Üveitik Hastalarda Korneal Değişikliklerin Non-Kontakt Speküler Mikroskopi ile Değerlendirilmesi: Retrospektif Çalışma

Yıl 2023, Cilt: 18 Sayı: 3, 7 - 12, 20.11.2023

Abdullah Beyoğlu , Banu Turgut Öztürk , Ali Meşen , Yalçın Karaküçük

https://doi.org/10.17517/ksutfd.1215746

Öz

Amaç: Üveitik gözler ile sağlıklı gözler arasında speküler mikrokopideki değişimlerin gösterilmesi.
Gereç ve Yöntemler: Retrospektif çalışmaya 2015-2018 yıllarında Selçuk Üniversitesinde takip edilen 66 hasta alındı. Tüm hastaların sağ gözleri değerlendirildi. Kontrol grubu olarak normal göz muayene bulgularına sahip 37 bireyin sağ göz verileri kullanıldı. Hastalar, anterior, intermedyer ve posterior üveit olarak subgruplara ayrıldı. Speküler mikrokopi ölçümleri Confo Scan 4 ile yapıldı. Endotel hücre yoğunluğu (EHY), pleomorfizm (%), polimegatizm (%), santral kornea kalınlığı (SKK) ve intraoküler basınç yönünden (GİB) gruplar karşılaştırıldı. İstatistiksel analizde p değerinin 0.05’den küçük olması anlamlı kabul edildi.
Bulgular: Yaş ortalaması üveitlerde 33.71±15.29, kontrol grubunda ise 37.78±13.17 olarak saptandı (p=0.432). EHY, pleomorfizm ve polimegatizm açısından gruplar arasında anlamlı fark tespit edildi (tüm gruplar; p<0.01). SKK ve GİB açısından ise anlamlı bir fark bulunamadı (sırası ile; p=0.812, p=0.381). Alt grup analizinde EHY açısından ön üveit ile intermediyer ve posterior üveit grubu arasında anlamlı fark tespit edildi (sırası ile; p=0.020, p=0.018). Ancak intermediyer üveiti olan grup ile posterior üveti olan grup arasında anlamlı bir farklılık tespit edilemedi (p=0.999). Monoküler üveiti olan hastaların sağlam gözleri ile karşılaştırmalarında ise tüm değişkenlerde fark vardı (tüm gruplar; p<0.01).
Sonuç: Üveit hastalarında EHY’nun azalmakta, pleomofizm ve polimegatizmin artmaktadır. Bu sonuç, üveit hastalarında erken tedavi ile sekel oluşumunun önüne geçilmesinin önemini gösterdi. İntraoküler cerrahi planlanan üveitik hastalarda speküler veya konfokal mikroskopi taraması önem arz etmektedir.

Anahtar Kelimeler

Üveit, speküler mikroskobi, endotel hücre dansitesi, pleomrfizm, polimegatizm, santral korneal kalınlık

Evaluation of Corneal Changes in Uveitic Patients by Non-Contact Specular Microscopy: A Retrospective Study

Öz

Objective: To demonstrate the changes in specular microscopy between uveitic eyes and healthy eyes.
Material and Methods: A retrospective study included 66 patients followed in the Uvea clinic of Selcuk University between 2015-2018. The right eyes of all patients were evaluated. The right eye data of 37 healthy individuals were used as the control group. The patients were divided into subgroups anterior, intermediate, and posterior uveitis. Specular microscopy measurements were made with Confo Scan 4. Comparisons were made between the groups in terms of endothelial cell density (ECD), pleomorphism (%), polymegatism (%), central corneal thickness (CCT), and intraocular pressure (IOP). A p-value less than 0.05 was considered significant.
Results: The mean age was 33.71±15.29 in the uveitis and 37.78±13.17 in the control group (p=0.432). There was a significant difference between the groups in terms of ECD, pleomorphism and polymegatism (all groups; p<0.01). No significant difference was found in terms of CCT and IOP (respectively; p=0.812, p=0.381). In the subgroup analysis, a significant difference was found between anterior, intermediate and posterior uveitis groups in terms of ECD (respectively; p=0.020, p=0.018). However, no significant difference in other groups (p=0.999). In comparison with healthy eyes of patients with monocular uveitis were significant differences in all parameters (all groups; p<0.01).
Conclusion: It is seen that ECD decreases, pleomorphism and polymegatism increase in patients with uveitis. This result showed the importance of preventing sequelae with early treatment in patients with uveitis. Speccular or confocal microscopy scanning is important in uveitic patients scheduled for intraocular surgery.

