The Effects of Various Hormone Replacement Treatments on Tear Functions in Postmenopausal Women

Yıl 2008, Cilt: 13 Sayı: 2, 127 - 130, 01.04.2008

Burak Turgut Peykan Türkçüoğlu Tamer Demir Emrah Kan Selahattin Kumru

Öz

Objectives: The effects of various hormonal replacement treatments (HRT) on tear functions in postmenopausal women were evaluated. Material and Methods: The study group consisted of 84 postmenopausal women, 26 patients using conjugated estrogen (Group1), 15 patients using conjugated estrogen + medroxyprogesterone acetate (Group 2), 19 patients using Tibolone (Group 3) and 24 patients as control group (Group 4). Schirmer test was performed and tear break up time (BUT) was measured. The mean of right and left eye measurements were used in the study. Groups that receiving HRT were compared with each other and with control group. Results: Mean age of 84 postmenopausal women was 51.97±5.70 years. Mean value of right and left eye Schirmer test was 18.57±3.98 mm in group 1, 20.80±2.84 mm in group 2, 21.00±5.05 mm in group 3, and 13.75±3.49 mm in group 4. Mean tear BUT was 12.05±3.45 sec. in group 1, 12.90±2.13 sec. in group 2, 14.00±2.77 sec. in Group 3, 8.10±3.21 sec. in Group 4. Schirmer test results and tear break up time of all groups that receive HRT were statistically higher than the control group. There was no statistical significant difference between the HRT receiving groups. Conclusion: HRT, independent from its content, preserves tear functions in postmenopausal women..©2008, Firat University, Medical Faculty.

Anahtar Kelimeler

-

Menapoz Sonrası Dönemde Farklı Hormon Replasman Tedavilerinin Göz Yaşı Fonksiyonlarına Etkileri

Öz

Amaç: Postmenapozal dönemde kullanılan hormon replasman tedavisinde östrojen, östrojen+progesteron ve östrojen+progesteron+androjen etkili hormon preparatlarının gözyaşı fonksiyonları üzerindeki etkilerini karşılaştırmak. Gereç ve Yöntem: Çalışmaya katılan, 26'si östrojen (Grup 1), 15'i östrojen+ medroksiprogesteron asetat (Grup 2), 19'u Tibolon (Grup 3) kullanan ve 24'ü ise ilaç kullanmayan (Grup 4=kontrol) toplam 84 menapoz hastasının ayrıntılı oftalmolojik muayeneleri yapılarak Schirmer testi ve gözyaşı kırılma zamanı (GKZ) değerleri kaydedildi; sağ ve sol göz ortalama değerleri çalışmada kullanıldı. Tedavi alan gruplar kendi aralarında ve kontrol grubu ile karşılaştırılarak sonuçlar istatistiksel olarak değerlendirildi. Bulgular: Çalışmaya katılan hastaların yaş ortalamaları 51.97±5.70 idi. Schirmer testi, sağ ve sol göz ortalamaları grup 1'de 18.57±3.98 mm, grup 2' de 20.80±2.84 mm, grup 3' de 21.00±5.05 mm, kontrol grubunda (grup 4); 13.75±3.49 mm olarak tespit edildi. Ortalama GKZ, sırasıyla grup 1'de 12.05±3.45 sn, grup 2'de, 12.90±2.13 sn, grup 3' de, 14.00±2.77 sn, kontrol grubunda (grup 4); 8.10±3.21 sn olarak tespit edildi. HRT alan grupların tümünde Schirmer ve GKZ değerleri, kontrol grubuna göre istatistiksel anlamlı yüksekti. Ancak HRT alan gruplar arasında istatistiksel anlamlı fark yoktu. Sonuç: Menapoz sonrası dönemde HRT'si ilaç içeriğinden bağımsız olarak gözyaşı fonksiyonlarının korunmasına etkilidir.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

