TRABEKÜLEKTOMİ OPERASYONU SONRASI ERKEN DÖNEMDE YÜKSEK GÖZ İÇİ BASINCI İÇİN YAPILAN LAZERLE SÜTÜR KESİLMESİNİN ETKİNLİĞİ

Abstract

Amaç: Trabekülektomi operasyonu sonrası erken dönemde yüksek göz içi basıncı (GİB) için yapılan lazerle sütür kesilmesinin (LSK) etkinliğini değerlendirmek.

Ge­reç ve Yön­tem: 2005 ile 2013 yılları arasında trabekülektomi cerrahisi sonrası erken dönemde yüksek GİB’ları olan, masajla blebleri belirginleşen ve bu sebeple LSK yapılan 42 hastanın 47 gözü retrospektif olarak değerlendirildi.

Bulgular: Olguların 22si kadın, 20si erkekti ve ortalama yaşı 62,1±16 (min 34; max 81) idi. Kırk yedi olgunun 22 sinde (%46,8) sadece 1 kez, 25 inde (%53,2) >1 kez LSK yapıldı. Yapılan ortalama LSK sayısı 1,63±0,7 (1-3) idi. Trabekülektomi öncesi ortalama GİB 30,2 mmHg, LSK öncesi ise 24,1±6,3 mmHg (14-42 mmHg) idi. LSK ile trabekülektomi arasında geçen süre ortalama 7,9±6,3 gündü. Bir kez LSK yapılan grupta LSK öncesi ortalama GİB 24,15±6,93 mmHg, LSK sonrası 17,47±5,81 mmHg idi. >1 kez LSK yapılan grupta ise LSK öncesi ortalama GİB 23,96±7,0 mmHg, LSK sonrası ise 16,6±4,61 mmHg idi. Her iki gruptada aradaki fark istatistiksel olarak anlamlı bulundu (p<0.001). Olguların son muayenesindeki ortalama GİB 14,6±4,07 mmHg idi (4-25 mmHg) (p<0,001). Olguların ortalama takip süresi 21,4±20,01 (1-89 ay) aydı.

Sonuç: Trabekülektomi sonrası erken dönemde GİB yüksek bulunan olgularda hedef GİBna ulaşmak için argon lazerle sütür kesilmesi etkin ve güvenilir bir yöntemdir ve birden çok kez uygulanabilir.

Anahtar kelimeler: Glokom; trabekülektomi; lazerle sütür kesilmesi.

Keywords

• Glokom,trabekülektomi,lazerle sütür kesilmesi

EFFECTIVENESS OF LASER SUTURE LYSIS AFTER TRABECULECTOMY WITH EARLY-POSTOPERATIVE HIGH INTRAOCULAR PRESSURE

Abstract

Objective: To evaluate the effectiveness of laser suture lysis (LSL) in patients with early high intraocular pressure (IOP) after trabeculectomy.

Material and Methods: Fourty seven eyes of 42 patients who had high IOP and bleb formation after ocular massage in early postoperative period after trabeculectomy and undergone LSL between 2005 and 2013 were evaluated resrospectively.

Results: Twenty-two patients were female, 20 patients were male and the mean age was 62.1±16 (34-81). LSL was performed once in 22 eyes (46.8%) and more than once in 25 eyes(53.2%). The mean number of LSL was 1.63±0.7. The mean IOP before trabeculectomy was 30.2 mmHg and it was 24.1±6.3 mmHg (14-42 mmHg) before LSL. The mean interval time between trabeculectomy and performance of suture lysis was 7.9±6.3 days. The mean IOPs before and immediately after laser suture lysis were 24.15±6.93 mmHg and 17.47±5.81 mmHg respectively in patients that LSL was performed once (p<0.001). The mean IOPs before and immediately after laser suture lysis were 23.96±7 mmHg and 16.6±4.61 mmHg respectively in patients that LSL was performed more than once (p<0.001). The difference was statistically significant in two groups (p<0.001). At the last visit, the mean IOP was 14.6±4.07 mmHg (4-25 mmHg) (p<0.001). The mean follow-up time was 21.4±20.01months (1-89 months).

Conclusion: Laser suture lysis is a safe and effective method in the management of the patients in whom the target IOP was not reached after trabeculectomy and it can be performed more than once.

Key words: Glaucoma; trabeculectomy; laser suture lysis.

