Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Aponevrotik Pitozis Cerrahisinde İki Farklı Sütür Materyalinin Karşılaştırılması
Comparison of Two Different Suture Materials in Aponeurotic Ptosis Surgery
Burcu DİRİMa, Selam Yekta ŞENDÜLa, Gürcan Doğukan ARSLANa, Semra TİRYAKİ DEMİRa, Ali OLGUNa, Dilek GÜVENa
aGöz Hastalıkları Kliniği, Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma
Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(4):219-24
doi: 10.5336/ophthal.2018-62273
Article Language: TR
Full Text
ÖZET
 Amaç: Aponevrotik ptozisli hastalarda uygulanan aponevroz ve levator rezeksiyonunda iki farklı sütür materyalini ameliyat sonuçları ve komplikasyonları açısından karşılaştırmak. Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2013-Mayıs 2016 tarihleri arasında aponevroz rezeksiyonu geçirmiş olan 42 hastanın 55 gözü dâhil edildi. Hastalar iki gruba ayrıldı. Tüm hastalara uygulanan aponevroz onarımında birinci gruptaki (22 hasta, 31 göz) hastalarda tarsa fiksasyon sütürü olarak absorbe olmayan keskin iğneli 6.0 polipropilen; ikinci gruptaki (20 hasta, 24 göz) hastalarda ise absorbe olan keskin iğneli 6.0 poliglaktin sütür kullanıldı. Tüm hastaların ameliyat öncesi ve sonrası 3-6 ve 6-12. aylardaki levator fonksiyonu (LF), vertikal kapak aralığı (VKA) ve kenar-refleks uzaklığı-1 (MRD-1) ölçümleri yapıldı. Her kontrolde VKA ve MRD-1 artışları kaydedildi. Gruplar arasında ameliyat sonrası VKA ve MRD-1 artışları, nüks ve komplikasyonlar açısından karşılaştırma yapıldı. Bulgular: Kırk iki hastanın 23'ü kadın; 19'u erkek olup, ortalama yaşları 53,2 yıl idi. Altı ay sonunda ortalama VKA 1.grupta 9,6 mm; 2. grupta 9,1 mm idi. On iki ay sonunda ortalama VKA 1. grupta 9,5 mm; 2. grupta 9,6 mm idi. Ortalama VKA artışı ise 1. grupta 3,2 mm; 2. grupta 3,6 mm idi. Altı ay sonunda ortalama MRD-1 1. grupta 3,9 mm; 2. grupta 3,5 mm idi. On iki ay sonunda ortalama MRD-1 her iki grupta da 3,9 mm idi. Ortalama MRD-1 artışı ise 1. grupta 2,9 mm; 2. grupta 3,0 mm idi. Her iki sütürasyonda da 12 ay sonunda VKA ve MRD-1'de azalma saptanmadı. Her iki grup arasında ortalama VKA ve MRD-1 artışları açısından istatistiksel olarak anlamlı fark saptanmadı. Her iki grupta 4 hastaya yetersiz düzeltme nedeni ile 2. operasyon; 1. grupta 4, 2. grupta 3 hastaya da asimetrik cilt kıvrımı nedeni ile revizyon yapıldı. Sonuç: Levator cerrahisinde keskin iğneli hem 6.0 polipropilen hem de 6,0 poliglaktin sütür ile yapılan aponevroz onarımı; kapak aralığı, nüks ve komplikasyon açısından benzer sonuçlara sahiptir. Buna göre her iki sütür materyali de aponevrotik pitozis cerrahisinde etkin ve güvenlidir.

Anahtar Kelimeler: Aponevrotik blefaropitozis; aponevroz onarımı; 6,0 poliglaktin sütür materyali; 6,0 polipropilen sütür materyali
ABSTRACT
 Objective: To compare the results of two different suture materials in terms of operation results and complications in levator surgery performed in patients with aponeurotic ptosis. Material and Methods: This retrospective study included 55 eyes of 42 patients who underwent levator surgery between January 2013 and May 2016. The patients were divided into two groups. In aponeurosis repair applied to all patients; in the first group (22 patients, 31 eyes) patients were treated with sharp needle 6.0 non-absorbable polypropylene suture as tarsal fixation suture; in the second group (20 patients, 24 eyes) sharp needle absorbable 6.0 polyglactin suture was used. All patients had measurements of levator function (LF), vertical eyelid opening (VEO) and margin- reflex distance-1 (MRD-1) before and after surgery at 3-6 and 6-12 months. VEO and MRD-1 increase were recorded at each control. Postoperative VEO and MRD-1 increase, recurrence and complications were compared among the groups. Results: Of the total forty-two patients, 23 were women; 19 were male and the mean age was 53.2. At the end of 6 months, mean VEO was 9,6 mm in the first group; and 9,1 mm in the second group. At the end of 12 months, mean VEO was 9,5 mm in the first group and 9,6 mm in the second group. Mean VEO increase was 3.2 mm in the first group and 3,6 mm in the second group. At the end of 6 months, mean MRD-1 was 3,9 mm in the first group and 3,5 mm in the second group. At the end of 12 months, mean MRD-1 was 3.9 mm in both groups. Mean MRD-1 increase was 2.9 mm in the first group and 3.0 mm in the second group. There was no decrease in VKA and MRD-1 at the end 12 months in both suturations. There was no statististically significant difference between the two groups in terms of mean VEO and MRD-1 increase. In both groups undercorrection was observed in 4 patients and second operation was applied; also 3 patients in the group 1 and 2 patients in the group 2 were revised because of asymetrical skin folds. Conclusion: Aponeurosis repair with levator surgery using both sharp needle 6.0 polypropylene or 6.0 polyglactin sutures have similar results in terms of eyelid height, recurrence and complication. Accordingly both suture materials are effective and safe in aponeurotic ptosis surgery.

Keywords: Aponeurotic ptosis; aponeurosis repair; 6,0 polyglactin suture; 6,0 polypropylene suture
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