Tus mob ntshav qab zib ua pauj

Tus mob ntshav qab zib retinopathy yog ib hom microangiopathy tsim tawm tiv thaiv tus keeb kwm yav dhau los ntawm cov ntshav qab zib mus ntev thiab muaj kev cuam tshuam cov hlab ntshav ntawm tus retina. Cov kab mob no yog qhov tseem ceeb vim li cas tsis pom kev thiab dig muag hauv cov neeg muaj ntshav qab zib.

Mob ntshav qab zib retinopathy feem ntau cuam tshuam rau ob lub qhov muag, tab sis cov qib ntawm kev puas tsuaj feem ntau txawv.

Cov Neeg Ua thiab Teeb Meem Qhov Tseeb

Nrog txoj kev mob ntshav qab zib ntev, mob dysmetabolic ua rau kev puas tsuaj rau cov hlab ntshav ntawm cov leeg ntshav (retina). Qhov no yog manifested:

• ua txhaum ntawm patency (occlusion) ntawm capillaries,
• nce permeability ntawm phab ntsa vascular,
• kev txhim kho ntawm qhov caws pliav (proliferative) cov ntaub so ntswg,
• tsim ntawm cov ntshav microvasculature tshiab.

Qhov tseem ceeb uas yuav ua kom mob ntshav qab zib ua rau cov neeg mob ntshav qab zib mellitus yog:

• lub sijhawm ua ntshav qab zib
• rog dhau
• theem ntawm hyperglycemia,
• haus luam yeeb
• leeg ntshav siab
• kev tshuaj ntsuam genetic predisposition
• mob raum tsis ua hauj lwm
• cev xeeb tub
• dyslipidemia,
• nkauj,
• metabolic mob.

Cov qauv ntawm tus kabmob

Ua raws li cov xeeb ceem ntawm cov kev hloov pauv hauv hnub ocular, cov nram qab no hom mob ntshav qab zib ua kom txawv:

1. Tsis-proliferative. Lub permeability thiab fragility ntawm cov hlab ntsha retinal nce, uas ua rau kev tsim ntawm microaneurysms thiab cov tsos ntawm taw tes los ntshav, kev txhim kho ntawm retinal edema. Nrog rau kev txhim kho ntawm macular edema (hauv thaj chaw hauv plawv ntawm retina), tsis pom kev zuj zus.
2. Preproliferative. Occlusion ntawm cov hlab ntsha tshwm sim, uas ua rau kom muaj kev nce qib ntawm cov leeg hlwb ischemia thiab hypoxia, qhov tshwm sim ntawm cov hlab ntsha tsis zoo thiab mob plawv nres.
3. Tshaj Tawm. Chronic retinal hypoxia ua rau cov txheej txheem neovascularization pib, uas yog, tsim cov hlab ntshav tshiab. Qhov no nrog los ntawm cov sij hawm ntau ntawm cov ntshav tsis tuaj ntshav. Raws li qhov tshwm sim, fibrovascular fusion maj tsim zuj zus tuaj, uas tuaj yeem ua rau muaj kev mob siab o tractional retinal detachment, cov tsos ntawm theem nrab neovascular glaucoma.

Cov qauv mob hnyav, tshwj xeeb tshaj yog ua ke nrog atherosclerosis thiab kub siab, feem ntau ua rau pom kev tsis pom kev.

Tus mob retinopathy uas mob ntev mus ntev heev. Hauv thawj theem, tus kab mob yuav luag tsis muaj asymptomatic thiab tsis mob. Tsis muaj qhov kev xav tshwj xeeb ntawm kev txo pom pom hauv cov theem tsis loj hlob. Nrog rau kev txhim kho macular edema, cov neeg mob yws yws ntawm qhov muag plooj ntawm lub nrug deb lossis qhov pom ntawm qhov muag plooj, pom cov khoom plooj.

Hauv theem loj ntawm tus kab mob, ib daim ntaub thaiv tsis tu ncua tshwm ua ntej lub qhov muag, tsaus ntab me ntsis. Lawv qhov kev tshwm sim cuam tshuam nrog kev mob ntshav ntawm txoj leeg ntshav. Tom qab resorption ntawm cov ntshav khov, cov kev mob no ploj ntawm lawv tus kheej. Nrog kev mob ntshav khov ntawm txoj hlab ntshav khov, ua tsis tiav ntawm lub zeem muag yuav tshwm sim.

