie anụ ahụ. N'otu oge ahụ, laser na - emebi ihe ndị na - eme ka akpa mmadụ na - eme ka ọ ghara ịdịkwa, mebie ya. A na-atụ aro ime ihe a n'oge mmalite nke ọrịa. Nke a na-ebelata oke ihe ọghọm nsogbu.

Ọ bụrụ na onye ọrịa nwere mgbanwe siri ike na fundus, ọtụtụ arịa akụrụngwa ohuru na ọbara ọgbụgba, a na-eme cryocoagulation nke retina. Ọ dịkwa mkpa ma ọ bụrụ na ọ bụrụ na ọ bụrụ na vitrectomy ma ọ bụ laser coagulation agaghị ekwe omume.

Nsogbu enwere ike

Ihe ojoo di oria na egbu dibia mamiri:

• cataract
• nke abụọ nke neovascular glaucoma,
• mbelata nke ukwuu n’ọhụụ
• hemoftahalmus,
• mkpoputa azụ
• ìsì zuru oke.

Ọnọdụ ndị a chọrọ nlebara anya mgbe niile site na onye na-agwọ ọrịa, neuropathologist, ophthalmologist na endocrinologist. A na-ewepụ nsogbu ụfọdụ site na ntinye aka n'ịwa ahụ.

Thezọ kachasị dị mma maka ọrịa mamịrị retinopathy na-arịa ọrịa shuga bụ iwetulata ọkwa glucose ọbara ma mee ka ụkpụrụ ha dị mma. Rie nri ma gaa ileta dibia gi nke oma. Otu ugboro n'izu, na mgbede, tụọ mgbali intraocular. Site na nyocha nke oge na ọgwụgwọ siri ike, enwere ohere ọ bụla iji lekọta ọhụụ.

Obere ọrịa mamiri Retinopathy

Ọrịa ịrịa ọrịa mamịrị nwere ọtụtụ usoro. A na-akpọ ọkwa mbụ nke retinopathy nke na - abụghị proliferative, na njiri mara microaneurysmsnke mejupụtara akwara ndị nwere oghere ọnya na anya dị n'ụdị okirikiri gbara ọchịchịrị ma ọ bụ ọnya gbara agba, ọdịdị nke akụkụ azụ nke akụkụ azụ, azụ azụ na mpaghara ihe, yana ịba ụba nke oghere nke arịa ọbara. N'okwu a, site na arịa ndị dị gịrịgịrị, akụkụ mmiri nke ọbara na-abanyekwa na retina, na-eduga izụlite edema. Ọ bụrụ n’etiti akụkụ retina na-esonye na usoro a, a ga-ahụ ya ọhụhụ ọhụhụ.

Ekwesiri iburu n'uche na ụdị ọrịa shuga a nwere ike ịda na ọkwa ọ bụla nke ọrịa ahụ, ma na-anọchitekwa mmalite nke ọrịa retinopathy. Ọ bụrụ na agwọghị ya, mgbe ahụ mgbanwe gafere ọkwa nke abụọ nke ọrịa ahụ.

Agba nke abuo nke retinopathy bu proliferative, nke na-esokwa nsogbu mgbasa na retina, nke na-eduga n’adịghị oxygen n’ime retina (agụụ oxygen, ischemia) Iji weghachite ọkwa oxygen, ahụ na-emepụta arịa ọhụrụ (a na-akpọ usoro a neovascularization) Vesselsgbọ ndị ahụ etolitela emebi emebi na-amalite ma na-agba ọbara, n'ihi na ọbara ya na-abanye Vitreousihie azu azu. N'ihi nke a, ahịhịa ndị na-ese mmiri na-apụta n'anya na-emegide ihe ndabere nke ọhụụ na-ebelata.

N'oge ngwụcha nke retinopathy na uto nke arịa ọhụrụ na akwara anụ ahụ, ọ nwere ike ibute idobe azụ na mmepe glaucoma.

Isi ihe kpatara mmepe nke ọrịa mamica retinopathy ezughi oke insulin, nke na-eduga n'ịba ụba fructose na sorbitolna-enye mmụba nke nrụgide, na-eme ka mgbidi nke okpu na warara nke oghere ha.

Mmepe na usoro nke ọrịa ahụ

N'ihi mmụba nke glucose ọbara, enwere mgbidi nke arịa ọbara. N'ihi ya, nrụgide dị na ha na-ebili, arịa ndị ahụ mebiri emebi, gbasaa (microaneurysms), na obere ọbara ọgbụgba na-etolite.

Imeju ọbara na-emekwa. Microdị Microthrombi, na-egbochi oghere nke arịa. Enwere oxygen agụụ nke retina (hypoxia).

Iji zere hypoxia, a na-egbochi oghere na arịa ọbara, na-agabiga ebe ndị emetụtara. Shunts na-ejikọta akwara na akwara, ma na-akpaghasị usoro ọbara si na obere obere ma si otú a na-abawanye hypoxia.

N'ọdịnihu, ụgbọ mmiri ọhụrụ na-abanye na retina, kama nke ndị mebiri emebi. Ma ha dị oke mkpa ma na-emebi emebi, yabụ, ha mebiri emebi ngwa ngwa, ọbara ọgbụgba na-apụta. Otu arịa nwere ike itolite n’ime akwara nke anya, anụ ahụ na-eme ka mmadụ nwee ike ibute glaucoma, na-egbochi imepụta mmiri ziri ezi n’anya.

