Tedavi seçeneği tartışmalı retina dekolmanlarında cerrahi yöntemlerin karşılaştırılması
Date
2005
Authors
Aygül , Feray
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Amaç: Tedavi seçeneğinin tartışmalı olduğu retina dekolmanlarında, skleral çökertme cerrahisi ile pars plana vitrektominin, anatomik ve görsel sonuçlar açısından karşılaştırılması. Gereç ve Yöntem: Eylül 2002 ile Haziran 2004 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı'na başvuran ve retina dekolmanı tanısı konulan 60 hastanın (44 erkek, 16 kadın) 60 gözü çalışma kapsamına alındı. Bu gözlerin 32'i psödofakik, 28'i fakik idi. Hiçbir hastada RD dışında görsel sonucu etkileyebilecek patoloji yoktu. Ameliyat öncesi muayenede hastaların düzeltilmiş görme keskinliği (GK), ön segment muayenesi, göz içi basıncı, proliferatif vitreoretinopati (PVR) varlığı, Goldman üç aynalı lensi kullanılarak yırtık varlığı ve yerleşimi değerlendirildi. Tedavi amacıyla 30 göze skleral çökertme cerrahisi (16 göze lokal çökertme, 14 göze lokal çökertme ve skleral çevreleme), 30 göze pars plana vitrektomi, endolaser fotokoagülasyon ve göz içi tamponad (19 göze silikon, 11 göze gaz) uygulandı. Ameliyat sonrası hastalar 1.gün, 1.hafta, 8. hafta, 6.ay ve 1.yılda değerlendirildi. Muayenede düzeltilmiş GK, göz içi basınçları, lensin opasite durumu, fundus muayenesi, PVR gelişimi incelendi. Her iki tedavi yöntemi görsel ve anatomik başarı yönünden karşılaştırıldı. Bulgular: Skleral çökertme uygulanan 18 gözde birinci girişimde, 6 gözde de ikinci girişimde retinal yatışma sağlanırken, 3 göze ikinci cerrahi sonucunda da retinal yatışma sağlanamadı. 3 hasta da ikinci cerrahiyi kabul etmedi. Vitrektomi uygulanan 26 gözde birinci girişimde, 1 gözdede ikinci girişimde retinal yatışma sağlanırken, 3 olgu makulayı tutmayan, alt retinada sınırlı retina dekolmanı nedeniyle takibe alındı. Skleral cerrahi ile başarı sağlanan 18 olgunun 16'sında 1 sıra ve üzeri görme artışı elde edilirken, 2 olguda aynı düzeyde kaldı. 10 olguda görme 0.4 ve üzeri olarak tespit edildi. Vitrektomi uygulanan grupta 26 başarılı olgunun 22'sinde 1 sıra ve üzeri görme artışı saptanırken, 3 olguda değişiklik olmadı ve 1 olguda da görmede azalma tespit edildi. 15 olguda görme 0.4 ve üzeri düzeyde bulundu. Sonuç: Tedavi seçeneği tartışmalı RD'lı olgularda, vitrektominin anatomik başarı ve erken görsel düzelme açısından, skleral çökertme yöntemine göre daha üstün bir teknik olduğu saptanmıştır.