Anahtar Kelimeler

Uveit, specular microscopy, endothelial cell density, pleomorphism, polymegatism, central corneal thickness

Kaynakça

• Dick AD: Immune mechanisms of uveitis: insights into disease pathogenesis and treatment. Inter Ophthal Clin. 2000;40(2):1-18.
• Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group: Amer J of Ophthalmol. 2005;140(3):509-16.
• Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C, et al. A focus on the epidemiology of uveitis. Ocul Immunol Inflamm. 2018;26:2-16.
• Thorne JE, Suhler E, Skup M, Tari S, Macaulay D, Chao J, et al. Prevalence of noninfectious uveitis in the United States: a claims-based analysis. JAMA Ophthalmol. 2016;134(11):1237-45.
• Quiroga L, Lansingh VC, Samudio M, Peña FY, Carter MJ. Characteristics of the corneal endothelium and pseudoexfoliation syndrome in patients with senile cataract. Clin Exp Ophthalmol. 2010;38(5):449-55.
• Garza-Leon, M: Corneal endothelial cell analysis using two non-contact specular microscopes in healthy subjects. Int Ophthalmol. 2016;36(4):453-61.
• Dar NR, Raza N, Zafar O. Papulonecrotic tuberculids associated with uveitis. J Coll Physicians Surg Pak. 2008;18 (4):236-8.
• Oliveira FD, Oliveira Motta AC, Muccioli C. Corneal specular microscopy in infectious and noninfectious uveitis. Arq Bras Oftalmol. 2009;72(4): 457-61.
• Olsen T. Changes in the corneal endothelium after acute anterior uveitis as seen with the specular microscope. Acta Ophthalmol. 1980;58(2):250-6.
• Guclu H, Gurlu V. Comparison of corneal endothelial cell analysis in patients with uveitis and healthy subjects. Int Ophthalmol. 2019;39(2):287-94.
• Siak J, Mahendradas P, Chee SP. Multimodal imaging in anterior uveitis. Ocul Immunol Inflamm. 2017;25(3): 434-46.
• Ozer MD, Batur M, Tekin S, Seven E, Kebapci F. Choroid vascularity index as a parameter for chronicity of Fuchs’ uveitis syndrome. Int Ophthalmol. 2020;40(6):1429-37.
• Alfawaz AM, Holland GN, Yu F, Margolis MS, Giaconi JA, Aldave AJ. Corneal endothelium in patients with anterior uveitis. Ophthalmol. 2016;123(8):1637-45.
• Ghita AC, Ilie L, Ghita AM. The effects of inflammation and anti-inflammatory treatment on corneal endothelium in acute anterior uveitis. Rom J Ophthalmol. 2019;63:161.
• Miyanaga M, Sugita S, Shimizu N, Morio T, Miyata K, Maruyama K, et al. A significant association of viral loads with corneal endothelial cell damage in cytomegalovirus anterior uveitis. British Journal of Ophthalmol. 2010;94(3):336-40.
• Wong SW, Carley F, Jones NP. Corneal Decompensation in Uveitis Patients: Incidence, Etiology, and outcome. Ocul Immunol Inflamm. 2021;19:771-5.
• Banaee T, Shafiee M, Alizadeh R, Naseri MH. Changes in corneal thickness and specular microscopic indices in acute unilateral anterior uveitis. Ocul Immunol Inflamm. 2016;24:288-92.
• Simsek M, Cakar Ozdal P, Cankurtaran M, Ozdemir HB, Elgin U. Analysis of Corneal Densitometry and Endothelial Cell Function in Fuchs Uveitis Syndrome. Eye Contact Lens. 2021;47(4):196-202.
• Ilhan N, Ilhan O, Coskun M, Daglioglu MC, Ayhan Tuzcu E, Kahraman H, et al. Effects of smoking on central corneal thickness and the corneal endothelial cell layer in otherwise healthy subjects. Eye and Contact Lens. 2016;42(5):303-7.
• Bozkurt B, Güzel H, Kamış Ü, Gedik Ş, Okudan S. Characteristics of the anterior segment biometry and corneal endothelium in eyes with pseudoexfoliation syndrome and senile cataract. Turk J Ophthalmol. 2015;45(5):188.
• Realini T, Gupta PK, Radcliffe NM, Garg S, Wiley WF, Yeu E, et al. The Effects of Glaucoma and Glaucoma Therapies on Corneal Endothelial Cell Density. J Glaucoma. 2021;30(3):209-18.
• Yu ZY, Wu L, Qu B. Changes in corneal endothelial cell density in patients with primary open-angle glaucoma. World J Clin Cases. 2019;7(15):1978-85.