Mgbanwe ndị a niile nwere ike ibute ọrịa na-eduga ìsì.

A na - ahuta usoro ato nke ọrịa mamiri ọrịa retinopathy (DR):

1. Ntighari ejighi oru (DR I).
2. Mkpesa preproliferative retinopathy (DR II).
3. Proliferative retinopathy (DR III).

E guzobere ogbo nke retinopathy site na dibia ophthalmologist mgbe ị na-enyocha fundus site na nwa akwụkwọ edetu, ma ọ bụ jiri ụzọ nyocha pụrụ iche.

Na retinopathy na-enweghị proliferative microaneurysms hiwere, obere ọbara ọgbụgba n'akụkụ akwara azụ, ngagharị nke ibu ahụ (ọsụsọ nke mmiri mmiri), shunns n'etiti akwara na veins. Ọbụna edema ga-ekwe omume.

Na usoro nkwadebe ọnụ ọgụgụ ọbara ọgbụgba, na-ebuwanye ibu, ha na-abawanye ụba. Akwara azụ na-agbasawanye. Optic edema nwere ike ime.

Na ọkwa na-aga n'ihu ọbara ọbara dị na retina, akwara optic, ọbara ọgbụgba dị ukwuu na retina na ahụ. Tissuedị anụ ahụ dị na ya, na-eme ka agụụ ikuku oxygen na-eduga ma na-eduga na mkpo anụ ahụ.

Ọrịa mamịrị Retinopathy Ọrịa mamịrị

Tinyere ụkpụrụ izugbe nke ọgwụgwọ nke retinopathies, ọgwụgwọ gụnyere mgbazi nke nsogbu metabolic, njikwa njikwa nke ọkwa glycemia, ọbara mgbali, metabolism lipid. Ya mere, n'oge a, a na-enye ọgwụ ndị bụ ọgwụ endocrinologist-diabetologist na cardio.

A na-eji nlezianya na-elele ọkwa glycemia na glucosuria, nhọrọ nke insulin ọgwụ zuru oke maka ọrịa shuga mellitus, a na-eme angioprotector, ọgwụ antihypertensive, ndị na-emegide antiplatelet, wdg. A na-eduzi intravitreal injections nke steroid iji gwọọ ọrịa edema.

A na-egosi ndị ọrịa nwere ọrịa retinopathy na-arịa ọrịa shuga dị elu maka coagulation laser. Igwunye ụdọ laser na-enye gị ohere imechi usoro nke neovascularization, iji nwetusị ike na njigide nke mkpochapu wepụ arịa ọbara, iji gbochie ihe egwu nke mkpochi azụ.

Laswa ahụ n’azu laser maka ọrịa mamị retinopathy na-eji ọtụtụ ụzọ arụ ọrụ. Ihe mgbochi retinapathy nke lasina gụnyere itinye pagacular coagulates nke ụdị "lattice", n'ọtụtụ ahịrị, ma egosiri maka ụdị protinerative retinopathy na ụbụrụ isi. A na-eji coagulation foda laser eme ka microaneurysms, exudates, na obere ọbara ọbara nke ekpughere n'oge angiography. Na usoro nke panretinal laser coagulation, a na-etinye coagulates na retina niile, ma ewezuga mpaghara macular, a na-ejikarị usoro a na ọkwa Preroliferative iji gbochie ọganiru ya.

Na opacification nke ngwa anya nke anya, ihe ọzọ maka laser coagulation bụ transscleral cryoretinopexy, dabere na mbibi oyi nke akụkụ akwara akụkụ nke retina.

N'ihe banyere ọrịa mamịrị retinopathy dị ukwuu nke na-agbagha site n'ọbara, akwara ma ọ bụ mkpụchi azụ, a na-ewepụta ọbara, mgbe a na-ewepu ọbara, akwara anụ ahụ, a na-ebepụ ụdọ anụ ahụ, a na-agba arịa arịa ọbara.

Amụma na Mgbochi Ya

Ọrịa siri ike nke ọrịa mameti retinopathy nwere ike ịbụ glaucoma nke abụọ, ọrịa nhụjuanya, njighachi azụ, hemophthalmus, mbelata ọhụhụ ụzọ, ikpu ìsì zuru oke. Ihe a niile chọrọ nlebara anya nke ndị ọrịa na-arịa ọrịa shuga site na endocrinologist na dọkịta na-ahụ maka ọrịa anya.

A na-arụ ọrụ dị mkpa iji gbochie ọganihu nke ọrịa mamịrị retinopathy site na ịchịkwa shuga n'ọbara na ọbara ọgbụgba, ịnweta hypoglycemic na ọgwụ antihypertensive n'oge kwesịrị ekwesị. Omume oge nke na - egbochi mgbochi ụkọ coalation nke retina na - enye aka na nkwụsị na iwe maka mgbanwe na fundus.

Psnye na-etolite karịa?

Enwere ihe ndị na - eme ka o nwekwuo ohere ịmalite ọrịa dibịa ọrịa mamịrị. Ndị a gụnyere:

• Ogologo afọ nke ọrịa shuga mellitus (afọ 15 mgbe mmalite nke ọrịa shuga na ọkara nke ndị ọrịa na-anabataghị insulin, na 80-90% nke ndị na-anata ya nwere ọrịa retinopathy).
• Ọbara glucose ọbara dị elu na oge ha na - efe efe site na oke dị elu rue ọnụ ọgụgụ dị ala.
• Ọbara ọbara.
• Cholesterol ọbara dị elu.
• Ime
• Ọrịa mamịrị nephropathy (mmebi akụrụ).

