Oküler Hipertansiyonlu Hastalarda Santral Kornea Kalınlığı, Optik Sinir Başı Analizi ve Retina Sinir Lifi Kalınlığı Arasındaki İlişkinin Değerlendirilmesi

Yıl 2019, Cilt: 5 Sayı: 2, 235 - 245, 01.01.2019

Abdulkadir Alış İclal Yücel Meryem Güler Alış

Öz

Amaç: Oküler hipertansiyon OHT tanısı alan hastalarda ultrasonik pakimetri ile ölçülen santral kornea kalınlıkları SKK ile Heidelberg Retinal Tomography HRT testinde optik sinir başı OSB analizleri, görme alanı GA testi ve spektral optik kohorens tomografi OKT ile ölçülen retina sinir lifi tabakası RSLT ortalama kalınlıkları arasındaki ilişkiyi belirlemek.Gereç ve Yöntemler: Çalışmaya Akdeniz Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Glokom biriminde OHT tanısı ile takip edilen 150 hasta ve sağlıklı bireylerden oluşan 150 kontrol hastası dahil edildi. Çalışma kapsamındaki tüm hastalar yaş, cinsiyet, ailede glokom hikayesi, sistemik hastalık, kullandığı ilaçlar açısından sorgulandı. Hastaların tam oftalmolojik muayeneleri, OKT, HRT, pakimetri ve GA testleri takipleri süresince yapıldı. Elde edilen verilerin değerlendirilmesinde Statistical Package for the Social Sciences SPSS paket sistemi kullanıldı. İki grubun verileri kıyaslanırken ManWhitney-U ve T testleriyle değerlendirme yapıldı. P değeri 0,05’in altında olması anlamlı olarak kabul edildi.Bulgular: Çalışmaya alınan 150 OHT’li hastaların 106’sı kadın, 44’ü erkekti. 106 kadın hastanın 212 gözü, 44 erkek hastanın 88 gözü toplam 300 göz çalışmaya dahil edildi. Yaş ortalaması kadınlarda 39,95±13,87, erkeklerde 36,13±7,41 idi. Kontrol grubundakilerin 87’si kadın, 63’ü erkekti. 87 kadın hastanın 174 gözü, 63 erkek hastanın 126 gözü çalışmaya dahil edildi. Yaş ortalaması kadınlarda 31,47±4,82, erkeklerde 30,00±5,83 idi. Her iki grupta da kadın erkek yaşları arasında istatistiksel olarak anlamlı fark bulunmadı. Ortalama göz içi basıncı GİB Grup 1’de Grup 2’ye göre anlamlı derecede yüksek bulundu. Grup 1’deki cinsiyet ayrımına göre ortalama GİB değerleri açısından anlamlı fark olmadığı görüldü. Ortalama SKK açısından Grup 1’deki değerlerin Grup 2’ye göre anlamlı derecede yüksek olduğu görüldü. Grup 1’deki cinsiyet ayrımına göre ortalama SKK değerlerinin kadın hastalarda, erkek hastalara göre anlamlı derecede yüksek olduğu görüldü. İki grup arasında GA’da ortalama Mean Deviation MD ve Pattern Standart Deviation PSD değerleri açısından anlamlı fark olmadığı görüldü. Ortalama RSLT kalınlığının Grup 1’deki değerlerinin Grup 2’ye göre istatistiksel olarak anlamlı derecede daha düşük olduğu görüldü. Grup 1’deki hastalar aile hikayesi olan ve olmayanlar olarak ayrıldı. Değerlendirdiğimiz parametreler kontrol grubu ile karşılaştırıldı. GA’daki MD ve PSD değerleri kontrol grubu ile kıyaslandığında anlamlı bir fark olmadığı görüldü. Oküler muayenede cup/disk C/D oranı, SKK, OKT’de ortalama RSLT kalınlığı ve GİB değerleri kontrol grubu ile kıyaslandığında istatistiksel olarak anlamlı fark olduğu gözlendi.Sonuç: Glokom, OHT ve normotansif glokom NTG tanısı konulurken mutlaka olguların SKK’ları değerlendirmeye alınmalıdır. SKK arttıkça aplanasyon tonometrisi ölçümleri gerçek GİB’in üstünde, SKK azaldıkça gerçek GİB’in altında çıkmaktadır. İnce kornea düşük GİB ölçümüne neden olarak, gelecekte oluşabilecek glokom tanısını geciktirebilir, kalın kornea ise yüksek GİB ölçümüne neden olarak, gereksiz tedaviye neden olabilir. Ayrıca çalışmamızda fonksiyonel olarak normal olan ve tedavi başlanması açısından karar verilemeyen şüpheli hastalarda erken glokomatöz hasarı saptamada OKT’nin etkili ve güvenilir bir yöntem olduğu sonucuna vardık

