Nyob rau hauv tsab xov xwm, peb yuav txiav txim siab dab tsi ua rau muaj mob xws li retinal detachment.
Lub retina yog lub luag haujlwm rau kev sib cuam tshuam ntawm lub hlwb thiab lub qhov muag. Nws lub luag haujlwm tseem ceeb yog hloov cov teeb liab teeb rau hauv paj hlwb impulses. Thaum ua haujlwm tsis zoo lossis raug cais tawm (thaum lub choroid thiab retina sib cais), qhov muag tsis pom kev thiab lub neej zoo ntawm tus neeg raug kev txom nyem.
Yog vim li cas
Retinal detachment tuaj yeem yog thawj lossis theem nrab. Qhov laj thawj tseem ceeb ntawm cov thawj hom yog retinal rupture thiab kua tsub zuj zuj nyob rau hauv cov cheeb tsam ntawm nws detachment. Lub hauv paus ntawm kev tshem tawm theem nrab yog ntau yam neoplasms. Yog li, cov laj thawj tseem ceeb yog:
- xov xwm ntxhov siab;
- kab mob kis;
- tib neeg kev cuam tshuam ophthalmic;
- retinal dystrophy;
- tawm dag zog ntau dhau;
- qhov muag raug mob;
- siab degree ntawm myopia;
- mob ntshav qab zib mellitus;
- pregnancy.
Qhov ua rau ntawm qhov muag tsis pom kev yuav tsum tau txiav txim los ntawm kws kho mob.
Symptoms
Yog ib tug neeg paub thawj cov tsos mob ntawm retinal detachment, nws yuav tau mus ntsib kws kho mob raws sij hawm thiab tiv thaiv cov teeb meem loj. Cov cim no yog:
- qhov pom ntawm tus duab ntxoov ntxoo lossis daim ntaub thaiv hauv ib qho ntawm qhov pom, thaum txav lub taub hau, nws yuav hloov pauv;
- qhov tshwm sim ntawm ntau cov xim dub hauv qhov pom, qhia txog thaj chaw ntawm cov ntshav tawm hauv lub cev vitreous;
- xav txog qhov ci ntsa iab "flashes", "sparks", "xiab" (xws li "pob ntseg" feem ntau yog sau tseg hauv thaj chaw qhov muag, uas nyob ze rau lub tuam tsev).
Cov cim saum toj no ntawm kev tshem tawm ntawm lub qhov muag yuav ua rau pom kev tsis pom kev. Tus neeg mob yuav pom qhov curvature ntawm cov kab thiab cov duab ntawm cov khoom. Yog hais tias lub retinal detachment yog tshiab, tej zaum yuav muaj ib tug syndrome ntawm kev txhim kho qhov zoo ntawm qhov muag thaum sawv ntxov. Qhov no yog vim hais tias cov kua uas accumulates nyob rau hauv cov cheeb tsam ntawm detachment yog me ntsis absorbed thaum hmo ntuj. Cov neeg mob feem ntau xav tias cov tsos mob zoo li no yog qhov ua rau qaug zog, thiab yog li ntawd kev mus ntsib kws kho qhov muag raug ncua, thiab cov txheej txheem pib ua kom nrawm nrawm.
Yog hais tias cov txheej txheem pathological tshwm sim nyob rau sab sauv ntawm lub qhov muag, ces cov tsos mob ntawm retinal detachment kis sai dua nyob rau hauv qis dua. Qhov no tau piav qhia los ntawm qhov tseeb tias, raws li kev cai lij choj ntawm lub cev, cov kua dej nkag tau pib poob, ua rau muaj kev puas tsuaj rau lub hlwb hauv cov chaw haujlwm.hauv qab no. Nyob rau hauv cov chaw no ntawm lub cev ntawm lub zeem muag, retinal so yog txaus ntshai vim hais tias lawv tuaj yeem mus ntev heev uas yuav luag tsis muaj tsos mob, qhia lawv tus kheej tsuas yog tom qab kis mus rau hauv nruab nrab (macular) cheeb tsam ntawm lub qhov muag. Hom retinal detachment cuam tshuam qhov hnyav ntawm cov tsos mob. Nws yog feem ntau hais nyob rau hauv rhegmatogenous detachment, thaum nyob rau hauv lub exudative los yog traction ntau yam, lub manifestations yog ntau meager, uas loj hlob maj mam thiab raug kuaj mob tsuas yog tom qab kev puas tsuaj rau lub ocular macula.