Kedu ihe mgbaàmà na-egosi mmepe nke ọrịa?

N'ime usoro mbido, ọrịa mamịrị retinopathy anaghị egosipụta onwe ya n'ụzọ ọ bụla. Ahụ erighị onye ọrịa ahụ ụjọ. Ọ bụ ya mere o ji dị ezigbo mkpa maka ndị ọrịa nwere ọrịa shuga, n'agbanyeghị agbanyeghị mkpesa, ịga hụ dọkịta na-ahụ maka ọrịa anya.

N’ọdịnihu, mmetụta dị n ’ọhụhụ, ọhụhụ na-egbu maramara, nke na-efe efe ma ọ bụ àmụ̀mà n’ihu anya, na n’ihu ọbara, ọ na-apụta tụrụ ọchịchịrị. N'ime usoro dị iche iche, akwara anya na-ebelata, ruo nhụcha zuru ezu.

Kedu ihe bụ nsogbu?

Na enweghị ọgwụgwọ ọfụma maka ọrịa shuga mellitus na ọrịa obi na-arịa ọrịa shuga, nsogbu ndị siri ike ha bilitere, na-eduga na ikpu ìsì.

• Mwepu azụ nke azụ. Ọ na - aputa ihe site na ntu ahu n’anyinye ahu putara na retina ma n’atu ya mgbe anya na -eme. N'ihi nke a, anya mmiri na-etolite ma ọhụhụ ụzọ na-eme.
• Rubeosis nke iris - germination nke arịa ọbara na iris. Mgbe ụfọdụ, arịa ndị a na-agbaji, na-ebute ọbara ọgbụgba n'ime ihu anya.

Ọgwụ nke ọrịa mamịrị retinopathy na-arịa ọrịa, yana ọrịa ndị ọzọ na-arịa ọrịa shuga, kwesịrị ịmalite site na nhazi nke glycemia, ọbara mgbali elu na cholesterol ọbara. Site na oke glucose dị n'ọbara nke ukwuu, ọ kwesịrị belata ya nwayọ nwayọ iji zere azụchemia azụ.

Isi ọgwụgwọ maka ọrịa mamịrị retinopathy na-arịa ọrịa shuga bụ laser coagulation nke retina. Mmetụta a na retina nwere mkpụrụ osisi laser, n'ihi nke ọ dị ka a gbanyere choroid nke anya. Igwunye ọkụ na laser na-enye gị ohere "ịgbanyụ" arịa ndị e guzobere ọhụrụ n'ọrụ, gbochie edema na idobe azụ, ma belata ischemia. A na-eme ya na proliferative na ụfọdụ ikpere prrolperative retinopathy.

Ọ bụrụ na ọ gaghị ekwe omume ime coagulation laser, a na-eji vitrectomy - wepu anụ ahụ vitreous yana mkpụkọ ọbara na ọnya.

Iji gbochie vaskụla neoplasm, ọgwụ ndị na-egbochi usoro a, dịka ọmụmaatụ, ranibizumab, dị irè. A na-ewebata ya n’ime ahụ vitreous ọtụtụ oge n’afọ ihe dị ka afọ abụọ. Ọmụmụ sayensị gosipụtara ọnụọgụ dị elu nke ọhụụ mgbe ị na-eji otu ọgwụ a.

Ọzọkwa, maka ịgwọ ọrịa ọrịa mamịrị, a na-eji ọgwụ ndị na-ebelata hypoxia, cholesterol dị ala (karịsịa fibrates), ọgwụ homonụ maka nchịkwa banye na ahụ vitreous.

Kedu ihe kpatara ọrịa ahụ ji dị njọ n'anya?

N'ọnọdụ ọ bụla, hyperglycemia, ya bụ, mmụba na shuga ọbara, na-emetụta mkpụrụ ndụ n'ụzọ dị egwu, gụnyere mgbidi vaskụla.

Ọ na - adịwanye ndụ - ọbara na plasma na - abanye na oghere intercellular, mkpụkọ ọbara na - etolite n'ụzọ dị mfe na endothelium mebiri emebi. Na mbido, ọrịa shuga na-emetụta obere arịa, yabụ na akụkụ azụ azụ na akwara akwara enweghị atụ.

Olee otú nke a si emetụta ọhụụ?

N'ime usoro mbido, ọdịda nke ọrụ visual nwere ike ọgaghị eme. N’ezie, retina - nke kachasị dịrị n ’anụ ahụ ike - na-enwe mmetụta dị n’ mmachi n’ọkpo ọbara, ma na-akwụghachi ụgwọ, yana ọnọdụ ọma nwa oge n’etiti, mpaghara na-enye ọhụụ dị mma.

Ọ bụrụ na ọbara esi na arịa ndị gbanwere agbanwe, akụkụ akụkụ retina na-adaba n'ọbara ma ọ bụ nwelata nri na-edozi ahụ.

N'oge ahụ, ihe mgbaàmà mbụ nke ọrịa ahụ ga-apụta:

• “Ijiji” n'anya anya,
• oyiyo
• usoro akara.

