Sistemik Skleroz Hastalarında Oküler Ön Segment Değişimleri

Öz

Amaç: Sistemik skleroz (SSc) hastalarında kornea ve diğer ön segment yapılarındaki değişiklikleri gözlemlemek. Yöntem: Bu retrospektif karşılaştırmalı vaka serisine SSc için takip edilen 22 hastanın 41 gözü dahil edildi. Kontrol grubu ayrıca yaş ve cinsiyet açısından uyumlu 22 katılımcının 42 gözünü içeriyordu. Demografik veriler, oküler görüntüleme sonuçları ve ayrıntılı oküler muayene bulguları hasta dosyalarından elde edildi. Tüm hastalara tam oftalmolojik muayeneye ek olarak kornea topografisi ve ön segment optik koherens tomografi (OKT) ölçümleri yapıldı. Bulgular: Kornea topografisi ve OKT ölçümleri arasında santral kornea kalınlığı (SKK) açısından çok yüksek pozitif korelasyon vardı (katsayı=0,985, p<0,001). Hem kornea topografisi (p=0,012) hem de OKT (p=0,002) ile ölçülen SKK, SSc hastalarında daha ince saptandı. SSc hastalarında topografi ile ölçülen kornea hacminde (KH) anlamlı bir azalma vardı (p=0,013). OKT ile kornea alt katmanlarının analizinde, SSc hastalarında kornea stroma kalınlığı (SK) (p=0,001) ve gözyaşı film tabakası kalınlığı (GK) (p<0,001) anlamlı derecede düşük bulundu. Ancak kornea epitel tabakası kalınlığı (p=0,316), Bowman membran tabakası kalınlığı (p=0,709) ve Descemet membran tabakası kalınlığı (0,344) açısından anlamlı kalınlık farkı saptanmadı. Korneanın ön yüzeyinin keratometri dik (Kd) (p=0,855) ve keratometri yatay (Ky) (p=0,704) değerleri, kornea arka yüzeyinin Kd (0,901) ve Ky (p=0,435) değerleri, ön kamara derinliği (0,635), ön kamara hacmi (0,861) ve topografi ile ölçülen ön kamara açısı (0,982) açısından anlamlı değişim saptanmadı. Sonuç: SKK, GK,SK ve KH SSc hastalarında anlamlı şekilde azalmaktadır. Bu sebeple hastalığın kontrolünde bu parametrelerin yakından takibi bir yol gösterici olabilir.

Anahtar Kelimeler

• Anterior göz segmenti
• kornea topografisi
• optik koherens tomografi
• sistemik skleroz

Ocular Anterior Segment Changes in Patients with Systemic Sclerosis

Abstract

Objective: To observe changes in the cornea and other anterior segment structures in patients with systemic sclerosis (SSc). Methods: This retrospective comparative case series included 41 eyes of 22 patients followed for SSc. The control group also included 42 eyes of 22 age- and sex-matched participants. Demographic data, ocular imaging results, and detailed ocular examination findings were obtained from patient files. In addition to the complete ophthalmological examination, corneal topography and anterior segment optical coherence tomography (OCT) measurements were performed on all patients. Results: There was a highly positive correlation between corneal topography and OCT measurements in terms of central corneal thickness (CCT) (coefficient=0.985, p<0.001). CCT measured by both corneal topography (p=0.012) and OCT (p=0.002) was found to be thinner in SSc patients. There was a significant decrease in corneal volume (CV) measured by topography in SSc patients (p=0.013). In the analysis of corneal sublayers by OCT, corneal stroma thickness (ST) (p=0.001) and tear film layer thickness (TT) (p<0.001) were found to be significantly lower in SSc patients. However, there was no significant difference in thickness in terms of corneal epithelial layer thickness (p=0.316), Bowman's membrane layer thickness (p=0.709), and Descemet's membrane layer thickness (p=0.344). Keratometry steep (Ks) (p=0.855), keratometry flat (Kf) (p=0.704) values of the anterior surface of the cornea, Ks (p=0.901), and Kf (p=0.435) values of the posterior surface of the cornea, anterior chamber depth (p=0.635), anterior chamber volume (p=0.861), and anterior chamber angle (p=0.982) measured by topography were not found to be significant between the groups. Conclusion: CCT, TT, ST, and CV are significantly reduced in SSc patients. For this reason, close monitoring of these parameters in the control of the disease may be a guide.