Retinal detachment hauv daim duab yog qhov nyuaj rau kev xa tawm.
Diagnosis
Yog tias muaj qhov tsis txaus ntseeg me ntsis ntawm lub qhov muag pom, kev kuaj pom qhov muag tau ua tiav. Txoj kev kuaj mob tau muab faib ua peb hom: tshwj xeeb, qauv, kuaj. Cov txheej txheem suav nrog:
- perimetry - kev tshuaj xyuas ntawm thaj chaw saib txhawm rau txhawm rau tsim nws thaj tsam thiab kuaj xyuas qhov tsis xws luag (tua nyuj);
- tonometry - kev txiav txim siab ntawm lub qhov muag;
- visometry - tsim kom pom kev pom kev los ntawm cov rooj tshwj xeeb;
- ophthalmoscopy - tsom xam ntawm fundus siv lub ophthalmoscope thiab ib lub lens fundus los ntsuas qhov mob ntawm lub paj hlwb lub taub hau, retina thiab fundus hlab ntsha;
- biomimicroscopy - kev tshuaj xyuas tag nrho ntawm lub qhov muag, uas yog ua los ntawm kev siv lub teeb hlais;
- tsom xam ntawm qhov tshwm sim entopic - ua rau nws muaj peev xwm los ntsuas qhov kev khaws cia ntawm cov haujlwm ntawm cov retinal.
Nyob rau hauv tus lej ntawm kev kawm tshwj xeebsuav nrog:
- B-mode ultrasound - tso cai rau koj los tshuaj xyuas lub pob muag hauv ob qhov ntev thiab pom cov ntsiab lus tom kawg thiab lub voj voog;
- EPS (electrophysiological txoj kev) - lawv suav nrog electroretinography, electrooculography thiab electroencephalography, uas sau npe qhov rhiab heev ntawm cov hlab ntsha ntawm optic thiab conditioned muaj peev xwm ntawm qhov muag pom ntawm lub paj hlwb cortex.
Kev tshawb fawb hauv chav kuaj yuav suav nrog:
- kuaj ntshav: rau kab mob siab C thiab B, HIV, syphilis, dav dav, biochemistry;
- kuaj zis - rau qab zib thiab dav.
Ophthalmoscopy yog qhov tseem ceeb tshwj xeeb hauv kev kuaj xyuas cov retinal detachment. Nrog kev pab los ntawm cov kev tshawb fawb no, nws muaj peev xwm tsim kom muaj qhov sib txawv ntawm qhov detachment, qhov chaw ntawm qhov chaw ntawm retinal so thiab dystrophy, thiab cov duab. Retinal detachment yog ophthalmoscopically manifested los ntawm qhov ploj ntawm ib txwm liab reflex nyob rau hauv qab ntawm lub qhov muag nyob rau hauv ib qho ntawm nws cov cheeb tsam. Hauv thaj tsam ntawm exfoliation, nws tau txais cov xim greyish-dawb. Nrog ntev detachment, coarse folds thiab lub hnub qub-zoo li nti nti tshwm nyob rau ntawm lub retina. Lub retina ua immobile thiab nruj thaum detachment. Cov cheeb tsam ntawm kev tsis sib xws tshwm sim hauv ntau yam duab thiab xim liab. Kev siv txhua txoj hauv kev ntawm kev kuaj xyuas lub cev ntawm lub zeem muag hauv qhov sib sau ua rau nws tuaj yeem tau txais daim duab qhia ntau tshaj plaws, uas ua rau nws muaj peev xwm kos cov phiaj xwm kho mob zoo tshaj plaws thiab tsim nyog.
tib txoj hauv kev zoo rau kev txiav cov retina yog kev kho mob phais. Nqa nws tawm ntawm qhov ntxov tshaj plaws ntawm qhov noCov txheej txheem pathological tso cai rau koj kom tau txais txiaj ntsig zoo tshaj plaws, ua kom muaj peev xwm rov ua kom tsis pom kev ploj. Lub hom phiaj tseem ceeb ntawm kev kho mob yog txhawm rau thaiv cov kua muag uas twb muaj lawm hauv cov neeg mob, txo qhov ntim ntawm lub qhov muag thiab rov ua kom muaj kev cuam tshuam ntawm thaj chaw exfoliated.