Anahtar Kelimeler

Oküler hipertansiyon, Santral korneal kalınlık, Optik kohorens tomografi

Evaluation of the Relationship Between Central Corneal Thickness, Optic Nerve Head Analysis and Retinal Nerve Fiber Thickness in Patients With Ocular Hypertension

Öz

Objective: To determine the relationship between central corneal thickness CCT measured by ultrasonic pachymetry and optic nerve head ONH analysis in Heidelberg Retinal Tomography HRT test, visual field VF test and mean thickness of the retinal nerve fiber layer RNFL measured by spectral optical coherence tomography OCT in patients with ocular hypertension OHT .Material and Methods: The study included 150 patients who were followed up with OHT at the Akdeniz University Medical Faculty, Department of Ophthalmology Glaucoma unit and 150 control patients consisting of healthy individuals. All patients in the study were questioned for age, gender, family history, systemic diseases and for the drugs used by them. Complete ophthalmologic examinations of the patients including OCT, HRT, pachymetry and VF were performed during their follow-up. The obtained data were evaluated using the Statistical Package for the Social Sciences SPSS package software. Comparison of the two groups was conducted with the Mann-Whitney U and t tests. A p value less than 0.05 was considered statistically significant.Results: Out of 150 OHT patients included in the study, 106 were females and 44 were males. A total of 300 eyes were involved in the study with 212 eyes of 106 female and 88 eyes of 44 male patients. The mean age was 39.95±13.87 in females and 36.13±7.41 in males. Of the subjects in the control groups, 87 were females and 63 were males. A total of 300 eyes were enrolled in the study with 174 eyes of 87 female and 126 eyes of 63 male patients. The mean age was 31.47±4.82 in females and 30.00±5.83 in males. There was no statistically significant difference between the ages of the male and female patients in the two groups. Mean intraocular pressure IOP was significantly higher in Group 1 than in Group 2. There was no significant difference in mean IOP values according to gender in Group 1. Mean CCT values were significantly higher in Group 1 compared with Group 2. The mean CCT values were significantly higher in female patients than male patients in Group 1 according to gender. There was no significant difference in mean VF in terms of Mean Deviation MD and Pattern Standard Deviation PSD values between the two groups. The mean thickness of RNFL around the ONH was found to be statistically significantly lower in Group 1 than in Group 2. Patients in Group 1 were divided as those with and without a family history. The parameters we evaluated were compared with the control group. MD and PSD values in the visual field were not significantly different when compared to the control group. In ocular examination; there were statistically significant differences between the two groups in terms of fundus cup-to-disc C/D ratio, CCT, and mean RNFL on OCT and IOP values.Conclusion: When glaucoma, OHT and normotensive glaucoma NTG are diagnosed, it is absolutely necessary to evaluate the CCT. As the CCT increases, the IOP value measured by the aplanation tonometer drops above the actual value. As CCK decreases, it falls below the true IOP. A thin cornea can cause low IOP measurement and may delay the diagnosis of glaucoma that may occur in the future while a thick cornea may cause unnecessary treatment because of high IOP measurements. We also concluded that OCT is an effective and reliable method for detecting early glaucomatous damage in suspected cases that are functionally normal in our study and where a decision cannot be made for treatment initiation

