Cov kab mob pob txha muaj thoob plaws hauv thaj chaw ophthalmological thiab suav txog 30% ntawm tag nrho cov kab mob qhov muag. Qhov no tuaj yeem piav qhia los ntawm qhov tseeb tias cornea tsim cov chav sab nrauv ntawm lub qhov muag thiab nthuav tawm ntau yam kab mob. Lub conjunctiva ib txwm tsim nws tus kheej microflora, yog li txawm tias me ntsis cuam tshuam los ntawm sab thiab raug mob mus rau txheej txheej ntawm lub cornea tuaj yeem ua rau qhov pib ntawm pathology.
Kev ua haujlwm ntawm lub pob txha
Lub pob kws nyob tom qab ntawm lub qhov muag thiab zoo li lub plhaub tsis muaj xim uas tso cai rau kev nkag mus rau lub teeb dawb rau qhov tob ntawm qhov muag. Cov duab ntawm lub cornea zoo li lub ntsej muag concave, lub vojvoog ntawm curvature uas ncav cuag 8 millimeters. Hauv cov txiv neej, qhov curvature yog ntau dua los ntawm 1.4%. Kev ua txhaum ntawm kev ua haujlwm ntawm qhov pom ntawm lub cev no tuaj yeem tshwm sim los ntawm qhov muaj kab mob.
Lub luag haujlwm tseem ceeb ntawm cov txheej txheej ntawm lub qhov muag ntawm lub qhov muag:
- Refractive. Lub cornea yog ib feem ntawm lub qhov muag qhov muag. Vim nws cov pob tshab thiab cov duab txawv txawv, nws pab ua thiab cuam tshuam lub teeb rays.
- Tiv thaivmuaj nuj nqi. Lub plhaub zoo li no txawv ntawm nws lub zog, nrog rau kev muaj peev xwm rov qab sai sai thaum puas.
- Txhawb nqa qhov muag tag nrho.
Cov kab mob pob txha tawm mus tawm tsam keeb kwm yav dhau los ntawm kev puas tsuaj sai hauv qhov pom kev pom, qee zaum tus neeg txawm dig muag. Txij li thaum tsis muaj cov hlab ntsha hauv lub cornea, thiab feem ntau ntawm cov ntaub so ntswg muaj cov qauv homogeneous, cov kab mob tuaj yeem tshwm sim thaum raug rau ntau yam txheej txheem pathological. Ua ntej pib kho, koj yuav tsum paub koj tus kheej nrog cov npe ntawm cov kab mob ntawm lub qhov muag.
Txhua yam kab mob qhov muag muaj cov tsos mob zoo sib xws, ua rau nws nyuaj rau tus kws kho mob kom kuaj tau. Tsis tas li ntawd, txij li lub pob kws tsis muaj cov hlab ntsha, thiab hauv nws lub cev nws zoo ib yam li cov kab mob conjunctiva, cov txheej txheem inflammatory pib hauv nws sai heev thiab sai li sai tau. Nyob rau hauv lub cornea, tag nrho cov txheej txheem metabolic pib ntawm qeeb qeeb.
hom kab mob tseem ceeb
Lus cov kab mob ntawm tib neeg qhov muag:
- cov teeb meem tshwm sim nrog lub plhaub loj hlob;
- cov txheej txheem mob - keratitis;
- keratectasia - anatomical abnormalities nyob rau hauv qhov loj thiab cov duab ntawm lub cornea;
- pib ntawm cov txheej txheem dystrophic lossis degenerative;
- mob qog noj ntshav thiab malignant;
- tau raug mob ntau yam.
Kev tsis sib haum xeeb vim kev xeeb tub
Hereditary teeb meem nyob rau hauv txoj kev loj hlob ntawm lub plhaub yog ib tug hloov nyob rau hauv cov duab thiab loj ntawm lub cornea. Megalocornea - txiav txim siabkab mob ntawm lub cornea ntawm tib neeg lub qhov muag, nyob rau hauv uas nws tau txais ib tug loj loj, ntau tshaj 10 mm. Raws li txoj cai, tus kws kho mob tsis qhia lwm yam kev ua txhaum cai thaum kuaj mob. Tus neeg mob tuaj yeem ntsib qhov xwm txheej thib ob ntawm pathology vim yog glaucoma.
