Retinopathy o ka wā ma mua

ʻO Retinopathy o ka prematurity (ROP) kahi ulu o ke kīʻaha koko ma ka retina o ka maka. Kū i loko o nā pēpē i hānau mua ʻia (premature).

ʻO nā kīʻaha koko o ka retina (i ka hope o ka maka) hoʻomaka e hoʻomohala ma kahi o 3 mau mahina i ka hāpai keiki. I ka hapanui o nā hihia, hoʻomohala piha lākou i ka manawa o ka hānau maʻamau. ʻAʻole hiki i nā maka ke hoʻomohala pono inā hānau ʻia kahi pēpē i ka wanaʻao. Hiki paha i nā moku ke kū i ka ulu ʻana a ulu ulu ʻole paha mai ka retina a i ka hope o ka maka. Ma muli o ka palupalu o nā moku, hiki iā lākou ke kahe a kumu ke kahe o ka maka i ka maka.

Hiki ke hoʻomohala a huki i kaʻiʻo scar mai ka maka o loko o ka maka (retina detachment). I nā hihia koʻikoʻi, hiki i kēia ke hopena i ka nalo ʻana o ka hihi.

I ka wā ma mua, ka hoʻohana ʻana o ka nui o ka oxygen i ka mālama ʻana i nā pēpē ma mua i ulu ai nā moku i mea maʻamau ʻole. Loaʻa nā ʻano hana ʻoi aku ka maikaʻi no ka nānā ʻana i ka oxygen. ʻO ka hopena, ua lilo ka pilikia i mea liʻiliʻi, keu hoʻi i nā ʻāina kūkulu. Eia nō naʻe, eia nō ke kānalua nei e pili ana i ka pae kūpono o ka oxygen no nā pēpē premature i nā makahiki like ʻole. Ke aʻo nei nā kānaka noiʻi i nā kumu ʻē aʻe ma mua o ka oxygen e ʻike ʻia e hoʻohuli i ka makaʻu o ROP.

I kēia lā, pili ka makaʻu o ka hoʻomohala ʻana i ka ROP i ke degere o ka prematurity. ʻO nā pēpē liʻiliʻi me nā pilikia o ka lāʻau i ʻoi aku ka makaʻu.

Aneane pau loa nā pēpē i hānau ma mua o 30 mau pule a i ʻole ke kaupaona ʻana ma lalo o 3 paona (1500 gram a i ʻole 1.5 kilokilo) i ka wā hānau e nānā ʻia no kēia ʻano. ʻO kekahi mau pēpē makaʻu nui i kaupaona i 3 a 4.5 mau paona (1.5 a 2 kilokilo) a i hānau ʻia ma hope o 30 mau pule e pono nō hoʻi e nānā ʻia.

Ma waho aʻe o ka prematurity, hiki i nā mea ʻē aʻe ke komo pū me:

• Kū iki i ka hanu ʻana (apnea)
• Maʻi maʻi puʻuwai
• ʻO ke kalapona kalapona kiʻekiʻe (CO2) i loko o ke koko
• Maʻi kīnā
• Hōʻemi koko haʻahaʻa (pH)
• Ka oxygen liʻiliʻi o ke koko
• Hoʻopilikia hanu
• Kuhi puʻuwai lohi (bradycardia)
• Hoʻokahekahe

Ua iho nui ka helu o ROP i ka hapanui o nā pēpē kamaliʻi i nā ʻāina kūkulu i nā makahiki i hala aku nei ma muli o ka mālama maikaʻi ʻana i ka neonatal intensive care unit (NICU). Eia nō naʻe, ʻoi aku ka nui o nā pēpē i hānau mua ʻia i kēia manawa e hiki ke ola, a ʻo kēia mau pēpē mua loa ka mea nui no ROP.

ʻAʻole hiki ke ʻike ʻia nā loli o ke kīʻaha me ka maka ʻōlohelohe. Pono kahi hoʻokolohua maka e ka ophthalmologist e hōʻike i kēlā mau pilikia.

Aia he ʻelima pae o ka ROP:

• Kahua I: Aia ka ulu liʻiliʻi o nā kīʻaha koko.
• Kahua II: He ulu kūpono ʻole ka ulu ʻana o nā kīʻaha koko.
• Kahua III: He mea ʻokoʻa ka ulu ʻana o nā kīʻaha koko.
• Kahua IV: He ulu ʻokoʻa ka ulu ʻana o ke kīʻaha koko a aia kekahi retina hoʻokaʻawale hapa.
• Kahua V: Aia he huina retina hoʻokaʻawale.

ʻO ke pēpē me ROP, hiki ke hoʻohālikelike ʻia me ka loaʻa ʻana o ka "maʻi plus" inā pili nā kīʻaha koko ʻokoʻa i nā kiʻi i hoʻohana ʻia e ʻike pono i ke ʻano.

