Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Epilepsi Tedavisinde Kullanılan İlaçların Retina Sinir Lifi Tabakası ve Koroid Kalınlığına Olan Etkilerinin Spektral Domain Optik Koherens Tomografi ile İncelenmesi
Investigation of the Effects of Anti-Epileptic Drug Treatment on Retinal Nerve Fiber Layer and Choroidal Thickness with Spectral Domain Optic Coherence Tomography
Bahriye HORASANLIa, Mehmet ATAKANb, Mahmut Oğuz ULUSOYc
aBaşkent Üniversitesi Konya Araştırma ve Uygulama Merkezi, Nöroloji ABD, Konya, TÜRKİYE
bSancaktepe Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, İstanbul, TÜRKİYE
cBaşkent Üniversitesi Konya Araştırma ve Uygulama Merkezi, Göz Hastalıkları ABD, Konya, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2020;29(4):264-70
doi: 10.5336/ophthal.2019-72999
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışma ile epilepsi tedavisinde ilaç kullanımının, retina sinir lifi tabakası [retinal nerve fiber layer (RNFL)] ve koroid kalınlığı üzerindeki etkilerinin, spektral domain optik koherens tomografi (SD-OKT) ile değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, farklı sayıda antiepileptik ilaç kullanan 66 epilepsi hastası ile 52 sağlıklı birey (kontrol) dâhil edilerek, rutin oftalmik muayeneleri yapıldı; SD-OKT ile RNFL ve koroid kalınlıkları ölçüldü. Ayrıca, epilepsi hastalarının da kendi içinde çoklu ve tekli ilaç kullanımı açısından RNFL ve koroid kalınlık değerleri karşılaştırıldı. Bulgular: RNFL kalınlıkları bakımından incelendiğinde, tüm 4 kadranda (superior, inferior, nazal ve temporal) ve ortalama RNFL kalınlığı değerlerinde kontrol grubu epilepsi grubuna göre daha yüksek değerlere sahipti. Sadece nazal RNFL (p=0,564) değerleri arasındaki fark anlamlı bulunmazken; diğer tüm kadran RNFL değerleri arasındaki farklar istatistiksel olarak anlamlıydı. Buna ilaveten epileptik grupta, çoklu antiepileptik ilaç kullananların inferior kadran RNFL değerleri, tek antiepileptik kullananlara göre anlamlı olarak düşük bulundu. Koroid kalınlık değerlendirilmesinde ise tüm subfoveal ve temporal 500 hariç tüm koroid ölçümlerinde kontrol grubu epilepsi grubuna göre istatistiksel olarak anlamlı derecede daha kalın koroid değerlerine sahipti. Çoklu ilaç kullanımının, tek ilaç kullanımına göre koroide etkisi bulunmazken; inferior RNFL (p=0,008) ve ganglion hücre tabakası (p<0,001) anlamlı olarak ince bulunmuştur. Sonuç: Antiepileptik ilaç kullanan hastalarda hem RNFL hem de koroid kalınlığında anlamlı derecede azalma bulunmuştur. Antiepileptik ilaç kullanımı, hastalığın kendi patofizyolojisine bağlı muhtemel retina ve koroid üzerindeki etkileri artırabileceği şeklinde yorumlanabilir.

Anahtar Kelimeler: Antiepileptik tedavi; epilepsi; koroid; optik koherens tomografi; retina sinir lifi tabakası
ABSTRACT
 Objective: To evaluate the effects of drug use on retinal nevre fiber layer (RNFL) and choroid thickness in the treatment of epilepsy by spectral domain optical coherence tomography (SD-OCT). Material and Methods: Routine ophthalmic examinations were performed by including 66 epilepsy patients and 52 healthy individuals (control) using a different number of antiepileptic drugs, and RNFL and choroid thicknesses were measured with SD-OCT. In addition, RNFL and choroidal thickness values were compared in terms of multiple and single drug use in epilepsy patients. Results: When examined in terms of RNFL thicknesses, the control group had higher values in all four quadrants (superior, inferior, nasal and temporal) and mean RNFL thickness values compared to the epilepsy group. While the difference between only nasal RNFL (p=0.564) values was not significant, the differences between all other quadrant RNFL values were statistically significant. In addition, in the epileptic group; Inferior quadrant RNFL values of those using multiple antiepileptic drugs were significantly lower than those using single antiepileptic drugs. In the evaluation of choroidal thickness, the control group had statistically significantly thicker choroidal values than the epilepsy group in all choroid measurements except for all subfoveal and temporal 500. While multidrug use has no effect on choroid compared to single drug use, inferior RNFL (p=0.008) and ganglion cell layer (p<0.001) were found to be significantly thin. Conclusion: Significant reduction in both RNFL and choroidal thickness was found in patients using antiepileptic drugs. The use of antiepileptic drugs can be interpreted as the disease may increase the effects on the possible retina and choroid due to its pathophysiology.

Keywords: Antiepileptic treatment; epilepsy,choroid; optic coherence tomography; retina nerve fiber layer
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