Mitomisin - C ile güçlendirilmiş nonpenetran glokom cerrahisinde filtrasyon alanının ultrasonik biyomikroskopla incelenmesi
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Date
2012
Authors
Ulutaş, Hafize Gökben
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Göziçi basınç (GİB) yüksekliğinin en önemli risk faktörü olduğu glokom, retina ganglion hücrelerinde ilerleyici dejenerasyona bağlı optik diskte çukurlaşma ile seyreden kronik bir optik nöropatidir. Glokom tedavisinin primer amacı GİB'i düşürmektir. Medikal tedavi ile kontrol altına alınamayan glokom olgularında cerrahi tedavi uygulanır. Nonpenetran glokom cerrahisi (NPGC), kontrollü GİB düşüşü sağlaması ve komplikasyon oranlarının düşük olması nedeniyle tercih edilen bir cerrahi yöntemdir. Başarılı glokom cerrahisinden sonra çoğunlukla cerrahi alanda konjonktiva yükselir. Buna `filtrasyon blebi' denir.Bu çalışmada Uludağ Üniversitesi Göz Hastalıkları Anabilim Dalı'nda Haziran 2009 ile Kasım 2011 tarihleri arasında NPGC geçiren 30 hastanın 34 gözünde cerrahi sonrası birinci yılda filtrasyon blebi ultrasonik biyomikroskopla (UBM) incelendi. Elde edilen görüntülerden bleb özelliği, bleb yüksekliği, skleral flep kalınlığı ve uzunluğu, sklera altı göllenme miktarı, konjonktiva altı göllenme miktarı, suprakoridal hipoekoik alan varlığı ve trabekülodesmetik membran kalınlığı ile GİB arasındaki ilişki değerlendirildi. Filtrasyon blebi UBM'de yansıtıcılıklarına göre değerlendirildiğinde en sık düşük yansıtıcılıklı bleb görüldü. Düşük yansıtıcılıklı blebler, diffüz bleblere göre istatistiksel olarak anlamlı daha düşük GİB değerlerine sahipti (p=0.003). Trabekülodesmetik membran kalınlığı ile GİB arasında pozitif korelasyon saptandı (p<0.001, r=0.731). Skleral flep kalınlığı ve uzunluğu, bleb yüksekliği, skleral göllenme ve subkonjonktival göllenme miktarı ile GİB arasında negatif korelasyon saptandı. Suprakoroidal hipoekoik alan varlığında istatistiksel olarak anlamlı daha düşük GİB değerleri elde edildi (p<0.001). Ultrasonik biyomikroskopi, biyomikroskop ile göremediğimiz derin göz yapılarının değerlendirmesini sağlayarak, derin sklerektomi sonrası cerrahi alanın anatomik sonuçlarını görmemize olanak sağlar. Hümör aközün dışa akım yollarının anlaşılmasında UBM faydalı bir yöntemdir. Bleb işlevselliğini değerlendirmekte kullanılabilir.
Glaucoma which is the most important risk factor is increased intraocular pressure is an chronic optic neuropathy due to progressive degeneration of the retinal ganglion cells characterized by optic disc cupping. Primary aim of the glaucoma treatment is to decrease intraocular pressure. Glaucoma surgery is performed in patients with glaucoma which could not be controlled with topical medication. Non-penetrating glaucoma surgery is the preferred method because of that provide a controlled decreasing the intraocular pressure with low rates of postoperative complications. After successful glaucoma surgery, conjunctiva often rises in the surgical field. This is called as 'filtration bleb'.In this study, filtration blebs in 34 eyes of 30 patients with glaucoma who underwent nonpenetrating glaucoma surgery at Department of Ophthalmology, Uludag University between June 2009- November 2011 were studied with ultrasound biomicroscopy (UBM) one year after surgery. Evaluated UBM findings from obtained images were as following; bleb structure, bleb height, scleral flap width and length, intrascleral lake, subconjunctival lake, presence of suprachoroidal hypoechoic area and the thickness of the trabeculodesmetic membrane. Relationship between this findings and intraocular pressure were evaluated.When blebs are evaluated in terms of reflectivity in UBM, the most frequent type was low reflective ones. The low reflective blebs had statistically significant lower intraocular pressures when compared with flat blebs (p=0.003). Positive correlation determined between the thickness of the trabeculodesmetic membrane and intraocular pressure (p<0.001, r=0.731). Negative correlation determined between the scleral flap width and length, bleb height, intrascleral lake, subconjonctival lake and intraocular pressure. Statistically significant lower intraocular pressure values obtained in the presence of suprachoroidal hypoechoic area (p<0.001). Ultrasound biomicroscopy provides evaluation of the deep ocular structures that can not visualised with biomicroscopy and allows us to see anatomic results of surgical field after deep sclerectomy. Ultrasound biomicroscopy is a useful method for understanding outflow pathways of humour aqueous and can be used for assessing functionality and failure of the bleb.
Glaucoma which is the most important risk factor is increased intraocular pressure is an chronic optic neuropathy due to progressive degeneration of the retinal ganglion cells characterized by optic disc cupping. Primary aim of the glaucoma treatment is to decrease intraocular pressure. Glaucoma surgery is performed in patients with glaucoma which could not be controlled with topical medication. Non-penetrating glaucoma surgery is the preferred method because of that provide a controlled decreasing the intraocular pressure with low rates of postoperative complications. After successful glaucoma surgery, conjunctiva often rises in the surgical field. This is called as 'filtration bleb'.In this study, filtration blebs in 34 eyes of 30 patients with glaucoma who underwent nonpenetrating glaucoma surgery at Department of Ophthalmology, Uludag University between June 2009- November 2011 were studied with ultrasound biomicroscopy (UBM) one year after surgery. Evaluated UBM findings from obtained images were as following; bleb structure, bleb height, scleral flap width and length, intrascleral lake, subconjunctival lake, presence of suprachoroidal hypoechoic area and the thickness of the trabeculodesmetic membrane. Relationship between this findings and intraocular pressure were evaluated.When blebs are evaluated in terms of reflectivity in UBM, the most frequent type was low reflective ones. The low reflective blebs had statistically significant lower intraocular pressures when compared with flat blebs (p=0.003). Positive correlation determined between the thickness of the trabeculodesmetic membrane and intraocular pressure (p<0.001, r=0.731). Negative correlation determined between the scleral flap width and length, bleb height, intrascleral lake, subconjonctival lake and intraocular pressure. Statistically significant lower intraocular pressure values obtained in the presence of suprachoroidal hypoechoic area (p<0.001). Ultrasound biomicroscopy provides evaluation of the deep ocular structures that can not visualised with biomicroscopy and allows us to see anatomic results of surgical field after deep sclerectomy. Ultrasound biomicroscopy is a useful method for understanding outflow pathways of humour aqueous and can be used for assessing functionality and failure of the bleb.
Description
Keywords
Nonpenetran glokom cerrahisi, Bleb, Ultrasonik biyomikroskopi, Non-penetrating glaucoma surgery, Bleb, Ultrasound biomicroscopy
Citation
Ulutaş, H. G. (2012). Mitomisin - C ile güçlendirilmiş nonpenetran glokom cerrahisinde filtrasyon alanının ultrasonik biyomikroskopla incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.