Eksudatif yaşa bağlı makula dejenerasyonu ile periferik retina dejenerasyonlarının ilişkisi
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Date
2011
Authors
Çakırlı, Emel Ebru
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Publisher
Uludağ Üniversitesi
Abstract
Yaşa bağlı makula dejenerasyonu (YBMD), gelişmiş ülkelerde, 50 yaş üzeri bireylerde gözlenen ciddi görme kaybının esas nedenidir. YBMD' nin primer olarak makulayı etkilemesinin nedeni, makuladaki Bruch membran yapı ve içeriğindeki topografik değişiklerle açıklanabilir. Yaşlanma süreci göz önünde bulundurulduğunda, yaşa bağlı periferik retinal değişikliklerin, YBMD ile birlikte gözlenebilmesi olasıdır. Biz bu prospektif çalışma ile yaşa bağlı makula dejenerasyonu ile periferik retina dejenerasyonları arasındaki ilişkiyi ortaya koymayı amaçladık.Bu çalışma, Uludağ Üniversitesi Göz Hastalıkları polikliniğinde, yaş tip YBMD tanısı konan toplam 100 hastayı (56 erkek, 44 kadın) ve 55 yaş üzeri bilinen göz hastalığı olmayan 100 sağlıklı olguyu (52 erkek, 48 kadın ) içerdi. Ortalama yaş YBMD grubunda 71,9 (55-85), kontrol grubunda ise 68.5 (55-88) idi. Tüm hastalara, Early Treatment of Diabetic Retinopathy (ETDRS) eşeli ile görme keskinliği muayenesi, GİB ölçümü, biomikroskopik muayene ve ardından 3 aynalı Goldmann lensi ile periferik retina muayenesi yapıldı. YBMD grubuna farklı olarak tanı ve koroid neovaskülarizasyonu (KNV) tiplendirmesi amacıyla floreseyin anjiografik görüntüleme yapıldı. YBMD olgularının flöresein anjiografi değerlendirmesinde %56'sı gizli, %18'i baskın klasik tipte KNV bulgularına sahipti, %15'i retinal anjiomatöz proliferasyon, %11'i polipoidal vaskülopati tanısı almıştı. Tüm olgular, yaşa bağlı periferik retinal değişiklikler arasında yer alan periferik tapetokoroidal dejenerasyon(PTKD), kistik dejenerasyon, drusen, dejeneratif retinoşizis, kaldırım taşı dejenerasyon ve lattice dejenerasyon varlığı açısından değerlendirildi. YBMD ve sağlıklı kontrol grubunda periferik retinal değişikliklerin gözlenme oranları karşılaştırıldı. Her iki grupta hastaların yaşı, cinsiyeti ,mesleği, sistemik hipertansiyon (HT) ve/veya diabetes mellitus (DM) varlığı, ilaç kullanımı, ön segment muayene bulguları, GİB değerleri, iris rengi ile periferik retina muayene bulguları karşılaştırıldı. YBMD olgularının %88'inde PTKD, %62'sinde periferik drusen, %22'sinde retiküler dejenerasyon, %20'sinde kaldırım taşı dejenerasyon, %2'sinde dejeneratif retinoşizis, ve % 2'sinde lattice dejenerasyon mevcuttu. Sağlıklı kontrol grubunun %41'inde PTKD, %46'sında drusen, %11'inde pigmenter retinopati, %3'ünde kaldırım taşı dejenerasyon,% 2'sinde lattice dejenerasyon saptandı.Yaş tip YBMD grubunda, PTKD, kaldırım taşı dejenerasyon, retiküler dejenerasyon, drusen ve dejeneratif retinoşizis saptanma oranı, sağlıklı kontrol grubuna göre anlamlı olarak yüksekti (p<0.005).YBMD grubunda, retiküler dejenerasyon ile UV maruziyeti ile ilişkili açık alanda çalışma öyküsü arasında anlamlı ilişki saptandı (p=0,030). YBMD grubunda, diğer periferik dejenerasyon varlığı ve tipi ile yaş, cinsiyet, meslek, HT ve/veya DM varlığı, ilaç kullanımı, lensin durumu, GİB değerleri, iris rengi ve KNV tipi arasında anlamlı bir ilişki saptanmadı. Kontrol grubunda açık iris rengi ile PTKD arasında anlamlı bir ilişki saptandı (p=0,037).Sonuç olarak bu çalışma ile yaşa bağlı makula dejenerasyonunun tüm retinayı ilgilendiren bir hastalık olduğu ortaya kondu. Hastalarda, tanı esnasında retinanın tümüyle değerlendirilmesinin prognozun belirlenmesi açısından faydası olabileceği düşünülmektedir.
