Optical paj hlwb atrophy lossis optic neuropathy yog ib feem lossis ua tiav ntawm kev ua haujlwm ntawm cov hlab ntsha fibers uas xa qhov muag pom ntawm retina mus rau lub hlwb. Qhov no ua rau, raws li txoj cai, kom txo qis lossis tsis pom kev tsis pom kev, nrog rau qhov nqaim ntawm qhov pom kev, tsis pom kev xim, thiab blanching ntawm ONH.
Kev kuaj mob tuaj yeem tsim los ntawm kev txheeb xyuas cov cim tshwj xeeb ntawm tus kab mob siv txoj hauv kev xws li ophthalmoscopy, perimetry, kuaj xim, pom kev pom, craniography, CT thiab MRI ntawm lub hlwb, B-scan ultrasound ntawm lub qhov muag, retinal angiography, pom EP thiab lwm yam
Yog hais tias ib feem ntawm atrophy ntawm lub paj hlwb, kev kho mob yuav tsum yog txhawm rau tshem tawm qhov ua rau ua rau qhov teeb meem no.
Kev piav qhia ntawm pathology
Kab mob ntawm cov paj hlwb hauv ophthalmology tshwm sim hauv 1-2% ntawm cov neeg mob; ntawm lawv los ntawm20 mus rau 25% txhuas, raws li txoj cai, ua kom tiav atrophy ntawm cov hlab ntsha optic thiab, raws li qhov tshwm sim, ua rau qhov muag tsis pom kev. Pathomorphological hloov nyob rau hauv lub xub ntiag ntawm tus kab mob no yog yus muaj los ntawm kev puas tsuaj ntawm ganglion hlwb nyob rau hauv lub retina nrog lawv glial-connective ntaub so ntswg hloov, obliteration ntawm lub capillary network ntawm cov hlab ntsha, thiab thinning. Tus kab mob tuaj yeem yog tshwm sim los ntawm ntau yam kab mob uas tshwm sim nrog o, nyem, o, puas tsuaj rau cov hlab ntsha tshwj xeeb thiab cuam tshuam cov hlab ntsha ntawm lub qhov muag.
ua rau ntawm pathology
Cov yam ntxwv uas ua rau lub paj hlwb atrophy (raws li ICD-10 code H47.2) - kab mob qhov muag, CNS kev puas tsuaj, kev puas tsuaj, qaug cawv, kab mob sib kis lossis kab mob autoimmune, thiab lwm yam.
Qhov ua rau ntawm qhov txhab thiab cov txheej txheem atrophic tom qab hauv cov hlab ntsha ntawm lub paj hlwb feem ntau yog qee cov kab mob ophthalmic pathological: glaucoma, retinal dystrophy, occlusive txheej txheem, myopia, uveitis, retinitis, optic neuritis, thiab lwm yam.
Kev phom sij ntawm optic paj hlwb tuaj yeem cuam tshuam ncaj qha rau ntau hom qog thiab kab mob ntawm lub qhov muag: meningioma thiab glioma ntawm cov hlab ntsha ntawm qhov muag, neurinoma, neurofibroma, thawj kab mob qog noj ntshav, osteosarcoma, hauv zos orbital vasculitis, sarcoidosis., etc.
Ntawm cov kab mob tshwm sim hauv lub hauv paus paj hlwb, lub luag haujlwm tseem ceeb yog ua los ntawm ntau hom qog ntawm lub caj pas pituitary thiab cranial fossa, compression ntawm thaj chaw ntawm qhov muag chiasm.paj hlwb (chiasm), purulent-inflammatory kab mob (abscesses, encephalitis, meningitis), sclerosis, pob txha raug mob thiab kev puas tsuaj rau lub ntsej muag, uas yog nrog los ntawm kev raug mob ntawm lub paj hlwb.
Yuav ua li cas lwm yam ua rau lub paj hlwb atrophy muaj?
Nws feem ntau tshwm sim tias pathology yog ua ntej los ntawm kev txhim kho ntshav siab, beriberi, atherosclerosis, nrog rau kev tshaib plab ntev lossis qaug dej qaug cawv ntawm lub cev (kev haus cawv lom, kev puas tsuaj los ntawm ntau cov nicotine, chlorophos, tshuaj tshuaj), ntshav poob hnyav, piv txwv li, nrog cov kab mob uterine lossis gastrointestinal, ntshav qab zib mellitus, anemia. Puas tuaj yeem kho optic paj hlwb atrophy? Cia peb kawm.
txheej txheem degenerative uas tsim nyob rau hauv lub paj hlwb tej zaum yuav yog vim antiphospholipid syndrome, systemic lupus erythematosus, Wegener's granulomatosis, Takayasu tus kab mob, Horton's kab mob.
