Hoʻokomo ʻia i ka retinopathy Diabetic > Hoʻopiʻi nā maʻi maʻi

ʻO ka microangionathia diabetic i kahi lesi mua o nā arterioles precapillary, nā capillaries a me nā mea kanu postcapillary me ka hiki ke komo o nā moku o kahi kalala nui. Hōʻike ʻia ka retinopathy e ka neʻe ʻana a me ka leakage. Hiki ke hoʻokaʻawale ʻana:

ʻano poʻomanaʻo (non-proliferative), kahi i pau ai ke ala i ka intraretinally
proliferative, ma kahi ana i piʻo ai ma ka maka o ka retina i ʻole ia ma mua o ka,
preproliferative, kiʻi ʻia e ka ʻano proliferative hiki ʻole.

ʻO ka maʻi mellitus ka maʻi maʻamau o ka maʻi metabolic i hōʻike ʻia e ka hyperglycemia lōʻihi o ke ʻano o ka paʻakikī, e ulu ana i kahi lua ma ka pane ʻana i ke kahe ʻana o ka neʻe a me / a i ʻole ka hana o ka insulin endogenous. Hiki i ka diabetes mellitus ke paulele ʻole i ka inikua a i ʻole ka hilinaʻi ʻole i ka insulin, i ʻole e hoʻohālikelike ʻia me ka maʻi type ʻelua a i ʻole 2. ʻOi aku ka mea maʻamau o ka maʻi retinopathy diabetes me ka maʻi type o ka maʻi 1 (40%) ma mua o ke ʻano type diabetes 2 (20%) a ʻo ia kekahi kumu nui o ka makapō i ka poʻe i nā makahiki he 20 a 65.

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ʻO nā mea Kūʻai no ka Diabetic Retinopathy

He mea nui ka lōʻihi o ka maʻi diabetes. ka hika i ka hoʻomā ʻana ʻana i ka maʻi diabetes i nā mea maʻi ma lalo o 30 mau makahiki he nui ka hopena o ka hoʻomohala ʻana i ka retinopathy maʻi ma hope o 10 mau makahiki he 50% a ma hope o 30 mau makahiki - 90% o nā hihia. Hoʻokomo pinepine ka retinopathy diabetes i nā makahiki 5 o ka mua a me ke ʻano maʻi maʻi kanikani, akā aia ma 5% o nā mea maʻi me ka maʻi maʻamau ʻo 2.

ʻO ka nele o ka hoʻokele ʻana i nā kaʻina metabolic i loko o ke kino he kumu maʻamau loa no ka hoʻomohala ʻana a me ka holomua o ka maʻi retinopathy diabetes. Hoʻomaʻa pinepine pinepine ka ʻōpū i ka holomua wikiwiki o ka retinopathy diabetes. Hoʻopili pū ʻia nā mea i hoʻopiʻi ʻia ʻana me ka ʻike ʻole o ka ma lalo o ka maʻi ma mua o ka wā hāpai ʻana, ka hoʻomaka koke ʻana i ka hoʻōla ma ka hoʻomaka ʻana o ka wā hapai, a me ka hoʻomohala ʻana o ka preeclampsia a me ka hoʻōki wai. Nā maʻi hypertension me ka lawa ʻole o ka kontrol e alakaʻi i ka holomua o ka retinopathy diabetic a me ka hoʻomohala ʻana i ka retinopathy diabetic proliferative ma ka maʻi mellitus type 1 a me 2. Hoʻokomo ka nephropathy ene i ka weliweli i ka papa o ka retinopathy diabetes. Ka mea maikaʻi loa, ke mālama ʻia ʻana o ka hana o ke alakaʻi (me ka laʻana, ka hoʻololi ʻana o ka huehue) me ka holomua o ke ʻano a me ka hopena maikaʻi ma hope o ka photocoagulation. ʻO nā mea ʻē aʻe ʻē aʻe no ka retinopathy diabetic he ulaula, ʻōpiopio, hyperlipidemia.

Nā pōmaikaʻi o ka Mana Metabolic Intensive

Ua lohi i ka hoʻomohala ʻana o ka retinopathy maʻi, akā ʻaʻole pale.
Ke hoʻolōʻihi nei i ka holomua o ka retinopathy maʻi latent.
ʻO ka emi o ke kahe o ka hoʻololi o ka maʻi retinopathy diabetes preproliferative i proliferative.
Hoʻopau i ka edema macular.
Hoemi ʻia ka coagulation laser.

