خاص كلاسي .. د/ عبدالعزيز حبيب : المياه الزرقاء تؤدي إلى العمى التام في الحالات المتأخرة
حوار : ندى علاء
عينا الإنسان دائماً ما تكون لهما خصوصية في التعامل وتتطلب دقة عالية وحساسة وعندما يصاب الإنسان بأي مشكلة لها علاقة بالعين دائماً ما يكون لديه الكثير من التخوفات والقلق ليبحث عن طبيب عيون موثوق ويمتاز بالكفاءة والدقة ويعطيه الآمان في الخطوات العلاجية خاصة عندما تتطلب هذه الخطوات إجراء عملية للعين
ومن هنا كان من الضروري إجراء حوار مع طبيب من أكثر الأطباء كفاءة وهو د. عبد العزيز حبيب – زميل المجلس الدولي لطب العيون بسويسرا، وعضو الكلية الملكية لجراحي العيون بإدنبرة – المملكة المتحدة
ليجيب لنا عن كل ما يتعلق بعمليات تصحيح الإبصار
* في البداية دكتور عبدالعزيز ما هو الفرق بين عمليات الليزك والفيمتو ليزك و PRK ؟
** الليزك هي عملية تصحيح إبصار عن طريق رفع شريحة رقيقة أو “فلاب” من القرنية وهذه “الفلاب” لها سمك محدد ولها أكثر من طريقة لرفعها فيمكن أن ترفع بمشرط إلكتروني أو “بإستخدام الفيمتوليزر” وبعد أن نرفعه نقوم بإصلاح المقاس المطلوب ثم نعيد الفلاب إلى مكانها الطبيعي ومن المفترض ألا تزيد مقاسات تصحيح الإبصار بالليزك والفيمتو ليزك عن -8 إلى -10 تختلف من حالة إلى أخرى وتسمى عملية الفلاب المقام بإستخدام الفيمتو باسم “فيمتو ليزك ” أما إذا كانت العملية مقامة بإستخدام مشرط إلكتروني فتسمى “ليزك”.
** أما ال PRK هو “الليزك السطحي” ليست ترجمة حرفية ولكن الإسم العملي لها فسطحي تعني نزول الليزر على سطح القرنية مباشرة دون عمل أي شريحة أو فلاب أو إحداث أي قطع بالقرنية لتصحيح الإبصار ويمكن تصحيح درجة، درجتين، ثلاثة أو أربعة.
** من عيوب الليزك السطحي أنه لا يمكن استخدامه في المقاسات الكبيرة، لأن التأهيل البصري يأخذ وقت أطول فممكن أن يمتد في بعض الحالات إلى 8 أسابيع أي شهرين تقريباً وهذا غير مناسب لكل الأشخاص.
** وبالتالى لا نستطيع أن نقوم بعمل أكتر من -3 أو -4 بالليزك السطحي، العيب الثانى لها أنها قد تكون مؤلمة في أول يومين أو ثلاثة لكنه ألم محتمل وهناك حالات عديدة تقوم بإجراء تلك العملية ويخرجون منها سعداء جداً بالنتيجة، وحالات أخرى لا يشعرون بأي ألم على الإطلاق.
** الميزة أنه آمن جداً بل من أكثر العمليات أمانا لأن القرنية لا يحدث أى تدخل أو قطع فيها ويكون مناسباً في حالة وجود شخص له سمك قرنية قليل ولا يمكن عمل فلاب له ويكون من الخطورة أن أقوم له بإجراء عملية ليزك أو فيمتو ليزك وبالتالى ال PRK إذا كانت مقاساته صغيرة سيكون الليزك السطحي هو الخيار المناسب.
* هل عملية تصحيح الإبصار تؤثر على كفاءة النظر للمريض على المدى الطويل؟
** الطبيعى أننا نقوم به في قصر النظر أو الإستيجماتيزم سواء الليزك أو ال PRK أو الفيمتو ليزك أما حالات طول النظر أنا شخصيا لا أفضل فيها عمل تصحيح للقرنية سواء بالليزك أو الفيمتو ليزك إلا في المقاسات الصغيرة. وقد نلجأ إلى التصحيح بزرع العدسات.
** أما إذا كان المريض عنده قصر نظر ومقاساته مناسبة وعمره 18 عام أو أكثر ونظره ثابت وهي من أهم النقاط أن يكون نظره ثابت لمدة عام على الأقل.
وفحوصات القرنية لديه جيدة فنتوقع بنسبة لاتزيد عن 3 – 5٪ أن المقاس يرجع بعد 3 أو 4 سنوات وإذا عاد فيعود بنسبة قليلة جداً.