Evaluation of The Relationship Between Age-Related Macular Degeneration and Age Related Peripheric Retinal DegenerationAge-related macular degeneration (AMD), is the leading cause of severe visual impairment in industrialized countries in patients over 50 years of age. The reason for the macular location of AMD, might be explained by topographical differences in the structure and composition of Bruch?s membrane in macula. In addition to the aging process, age related periferic retinal degenerations can be possibly detected within the age related macular degeneration. The aim of this prospective study is, to determine the relationship between age related macula degeneration and periferic retinal degeneratiosA hundred patients (56 male, 44 female), who were diagnosed with wet AMD and 100 healty control subjects (52 male, 48 female) who were over 55 years of age were enrolled in Uludag University Department of Ophtalmology in the present study. Mean age of cases was 71,9 (aged 55 to 85 years) and the mean age of control subjects was 68,5 (aged 55 to 88 years) years. The visual acuity measurements with Early Treatment of Diabetic Retinopathy (ETDRS) chart, intraocular pressure measurement, biomicroscopic anterior segment examination and indirect funduscopic examination of periferic retina with Goldmann triple mirror lens were performed for all the patients of two groups .Additonally, floresecein angiographic imaging was performed to detect and categorize CNV?s in AMD group. Lesions of wet AMD were divided into 4 groups, as predominantly classic CNV (%18), occult CNV (%56), retinal angiomatous proliferation (%15) and polipoidal coroidal vasculopathy (%11). All the patients were examined for the periferal retinal degeneratios including periferic tapetochoroidal degeneration (PTKD), cystic degeneration, drusen, degenerative retinoshisis, pavingstone degeneration, reticular degeneration and lattice degeneration. Fundoscopic examination findings of two groups were compared. The relationship between periferic retinal examination findings and each patients? age, gender, presence of systemic hypertension (HT) and/or diabetes mellitus (DM), history of working at the jobs in outdoor, intraocular pressure values, anterior segment findings, iris color was evaluated. In AMD group, tapetochoroidal degeneration was the most frequently detected periferic degeneration type. Periferic drusen(%62), reticular degeneration(%22), pavingstone degeneration(%20), degenerative retinoshisis(%2), lattice degeneration(%2) were the other most frequently detected degenerations,respectively. In the control group, PTKD(%41), drusen(%46), reticular degeneration(%11) , paving stone(%3) and lattice degeneration(%2) were detected. When the two of groups compared, ıt was determined that PTKD, paving stone degeneration, reticular degeneration, drusen and degenerative retinoschisis was detected in higher incidences in AMD group than the control group. In AMD group there was a correlation between the presence of reticular degeneration and the history of working at the jobs in outdoor, which is related to UV exposition (p=0,030). In AMD group, there was no significant correlation between the other periferic degenerations and age, gender, systemic disorders, history of working at the jobs in outdoor, anterior segment examination findings, intraocular pressure values, iris color and CNV types. In the control group, light iris color, was correlated with PTKD (p=0,037).However, our study demonstrated that age related macula degeneration is a disease that concerns the whole retina. More detailed evaluation of the retina while diagnosing age related macular degeneration may give some clues about the prognosis of the patients.
Evaluation of The Relationship Between Age-Related Macular Degeneration and Age Related Peripheric Retinal DegenerationAge-related macular degeneration (AMD), is the leading cause of severe visual impairment in industrialized countries in patients over 50 years of age. The reason for the macular location of AMD, might be explained by topographical differences in the structure and composition of Bruch?s membrane in macula. In addition to the aging process, age related periferic retinal degenerations can be possibly detected within the age related macular degeneration. The aim of this prospective study is, to determine the relationship between age related macula degeneration and periferic retinal degeneratiosA hundred patients (56 male, 44 female), who were diagnosed with wet AMD and 100 healty control subjects (52 male, 48 female) who were over 55 years of age were enrolled in Uludag University Department of Ophtalmology in the present study. Mean age of cases was 71,9 (aged 55 to 85 years) and the mean age of control subjects was 68,5 (aged 55 to 88 years) years. The visual acuity measurements with Early Treatment of Diabetic Retinopathy (ETDRS) chart, intraocular pressure measurement, biomicroscopic anterior segment examination and indirect funduscopic examination of periferic retina with Goldmann triple mirror lens were performed for all the patients of two groups .Additonally, floresecein angiographic imaging was performed to detect and categorize CNV?s in AMD group. Lesions of wet AMD were divided into 4 groups, as predominantly classic CNV (%18), occult CNV (%56), retinal angiomatous proliferation (%15) and polipoidal coroidal vasculopathy (%11). All the patients were examined for the periferal retinal degeneratios including periferic tapetochoroidal degeneration (PTKD), cystic degeneration, drusen, degenerative retinoshisis, pavingstone degeneration, reticular degeneration and lattice degeneration. Fundoscopic examination findings of two groups were compared. The relationship between periferic retinal examination findings and each patients? age, gender, presence of systemic hypertension (HT) and/or diabetes mellitus (DM), history of working at the jobs in outdoor, intraocular pressure values, anterior segment findings, iris color was evaluated. In AMD group, tapetochoroidal degeneration was the most frequently detected periferic degeneration type. Periferic drusen(%62), reticular degeneration(%22), pavingstone degeneration(%20), degenerative retinoshisis(%2), lattice degeneration(%2) were the other most frequently detected degenerations,respectively. In the control group, PTKD(%41), drusen(%46), reticular degeneration(%11) , paving stone(%3) and lattice degeneration(%2) were detected. When the two of groups compared, ıt was determined that PTKD, paving stone degeneration, reticular degeneration, drusen and degenerative retinoschisis was detected in higher incidences in AMD group than the control group. In AMD group there was a correlation between the presence of reticular degeneration and the history of working at the jobs in outdoor, which is related to UV exposition (p=0,030). In AMD group, there was no significant correlation between the other periferic degenerations and age, gender, systemic disorders, history of working at the jobs in outdoor, anterior segment examination findings, intraocular pressure values, iris color and CNV types. In the control group, light iris color, was correlated with PTKD (p=0,037).However, our study demonstrated that age related macula degeneration is a disease that concerns the whole retina. More detailed evaluation of the retina while diagnosing age related macular degeneration may give some clues about the prognosis of the patients.
Description
Keywords
Yaşa bağlı makula dejenerasyonu, Periferik retina dejenerasyonu, Age related macular degeneration, Peripheric retinal degeneration
Citation
Çakırlı, E. E. (2011). Eksudatif yaşa bağlı makula dejenerasyonu ile periferik retina dejenerasyonlarının ilişkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.