Kev kuaj mob

Txog kev kuaj mob ntshav qab zib thaum ntxov, cov neeg mob ntshav qab zib yuav tsum mus kuaj xyuas tsis tu ncua ntawm kws kho mob ntsej muag. Cov txheej txheem hauv qab no yog siv los ua cov qauv kev soj ntsuam kuaj pom kev hloov pauv hauv qhov muag ntawm retina:

• perimetry
• Qhuas
• qhov muag biomicroscopy nrog lub teeb hlais,
• ophthalmoscopy nrog rau kev siv yeeb siv tshuaj ua kom sai cov tub ntxhais kawm,
• diaphanoscopy ntawm lub qhov muag qauv,
• ntsuas ntsuas ntawm intraocular siab (tonometry).

Yog tias lub cev vitreous thiab lub lens tau huab, qhov ntsuas ntawm lub qhov muag tau ua dua ntawm ophthalmoscopy.

Txheeb xyuas cov haujlwm ntawm optic hlab ntaws thiab retina, electrophysiological kev kuaj mob yog siv, tshwj xeeb yog electrooculography, electroretinography. Yog tias qhov mob neovascular glaucoma xav tias yog, gonioscopy yog qhia.

Ib txoj hauv kev tseem ceeb rau kev kuaj mob ntshav qab zib retinopathy yog fluorescence angiography, uas tso cai rau koj los soj ntsuam cov yam ntxwv ntawm cov ntshav txaus hauv cov hlab ntsha retinal.

Mob ntshav qab zib retinopathy feem ntau cuam tshuam rau ob lub qhov muag, tab sis cov qib ntawm kev puas tsuaj feem ntau txawv.

Kev kho mob ntawm cov ntshav qab zib retinopathy yog tsom rau qhov ntau tshaj plaws kho ntawm cov teeb meem hauv cov zaub mov hauv lub cev, ua kom cov ntshav khov, thiab txhim kho microcirculation.

Nrog rau macular edema, intravitreal txhaj ntawm corticosteroids muaj cov tshuaj kho tau zoo.

Kev nce siab ntawm cov ntshav qab zib retinopathy yog lub hauv paus rau laser coagulation ntawm retina, uas txo qhov kev siv ntawm cov txheej txheem neovascularization thiab txo qhov kev pheej hmoo ntawm retinal detachment.

Hauv kev mob ntshav qab zib kom rov zoo li qub, muaj teeb meem los ntawm retinal detachment lossis macular traction, vitrectomy ua. Thaum txoj kev phais mob, raug tshem tawm, tu txoj hlab ntaws ntshav, hle cov nqaij txuas rau qhov nqaij.

Yuav muaj teeb meem thiab tshwm sim

Qhov muaj mob ntawm cov ntshav qab zib ua kom rov qab ua rau muaj cov teeb meem hauv qab no:

• retinal detachment,
• glaucoma theem nrab
• tseem ceeb txwv ntawm kev pom teb,
• cataract
• ua tiav dig muag.

Txog kev kuaj mob ntshav qab zib thaum ntxov, cov neeg mob ntshav qab zib yuav tsum mus kuaj xyuas tsis tu ncua ntawm kws kho mob ntsej muag.

Qhov tshwm sim ntawm tus kab mob ntshav qab zib ua kom qhov muag pom kev yog ib qho hnyav. Cov qauv mob hnyav, tshwj xeeb tshaj yog ua ke nrog atherosclerosis thiab kub siab, feem ntau ua rau pom kev tsis pom kev.

Kev Tiv Thaiv

Cov txheej txheem tiv thaiv tsom mus rau tiv thaiv qhov pib los yog mob ntxiv ntawm cov ntshav qab zib retinopathy muaj xws li:

• kev saib xyuas tsis tu ncua ntawm glycemia,
• ua tib zoo ua raws li cov tshuaj insulin kho mob lossis kev tswj hwm ntawm cov tshuaj muaj ntshav qab zib,
• kev noj haus (cov lus ntawm Zaj 9 raws li Pevzner),
• normalization ntawm ntshav siab,
• raws sij hawm laser retinal coagulation.