Kev cuam tshuam kev phais kom tshem tawm cov retinal detachment tau muab faib ua:
- laser;
- endovitreal;
- extrascleral.
Cov kev tawm tsam ntawm kev kho mob phais yog xaiv tus kheej nkaus xwb, nyob ntawm seb qhov degree thiab ua rau lub qhov muag puas.
Cov tshuaj tiv thaiv qhov muag tau zoo rau cov retinal detachment:
- "Tauron".
- "Emoxipin".
Lawv muaj qhov zoo ib yam. Txawm li cas los xij, "Emoxipin" muab qhov tsis xis nyob kub hnyiab, ua rau tsis xis nyob. Yog li ntawd, yog tias "Emoxipin" tsis haum koj, ces nws muaj peev xwm hloov nws nrog "Tauron". Tau kawg, ua ntej siv cov tshuaj no, koj yuav tsum sab laj nrog kws kho qhov muag, thiab hauv cov txheej txheem ntawm kev siv, saib xyuas qhov kev hloov pauv.
Kev kho mob ntxiv rau
Kev ua haujlwm nrog cov txheej txheem extrascleral ntawm kev kho mob phais yog ua rau ntawm qhov chaw ntawm sclera. Cov txheej txheem no suav nrog kev sau thiab zais pa.
thawj txoj kev txhais li cas? Cov txheej txheem no yog ua rau ntawm qhov chaw ntawm lub sclera, nws lub hom phiaj tseem ceeb yog ua raws li kev sib koom ua ke ntawm cov xim ntawm cov epithelium thiabdetached cheeb tsam ntawm lub retina. Ua ntej qhov kev ua haujlwm, qhov tseeb cheeb tsam ntawm detachment yog txiav txim siab. Qhov xav tau loj ntawm lub foob yog ua los ntawm cov mos mos silicone daim txhuam cev. Tus kws phais txiav qhov conjunctiva thiab siv cov khoom npaj rau thaj tsam ntawm sclera. Nyob ntawm seb hom retinal detachment, filling tuaj yeem ua tau siv cov txheej txheem ua haujlwm, ncig lossis radial. Yog tias tsim nyog, nws muaj peev xwm tshem tawm cov kua nplaum. Qee qhov kev kho mob yuav tsum tau muab cov pa tshwj xeeb lossis cua rau hauv qhov muag kab noj hniav. Tom qab qhov kev cuam tshuam tiav lawm, tus kws phais yuav suture qhov incision ntawm lub conjunctiva. Qhov kev ua haujlwm no tuaj yeem nyuaj rau qee qhov xwm txheej. Yog li, nyob rau lub sijhawm thaum ntxov tom qab kev cuam tshuam, kev kis kab mob ntawm qhov txhab ntawm qhov txhab, kev ua haujlwm tsis zoo ntawm cov leeg oculomotor, detachment ntawm vascular membrane thiab poob ntawm daim tawv muag sab sauv, nce siab hauv lub qhov muag tuaj yeem raug sau tseg. Nyob rau lub sijhawm lig tom qab kev phais, cov hauv qab no tuaj yeem ua tau: raug kev cog qoob loo, kev loj hlob ntawm cataracts, tsim ntawm daim nyias nyias, degeneration foci thiab microcysts hauv cheeb tsam macula, nrog rau kev hloov pauv ntawm qhov muag pom ntawm myopia. Yog hais tias qhov kev cuam tshuam rau extrascleral filling yog ua tsis tau zoo, ces tej zaum yuav tsis muaj snug haum ntawm exfoliated cheeb tsam thiab retinal detachment.
