Vitreomaküler Traksiyonlu Diyabetik Retinopatili Hastalarda Pars Plana Vitrektomi?nin Anatomik ve Fonksiyonel Etkileri

Öz

Amaç: Diyabetik retinopatiye sekonder fibrovaskuler traksiyonel retina dekolmanı TRD olgularında pars plana vitrektominin PPV maküla üzerindeki anatomik ve fonksiyonel etkisini araştırmak. Gereç ve Yöntemler: 2003-2009 arasında Akdeniz Üniversitesi hastanesinde maküla tutulumlu aktif fibrovasküler membrana sekonder en az iki disk çapı maküla merkezli yeni TRD nedeniyle vitrektomi yapılmış 83 olgunun 83 gözü retrospektif olarak değerlendirildi. Olguların görme keskinlikleri, santral maküla kalınlıkları SMK ve retina duyarlılıkları postoperatif 6. hafta, 3, 6, ve 12. aylardaki verileri ile retrospektif olarak değerlendirildi. SMK, optik kohorens tomografi OKT ile retina duyarlılıkları ise mikroperimetri programı kullanılarak elde edildi. İstatistiksel analizler tanımlayıcı istatistikler kullanılarak yapıldı, ANOVA ve Fisher’s PLSD çoklu karşılaştırma post hoc test, Pearson’s korelasyon ve çoklu değişken biçimsel gerileme analizi. 0,05’ten küçük p değerleri anlamlı olarak kabul edildi. Bulgular: TRD olan 83 olgunun 72’sinde %86,7 primer anatomik başarı sağlandı. Başarısız olguların n:11 , 5’inde rekürren preretinal traksiyonel membran ve ardından gelişen maküler dekolman saptandı. 4’ünde trokar giriş yerlerinde oluşan yırtıklara sekonder totale yakın retina dekolmanı gelişimi görüldü. Olguların 2’sinde ise rekürren vitre içi hemoraji VİH gelişirken bu olguların birinde de hifema görüldü. İntraoperatif olarak en sık karşılaşılan komplikasyon ise 19 olguda %22,9 iyatrojenik retina yırtıklarının gelişmesiydi. 13 hastada geçici ön kamara fibrin reaksiyonları görüldü. Olguların preoperatif görme keskinlikleri el hareketleri ile 0,1 arasında iken postoperatif 1.yılda görme keskinlikleri 1 mps ile 0,8 arasında idi. Hastalarımızda hem görsel keskinlikleri hem de retina duyarlılık ve SMK’da postoperatif dönemde istatistiksel olarak anlamlı düzelmeler görüldü. Sonuç: TRD hastalarında erken zamanda ve başarılı şekilde uygulanan PPV ile anatomik ve fonksiyonel kazanım sağlanabilir

Anahtar Kelimeler

• Diyabetik retinopati, Traksiyonel retina dekolmanı, OKT, Mikroperimetri

Anatomic and Functional Effects of Pars Plana Vitrectomy in Patients with Diabetic Tractional Retinal Detachment

Abstract

Objective: To evaluate the morphological and functional effects of pars plana vitrectomy PPV in eyes with fibrovascular tractional retinal detachment TRD secondary to diabetic retinopathy. Material and Methods: Between 2003 and 2009, 83 eyes of 83 patients who underwent vitrectomy for at least two disc diameters with macular involvement secondary to fibrovascular membrane were evaluated retrospectively. Visual acuity, central macular thickness and retinal sensitivities of the patients were evaluated retrospectively with the data from the 6th week, 3rd, 6th and 12th months.CMT was measured by optical coherence tomography OCT . Retinal sensitivities were obtained by using microperimetry program. Statistical analyses were performed using descriptive statistics, ANOVA and Fisher's PLSD multiple comparison post hoc test, Pearsonʼs correlation and multivariate formal regression analysis. P values less than 0.05 were considered significant. Results: Primary anatomic success was achieved in 72 86.7% of the 83 patients. Five patients had recurrent preretinal tractional membrane and subsequently developed macular detachment. In 4 patients, retinal detachment developed due to tears around trocar entry sites. Recurrent intravitreal hemorrhage IVH was observed in 2 patients and hyphema was observed in one of these cases. The most common intraoperative complication was the development of iatrogenic retinal tears in 19 cases 22.9% . Transient anterior chamber fibrin reactions were seen in 13 patients. Preoperative visual acuities of the cases were between 0.1 and hand movements. In the first postoperative year, visual acuities were between counting fingers at 1 meter and 0.8. Visual acuity, retinal sensitivity and central macular thickness values were statistically significantly improved postoperatively. Conclusion: Anatomical and functional recovery can be achieved in patients with tractional retinal detachment if pars plana vitrectomy is done early and successfully

Keywords

• Diabetic retinopathy, Tractional retinal detachment, OCT, Microperimetry

Kaynakça

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