Hormon replasman tedavisi, gözyaşı fonksiyonları, postmenapozal dönem

Kaynakça

• Thatcher RW, Daraguar S, Barrie RJ. Conjunctival impression cytology. Arch Ophthalmol 1977; 95: 678-681.
• Nelson JD, Hanever VR, Cameron JD. Cellulose acetate impressions of the ocular surface: Dry eye states. Arch Ophthalmol 1983; 01: 1869-1872.
• Nelson JD, Wright JC. Conjunctival goblet cell densities in ocular surface disease. Arch Ophthalmol 1984; 102: 1049-1051.
• Rolando M, Teraggna F, Giordano G, Calabrita G. Conjunctival surface damage distrubition in keratoconjunctivitis sicca. Ophthalmologica 1990; 200: 170-176.
• Holly J. Tear film physiology. Int Ophthalmol Clin 1987; 27: 2-6.
• Whichter JP. Clinical diagnosis of the dry eye. Int Ophthalmol Clin 1987; 27: 7-24.
• Bron AJ. Duke-Elder Lecture: Prospects for the dry eye. Trans Opht Soc UK 1985; 104: 801-826.
• Taylor HR, Louis WJ. Significance of tear function abnormalities. Ann Ophthalmol 1980; 531-5.
• Azzarolo AM, Bjerrum K, Maevs JA, et al. Hypophysectomi induced regression of female rat lacrimal glands, partial restoration/maintenance by dihydrotestosterone and prolactin. Invest Ophthalmol Vis Sci 1995; 36: 216-226
• Lucca JA, Nunez JN, Farris RL. A Comparision of diagnostic tests for keratoconjunctivitis sicca: Lactoplate, Schirmer and tear osmolarity. CLAOJ 1990; 16: 109-112.
• Burger HG, Dudley EC, Hopper JL, et al. The endocrinology of the menouposal transition; a cross-section of a population-based sample. J Clin Endocrinol Metab 1995; 80: 3537-3545
• Kramer P, Lupkin V, Potter W, Jacobs M, Labay G, Silverman P. Cyclic changes in conjunctival smears from menstruating females. Ophthalmology 1990; 97: 303-307.
• Strickland RW, Tesar JT, Berne BH, Hobbs BR, et al. The frequency of sicca syndrome in an elderly female population. J Rheumatol 1987; 14: 766-771
• Gans LA, Lee FS, Lemp MA, Pepose JS. Estrogen and progesterone Ophthalmology 1990; 109: 474-477. human conjunctiva. Am J
• Sator MO, Joura EA, Golaszewski T, Gruber D, Frigo P. Treatment of menopausal keratoconjunctivitis sicca with topical oestradiol BrJ Obstet Gynaecol 1998 Jan; 105: 100-102.
• Lemp MA. General measures in management of the dry eye. Int Ophthalmol 1987; 36-43.
• Affinito P, Di Spiezio Sardo A, Di Carlo C, Sammartino A, Tommaselli GA. Effects of hormone replacement therapy on ocular function in postmenopause. Menopause 2003; 10: 482-487
• Mathers WD, Stovall D, Lane JA, Zimmerman MB, Johnson S. Menopause and tear function: the influence of prolactin and sex hormones on human tear production. Cornea 1998; 17: 353-358.
• Amy JJ. Hormones and menopause: pro.Acta Clin Belg. 2005; 60: 261-268.
• Akramian J, Wedrich A, Neep J: Estrogen therapy in keratoconjunctivitis sicca. Adv. Exp. Med. Biol 1998; 438: 1005- 1009
• Jensen AA, Higginbotham EJ, Guzinski GM, Davis IL, Ellish NJ. A survey of ocular complaints in postmenopausal women. J Assoc Acad Minor Phys 2000; 11: 44-49.
• Warren DW. Hormonal influences on lacrimal gland. Int Ophthalmol Clin 1994; 34: 19-25
• Stern ME, Beuerman RW, Fox RI, et al.The pathology of dry eye; the interaction between the ocular surface and lacrimal glands. Cornea 1998; 17: 584-589
• Toda I, Wicham LA, Sullivan DA, Gender and androgen treatment influence the expression of proto-oncogenes and apopitotic factors in lacrimal and salivary tissues. Clin Immunol Immunopathol 1998; 86: 59-71
• Azzaralo AM, Wood RL, Mircheff AK, et al. Androgen influence on lacrimal gland apopitosis, necrosis and lymphocytic infiltration. Invest Ophthalmol Vis Sci 1999; 40: 592-602
• Azzaralo AM, Wood RL, Mircheff AK, et al. Time course of apopitosis in lacrimal gland after rabbit ovariectomy. Adv Exp Med Biol 1998; 438: 523-526
• Sullivan DA, Sullivan BD, Evans JE. Androgen deficiency, meibomian gland dysfunction, and evaporative dry eye., Ann NY Acad Sci.2002 Jun; 966: 211-222
• Modelska K, Cummings S. Tibolone for postmenopausal women: systematic review of randomized trials. J Clin Endocrinol Metab. 2002; 87: 16-23
• Taner P, Akarsu C, Atasoy P, Bayram M, Ergin A. The effects of hormone replacement therapy on ocular surface and tear function tests in postmenopausal women. Ophthalmologica 2004; 218: 257- 259.
• Oprea L, Tiberghien A, Creuzot-Garcher C, Baudouin C. Hormonal regulatory influence in tearfilm. J Fr Ophtalmol 2004; 27: 933-941.
• Uncu G, Avcı R, Uncu Y, Kaymaz C, Develioglu O. The effects of different hormone replacement therapy regimens on tear function, intraocular Endocrinology 2006; 22: 501–505. lens opacity. Gynecological
• Kabul Tarihi:24.09.2007