Turkiye Klinikleri Journal of Ophthalmology

.: REVIEW
Koroidal Rüptürler, Güncel Tanı ve Tedavi: Geleneksel Derleme
Choroidal Ruptures, Current Diagnosis and Treatment: Traditional Review
Doğukan CÖMERTERa , Eyüp DÜZGÜNa , Işıl Merve TORUNa
aSağlık Bilimleri Üniversitesi İstanbul Sultan 2. Abdülhamid Han Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, İstanbul, Türkiye
Turkiye Klinikleri J Ophthalmol. 2023;32(3):191-7
doi: 10.5336/ophthal.2023-97346
Article Language: TR
Full Text
ÖZET
 Koroidal rüptür, glob travması nedeniyle gelişen retina pigment epiteli, Bruch membranı ve altındaki koryokapillarisin yırtılması ile karakterize gözün arka segment hastalığıdır. Oküler travma ile başvuran hastaların yaklaşık %5-10'unda koroid rüptürü gelişebilir. Rüptür, doğrudan çarpma bölgesinde veya indirekt olarak (kontrakup yaralanması) etki alanından uzakta meydana gelebilir. İndirekt travmalar, ciddi glob yaralanmasının ana nedeni olarak kabul edilir. Makula tutulumu söz konusu olan vakalarda görsel prognoz son derece kötü olabilir. Fundoskopik incelemede rüptür; beyazımsı/sarımsı hilal şeklinde, çatallı veya konik uçlu bir lezyon olarak görünür. Floresein anjiyografi, indosiyanin yeşili anjiyografi, optik koherens tomografi (OKT) ve OKT-anjiyografiyi (OKT-A) içeren multimodal görüntüleme, hasarın boyutu ve komplikasyonların takibi açısından ayrıntılı bir değerlendirme sağlamaktadır. Floresein anjiyografi, koroid rüptürlerin izlenmesinde altın standart görüntüleme tekniği olmasına rağmen OKT-A'nın ortaya çıkmasıyla birlikte daha fazla tercih edilen yöntem OKT-A olmuştur. Kendi başına koroid rüptürü için bir tedavi olmamasına rağmen açı resesyon glokomu, retina dekolmanı veya eksüdatif koroidal neovaskülarizasyon gibi komplikasyonlar gelişirse müdahale gerekebilir. Koroidal neovaskülarizasyon en sık görülen komplikasyondur. Bu derlemede; koroid rüptürü patofizyolojisini, son multimodal görüntüleme bulgularını ve komplikasyonların yönetimi için mevcut tedavi seçeneklerini tanımlamayı amaçladık.

Anahtar Kelimeler: Koroidal rüptür; oküler travma; retina dekolmanı; koroid neovaskülarizasyonu; optik koherens tomografi anjiyografi
ABSTRACT
 Choroidal rupture is a posterior segment affliction following a traumatic event that results in a break in the retinal pigment epithelium, Bruch membrane, and the underlying choriocapillaris. Approximately 5 to 10% of patients presenting with ocular trauma develop a choroidal rupture. The break can be produced directly at the impact site or, indirectly, away from the impact area as a contrecoup injury. Indirect traumas are considered the main cause of severe globe injury. The visual prognosis may be extremely poor when involving the macular area or in cases with significant comorbidities. On funduscopic examination, the rupture appears as a whitish/yellowish curvilinear or crescent-shaped lesion with forked or tapered endings. Multimodal imaging including fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography can provide a detailed assessment of the extent of damage and the onset of complications. Fluorescein angiography has been the gold standard imaging technique in monitoring choroidal ruptures; however, after the introduction of OCT-A, its use in case of choroidal ruptures is strongly recommended. Although there is no treatment for choroidal rupture per se, associated complications such as angle recession glaucoma, retinal detachment, or exudative choroidal neovascularization might need therapeutic interventions. Choroidal neovascularization is the most common complication. In this review; we aimed to describe the pathophysiology of choroidal rupture, the recent multimodal imaging findings, and the available treatment options for the management of complications.

Keywords: Choroidal rupture; ocular trauma; retinal detachment; choroidal neovascularization; optical coherence tomography angiography
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