Cov Tshuaj Kho Mob

Cov piam thaj hauv ntshav siab cuam tshuam cov hlab ntsha uas pub lub qhov muag, cuam tshuam rau cov ntshav ntws hauv lawv. Cov nqaij qhov muag pom kev ua pa oxygen tsis ua haujlwm. Lawv tso cov tshuaj hu ua kev loj hlob ntxiv kom ua rau cov hlab ntsha loj tuaj thiab rov qab ua ntshav ntshav. Hmoov tsis zoo, cov hlab ntsha tshiab tawg yooj yim dhau lawm. Ntawm cov no, hemorrhages feem ntau tshwm sim. Qhov tshwm sim ntawm cov ntshav tawm ntawm lub sijhawm no tuaj yeem ua rau retinal tsis ua (tshem tawm) thiab dig muag tag.

Cov tshuaj hu ua kev loj hlob yam inhibitors (los tiv thaiv VEGFs) inhibit cov tsos ntawm cov hlab ntshav tshiab. Txij li xyoo 2012, hauv cov tebchaws Lavxias hais lus, cov tshuaj Lucentis (ranibizumab) thiab Zaltrap (aflibercept) tau siv. Cov no tsis yog tshuaj noj. Lawv txhaj rau hauv vitreous (intravitreal). Txhawm rau nqa tawm kev txhaj tshuaj no, koj xav tau tus kws tshaj lij uas tsim nyog. Cov tshuaj no nws kim heev. Lawv raug tiv thaiv los ntawm cov ntawv sau npe thiab yog li ntawd tsis muaj cov qauv sib txig uas muaj nqis dua. Ntxiv nrog rau cov neeg sawv cev no, tus kws kho mob tuaj yeem sau tshuaj kho lub cev ntev ntev ua kom dexamethasone cog ntshav los kho cov ntshav qab zib macular edema. Cov tshuaj no yog hu ua Ozurdeks.

Lucentis (ranibizumab)

Tsis muaj qhov muag pom kev thiab tshuaj ntsuab rau cov neeg mob ntshav qab zib ua kev pab. Cov neeg mob feem ntau qhia kev txaus siab rau Taufon qhov muag tee. Cov tshuaj no tseem tsis muaj kev mob ntshav qab zib ua si nyob rau daim ntawv ua pov thawj ntawm kev cim rau kev siv. Nws cov khoom tseem ceeb yog taurine. Tej zaum nws muaj txiaj ntsig rau edema, ua ib feem ntawm txoj kev kho mob ntawm txoj kev mob ntshav siab thiab lub plawv tsis ua haujlwm. Nyeem txog nws ntawm no hauv kev nthuav dav. Nws yog qhov zoo dua los noj nws ntawm qhov ncauj, thiab tsis nyob rau hauv daim ntawv ntawm lub qhov muag tee. Ib yam li riboflavin thiab lwm cov vitamins ntawm pawg B. Tsis txhob siv nyiaj rau cov tshuaj pleev qhov muag thiab tshuaj ntsuab rau pej xeem. Tsis txhob nkim lub sijhawm tsim txiaj, tab sis pib kho kom zoo kom tsis txhob dig muag.

Laser retinal coagulation

Coagulation yog moxibustion. Thaum lub sij hawm laser coagulation txheej txheem ntawm lub retina, pua pua taw tes kub hnyiab thov rau cov hlab. Qhov no inhibits qhov kev loj hlob ntawm cov tshiab capillaries, txo qhov zaus thiab mob ntshav khov. Cov kev teev tseg yog siv tau zoo heev. Nws tso cai rau koj los tswj cov txheej txheem nyob rau ntawm preproliferative theem ntawm tus mob ntshav qab zib retinopathy nyob rau hauv 80-85% thiab nyob rau theem kev loj hlob hauv 50-55% ntawm cov neeg mob. Hauv kev mob nyhav heev ntawm ntshav qab zib hauv kev pom, nws ua rau kom tsis txhob dig muag nyob hauv kwv yees li 60% ntawm cov neeg mob rau 10-12 xyoo.