Purpose: To compare scleral buckling surgery and pars plana vitrectomy for retinal detachments in which the treatment alternative is under debate with regard to anatomical and visual results. Material and Method: 60 eyes of 60 patients (44 males, 16 females) diagnosed with retinal detachment who were referred to Uludag University Faculty of Medicine, Ophthalmology Department between September 2002 and June 2004 were included in the study. 32 eyes were pseudophakic and 28 were phakic. None of the patients had any pathology except retinal detachment which could effect the visual result. Best corrected visual acuity 0/A), anterior chamber examination, intraocular pressure, presence of proliferative vitreoretinopathy (PVR), presence and location of retinal break by using Goldmann three mirror contact lens were all preoperatively evaluated. Sciera! buckling (16 local buckling, 14 local buckling and scleral encircling) were performed in 30 eyes, whereas pars plana vitrectomy, endolaser photocoagulation and intraocular tamponade (19 silicone, 11 gas) were performed in other 30 eyes. Patients were evaluated at postoperative 1st day, 1st week , 5th week, 5th month and 1st year. Best corrected VA, intraocular pressure, lenticular opacity, funduscopic examination and PVR devolopment were evaluated at each visit. Both treatment alternatives were compared with regard to visual and anatomical success. Results: Retina was reattached in 18 eyes which underwent scleral buckling at first attempt, and in 6 eyes at second attempt. 3 patients did not accept the secondary surgery. Retinal reattachment was noted in 26 eyes which underwent vitrectomy at first attempt and in 1 eye at second attempt. 3 patients were followed for the retinal detachment localised to inferior retina without macular involvement. 16 of 18 eyes with successful scleral surgery had VA improvement of 1 or more Snellen lines, whereas no improvement was noted in 2 eyes. Visual acuity was measured as 0.4 or more in 10 eyes. 22 of 26 eyes which underwent successful vitrectomy had VA improvement of 1 or more Snellen lines. No change was observed in 3 eyes and 1 eye had visual deterioration. Visual acuity was measured as 0.4 or more in 15 eyes. Conclusion: Vitrectomy was determined to be superior to scleral buckling method in retinal detachment in which the treatment alternative was under debate with regard to anatomical success and early visual improvement.
Purpose: To compare scleral buckling surgery and pars plana vitrectomy for retinal detachments in which the treatment alternative is under debate with regard to anatomical and visual results. Material and Method: 60 eyes of 60 patients (44 males, 16 females) diagnosed with retinal detachment who were referred to Uludag University Faculty of Medicine, Ophthalmology Department between September 2002 and June 2004 were included in the study. 32 eyes were pseudophakic and 28 were phakic. None of the patients had any pathology except retinal detachment which could effect the visual result. Best corrected visual acuity 0/A), anterior chamber examination, intraocular pressure, presence of proliferative vitreoretinopathy (PVR), presence and location of retinal break by using Goldmann three mirror contact lens were all preoperatively evaluated. Sciera! buckling (16 local buckling, 14 local buckling and scleral encircling) were performed in 30 eyes, whereas pars plana vitrectomy, endolaser photocoagulation and intraocular tamponade (19 silicone, 11 gas) were performed in other 30 eyes. Patients were evaluated at postoperative 1st day, 1st week , 5th week, 5th month and 1st year. Best corrected VA, intraocular pressure, lenticular opacity, funduscopic examination and PVR devolopment were evaluated at each visit. Both treatment alternatives were compared with regard to visual and anatomical success. Results: Retina was reattached in 18 eyes which underwent scleral buckling at first attempt, and in 6 eyes at second attempt. 3 patients did not accept the secondary surgery. Retinal reattachment was noted in 26 eyes which underwent vitrectomy at first attempt and in 1 eye at second attempt. 3 patients were followed for the retinal detachment localised to inferior retina without macular involvement. 16 of 18 eyes with successful scleral surgery had VA improvement of 1 or more Snellen lines, whereas no improvement was noted in 2 eyes. Visual acuity was measured as 0.4 or more in 10 eyes. 22 of 26 eyes which underwent successful vitrectomy had VA improvement of 1 or more Snellen lines. No change was observed in 3 eyes and 1 eye had visual deterioration. Visual acuity was measured as 0.4 or more in 15 eyes. Conclusion: Vitrectomy was determined to be superior to scleral buckling method in retinal detachment in which the treatment alternative was under debate with regard to anatomical success and early visual improvement.
Description
Keywords
Yırtıklı retina dekolmanı, Skleral çökertme, Vitrektomi, Görsel sonuç, Anatomik sonuç, Rhegmatogenous retinal detachment, Scieral Buckling, Vitrectomy, Visual prognosis, Anatomical prognosis
Citation
Aygül, F. (2005). Tedavi seçeneği tartışmalı retina dekolmanlarında cerrahi yöntemlerin karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.