Pohō ʻAna Makaʻala, Hoʻokaʻawale ʻia ʻo Retinal, a me ka Glaucoma Paʻa ʻAiki¶

ʻO ka nalo koke ʻana o ka ʻike, ke kolo ʻeleʻele e kolo ana ma ke kahua ʻike, a i ʻole ka ʻeha ʻeha o ka maka i hui pū ʻia me nā halo anuenue a me ka luaʻi ʻana he mau pilikia olakino e weliweli ai ka ʻike. No ka mea, ʻo ka ** retina** a me ** optic nerve ** he mau hoʻopaneʻe pololei o ka ʻiʻo o ka lolo me ka hiki ʻole ke hoʻōla hou i ka wā i pōloli ʻia i ke koko a i ʻili ʻia paha mai ko lākou kumu hānai, hoʻoholo nā minuke a me nā hola inā loaʻa ke kanaka i ka ʻike piha a i ʻole ka makapō mau. Eia kekahi, ʻo ka makapō hikiwawe ʻole ʻeha ma ka maka hoʻokahi (Central Retinal Artery Occlusion [CRAO] a i ʻole Amaurosis Fugax) ua like ia me kahi maʻi ischemic acute. hahau, oiai napoo ka hihio o kekahi kanaka makua me ke poo o ka luakini a i ole eha auwae (Giant Cell Arteritis) hiki ke makapo i ka maka elua i loko o na la ke hookaulua ia na corticosteroids intravenous. ʻO ka ʻike koke ʻana i nā hae ʻulaʻula ocular, ka hoʻonoho ʻana i ke poʻo kūpono, ka pale ʻana i ka ʻili o ka maka a i ʻole ka hamo ʻana i ka maka, a me ka hele pololei ʻana i kahi keʻena pilikia me ka ophthalmology a me ka hiki ke hahau ʻana he mea koʻikoʻi ia i ka mālama ʻana i ka ʻike a me ke ola.