Microcornea - lub cornea me dhau, nws txoj kab uas hla tsis tshaj 5 hli. Tus kab mob no tuaj yeem nrog qhov txo qis ntawm qhov loj ntawm lub qhov muag. Yog li ntawd, muaj teeb meem xws li pob txha opacity thiab glaucoma yuav tshwm sim.
Keratoconus yog ib yam kab mob ntawm cov pob txha ntawm lub qhov muag. Nrog xws li ib tug lesion, cov duab ntawm lub cornea hloov heev, nws ua conical. Lub plhaub nyob rau hauv nruab nrab ntawm lub qhov muag ua ho thinner thiab nws tag nrho chamber poob nws natural elasticity. Tus kab mob pib tshwm sim hauv cov menyuam yaus hnub nyoog 11 thiab 12 xyoo thiab ua rau astigmatism tsis tuaj yeem kho. Tus neeg mob yuav tsum hloov lo ntsiab muag txhua lub sijhawm vim qhov tseeb tias axis thiab cov duab ntawm astigmatism feem ntau hloov.
Nyob rau theem pib ntawm kev loj hlob, keratoconus tuaj yeem kho nrog lo ntsiab muag. Tab sis thaum pathology tshwm sim, lub lens tsis tuav ntawm lub qhov muag loj thiab tsuas yog poob. Nyob rau hauv rooj plaub no, tus kws kho mob yuav sau ib qho kev phais kom tshem tawm ib feem ntawm lub cornea - nkag mus rau subtotal keratoplasty.
Keratoconus tuaj yeem tshwm sim hauv tus neeg mob raws li qhov teeb meem tom qab LASIL phais. Nyob rau hauv cov ntaub ntawv no, tus kab mob no loj hlob mus rau ib tug ntev lub sij hawm thiab yog tsis pom zoo. Nws tuaj yeem ua rau nws tus kheej xav tias tsuas yog 20 xyoo tom qabphais.
YZoo kab mob keratitis
Keratitis yog ib yam kab mob ntawm lub qhov muag ntawm lub qhov muag, uas tshwm sim los ntawm nws qhov dav dav hauv cov neeg mob. Tus kab mob nkag mus rau hauv daim nyias nyias los ntawm cov ntaub so ntswg uas nyob ib sab. Qhov nyuaj ntawm txoj kev loj hlob ntawm tus kab mob yuav ncaj qha nyob ntawm seb cov kab mob thiab kev tiv thaiv ntawm lub plhaub.
Keratitis tuaj yeem yog:
- Endogenous. Lawv tshwm sim hauv tib neeg tawm tsam keeb kwm ntawm kev kis kab mob, kab mob hauv lub cev, kev tsis haum tshuaj, beriberi, lossis mob ruas. Feem ntau qhov teeb meem no provoked los ntawm neuroparalytic thiab neurotrophic mob. Cov no suav nrog kev ua xua, kis kab mob, tuberculous, syphilitic thiab neuroparalytic keratitis.
- Exogenous. Lawv tshwm sim thaum lub cornea raug cuam tshuam los ntawm ib puag ncig sab nraud - kis kab mob, kub hnyiab, raug mob, kab mob ntawm cov qog meibomian, daim tawv muag thiab conjunctiva. Cov kab mob tuaj yeem yog kab mob, kab mob lossis kab mob hauv qhov xwm txheej. Cov pab pawg no suav nrog cov ntaub ntawv hauv qab no ntawm keratitis: kis kab mob (cov kab mob ntawm lub pob txha), kev raug mob, thiab cov kab mob fungal.
