Ntshav Qab Zib Retinopathy > Mob ntshav qab zib muaj teeb meem

Tus mob retinopathy yog microangionathia nrog thawj qhov mob ntawm cov hlab ntsha sai, capillaries thiab postcapillary venules nrog kev koom tes ntawm cov hlab ntsha ntawm lub caliber loj. Retinopathy tshwm sim los ntawm microvascular occlusion thiab to. Kev kuaj mob ntshav qab zib, kev cia ntshav qab zib tuaj yeem yog:

tom qab (tsis-proliferative), nyob rau hauv uas tus pathology yog txwv intraretinally,
proliferative, nyob rau hauv uas pathology kis mus rau saum npoo ntawm retina los yog dhau ntawm nws,
preproliferative, pom los ntawm qhov ua tsis pom tseeb nyob rau hauv daim ntawv.

Mob ntshav qab zib mellitus yog ib hom kev mob tshwm sim ntawm cov metabolic feem ntau ua los ntawm lub caij ntev hyperglycemia ntawm qhov sib txawv, uas tsim kho zaum ob hauv kev teb rau qhov kev poob qis thiab / lossis kev ua haujlwm ntawm cov tshuaj insulin endogenous. Mob ntshav qab zib mellitus tuaj yeem yog cov tshuaj insulin lossis tsis-insulin-cuam tshuam, txwv tsis pub txhais hom ntshav qab zib hom 1 lossis hom 2. Tus mob ntshav qab zib retinopathy muaj feem ntau nrog ntshav qab zib hom 1 (40%) dua li mob ntshav qab zib hom 2 (20%) thiab yog ib qho tseem ceeb ua rau kev dig muag hauv cov neeg hnub nyoog 20 txog 65 xyoos.

, , , , , , , , , , ,

Kev Pheej hmoo Txoj Kev Mob Ntshav Qab Zib Retinopathy

Lub sijhawm ua ntshav qab zib yog qhov tseem ceeb. piam thaj Thaum kuaj mob ntshav qab zib hauv cov neeg mob hnub nyoog qis dua 30 xyoo, qhov yuav ua rau tus mob ntshav qab zib tsawg tom qab 10 xyoo yog 50% thiab tom qab 30 xyoo - 90% ntawm cov mob. Tus mob retinopathy mob ntshav qab zib feem ntau tshwm sim hauv thawj 5 xyoo mob ntshav qab zib thiab pub dawb, tab sis tshwm sim hauv 5% ntawm cov neeg mob ntshav qab zib hom 2.

Kev tswj tsis tau cov txheej txheem hauv cov zaub mov hauv lub cev yog qhov tsim nyog rau kev txhim kho thiab kev loj hlob ntawm kev mob ntshav qab zib. Cev xeeb tub feem ntau pab txhawb rau qhov mob ceev ceev ntawm tus mob ntshav qabzib retinopathy. Cov ntsiab lus tseem ceeb kuj suav nrog kev tswj tsis txaus ntawm cov mob ua ntej muaj menyuam hauv plab, maj mam pib kho thaum ntxov ntawm cev xeeb tub, thiab kev txhim kho ntawm preeclampsia thiab kua tsis txaus. Arterial hypertension nrog kev tswj tsis tau txaus ua rau muaj kev vam meej ntawm cov ntshav qabzib retinopathy thiab kev txhim kho ntawm cov kabmob ntshav qab zib muaj peev xwm ua rau cov ntshav qab zib mellitus hom 1 thiab 2. Mob nephropathy ua rau mob heev ntxiv rau qhov kev kawm ntawm tus mob ntshav qab zib retinopathy. Hloov siab, kev kho mob ntawm lub raum pathology (piv txwv li, lub raum hloov raum) tej zaum yuav muaj nrog kev txhim kho hauv tus mob thiab muaj txiaj ntsig zoo tom qab photocoagulation. Lwm yam kev pheej hmoo rau tus mob ntshav qab zib retinopathy yog haus luam yeeb, rog dhau, hyperlipidemia.

Cov txiaj ntsig ntawm Kev Tswj Xyuas Metabolic Zoo

Ncua kev txhim kho kev mob ntshav qab zib, tab sis tsis tiv thaiv.
Ua rau qhov mob qeeb zuj zus ntawm qhov mob ntshav qab zib poob siab retinopathy.
Kev txo qis hauv tus nqi ntawm kev hloov pauv ntawm preproliferative diabetic retinopathy rau proliferative.
Txo macular edema.
Txo cov laser coagulation.

Pathogenesis ntawm kev mob ntshav qab zib retinopathy

Lub pathogenesis ntawm retinopathy yog raws cov txheej txheem pathological hauv cov hlab ntsha ntawm retina.

hlab ntsha. Lawv cov kev hloov pauv yog sawv cev los ntawm qhov ploj ntawm cov xaum xaim, ua rau ntawm qis ntawm lub qab daus puas, puas tsuaj thiab nthuav tawm ntawm cov hlwb endothelial. hematological txawv txav yog sawv cev los ntawm deformation thiab nce qhov tshwm sim ntawm cov tsos mob ntawm "npib cim", txo qis platelet yooj thiab kev sib sau ua ke, uas ua rau txo qis ntawm oxygen thauj.

