Agresif posterior prematüre retinopatisi tedavisinin uzun dönem anatomik ve fonksiyonel sonuçları
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Date
2020
Authors
Çalışkan, Tuba
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Agresif posterior prematüre retinopatisi (APPR) nedeniyle tedavi edilen olguların uzun dönem refraktif durumları ile ön ve arka segment bulgularının geriye dönük olarak incelenmesi. Gereç ve Yöntem: Ocak 2009 ile Aralık 2015 tarihleri arasında çalışmaya dahil etme kriterlerine uygun, APPR tanısıyla tedavi edilip takipleri yapılan 47 olgunun 94 gözü ve prematüre doğup prematüre retinopatisi (PR) geliştirmeyen 35 olgunun 70 gözü dosyalarından geriye dönük olarak tarandı. Olgular tedaviye göre, lazer, enjeksiyon (bevacizumab) ve kontrol grubu olarak ayrıldı. Tüm olguların biyomikroskopik ve fundoskopik muayene bulguları, ambliyopi, anizometropi, şaşılık durumları değerlendirildi. Sikloplejik refraksiyonları, en iyi düzeltilmiş görme keskinlikleri (EİDGK), aksiyel uzunlukları (AU) kaydedildi. Bulgular: Tüm gruplar doğum haftası (DH), doğum ağırlığı (DA), tedavi haftası açısından benzerdi. Zon 1’de hastalık oranı enjeksiyon grubunda, zon 2 posterior’da hastalık oranı lazer grubunda daha yüksek bulundu (p=0,016). Lazer grubunda tedavi sonrası rekürrens oranı %37,5, rekürrens süresi 2,9±1,2 hafta, enjeksiyon grubunda ise rekürrens oranı %26,6, rekürrens süresi 8,5±1,7 haftaydı. Rekürrensin enjeksiyon grubunda lazer grubuna göre daha geç ortaya çıkması istatistiksel olarak anlamlıydı (p<0,001). Lazer grubunda 14 göze (%21,8) pars plana vitrektomi (PPV) gerekirken, enjeksiyon grubunda hiçbir göze PPV gerekmedi (p=0,024). Olguların ortalama sferik ekivalanları (SE) incelendiğinde lazer grubu (-4,97 ± 5,12) enjeksiyon grubuna (-1,58 ± 2,85) göre daha miyopikti (p=0,008). Ortalama EİDGK enjeksiyon grubunda lazer grubuna göre daha yüksekti (p=0,001). Lazer grubundaki anizometropi oranı (%63) enjeksiyon grubuna (%40) göre yüksek bulundu (p=0,005), ambliyopi açısından ise iki grup arasında anlamlı farklılık saptanmadı. Kontrol grubunda; tedavi gruplarıyla karşılaştırıldığında, EİDGK daha yüksek iken, SE’leri istatistiksel anlamlı daha düşüktü (p<0,001). Tedavi sonrası lazer grubunda gözlerin %67,19’unda, enjeksiyon grubunda gözlerin %96,67’sinde iyi anatomik sonuç elde edilebildi (p<0,05). Olguların %29,7’sinde şaşılık mevcuttu ve baskın olan kayma ezotropyaydı (%71,4). Her iki tedavi grubunun ortalama AU değerleri benzerdi (22,70±1,78, 22,53±1,59). Lazer grubunun 9-11 yaş ortalamasındaki AU, kontrol grubundaki 9-11 yaş ortalamasındaki AU’ya göre istatistiksel olarak anlamlı uzun bulundu (p<0,05). Tartışma ve Sonuç: Erken dönemde enjeksiyon grubunda ek tedavi ihtiyacı ve cerrahi gereksinimi lazer grubuna göre daha azdı. Geç dönemde enjeksiyon grubu anatomik sonuç, EİDGK ve refraktif durum açısından daha iyiydi. APPR’li olgularda ilk tedavi seçeneği olarak intravitreal bevacizumab (IVB) enjeksiyonu tercih edilebilir.