ʻO pathogenesis o retinopathy diabetes

Kuhi ʻia nā pathogenesis o retinopathy i nā kaʻina pili i loko o nā moku o ka retina.

lolilila. ʻO ko lākou mau hoʻololi e hōʻike ʻia e ka nalowale o nā pericytes, ʻokiʻoki i ka membrane basement, hōʻino a me ka hoʻopuka ʻana o nā pūpū endothelial. he hanological abnormalities e hōʻike i ka deformation a me ka hoʻonui hou ʻana i ka hōʻailona o ka "kolamu kālā", i hoʻemi ʻia ka platelet flexity a me ka hōʻuluʻulu ʻana, e alakaʻi ana i ka hoʻoemi o ka lawe o ka oxygen.

ʻO ka hopena o ka nele o ka wili ʻana o nā capillaries o retinal i ka ischemia, kahi mea e hōʻike mua ana ma luna o ke kai waena. ʻO nā hōʻike ʻelua ʻelua o ka retox hypoxia he:

nā ʻanuʻu arteriovenular, i ukali ʻia e ka hoʻokūkū koʻikoʻi ("pio") o nā capillaries ma ke ala mai nā arterioles i nā venules. ʻAʻole i akaka kēia no ka hoʻohuli ʻia o kēia mau loli e ka moku hou a i ʻole ka wehe ʻana o nā ala vask e noho nei, no laila ua kapa ʻia lākou he mau ʻano pelekikena intraretinal.
ua manaʻo ʻia ʻo neovascularization ke kumu o ka hana o nā mea kūlohelohe (nā mea ulu) i hoʻokumu ʻia i loko o ka iwi hypoxic o ka retina i ka wā e hoʻāʻo ʻia e revascularize. Hāʻawi kēia mau mea i ka neovascularization o ka retina a me ka optic disc, a ʻo ka manawa pinepine o ka iris (iris rubeosis). Ua hoʻokaʻawale ʻia nā mea ulu nui, akā ʻo ka mea nui ka nui o ka ulu mua ʻana o viva endothelial.

ʻO ka nele o ka pālākahi hematoretinal kūloko e alakaʻi i kahi leakage o nā kulu plasma i loko o ka retina. ʻO ka hoʻonāukiuki kino o nā paia o nā capillaries e alakaʻi i ka protrusion saccular kūloko o ka paia vascular, i ho'ākāka ʻia me microaneurysms, me ka ʻoluʻolu a i ʻole kekahi manawa.

ʻO kahi hōʻike o ka hoʻonui ʻia vascular permeability ka hoʻomohala ʻana o ka hemorrhage intraretinal a me ka edema, hiki ke lūlū ʻia a i ʻole kaiāulu.

diffuse retinal edema ka hopena o ka hōʻailona hoʻonui ʻia ʻana o nā capillaries a me ka holo,
edema retina kūloko ka hopena o ka leakage o nā focal mai microaneurysms a me nā pā i hoʻonui ʻia i nā kapillaries.

Ka lāʻau edema retinal kūloko e alakaʻi i nā huna o ka exudate paʻa i ka wahi o ka hoʻololi o ka retina olakino a me nā edema. Nā Exudates i hana ʻia e nā lipoproteins a me nā macrophages i hoʻopiha ʻia me nā lipid e puni ana i ka wahi o ke leʻaleʻa microvascular i ke ʻano o ke apo. Ma hope o ka pau ʻana o ka leakage, ua komo lākou i ka paʻa ʻana i loko o nā kapili a puni, a i ʻole phagocytosed; noho mau ke kaʻina no nā mahina he mau makahiki a keu paha mau makahiki. Hoʻokomo ka leakage maʻi e hoʻonui i ka exudates a me ka haʻalele ʻana o ka cholesterol.

Nonproliferative Diabetic Retinopathy

Hoʻonohonoho ʻia nā Microaneurysms i loko o ke kaona kaulike o loko a ʻo ia kekahi o nā maʻi ʻeha a ʻike mua ʻia e ka ʻoihana.

ʻokoʻa, hoʻokaʻawale, ʻūhā, ʻūhā, kū like ka loa mai ke fovea. Inā lākou e hoʻopuni ʻia e ke koko, a laila ʻaʻole ʻokoʻa lākou mai nā ʻūhaka kiko,
assay retinal o trypsin i loko o retinopathy diabetes me perifocal microaneurysms:
nā microaneurysms me kahi kikoʻī ma ke kūleʻa kiʻekiʻe,
Hōʻike ka FAG i nā pihi hanahana hyperfluorescent, ʻo nā microaneurysms nā nontrombiric, ʻo ka nui o ka manawa e hoʻohālikelike ʻia i ka nānā pū ʻia e ophthalmoscopically. I nā papaha hope aʻe, ʻike ʻia ka hyperfluorescence ma muli o ka nānā ʻana o ka puna wai.

