ʻO ka retinopathy Diabetic (ICD-10 code - H36 a i ʻole E10-E14 p. 3) he maʻi hoʻopiʻi maʻi o ka maʻi mellitus, kahi e hoʻolohi ai a i ʻole ka pau o ka nānāʻana i waena o nā mea maʻi o ka makahiki hana. ʻO ka hiki ke hoʻomohala i kahi ʻano e pili ana i ke ʻano o ka ma lalo o ka maʻi, ka mālama ʻana a me ka uku uku.
ʻO nā kumu maʻi
Hoʻoulu ʻia ka hoʻomohala ʻana o ke ʻano o ke kākāʻōlelo nānā e ka:
- ʻO ka lōʻihi o ke maʻi i lalo. Kuhi pinepine ka retinopathy diabetes i nā makahiki 6-7 mua, pēlā nō hoʻi i ka wā ʻōpiopio, eia nō ka mea i ʻike ʻia ma ka 5% o nā hihia i ka maʻi me ka maʻi non-insulin-dependant i ka manawa o ka hoʻopili ʻana i nā loea.
- ʻO ka hemahema kūpono o ka mālama koko ʻana e hoʻonāukiuki i ka hiʻohiʻona o ka decompensation ma mua.
- ʻO ka wā hānau o ke keiki. ʻO ka mea nui o ka hoʻomohala ʻana o ka wā kahiko o ka gestosis (preeclampsia).
- He koko koko nui. Ua hoʻonāukiuki kēia kūlana i ka holomua o ka maʻi diabetes.
- ʻO nā ʻōhumu o nā pūpū (nephropathy). Ua hōʻoia nā ʻepekema ʻepekema ʻo ka mālama ʻana i nā pathology renal i hui pū me ka photocoagulation e hiki ke hoʻomaikaʻi i ke kūlana o ka mea maʻi.
- ʻOi momona.
- ʻAno maikaʻi.
ʻEnehana hoʻomohala
ʻO kahi maʻi mellitus ka maʻi maʻi kahi e hoʻopilikia ai nā ʻano āpau. ʻO ka mea mua, ʻeha nā kīʻaha o ka ipu nunui a me nā mea liʻiliʻi.
ʻO ka glycemia kiʻekiʻe ka mea hoʻokūkū i ka hoʻomohala ʻana o nā pathology o ka mea hoʻopuka ʻike
Hoʻokumu ʻia ka pathogenesis o retinopathy diabetic i nā loli o ka metabola i nā pae āpau, a me kahi hoʻonui o ka coagulation koko, hypoxia a me nā protein kiʻekiʻe glycated. ʻOi aku ka nui o nā ʻōhua glucose i ka pale ʻole, e kū i ke kua o nā loli i ke kino, ka ʻano o ka nele o ka oxygen i nā ʻili a me nā huina. I ka hoʻomaka mua ʻana, hoʻohana ʻia nā mīkini hoʻokūkū, akā me ka piʻi ʻana o ka maʻi maʻi maʻi maʻi, ka hoʻohaʻahaʻa ʻana i nā lumen o nā moku e ʻike ʻia ma muli o ke kani nui o ko lākou mau pā.
ʻO ka hana ʻana o nā protein glycosylated (hoʻohui pū me nā molekala glucose) me ka hoʻokuʻu ʻana o nā huahana o nā hopena, ka nui o nā mea hoʻonāukiuki i ka protein proteinism, a me ka mānoanoa o nā membranes. E kū'ē i ka maikaʻi o kēlā mau loli, e kū mai ana ka hoʻokumu ʻana o nā mea ʻōmole protein hou, ke ʻimi nei ke kino e luku, e hoʻomaka ana i ka huli ʻana o ka "pilina". ʻO ka hopena he pōʻino i nā paia o nā capillaries, ko lākou kiʻekiʻe kiʻekiʻe.
ʻO ke ala o ka metabolism momona ka hoʻonāukiuki i kahi synthesis nui o ka kolamu, triglycerides a me nā mea like like e hiki ke pani i ka lumen o nā moku retinal. Ke alakaʻi nei kēia i kahi o ka pōʻino o ka pōʻino a me ka microcirculation koko.