Keywords

• Glaucoma,trabeculectomy,laser suture lysis

References

1. 1. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 1968;66: 673–9.
2. 2. Jampel HD, Pasquale LR, Dibernardo C. Hypotony maculopathy following trabeculectomy with mitomycin C. Arch Ophthalmol 1992;110: 1049–50.
3. 3. Shields MB, Scroggs MW, Sloop CM, Simmons RB. Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin C. Am J Ophthalmol 1993;116:673–83.
4. 4. Costa VP, Wilson RP, Moster MR, Schmidt CM, Gandham S, Smith M. Hypotony maculopathy following the use of topical mitomycin C in glaucoma filtration surgery. Ophthalmic Surg 1993;24: 389–94.
5. 5. Zacharia PT, Deppermann SR, Schuman JS. Ocular hypotony after trabeculectomy with mitomycin C. Am J Ophthalmol 1993;116:314–26.
6. 6. Hoskins HD, Migliazzo C. Management of failing filtering blebs with the argon laser. Ophthalmic Surg 1984;15: 731-3.
7. 7. Shin DH. Removable-suture closure of the lamellar scleral flap in trabeculectomy. Ann Ophthalmol 1987;16: 51-3.
8. 8. Pappa KS, Derick RJ, Weber PA, Kapetansky FM, Baker ND, Lehmann DM. Late argon laser suture lysis after mitomycin C trabeculectomy. Ophthalmology 1993;100:1268-71.

9. 9. Melamed S, Ashkenazi I, Glovinski J, Blumenthal M. Tight skleral flap trabeculectomy with postoperative laser suture lysis. Am J Ophthalmol 1990;109:303-9.
10. 10. Kapetansky FM. Laser suture lysis after trabeculectomy. J Glaucoma 2003;12: 316-20.
11. 11. Ralli M, Nouri-Mahdavi K, Caprioli J. Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C. J Glaucoma 2006;15: 60-7.
12. 12. Aykan U, Bilge AH, Akin T, Certel I, Bayer A. Laser suture lysis or releasable sutures after trabeculectomy. J Glaucoma 2007;16: 240-5.
13. 13. Mudgil AV, To KW, Balachandran RM, Janigian RH, Tsiaras WG. Relative efficacy of the argon green, argon blue-green, and krypton red lasers for 10-0 nylon subconjunctival laser suture lysis. Ophthalmic Surg Lasers 1999;30: 560-4.
14. 14. Lieberman MF. Suture lysis by laser and goniolens. Am J Ophthalmol 1983;95: 257-8.
15. 15. Singh J, Bell RW, Adams A, O'Brien C . Enhancement of posttrabeculectomy bleb formation by laser suture lysis. Br J Ophthalmol 1996;80: 624-7.
16. 16. Altan Ç, Özturker C, Eren H,Bayraktar Ş, Kayaarası Z,Yılmaz O F.Trabekülektomi sonrası lazer sütürlizis. Glo-Kat 2006;1: 35-8.
17. 17. Şatana B, Kocasaraç C, Altan Ç, Baz Ö, Başarır B, Küçüksümer Y ve ark. Trabekülektomi sonrası erken dönem yüksek göz içi basıncında laser sütür lizisin etkinliği Turk J Ophthalmol 2013;43: 91-3.
18. 18. Ritch R, Potash SD, Liebmann JM. A new lens for argon laser suture lysis. Ophthalmic Surg 1994;25: 126-7.
19. 19. Sayın İ, Temel A, Kazokoğlu H. Trabekulektomi sonrası lazer sutur lizis sonuclarımız. Turk Oftalmoloji Derneği XXVIII. Ulusal Kongresi Bulteni 1994;1: 267-8.
20. 20. Bardak Y, Cuypers MH, Tilanus MA, Eggink CA. Ocular hypotony after laser suture lysis following trabeculectomy with mitomycin C. Inter Ophthalmol 1998;21:325-30.
21. 21. Macken P, Buys Y, Trope G E. Glaucoma laser sütür lysis, Br J Ophthalmol 1996;80: 398-401.
22. 22. Savage JA, Condon GP, Lytle RA, Simmons RJ. Laser suture lysis after trabeculectomy. Ophthalmology 1988;95: 1631-8.
23. 23. Morinelli EN, Sidoti PA, Heuer DK, Minckler DS, Baerveldt G, LaBree L, et al. Laser suture lysis after mitomycin C trabeculectomy. Ophthalmology 1996;103:306-14.
24. 24. Geijssen HC, Greve EL. Mitomycin, suturelysis and hypotony. Int Ophthalmol 1992;16: 371-4.
25. 25. Porges Y, Ophir A: Surgical outcome after early intraocular pressure elevation following combined cataract extraction and trabeculectomy. Ophthalmic Surg Lasers 1999;30: 727-33.
26. 26. Kapetansky FM. Laser suture lsis after trabeculectomy. J Glaucoma 2003;12: 316-20.