Aia ka exudates Solidates ma ka papale plexiform waho.

ka waxy, nā leona melemele me nā kihi kaʻo i hoʻomaʻamaʻa ʻia, ka hoʻopili ʻana a me / a i ʻole nā apo paha i ka pou posterior. Ma ke kikowaena o ke apo o ka exudate paʻa (annular exudate), hoʻoholo pinepine nā microaneurysms. A hala ka manawa, hoʻonui ko lākou helu a me ka nui, e hoʻoweliweli ana i kahi fovea me ka hiki ke komo i loko o ke kaʻina pili.
Hōʻike ka phage i ka hypofluorescence ma muli o ke kālai ʻana o ka pae ʻana o ka choroid.

ʻO ka retina edema ka ʻōnaehana kūloko ma waena o ka plexiform a me nā ʻāpana ʻihi o loko. Ma hope mai, ua hoʻopili ʻia nā palapala plexiform i loko a me nā papena o nā nerve nerve i ka edema o ka retina i ka mānoanoa holoʻokoʻa. ʻO ka hōʻemi hou ʻia o ka nui o ka wai i loko o ka fovea e alakaʻi i kahi hoʻokumu o kahi cystic (cystic macular edema).

ʻike maikaʻi ʻia ʻo retinal edema i ka manawa i nānā ʻia ma ke kukui kuʻi e hoʻohana ana i kahi lensa Goldmann,
Hōʻike ka phage i nā hyperfluorescence hope ma muli o ke leakage o nā capillaries retinal.

hele mai nā ʻāpana o ka intraretinal mai loko o nā wahi kūpono o nā capillaries a loaʻa i nā pae waena o ka retina. ʻO kēia mau ʻāpana hemorrhages, he ʻula ʻulaʻula a me kahi hoʻonohonoho kūlike ʻole.
i ka papakū o nā kinona o ka retina, kū i ka hemorrhages mai nā arterioles superpicial nui loa, ka mea e hoʻoholo ai i ko lākou ʻano ma ke ʻano o "nā ʻōlelo o ka lapalapa".

ʻO nā hana aʻoaʻo hoʻokele no ka poʻe maʻi me ka non-proliferative diabetic retinopathy

ʻO nā mea maʻi me ka non-proliferative diabetic retinopathy ʻaʻole pono i ka lawelawe ʻana, akā e koi ʻia kahi hoʻokolohua makahiki. Hoʻopili i nā mālamalama kūpono no ka maʻi maʻi, pono e pili pono i nā mea pili.

Maʻa retinopathy diabetic preproliferative

ʻO kahi hōʻike o nā hōʻailona hoʻoweliweli i ka proliferation non-proliferative retinopathy diabetic e hōʻike i ka hoʻomohala ʻana o ka retinopathy diabetic preproliferative. Nā hōʻailona maʻi lapaʻau o ka retinopathy maʻi preproliferative e hōʻike ana i ka ischemia retinal holomua, ʻike ʻia ʻo ia ma FLG i ke ʻano o nā wahi koʻikoʻi o ka hypofluorescence o kahi retina unperfused (capillary "off"). Hōʻailona ka nui o ka holomua o ka holomua no ka nui o nā loli.

ʻO nā hiʻohiʻona maʻi o ka retinopathy diabetic preproliferative

ʻO ka foci-like Cotton ka paukū kūloko o ka puʻuwai o ka naʻau ma ka papena o nā koikoi retinal ma muli o ka hiki ʻana o nā arterioles precapillary. ʻO ka wehe o ka wā o ka axoplasmic me ka hōʻiliʻili o ka mea lawe i lawe ʻia i nā axons (axoplasmic stasis) e hāʻawi ai i ka foci i kahi hue keʻokeʻo.

nā hōʻailona: liʻuliʻu, keʻokeʻo, ka pīpī i like me ka nui o ka foci, e uhi ana i nā moku koko lae lalo, i hoʻopaʻa ʻia ma ka ʻaoʻao i ka wahi hope-equatorial o ka retina, kahi i lawa ai ka mānoanoa o nā papa o nā nerve e ʻike pono ai iā lākou,
Hōʻike ka FAG i ka hypofluorescence kūloko ma muli o ka pale ʻana i ka hopena o ka hopena o ka choroid, hoʻopili pinepine ʻia me nā ʻāpana e pili ana i ka capillaries no ka mea ʻole i kaʻaila.

Hōʻike ʻia nā maʻi microvascular intraretinal e ka ʻalā mai nā arterioles retinal i ka venules, ke kāʻei i ka moena o ka capillary, no laila, ʻōpiopio pinepine ʻia lākou i kahi kokoke i nā wahi o ka hopena o ke kahe o ke kahe koko.

nā hōʻailona: nā kala ʻulaʻula e hoʻopili ana i nā arterioles a me nā mea hoʻonaninani, ke loaʻa ʻana o nā ʻāpana kūloko o nā moku Retinal hou i hoʻokumu ʻia. ʻO ka hiʻohiʻona nui o ka maʻi microvascular intraretinal ko lākou wahi i loko o ka retina, ka hiki ʻole o ke keʻa ʻana i nā kīwaha nui a me ka nele o ka palau ʻana i ka laha,
Hōʻike ka phage i ka hyperfluorescence kūloko e pili ana i nā wahi e pili ana i ka hopena o ke kahe o ke kahe koko.