Hōʻike ʻia ka retinal hypoxia e ka hoʻokumu ʻana o kahi pūnaewele vascular pathological hou (neovascularization) a me ka hōʻike ʻana o nā shrul arteriovenous (hana i nā kahe koko).
Kahi helu
Nui ka helu o nā papa o ka retinopathy i ka maʻi maʻi. Hoʻopili kēia e pili ana i nā hōʻike he nui o ka pathology. ʻO kahi hoʻohana nui ʻia:
- ʻaʻole kahi kūlana-proliferative;
- preproliferative hana;
- proliferative kūlana.
Nui! ʻO kēlā hoʻokaʻawale ʻana o nā hoʻopiʻi e wehewehe pono i ka manawa e pono ai ka mālama ʻana i ka laser.
ʻO nā hoʻololi i ka choroid - nā hōʻike nui o ka retinopathy me ka maʻi diabetes
Ka paukū haʻahaʻa:
- retinopathy o kahi ʻano maʻalahi (background);
- maculopathy;
- retinopathy preproliferative;
- proliferative retinopathy.
Kūleʻa ʻole-hoʻomōlapa
ʻO ka retina o ka mea nānā loiloi ua loaʻa nā microaneurysms, nā ʻōpū liʻiliʻi e like me nā pōʻeleʻeleʻeleʻele a ʻike ʻia i ka wā e nānā ana i ka waihona kālā. ʻO nā hemorrhages, ma ke ʻano he kānāwai, e kū ana i ka waenakonu o ka choroid o nā maka a i ʻole i ka ʻōnaehana venous hohonu. I ka manawa like, ʻike ʻia nā foci o ka hōʻuluʻulu ʻana o ka exudate (i hoʻonohonoho ʻia i loko o ke kikowaena, e like me nā keʻokeʻo a i ʻole nā melemele i ʻike ʻole ʻia nā palena) a me ka pua.
Kūlana preproliferative
Hōʻike nā anomalies o kahi ʻōnaehana ʻano like ʻole. Hoʻopili ʻia nā ʻōpala, ʻano like i ka mea i ka rosary, e kū mai nā puka, e loli ana ke ʻano o nā moku. Hoʻopili ʻia nā membrane vascular i kahi helu nui o nā hoʻopiʻi exudative. ʻO nā hemorrhages i ulu nui loa.
Papa hana hoʻomaʻamaʻa
I kēia kaʻina, ua hoʻokumu ʻia ke hoʻokumu ʻana o neovascularization (hoʻonui i nā pathological o nā kīʻaha koko kahi i ʻike ʻole ʻia ai). ʻO ka mea mua, ʻike lākou ma waena o ka choroid a me ka membrane vitreous posterior, a laila ulu a ulu i ka vitreous iho.
ʻO Neovascularization kekahi o nā hōʻike o ka priniferative retinopathy.
Inā pili ka neovascularization i ka iris, ʻoi ka nui o ka nui o ka glaucoma kūleʻa i kekahi mau manawa. Eia kekahi, ua hoʻololi ʻia ka hemorrhage e ka fibrous kiko, e hiki ai ke hoʻonāukiuki i ke ʻano o nā detinalment retinal.
Nā hōʻailona o ka patology
Initial diabetic retinopathy paha he asymptomatic a maopopo paha e like me kēia:
- ua emi mai a ikeu;
- pākū a i ʻole nā wahi i hele mai i nā pōuliʻeleʻele i mua o nā maka - nā hōʻailona o ka hemorrhage;
- hiki ole ke ike i na mea liilii;
- nā keʻena keʻokeʻo keʻokeʻo - kahi hōʻailona o ka edema;
- ʻeha ʻole ma ka wahi maka.
ʻO ka ʻemi a i ʻole ka ʻike ʻia o ka ʻike maka nā hōʻailona o nā maʻi retinopathy diabetes. Ke hōʻike nei kā lākou hoʻolālā i ka hiki ʻole o ke kaʻina hana. Wahi a nā helu helu, hele mai ka makapō piha i 2% o nā maʻi maʻi.