Cov tsos mob tseem ceeb ntawm cov kab mob keratitis
Cov tsos mob ntawm qhov mob ntawm lub pob txha hauv cov kab mob tshwm sim vim kev khaus ntawm cov paj hlwb rhiab heev. Nws tag nrho pib nrog kev tsis xis nyob. Tsis tas li ntawd, tus neeg mob tuaj yeem pom cov tsos mob hauv qab no ntawm cov kab mob pob txha: intolerance rau lub teeb ci, lacrimation hnyav, blepharospasm. Nrog keratitis ntawm ib qho xwm txheej neurotrophic, cov tsos mob zoo li no tsis raug kuaj pom. Ntxiv rau keratitisvim o ntawm cov hlab ntsha, cov hlab ntsha ntawm marginal looped network tsim ib corolla liab nrog ib tug bluish tint raws ib ncig ntawm lub pob kws.
Cov cim qhia tshwj xeeb ntawm qhov mob ntawm lub pob txha ntawm lub qhov muag hu ua corneal syndrome. Ntxiv nrog rau cov tsos mob tau piav qhia saum toj no, tus neeg mob muaj pos huab ntawm lub pob kws (pos pos) thiab ib daim ntawv inflammatory ntawm infiltrate yog tsim - ib tug ntom tsub zuj zuj ntawm cov khoom o (leukocytes, lymphocytes thiab lwm yam hlwb) uas nkag mus rau hauv lub qhov muag plhaub los ntawm lub cov hlab ntsha ntawm marginal looped network.
Cov xim ntawm kev suav nrog yuav ncaj qha nyob ntawm seb muaj pes tsawg leeg thiab cov cell tsim nws. Nrog ib tug purulent lesion, xim yuav daj, nrog loj neovascularization - ib tug rusty-xim av xim, nrog ib tug tsis txaus leukocytes - ib tug ntxoov ntxoo ntawm grey. Ciam teb ntawm cov infiltrate ua qhov muag plooj, thiab cov ntaub so ntswg nyob ze swell thiab hloov mus rau dawb.
Lub pob muag ntawm qhov muag tsis ci, plam nws qhov pom, nyob rau hauv qhov chaw ntawm huab nws yog ntxhib, tsis hnov tsw thiab nce hauv tuab.
Tom qab qee lub sijhawm, cov foob pob tawg, cov epithelium pib exfoliate, cov ntaub so ntswg tuag, thiab cov kab mob ua rau ntawm daim nyias nyias. Tus neeg mob yuav tsum tau kuaj xyuas raws sijhawm thiab pib kho tus kab mob ntawm lub qhov muag ntawm lub qhov muag.
Ib qhov txhab yog qhov ua txhaum ntawm kev ncaj ncees ntawm cov pob txha. Kev kawm yuav txawv ntawm qhov loj thiab cov duab. Hauv qab ntawm daim tawv nqaij yog pleev xim rau hauv cov xim grey du (tej zaum yuav huv si lossis muaj kua paug). Lub ntug ntawm lub rwj yog du los yog ntxhib. Plhaub tsim tuaj yeem tshwm simntawm lawv tus kheej lossis kev vam meej dhau sijhawm.
Nrog rau kev puas tsuaj rau tus kheej hauv lub qhov txhab, cov txheej txheem ntawm kev tshem tawm cov ntaub so ntswg tuag pib, hauv qab yog tshem tawm cov kab mob thiab nws thiaj li npog nrog cov epithelium tshiab, uas tau hloov kho tas li. Tom qab lub epithelium yog hloov los ntawm ib tug connective cov ntaub so ntswg caws pliav, uas tsim corneal opacity ntawm txawv qhov hnyav. Hauv qhov xwm txheej no, tus neeg mob tuaj yeem pib cov txheej txheem ntawm vascularization thiab kev loj hlob ntawm cov hlab ntsha hauv thaj tsam ntawm cataract.
Raws li kev tsim kho zuj zus, thaj tsam ntawm necrosis pib loj tuaj, ob qho tib si hauv qhov tob thiab dav, kis mus rau cov ntaub so ntswg tshiab. Qhov tsis xws luag tuaj yeem kis thoob plaws lub pob kws thiab loj hlob tob rau hauv lub anterior chamber. Thaum qhov txhab mus txog Descemet's membrane, hernia yuav tsim. Nws yog ib lub vial nrog cov ntsiab lus tsaus, uas tau muab cais los ntawm cov ntaub so ntswg uas nyob ib sab los ntawm ib qho tshuaj ntsiav nyias nrog me me tuab. Feem ntau, qhov kev ncaj ncees ntawm cov tshuaj ntsiav pib tawg, thiab cov kab mob tau dhau los ua ib txoj hauv kev, cuam tshuam rau iris, uas fuses nrog cov npoo ntawm qhov txhab.
