Laser Tedavisi Yapılan Prematüre Retinopatili Olguların Anatomik ve Fonksiyonel Sonuçları

Year 2009, Volume: 7 Issue: 3, 62 - 67, 01.12.2009

Meral Yıldız Ahmet Tuncer Özmen Ayşe Tör Ayvaz Özgür Yalçınbayır Berkant Kaderli Remzi Avcı Öner Gelişken

Abstract

Amaç: Bu çalışmada prematüre retinopatisi PR için lazer fotokoagülasyon LFK uygulanan olgularda anatomik ve refraktif sonuçları değerlendirmekamaçlanmıştır. Gereç ve Yöntem: Prematüre retinopatisi için Uludağ Üniversitesi GözHastalıkları Anabilim Dalı’nda 2004-2007 tarihleri arasında LFK yapılan, 21’ierkek 17’si kız, 38 olgunun dosyaları geriye dönük olarak gözden geçirildi.Toplam 73 göze LFK yapılmıştı. Lazer fotokoagülasyon öncesi ve sonrası PRevresi, doğum haftası, doğum ağırlığı, komplikasyonlar, skiyaskopi ile refraksiyondeğerleri ve “Teller” görme kartları ile görme keskinliği değerlendirildi.Bulgular: Olguların gestasyonel yaşları 26-34 hafta ortalama 29±2 hafta ,doğum ağırlıkları 850-1950 gr ortalama 1262±304 g idi. Çalışmaya alınan olgularda tüm gözlerin %89’u PR gerilemesi ile lazer tedavisine cevap verdi. Sekizgöz LFK tedavisine rağmen Evre 4 veya 5’e ilerledi. Üç gözde vitre hemorajisi, 2gözde preretinal hemoraji gelişti. Lazer uygulaması sonrası düzeltilmiş yaş 6.ayda sferik eşdeğer -8D ve +2,5D arasında, 12. ayda -11D ve +2D arasındadeğişiyordu. Gözlerin %53’ünde hipermetropi, %25,5’inda miyopi mevcuttu.Düzeltilmiş yaş 6. ayda ortalama görme keskinliği 3,5 cpd 1,3-6,4 , 12. ayda 6,2cpd 1,3-9,6 olarak bulundu.Sonuç: Çalışma grubundaki olgularda LFK tedavisi zamanında ve yeterli yapılmışise eşik hastalık PR’nin gerilemesine ve iyi görsel sonuçlara neden olmuştur.Ayrıca refraktif kusur yönünden hipermetropi daha yüksek oranda bulunmuştur

Keywords

Prematüre retinopatisi, lazer fotokoagülasyon, görme keskinliği

Anatomical and the Refractive Outcomes in the Eyes Undergoing Laser Photocoagulation for Retinopathy of Prematurity

Abstract

Aim: This study aimed to evaluate the anatomical and the refractive outcomes incases that underwent laser photocoagulation LP for retinopathy of prematurity ROP . Materials and Method: Medical records of 38 cases that underwent LP for ROP in Uludag University Department of Ophthalmology, between 2004 and2008, were reviewed. LP was performed in 73 eyes. Stages of ROP before andafter LP were recorded. Additionally gestational age and birth weight, complications, sciascopic refractions were assessed and visual acuities were evaluated with “Teller Acuity Cards”. Results: Gestational age ranged from 26 to 34 weeks, mean 29±2 weeks , birthweight ranged from 850 g to 1950 g mean 1262±304 g . Among all cases in thestudy 89%, responded with a remarkable regression of ROP with LP treatment.However, 8 eyes progressed to stage 4 and 5 despite treatment. Three eyesdeveloped vitreous hemorrhage and 2 eyes developed preretinal hemorrhage.In the 6thmonth of the corrected age, spherical equivalent ranged between -8Dto +2.5D, however it ranged between -11D to +2D in the 12thmonth. Hyperopiawas present in 53% of all eyes and myopia was present in 25.5%. Mean visualacuity was 3.5 cpd 1.3-6.4 in the 6thmonth of the corrected age whereas it was6.2 cpd 1.3-9.6 in the 12thmonth. Conclusion: Adequate and appropriate treatment with LP, has led to fair visual outcomes and an evident regression

