DIEN DAN
TIEN TRIEN NANG CUA THOAI HOA HOANG DIEM TUOI GIA VA MANG TRUaC VONG MAC
SAU PHAU THUAT THUY TINH THE
[ HdXudnHdT )
Tom tat
Chimg toi mo td mpt ca ldm sdng vdi bieu hien ndng len nhanh chong cua benh ly thoai hod hodng diem tuoi gid vd mdng trudc vong mgc sau phdu thudt thiiy tinh the. Benh nhdn dugc phdu thudt phaco dat thiiy tinh the nhdn tgo mem, phdu thudt diin ra khong co bien co. Diin biin trong 3 thdng ddu hdu phdu thuan Igi, benh nhdn phuc hoi thi luc tot. Tir thdng thic 3, binh nhdn gidm ddn thi luc do phii hodng diem khong dap img vdi dieu tri npi khoa, kem theo su xudt hiin ciia mdng trudc vong mgc tiin triin nhanh vd su ndng lin nhanh chong ciia benh ly thodi hoa hodng diem tuoi gid sdn co tic trudc.
\. Benh nhan
Benh nhan nam 87 tu6i, den kham vao thang 04/2009 vi hai mat nhin ma. Tham kham tren sinh hien vi cho thay ban phan truac hoan toan binh thuang kem theo due thiiy tinh the tien trien hai mat voi thj lire mat phai 1/10, mat trai 2/10 (qua kinh 16 kh6ng tang). Kham day mat bang kinh 90 diop, phat hien hai mat co rai rac drusen kich thuac trung binh rai, phan b6 ehu yeu ngoai cung mach thai duong. Benh nhan dugc chan doan hai mat:
due thiiy tinh the kem theo thoai hoa hoang diem tu6i gia.
Benh nhan dugc phau thuat phaco-IOL mat phai 4/2009, phau thuat dien ra kh6ng co bien c6 voi thj lire sau m6 la 5/10, nhan ap binh thuong.
Sau m6 3 thang, benh nhan thay nhin ma nhe mat phai, kh6ng dau nhirc. Thi luc mat phai giam con 3/10, nhan ap binh thuang. Kham tren sinh hien vi, phat hien ban phan truac sach, lOL can, djch kinh sanh, viing hoang diem kh6ng co anh
'Khoa Ddy mdt - mdng bo dao, Benh vien Mdt Trung uong
trung tam. Do benh nhan cao tu6i nen ehi djnh chup mach huynh quang kh6ng dat ra, benh nhan dugc chup OCT va phat hien phii hoang diem voi do day viing hoang diem la 280 micromet. Benh nhan dugc dieu trj acetazolamid u6ng (kem kali), thu6e tra tai cho corticoid va ch6ng viem non - steroid va dugc kham djnh ki hai tuan, thj lire kh6ng cai thien dang ke.
Sau m6 6 thang, benh nhan tiep tuc dugc dieu tri ngi khoa nhung thj lire kh6ng cai thien. Benh nhan dugc lam OCT kilm tra va phat hien ngoai phii hoang diem, con co sir hinh thanh ciia mang truoc vong mac viing hoang diem. Tuy nhien, mang truoc vong mac a mirc do nhe, chua gay co keo vong mac va mach mau vimg hoang dilm, benh nhan cung chua xuat hien trieu chimg nhin hinh bien dang hoac nhin d6i... Do miic do ciia mang truac vong mac va thi trang benh nhan, nen chiing t6i chua dua ra chi djnh phlu thuat. Ngoai ra, hinh anh day mat con cho thiy sir xuit hien cac drusen trung binh 6 viing hau cue, bilu hien su tiln triln ciia benh li thoai hoa hoang dilm tuli gia.
56 Nhan khoa Viet Nam (So 21/2011)
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Hinh 1. Anh OCT viing hodng diem 18 thdng sau phdu thudt
Thang 11 nam 2010 (18 thang sau phiu thuat), benh nhan den kham lai vi thj lire mat phai giam nghiem trgng kem nhin vat bien dang nhieu. Thi luc
•...i
mat phai dem ngon tay 4 met, nhan ap binh thuang.
