Katarakt Operasyonu Uygulanan Hastalarda Pseudoeksfoliasyon Sendromu Prevalansı ve İntraoperatif Komplikasyonlar

Öz

Amaç: Katarakt operasyonu uygulanan olgularda pseudoeksfoliasyon sendromu (PES) prevalansı ve buna bağlı gelişen kataraktın tipini, glokomun sıklığını ve intraoperatif komplikasyonları belirlemektir. Gereç ve Yöntemler: Adana Numune Eğitim ve Araştırma Hastanesi’ne başvuran ve katarakt nedeniyle opere edilen hastalar geriye dönük olarak değerlendirildi. Hastaların yaş, cinsiyet, ön segment ve fundus bulguları, göz içi basıncı ve intraoperatif komplikasyonlar incelendi. Vakalar PES + ve PES - olarak iki gruba ayrıldı. Bulgular: PES’li hastalarda yaş ortalaması 76,4±10 iken PES’li olmayan olguların yaş ortalaması 66,8±12 bulundu( p<0,001). 390 kataraktlı gözün %9’unda PES gözlendi (n=35). PES’li hastalarda en sık nükleer katarakt tespit edildi. PES olan ile olmayan grupların ortalama intraokuler basınçları arasında anlamlı fark bulunmadı (p>0,05). PES olan olgularda %11,5, olmayanlarda %8,4 intraoperatif komplikasyon görülmüştür (p>0,05). Sonuçlar: PES prevalansının farklı coğrafyalarda aralığı çok değişkendir. PES beraberinde görülen hastalıklar, komplikasyonlar nedeniyle oftalmolojik muayenede dikkat edilmesi gereken bir antitedir.

Anahtar Kelimeler

• pseudoeksfoliasyon sendromu
• katarakt
• intraoperatif komplikasyon

Prevalence of Pseudoexfoliation Syndrome and Intraoperative Complications in Patients Underwent Cataract Surgery

Abstract

Aim: The aim of the study was to evaluate pseudoexfoliation syndrome (PEX) prevalence, type of cataract, frequency of pseudoexfoliation glaucoma, and intraoperative complications in patients having cataract surgery. Material and Methods: Patients who underwent cataract surgery at Adana Numune Training and Research Hospital were evaluated retrospectively. The study assessed patient age, gender, anterior segment and fundus findings, intraocular pressure measurement, intraoperative complication notes. The cases were classified into two groups: the PEX + and the PEX - group. Results: The mean age was 76.4 ± 10 in patients with PEX and 66.8 ± 12 in patients without PEX (p <0.001). The overall prevalence of PEX syndrome was found to be % 9 in 390 cataract cases. The most common cataract type was a nuclear cataract in PEX patients. There was no significant difference in intraocular pressure between PEX + and PEX- groups (p> 0.05). Intraoperative complications in PEX+ and PEX- cases were observed %11.5 and %8.4 respectively (p> 0.05). Conclusion: The prevalence of PEX is very variable in different geographical regions. PEX should be considered in the ophthalmologic examination due to risk factors and complications.