Qhov txiaj ntsig ntawm qhov tsis muaj ntawm kev rov qab ua tiav ntawm cov pob txha rov ua dua yog nws lub ischemia, uas pib tshwm rau ntawm nruab nrab periphery. Qhov ob lub ntsiab ntawm retinal hypoxia suav nrog:

arteriovenular shunts, nrog rau kev mob siab heev ("tawm") ntawm cov hlab ntsha hauv qhov kev coj ntawm arterioles mus rau venules. Nws tsis paub meej tias cov kev hloov no tau sawv cev los ntawm cov nkoj tshiab lossis qhib ntawm cov leeg ntshav uas twb muaj lawm, yog li lawv feem ntau hu ua kev mob ntshav tsis txaus ntawm lub plab microvascular.
neovascularization yog suav tias yog qhov ua rau kev txiav txim ntawm angiopoietic tshuaj (kev loj hlob yam) tsim nyob rau hauv cov ntaub so ntswg hypoxic ntawm retina thaum nws sim ua kom rov mob. Cov tshuaj no ua rau neovascularization ntawm retina thiab optic disc, thiab feem ntau ua rau IRIS (iris rubeosis). Ntau yam kev loj hlob tau cais tawm, tab sis qhov tseem ceeb tshaj plaws yog vascular endothelial kev loj hlob yam.

Ua tsis tiav ntawm qhov teeb meem sab hauv hematoretinal ua rau kom to ntawm plasma cov Cheebtsam kom mus rau qhov retina. Kev tawm dag lub cev ntawm lub cev ntawm cov hlab ntsha ua rau lub zos saccular protrusion ntawm lub vascular phab ntsa, txhais tau tias yog microaneurysms, muaj peev xwm tawm hws los yog occlusion.

Ib qhov kev paub ntawm nce vascular permeability yog txoj kev txhim kho ntawm txoj leeg ntshav thiab edema, uas tuaj yeem yog diffuse lossis hauv zos.

diffuse retinal edema yog qhov tshwm sim ntawm cov cim nthuav ntawm cov hlab ntsha thiab seepage,
cov pob txha mos hauv zos yog cov txiaj ntsig ntawm focal paim los ntawm microaneurysms thiab nthuav dav ntawm cov hlab ntsha.

Cov kab mob hauv lub tsev nyob ntev retinal ua rau kom tso nyiaj ntawm cov exudate nyob rau thaj tsam ntawm kev hloov ntawm ib qhov muaj mob muaj qhov muag tsis pom kev thiab edema. Exudates tsim los ntawm lipoproteins thiab macrophages puv nrog lipids puag ncig thaj tsam ntawm microvascular cov tawv nqaij xau rau hauv daim ntawv ntawm lub nplhaib. Tom qab qhov txiav tawm ntawm cov dej txeej, lawv dhau ntawm qhov kev nqus mus rau hauv cov hlab ntsha ib puag ncig, los yog phagocytosed, cov txheej txheem kav rau ob peb lub hlis thiab txawm ntau xyoo. Ntev paum ua rau muaj kev nce ntxiv hauv exudates thiab tso cov roj cholesterol.

Nonproliferative Mob Ntshav Qab Zib Retinopathy

Microaneurysms yog ib cheeb tsam hauv nruab nrab cov txheej txheem nuclear thiab yog cov thawj qhov chaw kuaj mob uas pom tau.

muag heev, sib npaug, liab tsuas me me, feem ntau tshwm sim sab nraud los ntawm fovea. Yog tias lawv raug ntshav los ntshav, tom qab ntawv lawv yuav tsis txawv qhov kis los ntshav,
rov qab saib xyuas qhov tseeb ntawm trypsin hauv kev kho tus kab mob ntshav qab zib nrog perifocal microaneurysms:
microaneurysms nrog cov ntsiab lus ntawm tes thaum lub siab loj,
FAG nthuav tawm qhov kev sib tw hyperfluorescent ntsiab lus, uas yog nontrombiric microaneurysms, ntau npaum li cas feem ntau yog piv rau ophthalmoscopically pom. Hauv ntu tom qab, diffuse hyperfluorescence vim cov kua dej pom pom pom.

Cov khoom coj ua haujlwm tau nyob hauv txheej txheej sab nrauv plexiform.

waxy, daj qhov chaw mob muaj qhov sib txuas meej heev, sib sau ua ib pawg thiab / lossis ib ncig hauv tus ncej. Hauv nruab nrab ntawm lub nplhaib ntawm cov khoom siv exudate (annular exudate), microaneurysms feem ntau txiav txim siab. Ua haujlwm dhau sijhawm, lawv tus lej thiab qhov loj me ntxiv, uas ua rau muaj kev hem thawj rau fovea nrog nws txoj kev koom tes hauv cov txheej txheem pathological,
Phage qhia tawm hypofluorescence vim los thaiv ntawm cov keeb kwm yav dhau ntawm fluorcence ntawm choroid.