Nā maʻi ʻino: ka hoʻonui ʻana, ka hoʻokumu ʻana o nā puka kuʻuna, ka hoʻokaʻina i ke ʻano o ka "bead" a i ʻole "rosary".

ʻO ka pilikia o ka arterial: constriction, kahi hōʻailona o ke "kaula kālā" a me ka obliteration, e hana ana iā lākou e like me ka wehe ʻana o kahi lālā o ka areli retinal central.

Nā wahiʻeleʻele o nā ʻōpū: hemorrhagic retinal infarcts i loaʻa i kona mau waena waena.

ʻO nā hana aʻoaʻo hoʻokele no ka poʻe maʻi me ka retrolopati diabetes preproliferative

Me ka retinopathy diabetic preproliferative, koi ʻia ka nānā ʻana ma muli o ka hiki ʻana o ka hoʻomohala ʻana i ka maʻi retinopathy diabetes proliferative.ʻO ka maʻi maʻamau ʻaʻole hōʻike ʻia, ke hiki ʻole ke nānā i loko o ka dinamics a i ka hihiʻo o ka maka paired, ua nalowale ia ma muli o ka proliferative diabetic retinopathy.

ʻO ka Diulopathy Diabetic

ʻO ke kumu nui o ka hōʻino o ka ʻike ma ka poʻe maʻi me ka maʻi diabetes, ʻoi aku ka maʻi diabetes type 2, ka fovea edema, ka haʻalele ʻana o ka exudate solid or ischemia (maʻi maʻa maculopathy).

Ka helu ʻana o ka Diulabetic Maculopathy

Makulopathy maʻi exudative kūloko

nā hōʻailona: kahi kikoʻī hoʻonaninani maoli i ka retina, i hoʻopili ʻia e ka pū poʻina piha piha piha ʻana o ka exudates solid perifoveal,
Hōʻike ʻo PHA i ka hyperfluorescence kūloko ma muli o ka lula a me ka momona macular maikaʻi.

Hoʻohālikelike i ka maʻi maculopathy maʻi exudative

nā hōʻailona: ke hoʻokaʻawale ʻana i nā mānoanoa o ka retina, i hui pū ʻia e nā loli cystic. ʻO ka Obliteration me ka edema koʻikoʻi i ka manawa hiki ke hoʻololi i ka fovea,
Hōʻike ka FAG i ka nui o ka hyperfluorescence o microaneurysms a me ka lohi i ka hyperfluorescence ma muli o ka luhi, ʻoi aku ka ʻōlelo i hoʻohālikelike ʻia me kahi hōʻike loiloi. I ka pihaʻana o ka edema macular edema, kahi pae ma ke ʻano o ka "petal pua" hoʻoholo ʻia.

Maculopathy Diabetic Ischemic

nā hōʻailona: hōʻemi i ka ʻike acuity ʻikea me ka fovea palekana palekana, pinepine ka pilina me ka retinopathy diabetic preproliferative. Hiki ke ʻike ʻia nā wahi pōʻele o nā hemorrhages,
Hōʻike ka phage i nā capillaries non-perfused i loko o ka fovea, kahiʻano paʻakikī i kūlike ʻole i ka pae o ke kahena o ka ʻike acuity.

ʻO nā ʻāpana ʻē aʻe o ka capillaries no ka lē-perfusion ka mea i kū pinepine i ka pali posterior a me nā periphery.

ʻO ka maculopathy maʻi hoʻohuihui ʻia i hōʻailona ʻia i nā hōʻailona o ka ischemia a me ka exudation.

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ʻO ka edema koʻikoʻi koʻikoʻi

Hōʻike ʻia ka maʻi macular edema e like me kēia:

ʻO ka edema retinal i loko o 500 μm o ka fove waena.
Hōʻalo ʻo Solid i loko o 500 μm mai loko mai o ka fove waena, inā ua hele pū lākou me ka ulaula o ka retina e puni ana iā ia (kahi paha eʻoi aku ma mua o 500 μm).
ʻO ka edema retinal i loko o 1 DD (1500 μm) a i ʻole, i.e. e hāʻule nā wahi o ka edema i loko o 1 DD mai kahi fove waena.

