{"id":9985,"date":"2019-05-22T12:09:06","date_gmt":"2019-05-22T05:09:06","guid":{"rendered":"https:\/\/www.hmm88i.com\/drug\/?p=9985"},"modified":"2019-05-22T12:09:32","modified_gmt":"2019-05-22T05:09:32","slug":"cac-thuoc-dieu-tri-nhung-benh-ly-lien-quan-den-nua-phan-sau-cua-mat","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/cac-thuoc-dieu-tri-nhung-benh-ly-lien-quan-den-nua-phan-sau-cua-mat\/","title":{"rendered":"\u001dC\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn n\u1eeda ph\u1ea7n sau c\u1ee7a m\u1eaft"},"content":{"rendered":"
– Trong s\u1ed1 c\u00e1c b\u1ec7nh v\u1ec1 m\u1eaft n\u00f3i chung, nh\u1eefng b\u1ec7nh thu\u1ed9c v\u1ec1 n\u1eeda ph\u1ea7n sau c\u1ee7a m\u1eaft \u0111\u1ec1u khi\u1ebfn c\u00e1c b\u00e1c s\u1ef9 nh\u00e3n khoa ph\u1ea3i \u201cng\u00e1n ng\u1ea9m\u201d v\u00e0 m\u1eb7c d\u00f9 \u0111\u00e3 t\u1ed1n r\u1ea5t nhi\u1ec1u c\u00f4ng s\u1ee9c, t\u1eadn d\u1ee5ng m\u1ecdi ph\u01b0\u01a1ng ph\u00e1p c\u1ea3 thu\u1ed1c, v\u1eadt l\u00fd l\u1eabn ph\u1eabu thu\u1eadt \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n nh\u01b0ng k\u1ebft qu\u1ea3 cu\u1ed1i c\u00f9ng l\u00e0 th\u1ecb l\u1ef1c (kh\u1ea3 n\u0103ng nh\u00ecn) c\u1ee7a b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u1ea3i thi\u1ec7n kh\u00f4ng nhi\u1ec1u, th\u1eadm ch\u00ed m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f2n s\u1ee5t gi\u1ea3m \u0111i so v\u1edbi th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. C\u00f3 r\u1ea5t nhi\u1ec1u nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn k\u1ebft c\u1ee5c n\u00e0y do v\u1eady b\u00e0i vi\u1ebft s\u1ebd ch\u1ec9 b\u00e0n lu\u1eadn m\u1ed9t ph\u1ea7n r\u1ea5t nh\u1ecf trong ch\u1ee7 \u0111\u1ec1 r\u1ed9ng l\u1edbn n\u00e0y c\u1ee7a ng\u00e0nh m\u1eaft.<\/p>\n
– B\u1ea1n c\u00f3 th\u1ec3 t\u01b0\u1edfng t\u01b0\u1ee3ng n\u1eeda ph\u1ea7n sau c\u1ee7a m\u1eaft gi\u1ed1ng nh\u01b0 ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a qu\u1ea3 d\u1eeba sau khi ch\u1eb7t m\u1edf n\u1eafp \u0111\u1ec3 u\u1ed1ng l\u1ea5y n\u01b0\u1edbc. Ph\u1ea7n n\u01b0\u1edbc b\u00ean trong c\u00f3 th\u1ec3 hi\u1ec3u \u0111\u01a1n gi\u1ea3n l\u00e0 m\u00f4i tr\u01b0\u1eddng d\u1ecbch k\u00ednh c\u1ee7a m\u1eaft v\u00e0 ph\u1ea7n c\u00f9i d\u1eeba b\u00e1m \u1edf vi\u1ec1n l\u00e0 khu v\u1ef1c d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c v\u00e0 m\u1ea1ch m\u00e1u v\u00f5ng m\u1ea1c. Vi\u1ebft nh\u01b0 v\u1eady cho d\u1ec5 hi\u1ec3u nh\u01b0ng th\u1ef1c t\u1ebf gi\u1ea3i ph\u1eabu sinh l\u00fd m\u1eaft \u1edf khu v\u1ef1c n\u00e0y r\u1ea5t ph\u1ee9c t\u1ea1p v\u00e0 c\u00e1c b\u1ec7nh l\u00fd th\u01b0\u1eddng ph\u00e1t sinh \u1edf c\u1ea5p \u0111\u1ed9 t\u1ebf b\u00e0o. M\u00e0 \u0111\u00e3 \u1edf c\u1ea5p \u0111\u1ed9 nh\u1ecf nh\u01b0 v\u1eady th\u00ec n\u1ebfu \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c, thu\u1ed1c \u0111\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c b\u00e0o ch\u1ebf \u0111\u1eb7c bi\u1ec7t \u0111\u1ec3 c\u00f3 \u00e1i l\u1ef1c cao nh\u1ea5t v\u00e0 ch\u1ecdn l\u1ecdc t\u00e1c d\u1ee5ng tr\u00ean t\u1ebf b\u00e0o \u0111\u00edch, c\u00f2n \u0111\u1ebfn giai \u0111o\u1ea1n c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt th\u00ec m\u1eb7c d\u00f9 \u0111\u1ebfn nay \u0111\u00e3 c\u00f3 nhi\u1ec1u thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 nh\u00ecn v\u00e0o b\u00ean trong m\u1eaft c\u0169ng nh\u01b0 c\u00e1c d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt tinh x\u1ea3o, c\u00e1c thao t\u00e1c v\u1eabn ph\u1ea3i th\u1ef1c hi\u1ec7n b\u1eb1ng tay ng\u01b0\u1eddi b\u00e1c s\u1ef9. \u0110i\u1ec1u \u0111\u00f3 \u0111\u1ed3ng ngh\u0129a v\u1edbi vi\u1ec7c nguy c\u01a1 th\u1ea5t b\u1ea1i trong ph\u1eabu thu\u1eadt r\u1ea5t cao \u0111\u1ed1i v\u1edbi nh\u00f3m b\u1ec7nh l\u00fd n\u00e0y, ch\u00ednh v\u00ec th\u1ebf nhi\u1ec1u b\u1ec7nh nh\u00e2n cho r\u1eb1ng m\u1ed5 xong th\u00ec th\u1ea5y m\u1eaft c\u00f2n k\u00e9m h\u01a1n, t\u1eeb \u201cl\u1ee3n l\u00e0nh th\u00e0nh l\u1ee3n qu\u00e8\u201d.<\/p>\n
– May m\u1eafn l\u00e0, m\u1ed9t s\u1ed1 b\u1ec7nh trong nh\u00f3m n\u00e0y c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 b\u1eb1ng thu\u1ed1c ti\u00eam n\u1ed9i nh\u00e3n (ti\u00eam v\u00e0o trong m\u1eaft) v\u00e0 duy tr\u00ec c\u1ea3i thi\u1ec7n th\u1ecb l\u1ef1c k\u00e9o d\u00e0i tr\u01b0\u1edbc khi ph\u1ea3i \u0111\u1ebfn giai \u0111o\u1ea1n can thi\u1ec7p b\u1eb1ng ph\u1eabu thu\u1eadt. Danh s\u00e1ch c\u00e1c b\u1ec7nh \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t ch\u1ec9 \u0111\u1ecbnh t\u1ea1i Vi\u1ec7t Nam c\u1ee7a nh\u00f3m thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea t\u1ed5ng h\u1ee3p nh\u01b0 sau (m\u1ed7i thu\u1ed1c s\u1ebd c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t kh\u00e1c nhau n\u00ean m\u1ecdi ng\u01b0\u1eddi c\u1ea7n ch\u00fa \u00fd \u0111\u1ecdc k\u1ef9 ch\u1ec9 \u0111\u1ecbnh tr\u00ean t\u1edd r\u01a1i s\u1ea3n ph\u1ea9m):<\/p>\n
1. Tho\u00e1i h\u00f3a ho\u00e0ng \u0111i\u1ec3m li\u00ean quan \u0111\u1ebfn tu\u1ed5i gi\u00e0 c\u00f3 t\u00e2n m\u1ea1ch (th\u1ec3 \u01b0\u1edbt) (Wet age-related macular degeneration – wAMD) (Lucentis\u00ae c\u1ee7a Novartis, Eylea\u00ae c\u1ee7a Bayer)<\/p>\n
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2. Suy gi\u1ea3m th\u1ecb l\u1ef1c do b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 ph\u00f9 ho\u00e0ng \u0111i\u1ec3m do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. (Diabetic retinopathy and diabetic macular edema \u2013 DR & DME) (Lucentis\u00ae c\u1ee7a Novartis, Eylea\u00ae c\u1ee7a Bayer, Ozurdex\u00ae c\u1ee7a Allergan)<\/p>\n
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3. Suy gi\u1ea3m th\u1ecb l\u1ef1c do ph\u00f9 ho\u00e0ng \u0111i\u1ec3m th\u1ee9 ph\u00e1t do t\u1eafc t\u0129nh m\u1ea1ch v\u00f5ng m\u1ea1c (t\u0129nh m\u1ea1ch v\u00f5ng m\u1ea1c nh\u00e1nh ho\u1eb7c t\u0129nh m\u1ea1c v\u00f5ng m\u1ea1c trung t\u00e2m) (Branch or Central macular edema following retinal vein occlusion \u2013 RVO) (Lucentis\u00ae c\u1ee7a Novartis, Eylea\u00ae c\u1ee7a Bayer, Ozurdex\u00ae c\u1ee7a Allergan)<\/p>\n
4. T\u00e2n m\u1ea1ch h\u1eafc m\u1ea1c do c\u1eadn th\u1ecb b\u1ec7nh l\u00fd (Myopic choroidal neovascularization \u2013 mCNV) (Lucentis\u00ae c\u1ee7a Novartis, Eylea\u00ae c\u1ee7a Bayer)<\/p>\n
5. Vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o sau (Posterior Uveitis) (Ozurdex\u00ae c\u1ee7a Allergan, Humira\u00ae c\u1ee7a Abbvie \u2013 thu\u1ed1c n\u00e0y ph\u1ea3i \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u1edbi corticoid)<\/p>\n
<\/p>\n[Trong nh\u00f3m n\u00e0y c\u00f2n c\u00f3 ho\u1ea1t ch\u1ea5t bevacizumab trong bi\u1ec7t d\u01b0\u1ee3c Avastine\u00ae c\u1ee7a Roche nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t ch\u00ednh th\u1ee9c cho \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd \u0111\u00e1y m\u1eaft]\n
– Ni\u1ec1m vui \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 b\u00e1c s\u1ef9 l\u00e0 c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 nh\u01b0ng n\u1ed7i bu\u1ed3n c\u0169ng b\u1eaft \u0111\u1ea7u khi nh\u00ecn l\u00ean b\u1ea3ng chi ph\u00ed \u0111i\u1ec1u tr\u1ecb t\u1ed5ng th\u1ec3 theo t\u1eebng m\u1eb7t b\u1ec7nh. Thu\u1ed1c n\u00e0o c\u0169ng \u0111\u1eaft ti\u1ec1n do ho\u1eb7c l\u00e0 c\u00f3 b\u1ea3n ch\u1ea5t sinh h\u1ecdc ho\u1eb7c l\u00e0 do b\u00e0o ch\u1ebf \u1edf d\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i (d\u1ea1ng implant c\u1ee7a Ozurdex\u00ae). V\u00ed d\u1ee5 nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n b\u1ecb tho\u00e1i h\u00f3a ho\u00e0ng \u0111i\u1ec3m li\u00ean quan \u0111\u1ebfn tu\u1ed5i gi\u00e0 th\u1ec3 t\u00e2n m\u1ea1ch (wAMD) c\u1ea7n ph\u1ea3i ti\u00eam duy tr\u00ec h\u00e0ng th\u00e1ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n th\u1ecb l\u1ef1c \u0111\u1ebfn m\u1ee9c t\u1ed1i \u0111a sau \u0111\u00f3 m\u1edbi chuy\u1ec3n sang ph\u00e1c \u0111\u1ed3 \u201c\u0111i\u1ec1u tr\u1ecb v\u00e0 m\u1edf r\u1ed9ng\u201d (hi\u1ec3u n\u00f4m na l\u00e0 theo d\u00f5i \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n r\u1ed3i n\u1ebfu th\u1ecb l\u1ef1c v\u1eabn duy tr\u00ec t\u1ed1t th\u00ec gi\u00e3n d\u1ea7n kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n ti\u00eam theo tu\u1ea7n). V\u00e0 n\u1ebfu b\u00e1c s\u1ef9 ch\u1ecdn bi\u1ec7t d\u01b0\u1ee3c Eylea\u00ae th\u00ec c\u0103n c\u1ee9 v\u00e0o nghi\u00ean c\u1ee9u RIVAL m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 \u0111\u1ea7u n\u0103m 2019 (https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30676617<\/a> ), s\u1ed1 ti\u1ec1n b\u1ec7nh nh\u00e2n Vi\u1ec7t Nam ph\u1ea3i b\u1ecf ra kho\u1ea3ng 291 tri\u1ec7u trong n\u0103m \u0111\u1ea7u ti\u00ean (t\u01b0\u01a1ng \u1ee9ng v\u1edbi s\u1ed1 m\u0169i trung b\u00ecnh l\u00e0 9.7 m\u0169i x 30 tri\u1ec7u\/(m\u0169i + ph\u00ed kh\u00e1m) trong v\u00f2ng 12 th\u00e1ng \u0111\u1ea7u), nh\u01b0ng n\u1ebfu b\u00e1c s\u1ef9 ch\u1ecdn bi\u1ec7t d\u01b0\u1ee3c Lucentis\u00ae th\u00ec s\u1ed1 ti\u1ec1n ph\u1ea3i b\u1ecf ra ch\u1ec9 b\u1eb1ng m\u1ed9t n\u1eeda v\u00ec c\u00f9ng s\u1ed1 m\u0169i ti\u00eam. Trong nghi\u00ean c\u1ee9u RIVAL n\u00e0y, c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 k\u1ebft lu\u1eadn kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a v\u1ec1 s\u1ef1 c\u1ea3i thi\u1ec7n th\u1ecb l\u1ef1c gi\u1eefa 2 ho\u1ea1t ch\u1ea5t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng sau 52 tu\u1ea7n (Aflibercept trong bi\u1ec7t d\u01b0\u1ee3c Eylea\u00ae v\u00e0 Ranibizumab trong bi\u1ec7t d\u01b0\u1ee3c Lucentis\u00ae).<\/p>\n