Ihe nrịba ama dị njọ bụ nlele dị anya na anya, ọdịdị nke oriọna (àmụ̀mà), mkpụchaghị nke otu akụkụ na mpaghara ọhụụ (ntinye nke "shroud"). Mgbe ụfọdụ ihe ijuanya ndị dị otú a na-egosi mmepe nke mkpochi azụ

Ihe ihe egwu

Site na mmebi ọ bụla akọwapụtara, ọ ka mma ilekọta mgbochi na ọgwụgwọ nke mgbaàmà nchegbu tupu oge eruo. Iyi egwu n’ọhụụ na-abawanye ma ọ bụrụ na ihe ndị ọzọ adịghị mma.

Kedu ihe na-abawanye ohere nke ngosipụta nke ọrịa:

1. Ọbara shuga na-enweghị nchịkwa
2. Ọbara mgbali elu
3. Ise anwụrụ na àgwà ọjọọ ndị ọzọ,
4. Pathology nke akụrụ na umeji
5. Oge ime na oge inye nwa nri,
6. Mgbanwe ndị metụtara afọ, na ahụ,
7. Ọkpụkpọ mkpụrụ ndụ ihe nketa.

Oge ọrịa shuga na-emetụtakwa ngosipụta nke ọrịa. A kwenyere na nsogbu ọhụụ na-apụta ihe dị ka afọ 15 ruo 20 mgbe nchọpụta nchoputa gasịrị, mana enwere ike ịnwe ike.

N'oge uto, mgbe echiche nke homonụ na -adabere na mgbaàmà nke ọrịa shuga, mmepe nke ọrịa mamịrị retinopathy nwere ike ime na ọnwa ole na ole. Nke a bụ ihe ịrịba ama na-eyi egwu, n'ihi na n'ọnọdụ dị otú a, ọbụlagodi na nleba anya na usoro nlekọta mmezi, ihe ize ndụ nke ikpu ìsì mgbe okenye.

Ọrịa shuga mellitus

Ọrịa shuga mellitus abụrụla ọrịa na-arịwanye elu na nso nso a. Ọrịa shuga na-emetụta ma okenye ma ụmụaka.

Ndị dọkịta na-ekwu maka mmụba n'ọnụ ọgụgụ ndị ọrịa na-arịa ọrịa shuga na eziokwu ahụ bụ na n'ime ọha mmadụ nke oge a, karịsịa na obodo ukwu, ihe ndị dị ize ndụ maka ọrịa a bụ ndị nkịtị:

• gburugburu ebe obibi
• ibu oke ibu
• erighị ihe na-edozi ahụ
• mmega ahụ nkịtị
• Ndụ Sedentary
• nrụgide
• ike ọgwụgwụ.

Dika ndi okacha mara, onu ogugu ndi mmadu n’aria oria nwere ike ibute oke nsogbu site na 2025 - 300 nde mmadu, nke di ihe dika 5% nke onu ogugu uwa.

A na-egosipụta shuga mellitus site na shuga dị elu. Dị ka ọ na-adịkarị, mkpụrụ ndụ akwara (mkpụrụ ndụ beta) na - ewepụta insulin - homonụ nke na - edozi metabolism, ọkachasị shuga (glucose) n'ọbara, yana abụba na protein.

Na ọrịa shuga mellitus, n'ihi mmepụta insulin nke ezughị, nsogbu nke metabolic na-ewere ọnọdụ, na shuga ọbara na-ebili. Ma dịka ị maara, ọ bụ shuga dị mkpa maka ịrụ ọrụ nke sel sel.

Enweghị insulin na ọrịa shuga mellitus abụghị nanị na mkpụrụ ndụ nke ahụ na-egbu, kamakwa ọ na-eduga n'ịba ụba shuga ọbara a na-ekwuputaghị. N'aka nke ya, oke abụba na-eduga na-egbochi metabolism nke abụba na ụba nke cholesterol n'ime ọbara, ịmalite nke iberibe ite.

Ọnọdụ a na-eduga n'eziokwu ahụ na akwara nke arịa ji nwayọọ nwayọọ na-agbakọ, ọbara na-abanye na akwara ga-akwụsịlata ruo mgbe ọ kwụsịrị kpam kpam. Na ọrịa shuga mellitus, ndị kachasị emerụ ahụ bụ obi, anya, ngwa anya, arịa nke ụkwụ, na akụrụ.

Ọrịa ịrịa ọrịa mamịrị na-ebulite afọ 5-10 site na mmalite nke ọrịa shuga na mmadụ. Typedị nke m nwere shuga mellitus (nke na-agbanye insulin), ọrịa retinopathy na-arịa ọrịa shuga na-adị ngwa ngwa ma bụrụkwa retinopathy na-arịa ọrịa shuga na-apụta ngwa ngwa.

Ihe na-akpata ọrịa shuga:

1. Akpachapụ ihe nketa
2. Ibu oke ibu.
3. Ọrịa ụfọdụ na-ebute mmebi na mkpụrụ ndụ beta na-emepụta insulin. Ndị a bụ ọrịa na-efe efe - pancreatitis, cancer pancreatic, ọrịa nke gland endocrine ndị ọzọ.
4. Ọrịa nje (rubella, chickenpox, ọrịa ịba ọcha n'anya na ụfọdụ ọrịa ndị ọzọ, gụnyere flu). Ọrịa ndị a na - eme dị ka ihe na - akpatara ndị mmadụ nọ n'ihe ize ndụ.
5. Obi erughị ala. Ndị nọ n'ihe ize ndụ kwesịrị izere ụjọ na nchegbu.
6. Afọ. Site na mmụba afọ n’afọ iri ọ bụla, enwere ike ibute ọrịa shuga okpukpu abụọ.