ʻO ka edema macular koʻikoʻi e koi i ka laser photocoagulation e pili ana i ka ʻike maka, no ka mea e hoʻemi ka mālama i ka hōʻemi o ka ʻike maka ma ka 50%. ʻO ka hoʻomaikaʻi ʻana i ka hana ʻike makele, no laila ua hōʻike ʻia ka mālama ʻana no nā kumu pale. Pono e alakaʻi i kahi phage ma mua o ka mālamaʻana e hoʻoholo ai i nā wahi a me nā nui o ka pulu. ka ʻike ʻana i nā capillaries maikaʻi ʻole i hana ʻia i ka fovea (ischemic maculopathy), he hōʻailona prognostic maikaʻi ʻole a me kahi contraindication e mālama ai.

Hoʻokomo ka coagulation laser kūloko i ka hoʻopili ʻana i ka hoʻokūkū laser i nā microaneurysms a me nā maʻi microvascular i ka waenakonu o nā apo o nā exudates solid, i hoʻokomo ʻia i loko o 500-3000 microns mai ka fove waena. ʻO ka nui o ka coagulate he 50-100 nā micons me ka lōʻihi o 0.10 kekona a lawa i ka mana e hāʻawi i kahi ʻolocololi ʻana a i ʻole nāʻeleʻele o nā microaneurysms. Hōʻike ʻia ka mālama ʻana o ka foci a i ka 300 μm mai fovea kikowaena me ka hoʻomau mau ʻia e ka edema macular edema koʻikoʻi, ʻoiai ke mālama mua ʻana a me ka ʻike kūlohelohe ma lalo o 6/12. I kēlā mau ʻano, ke kauoha ʻia e pōkole ka manawa i ka manawa 0,05 kekona, b) hoʻohana ʻia ka coagulation laser trellised i mua o nā wahi o ka hoʻopalapula i ke ʻano o ka retina i loaʻa ma kahi mamao o 500 μm mai ka fove waena a me 500 μm mai ka palena kino o ke poʻo o ka ulu optic. ʻO ka nui o ka coagulate he 100-200 mau micons, ka manawa o ka hoʻolaha ʻana he 0.1 sec. Pono lākou he kala kukui loa ia, e hoʻokaʻawale ʻia lākou i kahi mamao e kūpono ai i ka anana o ka 1 coagulate.

Nā hopena Ma kahi o 70% o nā hihia, hiki ke hoʻokō ʻo ka hoʻokō ʻana i nā hana ʻike, i ka 15% - i laila ka hoʻomaikaʻi ʻana, a ma 15% o nā hihia - kahi maʻi i hala. Hoʻoholo ʻia ka hoʻonā ʻana o ka edema i loko o 4 mau mahina, no laila ʻaʻole hōʻike ʻia ka hoʻomaʻamaʻa ʻana i kēia manawa.

ʻO nā mea kumu no ka Hōʻoka Kino

Solid exudates e uhi ana i ka fovea.

ʻO ka hoʻōla pālahalaha o ka macula.
Cystic edema o ka makula.
Ka huina exudative-ischemic maculopathy.
Retinopathy koʻikoʻi i ka manawa o ka hoʻokolokolo.

Hiki i kahi pā plana vitrectomy ke hōʻike ʻia no ka edular macular e pili ana me ka tangential traction, kahi e kaʻi ana mai ka membid posterior hyaloid posterior. I kēlā mau kūlana, ʻaʻole i kūlike ka mālama ʻana o ka laser me ka wehe ʻana i ka macular traction.

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Proliferative Diabetic Retinopathy

Loaʻa ia ma 5-10% o nā maʻi me ka maʻi maʻi. Ma ka maʻi diabetes type 1, nui ka nui o ka pilikia: ʻo ka nui o ka ulu ʻana ʻo 60% ma hope o 30 mau makahiki. ʻO ka hāʻawi ʻana i nā mea wili o ka carotid artery occlusion, detiorment posterre vitreous, myopia kiʻekiʻe, a me ka atric optic.

Nā hiʻohiʻona haukapila o ka retinopathy diabetic proliferative

ʻO nā hōʻailona o ka retinopathy diabetic proliferative. ʻO Neovascularization kahi hōʻailona o ka retinopathy diabetic proliferative. Hiki i ke kūleʻa ʻana o nā moku hou i kūkulu ʻia ma kahi mamao a hiki i 1 DD mai ka opt disk nerve (neovascularization ma ka ʻāpana disk) a i ʻole nā kīʻaha nui (neovascularization ma waho o ka pā). Loaʻa nā koho ʻelua. Ua hoʻokumu ʻia ka hoʻomohala ʻana o ka maʻi retinopathy diabetes proliferative ma mua o ka nonperfusion ʻoi aku ma mua o kahi hapaha o ka retina. ʻO ka hala ʻole o kahi membrane palena kūloko a puni ke kaila optic nepū ʻokoʻa wehewehe i ka manaʻo i ka neoplasm ma kēia wahi. Kēia nā puka hou i ke ʻano o ka hoʻomaʻamaʻa ʻana o nā endothelial, ka mea pinepine loa mai nā veins, a laila hāhai lākou i nā hemahema o ka membrane palena kūloko, e waiho ana i ka mokulele e hiki mai ana ma waena o ka retina a me ka pōpō o ka papakui o ka kino vitreous, e lawelawe ai i ko lākou kākoʻo.

