Scheimpflug-Placido Disk Topografi ile Sağlıklı ve Sistemik Arteryel Hipertansiyon Hastalarında Fakoemülsifkasyon Öncesi ve Sonrası Pupil Çapının Değerlendirilmesi

Öz

Amaç: Sağlıklı ve sistemik arteriyel hipertansiyonu olan hastalarda fakoemülsifikasyon cerrahisi öncesi ve sonrası pupil çapının değişimini Scheimpflug-Placido Disk Topografisi (Sirius, CSO Inc.) ile değerlendirmeyi amaçladık.
Materyal ve metod: Bu çalışmada fakoemülsifikasyon planlanan 75 sağlıklı ve 77 sistemik arteriyel hipertansiyon (HT) hastası alındı. Pupil çapı (PÇ) ameliyat öncesi ve ameliyattan 1 ay sonra Kombine Scheimpflug-Placido Disk Topografisi pupillometresi ile ölçüldü. Grupların ameliyat öncesi ve ameliyat sonrası pupil çapı değerleri karşılaştırıldı.
Bulgular: Sağlıklı grupta ameliyat öncesi ve sonrası pupil çapı değişimi anlamlı bulundu (5,13± 1,38 mm ve 3,07± 0,52 mm sırasıyla. p < 0,05). HT grupta ameliyat öncesi ve sonrası pupil çapı değişimi anlamlı bulundu (5,26± 1,39 mm ve 3,14± 0,51 mm sırasıyla. p < 0,05). Sağlıklı ve HT gruplarında PÇ değişiminin etki değerleri farklı bulundu (1,48; 1,77 sırasıyla).
Sonuç: Fakoemülsifikasyon sonrası iki grupta PÇ azaldı. Fakoemülsifikasyon cerrahisinin HT hastalarında PÇ değişimi, sağlıklı gruba göre daha fazla olduğu izlenmektedir. Bu değişimi HT hastalar’da yapılacak refraktif cerrahi palanlarken göz önüne alınması önemli olacaktır.

Anahtar Kelimeler

• Fakoemülsifikasyon
• Pupil Çapı
• Topografi

Evaluation of Pupil Diameter Before and After Phacoemulsification in Healthy and Systemic Arterial Hypertension Patients with Scheimpflug-Placido Disc Topography

Öz

Background: We aimed to evaluate the change of pupil diameter before and after phacoemulsification surgery in patients with healthy and systemic arterial hypertension with Scheimpflug-Placido Disc Topography (Sirius, CSO Inc.).
Materials and Methods: This study included 75 healthy and 77 systemic Arterial Hypertension (HT) patients scheduled for phacoemulsification. Pupil Diameter (PD) was measured by combined Scheimpflug-Placido Disc Topography pupillometer before and 1 month after surgery. The preoperative and postoperative pupil diameter values of the groups were compared.
Results: In the healthy group, the change of pupil diameter before and after surgery was significant (5.13 ± 1.38 mm and 3.07 ± 0.52 mm, respectively. p <0.05). In the HT group, the change of pupil diameter before and after surgery was significant (5.26 ± 1.39 mm and 3.14 ± 0.51 mm, respectively. p <0.05). The effect values of PS change in healthy and HT groups were found different (1.48; 1.77 respectively).
Conclusion: PD decreased in two groups after phacoemulsification. It is observed that phacoemulsification surgery is more prominent in HT patients than in the healthy group. It will be important to consider this change when planning refractive surgery in HT patients.

Kaynakça

1. 1. Rabsilber TM, Khoramnia, Auffarth GU. Anterior chamber measurements using Pentacam rotating Scheimpflug camera. J Cataract Refract Surg. 2006;32: 456-59.
2. 2. Koch DD, Samuelson SW, Haft EA, Merin LM. Pupillary size and responsiveness implications for selection of a bifocal intraocular lens. Ophthalmology.1991;98:1030-35.
3. 3. Koch DD, Jardeleza TL, Emery JM, Franklin D. Glare following posterior chamber intraocular lens implantation. J Cataract Refract Surg. 1986; 12:480-84.
4. 4. Masket S. Relationship between postoperative pupil size and disability glare. J Cataract Refract Surg. 1992; 18: 506–07.
5. 5. Nakazawa M, Ohtsuki K. Apparent accommodation in pseudophakic eyes after implantation of posterior chamber intraocular lenses: optical analysis. Invest Ophthalmol Vis Sci.1984; 25:1458-60.
6. 6. Elder MJ, Murphy C, Sanderson GF. Apparent accommodation and depth of field in pseudophakia. J Cataract Refract Surg. 1996; 22:615-19.
7. 7. Obara Y, Hashi H, Tonaki M, Yoshida S. Causes of binocular dysfunction in pseudophakic eyes[Japanese]. Jpn IOL Soc J. 1989; 3:59-63.
8. 8. Ravalico G, Baccara F, Bellavitis A. Refractive bifocal intraocular lens and pupillary diameter. J Cataract Refract Surg. 1992; 18:594-97.