وإذا كان سنه أقل من 18 عام أو أن يكون مقاسه غير ثابت أو الفحوصات بها خلل أو غير جيدة فلا يُنصح بإجراء عمليات تصحيح الإبصار.
* متى يمكن إعادة الفحوصات للتأكد من عدم ضعف النظر مرة أخرى بعد عمليات تصحيح الإبصار ؟
** نحن لا نطلب من المريض أن يقوم بأي فحوصات للإطمئنان على عملية تصحيح الإبصار إلا إذا كان هناك شكوى أو تدهور في النظر عقب العملية فإذا قام مثلاً بعمل العملية في سن ال20 ..طالما هو في حالة جيدة فليس مطالب بالكشف أو عمل فحوصات لعدم وجود شكوى إطلاقا هذا من جهة أما من جهة أخرى فإذا قام بعملية الليزك بعد سن 18 حتى سن 40 فيُنصح بالكشف مرة كل عامين على الأقل.
وإذا شعر المريض بقصور في الرؤية أو وجود مشكلة ما فيجب عليه الكشف على الفور سواء كان عامل تصحيح ابصار قبل ذلك أم لا.
* مرضى السكر أول جزء يحدث به خلل هي شبكية العين فما نصيحتك لمريض السكر ؟
** مريض السكر من الضروري جدا أن يضبط سكره زي الطبيعي وهذا ليس شئ مستحيل مع دكتور غدد الصماء والسكر وهذا التخصص المسؤول عن ضبط السكر سواء بأدوية أو أنسولين فيجب سماع إرشادات الطبيب ومن الضروري جداً ضبط السكر بحيث أن السكر التراكمي لا يجب أن يزيد عن 6,5 الى 7 كحد أقصى ويجب إجراؤه كل 3 شهور.
** بعد ضبط السكر يجب متابعة العين وعمل فحص قاع العين على الأقل مرة في العام إلا إذا اكتشفنا خلل في الشبكية فيطلب منك طبيب العيون المتابعة كل 3 شهور أو كل 6 شهور حسب كل حالة حتى وإن كان نظرك جيداً فإن السكر يؤدى في البداية إلى تآكل واعتلال في أطراف الشبكية في والذي لا يؤثر كثيراً على الرؤية في بداية الأمر ولا يشعر به المريض.
* ما هى المياه البيضاء وأخطارها على مريض السكر ؟وهل يمكن أن تتحول إلى المياه الزرقاء؟
** المياه البيضاء هي اعتام في العدسة البلورية الداخلية للعين.
** في مرضى السكر يكون تكونها أسرع من الطبيعي
وفي الإنسان الطبيعي تأتى له المياه البيضاء فوق سن الخمسين أو 55 وذلك بسبب تقدم السن وليست مرض في العين أما مريض السكر يمكن أن تأتي له مبكراً قبلها ب5 أو 10 سنوات وكلما أهملت السكر كلما زادت إحتمالات إصابة الشبكية أو سرعة تكوّن المياه البيضاء.
** لا نخاف من إجراء عملية المياه البيضاء نفسها فهي عملية سهلة وهي أكثر العمليات إجراءاً في العالم ونسبة نجاحها عالية جداً ولكن الخوف من تأثير السكر على الشبكية ومن الاعتلال السكري للشبكية أو المياه الزرقاء التي من الممكن أن تأتي كمضاعفات للسكر حتى مع عدم وجود المياه البيضاء فالسكر يمكن أن يقوم بعمل خلل في الأوعية الدموية للعين فبالتالي تتكون أوعية غير طبيعية أو “تكاثرية” كما تسمى فتظهر في الأماكن المسؤولة عن تنظيم ضغط العين وهي “زاوية العين” وتتسبب في ارتفاع ضغط العين وتكوين المياه الزرقاء.
*هل من الممكن أن تتحول المياه البيضاء إلى زرقاء أو تسببها ؟!
** في حالات قليلة جدا تتسبب المياه البيضاء في حدوث مياه زرقاء لكن لا تتحول إليها هذا شيء وذلك شيء آخر.
** لكن بعض أنواع المياه البيضاء تتسبب في حدوث المياه الزرقاء مبكراً حتى دون أن تكون المياه البيضاء مؤثرة على النظر ويمكن أن نعرفها بالكشف العادي وحينها ننصح المريض بإجراء عملية المياه البيضاء لمنع التسبب حدوث في المياه الزرقاء.
* هل المياه الزرقاء تؤدى إلى العمى ؟
** بالطبع في الحالات المتأخرة منها دون علاج قد تؤدي إلى العمى التام.
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