Retinal edema feem ntau tau ib cheeb tsam ntawm sab nrauv plexiform thiab sab hauv nuclear txheej. Tom qab ntawd, sab hauv plexiform txheej thiab txheej txheej ntawm cov hlab ntsha xov xwm tuaj yeem koom nrog txog ntog ntawm qhov khoob khoob mus rau tag nrho cov tuab. Ib qho txuas ntxiv ntawm cov kua dej hauv lub fovea ua rau kev tsim cov cyst (cystic macular edema).

Cov pob txha mos thaum lub ntsej muag tau pom zoo tshaj thaum pom ntawm lub teeb uas siv lub ntsej muag siv Goldmann lens,
Phage qhia tawm sai sai hyperfluorescence vim to ntawm retinal capillaries.

txoj leeg ntshav ntawm ntshav tawm tau los ntawm cov leeg ntshav thiab cov nyob hauv nruab nrab txheej ntawm retina. Cov hemorrhages no yog taw tes, muaj xim liab thiab muaj lub peev xwm tsis meej,
nyob rau hauv txheej txheej ntawm cov hlab ntsha ntawm retina, hemorrhages tshwm sim los ntawm qhov loj dua ntawm cov leeg ntshav ntawm txoj hlab ntsha, uas txiav txim siab lawv cov duab ua hom ntawm "nplaig ntawm nplaim taws".

Kev tswj hwm kev tawm tsam rau cov neeg mob uas tsis yog-loj hlob ntawm cov ntshav qab zib ua lub cev rov qab

Cov neeg mob uas tsis yog mob ntshav qab zib kom tsis txhob mob hlwb tsis xav tau kev kho mob, tab sis yuav tsum kuaj txhua xyoo. Ntxiv nrog rau kev tswj xyuas kab mob ntshav qab zib kom zoo, muaj feem cuam tshuam (ntshav liab, ntshav khov, thiab mob raum) yuav tsum txiav txim siab.

Preproliferative mob ntshav qab zib retinopathy

Qhov pom ntawm cov cim ntawm kev hem thawj nyob rau hauv cov mob ntshav qab zib tsis ua mob ntshav siab qhia kev txhim kho ntawm preproliferative diabetic retinopathy. Soj ntsuam cov cim ntawm preproliferative diabetic retinopathy qhia kev nce qib ischemia, kuaj ntawm FLG nyob rau hauv qhov kev sib zog ntawm thaj chaw ntawm hypofluorescence ntawm kev tsis pom kev tsis pom kev (qhov "tawm"). Txoj kev pheej hmoo ntawm kev nce zuj zus mus rau kev loj hlob yog ncaj qha ncaj qha rau cov xov tooj ntawm kev hloov pauv focal.

Soj ntsuam cov yam ntxwv ntawm preproliferative mob ntshav qab zib retinopathy

Cov paj rwb-zoo li foci yog qhov chaw hauv plawv ntawm kev mob plawv hauv txheej txheej ntawm cov leeg retinal vim muaj occlusion ntawm precapillary arterioles. Kev cuam tshuam ntawm cov axoplasmic tam sim no nrog cov khoom sib txuas ntxiv ntawm cov khoom thauj thauj hauv axons (axoplasmic stasis) muab lub foci zoo li daim tawv nqaij.

cov cim qhia: me me, tawv nqaij, paj rwb-zoo li lub ntsej muag foci, npog qis qis hauv cov hlab ntsha, thaj chaw kho mob tau txiav txim siab tsuas yog nyob rau thaj tsam post-equatorial ntawm retina, qhov twg cov tuab ntawm txheej txheej ntawm cov hlab ntsha yog qhov txaus rau lawv pom,
FAG nthuav tawm lub zos hypofluorescence vim los thaiv ntawm cov keeb kwm yav dhau los ntawm cov choroid, feem ntau nrog cov neeg nyob sib ze ntawm cov tsis muaj roj.

Kev tso ntshav microvascular mob siab rau yog sawv cev los ntawm shunts los ntawm cov leeg ntshav hlab ntsha mus rau venules, hla lub txaj capillary, yog li ntawd, lawv feem ntau txiav txim siab nyob ze ntawm qhov chaw ntawm kev cuam tshuam ntawm cov hlab ntsha capillary.

cov phiajcim: cov kab liab liab uas txuas txuas rau txoj hlab ntsha thiab cov hlab ntsha, muaj cov ntsej muag hauv cov cheeb tsam ntawm cov tiaj ua kom tshiab tsim cov hlab. Lub ntsiab tseem ceeb ntawm cov teeb meem me me hauv lub plab yog lawv qhov chaw nyob sab hauv ntawm qhov tshuaj retina, qhov tsis tuaj yeem hla cov nkoj loj thiab qhov uas tsis tawm hws ntawm lub phage,
Phage qhia tawm hauv zos cov ntshav siab ntsig txog cov chaw nyob sib ze ntawm kev cuam tshuam ntawm cov hlab ntsha capillary.

