Lazer Tedavisine Dirençli Diffüz Diyabetik Maküla Ödemi Olan Olgularda Pars Plana Vitrektomi İnternal Limitan Membran Soyma Cerrahisi Sonrası Fonksiyonel ve Yapısal Değişiklikler

Öz

Amaç: Vitreoretinal traksiyonu olmayan lazer fotokoagulasyona dirençli diyabetik maküla ödemi DMÖ olan olgularda pars plana vitrektomi PPV internal limitan mebran ILM soyma operasyonunun morfolojik ve fonksiyonel etkilerini değerlendirmek. Gereç ve Yöntemler: Ocak 2004-Ağustos 2009 tarihleri arasında Akdeniz Üniversitesi Hastanesinde klinik olarak anlamlı DMÖ tanısı ile PPV +/- ILM soyma operasyonu yapılmış, postoperatif dönemde 12 ay takip edilmiş 71 hastanın 86 gözü retrospektif olarak incelendi. Hastalar ILM soyma yapılan Grup 1 ve ILM soyma yapılmayan Grup 2 olarak iki gruba ayrıldı. Olgular kendi arasında da IS/ OS bandında bozulmaya göre IS/OS + ve IS/OS - olarak iki gruba ayrıldı. Operasyondan önceki bir ay içinde ve operasyondan sonraki 6. hafta, 3-6 ve 12. aylarda yapılan tam oftalmolojik muayene, Optik kohorens tomografi OKT ve mikroperimetri testleri değerlendirildi. P değerinin 0,05’in altında olması anlamlı olarak kabul edildi. Bulgular: 71 hastanın 86 gözü 39 kadın, 32 erkek çalışmaya alındı. Hastaların ortalama yaşı 55,1 ± 13,3 idi. 8 erkek ve 7 kadın hastanın her iki gözü çalışmaya alındı. Ortalama diyabet süresi 14,9 ± 7,1 yıl idi. Operasyondan önceki ortalama DMÖ süresi 6,3 ± 2,1 ay 5-14 ay idi. Maküler ödem nedeni ile yapılan en son lazer tedavisi operasyondan ortalama 6,1 ay 3-7 ay önce idi. Operasyon sonrası takip süresi 13 ile 21 ay 13,6 ± 2,7 ay arasında idi. Takiplerde logMAR ile ölçülen görme keskinliği Grup 1 ve Grup 2’de anlamlı olarak 3. ve 6. ayda değişmeye başladı p

Anahtar Kelimeler

• Diyabetik maküler ödem, OKT, Mikroperimetri, Vitrektomi, IS/OS segme

Functional and Morphological Changes After Pars Plana Vitrectomy with Internal Limiting Membrane Peeling in Patients with Diabetic Macular Edema Refractory to Laser Photocoagulation

Abstract

Objective: To evaluate the morphological and functional effects of vitrectomy and ILM removal in eyes with diffuse diabetic macular edema DME and with no vitreomacular traction refractory to macular laser photocoagulation. Material and Methods: Between January 2004 and August 2009, 86 eyes of 71 patients who underwent PPV / - ILM peeling operation with clinical diagnosis of DME and followed up for 12 months postoperatively were evaluated retrospectively. The patients were divided into two groups as ILM peeling Group 1 and ILM peeling Group 2 . The patients were divided into two groups as IS / OS + and IS / OS - according to the IS / OS band deterioration. Complete ophthalmologic examination, optical coherence tomography OCT and microperimetry tests were performed within one month before the operation and at 6 weeks, 3-6 and 12 months after the operation. P value below 0.05 was considered significant.Results: Overall, 86 eyes of 71 patients 39 women and 32 men were included in the study. The mean age of the patients was 55.1± 13.3 years range, 31- 82 years . The mean duration of diabetes was 14.9 ± 7.1 years. The mean duration of DME prior to surgery was 6.3 ± 2.1 months 5-14 months . The latest laser treatment due to macular edema was an average of 6.1 months 3-7 months before surgery. The follow-up period after surgery was between 13 and 21 months 13.6 ± 2.7 months . Follow-up logMAR vision of Group 1 and Group 2 started to change significantly at the 3 month and 6 month exams, respectively p

Keywords

• Diabetic macular edema, Microperimetry, OCT, Vitrectomy, IS/OS segment

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