Oküler Hipertansiyonlu Hastalarda Santral Kornea Kalınlığı, Optik Sinir Başı Analizi ve Retina Sinir Lifi Kalınlığı Arasındaki İlişkinin Değerlendirilmesi

Year 2019, Volume: 5 Issue: 2, 235 - 245, 01.01.2019

Abdulkadir Alış İclal Yücel Meryem Güler Alış

Abstract

Amaç: Oküler hipertansiyon OHT tanısı alan hastalarda ultrasonik pakimetri ile ölçülen santral kornea kalınlıkları SKK ile Heidelberg Retinal Tomography HRT testinde optik sinir başı OSB analizleri, görme alanı GA testi ve spektral optik kohorens tomografi OKT ile ölçülen retina sinir lifi tabakası RSLT ortalama kalınlıkları arasındaki ilişkiyi belirlemek.Gereç ve Yöntemler: Çalışmaya Akdeniz Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Glokom biriminde OHT tanısı ile takip edilen 150 hasta ve sağlıklı bireylerden oluşan 150 kontrol hastası dahil edildi. Çalışma kapsamındaki tüm hastalar yaş, cinsiyet, ailede glokom hikayesi, sistemik hastalık, kullandığı ilaçlar açısından sorgulandı. Hastaların tam oftalmolojik muayeneleri, OKT, HRT, pakimetri ve GA testleri takipleri süresince yapıldı. Elde edilen verilerin değerlendirilmesinde Statistical Package for the Social Sciences SPSS paket sistemi kullanıldı. İki grubun verileri kıyaslanırken ManWhitney-U ve T testleriyle değerlendirme yapıldı. P değeri 0,05’in altında olması anlamlı olarak kabul edildi.Bulgular: Çalışmaya alınan 150 OHT’li hastaların 106’sı kadın, 44’ü erkekti. 106 kadın hastanın 212 gözü, 44 erkek hastanın 88 gözü toplam 300 göz çalışmaya dahil edildi. Yaş ortalaması kadınlarda 39,95±13,87, erkeklerde 36,13±7,41 idi. Kontrol grubundakilerin 87’si kadın, 63’ü erkekti. 87 kadın hastanın 174 gözü, 63 erkek hastanın 126 gözü çalışmaya dahil edildi. Yaş ortalaması kadınlarda 31,47±4,82, erkeklerde 30,00±5,83 idi. Her iki grupta da kadın erkek yaşları arasında istatistiksel olarak anlamlı fark bulunmadı. Ortalama göz içi basıncı GİB Grup 1’de Grup 2’ye göre anlamlı derecede yüksek bulundu. Grup 1’deki cinsiyet ayrımına göre ortalama GİB değerleri açısından anlamlı fark olmadığı görüldü. Ortalama SKK açısından Grup 1’deki değerlerin Grup 2’ye göre anlamlı derecede yüksek olduğu görüldü. Grup 1’deki cinsiyet ayrımına göre ortalama SKK değerlerinin kadın hastalarda, erkek hastalara göre anlamlı derecede yüksek olduğu görüldü. İki grup arasında GA’da ortalama Mean Deviation MD ve Pattern Standart Deviation PSD değerleri açısından anlamlı fark olmadığı görüldü. Ortalama RSLT kalınlığının Grup 1’deki değerlerinin Grup 2’ye göre istatistiksel olarak anlamlı derecede daha düşük olduğu görüldü. Grup 1’deki hastalar aile hikayesi olan ve olmayanlar olarak ayrıldı. Değerlendirdiğimiz parametreler kontrol grubu ile karşılaştırıldı. GA’daki MD ve PSD değerleri kontrol grubu ile kıyaslandığında anlamlı bir fark olmadığı görüldü. Oküler muayenede cup/disk C/D oranı, SKK, OKT’de ortalama RSLT kalınlığı ve GİB değerleri kontrol grubu ile kıyaslandığında istatistiksel olarak anlamlı fark olduğu gözlendi.Sonuç: Glokom, OHT ve normotansif glokom NTG tanısı konulurken mutlaka olguların SKK’ları değerlendirmeye alınmalıdır. SKK arttıkça aplanasyon tonometrisi ölçümleri gerçek GİB’in üstünde, SKK azaldıkça gerçek GİB’in altında çıkmaktadır. İnce kornea düşük GİB ölçümüne neden olarak, gelecekte oluşabilecek glokom tanısını geciktirebilir, kalın kornea ise yüksek GİB ölçümüne neden olarak, gereksiz tedaviye neden olabilir. Ayrıca çalışmamızda fonksiyonel olarak normal olan ve tedavi başlanması açısından karar verilemeyen şüpheli hastalarda erken glokomatöz hasarı saptamada OKT’nin etkili ve güvenilir bir yöntem olduğu sonucuna vardık