ʻO ka ʻokoʻa ma waena o ka hihiʻo o kahi kanaka olakino a me kahi maʻi maʻi hānai me ka pathology o ka mea nānā loiloi
ʻO nā mea hou aku ka ʻike
ʻO nā Microaneurysms nā lula o nā pā o nā moku liʻiliʻi-caliber. ʻO kā lākou kūlala kaiāulu ka palena o ia mau wahi ʻaʻole i loaʻa ke koko. ʻO ka ʻokiʻomo i nā hoʻomaka mua kahi hōʻailona o ka hoʻokomo ʻana i nā mīkini uku.
Inā aia nā microaneurysms me ka ʻole o nā hōʻike ʻē aʻe o ka pathology o ka analyzer, ʻaʻole lākou e hali i kekahi pilikia, akā e hōʻike wale ana i ka hoʻomaka o ka hoʻomohala ʻana o nā pilikia. Eia naʻe, hele ka nui o ka maʻi, ke hoʻonui aʻe nei lākou. ʻO ka hopena maʻamau e pili ana i ka microaneurysms ma ka ʻaoʻao i loko o ka mea i huli ai ke ʻano o ka puffiness.
ʻĀpono
Hiki iā lākou ke hele i nā ʻāpana ʻokoʻa o ka choroid, he ʻano ʻokoʻa. Inā hoʻokomo ʻia nā papalua hohonu, he ʻōpū a i ʻole nā ʻāpana o nā ʻano hemolele a hemorrhages. I ka wā e hoʻokūkū hou ʻia nā laina ʻē aʻe, ua like lākou me nā laina lima.
"Solid" exudate
ʻO kahi hōʻiliʻili o nā lipids a me kā lākou huahana pākaha. He ʻōpau melemele lākou a me ke ʻano kūpono. Aia nā kauā "Solid" ma nā wahi o ka hoʻonui ʻana i nā capillaries a ma ke kaʻe o ka pu puʻu. Nā waihona like ma ke kikowaena o ka choroid alakaʻi i ka emi nui o ka ʻike maka ʻana.
Nā ʻudpihi palupalu
He mau wahi liʻiliʻi o nā ischemia (necrosis) o nā kinipiko nerve e kū mai ma muli o ka komo ʻana o ka capillary. ʻO "exudes" nānā i ke ʻano o nā ʻokeʻo keʻokeʻo ʻaʻole i palena nā palena.
Maʻaau hoʻōliko
ʻO kekahi o nā hōʻike o ka angioretinopathy, ka hiʻohiʻona e nā ʻāpana o ka makula.
E hele mai ka maculopathy Diabetic ma muli o ka nui o ke ʻano o nā capillaries a me kā lākou microoclus wawe. Hōʻike ka ʻikepili o kēia manawa i ka hapa ʻole o ka hoʻokaʻawale pinepine ʻana i nā lesiona macular, akā makemake ka hapa nui i nā mea kākau e hoʻokaʻawale iā ia i loko o edematous a me ischemic, i pili i ka ākea o nā hōʻike kūloko.
Hiki i ka Edematous maculopathy ke:
Ka hoʻomaʻamaʻa ʻana o ka polyneuropathy ma ka maʻi diabetes- kūloko (palena) - hōʻike i ka hoʻokau ʻana i hoʻokahi wahi a i hoʻopaʻa ʻia paha i loko o ka retina;
- huehue - ʻike ʻia ka edema koʻikoʻi, ka mea ʻaʻole i nā palena maopopo, i hui pū me ka hoʻokumu ʻana o nā cyst liʻiliʻi.
ʻO ka maculopathy Ischemic ka hopena maikaʻi loa e pili ana i ka hana a ka mea hoʻokalakupua o nā ʻike loiloi a me ka ʻike acuity. He mea paʻakikī loa ka wehe ʻana i ka wā e nānā ana i ke kālā. ʻO Optometrists, ma ke ʻano he kānāwai, e noʻonoʻo e pili ana i ka hoʻolālā ʻana o kēia ʻano ʻano palolo me kahi mismatch ma waena o ka puʻu haʻahaʻa haʻahaʻa a me nā loli o ka liʻiliʻi. No ka maʻi maʻamau, hoʻohana ʻia ka angiography fluorescence.