Parenchymal keratitis
Nws yog ib qho tseem ceeb uas yuav tau xav txog cov tsos mob thiab ua rau cov kab mob pob txha. Parenchymal keratitis yog cov tsos mob ntawm congenital syphilis. Feem ntau, tus kab mob kis tau los ntawm 2-3 tiam. Cov tsos mob ntawm tus kab mob tuaj yeem sib txawv heev, tab sis cov kws kho mob kuj tau pom qee cov cim qhia ntawm kev puas tsuaj: qhov tsis muaj qhov txhab, kev koom tes ntawm choroid, tus kab mob kis mus rau ob lub qhov muag ib zaug. Kev kwv yees ntawm cov kws kho mob yog qhov zoo - 70% ntawm cov neeg mob tau kho tag nrho ntawm qhov txhab thiabkho lub pob txha noj qab haus huv.
theem tseem ceeb ntawm tus kab mob:
- thawj theem yog infiltration. Vim yog diffuse infiltration, lub cornea pib ua huab. Nws cov xim hloov mus rau greyish dawb. Tus neeg mob ceeb toom rau tus kws kho mob txog kev tsim kua muag ntawm lub qhov muag thiab intolerance rau lub teeb. Tsis tas li ntawd, cov infiltrate pib nquag kis mus rau tag nrho cov membranes ntawm lub qhov muag. Cov theem txuas ntxiv txhim kho hauv tus neeg mob rau 1 lub hlis, tom qab ntawd nws txav mus rau theem tshiab.
- theem ob ntawm keratitis yog vascularization. Cov hlab ntsha pib nquag tsim ntawm lub pob kws, kis mus rau hauv cov txheej txheej tob ntawm lub qhov muag. Yog li ntawd, lub plhaub ua ntau thicker thiab pib zoo li cov iav frosted. Cov cim tseem ceeb ntawm theem thib ob: mob hnyav, cov menyuam kawm ntawv constriction, deterioration ntawm pom acuity. Nyob rau sab nraum qab ntawm lub cornea, sebaceous formations yog tsim - precipitates. Lawv adversely cuam tshuam rau lub endothelial txheej thiab nce nws permeability, uas ua rau muaj zog o ntawm ciam teb daim nyias nyias. Lub sijhawm nce qib ntawm theem thib ob yog 6 lub hlis.
- theem peb ntawm qhov txhab yog resorption. Restorative txheej txheem ntawm lub cornea txuas ntxiv nyob rau hauv tib theem li clouding. Lub cloudiness nyob rau hauv nruab nrab ntawm lub cornea daws kawg. Kev rov qab los txuas ntxiv mus ntev, ntau xyoo.
Keratitis thiab kws kho mob 'prognosis
Nrog rau txoj kev loj hlob zoo, tus kab mob xaus nrog lub resorption ntawm infiltrate, ib tug pos yog tsim nyob rau hauv lub cornea, uas yuav ua tau ntau thiab tsawg thiab hnyav. Vascularization yogkuj yog ib qho zoo kawg nkaus rau tus kab mob, raws li nws pab cov as-ham nkag mus rau lub cornea sai, thiab cov rwj tuag tawm. Belmo tuaj yeem ua rau ua tiav lossis ib nrab tsis pom kev.
Cov kab mob tsis zoo yog ib txoj hauv kev uas cov kab mob loj tuaj ntawm lub pob kws, qhov txhab txuas mus rau Descemet's membrane. Hauv qhov no, cov kab mob pathogenic nkag mus rau hauv cov khaubncaws sab nraud povtseg ntawm qhov muag. Raws li qhov tshwm sim, tus mob no ua rau mob qog ntshav qab zib theem ob, endophthalmitis thiab panophthalmitis.