Na mgbakwunye na mmetụta adịghị ike na ike ọgwụgwụ, ike ọgwụgwụ ngwa ngwa, dizzness na mgbaàmà ndị ọzọ, ọrịa shuga na-eme ka ohere nke ịmalite ọrịa na glaucoma na-emebi, yana mmebi nke retina. Otu n'ime ngosipụta dị otú ahụ nke ọrịa shuga bụ ọrịa retinopathy na-arịa ọrịa shuga.

Ihe na-akpata ọrịa mamịrị Retinopathy

Na nkenke ịkọwa ihe dị n’usoro na-eduga n’itolite ọrịa a dị mfe. Mgbanwe na usoro metabolic na-eduga na ọrịa shuga na-enwe mmetụta dị njọ na ịnye ọbara na ngwa ocular. A na-ekechi microvessels nke anya, nke na-eduga na nrụgide na-abawanye na ihe mgbochi nke mgbidi ahụ.

Na mgbakwunye, ihe ndị si mba ọzọ sitere na akwara ọbara nwere ike ịbanye na retina, n’ihi na ihe mgbochi sitere n'okike na-arịa ọrịa shuga na-amalite ịrụzu ọrụ ya. Mgbidi nke arịa ọbara ji nwayọọ nwayọọ na-apụ n'anya ma kwụsị ịdị nkọ, nke na-eme ka ohere ọbara ọgbụgba na nkwarụ anya na-ahụ ụzọ.

Ọrịa mamịrị na -akpata retina na cornea nke anya na-eme dị ka nnabata ọrịa mamelitus ọrịa shuga, ihe dị ka 90% n'oge a nwere nkwarụ anya.

A na-ahuta ọdịdị nke ọrịa a dịka agam na-agagharị mgbe niile, ebe mmeri nke cornea na retina na ọkwa nke mbụ na-aga n'ihu na-enweghị mgbaàmà ọ bụla. Nke nta nke nta, onye ọrịa ahụ na-achọpụta obere ọhụhụ nke onyonyo ahụ, ntụpọ na veel na-apụta n’ihu anya, nke kpatara mmebi nke akwa oyi nke anya - cornea.

Ka oge na-aga, isi ihe na-akawanye njọ, ọhụụ na-agbadata nke ọma, ikpu ìsì wee jiri nwayọọ nwayọọ banye.

Vesselsgbọ mmiri ndị a na-ejigide retina na-emebi emebi. Ha nwere mgbidi dị gịrịgịrị, nke mejupụtara otu sel nke mkpụrụ ndụ, na-eto n’ike n’ike, ka a na-amata ngwa ngwa transsma ọbara, abawanye n’arụ. Ọ bụ adịghị ike a na-eduga n'ọrịa hemorrhages n'ime anya nke ịdị iche iche.

Ọ bụ ihe nwute, ikpe dị egwu hemophthalmus abụghị naanị ihe kpatara ọnwụ ọhụụ. Ọzọkwa, mmepe nke ìsì bụ ihe mkpasu sitere na irighiri protein nke plasma ọbara nke sitere na arịa ndị ahụ a kpụrụ, gụnyere usoro ntanetị nke retina, akụkụ ahụ na-emebi ma na-emebi cornea.

Ntughari akwara nke fibrovascular formations nke putara na diski optic na akwara akwara nke nwa oge na-ebute mmalite nkewapu nke retina, nke na agbasa na mpaghara ihe ma metuta obula.

Nke a, n'ikpeazụ, bụrụ ihe dị mkpa na mpụta nke azụ mkpokọ mmiri, nke na-akpalite mmepe nke iris rubeosis. N’ịkpa ike n’arịa ndị mejupụtara ọhụụ, plasma ọbara na-egbochi mpụta nke intraocular fluid, nke na-ebute mmepe nke glaucoma neovascular nke abụọ.

Chaindị n'ụdị nje a dị ụkọ ma na-akọwa naanị ọnọdụ dị oke njọ. N'ezie, usoro ịmụba na-arịa ọrịa mamịrị retinopathy anaghị akwụsị mgbe niile ikpu ìsì.

N'oge ọ bụla, uto ya nwere ike ịkwụsị na mberede. Ma n’agbanyeghi na nke a, dị ka a na-achị, enweghị atụ nke ọhụụ na-ebilite, usoro mmebi nke ọrụ ndị ọzọ dị n’iru na-eji nwayọ nwayọ nwayọ.

Ọrịa mamịrị nwere ike igbochi ìsì?

Ọtụtụ ndị ọrịa na-arịa ọrịa shuga ogologo oge nwere ọnya ọnya anya ya na retina ya, nke nwere ike ịnwe ogo ogo ogo dị iche iche.

Ya mere, ndị ọkachamara kpebiri na ihe dị ka 15% nke ndị ọrịa chọpụtara ọrịa shuga nwere akara dị nro nke ọrịa retinopathy na-arịa ọrịa shuga, yana oge ọrịa na-erughị afọ ise, ihe fọrọ nke nta ka ọ bụrụ 29% nke ndị ọrịa nwere mgbaàmà, 50% nke ndị ọrịa nwere oge 10 ruo 15.

Ọ na - esochi na ogologo oge mmadụ na - arịa ọrịa shuga, ka ọ dị elu na - enwekarị ọhụhụ ụzọ.