Diagnosis
Hoʻopau ka Ophthalmologist i nā maʻi maʻi maʻi me kekahi neʻe ʻana:
- ma hope o 5 mau makahiki mai ka hoʻomaka ʻana o ka "maʻi ʻeha" i ʻike ʻia me ke ʻano maʻi type 1;
- i ka wā e hui mua ai i ka endocrinologist me nā maʻi type 2;
- 1 ka manawa i ka makahiki me ka loaʻa ʻole o retinopathy;
- kēlā me kēia 6 mahina me kahi hōʻike o ka retinopathy non-proliferative;
- helehelena preproliferative - hoʻokahi manawa i kēlā me kēia mahina 3-4;
- "retolopati proliferative" ma ka mōʻaukala olakino - hoʻokahi manawa i kēlā me kēia 2-3 mau mahina.
ʻOphthalmologist - ke kōkua nui i ka mālama ʻana a me ka pale ʻana i nā patology
Hoʻohana ʻia nā hana Diagnostic:
- Hoʻoholo ʻia e pili ana i nā pānaʻi retinal maʻamau - e lawe ʻia ana me ka kiʻi kiʻi stereoscopic. Hōʻike ʻia ke kaʻina hana e ka naʻau kiʻekiʻe, ke kaʻina hana kiʻi wikiwiki. He taugake ka noiʻi.
- ʻO ka ophthalmoscopy pololei - kuhikuhi ke kauka i kahi mālamalama o ke kukui i ka maka o ka mea maʻi, hiki iā ʻoe ke nānā i ke ʻano o ka waihona kālā.
- Hoʻohana ka Biomicroophthalmoscopy - nā lono loiloi aspherical no ka noiʻi.
- Hōʻuluʻulu ʻo Fluorescence - ua hoʻoili ʻia kahi mea kūikawā i ka punawai o ke kumuhana, hiki iā ia ke kūleʻa i ka pane ʻana i ka ʻike i ka ʻike. Hāʻawi ʻoe iā ʻoe e nānā i ke ʻano o ka microcirculation, kūloko i nā kahe koko, ka manawa o ischemia, hemorrhage.
- Optical coherence tomography - hiki iā ʻoe ke nānā i ke ʻano o ka puhi ʻana.
- Echographie - e hoʻohana ana i ke ʻano e hoʻoholo i ka maʻa a me ka hoʻokele i nā mea pili i loko o ka maka.
- He paʻakikī kahi paʻakikī o ka EFI. Hāʻawi lākou iā mākou e hoʻomaʻamaʻa i nā ʻōnaehana o ka bioelectrogenesis o nā papa o ke choroid o ka loiloi ʻikeʻike.
Nā kuʻina mālama
ʻO ka mea mua, he mea koʻikoʻi ke hoʻomohala i nā hōʻailona glucose koko a loaʻa i kahi ala uku no ka maʻi lalo. Manaʻo ʻia e helu ʻole ka helu ʻai wikiwiki i ka 6 mmol / L, a ʻo ke kiʻekiʻe o ka hemoglobin glycated a hiki i ka 6.5%.
Eia kekahi, ʻo ka loaʻa ʻana o ka hypertension ua manaʻo ʻia he mea nui. ʻO ka pahuhopu nui o ka maʻi diabetes he koko ʻaʻole i kiʻekiʻe ma mua o 140/90 mm Hg. No ka hoʻoponopono ʻana i nā helu, ua hoʻohana ʻia nā pūʻulu o nā hua lāʻau:
- ACE inhibitors - C hakuopala, Lisinopril.
- Nā Pākīkeka Kalikimaka - Verapamil, Tiapamil.
- Diuretics - Dichlothiazide, Furosemide.