Dystrophic thiab degenerative txheej txheem
pob txha dystrophy yog ib yam kab mob uas tshwm sim los ntawm kev loj hlob sai thiab clouding ntawm feem ntau ntawm daim nyias nyias ntawm lub qhov muag.
Cov kab mob zoo li no tsis tshwm sim tawm tsam keeb kwm ntawm cov kab mob hauv lub cev thiab tsis muaj qhov tshwm sim ntawm keeb kwm. Qhov laj thawj tseem ceeb ntawm tus mob yog ib qho autosomal dominant disorder hauv qee cov noob. Txhawm rau txheeb xyuas cov tsos mob thiab ua rau muaj kab mob pob txha, tus kws kho mob ua tib zoo tshuaj xyuas tus neeg mob thiab sau ntawv tshuaj ntsuam caj ces rau txhua tus neeg hauv tsev neeg.
Cov tsos mob tseem ceeb ntawm qhov txhab:
- mob hnyav thiab xav tias muaj lub cev txawv teb chaws hauv qhov muag - tus mob no qhia tau tias pib yaig;
- mob qhov muag liab, intolerance rau lub teeb ci, profuse lacrimation;
- teeb meem nrog lub zeem muag, nws maj mam deterioration, nrog rau huab cua ntawm lub pob ntseg thiab tsim puffiness.
Thaum qhov erosive nto raug cuam tshuam, tus kab mob no nyuaj los ntawm keratitis. Kev kho mob yog cov tsos mob. Tus kws kho mob muab tshuaj tee tshwj xeeb uas muabkhoom noj khoom haus zoo nrog cov khoom tseem ceeb ntawm lub cornea ntawm lub qhov muag. Tab sis lawv tsis tas yuav muab cov txiaj ntsig xav tau. Nrog rau qhov tsis zoo nyob rau hauv qhov muag pom kev, cov kws kho mob feem ntau sau ntawv nkag mus rau keratoplasty lossis hloov lub pob txha.
Fuchs 'dystrophy yog ib yam kab mob uas cuam tshuam rau endothelium ntawm pob kws, tab sis nws tsis tshua muaj tshwm sim rau tib neeg. Nyob rau hauv lub cornea, xws li ib cheeb tsam yog lub thinnest thiab deb tshaj nyob rau hauv. Nws yuav luag tsis rov tsim dua. Thaum kis tau, cov hlwb pib muaj hnub nyoog thiab tsis ua haujlwm li qub. Lub npe thib ob ntawm Fuchs 'dystrophy feem ntau yog endothelial-epithelial dystrophy, feem ntau nws tshwm sim nrog kev poob ntawm lub cev hauv cov neeg laus. Thaum lub cornea puas lawm, nws pib pos huab heev, nws qhov dav nce, thiab qhov pom kev ntawm tus neeg mob hnyav zuj zus. Kev kho mob pob txha tuaj yeem yog ib qho - hloov pauv.
pob txha epitheliopathy
Qhov ua rau mob ntawm pob txha ntawm lub qhov muag tuaj yeem yog epitheliopathy ntawm txheej txheej ntawm lub plhaub. Nyob rau hauv cov ntaub ntawv no, tus neeg mob muaj kev detachment ntawm lub epithelium los ntawm lub qis plhaub, ua rau tsis zoo adhesion. Feem ntau, qhov mob no tau pom tom qab raug mob ntawm lub qhov muag, tau txais qhov kub hnyiab lossis cov txheej txheem dystrophic. Tus neeg mob tsim kev mob hnyav, muaj qhov hnov ntawm qhov muaj qee yam txawv teb chaws hauv lub qhov muag, kev ntshai ntawm lub teeb thiab kev tsis pom kev sai tau kuaj pom.
ntsuas ntsuas
Kev kuaj mob thiab kho cov kab mob ntawm lub pob txha ntawm lub qhov muag yog ua los ntawm kev siv cov hauv qab no:
- qhov muag biomicroscopy;
- keratotopography;
- confocal microscopy.