E hana i kēia i kēia manawa¶

1. E hoʻāʻo wikiwiki i kēlā me kēia maka (e uhi i ka maka hema, a laila e uhi i ka maka ʻākau) a nīnau i ʻelua mau nīnau hoʻāʻo: "E ʻeha ka maka?" a "Pehea i loli ai ka ʻike?" Manaʻo ka poʻe he poʻe maka ʻelua a hiki i ka uhi ʻana o ka maka hoʻokahi a ʻike lākou ua ʻeleʻele loa kekahi maka a i ʻole kahi kihi o ka ʻike.
2. ** Maka ʻulaʻula ʻeha, ʻoʻoleʻa-pōhaku + ʻohu pohu + haumāna i hoʻopaʻa ʻia i waena o ke anuenue + nausea/luaʻi:** Suspect Acute Angle-Closure Glaucoma (AACG).
3. ** ʻO ka ua ʻeha ʻole o nā mea lana ʻeleʻele hou + ʻālohilohi uwila ʻālohilohi + kahi "pale" ʻeleʻele a i ʻole "pale" e kolo ana i ka ʻike:** Suspect Acute Retinal Detachment.
4. ** ʻEleʻele koke ka ʻeha ma ka maka hoʻokahi (mau minuke mau a noho ʻeleʻele paha):** Suspect Central Retinal Artery Occlusion (CRAO / "Eye Stroke") a i ʻole Amaurosis Fugax (TIA).
5. Nalo ka ʻike i ke kanaka makua ma luna o 50 makahiki + hou ma ka luakini poʻo, ʻeleʻele ke poʻo i ka wā e hui ai i ka lauoho, a i ʻole ka ʻeha ʻāwae i ka wā e nahu ai: Suspect Giant Cell Arteritis (Temporal Arteritis).
6. **E kelepona koke i kāu helu ulia pōpilikia no ka pohō ʻeleʻele ʻole, nā hae ʻulaʻula Giant Cell Arteritis, a i ʻole Acute Angle-Closure Glaucoma nui. helu pilikia. No ka wehe 'ana i ka retina i mana'o 'ia (nā lana, nā 'ālohilohi, a me ka malu pale), e ho'onohonoho koke i ka loiloi 'ophthalmology ulia pōpilikia i ka lā ho'okahi i hiki i ke kauka lapa'au ke ho'opili hou i ka retina ma mua o ka 'ili 'ana o ka detachment ma waena o ka macula waena.
7. E hoʻonoho i ke poʻo a me ke kino o ke kanaka no ka pilikia o ka maka i manaʻo ʻia:
8. No ka Suspected Acute Angle-Closure Glaucoma: E hoʻomoe i ke kanaka me ka palahalaha ma kona kua (hoʻomoe) me ka nānā pono ʻana o kona alo i ke kaupaku i loko o kahi lumi mālamalama maikaʻi. ʻO ka moe ʻana i luna e hiki ai i ka ʻumekaumaha ke huki iki i ka lens maoli o ka maka i hope mai ka iris e kōkua i ka wehe hou ʻana i ke kihi hoʻokaʻawale i hoʻopaʻa ʻia, ʻoiai ʻo ke kukui ambient e hoʻopaʻa mālie i ka haumāna (ʻaʻole loa e noho i loko o kahi lumi pōʻeleʻele, e hoʻomāhuahua i ka haumāna a hoʻopaʻa paʻa i ka iris i loko o ke kihi wai).
9. No ka Hoʻokaʻawale ʻia ʻo Retinal: E mālama i ke kanaka noho a moe mālie me ka liʻiliʻi o ka neʻe ʻana o ke poʻo a me ka heluhelu ʻole ʻana (ʻo ka heluhelu ʻana e hoʻoneʻe wikiwiki ʻia nā maka saccadic ʻaoʻao e hahau i ka wai vitreous ma lalo o ka waimaka retinal). E hoʻopololei i ke poʻo i noho haʻahaʻa loa ka ʻaoʻao o ka waimaka (noka: no ka mea, ua hoʻohuli ka lens o ka maka i ka mālamalama, ʻo kahi ** aka ʻeleʻele ma lalo/haʻahaʻa hiʻohiʻona ** ʻo ia hoʻi, aia ka haʻihaʻi retinal maoli ma ka ** retina luna/luna**).
10. No ka mea i manaʻo ʻia ʻo Central Retinal Artery Occlusion (CRAO): E hoʻomoe i ke kanaka palaha loa ma kona kua no ka hoʻonui ʻana i ke koko a me ka hoʻoheheʻe ʻana o ke koko i ka maka a me ka lolo.
11. ** ʻAʻole e hamo, kaomi, a lomilomi paha i ka maka, a ʻaʻole e uhi i ka maka glaucoma pani ʻana me kahi ʻāpana maka ʻeleʻele.** ʻO ka hamo ʻana i ka maka me ka waimaka retinal e hoʻoluliluli i ka gel vitreous a ʻoki loa i ka retina mai ka paia hope. ʻO ka kau ʻana i kahi ʻāpana ʻeleʻele ma luna o ka maka me ka glaucoma pani ʻana i ka angle acute e hoʻolei ana i kēlā maka i loko o ka pōʻeleʻele e hoʻomāhuahua ai ka haumāna (mydriasis), e hōʻino ana i ka paʻa ʻana o ke kihi.
12. E mālama pono i ka mea maʻi Nothing by Mouth (NPO) a nānā i nā lāʻau lapaʻau hou loa. Kāohi i ka meaʻai a me ka mea inu no ka mea e pono ai ka ʻōpū ʻole o ka ʻōpū vitrectomy (no ka retinal detachment) a i ʻole iridotomy laser. E ho'ōki koke i kekahi ** nā mea hoʻoheheʻe ihu decongestant, nā papa anu/flu (pseudoephedrine, phenylephrine), antihistamines (diphenhydramine), motion-sickness patches (scopolamine), a i ʻole anticholinergic inhalers** i hoʻomaka ʻia ai ka glaucoma pani ʻana.
13. E nānā i nā hōʻailona FAST stroke a kākau i lalo i ka minuke pololei i hoʻololi ʻia ka ʻike. E nānā no ka hāʻule ʻana o ka maka, ka ʻauheʻe lima, a i ʻole ka haʻi ʻōlelo ʻana. alakaʻi hahau). Pono nā hui hōʻeha o ka haukapila a me nā ophthalmologists i nā hōʻailona minuke pololei i hoʻomaka e hoʻoholo i ke kūpono no ka thrombolysis intravenous (i loko o \(4.5\text{ hola}\) no CRAO) a i ʻole ka methylprednisolone intravenous kiʻekiʻe (no Giant Cell Arteritis).

Nalo koke ka ʻike a me ka lāʻau hoʻoholo pilikia ocular¶

E hoʻohana i kēia palapala hoʻoheheʻe lapaʻau no ka hoʻāʻo ʻana i nā haunaele ʻike koke ʻia i loko o 60 kekona a koho i ka huakaʻi ulia pōpilikia a me ke kūlana.

flowchart TD
    Start["Nalo Ka Makana Hiki, Ka Malu Makana,<br/>A i ʻole ʻEha ʻEha Maka me ka ʻike pohihihi<br/>(E hoʻokaʻawale i kēlā me kēia maka ma ka uhi ʻana i hoʻokahi maka)"] --> PainCheck{"He 'eha loa ka Maka i ho'opilikia 'ia<br/>a me ka 'ula'ula, a 'ole ka 'eha 'ole?"}

    PainCheck -->|"ʻEHA & ULAULA:<br/>Eha ʻeha nui ka maka/maka, ʻulaʻula ka maka,<br/>huhuhu, paʻa i waena o ka haumāna,<br/>halo a puni nā kukui, nausea/luaʻi."| AACG["SUSPECT ACUTE ANGLE-CLOSURE GLAUCOMA<br/>(IOP pinepine 50 a 80+ mmHg):<br/>1. E hele i ka lumi ulia pōpilikia / halemai maka i kēia manawa<br/>2. E moe PAHA MA KE kua e nana ana i ke kaupaku (huki hope ka lens i ka umekaumaha)<br/>3. E mālama pono i ka lumi (ʻAʻole e kau i kahi ʻāpana ʻeleʻele ma ka maka)<br/>4. E kāpae i nā lāʻau anu a pau, nā antihistamines, a me nā hāʻule hoʻomāhuahua"]

    PainCheck -->|"PAINLESS (a i ʻole Temple/Jaw Ache Only)"| PatternCheck{"He aha ke ʻano hiʻohiʻona <br/>a me ka moʻolelo makahiki/hōʻailona?"}