Kev mob siab rau lub cev: nce ntxiv, tsim cov loops, ntu hauv cov qauv ntawm "hlaws" lossis "rosary".

Arterial ntshawv siab: constriction, kos npe ntawm "hlau xaim" thiab obliteration, uas ua rau lawv zoo ib yam li occlusion ntawm ib ceg ntawm nruab nrab retinal leeg.

Qhov tsaus nti ntawm cov ntshav hemorrhages: hemorrhagic retinal infarcts nyob rau hauv nws nruab nrab txheej.

Kev tswj fwm siv rau cov neeg mob uas preproliferative mob ntshav qab zib retinopathy

Kev kho mob ntshav qab zib feem ntau tsis pom tshwm sim, tshwj tsis yog nws tsis tuaj yeem pom nyob rau hauv kev hloov pauv lossis lub zeem muag ntawm lub qhov muag pawv twb ploj vim yog qhov muaj peev xwm tsim tau cov ntshav qab zib ua kom rov ua mob dua tshiab.

Ntshav qab zib rau Maculopathy

Qhov tseem ceeb ua rau pom kev tsis pom kev hauv cov neeg mob ntshav qab zib, tshwj xeeb tshaj yog ntshav qab zib hom 2, yog fovea edema, kev tso tawm ntawm cov tawv nqaij exudate lossis ischemia (mob ntshav qab zib maculopathy).

Ntawm Cov Mob Ntshav Qab Zib Maculopathy

Hauv zos exudative ntshav qab zib maculopathy

cov cim qhia: lub ntsej muag tsis tshua pom tseeb tuab ntawm cov retina, nrog lub nplhaib los ua tsis tiav los ntawm cov khoom pov thawj ruaj ruaj,
PHA qhia qhov teeb meem hyperfluorescence lig dhau los vim tawm hws thiab zoo macular perfusion.

Txawv exudative uas mob ntshav qab zib maculopathy

cov cim: diffuse thickening ntawm retina, uas tuaj yeem nrog cov kev hloov cystic. Caw nrog edema loj heev qee zaum ua rau nws tsis tuaj yeem mus rau hauv cheeb tsam fovea,
FAG nthuav tawm ntau qhov taw qhia hyperfluorescence ntawm microaneurysms thiab lig diffuse hyperfluorescence vim tawm hws, uas ntau tshaj tawm piv nrog kev kuaj mob. Hauv lub xub ntiag ntawm cystic macular edema, ib tus xaib hauv daim ntawv ntawm "paj nplaim paj" yog txiav txim siab.

Ischemic Ntshav Qab Zib Maculopathy

cov cim: tsis pom kev pom tseeb nrog lub cev zoo fovea, feem ntau cuam tshuam nrog preproliferative diabetic retinopathy. Qhov tsaus ntuj ntawm cov ntshav tsis tuaj yeem pom,
Phage qhia tawm cov tsis-perfused capillaries nyob rau hauv fovea, qhov loj heev ntawm uas tsis ib txwm xov mus rau cov neeg kawm ntawv ntawm txo nyob rau hauv kev pom tseeb.

Lwm feem ntawm cov kab mob tsis ua kom tsis haum cov hlab ntsha feem ntau muaj nyob hauv cov txheej txheem tom qab thiab hauv qhov sib nrug.

Mixed diabetic maculopathy yog tus yam ntxwv ntawm ob ischemia thiab exudation.

, , , , , , , ,

Clinically tseem ceeb macular edema

Clinically macular edema yog tus cwj pwm los ntawm cov hauv qab no:

Retinal edema tsis pub dhau 500 μm ntawm lub hauv paus fovea.
Khoom exudates tsis pub dhau 500 μm los ntawm lub hauv paus fovea, yog tias lawv nrog nrog tuab ntawm qhov retina ncig nws (uas yuav ntev tshaj 500 μm).
Retinal edema nyob rau hauv 1 DD (1500 μm) lossis ntau dua, i.e. tej cheeb tsam ntawm edema yuav tsum poob tsis pub dhau 1 DD ntawm lub hauv paus fovea.

Clinically macular edema qhov tseem ceeb yuav tsum tau siv laser photocoagulation tsis hais txog qhov pom ntawm qhov pom, txij li kev kho mob txo qhov kev pheej hmoo ntawm qhov tsis pom kev los ntawm 50%. Txhim kho qhov muag pom haujlwm tsis tshua muaj, yog li kev kho yog qhia rau lub hom phiaj prophylactic. Nws yog qhov tsim nyog kom ua lub phage ua ntej kev kho mob txhawm rau txiav txim siab thaj chaw thiab qhov loj me ntawm hws. kuaj pom tias tsis muaj qhov tsis zoo nyob hauv cov hlab ntsha hauv fovea (ischemic maculopathy), uas yog lub cim tsis zoo thiab muaj kev sib kis tsis zoo rau kev kho mob.