Nā hōʻailona maʻamau o BP - kahi loulou i ka nānā ʻana o ka retinopathy
Kāleka Hoʻōla
ʻO nā lāʻau lapaʻau i hoʻohana ʻia no kēia hana e hiki ai ke hoʻopiʻi i ka mellitus no ka diabetes mellitus a lohi i ka hoʻomohala ʻana a me ka holomua ʻana o nā ʻōnaehana. E hoʻohana i nā kālā mai ka hui o statins (Lovastatin, Fluvastatin) a me nā fibrates (Fenofibrate, Bezafibrat).
Ka hoʻomaikaʻi ʻana i ka rheology koko a me ke ʻano pā wall
Hoʻopili ʻia nā retinopathy Diabetic me ka hoʻonui o ka pihi platelet. Ke wehewehe nei kēia i ka pono o ke koho ʻana o kēia kālā:
- Acetylsalicylic acid;
- Heparin;
- Sulodexide;
- Ticlopidine;
- Pentoxifylline.
I mea e hoʻoponopono ai i ke kani o ka paia vascular, vitamina C, Rutozid, Pirikarbat, Etamzilat i kuhikuhi ʻia.
Antioxidants a me ka hiki ke hoʻonuiʻana i ka metabolic
ʻO ka hoʻohanaʻana o ka vitamini E, methylethylpyridinol, ʻo Ginkgo biloba extract i nā manawa hou aku nei. He hopena antioxidant nā lāʻau lapaʻau, hoʻopaʻa ai a hoʻoneʻe i nā radical manuahi mai ke kino.
ʻO nā manaʻo e hoʻomaikaʻi i nā kaʻina metabolic i ka retina (i hoʻokumu ʻia i ka makua, i ka waha a me ka periocularly):
- Dihydroergocriptine;
- Inosine;
- hua ʻuala hua palu maloʻo;
- hua moa blueberry me beta-carotene.
Coagulation Laser
Hoʻoholo ʻia kēia ʻano o nā mea i ʻoi loa i ka mālama ʻana o ka retinopathy diabetes. ʻO kāna kumu i:
- nā pani ʻana o nā ʻāina ischemic;
- ke pani ʻana i ka hoʻokumu ʻana o nā moku pathological hou;
- ka pani ʻana i ka lumen vascular o nā capillaries i nui i loaʻa ke kū pono o ka pā;
- ka hoʻohuhopu o ka adhesions, a me ka hoʻēmi ʻana i ka hopena o kahiʻoki.
Coagulation Laser retinal - kahi hana pono e pani ai i ka holomua o ka maʻi
Hoʻopuka ʻia ka coagulation e ke ʻano hoʻokūkū, solid-state a diode (infaredared). Nui nā ʻano hana o ka hoʻokūkū laser, ʻokoʻa i kēlā me kēia i ke kumu o ka lawe ʻana i nā hōʻike, ʻike ʻia.
Kaomi panretinal
Hoʻohana ʻia ma ka mālama ʻana o ka preproliferative a me ka retinopathy proliferative o nā etiologies. Hoʻohui ʻia nā coagulate i ke āpau āpau o ka choroid, koe wale nō ka corpus luteum, i mea e pale ʻole ai i ka hōʻemi ʻana i nā hiʻohiʻona hou o nā moku hou. ʻAe kēia iā mākou e hoʻomaikaʻi i ka trophism o kēlā mau wahi o ka retina i paʻa ʻole ʻia e ke kaʻina pili.
Ma mua o ka hoʻopunipuni ʻana, pono ke ʻike ʻia ka mea maʻi me ka manaʻo ʻole e lawe ʻia ka hana me ka pahuhopu o ka hoʻihoʻi ʻana i ka maʻi ʻike, akā i mea e pale ai i ka holomua o kona emi ʻana.
ʻO ka hoʻomaʻamaʻa antiangiogenic
Kahi ala e hoʻohālikelike ai nā lāʻau lapaʻau i ka vitreous. I mea e pale ai i ka neovascularization, hoʻohana ʻia nā blocki angiogenesis. ʻO ka hopena kahi e hōʻemi ʻia i loko o ka edema ma kahi o ka corpus luteum.