    PatternCheck -->|"ʻO nā mea lele (nā pūnana cob/gnats) + Nā kukui ʻālohilohi<br/>+ 'Paku' ʻeleʻele a i ʻole 'Shadow' e kolo ana i ka ʻike."| RD["HOʻOPIʻI I KA HOʻOPIʻI O KA RETINAL ACUTE:<br/>1. ʻO ka Ophthalmologist pilikia o ka lā hoʻokahi / Maka ER NOW<br/> (CRITICAL: E mālama i ka macula waena ma mua o ka wehe ʻana)<br/>2. E noho mālie ke poʻo; pale i ka heluhelu (ho'ōki i ka hahau maka saccadic)<br/>3. E mālama i kekahi mea ma ka waha (NPO) no ka ʻoki ʻana i ka retinal wikiwiki"]

    PatternCheck -->|"Makahiki >= 50 makahiki + ʻEha Poʻo Hale Hōʻikeʻike Hou, ʻAha ʻEha o ka Poʻo,<br/> ʻEha ʻāwae i ka wā e nahu ai, ʻike ʻelua, a i ʻole nalo ʻia ʻo Chalky Vision."| GCA["HOʻOPIʻI ʻia ka maʻi maʻi maʻi nui (GCA):<br/>1. E kelepona iā 911 / 112 / 999 a i ʻole ke keʻena ulia pōpilikia koke<br/>2. Pono koke i ka High-Dose IV Methylprednisolone<br/> (500-1,000 mg IV) MAMUA o ka biopsy e ho'ōla i ka maka 'ē aʻe."]

    PatternCheck -->|"ʻEleʻele ʻeha ʻeha koke i ka maka hoʻokahi<br/>(a i ʻole ka malu 2-15 min ka manawa = Amaurosis Fugax)"| CRAO["SUSPECT CENTRAL RETINAL ARTERY OCCLUSION<br/>(CRAO / 'Eye Stroke') a i ʻole Carotid TIA:<br/>1. E kelepona iā 911 / 112 / 999 koke ('Suspected Eye Stroke')<br/>2. E lawe pololei aku i ka Center Stroke Designated (<4.5 hola pukaaniani)<br/>3. E moe palahalaha ma ke kua; e nānā i nā hōʻailona FAST no ka lolo lolo"]

    PatternCheck -->|"Nalo o ka Hapa hema a i ole ka Hapa akau o ka hihio<br/>ma na maka elua i ka manawa like"| Hemianopia["HOMONYMOUS HEMIANOPIA (Occipital Brain Stroke):<br/>E kelepona iā 911 / 112 / 999 koke no ka Brain Stroke Protocol"]

ʻO ka hoʻohālikelike piha ʻana o nā ulia pōpilikia nui e weliweli¶

Ma muli o ka ʻike ʻana o nā kahu hānai a me nā kauka lapaʻau maʻamau i nā maka ʻulaʻula a me ka ʻike pohihihi i kēlā me kēia lā, ʻo ka ʻike ʻana i nā ʻokoʻa kikoʻī ma waena o nā ulia pōpilikia ʻelima manawa koʻikoʻi e hōʻoia i ka mālama kūikawā koke:

Kūlana 1: Acute Angle-Closure Glaucoma (AACG)¶

Pehea i pani ʻia ai nā laka paipu wai o ka maka ("Pupillary Block")¶

I loko o ke alo o ka maka olakino, hoʻopuka mau ʻia kahi wai meaʻai maʻemaʻe i kapa ʻia ʻo aqueous humor ma hope o ka iris kala e ke kino ciliary. Holo kēia wai i mua ma o ka haumāna i loko o ke keʻena mua (keʻena mua) a kahe i waho ma kahi kānana microscopic 360-degree i kapa ʻia ʻo trabecular meshwork, aia ma ka ʻaoʻao kahi e hui ai ka ʻaoʻao o waho o ka iris me ke koʻo maʻemaʻe. Noho kaulike ke kaomi intraocular maʻamau (IOP) ma waena o \(10\text{ a me }21\text{ mmHg}\).

Ma Acute Angle-Closure Glaucoma, kaomi pono ka ili hope o ka iris i ka ili mua o ka lens o ka maka (pupillary block), i ka manawa maʻamau i ka manawa e hoʻonui ai ka haumāna i ka mid-dilated size (\(4\text{ to }6\text{ mm}\)). ʻO ka wai wai i hoʻopaʻa ʻia ma hope o ka iris e hoʻokuke i ka iris peripheral i mua (iris bombe), me ka paʻi ʻana i ke kihi hoʻoheheʻe e paʻa loa e like me kahi pani pani e uhi ana i kahi kahawai. I loko o 30 a 60 mau minuke, piʻi ka piʻi ʻana o ke kaomi intraocular mai ka \(15\text{mmHg}\) maʻamau a hiki i ka \(50\text{ a i }80+\text{ mmHg}\): - ʻO ke kaomi nui e hoʻoneʻe i ka wai i loko o ka ʻāʻī maʻemaʻe, e hoʻohuli ana i ka puka makani mua o ka maka huhū a pohue (no ke anuenue halos a puni nā kukui). - Hoʻopiʻi ke kaomi i ke kahe o ke koko i ka ʻiʻo o ka iris sphincter, laka ʻia ka haumāna ma kahi **paʻa, oval vertical, waena-dilated kūlana ** e hōʻole ʻole e hoʻopaʻa i ka wā e ʻā ana ke kukui uila i loko. - ʻO ka oculogastric vagal reflex ka mea e hoʻoulu ai i ka nausea a me ka luaʻi ʻana, ʻoiai ʻo ke aʻalolo optic ma hope o ka maka e ʻeha ma lalo o ke kaomi.

