Diyabetik Hastalarda Peripapiller Sinir Lifi Kalınlığını Etkileyen Demografik Faktörlerin Optik Koherens Tomografi ile Değerlendirilmesi

Abstract

Amaç: Diyabetik hastalarda optik koherens tomografi (OKT) ile ölçülen peripapiller sinir lifi kalınlığını (PLSK) etkileyen demografik faktörleri araştırmaktır.
Yöntem: Bu çalışmaya 2009-2013 yılları arasında izlenen 104 diyabetik hastanın (46 erkek hastanın 92 gözü, 58 kadın hastanın 115 gözü) toplam 207 gözü dahil edildi. PLSK, OCT ile üst, alt, temporal ve nazal kadranlarda ölçüldü ve demografik faktörlerle karşılaştırıldı.
Bulgular: 60 yaş ve üzerinde ortalama PSLK, 60 yaş altına göre üst ve alt kadranda daha ince olduğu görüldü(p=0,004, p=0,001). Cinsiyet ile ortalama PSLK arasında sadece alt kadranlarda anlamlı bir ilişki vardır (p = 0,006). Dört kadranda da hipertansiyon(HT) ile ortalama PSLK arasında ilişki yoktur(p>0.05). Glokomlu gözlerde, glokomu olmayanlara göre üst kadranda ortalama PLSK azalmaktadır(p=0.019). 15 yıldan fazla diyabet süresi olan hastalarda üst, alt ve nazal kadranlarda ortalama PLSK, 15 yıl veya daha az olanlara göre azaldığı görüldü(p=0,048, p=0,020, p=0,020). Retinopatisi olmayan gözlerde ortalama temporal PLSK, proliferatif diyabetik retinopatili (PDR) ve non-PDR olan gözlerle karşılaştırıldığında azalmıştı(p=0,025). Temporal PLSK hem diyabetik maküla ödemi (DMÖ) olan hem de panretinal fotokoagülasyon uygulanan hastalarda artmıştı (p=0,001,p=0,001). Fokal lazer tedavisi uygulanan hastalarla dört kadrandaki ortalama PLSK arasında korelasyon bulunmadı (p>0.05).
Sonuç: Yaş, cinsiyet, diyabet süresi, glokom varlığı, DMÖ, PDR-nonPDR gibi faktörlerin PSLK üzerine etkisinin olduğu fakat HT, fokal lazer gibi faktörlerin PSLK üzerine etkisi yoktur. Ayrıca hem glokomu hem de diyabeti bulunan olgularda, retina sinir lifi defektlerinin progresyonunu değerlendirirken diyabet süresi ve diyabetik retinopati mevcudiyetinin dikkate alınması gerekir.

Keywords

• Diyabetes mellitus
• Peripapiller sinir lifi kalınlığı
• Optik koherens tomografi
• Demografik faktörler

Evaluation of Demographic Factors Affecting Peripapillary Nerve Fiber Thickness by Optical Coherence Tomography in Diabetic Patients

Abstract

Objective: To investigate the demographic factors affecting the peripapillary nerve fiber thickness(PNFL) measured with optical coherence tomography(OCT) in diabetic patients.
Method: A total of 207 eyes of 104 diabetic patients(92 eyes of 46 male, 115 eyes of 58 female) who were followed-up between 2009-2013 were included. PNFL was measured with OCT in the superior, inferior, temporal and nasal quadrants and compared with demographic factors.
Result: PNFL was found to be thinner in superior and inferior at the age of 60 years and above compared to under 60 years(p=0.004,p=0.001). There is a significant relationship between gender and the average PNFL only in inferior quadrants(p=0.006). There is no relationship between hypertension and the mean PNFL in 4 quadrants(p>0.05). Superior PNFL was decreased in eyes with glaucoma compared to those without glaucoma(p=0.019). The mean PNFL in superior, inferior and nasal patients with diabetes duration of more than 15 years decreased compared to those with 15 years or less(p=0.048,p=0.020,p=0.020). Temporal PNFL was decreased in eyes without retinopathy compared to eyes with proliferative diabetic retinopathy(PDR) and non-PDR(p=0.025). Temporal PNFL was increased both in patients with diabetic macular edema(DME) and the patients treated with panretinal photocoagulation(p=0.001,p=0.001). No correlation was found between the mean PNFL in four quadrants with focal laser treatment(p>0.05).
Conclusion: Age, gender, duration of diabetes, glaucoma, DME, PDR, non-PDR have an effect on PNFL, but HT and focal laser have not. In addition, the duration of diabetes and the presence of diabetic retinopathy(DR) should be taken into account when evaluating the progression of PNFL defects in patients with both glaucoma and diabetes.

Keywords

• Diabetes mellitus
• peripapillary nerve fiber thickness
• Optical coherence tomography
• Demographic factors

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