Valsalva Manevrasına Bağlı Ön Segment Değişiklikleri: Fakik ve Psödofakik Gözlerde

Abstract

Amaç: Bu çalışmanın amacı, Scheimpflug görüntüleme kullanılarak Valsalva manevrasının fakik ve psödofakik gözlerde oluşturduğu ön segment değişikliklerini değerlendirmektir.
Gereç ve yöntem: Eşleştirilmiş göz tasarımına sahip bu kesitsel gözlemsel çalışmaya, tek taraflı psödofakisi bulunan 68 hastanın toplam 136 gözü dahil edildi. Her katılımcının bir psödofakik gözü ile karşı tarafındaki fakik gözü çalışmaya alındı. Göz içi basıncı (GİB), santral kornea kalınlığı (SKK), kornea hacmi (KH), ön kamara derinliği (ÖKD), ön kamara hacmi (ÖKH), pupil çapı (PÇ), iridokorneal açı (İKA), aksiyel uzunluk (AU) ve ÖKD/AU oranı başlangıçta ve standartlaştırılmış Valsalva manevrası sırasında ölçüldü. Ölçümlerde temassız tonometri, Scheimpflug görüntüleme ve optik biyometri kullanıldı. Başlangıç değerlerine göre meydana gelen göz içi değişimler fakik ve psödofakik gözlerde ayrı ayrı analiz edildi.
Bulgular: Valsalva manevrası sırasında GİB ve PÇ hem fakik hem de psödofakik gözlerde anlamlı olarak arttı (tüm karşılaştırmalar için p≤0,003). Fakik gözlerde ÖKD ve ÖKH anlamlı olarak azalırken (her ikisi için p=0,03), İKA’da anlamlı bir değişiklik saptanmadı (p=0,58). Psödofakik gözlerde İKA anlamlı olarak azalırken (p=0,002), ÖKD ve ÖKH’deki değişiklikler istatistiksel olarak anlamlı değildi (sırasıyla p=0,08 ve p=0,61). Her iki grupta da AU, KH ve ÖKD/AU oranında istatistiksel olarak anlamlı bir değişiklik saptanmadı. SKK’daki değişiklikler önceden belirlenen istatistiksel anlamlılık düzeyine ulaşmadı.
Sonuç: Valsalva manevrası, fakik ve psödofakik gözlerde GİB, pupil çapı ve bazı ön segment parametrelerinde geçici değişikliklerle ilişkili bulundu. Göz içi karşılaştırmalarda fakik gözlerde ÖKD ve ÖKH’de anlamlı azalma, psödofakik gözlerde ise İKA’da anlamlı daralma saptandı. Bununla birlikte, fakik ve psödofakik gözlerin farklı biyomekanik yanıtlar gösterdiği sonucuna varılabilmesi için bu değişimlerin lens durumu grupları arasında doğrudan karşılaştırılması gerekmektedir. Solunum çabasının standartlaştırılması, ön segment görüntüleme ve biyometrik ölçümlerin güvenilirliğinin artırılmasına katkı sağlayabilir.
 

Keywords

• Valsalva manevrası
• fakik göz
• psödofaki
• scheimpflug görüntüleme
• göz içi basıncı

Supporting Institution

Pamukkale Üniversitesi

Ethical Statement

Bu çalışma için etik kurul onayı, Pamukkale Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu'ndan alınmıştır (Onay No: E-60116787-020-761878, Tarih: 30.09.2025).

Thanks

Pamukkale Üniversitesi

Valsalva-induced anterior segment changes in phakic and pseudophakic eyes

Abstract

Purpose: To evaluate anterior segment changes induced by the Valsalva maneuver in phakic and pseudophakic eyes using Scheimpflug imaging.
Materials and methods: This paired-eye cross-sectional observational study included 136 eyes of 68 patients with unilateral pseudophakia, with each participant contributing one pseudophakic eye and the contralateral phakic eye. Intraocular pressure (IOP), central corneal thickness (CCT), corneal volume (CV), anterior chamber depth (ACD), anterior chamber volume (ACV), pupil diameter (PD), iridocorneal angle (ICA), axial length (AL), and the ACD/AL ratio were measured at baseline and during a standardized Valsalva maneuver. Measurements were obtained using non-contact tonometry, Scheimpflug imaging, and optical biometry. Within-eye changes from baseline were analyzed separately for phakic and pseudophakic eyes.
Results: During the Valsalva maneuver, IOP and PD increased significantly in both phakic and pseudophakic eyes (all p≤0.003). In phakic eyes, ACD and ACV decreased significantly (both p=0.03), whereas ICA did not change significantly (p=0.58). In pseudophakic eyes, ICA decreased significantly (p=0.002), whereas the changes in ACD and ACV were not statistically significant (p=0.08 and p=0.61, respectively). No statistically significant changes were detected in AL, CV, or the ACD/AL ratio in either group. CCT changes did not reach the predefined threshold for statistical significance.
Conclusions: The Valsalva maneuver was associated with transient changes in intraocular pressure, pupil diameter, and selected anterior segment parameters in both phakic and pseudophakic eyes. Within-eye analyses showed significant reductions in ACD and ACV in phakic eyes and significant narrowing of the ICA in pseudophakic eyes. However, direct comparison of these changes between lens-status groups is required before concluding that phakic and pseudophakic eyes exhibit different biomechanical responses. Standardization of respiratory effort may improve the reliability of anterior segment imaging and biometric measurements.

Keywords

• Valsalva maneuver
• phakic eye
• pseudophakia
• scheimpflug imaging
• intraocular pressure

Supporting Institution

Pamukkale University

Ethical Statement

Ethical approval for this study was obtained from the Non-Interventional Clinical Research Ethics Committee of Pamukkale University (Approval No: E-60116787-020-761878, Date: 30.09.2025).

Thanks

Pamukkale University

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