Manaʻo. No ka helu ʻana, ʻaʻole pono ia, akā, ke hōʻike nei neovascularization i nā manawa mua o ka angiograms a hōʻike i ka hyperfluorescence i nā hope hope aʻe, ma muli o ka kolo ikaika o ka pulu mai ka kiko neovascular.

Hoʻomaka o nā hōʻailona o ka retinopathy diabetes proliferative

ʻO ka paʻakikī o ka retinopathy diabetes proliferative e hoʻoholo i ka hoʻopiʻi ʻana i ka wahi i noho ʻia e nā moku hou i kūkulu ʻia me ka wahi o ka disc optic:

Disk Neovascularization

Keʻano haʻahaʻa - nā ʻāpana a emi mai ka 1/3 DD.
'Ōlelo - ka nui ma luna o 1/3 DD.

Nā neovascularization kikowaena disk

Keʻano haʻahaʻa - nā ʻāpana a emi mai ka 1/2 DD.
'Ouncedlelo - nui ma luna o 1/2 DD.

ʻImi i nā moku i hou ʻia e pane iki aku i ka mālama ʻana i ka laser ma mua o nā moku ʻāpana.

ʻO Fibrosis e pili ana me ka neovascularization o ka makemake no ka hoʻonui nui ʻana i ka momona fibrous, ʻoiai me ka haʻahaʻa haʻahaʻa o ke kahe, he nui ka hopena o ka tractinal retinal detachment.

ʻO ka hemorrhages, ʻo ia paha kahi preretinal (subhialoid) a / a i ʻole vitreous i loko o ka vitreous, he mea koʻikoʻi kahi mea no ka hoʻemi ʻana i ka acuity ʻike.

ʻO nā hiʻohiʻona o ka hoʻonui nui o ka emi ʻana o ka hihio i ka wā 2 mau makahiki mua i ka hemo ʻole o ka mālama ʻana, penei:

ʻO ka neovascularization Modle i ka wahi o ka pā i ka hemorrhages he 26% o ka loaʻa ʻana o ka hopena, ka mea i hōʻemi ʻia i ka 4% ma hope o ka mālama ʻana.
ʻO ka neovascularization koʻikoʻi ma ka pā disk a ʻaʻole hemorrhage he 26% o ka loaʻa ʻana o ka hopena, ka mea ma hope o ka mālama ʻana i ka hōʻemi iā 9%.

ʻO neovascularization koʻikoʻi o ka mīkini optic me ka kiʻekiʻe

ʻO ka neovascularization koʻikoʻi ma ka wahi o ka disoka me ka hemorrhages he 37% o ka loaʻa ʻana o ka hopena, ka mea ma hope o ka mālama ʻia ʻana o ka mālama ʻana i 20%.
ʻO ka neovascularization koʻikoʻi ma waho o ka disk hemorrhagic he 30% o ka hopena o ka hopena, ka mea ma hope o ka mālamaʻana i ka hōʻemi iā 7%.

Inā kū ʻole kēia mau ʻōkuhi, ua pono ia e pale i ka photocoagulation a nānā i ka mea maʻi i kēlā me kēia 3 mahina. Eia nō naʻe, ʻo ka mea nui, ʻo ka poʻe ophthalmologists e hoʻohana i ka photocoagulation laser a hiki i ka hōʻailona mua o neovascularization.

Nā hopena o ka Diabetic Eye Damage

I loko o ka retinopathy maʻi maʻi, ua loaʻa nā pilikia hōʻeha nui a me ka hoʻoweliweli i nā mea maʻi i mālama ʻole ʻia e ka laser, a i ʻole nā hopena i hopena ʻole ʻia. Malia paha he hoʻomohala a i ʻole o nā ʻōlelo hoʻopiʻi i lalo.

Hiki iā lākou i ka vitreous a i ole ke kiko retrogyaloid (preretinal hemorrhages) a i hui pū ʻia. Loaʻa nā hemorrhages preretinal i kahi kūlana o ka crescent, e hana ana i kahi pae demarcation me kahi posterior detachment o ka vitreous. I kekahi manawa hiki ke komo ka hemorrhages preretinal i ke kino vitreous. ʻO ka mālama ʻana i kēlā mau hemorrhages e lōʻihi ka lōʻihi ma mua o nā hemorrhages preretinal. I kekahi mau hihia, loaʻa i ka hoʻonohonoho a me ka hoʻopiʻi ʻana i ke koko ma ka ʻaoʻao o ka posterior o ka kino vitreous me ka hoʻokumu ʻia ʻana o ka "ocer-color membrane." Hoʻomaʻamaʻa ʻia nā maʻi e hiki ke hele mai ka hemorrhage mai ka nui o ke kino a i ʻole ke kaumaha, me ka hypoglycemia a i ʻole hōʻeha paha ka maka. Eia naʻe, ʻo ka hiʻohiʻona o ka hemorrhage i ka wā hiamoe.