Hauv zos laser coagulation koom nrog thov laser coagulation mus rau microaneurysms thiab microvascular kev cuam tshuam hauv nruab nrab ntawm cov nplhaib ntawm cov khoom exudates, hauv ib cheeb tsam tsis pub dhau 500-3000 microns los ntawm central fovea. Qhov loj ntawm coagulate yog 50-100 microns nrog lub sijhawm ntev ntawm 0.10 vib nas this thiab lub zog txaus los muab cov xim zoo nkauj lossis tsaus tsaus ntawm cov microaneurysms. Kev kho mob ntawm foci txog 300 μm los ntawm central fovea yog qhia nrog kev kuaj mob tseem ceeb macular edema, txawm hais tias kev kho yav dhau los thiab pom tseeb hauv qab 6/12. Nyob rau hauv cov xwm txheej zoo li no, nws raug pom zoo tias lub sijhawm raug luv rau 0.05 vib nas this, b) trellised laser coagulation yog siv nyob rau thaj chaw ntawm diffuse tuab ntawm cov retina uas nyob ntawm qhov deb ntawm ntau dua 500 μm los ntawm lub hauv paus fovea thiab 500 fromm los ntawm ib ntus ntu ntawm lub qhov muag plooj taub. Qhov loj ntawm coagulates yog 100-200 microns, lub sijhawm kis tau yog 0.1 sec. Lawv yuav tsum muaj lub teeb xim heev, lawv tau yuam kom txav ntawm qhov sib nrug ntawm txoj kab uas hla ntawm 1 coagulate.

Tshawb Tau Hauv thaj tsam li ntawm 70% ntawm cov neeg mob, nws yog qhov ua tau kom ua tiav kev ua kom ruaj khov ntawm kev ua kom pom, hauv 15% - muaj kev txhim kho, thiab hauv 15% ntawm cov neeg mob - muaj teeb meem txuas ntxiv. Kev daws teeb meem ntawm edema tshwm sim nyob rau hauv 4 lub hlis, yog li kev rov kho thaum lub sijhawm no tsis pom.

Txheej Xwm Rau Cov Huab Cua Tsis Txaus

Khoom exudates npog fovea.

Diffuse o ntawm cov macula.
Cystic edema ntawm lub macula.
Sib xyaw exudative-ischemic maculopathy.
Kev mob siab thaum lub sijhawm kuaj.

Ib qhov kev sib txuas ua ke plana vitrectomy tuaj yeem ua rau pom macular edema cuam tshuam nrog kev sib txuam, uas txuas ntxiv los ntawm cov tuab thiab densified posterior hyaloid membrane. Nyob rau hauv cov xwm txheej zoo li no, kev kho laser tsis ua hauj lwm zoo hauv kev sib piv rau kev phais mob tshem tawm macular traction.

, , , ,

Loj Hlawv Neeg Mob Noj Qab Haus Huv Retinopathy

Nws tshwm sim hauv 5-10% ntawm cov neeg mob ntshav qab zib. Hauv hom 1 mob ntshav qab zib, qhov kev pheej hmoo yog tshwj xeeb: qhov tshwm sim ntawm 60% tom qab 30 xyoo. Muaj feem cuam tshuam yog carotid leeg leeg occlusion, posterior vitreous detachment, siab myopia, thiab optic atrophy.

Soj ntsuam cov yam ntxwv ntawm kev mob ntshav qab zib feem ntau retinopathy

Cov tsos mob ntawm tus mob ntshav qab zib ua mob hlwb. Neovascularization yog qhov taw qhia ntawm kev loj hlob ntawm tus mob ntshav qab zib retinopathy. Tshaj tawm ntawm cov nkoj tsim tshiab tuaj yeem tshwm sim ntawm qhov deb li ntawm 1 DD los ntawm qhov kho qhov muag ntawm lub paj tawg (neovascularization hauv thaj tsam disk) lossis raws cov hlab ntsha tseem ceeb (neovascularization sab nraum lub disk). Ob qho kev xaiv muaj peev xwm ua tau. Nws yog tsim los hais tias kev txhim kho ntawm kev nthuav dav cov ntshav qab zib retinopathy yog preceded los ntawm nonperfusion ntawm ntau tshaj ib quarter ntawm retina. Qhov tsis muaj sab hauv lub ciam av ib puag ncig ntawm lub optic cov hlab ntaws tawm ib nrab piav qhia txog kev nyiam rau neoplasm hauv cheeb tsam no. Cov hlab ntsha tshiab tshwm sim hauv daim ntawv ntawm endothelial proliferation, feem ntau los ntawm veins, tom qab ntawd lawv hla cov qhov tsis xws ntawm lub puab ciam teb sab hauv, dag hauv lub dav hlau uas muaj peev xwm nyob nruab nrab ntawm cov retina thiab cov posterior nto ntawm lub cev vitreous, uas ua haujlwm pab lawv.