Anahtar Kelimeler

Ocular hypertension, Central corneal thickness, Optical coherence tomography

Kaynakça

• Turaclı ME. Açık açılı glokomların epidemiyolojisi ve risk faktörleri. T Klin Oftalmol 2004; 13: 1-5.
• Kass MA, Gordon MO, Gao F, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JK, Miller JP, Parrish RK, Wilson MR. Ocular Hypertension Treatment Study Group Arch Ophthalmol. Delaying treatment of ocular hypertension: The ocular hypertension treatment study. Arch Ophthalmol 2010; 128(3): 276-87.
• Keltner JL, Johnson CA, Cello KE, Edwards MA, Bandermann SE, Kass MA, Gordon MO for the Ocular Hypertension Study Group. Classification of visual field abnormalities in the Ocular Hypertension Treatment Study. Arch Ophthalmol 2003;121:643-50.
• Argus WA. Ocular hypertension and central corneal thickness. Ophthalmology 1995;102:1810-2.
• Medeiros FA, Sample PA, Weinreb RN. Corneal thickness measurements and visual function abnormalities in ocular hypertensive patients. Am J Ophthalmol 2003;135:131-7.
• Gordon MO, Kass MA. The Ocular Hypertension Treatment Study (OHTS) group; The Ocular Hypertension Treatment Study. Design and baseline description of the participants. Arch Ophthalmol 1999;117:573-83.
• Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK 2nd, Wilson MR, Gordon MO. The Ocular Hypertension Treatment Study. A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open angle glaucoma. Arch Ophthalmol 2002; 120: 701-13.
• Leske MC, Nemesure B, He Q. Patterns of open-angle glaucoma in the Barbados Family Study. Ophthalmology 2001; 108: 1015-22.
• Tielsch JM, Katz J, Sommer A. Family history and risk of primary open angle glaucoma: The Baltimore Eye Survey. Arch Ophthalmol 1994; 112: 69–73.
• Wilson MR, Hertzmark E, Walker AM. A case control study of risk factors in open angle glaucoma. Arch Ophthalmol 1987; 105: 1066-71.
• Uhm KB, Shin DH. Glaucoma risk factors in primary open angle glaucoma patients compared to ocular hypertensives and control subjects. Korean J Ophthalmol 1992;6: 91-9.
• Jonas JB, Grundler AE. Prevalance of diabetes mellitus and arterial hypertension in primary and secondary openangle glaucomas. Graefes Arch Clin Exp Ophthalmol 1998; 236: 202-6.
• Chakrabarti HS, Craig JP, Brahma A, MD, Malik TY, McGhee CNJ. Comparasion of corneal thickness measurements using ultrasound and Orbscan Slitscanning topographybin normal and post-LASIK eyes,J Cataract and Refract Surg 2001;27:1823-8.
• Modis L, Langerbucher A, Seitz B. Corneal thickness measurements with contact and noncontact specular microscopic and ultrasonic pachymetry. Am J Ophthalmol 2001;132:517-21.
• Dought MJ, Zaman M. Human corneal thickness and its impact on intraocular pressure measures: Review and metaanalysis approach. Surv Ophthalmol 2000; 118: 511- 8.
• Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbothom EJ, Johson CA. The ocular Hypertension Treatment Study: Baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120:714-20.
• Miglior S, Pfeiffer N, Torri V, Zeyen T, Cunha-Vaz J, Adamsons I. Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. European Glaucoma Prevention Study (EGPS) Group,Ophthalmology. 2007;114(1):3-9.
• Shih CY, Graff Zivin JS, Trokel SL. Clinical Significance of central corneal thickness in the management of Glaucoma. Arch Ophthalmol 2004;1222:1270-5.