ʻO nā lāʻau lapaʻau maʻamau a me nā kūlana e hoʻoulu ai i ka hoʻouka ʻana i kahi kihi-pani¶

Hiki ke hoʻouka ʻia ka ʻoki ʻoki ʻana i kahi mea e hoʻomāhuahua ai ka haumāna i loko o ka ʻāpana pōʻino koʻikoʻi i waena o ke kanaka i hānau ʻia me kahi kihi keʻena mua haiki (maʻa mau i nā maʻi ** ʻike maka [hyperopic] , nā poʻe ʻelemakule me nā maʻi maʻi nui, nā wahine, a me nā poʻe o ** ʻAsia Hikina, ʻAsia Hema, a i ʻole hoʻoilina Inuit):

1. Nā Laʻau Anu, Flu, Allergy, a me Sinus:
2. Sympathomimetic decongestants: Pseudoephedrine, phenylephrine, oxymetazoline nasal sprays.
3. ** ʻO nā antihistamines hoʻomaha o ka hanauna mua:** Diphenhydramine (Benadryl), chlorpheniramine, doxylamine (NyQuil/mea kōkua hiamoe), promethazine.
4. Nā Laʻau Laʻau me nā hopena Anticholinergic a Sulfonamide:
5. ** ʻO ka maʻi neʻe ʻana a me ka ʻāʻī ʻana o ka ʻōpū:** Nā ʻāpana transdermal Scopolamine, oxybutynin, tolterodine.
6. Hana hanu: ʻO Ipratropium a i ʻole tiotropium nebulizer noe i puhi ʻole ʻia i loko o nā maka.
7. Na Antidepressants & Migraine/Seizure Drugs: Tricyclic antidepressants (amitriptyline), SSRI/SNRI, a me topiramate (Topamax). (Meka koʻikoʻi: ʻO Topiramate ke kumu o ka pehu ʻana o ke kino ciliary i loko o nā pule 2 mua o ka hoʻomaka ʻana i ka lāʻau lapaʻau, e hoʻokuke ana i ka lens a me ka iris i mua e hoʻoulu ai i bilateral acute angle-closure glaucoma a me ka ʻike kokoke koke ʻoiai i nā maʻi ʻōpio me nā kihi ākea.)
8. Nā Kaiapuni: E hele ana i loko o kahi hale kiʻiʻoniʻoni ʻeleʻele, e noho ana i loko o kahi lumi ʻeleʻele e nānā ana i ke kīwī i ka pō, e hoʻomāhuahua ana i nā kulu maka ma ke keʻena optometrist, a i ʻole ka manaʻo hopohopo.

ʻO ke kōkua mua ma mua o ka haukapila a me ka mea e hana ai ka haukapila no AACG¶

• Ka hoʻonoho ʻana a me ka māmā ma mua o ka hale maʻi: E hoʻomoe i ka mea maʻi palaha ma ke kua e nānā pololei ana i luna no laila e huki ka ʻumekaumaha i ka lens i hope mai ka iris. E mālama i ka lumi **'ālohilohi ** (hoʻoulu ʻia ke kukui ʻālohilohi i ka reflex pupillary consensual e kōkua i ka huki ʻana i ka iris mai ke kihi). Mai hoʻopaʻa i ka maka, a mai kaomi i ka pōpō maka.
• Ka lāʻau lapaʻau a me ka laser sequence: Hāʻawi koke nā Ophthalmologists i ka hui pū ʻana o nā kulu maka hoʻohaʻahaʻa i ke kaomi (timolol beta-blocker, apraclonidine/brimonidine alpha-agonist, a me prednisolone steroid), intravenous a waha acetazolamide (\(500\text{ mg}\)) ( nie hoʻopaʻa i ka wai i loko o **) 60 mau minuke ma hope (i ka manawa e hāʻule ai ke kaomi ma lalo o \(35\text{ a i }40\text{ mmHg}\) a hoʻi ka iris mai ka ischemia) na pilocarpine (\(1\%\) a i \(2\%\)) hāʻule no ka huki ʻana i ka iris. ʻO ka lāʻau lapaʻau he 2 mau minuke kaʻina laser i kapa ʻia he laser peripheral iridotomy (LPI), e hana ana i kahi microscopic safety-valve pinhole ma luna o ka iris ma ʻelua mau maka (no ka mea, he 50 pakeneka ka pilikia o ka maka o ka maka i loko o 5 mau makahiki).