Phase. Nws tsis tas yuav kuaj mob, tab sis qhia tawm neovascularization nyob rau theem thaum ntxov ntawm angiograms thiab qhia hyperfluorescence nyob rau theem tom qab vim kev tawm hws ntawm cov zas los ntawm cov nqaij mos neovascular.

Cov tsos mob ntawm proliferative diabetic retinopathy

Qhov loj ntawm qhov tshwm sim ntawm cov ntshav qab zib ua kom rov zoo siab yog txiav txim siab los ntawm qhov sib piv thaj chaw uas cov neeg nyob hauv cov nkoj tshiab ua nrog thaj tsam ntawm lub optic disc:

Disk Neovascularization

Ntsig - qhov ntau thiab tsawg dua li 1/3 DD.
Tshaj tawm - qhov ntau thiab tsawg tshaj li 1/3 DD.

Off-disk neovascularization

Ntsig - qhov ntau thiab tsawg dua li 1/2 DD.
Tshaj tawm - qhov ntau thiab tsawg tshaj li 1/2 DD.

Lub nkoj loj dua tshiab tsim cov lus teb ua rau kev kho laser tsawg dua li cov hlab ntsha.

Fibrosis cuam tshuam nrog neovascularization yog qhov txaus siab vim tias nrog cov kabmob tseem ceeb, txawm hais tias muaj teeb meem los ntshav tsawg, muaj kev pheej hmoo siab ntawm tractional retinal detachment.

Hemorrhages, uas tej zaum yuav yog preretinal (subhialoid) thiab / lossis sab hauv lub vitreous, yog qhov muaj kev pheej hmoo tseem ceeb rau txo qhov pom tseeb.

Cov yam ntxwv ntawm kev pheej hmoo ntawm kev pheej hmoo ntawm lub zeem muag txo qis heev thaum thawj 2 xyoos hauv kev tsis muaj kev kho yog muaj li hauv qab no:

Nruab nrab neovascularization nyob rau thaj tsam ntawm lub disk nrog hemorrhages yog 26% ntawm kev pheej hmoo, uas yog txo mus rau 4% tom qab kho.
Kev mob hnyav neovascularization hauv thaj av disk tsis muaj hemorrhage yog 26% ntawm kev pheej hmoo, uas tom qab kev kho mob txo qis mus rau 9%.

Kev hnyav neovascularization ntawm optic disc nrog nce qhov siab

Kev mob hnyav neovascularization rau thaj tsam ntawm lub disk nrog hemorrhages yog 37% ntawm kev pheej hmoo, uas tom qab kev kho mob txo qis mus rau 20%.
Kev mob hnyav neovascularization sab nraum lub hemorrhagic disk yog 30% ntawm kev pheej hmoo, uas tom qab kev kho mob txo qis rau 7%.

Yog tias cov qauv no tsis tau ntsib, nws raug nquahu kom tsis kam los ntawm photocoagulation thiab kuaj tus neeg mob txhua 3 lub hlis. Txawm li cas los xij, qhov tseeb, feem ntau cov kws kho mob ophthalmologists tau mus rau laser photocoagulation txawm tias ntawm thawj lub npe neovascularization.

Lwm yam mob uas zawv ntshav qab zib lub qhov muag puas

Hauv kev rov qab kho cov ntshav qab zib, qhov muag pom hnyav uas pom tshwm sim hauv cov neeg mob uas tsis tau kho laser, lossis nws cov txiaj ntsig tau ua rau tsis txaus siab lossis tsis txaus ntseeg. Tej zaum qhov kev txhim kho ntawm ib lossis ntau cov kev mob hauv qab no.

Lawv tuaj yeem nyob hauv qhov chaw vitreous lossis hauv qhov chaw retrogyaloid (preretinal hemorrhages) lossis koom ua ke. Preretinal hemorrhages yog nyob rau hauv daim ntawv ntawm crescent, sib sau ib qib sib nrog nrog posterior detachment ntawm lub vitreous. Qee zaum preretinal hemorrhages tuaj yeem nkag mus rau hauv lub cev vitreous. Kev kho cov mob ntshav siab dua yuav siv sijhawm ntev dua li ntawm kev mob plab preretinal hemorrhages. Qee qhov xwm txheej, lub koom haum thiab cov ntshav sib txuam tshwm sim ntawm lub cev nqaij daim tawv tom qab lub cev nrog qhov tsim ntawm "ocher-xim membrane." Cov neeg mob yuav tsum ceeb toom tias hemorrhage tuaj yeem tshwm sim los ntawm ntau dhau ntawm lub cev lossis lwm yam kev ntxhov siab, nrog rau kev mob ntshav qab zib lossis qhov muag raug mob. Txawm li cas los xij, cov tsos mob hemorrhage thaum pw tsaug zog yog feem ntau.

