Kuwona kochepa kumapezeka pafupifupi 85% ya odwala omwe ali ndi matenda a shuga 1. Matenda a shuga a retinopathy amaphatikizira njira ya matenda ashuga pambuyo pa zaka 15-20 zodwala. Ngati matenda amtundu wa 2 apezeka ndi ukalamba, ndiye kuti theka la odwala amapezeka nthawi yomweyo kuwonongeka kwa ziwiya zomwe zimadyetsa maso.
Monga lamulo, retinopathy mu matenda a shuga amaphatikizidwa ndi zovuta kuzungulira kwa magazi, kuwonetsa kwa phazi la matenda ashuga komanso nephropathy.
Kuopsa kwa kuwonongeka kwa maso kumakhudzana ndi kuchuluka kwa kuchuluka kwa shuga m'magazi, kuchuluka kwa kuthamanga kwa magazi, komanso kukwera kwa cholesterol ndi vuto la magazi
Kuwonetsedwa kwa retinopathy mu shuga
Chinthu chachikulu chomwe chikuthandizira kuchepetsedwa kwa kuwona kwa chidwi ndi odwala omwe ali ndi matenda ashuga ndi matenda a shuga a macular edema. Potere, madzimadzi amadziunjikira pakatikati pa retina, pomwe pali malo achikasu (macula), omwe maselo ake ndi omwe amawongolera chapakati.
Kupanga kwa chitukuko cha edema kumalumikizidwa ndi kuchuluka kwa shuga, makhoma a zombo zazing'ono zimawonongeka. Kusintha kotereku kumatchedwa microaneurysms. Pali thukuta lotuluka m'madzi ziwiya zosalimba, ndipo limadziunjikira mu retina.
Kafukufuku wogwiritsa ntchito kuphatika kwamalumikizidwe a m'maganizo adavumbulutsa mitundu ingapo ya matenda a shuga a shuga: spongy retinal edema, edstic edema ndi retinal detachment.
Kuphatikiza pa matenda ashuga a retinopathy, edema imatha kuyambitsa matenda:
- Msempha wamitsempha wam'mimba.
- Uveitis, momwe choroid yamaso amadzimenya.
- Kuvulala koopsa.
- Mavuto a opaleshoni.
Matenda a shuga a macula amaphatikizidwa ndi kuchepa kwa gawo lalitali pakati pa chithunzicho, chithunzicho chimakhala chosalala, mizere yolakwika, mizere yolunjika imawoneka yopindika.
Masinthidwe amtundu wamtundu wamtundu wamtundu wamtundu wamtambo wamtunduwu amapezeka. Kuzindikira kwa kuwala kowala kumawonjezeka. M'mawa, maonedwe acuity akhoza kukhala oyipa kuposa masana, kusiyana kutulutsa kungakhale kochokera ku 0,25 diopters.
Ngati matendawa apezeka m'mayambiriro oyambirira, mpaka ziwiya zatsopano zimayamba kupanga, ndiye kuti kuchepa kwa masomphenyawo kumatha kusintha. Koma nthawi yobwezeretsa ndi yayitali ndipo imayambira masiku 90 mpaka miyezi 15.
Kutupa kwa nthawi yayitali kwa macula kumatha kubweretsa kufa kwa cell ndikuwonongeka kwathunthu. Zimatengera kuchuluka kwa njirayi. Ngati zotupa zimagwira gawo lonse lapakati, ndiye kuti matendawa ndi osachiritsika. Kusintha kwa mfundo nthawi zambiri kumatha kuchiritsidwa.
Mukamayeserera ndendende, zimangotchulidwa kuti ndi edema yayikulu. Ndi zazikulu zing'onozing'ono, zitha kukayikiridwa ndi mtundu wowuma komanso kukula kwa gawo lapakati. Chodziwika ndi kuphatikizika kwa mitsempha yamagazi mu macula. Mwa njira zamakono zodziwira matenda:
- Mgwirizano wogwirizira tomography (makulidwe amtundu, voliyumu, kapangidwe kamasankhidwa).
