I- posterior engxenyeni yemisebenzi iso ngokulondoloza isimo se-eyeball, ibambe i-lens endaweni, futhi idala impulses ye-nerve ebuchosheni ukusuka kumaseli we-photoreceptor ngemuva kwamehlo.
I- retina , i- choroid (i-layer layer ye-iso), ne-optic nerve ihlanganisa ingxenye enkulu ye-posterior, enezinkinga eziningi ezihlobene ne-HIV ezethula ngaphakathi kwalezi zingxenye zomzimba, kaningi kwisifo se-HIV esesimweni esilandelayo.
Ukuphazamiseka kwesigaba se-posterior-ngokuyinhloko okwethulwa ngezinguquko zamathambo ku-retina-kubonakala ku-50% kuya ku-70% weziguli ezine- HIV , futhi kungase kube nomphumela wokulimala okuqhubekayo noma okunamandla ku-retina (ebizwa ngokuthi i-retinopathy).
Ezinye izifo ezihlobene ne-HIV ezingxenyeni ezihamba phambili zifaka:
- I-Cytomegalovirus (eyaziwa nangokuthi i-CMV)
- I-Toxoplasmosis (isifo sofuba esivamile futhi esithwala kalula)
- I-Cryptococcosis (esinye isifo sofuba esithinta i-HIV)
- Isifo sofuba (i-TB)
I-Cytomegalovirus
I-Cytomegalovirus (i-CMV) i-herpesvirus ehlasela abangaphezu kwengu-50 yabantu abadala, engabonakali ngezifo kulabo abanamasosha omzimba afanelekayo (ngaphandle, ngezikhathi ezithile, nezimpawu ezinjenge- mononucleosis ). Ngenkathi ivame ukudluliselwa ngokungafani kusukela kumama kuya kumntanami, ingadluliselwa ekukhuleni ngokuxhumana kocansi. Ngenxa yalokho, ukusabalalisa kwe-CMV kubantu abesilisa nabesilisa kungaba ngu-90%, njengoba kunabantu abanesandulela ngculaza.
I-CMV ingabonisa ngezindlela ngezindlela eziningi, nakuba ivame ukwenza njalo nge-inflammation ekhubazayo nge-retina, eyaziwa nje ngokuthi i-retinitis. Lesi sifo sivame ukuvela ezigulini ezibalwa nge- CD4 count ngaphansi kwezingu-50 amaseli / mL futhi zibonisa izimpawu ezivela ekubonweni kwezinto ezibhebhetheka phansi kuya ekulahlekelweni okubukwayo ngisho nokuphuphuthekisa.
Uma izilonda ze-CMV zikhonjisiwe kwi-retina, zingathuthuka ngokushesha, ngokuvamile zingakapheli amasonto. Ngaphandle kokungenelela kwezokwelapha, izilonda zingathuthuka phakathi kwe-centrifugally (ukwandisa ngaphandle ukusuka phakathi), ukunciphisa amandla okubukwa futhi ngezinye izikhathi kuholela ekulahlekelweni okuphelele kombono. Ngenkathi i-CMV retinitis ivame ukuveza ngokubili (kokubili amehlo), ingabonisa futhi ngokungafani (kwelinye iso).
I-Valganciclovir ibhekwa njengesidakamizwa esikhethweni sokwelashwa kwe-CMV retinitis, enqunywe ngomlomo njengomthamo wemihla ngemihla ngesikhathi sokungeniswa, kulandelwa umthamo owodwa wansuku zonke ngesikhathi sokugcinwa. I-Ganciclovir ingabuye ibekwe kodwa ihanjiswe ngaphakathi, kunokuba isetshenziswe ngomlomo, isikhathi esingangezinsuku ezingama-21.
Ngokuvamile, izimpande ze-intravitreal ganciclovir-ngokoqobo, izintambo ezincane ezingenakunikelwa ezithunyelwa ngqo kusayithi lokutheleleka-ngezinye izikhathi zifakwe esweni. Ngokuvamile esetshenziselwa amacala amakhulu kakhulu we-CMV retinitis, ivumela ukugxila kwezidakamizwa okwesikhathi eside, okuqhubekayo ku-vitreous humor (ijel ecacile eligcwalisa isikhala phakathi kwe-lens ne-retina).
I-Toxoplasma
I-Toxoplasma iyimbangela ejwayelekile kunazo zonke ye-retinochoroiditis (ukutheleleka kwe-retina kanye / noma i-choroid) kubantu abaningi, kanti okwesibili kuvame kakhulu kubantu abane-HIV.
Ebangelwa i-protozoan parasite, i- Toxoplasma gondii , lesi sifo sithinta abantu abangaphezu kuka-200 000 e-US njalo ngonyaka, futhi sisakazwa ngokungahambisani noma ngokungenisa inyama ecolile. Ngokuvamile kuvame ukuhambisana namakati (nakuba ekhona ngezidalwa eziningi ezifudumele), uxhumane ne-cat feces kubonakala nokuba yisisusa esibalulekile sokudluliselwa kwe- T. gondii .
Lapho i-toxoplasmosis ibeka iso, ibonisa ukuthi i-yellow-white i-lesion grey ekhanyayo ihambisana nokuvuvukala kwama-vitreous humor. Ukutholakala ngokuvamile kungenziwa ngokuhlolwa kwamehlo, nokuhlolwa kwegazi okwenziwe i- antibody- basesimweni esihlinzeka isiqiniseko se-serological.