Hopu retinal trinal detachment

ʻIke ʻia me kahi neʻe holomua o nā membran fibrovascular ma nā wahi nui o ka fele vitreoretinal. ʻO ka hoʻokuʻu aku i ka maʻi posteriorous i loko o nā mea maʻi me ka maʻi maʻi e kū lohi, ʻoi aku ka piha pono, ʻo ia no nā pale ikaika o ka papa cortical o ka vitreous me nā wahi o ka fibrovascular proliferation.

ʻO nā ʻano o ka hoʻonani vitreoretinal kikowaena e alakaʻi i ka detinalment retinal:

ʻikea ka helehelena anteroposterior i ka wā ʻo ka fibrovascular membranes contract, e hoʻonui ana mai ka māhele posterior, ka mea maʻamau me ka huina nui ʻōnaehana vascular, kahi kūloko o ke kumu o ka vitreous,
ka hopena poloka i ka hopena o ka hopena o nā membran fibrovascular, kahi e laha ana mai ka hapa hapa o ka māhele kiʻi i ka ʻaoʻao. Ke alakaʻi nei kēia i ka luhi ma ka wahi o kēia mau kuhi a hiki i ke kumu o ka hoʻokumu ʻana o nā kīwī, a me ka neʻe o ka macula pili i ka pākuʻi, a i ʻole, e pili ana i ka kuhikuhi a ka traction.

ʻO nā maʻi ʻē aʻe o ka retinopathy diabetes

ʻO nā kiʻi ʻaniʻoni i hiki ke hoʻomohala ma ka papakū o ka vitre exfoliated e huki i ka retina mai luna a lalo i ka pae pākula honua. Hiki i nā kiʻiʻoniʻoni ke uhi piha i ka macula me ka pohō o ka nānā ʻana ma hope.

ʻAʻole loli.
Model retinopathy maʻi preproliferative me nā ʻōpū liʻiliʻi a me / a i ʻole exudates paʻa i kahi mamao ma mua o 1 DD mai fovea.

ʻO ke kuhikuhi i hoʻolālā i ka ophthalmologist

ʻO ka retinopathy diabetic non-proliferative me nā waihona kālā o ka exudate paʻa i ke ʻano o ke apo ma nā arcades temporal nui, akā me ka hoʻoweliweli ʻole i ka fovea.
ʻO ka maʻi retinopathy non-proliferative me ka maculopathy, akā me ka hoʻemi ʻana i ka hihiʻo e hoʻoholo i kona kumu.

ʻO ka ʻōlelo hoʻopuka mua ʻana i kahi kanaka ophthalmologist

Retinopathy diabetes non-proliferative me nā palena o ka exudate paʻa a / a hemorrhage i loko o 1 DD o fovea.
Maculopathy
Maʻa retinopathy diabetic preproliferative.

Hōʻike pili i ka ophthalmologist

Proliferative diabetic retinopathy.
ʻO nā hemorrhages preretinal a vitreous.
Rubeosis o ka iris.
Hewa detinalment.

, , ,

Hoʻomaopopo i ka Diinic Retinopathy Diabetic

Hōʻeu ʻia me ka panretinal laser coagulation e hoʻoikaika i ka komo ʻana o nā moku hou i hana ʻia a pale aku i ka nalowale ʻana o ka ʻike ma muli o vitreous hemorrhage a i ʻole tractional retinal detachment. Ka nui o ka mālama ʻana i ke ʻano o ka nui o ka retinopathy diabetic proliferative. Me kahi papa maʻamau o ka maʻi, e pili ʻia nā coagulate i kahi mamao mai kahi ʻē aʻe i ke kaha haʻahaʻa, a me kahi kaʻina e hōʻaila ʻia a hoʻomaha hou paha, pono e hoʻemi ʻia ka mamao ma waena o nā coagulate, a pono e hoʻonui ʻia ka mana.

ʻO ka hoʻomaka ʻana i nā ophthalmologists e hoʻohana i kahi panfundoscope. e hāʻawi ana i ka hoʻonui nui ʻana ma mua o ke kahe ʻo ka punaewele Goldmannʻakolu. ʻoiai ke hoʻohana ʻana i ka hopena, ʻoi aku ka kiʻekiʻe o ka photocoagulation hiki ʻole me nā hopena pōʻino.

ka laulā coagulate i luna o ka lens maka e hoʻohana ʻia. Me kahi lensa Goldmann, ʻo ke ana o ka coagulum he 500 micons, ʻoiai me kahi panfundoscope - 300-200 microns,
ka manawa hōʻike - 0,05-0.10 kekona i kahi mana e ʻae iā ʻoe e noi i nā coagulates mālie.

