Primer açık açılı glokom tanı ve takibinde bilgisayarlı görme alanı ile optikal koherens tomografinin karşılaştırılması

Öz

Amaç: Primer açık açılı glokom (PAAG) hastalarında görme alanı (GA) indeksleri ile optikal koherens tomografi (OKT) ölçümleri arasındaki ilişkinin değerlendirilmesi ve glokomatöz progresyonun erken tespitindeki rollerinin araştırılması amaçlanmıştır. Yöntemler: 2007 Ocak ile 2012 Haziran tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Göz Hastalıkları Glokom Biriminde takipli, ilaç tedavisiyle göz içi basıncı kontrolü sağlanan, PAAG tanısı almış 72 hastanın 84 gözü çalışmaya alındı. GA’daki MD değeri temel alınarak glokom evrelemesi yapıldı. Buna göre; Grup 1 MD ≥-6dB olan “erken evre glokom” hastalarını, Grup 2 MD -6dB ile -12dB arası olan “orta evre glokom” hastalarını, Grup 3 MD ≤-12dB olan “ileri evre glokom” hastalarını kapsamaktaydı. Ölçülen OKT değerleri ile GA değerleri arasındaki ilişki incelendi. Ayrıca gruplardaki hastaların ortalama optik sinir başı (OSB) ve retina sinir lifi tabakası (RSLT) kalınlıkları hesaplanarak gruplar arasında karşılaştırıldı ve glokom evresi ile OKT’de ölçülen RSLT kalınlığı arasındaki ilişki değerlendirildi. MD’de 2 dB artış ve Avg Thickness’da 20 µm incelme progresyon olarak kabul edilerek, GA ve OKT’ deki progresyon oranları hesaplandı. Bulgular: GA; MD indeksi ile OKT; Smax/Tavg, Imax/Tavg, Smax/Navg, Max-Min, Smax, Imax, Savg, Iavg, Avgthick, RA, RCSA, RV, CA, CV, CDHR, CDVR, CDAR parametreleri arasında güçlü pozitif korelasyon görüldü. GA; PSD indeksi ile OKT; Smax/Imax, Max-Min, Smax, Imax, Savg, Iavg, AvgThick, DA, RA, RCSA, RV, CA, CV, CDHR, CDVR, CDAR parametreleri arasında istatistiksel olarak pozitif korelasyon izlendi. Çalışmamızda PAAG alt grupları açısından da ortalama RSLT kalınlığı arasında istatistiksel olarak anlamlı farklılık olduğu saptandı. Glokomun evresi arttıkça ortalama RSLT kalınlığının azaldığı tespit edildi. Tüm hastaların GA ve OKT parametrelerin ilk ve son ölçümleri arasındaki ilişki incelenerek progresyon araştırıldı. Hastaların %25’inde GA’da progresyon, %29,6’sında OKT’de progresyon saptandı. GA’da progresyon saptanan tüm hastalarda OKT’de de progresyon vardı. Olguların %4,6’sında GA’da progresyon olmaksızın OKT’de progresyon olduğu görüldü. Sonuç: Glokomda GA indeksleri ile OKT parametreleri arasında anlamlı bir pozitif korelasyonun olduğu görüldü. Glokomatöz progresyonun erken tanısı için OKT’de RSLT kalınlığı takibi GA indekslerinden daha erken bulgu verdiğinden glokom takibinde ümit vericidir

Anahtar Kelimeler

• Glokom, görme alanı, optikal koherens tomografi

Comparasion of computerized visual field and optical coherence tomography in diagnosis and follow-up of primary open-angle glaucoma

Öz

Objective: To evaluate the relationship between visual field in­dices and optical coherence tomography measurements in pri­mary open-angle glaucoma (POAG) patients and to investigate the role of early detection of glaucomatous progression. Methods: 84 eyes of 72 patients who diagnosed with POAG that controlled with medical treatment at Dicle University Faculty of Medicine, Unit of Ophthalmology Glaucoma follow-up between January 2007 and June 2012 included to the study. Glaucoma staging was done according to the value of visual field (VF) MD. Patients MD value ≥ -6dB (early-stage glaucoma) patients in­cluded in Group 1, MD value between -6dB and -12dB (middle-stage glaucoma) in Group 2 and MD value ≤-12dB (advanced stage glaucoma) in Group 3. The relationship between measured Optical Coherence Tomography (OCT) values and VF values has been examined. In addition, patients in each group were com­pared among groups by calculating the average optic nerve head (ONH) and retinal nerve fiber layer (RNFL) thickness measured by OCT with the stage of glaucoma and the relationship between RNFL thickness values was examined. 2 dB increase in MD and 20 microns thinning in Avg Thickness have been accepted as a progression and OCT in VF progression rates were calculated. Results: There was a strong relationship between VF MD index and OCT Smax/Tavg, Imax/Tavg, Smax/Navg, Max-Min, Smax, Imax, Savg, Iavg, Avgthick, RA, RCSA, RV, CA, CV, CDHR, CDVR, CDAR parameters. Significant correlation between the parameters of VF PSD index and OCT and Smax / Imax, Max-Min, Smax, Imax, Savg, Iavg, Avgthick, DA, RA, RCSA, RV, CA, CV, CDHR, CDVR, CDAR were found statistically. Also there were statistically significant differences in RNFL thickness be­tween sub-groups of POAG in our study. The average RNFL thickness decreased with increasing stage of glaucoma. To in­vestigate the progression, first and last measurements of VF and OCT parameters were compared in all patients. VF and OCT progression was found in 25% and 29,6% of patients respec­tively. In 4,6% of patients OCT progression observed without VF progression. Conclusion: There was a strong correlation between indices of VF and OCT measurements. OCT RNFL thickness in the moni­toring of early progression in glaucoma are promising in terms of providing follow-up of glaucoma because it detects early signs before VF analysis.

Anahtar Kelimeler

• Glaucoma, visual field, optical coherence tomography

Kaynakça

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