9. 9. Gibbens MV, Goel R, Smith SE. Effect of cataract extraction on the pupil response to mydriatics. Br J Ophthalmol. 1989; 73:563-65.
10. 10. Yap EY, Aung T, Fan RFT. Pupil abnormalities on the first postoperative day after cataract surgery. Int Ophthalmol. 1996; 20:187-92.
11. 11. Golnik KC, Hund PW, Apple DJ. Atonic pupil after cataract surgery. J Cataract Refract Surg. 1995; 21:170-75.
12. 12. Koch DD, Samuelson SW, Villarreal R, Haft EA, Kohnen T. Changes in pupil size induced by phacoemulsification and posterior chamber lens implantation: consequences for multifocal lenses. J Cataract Refract Surg. 1996; 22:579-84.
13. 13. Zaczek A, Zetterstro¨m C. Cataract surgery and pupil size in patients with diabetes mellitus. Acta Ophthalmol Scand. 1997; 75:429–32.
14. 14. Watson AB, Yellott JI. A unified formula for light-adapted pupil size. J Vis. 2012;12(10):12.
15. 15. Lee JC, Kim JE, Park KM, Khang G. Evaluation of the methods for pupil size estimation: on the perspective of autonomic activity. Conf Proc IEEE Eng Med Biol Soc. 2004;2:1501-04.
16. 16. Roberts DK, Yang Y, Lukic AS, Wilensky JT, Wernick MN. Quantification of pupil parameters in diseased and normal eyes with near infrared iris transillumination imaging. Ophthalmic Surg Lasers Imaging. 2012; 43(3):196-204.
17. 17. Koch DD, Samuelson SW, Villarreal R, Haft EA, Kohnen T. Changes in pupil size induced by phacoemulsification and posterior chamber lens implantation: consequences for multifocal lenses. J Cataract Refract Surg. 1996;22(5):579-84.
18. 18. Keuch RJ, Bleckmann H. Pupil diameter changes and reaction after posterior chamber phakic intraocular lens implantation. J Cataract Refract Surg. 2002;28(12):2170-72.
19. 19. Dick HB, Aliyeva S, Tehrani M. Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens. J Cataract Refract Surg. 2005;31(2):302-07.
20. 20. Totsuka K, Kato S, Shigeeda T, Honbo M, Kataoka Y, Nakahara M et al. Influence of cataract surgery on pupil size in patients with diabetes mellitus. Acta Ophthalmol. 2012;90(3):237-39.
21. 21. Holladay JT, Praeger TC. Accurate ultrasonic biometry in pseudophakia. Am J Ophthalmol. 1989;107(2):189-90.
22. 22. Arıng A, Jones D, Falko J. Evaluation and prevention of diabetic neuropathy. Am Fam Physician. 2005;7:2123-30.
23. 23. Vinik AI, Stansberry KB, Nakave AA, Patel CV. Diabetic neuropathy in older adults. Clin Geriatr Med 2008;24:407-39.
24. 24. Jacobson DM. Pupil involvoment in patients with diabetes-associated oculomotor nevre palsy. Arch Ophthalmol. 1998;116:723-7.
25. 25. Smith SE, Smith SA. Reduced pupillary light reflexes in diabetic autonomic neuropathy. Diabetologia. 1983;24:330-2.
26. 26. Ishikawa S, Bensaoula T, Uga S, Mukuno K. Electron microscopic study of iris nerves and muscles in diabetes. Ophthalmologica. 1985;191:17283.
27. 27. Fraser-Bell S, Symes R, Vaze A. Hypertensive eye disease: a review. Clin Exp Ophthalmol. 2017;45(1):45-53.
28. 28.Rassam SM, Patel V, Kohner EM. The effect of experimental hypertension on retinal vascular autoregulation Hypertensive eye disease: a review 51 in humans: a mechanism for the progression of diabetic retinopathy. Exp Physiol. 1995; 80: 53.