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დიაბეტური რეტინოპათია

თარიღი: 09 დეკემბერი, 2020

დიაბეტით დაავადებულებს შესაძლოა განუვითარდეთ თვალის დაავადება, რომელსაც დიაბეტური რეტინოპათია ეწოდება. სისხლში გლუკოზის (შაქრის) მაღალი დონე იწვევს ბადურის სისხლძარღვების დაზიანებას. დიაბეტის დროს დაზიანებული სისხლძარძღვები შუპდება. შედეგად ფერხდება სისხლძარღვში სისხლის მოძრაობა და ზიანდება ბადურა. დროთა განმავლობაში ბადურაზე ჩნდება ახალი, პათოლოგიური სისხლძარღვები, რაც ხშირად თვალის შიგნით სისხლჩაქცევის და მხედველობის სიმახვილის მკვეთრი გაუარესების მიზეზი ხდება.

არსებობს დიაბეტური რეტინოპათიის ორი ძირითადი ტიპი:
1. არაპროლიფერაციული დიაბეტური რეტინოპათია - უმეტესწილად დაავადების ადრეულ ეტაპზე გვხვდება. ამ დროს წვრილი სისხლძარღვებიდან ჟონვადობის მატება იწვევს ბადურის შეშუპებას. კლინიკურად მნიშვნელოვანია ბადურის ცენტრალური ზონის, მაკულის შეშუპება, რაც მხედველობის სიმახვილეს მკვეთრად აუარესებს.

ბადურის სისხლძარღვებში სისხლის მიმოქცევის შეფერხებისას, ბადურა ღარიბდება ჟანგბადით. ამ პროცესს იშემია ეწოდება. ქრონიკული იშემიისას იკლებს მხედველობითი ფუნქციები, ასევე თავს იჩენს პატარა ზომის მრავალი სისხლჩაქცევა ბადურის შიგნით.

2. პროლიფერაციული დიაბეტური რეტინოპათია დაავადების უფრო მწვავე გამოვლინებაა. პროლიფერაციულ ფაზაში ჩნდება ახალი, პათოლოგიური სისხლძარღვები. ახალი სისხლძარღვები ადვილად ზიანდება, რაც თვალის შიგნით სისხლჩაქცევის მიზეზი ხდება.

დროთა განმავლობაში ბადურის ზედაპირზე ჩნდება პათოლოგიური ქსოვილი, რომელიც მჭიდროდ უკავშირდება ბადურას და ახდენს მასზე მექანიკურ ზემოქმედებას. შედეგად ვითარდება ბადურის აშრევება, რასაც ბადურის ტრაქციული ჩამოცლა ეწოდება. ბადურის ტრაქციული ჩამოცლა მკვეთრად აქვეითებს მხედველობას და შესაძლოა სრული სიბრმავე გამოიწვიოს.

დიაბეტური რეტინოპათიის სიმპტომები
დიაბეტური რეტინოპათია საწყის ეტაპზე ხშირად უსიმპტომოდ მიმდინარეობს, თუმცა პროგრესირებასთან ერთად შესაძლოა თავი იჩინოს შემდეგმა სიმპტომებმა:
- მხედველობის გაუარესება
- მრავლობითი „მცურავი’’ ლაქებისა და წერტილების გაჩენა მხედველობის ველში
- ფერების აღქმის უნარის დაქვეითება
- ღამით მხედველობის გაუარესება
- უცაბედად მხედველობის დაკარგვა
- დიაბეტური რეტინოპათია როგორც წესი ორივე თვალს აზიანებს.

დიაგნოსტიკა:
თავდაპირველად დიაბეტური რეტინოპათია უსიმპტომოდ იწყება, თუმცა ოფთალმოლოგიური კვლევისას ადრეულ ეტაპზევე შესაძლებელია რეტინოპათიის ნიშნების აღმოჩენა. სწორედ ამიტომ, მნიშვნელოვანია დიაბეტით დაავადებულ პაციენტებს პერიოდულად უტარდებოდეთ სრულყოფილი ოფთალმოლოგიური კვლევა. კვლევის მიზანია ადრეული ნიშნების გამოვლენისთანავე მოხდეს დროული მკურნალობის დაწყება, მომავალში დაავადების პროგრესირების შესაფერხებლად.

ეს კვლევებია:
- ვიზომეტრია - მხედველობის სიმახვილის შემოწმება
- ტონომეტრია - თვალშიდა წნევის გაზომვა
- ნაპრალოვანი სანათით თვალის წინა ნაწილის დათვალიერება
- ფუნდუსკოპია - სპეციალური მიკროსკოპით ბადურის გამოკლვევა
- ფლუორესცენტული ანგიოგრაფია - სპეციალური კონტრასტის საშუალებით სისხლძარღვების დაზიანების ხარისხის (ჟონვადობის) შეფასება
- ოპტიკურ კოჰერენტული ტომოგრაფია (OCT) – იძლევა საშუალებას მოხდეს ბადურის შრეობრივი ანალიზი

მკურნალობა:
დიაბეტური რეტინოპატიის მკურნალობა დამოკიდებულია მის სიმწვავეზე. დაავადების ადრეულ პერიოდში, ოფთალმოლოგი შესაძლოა მხოლოდ აკვირდებოდეს პაციენტის მდგომარეობას. ამ დროს მნიშვნელოვანია პაციენტმა აკონტროლოს სისხლში გლუკოზის (შაქრის) დონე და არტერიული წნევა.

დაავადების პროგრესირებასთან ერთად შესაძლოა საჭირო გახდეს ბადურის პანრეტინალური ფოტოლაზერკოაგულაცია და/ან იტრავიტრეალურად (თვალის შიგნით) მედიკამენტის შეყვანა, რაც ხელს უწყობს ბადურის ახალი სისხლძარღვებისა (ნეოვასკულარიზაცია) და მისი შეშუპების შემცირებას.

დაავადების შორსწასულ ფაზაში პაციენტებს ხშირად ესაჭიროებათ ქირურგიული ჩარევა - ვიტრექტომია. ვიტრექტომიის დროს, სისხლჩაქცევასთან ერთად ამოიკვეთება თვალის გამჭვირვალე ქსოვილი, მინისებრი სხეული. ბადურის ზედაპირიდან მოცილდება ახალი, ნაწიბუროვანი ქსოვილი (მემბრანა) და გასწორდება დანაოჭებული ბადურა. ლაზერის საშუალებით მოხდება დაზიანებული უბნების მკურნალობა. ბადურის ჩამოცლის შემთხვევაში, იგი დაუბრუნდება თავის ბუნებრივ მდებარეობას.

შეჯამება:
დიაბეტური რეტინოპათია თვალის სერიზული დაავადებაა, რომელსაც პოტენციურად სიბრმავის გამოწვევა შეუძლია. ოფთალმოლოგის მეთვალყურეობა და მკურნალობის ადრეულ სტადიაზევე დაწყება, მნიშვნელოვნად ამცირებს დაავადებასთან ასოცირებული გართულებების ალბათობას.