Qee zaum, cov kab mob no tshwm sim raws li qhov teeb meem ntawm cov kab mob hnyav lossis kab mob kab mob los yog kab mob cab.
Congenital atrophy ntawm lub paj hlwb yog pom nyob rau hauv acrocephaly (ntauwd-puab pob txha taub hau), micro- thiab macrocephaly, craniofacial dysostoses (Cruson's disease), hereditary syndrome. Hauv 30% ntawm txhua qhov kev soj ntsuam, etiology ntawm tus kab mob no tseem tsis meej.
Kev faib tawm
Atrophy ntawm cov hlab ntsha ntawm qhov muag tuaj yeem ua tau los ntawm cov noob caj noob ces thiab tsis yog caj ces (tau txais). Cov ntaub ntawv keeb kwm ntawm cov kab mob no suav nrog autosomal diminant, autosomal recessive thiab mitochondrial. Autosomal dominant cov ntaub ntawv tuaj yeem ua mob hnyav lossis mob me, qee zaum cov kab mob ua ke nrog kev lag ntseg. Autosomal recessive hom atrophy ntawm optic paj hlwb tshwm sim nyob rau hauv cov neeg mob uas muaj lub syndrome ntawm Vera, Bourneville, Kenny-Coff, Wolfram, Rosenberg-Chattorian, Jensen, thiab lwm yam. nrog rau Leber tus kab mob.
Tau txais cov ntaub ntawv ntawm optic paj hlwb atrophy hauv cov menyuam yaus thiab cov neeg laus, nyob ntawm ntau yam, tuaj yeem yog thawj, theem nrab thiab glaucomatous.
daim ntawv tseem ceeb thiab theem nrab
Lub tswv yim ntawm kev loj hlob ntawm thawj daim ntawv ntawm atrophy yog txuam nrog compression ntawm peripheral neurons hauv txoj kev pom. Lub ONH tsis hloov pauv, thiab nws cov ciam teb khaws lawv qhov tseeb.
Nyob rau hauv lub pathogenesis ntawm cov ntaub ntawv thib ob ntawm paj hlwb atrophy, optic disc o tau pom, vim yog cov txheej txheem pathological hauv retina, nrog rau hauv cov hlab ntsha ntawm lub paj hlwb nws tus kheej. Kev hloov cov paj hlwb los ntawm neuroglia dhau los ua cov lus tshaj tawm; Lub optic paj hlwb loj hlob nyob rau hauv txoj kab uas hla thiab cov txheej txheem ntawm kev poob ntawm clarity ntawm ciam teb pib. Qhov tshwm sim ntawm glaucomatous atrophy ntawm cov hlab ntsha ntawm lub paj hlwb tuaj yeem tshwm sim los ntawm lub cev qhuav dej ntawm daim phiaj cribriform ntawm sclera nrog kev nce siab hauv intraocular.
Xov xwm hloov pauv
Nyob rau hauv daim ntawv ntawm discoloration ntawm cov discs ntawm lub paj hlwb, pib, ib nrab (tsis tiav) thiab ua tiav atrophy ntawm lub paj hlwb yog txawv. Thawj theem ntawm pathology tuaj yeem tshwm sim los ntawm me ntsis blanching ntawm optic disc nrogpreservation ntawm ib txwm xim. Nrog ib feem ntawm daim ntawv, blanching ntawm cov discs nyob rau hauv ib ntu yuav raug soj ntsuam. Ua kom tiav atrophy yog tus cwj pwm los ntawm kev sib xyaw blanching thiab thinning ntawm tag nrho cov paj hlwb, nrog rau kev nqaim ntawm qee cov hlab ntsha hauv cov nyiaj.
Localization
Raws li localization, muaj: ascending (nrog retinal puas) thiab nqis (nrog fiber puas) atrophy; Raws li localization, unilateral thiab ob tog kuj tau sau tseg; Raws li cov qib ntawm kev loj hlob - nyob ruaj ruaj thiab nce qib (txiav txim siab thaum soj ntsuam los ntawm tus kws kho qhov muag pom kev zoo).
