Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
COVID-19 Pandemisindeki Kısıtlamaların Keratokonus Progresyonuna Etkisi: Retrospektif Çalışma
Impact of COVID-19 Restrictions on Keratoconus Progression: A Retrospective Study
Esra DAĞ ŞEKERa, İnci Elif ERBAHÇECİ TİMURa, Özge SARAÇa
aAnkara Şehir Hastanesi, Göz Hastalıkları Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Ophthalmol. 2022;31(3):145-51
doi: 10.5336/ophthal.2021-87229
Article Language: TR
Full Text
ÖZET
 Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemi sürecindeki kapanmalar ve elektif ameliyatların durdurulması sebebiyle korneal kollajen çapraz bağlama (KÇB) tedavisi ertelenen hastaların keratokonus progresyonunu değerlendirmektir. Gereç ve Yöntemler: Pandemi sürecinde KÇB tedavisi ertelenen 29 hastanın 34 gözü çalışmaya dâhil edildi. Keratometri (K) değerleri, santral ve en ince korneal kalınlık değerleri, Sirius (CSO, Firenze, İtalya) Topografi cihazından elde edilerek, bekleme süresindeki değişiklikler analiz edildi. Kmaks değerinde 1D ve üzeri artış ile korneal kalınlıkta %2 ve üzeri incelme progresyon olarak değerlendirildi. Bulgular: Çalışmaya dâhil edilen 29 hastanın %20,6'sı kadın, yaş ortalaması 22,8±5,6 yıl ve ortalama bekleme süresi 109,78±48,62 gündü. Bekleme süresince ortalama Kmaks ve arka elevasyon değerlerindeki artış istatistiksel olarak anlamlı bulundu (p=0,023, p=0,002). Ortalama santral kornea kalınlığı ve en ince kornea kalınlığı istatistiksel olarak anlamlı bir şekilde azalmıştı (p<0,001 ve p=0,002). On altı (%47,1) hastada hastalığın ilerlediği tespit edildi. Hastaların %11,8'inde Kmaks değerinde 1D ve üzerinde artış vardı. Hastaların %38,2'sinde kornea %2 ve üzerinde incelmişti. Progresyon gösteren hastalar ile göstermeyen hastalar yaş ortalaması, görme keskinlikleri, sferik eş değerleri, KÇB gecikme süreleri açısından karşılaştırıldığında, progresyon göstermeyen hastaların yaş ortalaması 25±6,07 yıl iken, progresyon gösteren hastaların yaş ortalaması 20,81±5,15 yıl olarak bulundu, aradaki fark istatistiksel olarak anlamlıydı (p=0,047). Sonuç: COVID-19 pandemisi, keratokonus hastalarında KÇB uygulamalarında gecikmelere neden olabilmektedir. Keratokonus tedavisindeki 3 ay gibi kısa süren gecikmeler bile, özellikle genç hastalarda, hastalığın ciddi oranda ilerlemesine neden olabilmektedir. Bu nedenle KÇB tedavisi, progresyon riski yüksek olan genç keratokonus hastalarında elektif olarak değil, öncelikli tedavi olarak değerlendirilmelidir.

Anahtar Kelimeler: COVID-19; keratokonus; korneal kollajen çapraz bağlama; kornea topografisi
ABSTRACT
 Objective: To investigate the progression of keratoconus patients whose corneal collagen cross-linking (CCL) treatment were delayed, due to lockdown and postponed elective surgery during coronavirus disease-2019 (COVID-19) pandemic. Material and Methods: Thirty four eyes of 29 keratoconus patients, whose CCL treatment were delayed during pandemic were recruited in the study. Keratometry (K) values, central and thinnest corneal thickness, were obtained from Sirius (CSO, Firenze, Italy) Topography device and the changes during the delay were analysed. 1D or more increase at Kmax or 2% or more thinning at cornel thickness was evaluated as progression. Results: A total of 29 patients, 20.6% were women, mean age was 22.8±5,6 years, average waiting time was 109.78±48.62 days. During the delay, increase at mean Kmax and posterior elevation (p=0.023, p=0,002), and decrease at mean central and thinnest corneal thicknesses (p<0,001 ve p=0.002) were statistically significant. Sixteen (47.1%) patients demonstrated progression either with 1D or more increase at Kmax (11.8), or more than 2% decrease at corneal thickness (38.2%). Patients with progression and without progression were compared according to average age, visual acuity, spherical equvalent, CCL delay time. The average age of patients without progresion was 25±6.07 years, while patients with progression was 20.81±5.15 years, and the difference was statistically significant (p=0.047). Conclusion: COVID-19 pandemic can cause delay at CCL treatment of keratoconus patients. Even short delays such as 3 months, especially for young patients, could cause severe progression of the disease. Though CCL should be evaluated as prior treatment not elective for younger patients those are at high risk for progression.

Keywords: COVID-19; keratoconus; corneal collagen crosslinking; corneal topography
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