Keywords

Retinopathy of prematurity, laser photocoagulation, visual acuity

References

• 1. Terry TL. Extreme prematurity and fibroblastic overgrowth of persistent vascular sheath behind each crystalline lens. I. Preliminary report. Am J Ophthalmol 1942;25:203-4.
• 2. Şener EC. Göz Hastal›klar›. Yurdakök M, Erdem G (eds). Neonatoloji. 2.Bask›. Alp Ofset I. 2004. p.856-84.
• 3. Flynn JT, Chan-Ling T. Retinopathy of Prematurity: Two Distinct Mechanisms That Underlie Zone 1 and Zone 2 Disease. Am J Ophthalmol 2006;142:46-59.
• 4. McNamara JA, Tasman W, Vander JF, Brown GC. Diode laser photocoagulation for retinopathy of prematurity: preliminary results. Arch Ophthalmol 1992;110:1714-6.
• 5. International Committee for the Classification of the Late Stages of Retinopaty of Prematurity. An international classification of retinopaty of prematurity. 2: The classification of retinal detachment. Arch Ophthalmol 1987;105:906-12.
• 6. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicentre trial of cryotherapy for retinopathy of prematurity: Preliminary results. Arch Ophthalmol 1988;106:471-9.
• 7. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicentre trial of cryotherapy for retinopathy of prematurity: 3 1/2 year outcome structure and function. Arch Ophthalmol 1993;11:339-44.
• 8. Noonan CP, Clark DI. Trends in the management of stage 3 retinopaty of prematurity. Br J Ophthalmol 1996;80:278-81.
• 9. Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity. Results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 2003;121:1684-96.
• 10. Lambert SR, Capone A Jr, Cingle KA, Drack AV. Cataract and phthisis bulbi after laser photoablation for threshold retinopaty of prematurity. Am J Ophthalmol 2000;129:585-91.
• 11. Phelps DL. ETROP Cooperative Group. The Early Treatment for Retinopathy of Prematurity Study: better outcomes, changing strategy. Pediatrics 2004;114:490-1.
• 12. Rudanko SL, Fellman V, Laatikainen L. Visual impairment in children born prematurely from 1972 through 1989. Ophthalmol 2003;110:1639-45.
• 13. Weinberger B, Laskin D, Heck DE, Laskin JD. Oxygen toxicity in premature infants. Toxicol Appl Pharmacol 2002;181:60-7.
• 14. Özcan A, Soylu M, Demircan N, Satar M, Narl› N. Prematü- re retinopatisi geliflimindeki risk faktörleri ve tedavi sonuç- lar›. T Oft Gaz 1997;27:290-4.
• 15. Bozkurt N, Anveriazer M, Ö¤üt MS, Kazoko¤lu H, Bavbek T, Özek E. Prematüre Retinopatisi , risk faktörleri ve takip sonuçlar›. T Oft Gaz 1997;29:149-56.
• 16. Gültan E, Kutluk S, Önder F, Arslan S, Kural G. Prematüre retinopatisi geliflmesinde etkili faktörler. Ret-Vit 1996;3:619-24.
• 17. Kulaço¤lu DN, Sertöz AD, Atefl O, Baykal O. Prematüre Retinopatisinde Risk Faktörleri ve Tarama Sonuçlar›. Ret-Vit 2005;13:33-7.
• 18. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB et al. Incidence and early course of retinopaty of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 1991;98:1628-40.
• 19. Yamashita Y. Studies on retinopathy of prematurity. 3. Cryocautery for retinopathy of prematurity. Rinsho Ganka 1972;26:385-93.
• 20. Laser ROP Study Group. Laser therapy for retinopathy of prematurity. Arch Ophthalmol 1994;112:154-6.
• 21. Ng EY, Connolly BP, McNamara JA, Regillo CD, Vander JF, Tasman W. A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years. Part 1. Ophthalmology 2002;109:928-34.
• 22. Capone A Jr, Diaz-Rohena R, Sternberg P Jr, Mandell B, Lambert HM, Lopez PF. Diode laser photocagulation for Zone 1 treshold retinopathy of prematurity. Am J Ophthalmol 1993;116:444-50.
• 23. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicentre trial of cryotherapy for retinopathy of prematurity: Three month outcome. Arch Ophthalmol 1990;108:195-204.
• 24. Cats BP, Tan KE. Prematures with and without regressed retinopathy of prematurity: Comparison of long term (6-10 years) ophthalmological morbidity. Pediatr Ophthalmol Strabismus 1989;26:271-5.
• 25. Fielder AR, Shaw DE, Robinson J, Ng YK. Natural history of retinopathy of prematurity: a prospective study. Eye 1992;6:233-42.
• 26. Holmstrom G, el Azazi M, Jacobson L, Sachs D, Sule J, Lennerstrand G. Epidemiology of ROP in the Stockholm area of Sweden. Acta Ophthalmol 1993;210:44-7.
• 27. Eric AP, Robert AP, Lois EHS. Retinopathy of prematurity. In: Albert DM, Jacobiec FA (eds). Principles and Practice of Ophthalmology. Philadelphia: WB Saunders; 1998. p.4443-60.
• 28. Kent D, Pennie F, Laws D, White S, Clark D. The influence of retinopathy of prematurity on ocular growth. Eye 2000;14:23-9.
• 29. Knight-Nanan DM, O’Keefe M. Refractive outcome in eyes with retinopathy of prematurity treated with cryotherapy or diode laser: 3 year follow up. Br J Ophthalmol 1996;80:998-1001.
• 30. Laws F, Laws D, Clark D. Cryotherapy and laser treatment for acute retinopathy of prematurity: refractive outcomes, a longitudinal study. Br J Ophthalmol 1997; 81:12-5.
• 31. Quinn GE, Dobson V, Siatkowski R, Hardy RJ, Kivlin J, Palmer EA, et al. Does cryotherapy affect refractive error? Results from treated versus control eyes in the cryotherapy for retinopathy of prematurity trial. Ophthalmology 2001;108:343-7.
• 32. Connoly BP, McNamara JA, Sharma S, Regillo CD, Tasman CD. A comparision of laser photocoagulation with transscleral cryotherapy in the treatment treshold retinopathy of prematurity. Ophthalmology 1998;105:1628-31.
• 33. Iverson DA, Trese MT, Orgel IK, Williams GA: Laser photocoagulation for threshold retinopathy of prematurity. Arch Ophthalmol 1991;109:1342-3.
• 34. Nissenkorn I, Yassur Y, Mashkowsk› D, Sherf I, Ben-Sira I. Myopia in premature babies with and without retinopathy of prematurity. British Journal of Ophthalmology 1983; 67:170-3.
• 35. Hall HL, Courage ML, Adams RJ. The predictive utility of the Teller acuity cards for assessing visual outcome in children with preterm birth and associated perinatal risks. Vision Research 2000; 40:2067-76.