PREMATÜRE RETİNOPATİSİ TEDAVİ SEÇENEKLERİNİN REFRAKSİYON ÜZERİNE ETKİSİ

Yıl 2019, , 33 - 39, 25.02.2019

Müberra Akdoğan

https://doi.org/10.18229/kocatepetip.457397

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

• 1-Gilbert C. Retinopathy of prematurity: A global perspektif of the epidemics, population of babies at risk and implications for control. Early Hum Dev 2008;84:77-82.2-Blencowe H, Lawn JE, Vasquez T et al. Associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res 2013;74 Suppl 1:35-49.3-Ergenekon E, Turan O, Özdek Ş ve ark. Türkiye’de prematüre retinopatisi sıklığının durumu. Çocuk Sağlığı ve Hastalıkları Dergisi. 2010;53:4-9.4-Fielder A, Blencowe H, O’Conner A et al. İmpact of retinopathy of prematurity on ocular structures and visual functions. Arch Dis Child Fetal Neonatal Ed 2015;100:F 179-184.5-Teng JT, Wong TY, Ling Y. Refractive errors and strabismus in prematüre Asian infants with and without retinopathy of prematurity. Singapore Med J 2000;41:393-397.6-Kaur, Savleen et al. “Refractive and Ocular Biometric Profile of Children with a History of Laser Treatment for Retinopathy of Prematurity.” Indian Journal of Ophthalmology 65.9 (2017): 835–840. PMC. Web. 23 May 2018.7. Yang CS, Wang AG, Shih YF et al. Long‑term biometric optic components of diode laser‑treated threshold retinopathy of prematurity at 9 years of age. Acta Ophthalmol 2013;91:e276‑82. 8. Katoch D, Sanghi G, Dogra et al. A. Structural sequelae and refractive outcome 1 year after laser treatment for type 1 Prethreshold retinopathy of prematurity in Asian Indian eyes. Indian J Ophthalmol 2011;59:423‑6. 9. Dhawan A, Dogra M, Vinekar et al.S. Structural sequelae and refractive outcome after successful laser treatment for threshold retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 2008;45:356‑61. 10. Goktas A, Sener EC, Sanac AS. An assessment of ocular morbidities of children born prematurely in early childhood. J Pediatr Ophthalmol Strabismus 2012;49:236‑41.11- Ziylan S, Serin D, Karslioglu S. Myopia in preterm children at 12 to 24 months of age. J Pediatr Ophthalmol Strabismus 2006;43:152‑6.12-Chen YH, Chen SN, Lien Rı et al. Refractive errors after use of bevacizumab fort he treatment of retinopathy of prematurity:2-year outcomes. Eye 2014;28:1080-87.13- International Committee for the classification of Retinopathy of Prematurity: The International Classification of Retinopathy of Prematırity revisited. Arch Opthalmology, vol. 123, no. 7, pp. 991- 999, 2005. 14- Zhou Y, Liu HY, Liu T. ‘'Aggressive Posterior Retinopathy of Prematurity in a Premature Male Infant.'' Case Rep. Opthalmology, vol. 8, no. 2, pp. 396-400, 2017.15-Kushner BJ. Strabismus and amblyopia associated with regressed retinopathy of prematurity. Arch Ophthalmol 1982;100:256-261.
• 16-Schalij-Delfos NE, de Graaf ME, Treffers WF, et al. Long term follow up of premature infants: detection of strabismus, amblyopia, and refractive errors. Br J Ophthalmol 2000;84:963-967.
• 17-Pennefather PM,Clarke MP,Strong NP.Ocular outcome in children born before 32 weeks gestation. Eye 1995; 9(suppl):26–30.18- Laws DE, Haslett R, Ashby D, O’Brien C, Clark D. Axial length biometry in infants with retinopathy of prematurity. Eye (Lond) 1994;8(Pt 4):427‑30. 19- Kelly SP, Fielder AR. Microcornea associated with retinopathy of prematurity. Br J Ophthalmol 1987;71:201‑3. 20- Fledelius HC. Pre‑term delivery and subsequent ocular development. A 7‑10 year follow‑up of children screened 1982‑84 for ROP 4) oculometric – And other metric considerations. Acta Ophthalmol Scand 1996;74:301‑5.21- Garcia‑Valenzuela E, Kaufman LM. High myopia associated with retinopathy of prematurity is primarily lenticular. J AAPOS 2005;9:121‑8.22- Hurley BR, McNamara JA, Fineman MS, Ho AC, Tasman W, Kaiser RS, et al. Laser treatment for ROP: Evolution in treatment technique over 15 years. Retina 2006;26:S16-7.23- Dhawan A, Dogra M, Vinekar A, Gupta A, Dutt a S. Structural sequelae and Refractive outcome aft er successful laser treatment for Threshold ROP. J Pediatr Ophthalmol Strabismus 2008;45:356-61. 24-Karataş E, Kurtul BE, Kabataş N. Lazer Fotokoagülasyon yapılan Tip 1 Prematüre Retinopatili Hastalarda Refraksiyon Kusurlarını Etkileyen Faktörler. TOD 2017 Ulusal Kongresi Sözlü sunum25- Early Treatment for Retinopathy of Prematurity Cooperative Group. Prevalence of myopia at 9 months in infants with highrisk prethreshold retinopathy of prematurity. Ophthalmology 2005;112:1564-8.)