Keywords

• anterior eye segment
• corneal topography
• optical coherence tomography
• systemic sclerosis

Kaynakça

1. 1. Chifflot H, Fautrel B, Sordet C, Chatelus E, Sibilia J. Incidence and prevalence of systemic sclerosis: a systematic literature review. Semin Arthritis Rheum 2008; 37:223–35.
2. 2. Gilliland BC. Systemic sclerosis (scleroderma) and related disorders. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (Eds.), Harrison's principles of internal medicine, 16th ed. McGraw-Hill, New York: 2005:1979-90.
3. 3. Moore SC, Desantis ER. Treatment of complications associated with systemic sclerosis. Am J Health Syst Pharm 2008; 65:315-21.
4. 4. Busquets J, Del Galdo F, Kissin EY, Jimenez SA. Assessment of tissue fibrosis in skin biopsies from patients with systemic sclerosis employing confocal laser scanning microscopy: an objective outcome measure for clinical trials? Rheumatology 2010; 49:1069–75.
5. 5. Czirjak L, Foeldvari I, Müller-Ladner U. Skin involvement in systemic sclerosis. Rheumatology 2008; 47:v44–5.
6. 6. Tailor R, Gupta A, Herrick A, Kwartz J. Ocular manifestations of scleroderma. Surv Ophthalmol 2009; 54(2):292–304.
7. 7. Robert L, Legeais JM, Robert AM, Renard G. Corneal collagens. Pathol Biol 2001; 49(4):353–63.
8. 8. Meek KM, Fullwood NJ. Corneal and scleral collagens—a microscopist’s perspective. Micron 2001; 32:261–72.

9. 9. Sii F, Lee GA, Sanfilippo P, Stephensen DC. Pellucid marginal degeneration and scleroderma. Clin Exp Optom 2004; 87:180–4.
10. 10. Wangkaew S, Kasitanon N, Sivasomboon C, Wichainun R, Sukitawut W, Louthrenoo W. Sicca symptoms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma: a comparison with age-matched controls and correlation with disease variables. Asian Pacific J Allergy Immunol 2006; 24:213-21.
11. 11. Sahin Atik S, Koc F, Akin Sari S, Sefi Yurdakul N, Ozmen M, Akar S. Anterior segment parameters and eyelids in systemic sclerosis. Int Ophthalmol 2016; 36:577–83.
12. 12. Mayali H, Altinisik M, Sencan S, Pirildar T, Kurt E. A multimodal ophthalmic analysis in patients with systemic sclerosis using ocular response analyzer, corneal topography and specular microscopy. Int Ophthalmol 2020; 40:287–96.
13. 13. de AF Gomes B, Santhiago MR, Kara-Junior N, Noé RAM, de Azevedo MNL, Moraes Jr H V. Central corneal thickness in patients with systemic sclerosis: a controlled study. Cornea 2011; 30:1125–8.
14. 14. Gomes BF, Santhiago MR, Kara-Junior N, Moraes Jr HV. Evaluation of corneal parameters with dual Scheimpflug imaging in patients with systemic sclerosis. Curr Eye Res 2018; 43:451–4.
15. 15. Nagy A, Rentka A, Nemeth G, Ziad H, Szücs G, Szekanecz Z, Gesztelyi R, Zsuga J, Aszalos Z, Szodoray P, Kemeny-Beke A. Corneal manifestations of systemic sclerosis. Ocul Immunol Inflamm 2019; 27:968-77.
16. 16. Şahin M, Yüksel H, Şahin A, Cingü AK, Türkcü FM, Kaya S, Yazmalar L, Batmaz İ. Evaluation of the anterior segment parameters of the patients with scleroderma. Ocul Immunol Inflamm 2017; 25:233–8.
17. 17. Gomes BF, Santhiago MR, Gomes SF, Kara-Junior N, Moraes HV. Longitudinal evaluation of central corneal thickness in patients with systemic sclerosis. Cornea 2016; 35:1584–8.
18. 18. Wong TY, Foster PJ, Ng TP, Tielsch JM, Johnson GJ, Seah SKL. Variations in ocular biometry in an adult Chinese population in Singapore: the Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2001; 42:73–80.
19. 19. de AF Gomes B, Santhiago MR, Magalhães P, Kara-Junior N, de Azevedo MNL, Moraes Jr H V. Ocular findings in patients with systemic sclerosis. Clinics 2011; 66:379–85.
20. 20. Doughty MJ, Zaman ML. Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach. Surv Ophthalmol 2000; 44:367–408.