Ọzọkwa, ihe ndị metụtara ya, dịka:

• ike na-abawanye na mgbali ọbara na ịta ọbara
• ọrụ ezughi oke,
• imebi nke ruru lipids ọbara,
• abawanye na visceral abụba uka,
• ọ nwere ike n'arụ ọrụ,
• oke ibu di iche iche
• mkpụrụ ndụ ihe nketa
• oge ime
• omume ojoo
• ọnya ọnya anya.

Agbanyeghị, ịchekwa shuga ọbara mgbe niile, ị followingụ ụfọdụ nri na ibi ndụ dị mma, na-ewere vitamin na mineral maka anya, nke mepụtara maka ndị ọrịa na-arịa ọrịa shuga (Antotsian Forte na ndị ọzọ) nwere ike belata nsogbu nke ikpu ìsì site na nsogbu shuga.

Ihe kachasị dị irè iji gbochie ọhụụ bụ nlebara anya nyochara ugboro ole nyocha nke onye ọrịa nwere ọrịa shuga site n'aka onye ọrịa ophthalmologist na endocrinologist, na-agbaso ndụmọdụ ha.

Ihe egwu kasịnụ nke ọrịa na-eburu bụ ogologo oge ọ na-enweghị ihe mgbaàmà. N’agba nke mbụ, a na-ahụkarị mbelata nke ọkwa ọhụụ, naanị ihe onye ọrịa nwere ike ị attentiona ntị na ya bụ obere akwara azụ, nke na-egosipụta onwe ya n’ụdị enweghị nkọcha ihe oyiyi, nke na-emekarị na ọnya isi.

Ọ na - esiri onye ọrịa ike ịgụ ma na - arụ ọrụ na obere nkọwa, nke ha na - ekwu na ọ bụ ike ọgwụgwụ ma ọ bụ ọrịa.

A na-egosipụta ihe mgbaàmà bụ isi nke mmerụ azụ naanị na oke ọbara n'ọbara, nke onye ọrịa nwere ọrịa retinopathy na-enwe n'ụdị nwayọ nwayọ ma ọ bụ na-ele anya ngwa ngwa.

Ọkpụkpụ intraocular ka a na-ejikọkarị ya na ihu ọyịfụ gbara agba na mkpuchi n'ihu anya, nke ga-apụ n'anya oge ụfọdụ ma ọ bụrụ na enweghị ọnaghị akara. Nnukwu ọbara ọbara na-eduga n'ọhụhụ ụzọ zuru oke.

Ihe iriba ama nke aruma aru bu obi ndi mmadu n’anya. Na mgbakwunye, o siri ike ọgụgụ ma ọ bụ rụọ ọrụ na nso.

Ihe ngosiputa oria a bu ihe ngosiputara na asymptomatic, nke mere ka amata na oge ya. Ọ na-abụkarị mkpesa maka mmebi nke ọrụ nlele na-abịa n'ọkwa nke abụọ ma ọ bụ nke atọ, mgbe mbibi ahụ ruru ọnụ ọgụgụ dị mkpa.

Isi ihe nke akara retinopathy:

1. Ọhụụ na-enweghị isi, karịsịa na mpaghara ihu,
2. Ọdịdị nke "ijiji" n'anya anya,
3. Ahọrọ ntụpọ
4. Ihe isi ike ọgụgụ
5. Ike gwụrụ ya na anya ya,
6. Ihe mkpuchi ma ọ bụ onyinyo na-egbochi ọhụụ.
7. Ọnụnọ nke otu ihe ma ọ bụ karịa nwere ike igosi nsogbu nsogbu ọhụụ.

N'okwu a, ịkwesịrị ịgakwuru dọkịta - dọkịta na-ahụ maka ọrịa anya. Ọ bụrụ na enwere obi abụọ maka mmepe nke ọrịa retinopathy nke ọrịa mamịrị, ọ ka mma ịhọrọ ọkachamara dị warara - dibia ophthalmologist - retinologist. Dọkịta dị otú ahụ maara ọkachamara na ndị ọrịa chọpụtara ọrịa shuga mellitus ma ga-enyere aka ikpebi ụdị mgbanwe ndị a.

Ọgwụ ọgwụ

Mezigharị ndị ọrịa nwere ọrịa ịba ọcha n'anya (DR) ka bụ otu n'ime nsogbu ophthalmology kachasị mkpa ma na-agakọ. DR bu onye mbu na-akpata ikpu ìsì na ndi okenye.

Ntụziaka nke ọgwụgwọ Conservative nke DR:

• Ikwụghachi ụgwọ ọrịa shuga na nsogbu ọrịa metabolic:
• carbohydrate metabolism
• ọbara mgbali (BP) (renin - angiotensin - aldosterone system blockers),
• lipid na protein metabolism (vitamin A, B1, B6, B12, B15, fenofibrates, anabolic steroids),
• mgbazi nke azụ azụ:
• ọgwụ antioxidant
• akwara anụ ahụ metabolism,
• emechi inhibitors,
• igbochi angiogenesis,
• mgbazi nke ọrịa vaskụla nsogbu na rheology.
• ọbara rheology nkwalite
• vasodilators,
• angioprotector
• ndị ọrụ na-eme ka ọnọdụ nke endothelium na okpuru ulo nke mgbidi vaskụla.

Edere ndepụta a oge niile ma na-emelite ya. O gụnyere ndi otu a ma ama abuo nke otutu ogwu ajuju, tinyere ebe ohuru ohuru.

Ihe ndabere n’ebighi ezi ọgwụgwọ ọ bụla nke DR (ma ihe ma na nke ịwa ahụ) bụ ụgwọ nke ọrịa shuga na nsogbu metụtara metabolism - protein na lipid metabolism.

