Primer Açı Kapanması Glokomunda Güncel Tanı ve Tedavi

Öz

Açı kapanması glokomu dünyada önemli körlük nedenlerinden birisi olup, periferik irisin ön kamara açısını apozisyonel veya sineşiyel olarak kapaması sonucu göz içi basıncı artışı, buna bağlı olarak da optik sinir başı hasarı ve görme alanı kaybı ile karakterizedir. Glokoma bağlı körlük nedenlerinin yaklaşık yarısını oluşturmaktadır. İleri yaşta, kadınlarda ve hipermetroplarda daha sık görülür. En sık pupiller blok mekanizmasına bağlı gelişmekle birlikte göze ait bir takım anatomik risk faktörleri de bulunmaktadır. Oftalmolojide yeni görüntüleme tekniklerinin gelişmesi ile primer açı kapanması glokomunun patogenezi ve tedavisinde yeni yaklaşımlar ortaya çıkmıştır. Tanı esas olarak gonyoskopi ile konulmakla birlikte ön segment optik koherens tomografisi ve ultrason biyomikroskopisi de tanıyı destekleyen diğer görüntüleme teknikleridir. Tedavi kararında periyodik açı muayenesi önem taşımaktadır. Tıbbi tedavide aköz dışa akımını artıran ve anatomik olarak açının periferik iris ile kapanmasını önleyen ajanlar öncelikli olarak tercih edilir. Pupiller blok mekanizması ile gelişen açı kapanmasında laser iridotomi, plato iris gibi pupiller blok dışı mekanizmalarda ise laser periferal iridoplasti yapılır. Son zamanlarda, lensin açı kapanması gelişimindeki rolünün anlaşılması nedeniyle lens ekstraksiyonu ile birlikte goniosineşioliz ameliyatları tıbbi tedavi ve laser iridotominin başarısız olduğu olgularda 2. Seçenek olarak tercih edilmeye başlamıştır. Primer açı kapanması glokomunda filtran cerrahinin komplikasyonları fazla olup lens ekstraksiyonuna rağmen göz içi basıncı kontrol altına alınamayan olgularda uygulanmaktadır.

Anahtar Kelimeler

• açı kapanması,glokom,laser iridotomi

Current Diagnosis and Management of Primary Angle Closure Glaucoma

Öz

Angle closure glaucoma is one of the leading cause of the glaucoma in the worldwide. It is characterized by appositional or synechial closure of the anterior chamber angle by peripheral iris resulting with intraocular pressure elevation, optic nerve head damage and visual field loss. It accounts for about fifty percent of blindness caused by glaucoma. It is more prevalent in female, hyperopic and elderly patients. Although the most common mechanism responsible for the primary angle closure glaucoma is pupillary block, there are additional some anatomic risk factors. New insights have been developed in the pathogenesis and the treatment approach of the angle closure glaucoma with the development of the new imaging technologies in ophthalmology. Diagnosis based on gonioscopy and aided with ultrasound biomicroscopic and anterior segment optical coherence tomography. Serial gonioscopy is important in the treatment decision. Drops that increase aqueous outflow and prevent angle closure with peripheral iris are the first line preferred medication in the medical treatment. Laser iridotomy should be performed if the angle closure caused by pupillary block mechanism. Argon laser peripheral iridoplasty is effective for the mechanism of closure other than pupillary block such as plateau iris syndrome. Phacoemulsification with or without goniosynechialysis is an alternative treatment if the medical and laser treatment are ineffective. Filtering surgery has serious post-operative complications in patients with primary angle closure glaucoma. For this reason, it performed in cases if the intraocular pressure cannot be controlled despite lens extraction.

Anahtar Kelimeler

• angle closure,glaucoma,laser iridotomy

Kaynakça

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