Tom qab muaj kev cuam tshuam ntawm extrascleral filling, lub zeem muag rov qab los nyob rau hauv ob mus rau peb lub hlis (ib lub sij hawm ntev - thaum laus). Feem ntau, nws yuav ua tsis tiav, nyob ntawm lub sijhawm ntawm kev tshem tawm thiab qib ntawm pathology ntawm lub hauv paus retina. Nqeextrascleral filling yog txiav txim siab los ntawm lub koob meej ntawm lub tsev kho mob thiab qhov ntim ntawm cov txheej txheem ua.
Dab tsi yog qhov kev zais zais zais zais pa? Thaum lub sij hawm tus txheej txheem, lub zais pa nrog ib tug tshwj xeeb catheter yog muab tso rau hauv qab ntawm lub qhov muag. Nrog kev pab los ntawm lub zais pa, lub siab yog siv rau lub sclera, lub plhaub sab hauv yog tsau nrog lub laser. Lub zais pa raug tshem tawm tsib mus rau xya hnub tom qab laser coagulation. Extrascleral ballooning nyob rau hauv qee kis tuaj yeem cuam tshuam los ntawm kev nce siab hauv lub paj hlwb, hemorrhages thiab cataracts.
Contraindications rau kev ua haujlwm zoo li no yog:
- kwv tij jagged kab so thiab so;
- tsau folds uas siv ntau tshaj ¾ ntawm cov nyiaj;
- tawg yog qhov nyuaj los ntawm cov ntshav tawm mus rau hauv lub cev vitreous.
Cov kev cuam tshuam zoo li no muaj kev cuam tshuam tsawg, ua rau 30-50 feeb. Nws txoj kev ua tau zoo yog txiav txim siab los ntawm lub sijhawm ntawm kev hu rau tus kws kho mob thiab tuaj yeem muab cov txiaj ntsig zoo hauv 98% ntawm cov neeg mob. Tus nqi ntawm cov txheej txheem yog nyob ntawm lub tsev kho mob uas nws tau ua thiab qhov hnyav ntawm qhov muag pom.
Yuav ua li cas lwm yam yog kev kho rau retinal detachment?
Endovitreal kev kho mob
Txoj kev endovitreal yog ua nyob rau hauv lub qhov muag. Qhov kev ua haujlwm no hu ua vitrectomy. Nws hais txog kev tshem tawm ib nrab lossis ua tiav ntawm lub cev vitreous. Ua tsaug rau qhov no, tus kws phais tau nkag mus rau phab ntsa tom qab ntawm lub qhov muag kab noj hniav. Ntxiv muslub cev rub tawm vitreous yog hloov nrog cov khoom tshwj xeeb, uas yuav tsum muaj qhov zoo ntawm viscosity thiab siab transparency, yuav hypoallergenic, ntev-ntev thiab tsis muaj tshuaj lom. Rau qhov no, feem ntau, lawv siv cov tshuaj ntsev tshwj xeeb sib npaug, npuas nrog roj lossis roj, cov khoom siv polymers.
Vitrectomy muaj cov hauv qab no contraindications:
- tag nrho cov teeb meem ntawm lub paj hlwb lossis retina;
- pronounced corneal opacity.
Thaum lub sijhawm vitrectomy, tus kws phais tshem tawm qhov tsim nyog ntawm lub cev vitreous los ntawm kev sib tsoo heev. Tom qab ntawd, laser coagulation ntawm lub retinal aav yog ua, lub detachment thickens, lub ncaj ncees ntawm lub retina yog rov qab los. Ib qho vitreous lub cev hloov tau muab tso rau hauv cov kab noj hniav tsim, uas ua rau lub retina nyob rau hauv ib txwm lub cev lub cev. Cov teeb meem tshwm sim ntawm vitrectomy: lens defects, los ntshav, retinal detachment los yog so. Nyob rau lub sijhawm tom qab kev ua haujlwm, tej zaum yuav rov qab hemorrhages, kev loj hlob ntawm cov txheej txheem o, nce siab hauv lub qhov muag, kev hloov pauv ntawm lub cornea, nrog rau rov stratification ntawm retina. Kev ua haujlwm tuaj yeem siv sijhawm li ib nrab mus rau ob mus rau peb teev. Hom kev cuam tshuam no tau ua pov thawj tias yog ib txoj hauv kev zoo los khaws thiab kho qhov muag. Tus nqi ntawm cov txheej txheem phais no yog txiav txim los ntawm cov xwm txheej hauv qab no: qhov mob ntawm lub qhov muag, txoj cai ntawm lub tsev kho mob thiab qhov xwm txheej ntawm kev cuam tshuam.