Ndabere maka igbochi na ọgwụgwọ DR bụ ụgwọ kachasị mma nke metabolism metabolism. N'ime ụdị shuga 1, a na-ewere ọkwa glucose na-ebu ọnụ nke ruru 7.8 mmol / L dị ka ihe anabatara, na ọdịnaya nke glycosylated haemoglobin HbA1 dị 8.5-9.5%. Na ụdị shuga nke 2, ọkwa nke glycemia nwere ike ịdị elu karịa, na-eburu n'uche ọdịmma onye ọrịa.

Dika nsonaazụ nke ihe omumu EUCLID, ojiji nke ACE inhibitor lisinopril belatara ihe ize ndụ nke inwe ọrịa retinopathy ugboro abụọ ma belata ọnụ ọgụgụ nke ikpe ọhụrụ site na 1/3 n'ime afọ abụọ nke nlele.

Na mgbakwunye na arụmọrụ nke lisinopril, a na-atụle ịdị irè nke ojiji nke ndị ọzọ ACE inhibitors (captopril, fosinopril, perindopril, wdg).

Ọzọkwa, maka mgbazi nke lipid na protein metabolism, ọtụtụ ndị na-ede akwụkwọ na-atụ aro iji vitamin A, B1, B6, B12, B15, fenofibrates na steroid anabolic.

A maara na fenofibrates, na mgbakwunye na mgbazi nke hypertriglyceridemia na dyslipidemia gwara ọgwa, nwere ike igbochi ngosipụta nke ndị na-anabata VEGF na neovascularization, nweekwa antioxidant, mgbochi mkpali na ọrụ neuroprotective.

Na mmalite nke DR, ekwuputara nkwupụta nke lipid peroxidation, n'ihi nke onye ode akwụkwọ nwetara nsonaazụ ọma site n'iji tocopherol (1200 mg kwa ụbọchị).

E gosipụtara mmetụta dị mma site na iji usoro ọgwụgwọ antioxidant dị mgbagwoju anya - systemic (alpha-tocopherol) na mpaghara (ihe nkiri ọgwụ ophthalmic nwere emoxipin), na ọgwụgwọ mexidol.

Nsonaazụ ụlọ ọgwụ nke ọtụtụ ọmụmụ-mmadụ abụọ kpuru ìsì, ebe a na-achịkwa njegharị na DR kwupụtara mmetụta ọgwụ nke ọrụ mgbagwoju anya nke Tanakan n'ụdị nkwalite na steeti retina na ụba acuity visual.

• Ndị na-eme ka akụrụngwa na-emegharị ahụ.

Kemgbe 1983, a na-eme ọtụtụ nnyocha na nyocha ụlọ ọgwụ na ojiji nke peptide bioregulators na DR. Ndị na-ahụ maka bioregulators na-achịkwa usoro metabolic dị na retina, nwee nchịkọta mgbochi na mmetụta hypocoagulation, yana ọrụ antioxidant.

Aldose reductase inhibitors.Ojiji nke aldose reductase inhibitors, enzyme nke na-ekere òkè na glucose metabolism site n'ụzọ polyol na mkpokọta sorbitol n'ime sel ndị na - ejighị insulin, yiri ka ọ na-ekwe nkwa.

Na nyocha anụmanụ, gosipụtara na aldose reductase inhibitors na-egbochi mmebi nke pericytes n'oge retinopathy.

• Ndị na-egbochi ya na ihe na - ebunye akwara votkụla na - akpata ihe mgbochi (VEGF).

Ojiji nke inhibitors kpọmkwem nke uto akwara endothelial (VEGF) bụ mpaghara ọzọ na-ekwe nkwa na ọgwụgwọ nke DR. Dị ka amaara, ihe VEGF na-akpalite uto nke ọrịa arịa, akwara ọbara na ebili mmiri site na arịa retina.

Nlekọta intraocular nke ihe na-emegide VEGF nwere ike ịdị irè na mbido DR ma belata ọrịa edema ma ọ bụ azụ neovascularization. Ugbu a ndị ọrụ 4 na-emegide VEGF dị: pegaptamib sodium, ranibizumab, bevacizumab, aflibercept.

A na-atụ aro ka ndị na-eme ka Vasodilators jiri ya mee ihe dị iche na ịkpachara anya. Enwere ahụmịhe dị mma na iji xanthinol nicotinate maka mgbazi nke nsogbu hemorheological na DR na ụdị normotonic na ụdị hypertensive mmeghachi omume neurovascular.

Ntinye nke na-ewusi mgbidi vaskụla ike, na-egbochi mmụba ya, bụ nnukwu otu n'ime ọgwụ ndị a na-emeso DR.

Site na otu a, rutin na usoro ya, vitamin E, ascorbic acid, na doxium (calcium dobsilate). Site na iji ọgwụ ọjọọ eme ihe otu oge (ọnwa 4-8 ma ọ bụ karịa), ndị ode akwụkwọ ahụ kwuru na akụkụ a na -akpọ azụ hemorrhages.

Mmezi nke steeti endothelium na okpuru ulo nke mgbidi vaskụla yiri ka ọ bụ otu n’ime ụzọ nkwanye aka na nkwalite n’ihe gbasara ọgwụgwọ nke mbido DR na igbochi mmepe nke ọrịa a.

