PREMATÜRE RETİNOPATİSİ TEDAVİ SEÇENEKLERİNİN REFRAKSİYON ÜZERİNE ETKİSİ

Öz

AMAÇ: Prematüre retinopatisi(ROP) nedeniyle değişik tedavi yöntemleriyle tedavi edilmiş çocukların tedavi seçeneklerinin refraksiyon üzerine etkisini araştırmak.GEREÇ VE YÖNTEM: Çalışmaya ROP nedeniyle 2016 Nisan ile 2017 Nisan tarihleri arasında takip ettiğimiz düzeltilmiş yaşları yaklaşık 1 olan 119 olgunun 238 gözü alındı. Retinopatisi olmayan veya tedavisiz retinopatili olgular grup 1 n=153(%64,2), intravitreal Bevacizumab(IVB) yapılmış olanlar grup 2 n=36(%15,1), lazer yapılmış olanlar grup 3 n=13(%5,4) ve lazer+IVB yapılmış olanlar grup 4 n=36(%15,1) olmak üzere gruplara ayrıldı. Grupların sferik eşdeğer (SE) değerleri irdelendi. Tüm ölçümler sikloplejili olarak Retinomax 3 otorefraktometre (Righton, Japonya) ile alındı. Grupların SE değerleri ile doğum haftası, doğum kilosu ve ROP evreleri arasında korelasyona analizi yapıldı.BULGULAR: Çalışmaya dahil edilen 119 olgunun ortalama gestasyonel yaşı 30.1±2.8 (23-36) hafta, ortalama doğum ağırlığı 1395±487 (520-3000)gr,ortalama küvezde kalma süresi 45.7±31 (0-175) gün idi. Grup 1’den 4’e doğru sırasıyla miyopi düzeyleri 0.019±0.2; 0.083±0.3; 0.76±1.64 ve 2.25±3.8, hipermetropi düzeyleri 2.46±1,59; 2.4±1.78; 1.41 ±1.39, ve 1.65±1.83 idi. Tedavisiz grupla karşılaştırıldığında miyopik olgularda grup 3 (p=0.12) ve grup 4 (p=0.001); hipermetropik olgularda grup 3 (p=0.02) ve grup 4 (p=0,018) istatistiksel olarak anlamlı düzeyde farklı idi. SE ise 2.4±4.5 (p=0.17), 1.75±1.76, (p=0,018), -1.5±5(p<0.0001) sırasıyla olarak bulunmuştur. Lazer sayısı ve 1D üstü miyopi karşılaştırıldığında 140±364- 1176±856 şut (p<0.0001) olup spot sayısı arttıkça miyopi sıklığının arttığı gözlenmiştir. Miyopi ile doğum haftası (r=-0,366, p<0,001) ve doğum kilosu (r=-0,299, p<0,001) arasında negatif korelasyon gözlenmiştir.SONUÇ: Lazer tedavisi ileri evre ROP’da regresyon sağlayabilse de miyopik yönde göz gelişimi ortadan kalkmamaktadır. Bu durum lazer gereken olguların lazer tedavisi gerekmeyenlere göre daha ileri evre ROP olguları olmalarından da kaynaklanabilir.

Anahtar Kelimeler

• Miyopi,Prematüre Retinopatisi,İntravitreal Bevacizumab,Lazer Tedavisi

THE EFFECT OF PREMATURE RETINOPATHY TREATMENT MODALITIES ON REFRACTIVE ERRORS

Öz

OBJECTIVE: To investigate the effect of treatment options on refraction in children who are treated with different treatment modalities for retinopathy of prematurity (ROP).MATERIAL AND METHODS: The study included 238 eyes of 119 patients almost 1 year old who were followed up at between April 2016 and April 2017. The patients were divided into 4 groups: Group 1 n = 153 (64.2%) without retinopathy or without treatment, Group 2 n = 36 (15.1% ) intravitreal bevacizumab (IVB), Group 3 n = 13 (5.4%) laser treatment and Group 4 n = 36 (15.1%) laser + IVB treatments. The spherical and spherical equivalan(SE) values were compared in Groups. All measurements were taken under cycloplegic conditions and with Retinomax 3 autorefractometer. Correlation with miyopia, gestational age, weight were also analysed.RESULTS: 119 cases with the mean gestational age 30.1 ± 2.8(23-36)week, the mean gestational weight 1395 ± 487(520-3000) gram, the mean incubation time 45.7 ± 31(0- 175) days were compared with treatment modalities. In group; myopia level were 0.019±0.2, 0.083±0.3, 0.76±1.64, 2.25±3.8 respectively. Hiperopia level were 2.46±1.59, 2.4±1.78, 1.41±1,39, 1.65±1,83 respectively. SE were 2.4±4.5, 1.75±1.76, -1.5±5 respectively. When we compered the laser shots and ≥ 1D myopia, it was foud 140±364-1176 ± 856 shots. It was also found that as the number of spots increased myopia frequency increased.

CONCLUSIONS: Although laser treatment provide regression in advanced ROP, It may cause myopic progression. However, these babies were born very early and exposure to the physical environment rather than the maternal environment. It’s also affects myopic progression.

Anahtar Kelimeler

• Myopia,retinopathy of prematurity,laser treatment,ıntravitreal bevacizumab(IVB),refractive outcome

Kaynakça

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