Kūlana 2: Hoʻokaʻawale ʻia ʻo Retinal Detachment (RD)¶

Hoʻomaopopo i ka Posterior Vitreous Detachment (PVD) vs. Retinal Tear vs. Detachment¶

Hoʻopiha ʻia ka loko o ka ʻōpoʻe maka me kahi gel collagen maʻemaʻe i kapa ʻia ʻo vitreous humor, e kau ana ma luna o ka ** retina ** ʻeleʻele a me ka māmā e pili ana i ka paia hope o ka maka. I ka makahiki o ka poʻe (ʻoi aku ka nui o nā makahiki he 50, a i ʻole ma mua o ka poʻe ** ʻike kokoke loa [myopic], ua loaʻa i ka ** ʻoki cataract, a i ʻole i loaʻa i ka ** ʻeha ʻeha o ka maka ), emi maoli ka gel vitreous a liʻiliʻi, a pau ka ʻili ʻana mai ka paia hope o ka maka (Posterior Vitreous Detachment [PV]). - I loko o 85 pakeneka o ka poʻe, ua hoʻokaʻawale ʻia ka gel vitreous me ka ʻole o ka pōʻino, e hana wale ana i kekahi mau mea hoʻoheheʻe cobweb. - Eia nō naʻe, i loko o 10 a 15 pakeneka o nā maʻi me nā hōʻailona PVD koʻikoʻi, ua huki ikaika ka gel emi ʻana ma kahi wahi paʻa o ka retina, e ʻoki ana i kahi kaʻa kāmaʻa lio ( uila uila** i ka huki ʻia ʻana o ka retina, a me ka ** ʻauʻau o nā haneli ʻeleʻele liʻiliʻi / ʻili pepa i hoʻoheheʻe ʻia i loko o kahi ʻāpana ʻeleʻele liʻiliʻi**. - I ka wā e hāmama ai ka waimaka, hū mai ka wai vitreous ma hope o ka retina a ʻili iā ia mai ka retinal pigment epithelium (RPE) hānai e like me ka pepa kiʻi paʻi e ʻili ana i ka pā (Rhegmatogenous Retinal Detachment).

No ke aha ʻo "Macula-On" vs. "Macula-Off" ka uaki koʻikoʻi loa i ka ophthalmology¶

ʻaneʻane e hoʻomaka mau ʻia ka wehe ʻana o ka retina ma ka ʻaoʻao o waho o ka retina (e hana ana i ka pale ʻeleʻele a i ʻole ke aka ʻāwili ma ka ʻaoʻao o waho o ka hihiʻo) a ʻili mālie i loko i ka macula (ka puʻu liʻiliʻi liʻiliʻi o ka retina nona ka 20/20 heluhelu, hoʻokele, a me ka ʻike maka):

Pehea e hoʻonoho ai a pale aku i ka mea maʻi me ka Retinal Detachment i manaʻo ʻia¶

1. E hōʻemi i ka neʻe wikiwiki ʻana o ka maka (E hōʻalo i ka heluhelu ʻana a i ʻole ka ʻōwili ʻana ma ke kelepona): Ke heluhelu ke kanaka i ka kikokikona a i ʻole ka ʻōwili ʻana ma ke kelepona paʻa, e hana ko lākou mau maka i nā lele hoʻoneʻe wikiwiki i kapa ʻia ʻo saccades. ʻO ka hoʻoneʻe ʻana o ka maka Saccadic e hahau i ka gel vitreous i hope a i waho i loko o ka maka, e puhi ana i ka wai ma ka waimaka retinal a ʻili i ka detachment ma o ka macula. E haʻi i ka mea maʻi e hoʻomaha me ka paʻa mālie nā maka ʻelua (a i ʻole e nānā mālie pololei i mua ma kahi pā mamao) i ka wā e lawe ʻia ai i ka haukapila maka.
2. E hoʻomaopopo i ka hoʻonohonoho ʻana i ka ʻike maka: No ka mea, ʻo ka maka o ke kanaka he leki pahupaʻikiʻi e hoʻohuli i nā kiʻi i luna a hema a ʻākau:
3. Inā ʻike ka mea maʻi i kahi pākū ʻeleʻele e piʻi aʻe ana mai ka BOTTOM (ke kahua ʻike haʻahaʻa), ke kau nei ka retinal detachment maoli ma ka TOP (superior retina) o ka maka. ʻO ka hoʻokaʻawale kiʻekiʻe ka mea weliweli loa no ka mea, huki pololei ka ʻumekaumaha i ka wai i lalo i ka macula waena; e hoʻomoe i ka mea maʻi ma luna o ko lākou kua no laila ua pau ka umekaumaha i ka huki ʻana i ka wai i lalo.
4. Inā aia ka pale ʻeleʻele ma ka ** ʻaoʻao ihu (ihu)** o ka ʻike, aia ka wehe ʻana ma ka ʻaoʻao ʻaoʻao (pepeiao)** o ka retina; e hoomaha ka mea ma'i me ko lakou poo i hio i ka aoao pepeiao.
5. Ka ʻōlelo aʻoaʻo ʻea ʻea ma hope o ka hana ʻana (\(SF_6\) a i ʻole \(C_3F_8\) intraocular gas): Inā ua hoʻoponopono ka mea maʻi i ka retinal detachment me ka ʻōhū kinoea intraocular i loko o ko lākou maka, ** ʻAʻole pono e lele i ka mokulele, hele i nā wahi kiʻekiʻe o nā mauna, a i ʻole e loaʻa i ka nitrous oxide ("ʻakaʻaka ʻakaʻaka") ka maʻi maʻi ** a hiki i ka manawa e hoʻopaʻa ʻia ai ka ophthalmologist i 8 pakeneka pule). ʻO ke kiʻekiʻe kiʻekiʻe a i ʻole ka nitrous oxide e hoʻonui i ka huʻi kinoea i loko o ka maka i hoʻopaʻa ʻia, e piʻi ana i ke kaomi i \(80+\text{mmHg}\) a me ka makapō mau loa.