Kev ua haujlwm
Kev kho mob ntawm lub pob kws muaj kab mob tuaj yeem ua tiav siv ntau yam txuj ci. Tus neeg mob tus mob thiab cov tsos mob tshwm sim yog muab rau hauv tus account. Txoj kev kho mob pob txha dystrophy:
1. Crosslinking ntawm lub cornea yog ib qho kev phais mob uas keratosis raug tshem tawm. Thaum lub sij hawm tus txheej txheem, tus kws kho mob txiav tawm sab saum toj txheej ntawm lub cornea, ces lub qhov muag yog irradiated nrog ultraviolet lub teeb thiab kho nrog antibacterial tee. Rau 3 hnub tom ntej tom qab ua haujlwm, nws yog ib qho tseem ceeb uas yuav tsum hnav lo ntsiab muag tshwj xeeb txhua lub sijhawm.
2. Keratectomy - tshem tawm me me opacities nyob rau hauv nruab nrab cheeb tsam ntawm lub cornea. Kev phais yog siv, qee zaum siv laser kho ntawm lub pob txha. Cov teeb meem tsim tom qab kev ua haujlwm overgrows ntawm nws tus kheej.
3. Keratoplasty (cornea hloov pauv) yog siv rau:
- teeb meem nrog pob tshab pob tshab;
- muaj astigmatism;
- qhov muag raug mob, mob keratoconus thiab keratitis;
- txhawm rau ntxiv dag zog rau pob txha pob txha thiab txhim kho qhov muag kev noj qab haus huv hauv kev npaj rau kho qhov muag keratoplasty.
Nyob zoo thiab malignant formations ntawm lub cornea ntawm lub qhov muag tshwm sim tsis tshua muaj, feem ntau cov qog tshwm sim ntawm conjunctiva, sclera los yog limbus.
Papilloma yog ib qho qog tsim nyob rau sab nrauv ntawm lub pob kws. papilloma ntopob thiab nws cov xim yog daj ntseg liab.
Tus kab mob no maj mam, kis mus rau qhov siab thiab qhov dav, nws tseem tuaj yeem kis tau tag nrho ntawm lub pob kws, uas yog qhov txaus ntshai heev thiab yuav tsum tau kho tam sim.
kev kho mob
Tshuaj tua kab mob thiab tshuaj tiv thaiv kab mob:
- Tshuaj tua kab mob tuaj yeem siv rau kev mob pob txha tom qab kev tshawb fawb ua ntej (Torbex, Tsiprolet).
- Tshuaj glucocorticoids yog siv los txo qis kev mob thiab txo cov caws pliav, txawm tias kev siv tsis txaus tuaj yeem txhawb kev loj hlob ntawm microbial (Sofradex, Maxitrol).
- Systemic immunosuppressive tshuaj yog siv nyob rau hauv qee hom mob peripheral corneal ulceration thiab thinning cuam tshuam nrog kev puas tsuaj rau cov ntaub so ntswg ("Advagraf", "Imuran").
Tshuaj uas ua kom lub pob txha rov ua dua tshiab:
1. Cov kua muag cuav (Taufon, Artelak) yuav tsum tsis txhob muaj cov tshuaj lom (piv txwv li, benzalkonium) lossis corneal sensitizing (xws li, thiomersal) preservatives.
2. Kev kaw lub qhov muag yog ib qho kev ntsuas kub ntxhov hauv neuroparalytic thiab neurotrophic keratopathies, nrog rau hauv lub qhov muag nrog qhov tsis xws luag hauv epithelial.
- Kev khi ib ntus ntawm daim tawv muag nrog Blenderm lossis Transpore tapes.
- CI tshuaj lom neeg. botulinum hauv m. levator palpebrae nrog lub hom phiajtsim ptosis ib ntus.
- Lateral tarsorrhaphy lossis plasty ntawm lub kaum sab xis ntawm lub qhov muag.
3. Bandage soft contact lenses txhim kho kev kho mob los ntawm mechanically tiv thaiv lub regenerating corneal epithelium nyob rau hauv tej yam kev mob ntawm daim tawv muag tas li raug mob.
4. Amniotic membrane grafting tej zaum yuav tsim nyog los kaw qhov kev pheej hmoo, refractory epithelial defect.