N'afọ ndị na-adịbeghị anya, enweela ọtụtụ akụkọ banyere iji ọgwụ ọgwụ Sulodexide (Wessel Duet F, Alfa Wassermann) sitere na otu glycosaminoglycans (GAG), nke nwere obere ụdị heparin (80%) na dermatin-sulfate (20%) na ọgwụgwọ nke DR.

Sulodexide na DR nwere mmetụta dị mgbagwoju anya:

1. akpọ angioprotective - mweghachi nke ụgwọ eletrik nke ọkpọ ala na iguzosi ike n'ezi ihe nke mgbidi akwara,
2. antithrombotic,
3. fibrinolytic,
4. antihypertensive.

Zọ ịwa ahụ

Igha cosalation nke laser bụ usoro na-adịchaghị mma ma rụọ ọrụ nke ukwuu. N'oge a n'ọkwa mmepe ọgwụ, nke a bụ nhọrọ kachasị mma maka mgbazi ọhụụ na ọrịa dibia ọrịa mamịrị.

A na-eme usoro ahụ site na iji ọgwụ anestetiiki mpaghara n'ụdị ọdịda, ọ dịghị achọ nlezianya nkwadebe na ogologo oge mgbake.

Nkwupụta ọkọlọtọ chọrọ nyocha nke mbido, ma ọ bụrụ na ọ dị mkpa, ọgwụgwọ ọgwụgwọ mgbe usoro ahụ gasịrị na oge izu ike mgbe ntinye aka ahụ.

Usoro ahụ na-ewe ihe dị ka ọkara awa, onye ọrịa ahụ anaghị enwe ihe mgbu na ahụ erughị ala. N'okwu a, a chọghị ka ụlọ ọgwụ onye ọrịa ahụ dị, n'ihi na a na-eme usoro ahụ na usoro nlekọta ahụ ike.

Naanị ọghọm nke coagulation laser bụ nchọta maka ezigbo ọkachamara na akụrụngwa ezughi oke nke ụlọ ọrụ ahụike. Ọ bụghị ụlọ ọgwụ ọ bụla nwere akụrụngwa dị otú a, yabụ ndị bi na ebe ndị dịpụrụ adịpụ ga-agbakwunyere ụgwọ nke njem ahụ.

N'ọnọdụ ụfọdụ, ịdị irè nke coagulation laser ezughị ezu, yabụ a na-eji usoro ọzọ - ọrụ ịwa ahụ. A na-akpọ ya vitrectomy, a na-arụkwa ya n'okpuru usoro izizi.

Njirimara ya bụ mwepu nke azụ azụ mebiri emebi, akụkụ ahụ gbara agba nke anụrị na ndọtị. A na-eweghachikwa ọnọdụ nkịtị nke retina n'ime nku anya na normalization nke nkwarụ vaskụla.

Oge ndozigharị ahụ na-ewe ọtụtụ izu ma ọ ga-achọ ọgwụ mgbe ọ gbasịrị ya. Ha na-enyere aka belata mbufụt nwere ike ime, gbochie mmepe nke ọrịa na-efe efe na nsogbu.

A na-eme nhọrọ nke usoro nlezi anya kwesịrị ekwesị maka ọrịa retinopathy na-arịa ọrịa shuga dabere na njirimara onye ọrịa ahụ. ekwesiri iburu n'uche na ọ gaghị ekwe omume ịnweta ọgwụgwọ zuru oke, yabụ, ụdịrị ịdọ aka na-ebelata usoro pathological na anya.

Ikekwe n'ime afọ ole na ole onye ọrịa ga-achọ ụdị enyemaka ọzọ, yabụ njem a na-eme ka dọkịta na-ahụ maka ọrịa na-aga n'ihu na-agaghị akagbu.

Prognosis maka ndị ọrịa

Oge ndụ na ichebe ọrụ ọhụụ na-adabere na ogo mmerụ anya, afọ na afọ nke ọrịa shuga. O siri ezigbo ike ịchọpụta ọrịa na-anọghị ya, n'ihi na e kwesịrị ichebara ihe ngosipụta nke onye ọrịa echiche.

Na mgbakwunye, na ọrịa retinopathy na-arịa ọrịa shuga, a na-enyocha mmebi nke akụkụ ndị ọzọ na sistemụ site na iji usoro dị iche iche nke ụwa. Na nkezi, mmepe nke retinopathy pụtara afọ 10 ruo 15 mgbe mkpebi nke ọrịa shuga na-akpata, nsonaazụ na-enweghị atụ na-erukwa n'oge a.

Ọtụtụ mgbe, enwere ike ịkpọ ihe mgbagwoju anya nke ọnọdụ a ka ọnụnọ nke ọrịa concomitant na pathologies. Ọrịa shuga na-emetụta akụkụ ahụ niile na sistemu nke anụ ahụ, mana ọrụ anya na-ata ahụhụ na mbụ.

Ọrịa mamịrị retinopathy na-arịa ọrịa shuga bụ nsogbu kachasị na-arịa ọrịa shuga. N'okpuru mmetụta nke mgbanwe nke usoro metabolic, ọrụ nke arịa ndị na-ebunye akwara ngwa ọgụ, na-eduga n'ọbara na usoro nke anya.

Ọrịa ahụ anaghị ekpughe onwe ya n'oge mbido, yabụ ọtụtụ ndị ọrịa na-agakwuru dọkịta ugbua na usoro enweghị mgbagha. Iji gbochie nke a ime, ịkwesịrị ị gaa na dọkịta na-ahụ maka ọrịa anya iji lelee anya gị na retina.