- Heidelberg retinal tomography (makulidwe omaliza a retinal ndi edema okha amawunika).
- Fluorescence angiography - kuphunzira kwa ziwiya zam'mimba pogwiritsa ntchito sing'anga yapakati.
Mankhwala a macular edema
Pomwe matenda a diabetes a macular edema akapezeka, chithandizo chimayamba ndi kuchepa kwa shuga wokwanira wamagazi. Zimatsimikiziridwa kuti posamutsa wodwala ku regimen yowonjezera ya insulin, chiwopsezo cha kupezeka ndi kupitilira kwa masomphenya otsika a shuga a retinopathy amachepetsa.
Kutengera kutalika kwa macular edema ndi gawo la njirayi, njira ya chithandizo imasankhidwa: yokhazikika, laser coagulation kapena opaleshoni. Mankhwala osokoneza, othandizira-kutupa ndikuyambitsa mankhwala apadera mu vitreous patsekitala amagwiritsidwa ntchito.
Kuchotsa kwa kutupa kumachitika pogwiritsa ntchito mankhwala osagwiritsa ntchito mankhwala osokoneza bongo monga ma dontho amaso, mapiritsi kapena jakisoni. Gulu la mankhwalawa limakhala ndi mwayi kuposa corticosteroids, chifukwa limayambitsa zotsatira zoyipa zochepa (kuchuluka kwazomwe zimayambitsa intraocular, kuchepa chitetezo chamderalo komanso kupezeka kwa zilonda zam'mimba).
Pakulowetsa mu mucre wa vitreous, mumagwiritsidwa ntchito izi:
- Corticosteroids - Kenalog ndi Dexamethasone.
- Maselo endothelial kukula factor blockers.
Kukhazikitsidwa kwa corticosteroids, ngakhale kamodzi kumachepetsa retema, kumakulitsa kuwona kwamphamvu. Kutalika kwa izi kungakhale mpaka miyezi isanu ndi umodzi, koma mankhwala akatsimikiza, zotsatira zake zimachepa ndipo matenda a shuga amamuwonjezera. Chifukwa chake, pakapita nthawi, kubayidwa mobwerezabwereza kumachitika.
Zotsatira zoyipa za mankhwala a steroid ndikutukuka kwa mandala ndi kuchuluka kwa mapangidwe a intraocular.
Kukula kwa mtima kumakhudza kukula ndi kupenyerera (kwabwinobwino komanso kwamatumbo) pabedi lonse lamatumbo. Kuphatikizika kwake mu minyewa yamaso kumawonetsa kuwuma kwa zamatsenga. Matenda a shuga a retinopathy amatha kuthandizidwa pogwiritsa ntchito antagonists a vascular endothelial grow factor.
Mankhwala atatu agwiritsidwa ntchito: Avastin, Macugen ndi Lucentis. Kuyambitsa kwawo kumathandizira kuti muchepetse kusintha kwa masomphenya, komanso kuyenera kutumikiridwa mobwerezabwereza chifukwa cha kuchepa kwa ntchito ndi kukhazikika kwa tinthu timene timayang'ana.
Chithandizo cha macular edema ndi laser coagulation
Ngakhale zotsatira zabwino zoperekera mankhwala kwa matreous thupi, zotsatira zazitali zimawonetsa kuti palibe mankhwala omwe angatilepheretse kuwonongeka kwa matenda ashuga a macular edema.
Pazifukwa zochizira, njira ya laser yophatikizika yoonongeka kwambiri, imagwiritsidwa ntchito ziwiya. Pankhaniyi, ndikofunikira kuganizira za chithunzi cha wodwala aliyense payekhapayekha, chifukwa ngati matenda a shuga amatha kudwala malo ochepa kapena sawopseza masomphenyawo, amapezeka pakatikati, ndiye kuti laser chithandizo sichichitika.