Cov tsos mob ntawm cov txheej txheem pathological
Cov tsos mob tseem ceeb ntawm optic paj hlwb atrophy yog qhov pom kev pom tsis tuaj yeem kho nrog tsom iav. Nrog rau cov ntaub ntawv ntawm tus kab mob no zuj zus, qhov txo qis hauv kev pom kev ua haujlwm tuaj yeem txhim kho nyob rau lub sijhawm ntawm ob peb lub lis piam mus rau ob peb lub hlis, thiab xaus, raws li txoj cai, nrog qhov muag tsis pom tseeb. Nyob rau hauv cov ntaub ntawv ntawm ib nrab atrophy, kev hloov pauv pathological nce mus txog qee qhov txwv, tom qab ntawd lawv tsis tsim. Vim li ntawd, kev pom kev tsuas yog ib feem poob xwb.
Narrowing of visual fields
Thaum cov txheej txheem pathological no tshwm sim, qhov pom kev tsis pom kev tuaj yeem tshwm sim nws tus kheej raws li kev sib koom ua ke ntawm qhov pom kev, piv txwv li, kev ploj ntawm lub zeem muag sab nraud, nrog rau kev txhim kho ntawm qhov hu ua "tunnel" vision, a xim tsis pom kev, tshwj xeeb tshaj yog ntsuab-liab, tsawg dua - xiav-daj qhov chaw ntawm spectrum; qhov pom ntawm qhov tsaus nti hauv qee qhov chaw ntawm thaj chawpom kev. Hom yog qhov kev txheeb xyuas ntawm afferent pupillary defects - ib tug txo nyob rau hauv cov kev tshwm sim ntawm cov menyuam kawm ntawv mus rau lub teeb, thaum tuav ib tug phooj ywg cov tshuaj tiv thaiv. Kev cuam tshuam zoo sib xws ntawm kev hloov pauv tuaj yeem pom ob leeg hauv ib qho thiab hauv ob tus menyuam kawm ntawv.
Cov cim tseem ceeb ntawm ib feem ntawm qhov muag pom kev tuaj yeem kuaj pom thaum lub sijhawm kuaj pom qhov muag.
Kev kuaj mob rau kev txiav txim siab tus kab mob
Thaum kuaj cov neeg mob uas muaj cov kab mob zoo li no, nws yog ib qho tsim nyog yuav tsum paub ua ntej ntawm txhua qhov muaj cov kab mob ywj pheej, qhov tseeb ntawm kev noj tshuaj, nrog rau kev sib cuag nrog tshuaj. Lub xub ntiag ntawm tus cwj pwm phem kuj ua lub luag haujlwm.
Thaum lub sijhawm kuaj, tus kws kho qhov muag yuav tsum txiav txim siab qhov tsis tuaj lossis muaj qhov exophthalmos, tshuaj xyuas qhov txav ntawm lub qhov muag, kuaj cov menyuam yaus cov kev cuam tshuam rau lub teeb, nrog rau cov pob txha reflexes. Kev ntsuam xyuas lub zeem muag zoo, kev tshawb fawb perimetry thiab xim pom kev yuav tsum tau ua.
Ophthalmoscopy
Cov ntaub ntawv tseem ceeb ntawm qhov muaj, qib thiab ntau yam kab mob tuaj yeem tau txais los ntawm kev siv tshuaj kho qhov muag. Raws li qhov ua rau thiab cov qauv ntawm tus kab mob no, daim duab ophthalmoscopic yuav txawv, txawm li cas los xij, muaj ntau tus yam ntxwv uas tshwm sim nrog ntau hom optic paj atrophy.
Cov no suav nrog:
- Hloov nws cov qauv thiab xim (los ntawm grey mus rau daj).
- Kev khawb ntawm qhov chaw disk.
- Disk txotus naj npawb ntawm capillaries (Kestenbaum tsos mob).
- Nyob ntawm cov calibers ntawm cov hlab ntsha ntawm retina.
- Venous change.
Lwm txoj kev kuaj mob
Lub xeev ntawm ONH tuaj yeem qhia meej nrog kev pab ntawm tomography. Electrophysiological hom kev tshawb fawb (VEP) qhia qhov txo qis hauv lability lossis nce qhov rhiab heev ntawm cov paj hlwb. Nyob rau hauv cov ntaub ntawv glaucomatous ntawm tus kab mob, tonometry tuaj yeem txiav txim siab qhov kev hloov pauv hauv lub siab hauv lub cev.
Kab mob ntawm lub qhov muag tau kuaj pom siv cov duab hluav taws xob. Kev kawm txog cov hlab ntsha ntawm retina yog ua los ntawm fluorescein angiography. Kev txiav txim siab ntawm cov yam ntxwv ntawm cov ntshav ntws hauv cov hlab ntsha ophthalmic thiab supratrochlear, nrog rau hauv cov intracranial ntawm cov hlab ntsha carotid, yog ua los ntawm Doppler ultrasound.