ʻAʻole hoʻohana ʻia kēia ʻano hana ma ke kaʻina kaʻawale. Hoʻomaopopo ʻia ka lāʻau antiangiogenic ʻo kahi ʻāpana o ka paʻakikī paʻakikī a hui pū ʻia me ka laser coagulation a i ʻole ʻoi ʻana.
Hoʻolālā
Pono ke ʻano hui loiloi e pale ai i ka holomua o ka hana pathological, a me ka hoʻoponopono ʻana i ke ʻano o ka mea maʻi i ke hihia o nā hoʻopiʻi. ʻAʻole hana ʻo Vitrectomy i kēia mau helu:
- rubeosis o ka iris;
- glaucoma kūleʻele neovascular;
- optic atrophy;
- pathology pathology;
- kahua hana hoʻomōlaʻi;
- decompensation o ka lolo a me nā maʻi ʻōnaehana ʻē aʻe.
Wahi a nā poʻe ophthalmologists, ʻo ka hoʻomau ʻana o nā hana o ke kaaniani ʻike ma hope o ke hōʻola ʻana ma kahi o 45% o nā hihia, aʻo waena o nā mea maʻi ʻaʻole i hahai i nā ʻōlelo aʻo a kauka, ʻo 14% wale nō.
ʻO nā hopena palekana
Hiki i ka hoʻomaʻamaʻa ʻia me nā mea hoʻomaha o ka iwi ke hoʻokō i nā hana o ke ala ʻike, akā e mālama pū i ke kōpaʻa koko ma loko o nā palena hiki. Pono ka hana pono i ka hōʻike nettle. Hoʻopili ʻia nā lau hou, ka wai momona. Pono e inu i ka hapakolu o ka ipu wai ʻekolu mau manawa o ka lā. Hiki ke hoʻohui ʻia nā lau nettle i nā māla, nā papa mua.
ʻO ka wai ʻaole - kahi hale mālama hale o nā waiwai pono ʻaʻole wale no nā mea maʻi, akā no nā kānaka olakino nō hoʻi
ʻO ka hopena like ka wai o nā lau aloe. Ma mua o ka unuhi ʻana i ka wai o ka ho'ōla, ua kau ʻia nā lau i loko o ka friji no kekahi mau hola. A laila ua nahu ʻia, ua loaʻa ka wai, ua kulu ʻia no nā lā he 3-4 mau minuke. Koke inu 1 tsp. ʻekolu mau lā i kahi lā, ma ka pō hiki ke moe i ka maka (2 kahe i kēlā me kēia).
Hiki iā ʻoe ke hoʻohana i ka infusion o nā blueberries (inu i loko o nā ʻāpana liʻiliʻi i ka lā), ka wai lingonberry, decoctions o ka hoʻomākaukau lāʻau.
Nā hana kūpono
ʻO kahi mea nui ʻo ka mālama ʻana i nā hōʻailona hiki i ke koko, ke koko, ke kaumaha o ke kino. Hāʻawi kēia iā ʻoe e pale aku a hoʻolohi i ka hoʻomohala ʻana, ʻaʻole wale o ka retinopathy wale nō, akā ʻo nā mea ʻē aʻe a me nā hoʻopiʻi kūpaʻa o ka maʻi mellitus.
Penei ke ʻao:
- piliʻole i kahi meaʻai haʻahaʻa-haʻahaʻa;
- lawa ka hana kino;
- nā hoʻopaʻa hōʻoia maʻamau me kahi kanaka ophthalmologist;
- ka mālama manawa kūpono o nā maʻi lalo a me nā hoʻomaka mua o nā ʻōpiopio.
Eia nō naʻe, he mea hiki ʻole ke hoʻōla i ka hoʻopiʻi, ʻoi aku hoʻi i nā hana ma hope, a he mea hiki ke pale i kona hoʻomohala ʻana, mālama i nā hana ʻike a hoʻopau i ka holomua. ʻO ka mea nui, ʻo ka hahai ʻana i nā ʻōlelo a me nā ʻōlelo aʻoaʻo o nā poʻe loea a he maʻi koʻikoʻi i ka maʻi lalo.