Kūlana 3: Hoʻopiʻi ʻia ʻo Central Retinal Artery Occlusion (CRAO / "Eye Stroke") a me Amaurosis Fugax¶

No ke aha i hoʻokaʻawale ai ka ʻAhahui Puʻuwai ʻAmelika iā CRAO ma ke ʻano he Acute Stroke¶

ʻO ka ophthalmic artery ka lālā mua loa mai ke aʻaʻa carotid kūloko i loko o ka iwi poʻo, a ʻo kona lālā hope, ʻo ke aʻa retina waena, e hoʻolako i nā ʻāpana o loko o ka retina. I ka wā e noho ai kahi aniani cholesterol (Hollenhorst plaque mai ke aʻa carotid ʻāʻī ʻāiki) a i ʻole ka ʻāʻī fibrin-platelet (mai ka puʻuwai i atrial fibrillation a i ʻole ka maʻi valve) i loko o ke aʻa retinal waena: - Loaʻa ka mea maʻi i ka ** hikiwawe, ʻeha ʻole, nalowale hohonu o ka ʻike ma ka maka hoʻokahi** i loko o kekona. - A i ʻole, inā e haki ka ʻōpū ma hope o 2 a 15 mau minuke, ʻike lākou i ka Amaurosis Fugax ("makapō wikiwiki", i wehewehe ʻia ma ke ʻano he malu puka aniani e huki mālie ana ma luna o ka maka hoʻokahi no 5 mau minuke a laila hoʻihoʻi i luna). ** ʻO Amaurosis fugax kahi Retinal Transient Ischemic Attack (TIA)**: inā paha e hoʻi ka ʻike i 100 pakeneka maʻamau ma hope o 5 mau minuke, hiki i ka mea maʻi ke loaʻa i ka lolo hemispheric nui a i ʻole ka makapō mau i loko o nā hola 24 a hiki i 72 mau hola.

ʻO ka protocol ulia pōpilikia koke no CRAO a me Amaurosis Fugax¶

1. Kahea koke iā 911 / 112 / 999 a noi i kahi kikowaena Stroke i koho ʻia: Mai ** ʻaʻole ** e hele i kahi keʻena mālama koʻikoʻi a i ʻole ka optometrist retail. Wahi a ka American Heart Association (AHA) Scientific Statement on Management of Central Retinal Artery Occlusion, ʻo nā maʻi e hōʻea ana i kahi Stroke Center i loko o **4.5 mau hola o ka hoʻomaka ʻana o ka hōʻailona ** hiki ke lilo i mau moho no **intravenous tissue plasminogen activator (alteplase a i ʻole tenecteplase) ** e hoʻopau i ka retinal artery clot ma ka ʻaoʻao o ke kaʻa. kiʻi, a me ka nānā ʻana i ka ECG.
2. E hoʻomoe i ka mea maʻi i palahalaha loa ma ko lākou kua: ʻO ka moe palahalaha e hoʻonui ai i ke kahe o ke koko i ke poʻo a me nā maka, e kōkua ana i ka hoʻokuʻu ʻana i ke koko ma nā moku koʻa i ka wā e hele ana nā mea lapaʻau.
3. Mai hana i ka lomilomi maka o ka maka a i ʻole ka ʻeke pepa ma ka home: ʻOiai ua wehewehe nā puke kahiko i ka lomilomi ocular digital a i ʻole ka hanu ʻana i loko o kahi ʻeke pepa, ʻo nā alakaʻi ophthalmology hou e hoʻoneʻe i ka hoʻopaʻa ʻia ʻana o ka maka ʻaʻole i aʻo ʻia no ka mea e hoʻopaneʻe ana i ka lawe ʻana i ke kikowaena waena a hiki ke haki i ka maka palupalu a ʻokiʻoki paha.

Kūlana 4: Giant Cell Arteritis (GCA / Temporal Arteritis) i nā mākua ma luna o 50 makahiki¶

ʻO Giant Cell Arteritis (GCA) he lāʻau ulia pōpilikia e hahau ana ** i nā poʻe mākua wale nō he 50 a ʻoi aku ** (ke kiʻekiʻe o ka makahiki 70 a 80 mau makahiki). I loko o GCA, hoʻouka ʻia ka ʻaʻaʻa ʻaʻa ʻokoʻa a me nā aʻa nui o ke poʻo a me ka ʻāʻī, ʻoi aku ka nui o ka ** aʻa ciliary hope pōkole e hānai i ke poʻo o ke aʻalolo optic (Arteritic Anterior Ischemic Optic Neuropathy [A-AION]).

