Primer Açı Kapanması Glokomunda Güncel Tanı ve Tedavi

Yıl 2018, Cilt: 40 Sayı: 2, 90 - 100, 01.05.2018

Tülay Şimşek

https://doi.org/10.20515/otd.309775

Cited By: 1

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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