I-retinopathy ye-prematurity

I-retinopathy ye-prematurity (ROP) ukukhula okungavamile kwesitsha segazi ku-retina yeso. Kwenzeka ezinganeni ezizalwa zisencane kakhulu (ngaphambi kwesikhathi).

Imithambo yegazi ye-retina (ngemuva kweso) iqala ukukhula cishe izinyanga ezintathu emva kokukhulelwa. Ezimweni eziningi, zikhula ngokuphelele ngesikhathi sokuzalwa okujwayelekile. Amehlo kungenzeka angakhuli kahle uma ingane izalwa kusenesikhathi. Imikhumbi ingayeka ukukhula noma ikhule ngokungajwayelekile isuka ku-retina iye emuva esweni. Ngenxa yokuthi le mikhumbi ibuthaka, iyakwazi ukuvuza futhi ibangele ukopha esweni.

Izicubu zesibazi zingakhula futhi zidonse i-retina ingxenyeni engaphakathi yeso (ithimba le-retinal). Ezimweni ezinzima, lokhu kungaholela ekulahlekelweni kombono.

Esikhathini esedlule, ukusetshenziswa komoya-mpilo omningi ekwelapheni izingane ezizalwe ngaphambi kwesikhathi kwadala ukuthi imikhumbi ikhule ngendlela engajwayelekile. Izindlela ezingcono manje sezitholakala zokuqapha umoya-mpilo. Ngenxa yalokhu, le nkinga seyingasavamile, ikakhulukazi emazweni athuthukile. Kodwa-ke, kusekhona ukungaqiniseki ngezinga elifanele le-oksijeni yezingane ezizalwe ngaphambi kwesikhathi ngeminyaka ehlukene. Abaphenyi bacwaninga ezinye izinto ngaphandle komoya-mpilo ezibonakala zithonya ubungozi be-ROP.

Namuhla, ingozi yokuthuthukisa i-ROP incike ezingeni lokungakhuli kuqala. Izingane ezincane ezinezinkinga eziningi zezokwelapha zisengozini enkulu.

Cishe zonke izingane ezizalwa ngaphambi kwamasonto angama-30 noma ezinesisindo esingaphansi kwamakhilogremu amathathu (1500 amagremu noma ama-1.5 kilograms) lapho zizalwa zihlolwe lesi simo. Ezinye izingane ezisengozini enkulu ezinesisindo esingamakhilogremu ama-3 kuye kwayi-4.5 (1.5 kuya ku-2 kilograms) noma ezizalwa ngemuva kwamasonto angama-30 nazo kufanele zihlolwe.

Ngaphezu kokuvuthwa ngaphambi kwesikhathi, ezinye izinto ezinobungozi zingafaka:

• Misa okwesikhashana ekuphefumuleni (i-apnea)
• Isifo senhliziyo
• Isikhutha esikhulu (CO2) egazini
• Ukutheleleka
• I-asidi yegazi ephansi (pH)
• I-oxygen ephansi yegazi
• Ukucindezeleka kokuphefumula
• Ukushaya kwenhliziyo okuhamba kancane (bradycardia)
• Ukumpontshelwa

Izinga le-ROP ezinganeni eziningi ezingakazalwa liye lehla kakhulu emazweni athuthukile emashumini ambalwa eminyaka edlule ngenxa yokunakekelwa okungcono egunjini lokunakekelwa kwabasanda kuzalwa (NICU). Kodwa-ke, izingane eziningi ezizalwe kusenesikhathi manje sezikwazi ukuphila, futhi lezi zingane ezingakafiki isikhathi zisengozini enkulu ye-ROP.

Ukushintshwa kwesitsha segazi akubonakali ngeso lenyama. Ukuhlolwa kweso kuyadingeka ngudokotela wezifo zamehlo ukuveza izinkinga ezinjalo.

Kunezigaba ezinhlanu ze-ROP:

• Isigaba I: Kunokukhula komthambo wegazi okungajwayelekile.
• Isigaba II: Ukukhula komkhumbi wegazi ngokujwayelekile akujwayelekile.
• Isigaba III: Ukukhula komkhumbi wegazi akujwayelekile kakhulu.
• Isigaba IV: Ukukhula komkhumbi wegazi akujwayelekile kakhulu futhi kukhona i-retina ehlukaniswe kancane.
• Isigaba V: Kunethimba eliphelele le-retinal.