Yog tias tsim nyog, kev tshuaj xyuas qhov muag tuaj yeem ntxiv los ntawm kev kuaj mob hlwb, uas suav nrog kev sab laj nrog kws kho mob hlwb, x-ray ntawm pob txha taub hau, nrog rau lub eeb Turkish.
Kev sab laj ntawm tus kws kho mob hlwb
Yog tias tus neeg mob muaj qhov mob loj hauv thaj tsam ntawm lub paj hlwb lossis muaj cov kab mob intracranial siab, koj yuav tsum sab laj nrog kws kho mob neurosurgeon. Nyob rau hauv cov ntaub ntawv ntawm pathogenetic txuas ntawm tus kab mob no nrog systemic vasculitis, kev sab laj nrog ib tug rheumatologist yog qhia. Nyob rau hauv lub xub ntiag ntawm cov qog ntawm lub qhov muag orbit, nws yog ib qhov tsim nyog yuav tau mus soj ntsuam los ntawm ib tug ophthalmic oncologist. Kev kho mob tactics nyob rau hauv cov kev tshwm sim ntawm occlusive lesions ntawm cov hlab ntsha yog txiav txim los ntawm tus kws kho mob ophthalmologist.
Nyob rau hauv rooj plaub ntawm atrophy ntawm ib lossis ob lub qhov muag tshwm sim los ntawm kev kis kab mob, qhiakuaj kuaj xws li ELISA lossis PCR diagnostics.
Kev kho mob ntawm optic paj hlwb atrophy
Txij li cov kab mob hauv feem ntau tsis tuaj yeem yog tus kab mob ywj pheej, tab sis ua raws li qhov tshwm sim ntawm lwm yam pathologies, nws txoj kev kho yuav tsum pib nrog kev tshem tawm cov xwm txheej uas ua rau nws. Cov neeg mob uas muaj cov qog intracranial, kub siab, arterial aneurysms nyob rau hauv lub hlwb yog qhia rau kev cuam tshuam neurosurgical.
Tsis yog txoj hauv kev tshwj xeeb ntawm kev saib xyuas kev noj qab haus huv ntawm tus kab mob no yog tsom rau kev khaws cia siab tshaj plaws ntawm kev ua haujlwm pom. Txhawm rau txo qis kev nkag mus rau hauv cov hlab ntsha thiab o ntawm cov hlab ntsha ntawm lub paj hlwb, kev txhaj tshuaj retrobulbar ntawm Dexamethasone cov tshuaj tau ua tiav, nrog rau kev txhaj tshuaj ntawm cov piam thaj thiab calcium chloride hauv cov ntshav thiab kev qhia txog cov tshuaj diuretic ("Furosemide") intramuscularly.
Dab tsi yog kev kho mob rau optic atrophy?
Tshuaj
Kom normalize ntshav ncig, pentoxifylline, xanthinol nicotinate, atropine (parabulbarno lossis retrobulbarno) tau qhia; intravenously - nicotinic acid thiab aminophylline; vitamins (B2, B6, B12), txhaj tshuaj nrog aloe extract; noj cov tshuaj "Cinnarizine", "Piracetam", "Riboxin", thiab lwm yam. Yuav kom tswj tau ib tug ib txwm theem ntawm intraocular siab, nws yog tsim nyog los nqa tawm instillations ntawm "Pilocarpine", diuretics kuj muab.
Nyob rau hauv rooj plaub uas tsis muaj contraindications, nws tuaj yeem sau tauacupuncture thiab physiotherapy, xws li electrophoresis, laser lossis hluav taws xob stimulation, magnetotherapy, thiab lwm yam.) Yog tias qhov muag poob qis dua 0.01, kev kho mob tsis zoo.
Pob optic paj hlwb atrophy muab kev tsis taus?
Huab cua thiab kev tiv thaiv
Yog tias tus kab mob ntawm cov hlab ntsha ntawm qhov muag pom tau raug kuaj pom thiab kho thaum ntxov, nws muaj peev xwm khaws cia qhov muag, txawm li cas los xij, nws txoj kev rov ua tiav tsis tshwm sim. Nrog rau kev nce qib ntawm atrophy ntawm lub paj hlwb ntawm lub qhov muag thiab qhov tsis muaj kev kho mob, kev txhim kho ntawm qhov muag tsis pom kev tuaj yeem pib. Kev xiam oob qhab nyob rau hauv cov ntaub ntawv no yog muab tawm yam tsis poob.
