Psödofakik Retina Dekolmanlı Hastaların Demografik ve Klinik Özellikleri ve Bunların Cerrahi Başarıya Etkisi

Year 2020, Volume: 25 Issue: 3, 206 - 213, 29.10.2020

Havva Kaldırım , Mehmet Çakır Ömer Yılmaz

https://doi.org/10.21673/anadoluklin.768979

Abstract

Amaç: Bu çalışmada psödofakik retina dekolmanı (PRD) nedeniyle opere edilen hastaların klinik ve demografik özelliklerini saptamak ve bu özelliklerin cerrahi başarıya etkisini değerlendirmek amaçlanmıştır.

Gereç ve Yöntemler: Şubat 2006—Ocak 2009 döneminde Beyoğlu Göz Eğitim ve Araştırma Hastanesi I. Göz Kliniği Retina Birimi’nde PRD tanısı alan 60 hastanın 60 gözü çalışmaya alındı. Hastaların demografik ve ameliyat öncesindeki, sırasındaki ve sonrasındaki klinik verileri kaydedildi.

Bulgular: Yaş ortalaması 58,45±14,91 yıl olan hastaların, 46’sı (%76,7) erkek, 14’ü (%23,3) kadın idi. Hastaların 52’sinde (%86,6) fakoemülsifikasyon cerrahisi, 1’inde (%1,6) planlanmış ekstrakapsüler katarakt ekstraksiyonu, 1’inde (%1,6) intrakapsüler katarakt ekstraksiyonu, 3’ünde (%5) refraktif şeffaf lens ekstraksiyonu, 3’ünde ise (%5) pediyatrik katarakt tanısıyla irigasyon/aspirasyon ile lens ekstraksiyonu gerçekleştirilmişti. Hastaların 22’sinde (%36,6) kapsül içine arka kamara lensi, 32’sinde (%53,3) sulkusa arka kamara lensi, 4’ünde (%6,6) ön kamara lensi, 2’sinde (%3,3) skleral fiksasyonlu lens implante edilmişti. Kırk dört (%73) hastada arka kapsül bütünlüğü bozulmuştu. Hastaların 27’sinde (%45) ameliyat öncesi göz dibi incelemesinde, 18 (%30) hastada ise ameliyat sırasında yırtık tespit edildi. On beş (%25) hastada ise yırtık saptanmadı. Hastalara proliferatif vitreoretinopati (PVR) evresi, lensin ve arka kapsülün durumu, retinal yırtığın yerleşimi gibi faktörlere göre 4 ayrı cerrahi prosedür uygulandı: 360 derece skleral çökertme + lokal çökertme (Grup I); 360 derece skleral çökertme + pars plana vitrektomi + tamponat (Grup II); 360 derece skleral çökertme + pars plana vitrektomi + intraoküler lens çıkarma + tamponat (Grup III); 23G pars plana vitrektomi + tamponat (Grup IV). Ortalama hasta takip süresi 18,3±5,2 (6–32) ay idi. Son kontrollerde 60 hastanın 58’inde (%96,6) anatomik başarı, 17’sinde (%32) fonksiyonel başarı elde edilmişti. PVR evresi C1 ve daha erken evre olan hastalarda fonksiyonel başarı oranı daha yüksekti (p<0,001).

Tartışma ve Sonuç: Bulgularımıza göre PRD’de PVR evresi anatomik ve fonksiyonel başarı ile direkt ilişkilidir. PVR’si erken evredeki PRD’li hastalarda cerrahi tedavi daha başarılıdır.

Keywords

arka kapsül perforasyonu, proliferatif vitreoretinopati, psödofakik retina dekolmanı, tamponat

Supporting Institution

yok

Demographic and Clinical Characteristics of Patients with Pseudophakic Retinal Detachment and Their Effects on the Success of Surgery

Abstract

Aim: In this study, we aimed to determine the demographic and clinical characteristics of patients who underwent surgical treatment for pseudophakic retinal detachment (PRD) and evaluate the effects of these characteristics on the success of the surgery.

Materials and Methods: The study included 60 eyes of 60 patients who were diagnosed with PRD at the Retina Section of the 1st Eye Clinic of the Beyoğlu Eye Training and Research Hospital between February 2006 and January 2009. Demographic and pre-, peri- and postoperative clinical data of the patients were recorded.

Results: The mean patient age was 58.45±14.91 years. Of the patients, 46 (76.7%) were male and 14 (23.3%) were female. Fifty-two (86.6%) patients underwent phacoemulsification surgery, 1 (1.6%) planned extracapsular cataract extraction, 1 (1.6%) intracapsular cataract extraction, 3 (5%) refractive clear lens extraction, and 3 (5%) lens extraction with irrigation/aspiration for diagnosed pediatric cataract. Twenty-two (36.6%) patients underwent posterior chamber lens implantation in the capsule, 32 (53.3%) posterior chamber lens implantation in the sulcus, 4 (6.6%) anterior chamber lens implantation, and 2 (3.3%) scleral-fixated lens implantation. In 44 (73%) patients, the posterior capsule integrity was impaired. A tear was detected in 27 (45%) patients during the preoperative retinal examination and in 18 (30%) patients during the surgery. No tear was detected in 15 (25%) of the patients. To treat the patients, four different surgical procedures were performed depending on factors including the proliferative vitreoretinopathy (PVR) stage, condition of the lens and posterior capsule, and location of the retinal tear: 360-degree scleral encircling band + local explant (Group I), 360-degree scleral encircling band + pars plana vitrectomy + tamponade (Group 2), 360-degree scleral encircling band + pars plana vitrectomy + intraocular lens removal + tamponade (Group III), and 23G pars plana vitrectomy + tamponade (Group IV). The mean follow-up was 18.3±5.2 (6–32) months. At the last follow-up visits, anatomical success was achieved in 58 (96.6%) of the 60 patients while 17 (32%) showed functional success. The functional success rate was higher in patients in the early stages (up to C1) of PVR (p<0.001).

Discussion and Conclusion: According to our findings, PVR stage is directly related to anatomical and functional success in PRD. Surgical treatment is more successful in PRD patients with early-stage PVR.

Keywords

posterior capsule perforation, proliferative vitreoretinopathy, pseudophakic retinal detachment, tamponade

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