Hoʻokomo ʻia i ka retinopathy Diabetic

ʻO ka retinopathy Diabetic kekahi o nā ʻano microangiopathy e ulu nei e kū'ē i ke kua o ka mellitus lōʻihi o ka maʻi mellitus a pili i nā pili koko o ka retina. ʻO kēia pathology ke kumu nui no ka ʻike haʻahaʻa a me ka makapō i nā poʻe me ka maʻi maʻi.

Hoʻopilikia pinepine ka maʻi retinopathy maʻi i nā maka ʻelua, akā ke ʻokoʻa nā ka nui o ka hōʻino.

Nā kumu kumu a me nā hopena paʻakikī

Me kahi papa lōʻihi o ka maʻi maʻi, hiki i nā maʻi dysmetabolic nā hōʻeha i nā moku koko o ka retina (retina). Ua hōʻike ʻia kēia:

• kuʻi o ka patency (occlusion) o nā kapillaries,
• hoonui nui o ka vascular,
• ka hoʻomohala ʻana o ka ʻili (proliferative) kiko,
• ka hoʻohūnā ʻana o ke ʻano loea hou.

ʻO nā mea koʻikoʻi koʻikoʻi no ka hoʻomohala ʻana i ka retinopathy diabetes i nā maʻi me ka maʻi mellitus no ka:

• ka lōʻihi loa o ka maʻi maʻi
• ʻopi momona
• pae nui o hyperglycemia,
• ulaula
• haehae maʻi
• predisposition genetic
• uhaola hooulu pila
• hapai
• kūlia
• akilekilā,
• maʻi o ka hoʻokalakupua.

Nā ʻano o ka maʻi

Wahi a nā hiʻohiʻona o nā loli i ka lā ocular, ua hoʻokaʻawale ʻia nā ʻano o ke ʻano maʻi retinopathy maʻi:

1. Nonololapa. Ka hoʻonui ʻia ʻana o ka mākaʻi a me ka nāwaliwali o nā moku retinal, kahi i hāʻawi ʻia i ka hoʻokumu ʻana o ka microaneurysms a me ka hiʻohiʻona o nā hemorrhages point, ka hoʻomohala ʻana o ka edema retinal. Me ka hoʻomohala ʻana o ka edema macular (ma ka palena o ka retina) e hiolo ana ka ʻike.
2. Hoʻopuka. Loaʻa ka loaʻa ʻana o nā arterioles, ka mea e alakaʻi ai i ka ischemia retinal a me hypoxia, ka loaʻa ʻana o nā pilikia venous a me ka puʻe ʻana i ka hemorrhagic naʻau.
3. Kumupua. ʻO ka hypoxia retinal hypoxia e hoʻomaka ai ke kaʻina neovascularization, ʻo ia hoʻi, ka hoʻokumu ʻana o nā kīʻaha koko hou. Hoʻopili ʻia kēia me nā hemorrhages vitreous pinepine. A ke hopena, ulu iki ka fibrovascular fusion, i hiki ai ke alakaʻi i ka detinalment retinal tractional, ka hiʻohiʻona o nā neu nepa neazascular lua.

ʻO nā hopena koʻikoʻi o ka maʻi, e hui pū ana me ka atherosclerosis a me ke hypertension, pinepine i ka hōʻeha o ka ʻike.

Hoʻokumu ka retinopathy Diabetic i kahi lōʻihi lōʻihi. I nā hoʻomaka mua, aneane ka maʻi like asymptomatic a me nā hōʻeha ʻole. ʻAʻohe pane kumumuaʻo i ka emi o ke akamai o ka ʻike i ka hana non-proliferative. Me ka hoʻomohala ʻana i ka edema macular, hiki i nā mea maʻi ke hoʻopiʻi i ka ʻike blurred i kahi lōʻihi pōkole a i ʻole ke ʻano o ka ʻano pāheʻe, nā mea kūmole i ʻike ʻia.