Purpose: Retrospective analysis of long-term refractive status, anterior and posterior segment ocular findings of patients treated for aggressive posterior retinopathy of prematurity (AP-ROP). Methods: Between January 2009 and December 2015, 94 eyes of 47 cases who were treated and followed-up with the diagnosis of AP-ROP and 70 eyes of 35 cases who were born premature but did not develop retinopathy of prematurity (ROP) were screened retrospectively. The cases were divided into laser photocoagulation, anti-VEGF injection and control groups according to treatment. Slit lamp and fundus examination findings, presence of amblyopia, anisometropia and strabismus of all cases were evaluated. Cycloplegic refractions, best corrected visual acuity (BCVA), axial length (AL) were recorded. Results: The groups were similar in terms of gestational week (GW), birth weight (BW), and treatment week. The disease rate was higher in the injection group in zone 1 and in the posterior zone 2 in the laser group (p=0.016). The recurrence rate after treatment was 37.5% in the laser group, the recurrence time was 2.9 ± 1.2 weeks, in the injection group the recurrence rate was 26.6%, and the recurrence time was 8.5 ± 1.7 weeks. Late recurrence in the injection group was statistically significant (p<0.001). Pars plana vitrectomy (PPV) was required in 14 eyes (21.8%) in the laser group, and none in the injection group. The laser group was more myopic when the mean spherical equivalents (SE) of the patients were evaluated at the last visit (p=0.008). The mean BCVA was better in the injection group at the last visit (p=0.001). When BCVA and SE of the control group were compared with the treatment groups, the control group was better in terms of both parameters (p<0.001). The anisometropia rate in the laser group (%63) was higher than the injection group (%40) (p=0.005), no significant difference was found in amblyopia. Favorable anatomical outcome was % 67,19 in the laser group and %96,67 in the injection group (p<0,05). Strabismus was observed in 29.7% of all the cases, the predominant type was esotropia. When the groups were evaluated in terms of AL, the averages were similar (22,70±1,78, 22,53±1,59). The AL of the laser group, mean age of 9- 11, was found to be statistically significantly longer than the control group (p<0.05). Conclusion: The injection group was better than the laser group in terms of need for additional treatment, surgical need, and long-term anatomical outcome, visual acuity and refractive status. Intravitreal bevacizumab injection may be preferred as the first treatment option in cases with AP-ROP.
Purpose: Retrospective analysis of long-term refractive status, anterior and posterior segment ocular findings of patients treated for aggressive posterior retinopathy of prematurity (AP-ROP). Methods: Between January 2009 and December 2015, 94 eyes of 47 cases who were treated and followed-up with the diagnosis of AP-ROP and 70 eyes of 35 cases who were born premature but did not develop retinopathy of prematurity (ROP) were screened retrospectively. The cases were divided into laser photocoagulation, anti-VEGF injection and control groups according to treatment. Slit lamp and fundus examination findings, presence of amblyopia, anisometropia and strabismus of all cases were evaluated. Cycloplegic refractions, best corrected visual acuity (BCVA), axial length (AL) were recorded. Results: The groups were similar in terms of gestational week (GW), birth weight (BW), and treatment week. The disease rate was higher in the injection group in zone 1 and in the posterior zone 2 in the laser group (p=0.016). The recurrence rate after treatment was 37.5% in the laser group, the recurrence time was 2.9 ± 1.2 weeks, in the injection group the recurrence rate was 26.6%, and the recurrence time was 8.5 ± 1.7 weeks. Late recurrence in the injection group was statistically significant (p<0.001). Pars plana vitrectomy (PPV) was required in 14 eyes (21.8%) in the laser group, and none in the injection group. The laser group was more myopic when the mean spherical equivalents (SE) of the patients were evaluated at the last visit (p=0.008). The mean BCVA was better in the injection group at the last visit (p=0.001). When BCVA and SE of the control group were compared with the treatment groups, the control group was better in terms of both parameters (p<0.001). The anisometropia rate in the laser group (%63) was higher than the injection group (%40) (p=0.005), no significant difference was found in amblyopia. Favorable anatomical outcome was % 67,19 in the laser group and %96,67 in the injection group (p<0,05). Strabismus was observed in 29.7% of all the cases, the predominant type was esotropia. When the groups were evaluated in terms of AL, the averages were similar (22,70±1,78, 22,53±1,59). The AL of the laser group, mean age of 9- 11, was found to be statistically significantly longer than the control group (p<0.05). Conclusion: The injection group was better than the laser group in terms of need for additional treatment, surgical need, and long-term anatomical outcome, visual acuity and refractive status. Intravitreal bevacizumab injection may be preferred as the first treatment option in cases with AP-ROP.
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Keywords
Agresif posterior prematüre retinopatisi, Aksiyel uzunluk, Bevacizumab, Lazer fotokagülasyon, Refraktif durum, Aggressive posterior retinopathy of prematurity, Axial length, Laser photocoagulation, Refractive status
Citation
Çalışkan, T. (2020). Agresif posterior prematüre retinopatisi tedavisinin uzun dönem anatomik ve fonksiyonel sonuçları. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.