ʻO ka "Save the Second Eye" Red Flag Checklist for Giant Cell Arteritis¶

Inā hoʻololi kekahi kanaka makua i ka makahiki 50 a ʻoi aku paha (ka ʻike pohihihi, ka pōʻeleʻele pōkole o ka hihiʻo, ka hapa o luna a i ʻole ka hapa lalo o ka hihiʻo, a i ʻole ** ʻike pālua ) i hele pū ʻia me KEKAHI o kēia mau hōʻailona, e hele koke i kahi keʻena pilikia o ka haukapila: - [ ] Hoʻomaka hou i ka ʻeha o ka ʻōpū (ʻoi loa ka ʻeha ʻana ma luna o hoʻokahi a i ʻole nā luakini ʻelua). - [ ] ** ʻO ka ʻeha o ke poʻo: ʻEha i ka wā e kāhili ai a i ʻole ka lauoho, e kau ana i nā aniani a i ʻole ka pāpale, a i ʻole e hoʻomaha i ke poʻo ma luna o ka uluna. - [ ] ** Hoʻomaka ʻia ka ʻāʻī (ʻO ka hōʻailona kikoʻī loa o GCA):** ʻO ka ʻeha ʻeha, ka luhi, a i ʻole ka ʻeha ma ka ʻiʻo a i ʻole ke alelo e ** hoʻomaka ma hope o ka nau ʻana i ka meaʻai paʻakikī (e like me ka ʻiʻo a i ʻole ka berena) no 1 a 2 mau minuke a kū i ka wā e hoʻomaha ai ka ʻāwae** (ke kuhi hewa pinepine ʻia ʻo TMJ a i ʻole he niho ʻino). - [ ] ** Nā hōʻailona Polymyalgia Rheumatica (PMR):** ʻO ka ʻoʻoleʻa o ke kakahiaka a me ka ʻeha ma nā poʻohiwi ʻelua, ka ʻāʻī, a me nā kāʻei ʻūhā, i hui pū ʻia me ka luhi i wehewehe ʻole ʻia, ka hou ʻana i ka pō, ke kuni haʻahaʻa, a i ʻole ka pohō kaumaha ʻole.

Palapala kamaʻilio pololei no 911/112/999 a me ka hoʻāʻo ʻana i ka haukapila¶

E hoʻohana i kēia mau palapala kikoʻī i hiki i nā mea hoʻouna a me nā limahana hoʻāʻo ke alakaʻi koke i ka mea maʻi i ka loea kūpono:

• No ka mea i manaʻo ʻia ʻo Central Retinal Artery Occlusion (CRAO) a i ʻole Amaurosis Fugax:

  "Pono au i kahi kaʻa kaʻa pilikia ma [Exact Address]. ʻO ka mea maʻi he [Male/female] makahiki i nalowale koke ka ʻike ma ka maka [hema / ʻākau] me ka ʻole o ka ʻeha o ka maka ma [Exact Time]. Manaʻo mākou he acute Central Retinal Artery Occlusion ('Eye Stroke') a i ʻole Retinal TIA a pono e lawe koke ʻia i loko o ka Designated Stroke5-hour. pukaaniani."

• No ka mea i manaʻo ʻia ʻo Giant Cell Arteritis (Makahiki 50+):

  *"Aia au i ka ho'āʻo ulia pōpilikia me kahi maʻi maʻi [makahiki] i hoʻomohala koke i ka [ʻike maka / ʻike pālua] ma ka maka [hema / ʻākau] i hui pū ʻia me [ke poʻo o ka luakini hou / ʻili poʻo / ʻeha ʻāwae i ka wā e nau ana]. Manaʻo mākou Giant Cell Arteritis (Temporal Arteritis) a pono e hoʻoponopono koke i ke kauka lapaʻau kūikawā no ka pale ʻana i ka methylpstat i loko o ka maka.

• No ka mea i manaʻo ʻia he maʻi maʻi maʻi hoʻopaʻa ʻana i ka angle-closure glaucoma:

  • "Ua loaʻa koke i ka mea maʻi ka ʻeha o ka maka a me ka lae [hema/ ʻākau] ʻeha, ʻike pohihihi me ke anuenue halo, luaʻi projectile, he maka ʻulaʻula me kahi koʻa mahu, a me kahi haumāna waena waena. Ke manaʻo nei mākou ʻo Acute Angle-Closure Glaucoma, ʻaʻole he migraine maʻalahi a i ʻole ka ʻōpū o ka ʻōpū, a pono e kāhea koke i ke ana o ka intraocular pressure a me ka ophthalm."*

Nīnau pinepine¶

No ke aha e noho ai ke kanaka me ka glaucoma pani ʻokiʻoki i loko o kahi lumi ʻālohilohi a ʻaʻole loa e ʻaʻahu i kahi pale maka ʻeleʻele?¶

I loko o ka glaucoma pani ʻokiʻoki, ʻo ka ʻaoʻao o waho o ka iris kala e hoʻopaʻa ʻia a keakea nei i ke kihi hoʻokahe wai o ka maka. ʻO ka uhi ʻana i ka maka me kahi ʻāpana ʻeleʻele a i ʻole ka noho ʻana i loko o kahi lumi ʻeleʻele e hoʻomāhuahua ai ka haumāna (ākea), ʻo ia ka mea e hoʻopili ai i ka ʻiʻo iris a mānoanoa aʻe i ke kihi o ka maka a hoʻonui i ke kaomi; ʻO ka noho ʻana i loko o kahi lumi mālamalama ʻoiai e moe palahalaha ana ma kou kua e kōkua i ka hoʻopaʻa ʻana i ka haumāna a huki i ka iris mai loko mai o ka ʻauwai paʻa.