Laser kho mob
Retinal Detachment Therapyob lub qhov muag nrog lub laser tuaj yeem nqa tawm tsuas yog ntawm nws cov theem pib. Cov txheej txheem no hu ua peripheral restrictive laser coagulation. Nws yog tsom rau kev tiv thaiv ntawm retinal detachment. Nws cov ntsiab lus yog ua raws li qhov cuam tshuam ntawm lub teeb ci laser ntawm qhov chaw puas ntawm lub retina. Lub laser hluav taws xob "solders" lawv, tsim ib tug soldering ntawm retina thiab cov ntaub so ntswg nyob rau hauv qab no. Kev txwv peripheral coagulation thaum kawg ua rau muaj kev nce hauv cov ntshav khiav ceev, normalizes khoom noj khoom haus thiab cov ntshav muab rau cov cheeb tsam pathological ntawm lub ocular membrane, thaiv cov dej ntws hauv qab retina. Ob lub lis piam tom qab ua haujlwm, kho qhov muag pom kev laser tuaj yeem ua tiav.
Kev siv lub laser rau retinal dissection muaj cov nram qab no contraindications:
- tag nrho cov kev hloov pauv hauv qab ntawm lub qhov muag;
- muaj qhov pom tseeb ntawm epiretinal gliosis (ib zaj duab xis ntawm retina);
- ntxhib rubeosis (pathological vascular loj hlob) ntawm retina;
- tsis txaus pob tshab ntawm cov xov xwm kho qhov muag.
Kev cuam tshuam tuaj yeem ua tiav ntawm tus neeg mob hauv tsev kho mob thiab tus neeg mob sab nraud hauv ib qho kev sib tham. Nws kav li tsib mus rau kaum tsib feeb. Kev kho mob ntawm retinal dissection los ntawm laser phais yog yooj yim zam los ntawm cov neeg mob, nws tsis nyuaj los ntawm dab tsi. Tus nqi ntawm kev txwv peripheral coagulation yog txiav txim los ntawm thaj tsam ntawm retina raug rau lub laser, nrog rau txoj cai ntawm lub koom haum kho mob.
kev kho neeg zoo
tshuaj ntsuab siv cov cuab yeej hauv qab no:
- blueberries (rawsab hauv ua antioxidant);
- mistletoe (koj yuav tsum tau ua ib lub decoction thiab haus nws - nws txo qis hauv qhov muag);
- elderberry (rau ntxuav qhov muag);
- eyebright (rau compresses);
- fennel (rau cov tshuaj pleev);
- blackberry (noj - antioxidant, muaj vitamin C);
- hawthorn (siv hauv daim ntawv ntawm tincture, ua tsaug rau cov pa oxygen thiab cov ntshav ncig ntawm cov ntaub so ntswg txhim kho).
Nyob rau hauv cov ntaub ntawv ntawm retinal detachment, nws yog nruj me ntsis txwv tsis pub hloov kev phais nrog tshuaj tsoos tshuaj. Lawv yuav tsis tiv nrog kev ua txhaum cai uas tau pib, tab sis tsuas yog txo cov tsos mob thiab ua rau tus kab mob qeeb zuj zus.
Kev sim kho cov retinal detachment nrog cov tshuaj pej xeem tuaj yeem ua rau tsis pom kev thiab ua rau dig muag. Nws tsis tsim nyog nkim sij hawm rau cov kev kho tsis tsim nyog - ntawm thawj cov tsos mob koj yuav tsum tau mus ntsib kws kho mob sai.