I ka lāmela o ka maʻi o ka maʻi, e kau i ka wā i uhi ʻia ai ka pale i mua o nā maka, nā wahi ʻenehina poʻomanaʻo. ʻO kā lākou hanana e pili ana me ka hemorrhage intraocular. Ma hope o ka mālama ʻana i ke koko koko, ua mau ʻia kēia mau hōʻike ma luna iho. Me ka hemorrhage intraocular nui, hiki ke hoʻopau i ka ʻike.

Naʻi hoʻolika

No ka hoʻomaka mua o ka maʻi retinopathy maʻi, e ʻike pinepine ʻia e nā mea maʻi me ka maʻi maʻi e ka ophthalmologist. Hoʻohana ʻia nā ʻano kaʻina ala e like me nā hana screening no ka nānā ʻana i nā loli i ka retina o ka maka.

• perimetry
• Nā kahakaha
• maka biomicroscopy me ke kukui manuahi,
• ophthalmoscopy me ka lāʻau lapaʻau mua i hoʻōla ʻia.
• diaphanoscopy o nā hoʻolālā maka,
• ka helu ʻana o ke kaomi intraocular (tonometry).

Inā he meli ka nui o ka kino vitreous a me nā lens, e hana ʻia kahi ultrasound maka ma mua o ka ophthalmoscopy.

No ka loiloi i nā hana o nā nerve optic a me nā alaʻala hoʻi, ua hoʻohana ʻia nā ala diagnostic electrophysiological diagnostic, i loko o ke electrooculography, electroretinography. Inā kānalua ka neovascular glaucoma, hōʻikeʻia ka gonioscopy.

ʻO kekahi o nā kumu nui no ka hōʻike ʻana i ka retinopathy maʻi maʻi ʻoi ʻo ka angiography fluorescence, kahi e hiki ai iā ʻoe ke loiloi i nā hiʻohiʻona o ke kahe koko i loko o nā moku retinal.

Hoʻopilikia pinepine ka maʻi retinopathy maʻi i nā maka ʻelua, akā ke ʻokoʻa nā ka nui o ka hōʻino.

Hoʻomaʻi ʻia ka mālama ʻana o ka retinopathy diabetic i ka hoʻoponopono nui ʻana o ka maʻi metabolic i loko o ke kino, ka maʻamau o ke kaʻe o ke koko, a me ka hoʻomaikaʻi ʻana i ka microcirculation.

Me nā edema macular, nā inikini intravitreal o nā corticosteroids i kahi hopena therapeutic maikaʻi.

ʻO ka holomua o ka retinopathy maʻi maʻi kumu kumu no ka coagulation laser o ka retina, e hōʻemi ana i ka nui o ke kaʻina neovascularization a hōʻemi i ka hopena o ka hana retinal.

Ma ka retinopathy maʻi maʻi paʻakikī, paʻakikī i ka ʻokiʻoki i ka retinal a i ʻole ke kani ʻana i ka macular traction, hana ʻia ka vitrectomy. I ka wā o ka ʻoihana, lawe ʻia ka vitreous, cauterize i nā kīʻaha koko, wehe i nā kaula kohu.

Hiki i nā hoʻopiʻi a me nā hopena

ʻO ka holomua o ka retinopathy maʻi maʻi alakaʻi i nā ʻōlelo hoʻopiʻi penei:

• detinalment retinalment,
• glaucoma kapu
• mau palena nui o nā nānā ʻike,
• cataract
• makapō piha.

No ka hoʻomaka mua o ka maʻi retinopathy maʻi, e ʻike pinepine ʻia e nā mea maʻi me ka maʻi maʻi e ka ophthalmologist.

ʻO ke kūlike o ka maʻi retinopathy maʻi no ka hana ʻike mau he mea koʻikoʻi mau ia. ʻO nā hopena koʻikoʻi o ka maʻi, e hui pū ana me ka atherosclerosis a me ke hypertension, pinepine i ka hōʻeha o ka ʻike.

Kāohi

Hōʻalo i nā hana e pale ai i ka hoʻomaka ʻana a i ʻole ka holomua ʻana o ka maʻi retinopathy diabetes.