Tham nrog kws kho mob ntsej muag seb ib qho txheej txheem rau laser photocoagulation puas txaus rau koj, lossis koj yuav tsum tau ua ob peb yam. Raws li txoj cai, tom qab txhua tus txheej txheem, tus neeg mob lub zeem muag tsis muaj zog me ntsis, qhov loj me ntawm nws daim teb txo qis, thiab tsis pom kev tshwj xeeb hmo ntuj. Tab sis tom qab ob peb hnub qhov teeb meem no ruaj khov. Muaj qhov xwm txheej loj uas qhov tshwm sim yuav ntev. Laser coagulation ntawm tus retina tuaj yeem ua ke nrog kev siv tshuaj, inhibitors ntawm kev loj hlob vascular (anti-VEGF), raws li kev txiav txim siab los ntawm tus kws kho mob. Qhov teeb meem tshwm sim yog rov ua dua ntawm cov ntshav tsis txaus, uas yuav ua rau nws ploj mus. Hauv qhov no, yuav tsum muaj vitrectomy.

Lub Neej Tsis Zoo

Txoj kev kho mob yog txoj kev phais mob ntawm lub cev vitreous uas tau dhau los ua qhov siv tsis tau vim yog hemorrhage. Tus qauv tshem tawm yog hloov nrog saline tsis muaj kab mob thiab khoom cua mos. Txhawm rau kom mus rau qhov hu ua vitreous, tus kws phais yuav txiav cov leeg ntawm retina. Hauv cov ntshav txhaws, lawv tseem raug tshem tawm, nrog rau cov ntaub so ntswg hloov kho pathologically.

Lub lag luam yog ua nyob rau hauv kev tso tshuaj loog hauv zos lossis dav dav. Tom qab nws lub zeem muag yuav zoo rov qab. Qhov tshwm sim no yog 80-90% rau cov neeg mob uas tsis muaj hlwb tsis lees txais. Yog tias qhov tsis txaus siab retinal tau tshwm sim, tom qab ntawd thaum lub sijhawm ua haujlwm nws yuav rov qab mus rau nws qhov chaw. Tab sis txoj hmoo ntawm txoj kev rov qab los txo rau 50-60%. Vitrectomy feem ntau kav 1-2 teev. Qee lub sijhawm nws tuaj yeem ua yam tsis muaj chaw pw hauv tus neeg mob.

Cov chaw kho mob tshwm sim

Microaneurysms, hemorrhages, edema, exudative foci hauv retina. Hemorrhages muaj daim ntawv ntawm cov dot me me, duav lossis tsaus nti ntawm cov duab sib npaug, thaj chaw hauv nruab nrab ntawm qhov fundus lossis raws cov leeg loj hauv qhov sib sib zog nqus ntawm retina. Cov ntaub ntawv tawv tawv thiab tawv sab hauv feem ntau yog nyob hauv nruab nrab ntawm qhov fundus thiab muaj daj lossis dawb. Ib qho tseem ceeb ntawm cov qib no yog retinal edema, uas yog thaj chaw hauv thaj av macular lossis raws cov nkoj loj (Daim duab 1, a)

Venous anomalies: ntse, tortuosity, looping, doubling thiab tshaj tawm nyob rau hauv lub caliber ntawm cov hlab ntshav. Qhov loj ntawm cov khoom thiab "paj rwb" exudates. Kev mob ntsws hauv lub plab microvascular ntau yam mob, ntau ntau cov leeg ntshav ntws loj (Daim Duab 1, b)

Neovascularization ntawm optic disc thiab lwm qhov chaw ntawm retina, vitreous hemorrhage, qhov tsim ntawm cov nqaij mos hauv thaj chaw ntawm preretinal hemorrhages. Cov nkoj tsim tshiab tsim muaj nyias heev thiab tsis yooj yim, qhov tshwm sim ntawm qhov uas pheej rov qab ntshav dua feem ntau tshwm sim. Vitreoretinal traction ua rau kom cov leeg rov qab los. Cov nkoj tshiab uas tsim los ntawm cov xim (iris (rubeosis)) feem ntau yog qhov ua rau muaj kev txhim kho ntawm cov kab mob glaucoma theem nrab (Daim Duab 1, c)