Cia peb xav txog kev tiv thaiv ntawm retinal detachment thiab nws cov txiaj ntsig.
Kev Tiv Thaiv thiab qhov tshwm sim
Lub txim loj ntawm pathology yog qhov muag tsis pom. Kev phais mob hauv cov kab mob no yuav tsum tau ua kom sai li sai tau, vim tias tsuas yog txoj kev no tuaj yeem pab kom tsis txhob ua tiav qhov tsis pom kev thiab ua tiav nws qhov kev rov zoo siab tshaj plaws.
Hmoov tsis zoo, ob peb tus neeg paub tias qhov retina detachment loj npaum li cas thiab nws qhov tshwm sim yog li cas.
Qhov kev tiv thaiv tseem ceeb los tiv thaiv tus kab mob yog kev mus ntsib kws kho qhov muag tsis tu ncua los ntawm cov neeg mob los ntawm cov pab pawg muaj kev pheej hmoo (cov neeg mob ntshav qab zib,myopia, kub siab, traumatized ob lub qhov muag lossis taub hau, poj niam cev xeeb tub, thiab lwm yam). Qhov zaus ntawm cov kev ntsuam xyuas no yog teem rau ib tus zuj zus (tsawg kawg ib xyoos ib zaug), tus kws kho mob qhov kev ntsuam xyuas yuav tsum muaj xws li kev kuaj mob ntawm peripheral cheeb tsam ntawm lub retina tiv thaiv keeb kwm yav dhau ntawm cov menyuam kawm ntawv loj. Xws li ib pab pawg neeg mob yuav tsum paub thawj cov tsos mob ntawm retinal detachment thiaj li nrhiav kev pab kho mob tam sim yog tias lawv tshwm sim. Yog tias pom cov cheeb tsam ntawm retinal dystrophy los yog tawg, cov neeg mob yuav raug muab tshuaj txwv peripheral laser photocoagulation uas tuaj yeem tiv thaiv kev txhim kho ntawm detachment. Txhawm rau tiv thaiv kev puas tsuaj rau lub qhov muag, cov neeg mob yuav raug qhia kom tso tseg cov kis las hnyav, qee qhov txwv kev xaiv ntawm txoj haujlwm, thiab muab cov lus qhia tshwj xeeb ntawm qhov muag pom ntawm lub qhov muag. Yog hais tias cov poj niam cev xeeb tub muaj kev pheej hmoo ntawm retinal detachment, ces ib tug caesarean seem yog pom zoo rau obstetrics. Txhawm rau tiv thaiv tus kab mob zoo li no, cov neeg mob uas muaj kev pheej hmoo thiab lwm pab pawg ntawm cov pej xeem yuav tsum ua raws li kev noj qab haus huv ntawm kev pom thiab lub cev, tsis txhob nqa qhov hnyav, thiab zam kev raug mob ntawm lub qhov muag thiab lub taub hau.
Retinal detachment tshuaj xyuas
Cov lus teb tus neeg mob feem ntau npau taws rau qhov ua tau zoo ntawm kev kho laser, qhov tsis xis nyob thaum lub sijhawm txheej txheem no tsawg dua li lwm hom kev cuam tshuam, thiab lub sijhawm rov qab los yog luv dua. Tib neeg tham txog yuav luag tag kev tsis mob (txawm hais tias qee qhov hais tias qhov tsis xis nyob yog tam sim no) thiabkev ua tiav ntawm kev kho mob. Ntawm qhov tsis txaus, cov neeg mob nco txog tus nqi siab ntawm kev cuam tshuam, mob taub hau tom qab thiab kub hnyiab ntawm qhov muag. Txawm li cas los xij, feem ntau xav txog qhov no yog ib qho me me piv rau qhov muag tsis pom.
Txoj hauv paus ntsiab lus, txhua tus neeg xav tau kev phais, vim tias kev sib cais yuav tsis daws nws tus kheej.