• mālama pinepine iā glycemia,
• ka makaʻala ma ka mālama ʻana i nā lāʻau lapaʻau i ka insulin a i ʻole ka hoʻokele ʻana o nā lāʻau hōʻemi i ke kō.
• ʻai kai (papa ʻaina 9 ma muli o Pevzner),
• kaohi ʻana i ke koko,
• polō laser wā retinal coagulation.

Nā lāʻau lapaʻau

Hoʻopilikia ke kōpaʻa koko nui i nā kīʻaha e hānai i nā maka, hōʻole i ke kahe o ke koko ma o lākou. Hōʻike nā kōpili o ka maka i ka hemo oxygen. Mālama lākou i nā mea i kapa ʻia nā mea ulu e hana ai nā moku a hoʻōla i ka kahe o ke koko. ʻO ka mea pōʻino, ua ulu nā pahu hou. ʻO kēia mau, e hele pinepine nā hemorrhages. Hiki i ke hopena o kēia mau hemorrhages ke hele i ka hōʻole hou i ka retinal (detachment) a me ka makapō piha.

ʻO nā lāʻau lapaʻau i kapa ʻia nā mea ulu o ka ulu lāʻau (anti-VEGF) e pale i nā hiʻohiʻona o nā moku koko hou. Mai ka makahiki 2012, i nā ʻāina ʻōlelo Lūkia, ua hoʻohana nā lāʻau lapaʻau ʻo Lucentis (ranibizumab) a me Zaltrap (aflibercept). ʻAʻole kēia he makana. Hoʻokomoʻia lākou i ka vitreous (intravitreal). No ka hoʻokau ʻana i kēlā ʻano maʻi, pono ʻoe i ka ʻike loea. He mea kūʻai loa kēia mau lāʻau. Mālama lākou iā ia e nā patent a no laila ʻaʻohe analogues e ʻoi aku ke kūpono. Eia nā mea āpau, hiki i ke kauka ke kuhikuhi i kahi lama implan dexamethasone e mālama pono i ka edema diabetes. Ua kapa ʻia kēia lāʻau hoʻōla o Ozurdeks.

Lucentis (ranibizumab)

ʻAʻohe maka maka a me nā kūleʻa o nā kānaka no ke kōkua retinopathy maʻi. Hōʻike pinepine nā maʻi i ka nānā ʻana i nā maka o Taufon. ʻAʻole loaʻa kēia lāʻau i ka retinopathy maʻi maʻi ma ka papa inoa o nā hōʻike hōʻike no ka hoʻohana. ʻO ke kūmole ka hana ikaika. Loaʻa paha ia he pono no ka edema, ma ke ʻano he nui o ka hopena paʻakikī o ka hypertension arterial a me ka nele ʻole o ka naʻau. E heluhelu e pili ana i kēia ma nā kikoʻī. ʻOi aku ka maikaʻi e lawe ma o ka waha, ʻaʻole ma ke ʻano o ka hāʻule ʻana o ka maka. E like me ka riboflavin a me nā huaora o ka hui B. Mai lilo i ke kālā ma ka nānā ʻana o ka maka a me nā hopena o nā kānaka. Mai hōʻalo i ka manawa kūpono, akā hoʻomaka e mālama ʻia i nā hana kūpono e pale ai i ka makapō.

Mālama hou retinal laser

ʻO ka hui ʻana he moxibustion. I ka wā o ke kaʻina hana ʻai ʻana o ka retina, ua hoʻohana ʻia nā haneli mau haneli i nā moku. Mālama kēia i ka ulu o nā capillaries hou, e hoʻemi i ke alapine a me ka paʻakikī o ka hemorrhage. He kūpono loa ke ʻano i hōʻike ʻia. Hāʻawi ia iā ʻoe e hoʻopaʻa i ke kaʻina ma ka papa preproliferative o ka maʻi retinopathy diabetes i 80-85% a ma ka hanana proliferative ma 50-55% o nā hihia. Ma nā hopena koʻikoʻi o ka maʻi maʻi i ka hihiʻo, hiki iā ia ke pale aku i ka makapō i ke 60% o nā mea maʻi no 10-12 mau makahiki.