Inā e piʻi aʻe ana kahi pale ʻeleʻele o ka nalo ʻana mai lalo mai o koʻu ʻike, no ke aha lā ka haʻihaʻi o ka retinal maoli ma ka piko o koʻu ʻōpoʻo maka?¶

ʻO ka leki ma ke alo o ka maka o ke kanaka e kulou i nā kukuna kukui e hiki mai ana i mea e hoʻohuli ʻia ke kiʻi i kau ʻia ma luna o ka retina ma hope o ka maka a huli i ka hema a i ka ʻākau. No laila, ʻike ka hapalua o luna (kiʻekiʻe) o kāu retina kino i ka hapa lalo (haʻahaʻa) o ka lumi; ʻO ka pale ʻeleʻele e piʻi aʻe ana mai lalo o kou ʻike maka ʻo ia ka wehe ʻana o ka piko o kou retina a ke huki nei ka ʻumekaumaha iā ia i lalo i kou macula waena, e lilo ia i mea hoʻomaʻamaʻa koke.

Inā pōʻeleʻele koʻu maka ma ka maka hoʻokahi no 5 mau minuke e like me ka malu o ka puka makani a hoʻi hou i ka maʻamau, pono anei au e hele i ka lumi pilikia i kēia manawa?¶

ʻAe, ʻo ka makapō ʻeha ʻole ma ka maka hoʻokahi a mau minuke (i kapa ʻia ʻo amaurosis fugax) he retinal transient ischemic attack (TIA), maʻamau ma muli o kahi pā cholesterol a i ʻole ʻāʻī koko e haki ana mai kahi aʻa carotid ʻāʻī a i ʻole ka puʻuwai a hoʻopili pōkole i ke aʻa retinal. ʻOiai ua hoʻomaʻemaʻe ʻia kāu ʻike i ka neʻe ʻana o ka puʻupuʻu liʻiliʻi, ua pilikia ʻoe i ka maʻi lolo mau loa a i ʻole ka makapō mau loa i nā hola 24 a hiki i 72 a pono ʻoe i kahi hoʻomaʻamaʻa ʻana o ka lumi pilikia.

Pehea e hiki ai i ke poʻo a me ka ʻeha ʻāwae ke nau ʻai i ka makapō mau loa?¶

I ka poʻe mākua ma luna o 50 mau makahiki, ʻo ka maʻi poʻo hou o ka luakini i hui pū ʻia me ka ʻeha a me ka luhi ʻoiai e nau ana i ka meaʻai (jaw claudication) ka hōʻailona maʻamau o Giant Cell Arteritis (temporal arteritis), he ʻaʻa autoimmune e pehu ana i nā paia o nā aʻa waena ma ke poʻo a paʻa lākou. Ke paʻa kēia ʻā i nā ʻaʻaʻa ciliary liʻiliʻi e hānai ana i ke aʻalolo optic, make koke ke aʻalolo optic; ʻO ka mālama ʻana i ka steroid intravenous i ka haukapila e koi ʻia i loko o nā hola e pale ai i ka mumū mai ka makapō ʻana i kekahi maka.

Nānā ʻia nā kumu¶

• Ahahui Puʻuwai ʻAmelika (AHA) a me American Stroke Association (ASA, United States): Management of Central Retinal Artery Occlusion: He Scientific Statement From the American Heart Association (Mac Grory et al., Stroke, classifying CRAO as a acute ischemic stroke emergency and outlining the \(\le 4.5\text{hour}\)).
• American Academy of Ophthalmology (AAO, United States): Preferred Practice Pattern (PPP) Guidelines: Primary Angle-Closure Disease, Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration, a me Retinal and Ophthalmic Artery Occlusions.
• Royal College of Ophthalmologists (RCOphth, United Kingdom) and College of Optometrists (United Kingdom): Ophthalmic Services Guidance: Emergency Eye Care in Hospital Eye Units and Primary Care (Macula-On vs. Macula-Off retinal detachment surgical time and acute angle-closure management).
• American College of Rheumatology (ACR, United States), European Alliance of Associations for Rheumatology (EULAR), a me British Society for Rheumatology (BSR, United Kingdom): Clinical Practice Guidelines for the Management of Giant Cell Arteritis (koke kiʻekiʻe kiʻekiʻe IV methylprednisolone $500\text/0}\text for prior text{0}\text no ka mg. biopsy).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Stroke and Transient Ischemic Attack in Over 16s: Diagnosis and Initial Management (NG128, me amaurosis fugax / retinal TIA ala pilikia).

Nā alakaʻi pili¶

• Nā ʻeha o ka maka: ke kuni kemika, ka ʻeha komo, a me ka hyphema
• ʻO nā mea ʻē aʻe ka maka, ka ʻāʻī ʻana o ka ʻiʻo, a me ke kōkua mua uila uila
• ʻO ka ʻike ʻana i ka hahau (FAST) a me ka pane ulia pōpilikia
• Nā ʻeha poʻo a me nā hae ʻulaʻula
• ʻO nā pilikia maʻi diabetes: hypoglycemia a me DKA kōkua mua