Retinal cov ntawv txiav tawm

Nws pom nrog qhov kev vam meej sai zuj zus ntawm cov nqaij fibrovascular hauv thaj chaw loj ntawm vitreoretinal fusion. Cov posterior vitreous detachment nyob rau hauv cov neeg mob ntshav qab zib tshwm sim maj, feem ntau nws ua tsis tiav, uas yog vim muaj qhov ua tau zoo ntawm cortical saum npoo ntawm vitreous nrog thaj chaw ntawm fibrovascular proliferation.

Cov nram qab no hom ntawm nyob ruaj ruaj vitreoretinal traction ua rau retinal detachment:

anteroposterior traction tshwm sim thaum daim ntawv cog lus fibrovascular daim nyias nyias, uas txuas ntxiv los ntawm cov ntu tom qab, feem ntau yog ua ke nrog cov kev sib txuam ntawm cov leeg ntshav ntau, ua ntej ntawm lub hauv paus ntawm cov vitreous,
choj traction yog qhov tshwm sim ntawm kev cog lus ntawm fibrovascular cov hlab ntsha, uas ncab los ntawm ib nrab ntawm ntu tom qab mus rau lwm yam. Qhov no ua rau muaj qhov tsis txaus siab nyob rau hauv thaj av ntawm cov ntsiab lus no thiab tuaj yeem ua rau qhov tsim kom muaj cov leeg nrawm, nrog rau lub sijhawm hloov chaw ntawm cov macula txheeb ze rau daim disk, lossis lwm yam, nyob ntawm kev coj ntawm lub zog traction.

Lwm yam kev cuam tshuam ntawm tus mob ntshav qab zib retinopathy

Clouded cov yeeb yaj kiab uas tuaj yeem txhim kho nyob rau txheej txheej tom qab ntawm exfoliated vitreous rub lub retina los ntawm sab saum toj mus rau hauv qab ntawm thaj av ib puag ncig. Cov yeeb yaj kiab no tuaj yeem npog cov macula nrog qhov tsis pom tom qab.

Cov fundus tsis hloov.
Ntshav mob preproliferative mob ntshav qab zib retinopathy nrog cov ntshav sib chwv me me thiab / lossis cov tawv ncauj exudates ntawm qhov sib txawv ntau dua 1 DD los ntawm fovea.

Cov kev taw qhia tau npaj rau tus kws kho qhov muag

Uas tsis yog-loj hlob rau cov mob ntshav qab zib retinopathy nrog tso cov khoom tseem ceeb hauv daim ntawv ntawm lub nplhaib raws lub ntsiab ntawm sab cev nqaij daim tawv, tab sis tsis muaj kev hem thawj rau fovea.
Uas tsis yog-loj hlob rau cov mob ntshav qab zib tsis ua mob hlwb tsis muaj mob maculopathy, tab sis nrog qhov tsis pom kev zoo txhawm rau txhawm rau txiav txim siab nws qhov ua rau.

Xa mus thaum ntxov rau tus kws kho qhov muag

Uas tsis yog-loj hlob rau cov mob ntshav qab zib retinopathy nrog qhov tso nyiaj ntawm cov khoom exudate thiab / lossis hem ntshav tsis dhau 1DD ntawm fovea.
Maculopathy
Preproliferative mob ntshav qab zib retinopathy.

Kev xa mus sai rau tus kws kho mob ntsej muag

Cawv neeg muaj ntshav qab zib ua kom rov zoo ntxiv.
Preretinal lossis vitreous hemorrhages.
Rubeosis ntawm iris.
Retinal kev ua haujlwm.

, , ,

Qhia Txog Tus Mob Ntshav Qab Zib Retinopathy Kev Kho Mob

Txoj kev kho nrog panretinal laser coagulation yog tsom rau kev ua kom tsis txaus siab ntawm cov nkoj tsim tshiab thiab tiv thaiv qhov tsis pom kev vim los ntawm vitreous hemorrhage lossis tractional retinal detachment. Qhov ntim ntawm txoj kev kho yog nyob ntawm qhov mob hnyav ntawm loj tshaj plaws ntawm kev mob ntshav qab zib retinopathy. Nrog cov kab mob hauv nruab nrab, cov coagulates raug thov sib nrug deb ntawm ib leeg ntawm lub zog qis, thiab nrog cov txheej txheem tshaj tawm lossis rov huam dua, qhov kev ncua deb ntawm coagulates yuav tsum raug txo, thiab lub zog yuav tsum tau nce ntxiv.

Pib ophthalmologists zoo dua siv cov panfundoscope. muab qhov loj dua ntxiv dua peb-tsom iav Goldmann lens. txij li thaum siv tom kawg, qhov tshwm sim ntawm qhov ua tsis tiav photocoagulation nrog cov nyom zoo yog qhov ntau dua.

coagulate loj yog nyob ntawm qhov sib chwv uas siv. Nrog lub lens Goldmann, qhov loj ntawm coagulum yuav tsum yog 500 microns, thaum nrog lub ntsuas pa - 300-200 microns,
sijhawm lub sijhawm - 0.05-0.10 vib nas this ntawm lub zog uas tso cai rau koj thov maj mam coagulates.