Kūkākūkā me kahi kanaka ophthalmologist inā lawa kekahi ala no ka photocoagulation laser no kou, a i ʻole ke ʻano he nui. E like me ke kānāwai, ma hope o kēlā me kēia kaʻina hana, nawaliwali ka ʻike o ka mea maʻi, ua emi ka nui o kāna kīhāpai, a ʻoi loa ka pilikia o ka pō. Akā ma hope o kekahi mau lā, e kū mālie ke kūlana. Aia kekahi manawa kiʻekiʻe e noho lōʻihi ka hopena. Hiki ke hoʻohui pū ʻia me ka hoʻohana ʻana i nā lāʻau lapaʻau, ʻāpono i nā mea ulu ulu vascular (anti-VEGF), e like me ka hoʻoholo a ke kauka. Hoʻoulu pinepine ʻia ka hoʻopiʻi pinepine ʻana i nā ʻāpana hemrewa, e hōʻa wale ʻia ia. I kēia hihia, koi ʻia ka vitrectomy.

ʻAuhulu

ʻO Vitrectomy ka hana ʻoki ʻana i ka kino vitreous i lilo i mana ʻole ma muli o ka hemorrhage. Hoʻopili ʻia ke kaila i hoʻoneʻe ʻia me ka paʻakai ka paʻakai a me nā polimilana kūloko. I ka hiki i ka vitreous, ua hōʻoki ke kauka i ka ligament o ka retina. I mua o nā clots koko, ua lawe pū ʻia lākou, me nā ʻaoʻao hoʻololi hoʻololi i ka pathologically.

Hoʻohana ʻia ka hana ma lalo o ka panui kūloko a i ʻole. Ma hope o ka hihiʻo e ola paha. ʻO kēia mana he 80-90% no nā poʻe maʻi i hōʻole ʻole iā lākou. Inā hele ʻo ka haʻalele ʻana i ka retinal, a laila i ka wā o ka hana e hoʻi nō ia i kona wahi. Akā ua emi iki ka manawa o ka hoʻihoʻi ma 50-60%. Kū pinepine ka Vitrectomy i nā hola 1-2. ʻO kekahi manawa hiki ke hana me ka hoʻokipa ʻole ʻana i ka mea maʻi.

Nā hōʻike haukapila

ʻO nā Microaneurysms, hemorrhages, edema, exudative foci i ka retina. ʻO nā ʻōpū he ʻano o nā puʻupuʻu liʻiliʻi, nā hōʻeha a me nā wahiʻeleʻele o kahi kūlana i hoʻopuni ʻia, i hoʻopaʻa ʻia i ka waenakonu o ka waihona kālā a i ʻole nā ​​ʻāpana nunui i nā ʻāpana hohonu o ka retina. Loaʻa ka exudates paʻakikī a palaka ma kahi o ke kikowaena o ka waihona kālā a ua melemele a keʻokeʻo paha. ʻO kahi mea nui o kēia hana ke kau i ka edema retinal, i hoʻopaʻa ʻia i ka ʻāina macular a i ʻole nā ​​moku nui (Fig. 1, a)

Nā kūlike hanana nui loa: ke kīpī, ka ʻūhā, ka hoʻopihapiha, hoʻopihapiha a hoʻolaha ʻia nā maʻi hou i loko o ke ʻano o nā kīʻaha koko. ʻO kahi helu nui o ka "solid" a exudates. Nā anomalies microvascular Intraretinal, nui nā hemorrhages retinal nui (Fig. 1, b)

Neovascularization o ka optic disc a me nā ʻāpana ʻē aʻe o ka retina, ka hemorrhage vitreous, ke ʻano o ka iwi fibrous i loko o ka wahi o ka hemorrhages preretinal. ʻO nā moku i hana ʻia ka palupalu loa a paʻakikī, ma muli o ia hana pinepine ʻia o nā hemorrhages. Hoʻokomo ka Vitreoretinal traction i ka detinalment retinal. ʻO nā kīʻaha hou i hana hou ʻia o nā iris (rubeosis) ke kumu o ke kūkulu ʻana i ka glaucoma kūloko (Fig. 1, c)