Keywords

• pseudoexfoliation syndrome
• cataract
• intraoperative complication

References

1. 1. Lindberg JG. Clinical investigations on depigmentation of the pupillary border and translucency of the iris in cases of senile cataract and in normal eyes in elderly persons. Acta Ophthalmol Suppl. 1989;190:1-96. PubMed PMID: 2541596.
2. 2. Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with increased vascular risk. Am J Ophthalmol. 1997;124(5):685-7. PubMed PMID: 9372724.
3. 3. Aydogan Ozkan B, Yuksel N, Keskin G, Altintas O, Karabas VL, Caglar Y, Almac A. Homocysteine levels in plasma and sensorineural hearing loss in patients with pseudoexfoliation syndrome. Eur J Ophthalmol. 2006;16(4):542-7. PubMed PMID: 16952092.
4. 4. Schlotzer-Schrehardt UM, Koca MR, Naumann GO, Volkholz H. Pseudoexfoliation syndrome. Ocular manifestation of a systemic disorder? Arch Ophthalmol. 1992;110(12):1752-6. PubMed PMID: 1463418.
5. 5. You QS, Xu L, Wang YX, Yang H, Ma K, Li JJ, Zhang L, Jonas JB. Pseudoexfoliation: normative data and associations: the Beijing eye study 2011. Ophthalmology. 2013;120(8):1551-8. doi: 10.1016/j.ophtha.2013.01.020. PubMed PMID: 23622877.
6. 6. Kozobolis VP, Papatzanaki M, Vlachonikolis IG, Pallikaris IG, Tsambarlakis IG. Epidemiology of pseudoexfoliation in the island of Crete (Greece). Acta Ophthalmol Scand. 1997;75(6):726-9. PubMed PMID: 9527341.
7. 7. Fontana L, Coassin M, Iovieno A, Moramarco A, Cimino L. Cataract surgery in patients with pseudoex-foliation syndrome: current updates. Clin Ophthalmol. 2017;11:1377-83. doi: 10.2147/OPTH.S142870. PubMed PMID: 28814824; PubMed Central PMCID: PMCPMC5546806.
8. 8. Foster PJ, Buhrmann R, Quigley HA, Johnson GJ. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002;86(2):238-42. PubMed PMID: 11815354; PubMed Central PMCID: PMCPMC1771026.