Hinh anh day mat eho thay mang truac vong mac tien trien day len, eo keo manh vong mac \ a mach mau -viing hoang diem, gay xuat huyet truoc vong mac. Ben canh do la su nang len ciia benh li thoai hoa hoang diem moi gia voi sir tang so lugng va kinh thuoc drusen vimg hoang diem. Chup mach huynh quang day mat, cho thay hinh anh mach mau vong mac bi co keo lam d6i huong nang, hieu ung che lap eiia dam xuat huyet tmoc vong mac, m6t s6 diem ro huynh quang nhe cua mang luoi mao mach quanh hoang diem va phii hoang diem kin dao...
Benh nhan dugc len ke hoach de tien hanh phau thuat cat djch kinh dieu trj mang truac vong mac.
Hinh 2. Anh ddy mdt vd dnh chup mgch huynh quang 18 thdng sau phdu thudt 2. Ban luan
Su xuat hien ciia mang truoc vong mac va sir tien trien nang len cua thoai hoa hoang diem tu6i gia sau phau thuat thiiy tinh the da dugc de cap nhieu lan trong y van.
Mang truac vong mac sau phau thuat thuy tinh the hay phau thuat ngi nhan noi chung la m6t bieu hien ciia qua trinh tang sinh djch kinh vong mac.
Nhiing vi chan thuang trong m6 va hien tugng viem sau mo da kich thich tao nen mgt lop mang tren be
mat vong mac vai ban chat co the tir nhieu ngu6n te bao khac nhau: te bao bieu m6 sac t6, te bao than kinh dem, te bao lien ket ...[1]. Chi djnh phau thuat mang truoc vong mac chi dat ra khi mang gay giam thj luc nang hoac gay nhin d6i hoac gay meo hinh.
Mat khac, cac gia thuyet ve co che nang len cua thoai hoa hoang diem tu6i gia g6m: ca che viem, co che tac dgng ciia anh sang, co che vi chan thuong do phau thuat. Thuyet ve co che viem neu len vai tro ciia phan iing viem sau mo lam giai
Nhan khoa Viet Nam (So 21/2011) 57
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phong cac dai thue bao, cac cytokine tien viem va gay phii hoang diem dang nang, deu la cac yeu t6 gop phan vao hien tu-gng tang sinh tan mach.
Thuyet ve ca che anh sanh cho rang, phau thuat thiiy tinh the da loai bo vai tro bao ve cua thuy tinh the due d6i vai -vung hoang diem do kha nang Ige tia cue tim. Vi vay, hien nay, viec sir dung thuy tinh the nhan tao co mau vang nham Igc tia cue tim da dugc ph6 bien r6ng rai, dii hieu qua can dugc kiem chirng them. Anh huong ciia anh sang manh tir sinh hien vi phau thuat trong m6 ciing dugc neu len. Vi chan thuang trong phau thuat nhu su thay d6i ap lire h6c mat va ngi nhan, sir dirt gay ciia mang Brueh, sir xuyen mach cua dai thue bao... dugc mgt s6 tae gia cho la nguyen nhan ciia TAI LIEU THAM KHAO
su tien trien ciia thoai hoa hoang diem tu6i gia sau phau thuat [2].
Dii ket qua cua cac nghien ciiu ve tae dgng cua phiu thuat thuy tinh the len tien trien cua thoai hoa hoang diem tu6i gia con nhieu mau thuan, da so tac gia deu th6ng nhat ve ich Igi cai thien thi lire ciia phau thuat thiiy tinh the tren benh nhan bi benh li nay [3].
3. Ket luan:
Tren nhirng benh nhan da san co benh li hoang diem tu6i gia hoac mang truac vong mac mirc do nhe (benh hoang diem giay bong kinh...), can giai thich kl cho benh nhan ve kha nang tien trien nang eiia benh sau m6 thuy tinh the va theo doi hau phau chat che sau m6 de phat hien va xir tri kjp thai cac bien ehiing eua benh.
1. JAHN CE, MINICH V: "Epiretinal membranes after extracapsular cataract surgery".
Ophthalmology 2007, 54.
2. BROCKMANNJ: "Cataract Refract Surg 2008".
3. "Nghien cim AREDS 27" (2009).
58 I Nhan khoa Viet Nam (So 21/2011)