Thawj txoj kev kho mob ntshav qab zib retinopathy yog nqa nrog daim ntawv thov ntawm 2000-3000 coagulates hauv qhov kev txiav txim siab tawg nyob rau hauv cov kev taw qhia los ntawm cov txheej txheem tom qab, npog cov periphery ntawm cov retina hauv ib lossis ob ntu, panretinal laser coagulation, txwv rau ib ntu, cuam tshuam nrog kev pheej hmoo siab ntawm cov teeb meem.

Qhov ntim ntawm kev kho mob hauv txhua ntu kev txiav txim siab los ntawm qhov ntsuas mob ntawm tus neeg mob thiab nws lub peev xwm mloog. Rau feem ntau cov neeg mob, qhov muag loog ntawm cov qhov muag nyob hauv zos yog qhov txaus, tab sis parabulbar lossis subthenon anesthesia yuav tsim nyog.

Cov kab ke ntawm kev coj ua yog raws li hauv qab no:

Kauj Ruam 1. Nyob ze ntawm lub disc, nqis los ntawm qis hauv ntiaj teb arcade.
Kauj Ruam 2. Qhov kev tiv thaiv ib puag ncig ntawm macula yog tsim los tiv thaiv kev phom sij ntawm kev cuam tshuam nrog cov vitreous. Lub laj thawj tseem ceeb rau kev ruaj khov neovascularization yog kev kho tsis tau zoo.

Cov cim ntawm kev cuam tshuam yog regression ntawm neovascularization thiab cov tsos ntawm cov hlab ntsha lossis cov ntaub so ntswg, kev cog lus ntawm cov leeg ntshav, kev nqus ntawm cov leeg ntshav thiab qhov txo qis ntawm disc blanching. Feem ntau ntawm retinopathy tsis muaj qhov ua tsis zoo, qhov kev pom kev ruaj khov kho tau zoo. Muaj qee kis, preproliferative diabetic retinopathy rov muaj dua li qhov kev tshwm sim thaum ntxov. Hauv qhov no, rov kuaj xyuas cov neeg mob nrog ntu 6-12 lub hlis yog qhov tsim nyog.

Panretinal coagulation cuam tshuam tsuas yog vascular tivthaiv ntawm cov txheej txheem fibrovascular. Nyob rau hauv cov ntaub ntawv ntawm regression ntawm tshiab tsim cov hlab ntsha nrog tsim ntawm cov nqaij mos ua ke, kev kho mob rov qab tsis qhia.

Rov qab kho mob

rov ua dua laser coagulation nrog daim ntawv thov ntawm coagulates nyob rau hauv qhov khoob nruab nrab ntawm cov ntsiab lus tsim ua ntej,
cryotherapy ntawm thaj av xub thawj ntawm qhov retina tau qhia thaum rov ua dua photocoagulation tsis tuaj yeem ua vim qhov tsis pom kev zoo ntawm lub pob nyiaj txhaws vim yog cov xov xwm turbid. Tsis tas li ntawd, nws tso cai rau koj los ua nyob rau thaj chaw ntawm cov kab mob retina uas tsis tau ua tiav panretinal laser coagulation ..

Nws yog qhov yuav tsum tau piav qhia rau cov neeg mob tias panretinal laser coagulation tuaj yeem ua rau pom kev tsis pom kev ntawm ntau qib, uas yog qhov tsim nyog contraindication rau kev tsav tsheb.

Kauj Ruam 3. Txij li ntawm tus hneev ntawm cov disc, qhov ua tiav ntawm kev cuam tshuam hauv cheeb tsam posterior.
Kauj Ruam 4. Lasercoagulation ntawm periphery kom kawg.

Nrog rau cov lus tshaj tawm cov kab mob ntshav qab zib ua kom rov ua mob, nws yog thawj qhov pom zoo kom ua ib qho kev cuam tshuam hauv qis dua ntawm ib nrab ntawm qhov retina, txij li thaum cov ntshav tawm hauv lub cev vitreous, thaj chaw no raug kaw, uas ua rau kev kho mob ntxiv mus tsis tau.

Ua raws li cov tswj kev cai

Kev soj ntsuam feem ntau yog 4-6 lub lis piam. Nyob rau hauv cov ntaub ntawv ntawm loj neovascularization ze ntawm daim disk, ob peb zaug yuav tsum tau nrog tag nrho cov naj npawb ntawm coagulates txog li 5000 lossis ntau dua, txawm tias qhov tseeb ntawm kev tshem tawm cov neovascularization yog qhov nyuaj ua tiav thiab yuav xav tau kev kho mob thaum ntxov.