Penetran keratoplasti endikasyonları: Bir üçüncü basamak sağlık merkezi deneyimi

Year 2021, Volume: 46 Issue: 4, 1409 - 1418, 30.12.2021

İbrahim İnan Harbiyeli Elif Erdem Anıl Uysal Meltem Yağmur

https://doi.org/10.17826/cumj.983002

Abstract

Amaç: Bu çalışmada bir üçüncü basamak sağlık merkezinde uygulanan penetran keratoplasti (PK) ameliyatlarının endikasyon dağılımının ve çalışma periyodu içerisinde bu dağılımda görülen değişimlerin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: PK ameliyatı geçiren hastaların tıbbi kayıtları retrospektif olarak incelendi. Endikasyonlar; korneal skar, korneal distrofi, keratokonus, büllöz keratopati, regreft ve akut enfeksiyöz keratit olmak üzere altı ana kategori altında incelendi. Endikasyonların zaman içerisindeki değişimini inceleyebilmek amacıyla çalışma periyodu iki eşit zaman dilimine ayrıldı ve bu iki periyottaki veriler karşılaştırıldı.
Bulgular: İki yüz altmış üç hastanın (117 kadın [%44,5], 146 erkek [%55,5]) 303 gözü çalışmaya dahil edildi. Penetran keratoplastinin en sık endikasyonu korneal skarlar (76 göz, %25,1) idi. Enfeksiyöz keratit sekelleri (38/76, %50) korneal skar etyolojisi içerisinde ilk sırayı alırken, etkenlere göre dağılım incelendiğinde herpetik keratite bağlı sekeller (21/38, %55,2) en büyük alt grubu oluşturmaktaydı. Çalışma periyodunun 2. yarısında korneal distrofi nedeniyle uygulanan cerrahilerin oranının azaldığı, regreft uygulanan olguların oranının ise artış gösterdiği saptandı.
Sonuç: Çalışmamızda PK’nın en sık nedeni korneal skar olarak bulunmuştur.. Enfeksiyöz keratit ve korneal travma olguları açısından sağlık hizmetlerinin iyileştirilmesi; korneal distrofiler açısından ise akraba evliliklerinin önlenmesine yönelik sosyal projelerin ve genetik danışmanlık hizmetlerinin yaygınlaştırılması, bölgemizde korneal patolojiler kaynaklı görme kayıplarını azaltabilecektir.

Keywords

Enfeksiyöz keratit sekeli, herpetik keratit, korneal distrofi, penetran keratoplasti, travmatik korneal skar.

Thanks

Bu çalışmadaki verilerin toplanması aşamasındaki katkılarından dolayı Çukurova Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Kornea Bankası teknisyeni Erhan Cansız’a teşekkürlerimizi sunarız.

Indications for penetrating keratoplasty: A single tertiary health clinic experience

Abstract

Purpose: The aim of this study was to investigate the indication distribution for penetrating keratoplasty (PK) surgeries performed in our clinic and the changes observed in this distribution during the study period.
Materials and Methods: Medical records of patients who underwent PK were retrospectively reviewed. Indications were examined under six main categories; corneal scarring, corneal dystrophy, keratoconus, bullous keratopathy, regraft and acute infectious keratitis. In order to examine the changes in indications over time, the study period was divided into two equal time periods and the data in these periods were compared.
Results: 303 eyes of 263 patients (117 women [44.5%], 146 men [55.5%]) were included in the study. The most common indication for penetrating keratoplasty was corneal scars (76 eyes, 25.1%). While infectious keratitis sequelaes (38/76, 50%) took the first place in the etiology of corneal scarring, sequelaes due to herpetic keratitis (21/38, 55.2%) were the largest subgroup whereas the distribution according to the microbial agents was examined. In the second half of the study period, the rate of surgeries performed due to corneal dystrophy decreased, whereas the rate of patients who underwent regraft increased.
Conclusion: The most common indication for PK was corneal scarring in this study. Improving health services in terms of infectious keratitis and corneal trauma cases; dissemination of social projects and genetic counseling services for the prevention of consanguineous marriages in terms of corneal dystrophies will reduce vision loss due to corneal pathologies in this region.

Keywords

Corneal dystrophy, herpetic keratitis, penetrating keratoplasty, traumatic corneal scar

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