Choyipa cha laser coagulation ndikuti sichimabweza masomphenyawo otayika, koma chimangolepheretsa kutayika kwake kwina. Kusintha kosasintha kwa retina mu shuga kumachitika chifukwa cha kufa kwa ma neuron ena.
Popeza ma cell a retinal amakhala mwachindunji, kuchira kwawo sikuchitika.
Zizindikiro zakukula kwa retinopathy mu shuga
Kukula kwa chithandizo cha mankhwalawa kumatengera gawo la matendawa. Maonekedwe a macular edema ndi gawo loyamba la matenda ashuga retinopathy.
Ngati matendawa sanapangidwe munthawi yake, kenako poyankha kuchepa kwa magazi, mapangidwe ndi kukula kwa mitsempha yamagazi amayamba kulipirira omwe awonongeka.
Zombo zatsopano zimamera mkati mwa retina ndipo nthawi zina zimalowa mkati mwa vitreous. Amakhala osalimba ndipo nthawi zambiri amawang'ambika, mawonekedwe amafupa. Pang'onopang'ono, m'malo awa minofu yolumikizana imakula.
Gawo lochulukirapo la matenda ashuga retinopathy amawonetsedwa ndi zizindikiro zotere:
- Tambasula retina ndikuchotsa pamaso pake.
- Kuchulukitsa kwamkati mkati mwake.
- Kutaya kwamaso.
- Kuzindikira kwamaso usiku.
- Kupotoza kwakukulu kwa zinthu.
Pakadali pano, chithandizo cha laser ndi chithandizo cha opaleshoni chimasonyezedwa. Ndi kusintha komwe kwatchulidwa, kutayika kwathunthu kwamawonedwe kumachitika mu shuga.
Kodi kuchotsera kwa vitreous kumachitika liti?
Pambuyo pakukula kwa laser, kupenya kumatha kuchepa, gawo la mawonekedwe limachepa komanso kuthekera kuwona mumdima kumachepa. Kenako, ikadzachira, nthawi zambiri imakhazikika.
Ngati zotupa m'matumbo a matreous sizimayima, ndiye kuti wodwalayo angafotokozedwe opaleshoni yochotsa thupi losakhazikika - vitrectomy. Pa opaleshoni, minofu ya retinal imadulidwa ndipo vitreous imachotsedwa, ndipo yankho losabala limayambitsidwa m'malo mwake. Ngati pali zizindikiro zokukanidwa kwina, ndiye kuti zimabwezeretsedwa monga momwe zimakhalira.
Pambuyo pakuchita opaleshoni, ndikotheka kubwezeretsa kuwona m'matenda ambiri, makamaka ngati palibe kutulutsa kwa retina. Zikatero, milandu yopambana yopanda nthawi yayitali imafika pafupifupi 50%.
Zizindikiro pakuchotsa kwamphamvu ndikusintha kwamatsimikizidwe amtundu wa retina ndikuthandizira macular edema. Zowonetsa ngati izi ndizophatikiza:
- Muli magazi okhathamira otupa, opezeka kupitirira miyezi isanu ndi umodzi.
- Kutengeka kwapang'onopang'ono.
- Kusintha kwamphamvu kwa fibrotic mu vitreous.
Ntchitozi zimachitidwa ndi njira yochepetsetsa, yosasokoneza.
Ndi retina yotayika, opaleshoni yathunthu imachitidwa pansi pa opaleshoni yayikulu.
Chitetezo cha matenda a shuga a retinopathy
Pofuna kupewa kuwonongeka kwa retina, muyenera kubweretsa kagayidwe kazinthu kakang'ono kwambiri kuti kazikhala kobwinobwino ndikwaniritse chiphuphu cha matenda a shuga. Chifukwa chaichi, mankhwala osokoneza bongo omwe ali ndi insulin amagwiritsidwa ntchito mu mtundu woyamba wa matenda ashuga. Ngati mulingo wa glycemia ndiwokwera, ndiye kuti ma jakisoni amawonjezeka ndipo mlingo umasinthidwa.