ʻO nā ʻōuli o ka ROP koʻikoʻi e hoʻopili ʻia:

• Nā neʻe maka ʻole
• Nā maka i kau ʻia
• ʻIke mamao loa
• Nā haumana ʻimi keʻokeʻo (leukocoria)

ʻO nā pēpē i hānau ʻia ma mua o 30 mau pule, kaupaona ma lalo o 1,500 mau huna (ma kahi o 3 paona a i ʻole 1.5 kilokilo) i ka wā hānau, a i ʻole he makaʻu nui no nā kumu ʻē aʻe e pono i nā hōʻike retina.

I ka hapanui o nā hihia, pono ka hōʻike mua ma waena o 4 a 9 mau pule ma hope o ka hānau ʻana, kaukaʻi ʻia i ka wā hānau o ka pēpē.

• Hānau ʻia nā pēpē i 27 mau pule a i ʻole ma hope pinepine i kā lākou hōʻike ma 4 mau makahiki o ko lākou makahiki.
• ʻO nā mea i hānau mua ʻia he mau hōʻike ma hope.

Hoʻokumu ʻia nā hoʻokolohua ukali ma nā hopena o ka hōʻike mua. ʻAʻole pono nā pēpē i kahi hōʻike hou inā ua hoʻopau nā kīʻaha koko i nā retina ʻelua i ka ulu maʻamau.

Pono e ʻike nā mākua i ka mea e pono ai nā hōʻike ʻana o ka maka o ka maka ma mua o ka haʻalele ʻana o ka pēpē i ka nursery.

Ua hōʻike ʻia ka lapaʻau mua ʻana e hoʻomaikaʻi i ka manawa o ka pēpē no ka hihi maʻamau. Hoʻomaka ka hoʻomaʻamaʻa ma waena o 72 mau hola o ka hōʻike maka.

ʻO kekahi mau pēpē me ka "plus disease" pono e mālama koke ʻia.

• Hoʻohana ʻia ka laser therapy (photocoagulation) e pale ai i nā pilikia o ka ROP holomua.
• Hoʻopau ka laser i nā kīʻaha koko maʻamau mai ka ulu ʻana.
• Hiki ke hana i ka lāʻau i loko o ka nursery me ka hoʻohana ʻana i nā pono lawe lima. E hana maikaʻi, pono e hana ʻia ma mua o ka hoʻomohala ʻana o ka retina i ka scarring a i ʻole ka hemo ʻana mai ke koena o ka maka.
• Ke aʻo ʻia nei nā ʻano lāʻau ʻē aʻe, e like me ka hoʻopili ʻana i kahi antibody i ālai i ka VEG-F (kahi ulu ulu o ke koko) i ka maka.

Pono ke ʻoki kino inā hemo ka retina. ʻAʻole ka hopena ke hopena ma ka ʻike maikaʻi.

ʻO ka hapa nui o nā pēpē me ka pohō ʻike nui e pili ana i ka ROP he mau pilikia ʻē aʻe e pili ana i ka hānau mua ʻana. Pono lākou i nā ʻano lapaʻau like ʻole.

Ma kahi o 1 o 10 mau pēpē me nā loli mua e ulu i ka maʻi retinal ʻoi loa. Hiki i ka ROP koʻikoʻi ke alakaʻi i nā pilikia nui o ka hihiʻo a makapō paha. ʻO ke kumu nui i ka hopena ka ʻike mua ʻana a me ka mālama ʻana.

Komo pū kekahi me ka pilikia i ka nearsightedness a makapō paha.

ʻO ke ala ʻoi loa e pale ai i kēia ʻano e hana i nā ʻanuʻu e hōʻalo ai i ka hānau mua ʻana. Hiki paha i ka pale ʻana i nā pilikia ʻē aʻe o ka prematurity ke pale aku iā ROP.

Ribrolental fibroplasia; ROP

Fierson WM; ʻAmelika ʻAmelika Hui Pū ʻIa Pediatrics ma Ophthalmology; American Academy o Ophthalmology; ʻAmelika Hui Pū ʻIa no Pediatric Ophthalmology a me Strabismus; ʻAmelika Hui Pū ʻIa o Orthoptists hōʻoia. ʻO ka loiloi loiloi ʻana i nā pēpē premature no ka retinopathy o ka wā ʻōpio. Pediatrics. 2018; 142 (6): e20183061. Pediatrics. 2019; 143 (3): 2018-3810. PMID: 30824604 www.ncbi.nlm.nih.gov/pubmed/30824604.

Olitsky SE, Marsh JD. Nā maʻi o ka retina a me ka vitreous. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 648.

ʻO Sun Y, Hellström A, Smith LEH. Retinopathy o ka wā ma mua. I: Martin RJ, Fanaroff AA, Walsh MC, hua. ʻO Fanaroff lāua ʻo Martin's Neonatal-Perinatal Medicine. 11th hua. Piladelapia, PA: Elsevier; 2020: chap 96.

ʻO Thanos A, Drenser KA, Capone AC. Retinopathy o ka wā ma mua. I: Yanoff M, Duker JS, eds. Ophthalmology. 5th lā. Piladelapia, PA: Elsevier; 2019: chap 6.21.