Makulanın tutulduğu yırtıklı retina dekolmanı hastalarında, klasik dekolman cerrahisinden sonra anatomik ve fonksiyonel açıdan makulanın iyileşmesinin değerlendirilmesi
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Date
2008
Authors
Yılmaz, Sami
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Klasik dekolman cerrahisi geçiren makulası tutulmuş hastalarda multifokal elektroretinogram (mfERG) ve optik koherens tomografi (OKT) kullanarak, cerrahi öncesi ve sonrası etkenler açısından makulanın iyileşmesini ve cerrahi sonrası görme keskinliğinin (GK) mfERG, OKT cihazlarından elde edilen sonuçlarla olan ilişkisinin değerlendirilmesi.Ocak 2007 ve Aralık 2007 tarihleri arasında makulayı tutan yırtıklı retina dekolmanı nedeni ile klasik dekolman cerrahisi geçiren 46 hasta ileriye dönük olarak değerlendirildi. Hastaların ameliyattan önce ve sonra belirli aralıklarla göz muayeneleri, OKT ve mfERG ölçümleri yapıldı. OKT ve mfERG testleri için kontrol grubu olarak hastaların sağlam gözleri kullanıldı.Kırkaltı hastanın 37'si altı aylık izlem süresini tamamladı. Altıncı ay sonundaki mfERG P1 ve N1 amplitüdleri, cerrahi öncesi değerlere göre yüksek olmasına rağmen (p<0,05), kontrol grubuna göre düşük saptandı (p<0,05). Cerrahi öncesi P1 ve N1 latansları uzamış olarak ölçüldü (p<0,05). Cerrahi öncesi OKT'deki fovea konfigürasyonu (normal sensoryel retina, intraretinal ayrılma, dış tabakada ondülasyon) ve foveal dekolmanın yüksekliği ile 6. ay GK ilişkisi değerlendirildiğinde konfigürasyon bozuldukça ve dekolmanın yüksekliği arttıkça GK'nin bozulduğu saptandı (p<0,05). Ameliyattan önce makula tutulumunun 1 haftadan daha kısa süreli olduğu tüm gözlerde 6. ay GK 0.4 logMAR değerinden düşük olarak saptandı. Altıncı ayın sonunda OKT'de 8 hastada subretinal sıvı, 3 hastada makula ödeminin devam ettiği, 6 hastada ise epimakuler membran geliştiği görüldü. Dört hastada ise takipleri sırasında yapılan göz muayenelerinde foveada pigmente değişiklikler saptandı.Anatomik olarak başarılı cerrahiye rağmen makulanın hem anatomik hem de fonksiyonel açıdan düzelmesi; başvuru süresi, cerrahi öncesi makulanın yapısı, foveal dekolmanın yüksekliği ve cerrahi sonrası gelişen problemlerle ilişkili olarak değişkenlik göstermektedir.
Evaluation of the relation of recovering macula in terms of elements before and after operation and outcome of visual acuity (VA) after operation obtained from multifocal electroretinography (mfERG) and optical coherence tomography (OCT) instruments using OCT and mfERG on patients having a classical retinal detachment (RD) operation whose macula was involved.Between January 2007 and December 2007, 46 patients with rhegmategenous RD involving the macula and having classical RD operation were prospectively examined. Before and after surgery, OCT and mfERG evaluations and ophthalmological examination of patients were performed in certain times. For OCT and mfERG tests as a control group healthy eyes of the patients were used.Thirty-seven of 46 patients completed the 6 months follow-up period. Although mfERG P1 and N1 amplitudes at the end of the 6th month follow-up were higher relatively the values before operation (p<0,05) as they were low according to control group (p<0,05). It was observed that P1 and N1 latents were extended before operation (p<0,05). It was determined that as configuration was impaired and height of foveal detachment was on the increase, VA became worse and it was statistically significant when the relation of VA and the 6th month was evaluated according to height of the foveal detachment and foveal configuration (normal sensorial retina, intra-retinal separation, undulation in outer retina) in OCT before operation (p<0,05). It was seen that the 6th month was lower than VA 0,4 logMAR value in all eyes whose period of time until surgery was shorter than a week with central loss of vision. It was observed that 8 of patients had subretinal fluid in OCT, there was ongoing of macula edema in 3 of patients, epimacular membrane developed in 6 of patients at the end of the 6th month. It was also found out that there were pigmentary changes in fovea of 4 patients at their ophthalmological examinations during follow-up.In spite of anatomically successful surgery, anatomical and functional recovery of macula shows changes in terms of application period, structure of macula before surgery, height of RD and problems developed after operation.
Evaluation of the relation of recovering macula in terms of elements before and after operation and outcome of visual acuity (VA) after operation obtained from multifocal electroretinography (mfERG) and optical coherence tomography (OCT) instruments using OCT and mfERG on patients having a classical retinal detachment (RD) operation whose macula was involved.Between January 2007 and December 2007, 46 patients with rhegmategenous RD involving the macula and having classical RD operation were prospectively examined. Before and after surgery, OCT and mfERG evaluations and ophthalmological examination of patients were performed in certain times. For OCT and mfERG tests as a control group healthy eyes of the patients were used.Thirty-seven of 46 patients completed the 6 months follow-up period. Although mfERG P1 and N1 amplitudes at the end of the 6th month follow-up were higher relatively the values before operation (p<0,05) as they were low according to control group (p<0,05). It was observed that P1 and N1 latents were extended before operation (p<0,05). It was determined that as configuration was impaired and height of foveal detachment was on the increase, VA became worse and it was statistically significant when the relation of VA and the 6th month was evaluated according to height of the foveal detachment and foveal configuration (normal sensorial retina, intra-retinal separation, undulation in outer retina) in OCT before operation (p<0,05). It was seen that the 6th month was lower than VA 0,4 logMAR value in all eyes whose period of time until surgery was shorter than a week with central loss of vision. It was observed that 8 of patients had subretinal fluid in OCT, there was ongoing of macula edema in 3 of patients, epimacular membrane developed in 6 of patients at the end of the 6th month. It was also found out that there were pigmentary changes in fovea of 4 patients at their ophthalmological examinations during follow-up.In spite of anatomically successful surgery, anatomical and functional recovery of macula shows changes in terms of application period, structure of macula before surgery, height of RD and problems developed after operation.
Description
Keywords
Retina dekolmanı, Optik koherens tomografi, Multifokal elektroretinogram, Retinal detachment, Optical coherence tomography, Multifocal electroretinography
Citation
Yılmaz, S. (2008). Makulanın tutulduğu yırtıklı retina dekolmanı hastalarında, klasik dekolman cerrahisinden sonra anatomik ve fonksiyonel açıdan makulanın iyileşmesinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.