Komanso, chifukwa cha matenda a insulin, kuthekera kwa njira yovuta yodwala matenda a shuga kuyenera kukumbukiridwa. Mtundu wachiwiri wa matenda ashuga, insulin yomwe imatenga nthawi yayitali imatha kutumizidwa ngati mapiritsi ochepetsa shuga. Ngati chiphuphu sichikwaniritsidwa, ndiye kuti odwala amasamutsidwa kwathunthu kukonzekera insulin.
Ndi mtundu uliwonse wa matenda ashuga, zakudya zamafuta, makamaka zomwe zimachokera ku nyama (nyama zamafuta, mafuta akunja, mkaka wazakudya zamafuta ambiri, batala) zimaletsedwa pazakudya zawo. Ngati ndi kotheka, muyenera kuchepetsa kudya nyama ndikusinthira ku mbale zam'madzi, masamba ndi masamba pang'ono.
Ndikofunikira kudya zakudya za lipotropic, zomwe zimaphatikizapo tchizi cha kanyumba, oatmeal, mtedza. Zakudya zamafuta osavuta ndizoletsedwa kwathunthu:
- Shuga, zinthu zonse ndi mbale nazo.
- Kuphika
- Maswiti, mchere, uchi.
- Kupanikizana ndi zipatso zokoma.
- Ayisikilimu.
- Madzi ndi zakumwa ndi shuga wamafuta.
Ulemu wolipirira matenda a shuga mellitus ndi mulingo wa glycated hemoglobin pansipa 6.2%. Chowonetserako bwino kwambiri chimakhala chowopsa cha kuwonongeka kwa mtima. Ndi mitengo yoposa 7.5%, mwayi wokhala ndi zovuta za matenda ashuga umachuluka kwambiri.
Chizindikiro chachiwiri chomwe chimayenera kuyang'aniridwa nthawi zonse ndi kuchuluka kwa kuthamanga kwa magazi. Pamafunika kuthandizidwa manambala osapitirira 130/80. Kugwiritsa ntchito mankhwala a antihypertensive kwawonetsedwa kuti ndi kothandiza poletsa kusintha kwa diso.
Ntchito yoletsa kupewa mtima wamankhwala osokoneza bongo, omwe akuphatikizapo Dicinon, Cavinton, Prodectin samabweretsa zotetezedwa mokhudzana ndi kukula ndi kupitilira kwa matenda ashuga a retinopathy.
Kuzindikira kwa retinopathy m'magawo oyambilira ndikotheka pokhapokha ngati mukuyendera pafupipafupi kwa opaletopo. Pankhaniyi, kuyesa kwa fundus kumachitika potsatira kuchuluka kwa ophunzira komanso muyeso wa kukakamizidwa kwa intraocular.
Kuyendera pafupipafupi kwa odwala omwe ali pachiwopsezo cha matenda ashuga retinopathy:
- Kupanda zizindikiro - 1 nthawi pachaka.
- Gawo losasangalatsa - katatu pachaka.
- Magawo a shuga a shuga a macular - osachepera katatu pachaka.
- Pakakhala chizindikiro cha kuchuluka kwa mtima - osachepera 5 pachaka (malinga ndi zambiri nthawi zambiri)
Ali pachiwopsezo chotenga matenda a shuga a retinopathy ndi odwala omwe amakhala ndi hyperglycemia wa nthawi yayitali komanso matenda oopsa a gawo lachiwiri ndi lachitatu, zizindikiro za ngozi ya mtima komanso kusuta. Chofunikanso ndichizolowezi chobadwa nawo chakuchepetsa maonedwe kapena matenda obisika.
Dziwani kanema wokhudza macular edema athandizira kanema yemwe ali munkhaniyi.