• Lee ES, Kim CY, Ha SJ, Seong GJ, Hong YJ. Central Corneal Thickness of Korean Patients with Glaucoma. Ophthalmology 2007;114(5):927-30.
• Chiselita D, Danielescu C, Gagos Zaharia O, Gherman C. Central corneal thickness of the cornea in ocular hypertension and open angle glaucoma. Ophthalmologia 2007;51(3):98-103.
• Atanassov MA, Konareva Kostianeva MI. Central corneal thickness measurement in ocülar hypertension, primary open angle, glaucoma suspects and control suspects. Folia Med 2008;50:35-9.
• Herndon LW, Choudhri SA, Cox T. Central corneal thickness in normal, glaucomatous and ocular hypertensive eyes. Arch Ophthalmol 1997;115:1137-41.
• Schuman JS, Pedut Kloizman T, Hertzmark E. Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology 1996; 103:1889-98.
• Gyatsho J, Kaushik S, Gupta A, Pandav SS, Ram J. Retinal nerve fiber layer thickness in normal, ocular hypertensive and glaucomatous Indian eyes: An optical coherence tomography study. J Glaucoma 2008;17(2):122-7.
• Polo V, Larrosa JM, Ferreras A. Retinal nerve fiber layer evaluation in open angle glaucoma. Optimum criteria for optical coherence tomography. Ophthalmologica 2009;223:2-6.
• Hewitt AW, Chappell AJ, Straga T, Landers J, Mills RA, Craig JE. Sensitivity of confocal laser tomography versus optical coherence tomography in detecting advanced glaucoma. Clin Exp Ophthalmol 2009;37:836-41.
• Budenz DL, Michael A, Chang RT. Sensitivity and specificity of the Stratus OCT for perimetric glaucoma. Ophthalmology 2005;112:3-9.
• Kim TW, Park UC, Park KH. Ability of Stratus OCT to identify localized retinal nerve fiber layer defects in patients with normal standard automated perimetry results. Invest Ophthalmol Vis Sci 2007;48:1635-41.
• Zhang Y, Wu LL, Yang YF. Potential of stratus optical coherence tomography for detecting early glaucoma in perimetrically normal eyes of open angle glaucoma patients with unilateral visual field loss. J Glaucoma 2010;19: 61-5.
• Takagishi M, Hirooka K, Baba T, Mizote M, Shiraga F. Comparison of retinal nerve fiber layer thickness measurement using time domain and spectral domain optical coherence tomography, and visual field sensitivity. J Glaucoma 2011;20(6):383-7.
• Lee JR, Jeoung JW, Choi J, Choi JY, Park KH, Kim YD. Structure function relationships in normal and glaucomatous eyes determined by time domain and spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci 2010 June Epub ahead of print.
• Cho JW, Sung KR, Hong JT, Um TW, Kang SY, Kook MS. Detection of glaucoma by spectral domain-scanning laser ophthalmoscopy/optical coherence tomography (SD-SLO/OCT) and time domain optical coherence tomography. J Glaucoma 2011;20(1):15-20.
• Chang RT, Knight OJ, Feuer WJ, Budenz DL. Sensitivity and specificity of timedomain versus spectral-domain optical coherence tomography in diagnosing early to moderate glaucoma. Ophthalmology 2009;116:2294-9.
• Akar Y, Yücel D, Hacıoğulları S, Özer H. Normal toplumda optik çukur konfigurasyonunun görme alanına etkisi. T Oft Gaz 2004;33:135-40.
• Stamper RL, Liberman MF, Drake MV. Introduction and classification of the glaucomas. Becker&Shaffer’s diagnosis and therapy of the glaucomas 7ed. St Louis Missouri: Mosby, 1999;2-9.
• Waring OG. Corneal structure and pathophysiology. In: Leibowitz HM, ed. Corneal disorders clinical diagnosis and management. Philadelphia: WB Saunders Company, 1984:1-265.