Keywords

Oküler hipertansiyon, Santral korneal kalınlık, Optik kohorens tomografi

Evaluation of the Relationship Between Central Corneal Thickness, Optic Nerve Head Analysis and Retinal Nerve Fiber Thickness in Patients With Ocular Hypertension

Abstract

Objective: To determine the relationship between central corneal thickness CCT measured by ultrasonic pachymetry and optic nerve head ONH analysis in Heidelberg Retinal Tomography HRT test, visual field VF test and mean thickness of the retinal nerve fiber layer RNFL measured by spectral optical coherence tomography OCT in patients with ocular hypertension OHT .Material and Methods: The study included 150 patients who were followed up with OHT at the Akdeniz University Medical Faculty, Department of Ophthalmology Glaucoma unit and 150 control patients consisting of healthy individuals. All patients in the study were questioned for age, gender, family history, systemic diseases and for the drugs used by them. Complete ophthalmologic examinations of the patients including OCT, HRT, pachymetry and VF were performed during their follow-up. The obtained data were evaluated using the Statistical Package for the Social Sciences SPSS package software. Comparison of the two groups was conducted with the Mann-Whitney U and t tests. A p value less than 0.05 was considered statistically significant.Results: Out of 150 OHT patients included in the study, 106 were females and 44 were males. A total of 300 eyes were involved in the study with 212 eyes of 106 female and 88 eyes of 44 male patients. The mean age was 39.95±13.87 in females and 36.13±7.41 in males. Of the subjects in the control groups, 87 were females and 63 were males. A total of 300 eyes were enrolled in the study with 174 eyes of 87 female and 126 eyes of 63 male patients. The mean age was 31.47±4.82 in females and 30.00±5.83 in males. There was no statistically significant difference between the ages of the male and female patients in the two groups. Mean intraocular pressure IOP was significantly higher in Group 1 than in Group 2. There was no significant difference in mean IOP values according to gender in Group 1. Mean CCT values were significantly higher in Group 1 compared with Group 2. The mean CCT values were significantly higher in female patients than male patients in Group 1 according to gender. There was no significant difference in mean VF in terms of Mean Deviation MD and Pattern Standard Deviation PSD values between the two groups. The mean thickness of RNFL around the ONH was found to be statistically significantly lower in Group 1 than in Group 2. Patients in Group 1 were divided as those with and without a family history. The parameters we evaluated were compared with the control group. MD and PSD values in the visual field were not significantly different when compared to the control group. In ocular examination; there were statistically significant differences between the two groups in terms of fundus cup-to-disc C/D ratio, CCT, and mean RNFL on OCT and IOP values.Conclusion: When glaucoma, OHT and normotensive glaucoma NTG are diagnosed, it is absolutely necessary to evaluate the CCT. As the CCT increases, the IOP value measured by the aplanation tonometer drops above the actual value. As CCK decreases, it falls below the true IOP. A thin cornea can cause low IOP measurement and may delay the diagnosis of glaucoma that may occur in the future while a thick cornea may cause unnecessary treatment because of high IOP measurements. We also concluded that OCT is an effective and reliable method for detecting early glaucomatous damage in suspected cases that are functionally normal in our study and where a decision cannot be made for treatment initiation

Keywords

Ocular hypertension, Central corneal thickness, Optical coherence tomography

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