Hoʻololi ʻia ka mālama mua ʻana o ka retinopathy diabetic i ka noi o 2000-3000 i ka puʻupuʻu i hoʻohele ʻia i ke ala mai ka māhele posterior, e uhi ana i ka periphery o ka retina i hoʻokahi a i ʻelua mau hālāwai paha, ka coagulation laser panretinal, i kaupalena ʻia i hoʻokahi hālāwai, ua pili pū me ka nui o ka hopena o ka hoʻopiʻi.

Hōʻike ka nui o ka mālama i ka wā o kēlā me kēia hālāwai e ka paepae hōʻeha o ka mea maʻi a me kona hiki ke paʻa. No ka hapanui o nā maʻi, ua lawa ka anesthesia maka maka a lawa paha, akā pono paha ka parabulbar a i ʻole subthenon anesthesia.

ʻO ka hana kēia o nā hana, penei:

Ka anuʻu 1. kokoke kokoke i ka disc, iho i lalo i ka pā kino i waena o ka pae kino.
Hana ʻAi 2. Hoʻohana ʻia kahi pale pale e puni ana i ka macula e pale i ka pōʻino o keakea me ka vitreous. ʻO ke kumu nui no ka neovascularization mau ʻoi aku ka mālama ʻana.

ʻO nā hōʻailona o ka komoʻana ke regression o neovascularization a me ke ʻano o nā moku neoneo a i ʻole nā fibrous tissue, hōʻemi ʻana i nā veins dilated, ka hoʻoluhi ʻana o nā ʻatikala retinal a me kahi hoʻēmi ʻana i ka disc blanching. I ka hapa nui o ka retinopathy me ka ʻole o ka dinamics hewa, mālama ʻia ka ʻike paʻa. I kekahi mau pilikia, huli ka preproliferative diabetic retinopathy akā ʻo kahi hopena maikaʻi loa. Ma kēia hana, pono ka nānā hou ʻana o nā poʻe maʻi me kahi 6 6 mau malama.

Hoʻopilikia ka panretinal coagulation wale nō i ka māhele vascular o ke kaʻina fibrovascular. Ma ka hihia o ka hoʻopiʻi hou ʻana o nā moku hou i kūkulu ʻia me ka hoʻokumu ʻana o ka iwi fibrous, ʻaʻole hōʻike ʻia ka mālama ʻana ma hope.

Hoʻihoʻi hou i ka mālama ʻana

ka hoʻokūkū ʻana me ka hoʻomohala ʻana i nā kikoo ma waena o nā mea i hana mua ʻia,
hōʻike ʻia ka cryotherapy ma ka anterior region o ka retina i ka wā hiki ʻole ka paʻi kiʻi ʻana i ka photocoagulation ma muli o ka ʻike ʻole ʻana o ka waihona kālā ma muli o nā nūhou polū. Eia kekahi, e hiki ai iā ʻoe ke hana ma nā wahi o ka retina i loaʻa ʻole i ka palena panretinal laser coagulation ..

Pono e wehewehe i nā poʻe maʻi e hiki ai i ka coetulation laser panretinal ke hōʻeha i nā nānā ākea o nā ʻano loiloi o nā ʻano like ʻole, he maʻi kūpono ia no ka hoʻolalelale ʻana i kahi kaʻa.

ʻLelo 3. Mai ke kakaka o ka kahe a ka hoʻopau ʻana i ke kikowaena i ka wahi posterior.
ʻLelo 4. Lasercoagulation o ka periphery a hiki i ka hopena.

Me ka hua nui o ka maʻi retinopathy diabetes proliferative, ua ʻōlelo mua ʻia e hana i kahi hōʻokoʻa ma ka hapa haʻahaʻa o ka retina, no ka mea i ka hopena o ka hemorrhage i ke kino vitreous, ua pani ʻia kēia wahi, e hana hou ai i ka hoʻōla hou aʻe.

ʻO nā hana hoʻokō e pili ana

ʻO ka nānā ʻana ma kahi o 4-6 mau pule. I ka hopena o ka neovascularization koʻikoʻi ma kahi o ka pā disk, e pono ai i kekahi mau hui me ka huina o nā kēkē a hiki i ka 5000 a ʻoi aʻe paha, ʻoiai ke kīnā o ka hoʻopau ʻana o ka neovascularization he mea paʻakikī ia e hoʻokō a koi paha i ka hoʻomaʻamaʻi mua.