9. 9. Kilic R, Sezer H, Comcali SU, Bayraktar S, Goktolga G, Cakmak Y, Cetin AB, Cumurcu T. The frequency of exfoliation syndrome in the central anatolia region of Turkey. J Ophthalmol. 2014;2014:139826. doi: 10.1155/2014/139826. PubMed PMID: 25165574; PubMed Central PMCID: PMCPMC4140104.
10. 10. Young AL, Tang WW, Lam DS. The prevalence of pseudoexfoliation syndrome in Chinese people. Br J Ophthalmol. 2004;88(2):193-5. PubMed PMID: 14736771; PubMed Central PMCID: PMCPMC1772018.
11. 11. Rao RQ, Arain TM, Ahad MA. The prevalence of pseudoexfoliation syndrome in Pakistan. Hospital based study. BMC Ophthalmol. 2006;6:27. doi: 10.1186/1471-2415-6-27. PubMed PMID: 16792800; PubMed Central PMCID: PMCPMC1513600.
12. 12. Lamba PA, Giridhar A. Pseudoexfoliation syndrome (prevalence based on random survey hospital data). Indian J Ophthalmol. 1984;32(3):169-73. PubMed PMID: 6335132.
13. 13. Nouri-Mahdavi K, Nosrat N, Sahebghalam R, Jahanmard M. Pseudoexfoliation syndrome in central Iran: a population-based survey. Acta Ophthalmol Scand. 1999;77(5):581-4. PubMed PMID: 10551306. 14. Moreno Montanes J, Alcolea Paredes A, Campos Garcia S. Prevalence of pseudoexfoliation syndrome in the northwest of Spain. Acta Ophthalmol (Copenh). 1989;67(4):383-5. PubMed PMID: 2801039.
14. 15. Esmail F. [Pseudoexfoliation syndrome]. Klin Monbl Augenheilkd. 1991;198(5):335-9. doi: 10.1055/s-2008-1045974. PubMed PMID: 1886350.
15. 16. Forsius H, Forsman E, Fellman J, Eriksson AW. Exfoliation syndrome: frequency, gender distribution and association with climatically induced alterations of the cornea and conjunctiva. Acta Ophthalmol Scand. 2002;80(5):478-84. PubMed PMID: 12390157.
16. 17. Ritch R. Exfoliation syndrome. Curr Opin Ophthalmol. 2001;12(2):124-30. PubMed PMID: 11224719.
17. 18. Puska P, Tarkkanen A. Exfoliation syndrome as a risk factor for cataract development: five-year follow-up of lens opacities in exfoliation syndrome. J Cataract Refract Surg. 2001;27(12):1992-8. PubMed PMID: 11738916.
18. 19. Seland JH, Chylack LT, Jr. Cataracts in the exfoliation syndrome (fibrillopathia epitheliocapsularis). Trans Ophthalmol Soc U K. 1982;102 Pt 3:375-9. PubMed PMID: 6964284.
19. 20. Sunay F, Şentürk A, Borataç N, Şendilek B, Erbil H. Katarakt Hastalarında Eksfoliasyon Sıklığı ve Cerrahi Sonuçları. Turkiye Klinikleri Journal of Ophthalmology. 1997;6(1):31-3.
20. 21. Dikci S, Türkoğlu EB, Tök Ö, Burcu A, Örnek F. Sublükse Senil Katarakt ve Psödoeksfolyasyon Sendromlu Olgularda Cerrahi Sonuçlarımız. MN Oftalmoloji 2011;18(3):146-52.
21. 22. Ekström C. Elevated intraocular pressure and pseudoexfoliation of the lens capsule as risk factors for chronic open-angle glaucoma. A population-based five-year follow-up study. Acta Ophthalmol (Copenh). 1993;71(2):189-95.
22. 23. Alpay H, Ersoy G. Psödoexfoliasyon sendromu (İstatistiksel bir çalışma). Türk Oftalmol Gazete 1989;19(1):63-6.
23. 24. Rotchford AP, Kirwan JF, Johnson GJ, Roux P. Exfoliation syndrome in black South Africans. Arch Ophthalmol. 2003;121(6):863-70. doi: 10.1001/archopht.121.6.863. PubMed PMID: 12796260. 25. Alfaiate M, Leite E, Mira J, Cunha-Vaz JG. Prevalence and surgical complications of pseudoexfoliation syndrome in Portuguese patients with senile cataract. J Cataract Refract Surg. 1996;22(7):972-6. PubMed PMID: 9041093.
24. 26. Govetto A, Lorente R, Vazquez de Parga P, Rojas L, Moreno C, Lagoa F, Lorente B. Frequency of pseudoexfoliation among patients scheduled for cataract surgery. J Cataract Refract Surg. 2015;41(6):1224-31. doi: 10.1016/j.jcrs.2014.09.039. PubMed PMID: 26100955.
25. 27. Schlotzer-Schrehardt U, Naumann GO. A histopathologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol. 1994;118(6):730-43. PubMed PMID: 7977599. 28. Drolsum L, Haaskjold E, Sandvig K. Phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg. 1998;24(6):787-92. PubMed PMID: 9642589.
26. 29. Shingleton BJ, Heltzer J, O'Donoghue MW. Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome. J Cataract Refract Surg. 2003;29(6):1080-6. PubMed PMID: 12842671. 30. Akinci A, Batman C, Zilelioglu O. Phacoemulsification in pseudoexfoliation syndrome. Ophthalmologica. 2008;222(2):112-6. doi: 10.1159/000112628. PubMed PMID: 18303232.
27. 31. Niyaz L, Erdoğan H. Intra- and Postoperative Cataract Surgery Complications in Patients with Pseudoexfoliation. Turkiye Klinikleri J Ophthalmol. 2013;22(3):154-8.
28. 32. Oltulu R, Şahin A, Pekel H. Psödoeksfoliasyon sendromlu gözlere uygulanan fakoemülsifikasyon cerrahisinde görülen intraoperatif komplikasyonlar. Tıp Araştırmaları Dergisi. 2008;6(3):142-5.
29. 33. Guzek JP, Holm M, Cotter JB, Cameron JA, Rademaker WJ, Wissinger DH, Tonjum AM, Sleeper LA. Risk factors for intraoperative complications in 1000 extracapsular cataract cases. Ophthalmology. 1987;94(5):461-6. PubMed PMID: 3601359.
30. 34. Akçay G, Mesci C, Aybar A, Bilge A, Erbil HH. Psödoeksfoliasyon sendromlu olgularda katarakt cerrahisi sonuçlarımız. Göztepe Tıp Dergisi 28(1):25-9. doi: 10.5222/J.GOZTEPETRH.2013.025.