Ngezinye izikhathi i-steroid ye-topical isetshenziselwa ukuphatha amacala amabi kakhulu okuthiwa i-toxoplasma retinochoroiditis, kuyilapho izimo ezinzima zivame ukushiwo inhlanganisela ye-pyrimethamine, i-folinic acid ne-sulfadiazine. Kubantu abanesandulela-ngculazi esithuthukisiwe, ukuqhubeka nokwelapha okungapheli kungadingeka, izikhathi eziningi ngokusetshenziswa kwe-trimethoprim-sulfamethoxazole, inhlanganisela evame ukubekezelela kahle.
Cryptococcosis
I-Cryptococcosis iyisifo esivela ekungeneni kwamanzi, ama- cryptococcal neoformans spores, angabonakala nge-meningitis (ukuvuvukala kwesinye isikhathi sokuphila kwesibindi sokuzivikela esizungeze ubuchopho nomgogodla). Ukubandakanyeka okukhulu kunomuntu okwenzeka njengesivivinyo sesibili ngesikhathi sezinkinga ezinkulu ze- cryptococcal meningitis , ikakhulukazi uma ihambisana ne-septicemia.
Izifo ze-OMS zingadluliselwa ngesimiso sezinzwa zomphakathi (CNS) nge-nertic optic noma ngegazi lapho isifo sisakazwa (ie, sisa ngaphezu kwengculaza yomthombo).
Uma uhlolwa, izilonda eziningi eziphuzi zingabonakala kwi-choroid kanye / noma i-retina. Uma ishiywe ingalashwa, ukusakazeka kokutheleleka emavikini we-optic nerve ngezinye izikhathi kungaholela ekulahlekelweni okubukwayo.
Ukwelashwa ngokwemvelo kwe-cryptococcal meningitis ngokuvamile kuhanjiswa nge-intraveous amphotericin B ne-flucytosine, kubhekwa ukwelashwa okukhethile. Imithi ye-Antifungal nayo ivame ukushiwo lapho kucatshangwa ukuthi kuhileleke ekuzileni.
Isifo sofuba
Isifo sofuba (i-TB) sivame ukungavamile kunezinye izifo zeso ezihlotshaniswa ne-HIV kodwa ngezinye izikhathi kubonakala ezigulini ze-HIV ezine-TB ezisebenzayo ze-TB. Kuvame ukwethula njenge-granuloma efana ne-nodule e-choroid futhi ingabonakalisa ekubalweni okungaphezulu kwe-CD4 (ngaphezu kuka-150 amaseli / mL) kunezinye izifo ezihlobene ne-HIV ezingxenyeni ezingemuva. Ukwelashwa okuyisimiso nemithi elwa ne-TB ngokuvamile kunqunywe njengenkambo yokunconywa enconywayo.
Imithombo:
I-Espino Barros Palau, A .; Morgan, L .; I-Foroozan, R .; et al. "Iziphakamiso Ze-Neuro-Ophthalmic and Treatment of Cryptococcal Meningitis-Related Increased Intracranial Pressure." I- Canadian Journal of Ophthalmology. Okthoba 2014; 49 (5): 473-477.
UHarll, uM. and Carvounis, uP. "Ukwelashwa Kwamanje Kwe-Toxoplasma Retinochoroiditis: Ukubukezwa Okusekelwe Ebufakazi." I-Journal of Ophthalmology. Agasti 13, 2014; DOI http://dx.doi.org/10.1155/2014/273506.
Jackson, J .; U-Erice, A .; Englund, J .; et al. "Ukuqhathaniswa kwe-Cytomegalovirus Antibody kumaHemophiliacs nobulili obufanayo abathintekayo nge-Human Immunodeficiency Virus Uhlobo 1." Ukuthutha. Ngo-Mashi-Ephreli, 1988; 28 (2): 187-189.
Okuphelele, J .; Ukudideka, W .; I-Dromer, F .; et al. "Imihlahlandlela Yokusebenza Ngokwemitholampilo Yokulawulwa Kwezifo Ze-Cryptococcal: Ukubuyekezwa kuka-2010 yi-Infectious Diseases Society of America." Izifo Ezithathelwanayo Emitholampilo. NgoJanuwari 4, 2010; I-DOI: 10.1086 / 649858.
Rocha Lima, B. "Ukubonakaliswa kwezifo ezithathelwanayo nge-HIV Infection." I-Digital Journal ye-Ophthalmology. Okthoba 29, 2004; 10 (3): inguqulo ye-intanethi.
Stewart, M. "Ukuphathwa Okuphelele Kwe-Cytomegalovirus Retinitis Kwabeziguli abane-AIDS." Ophthalmology Clinic. Ngo-Ephreli 6, 2010; 4: 285-299.
I-Sudhakar, i-P .; IKedari, uS .; noBergger, J. "I-Neuro- Ophthalmalogy ye-HIV / AIDS Review of Neurobehavioral HIV Medicine." Imithi ye-HIV ye-Neurobehavioral . Ngo-September 17, 2012; 2012 (4): 99-111.
I-Zhang, M .; I-Zhang, J .; kanye no-Liu, Y. "Imibukiso Yomtholampilo Nemiphumela Yokwelapha Yesifo Sesifo Sofuba Esithathelwanayo." I-Retina. April 2012; 32 (4): 805-813.