Usana olune-ROP nalo lungabhekwa njengolune- "plus disease" uma imithambo yegazi engajwayelekile ifana nezithombe ezisetshenziselwa ukuxilonga lesi simo.

Izimpawu ze-ROP ezinzima zifaka:

• Ukunyakaza kwamehlo okungajwayelekile
• Amehlo awele
• Ukubona eduze okukhulu
• Abafundi ababukeka mhlophe (leukocoria)

Izingane ezizalwa ngaphambi kwamasonto angama-30, zinesisindo esingaphansi kwama-gram ayi-1,500 (cishe amakhilogremu ama-3 noma ama-1.5 kilograms) lapho zizalwa, noma zisengozini enkulu yezinye izizathu kufanele zibe nezivivinyo ze-retinal.

Ezimweni eziningi, ukuhlolwa kokuqala kufanele kube phakathi kwamasonto amane kuya kwayisi-9 ngemuva kokuzalwa, kuya ngeminyaka yokukhulelwa kwengane.

• Izingane ezizalwa emasontweni angama-27 noma kamuva zivame ukuhlolwa kwazo zinamasonto amane ubudala.
• Labo abazalwa ekuqaleni bavame ukuba nezivivinyo kamuva.

Izivivinyo zokulandelela zisuselwa kwimiphumela yokuhlolwa kokuqala. Izingane azidingi okunye ukuhlolwa uma imithambo yegazi kuwo womabili ama-retina isiqedile ukukhula okujwayelekile.

Abazali kufanele bazi ukuthi yiziphi izivivinyo zamehlo zokulandelela ezidingekayo ngaphambi kokuba ingane ishiye inkulisa.

Ukwelashwa kwasekuqaleni kukhonjisiwe ukuthuthukisa amathuba engane okuthola umbono ojwayelekile. Ukwelashwa kufanele kuqale kungakapheli amahora angama-72 wokuhlolwa kwamehlo.

Ezinye izingane ezine- "plus disease" zidinga ukwelashwa ngokushesha.

• Ukwelashwa nge-Laser (photocoagulation) kungasetshenziselwa ukuvimbela izinkinga ze-ROP esezingeni eliphakeme.
• I-laser imisa imithambo yegazi engajwayelekile ukuthi ikhule.
• Ukwelashwa kungenziwa enkulisa ngokusebenzisa imishini ephathekayo. Ukuze usebenze kahle, kufanele wenziwe ngaphambi kokuba i-retina iqale ukuba nesibazi noma ihlukane nalo lonke iso.
• Ezinye izindlela zokwelapha, njengokujova i-antibody evimba i-VEG-F (into ekhulisa umkhumbi wegazi) esweni, zisacwaningwa.

Ukuhlinzwa kuyadingeka uma i-retina ithambeka. Ukuhlinzwa akuholeli ekuboneni okuhle ngaso sonke isikhathi.

Iningi lezinsana ezinokulahleka okukhulu kombono okuhlobene ne-ROP zina ezinye izinkinga ezihlobene nokuzalwa kwasekuqaleni. Bazodinga ukwelashwa okuhlukahlukene.

Cishe ingane eyodwa kwezingu-10 enezinguquko zakuqala iyoba nesifo esibi kakhulu se-retinal. I-ROP enamandla ingaholela ezinkingeni ezinkulu zombono noma ubumpumputhe. Isici esiyinhloko emphumeleni ukutholwa nokwelashwa ngaphambi kwesikhathi.

Izinkinga zingabandakanya ukubona eduze okukhulu noma ukungaboni.

Indlela engcono yokuvikela lesi simo ukuthatha izinyathelo zokugwema ukuzalwa ngaphambi kwesikhathi. Ukuvimbela ezinye izinkinga zokungakhuli kungasiza futhi ekuvimbeleni i-ROP.

I-Retrolental fibroplasia; ROP

UFierson WM; Isigaba seAmerican Academy of Pediatrics esigabeni se-Ophthalmology; I-American Academy ye-Ophthalmology; I-American Association for Pediatric Ophthalmology neStrabismus; I-American Association of Certified Orthoptists. Ukuhlolwa kwezinsana ezingakafiki ngaphambi kwesikhathi ukuze kutholakale ukuphindaphinda komzimba ngaphambi kokuvuthwa. Izifo zezingane. I-2018; 142 (6): e20183061. Izifo zezingane. 2019; 143 (3): 2018-3810. I-PMID: 30824604 www.ncbi.nlm.nih.gov/pubmed/30824604.

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