Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Primer Açık Açılı Glokom Hastalarında Otomatik Pupillometri ile Ölçülen Pupilla Karakteristikleri: Randomize Klinik Çalışma
Pupillary Characteristics Measured by Automated Pupillometry in Patients with Primary Open-Angle Glaucoma: Randomized Clinical Study
Mert ŞİMŞEKa, Ali Mert KOÇERa, Emine ŞENa, Ufuk ELGİNa
aSağlık Bilimleri Üniversitesi Ulucanlar Göz Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2021;30(4):227-33
doi: 10.5336/ophthal.2021-82010
Article Language: TR
Full Text
ÖZET
 Amaç: Primer açık açılı glokom (PAAG) hastalarında statik ve dinamik pupilla fonksiyonlarını tespit etmek ve glokom evresi ile ilişkisini değerlendirmek. Gereç ve Yöntemler: Bu kesitsel-karşılaştırmalı çalışmaya, glokom birimimize başvuran yeni tanı PAAG olguları ve herhangi bir oküler/orbital hastalığı olmayan sağlıklı katılımcılar dâhil edildi. PAAG'li katılımcılar glokomatöz hasar evresine göre erken evre (Grup 1; n=32), orta evre (Grup 2; n=35) ve ileri evre (Grup 3; n=30) olarak sınıflandırıldı. Kontrol grubu sağlıklı 30 katılımcıdan oluşturuldu (Grup 4). Bir otomatik pupillometri sistemi ile hastaların pupilla fonksiyonları değerlendirildi. Statik karakteristikler skotopik, mezopik, düşük fotopik ve yüksek fotopik pupilla çapı (PÇ, mm); dinamik karakteristikler ise dinlenim çapı (DÇ, mm), pupilla kontraksiyon genliği (PKGen, mm), pupilla kontraksiyon gecikmesi (PKG, ms), pupilla kontraksiyon süresi (PKS, ms), pupilla kontraksiyon hızı (PKH, mm/s), pupilla dilatasyon gecikmesi (PDG, ms), pupilla dilatasyon süresi (PDS, ms) ve pupilla dilatasyon hızı (PDH, mm/s) idi. Elde edilen veriler gruplar arasında varyans analizi ile değerlendirildi. Bulgular: Kontrollerle karşılaştırıldığı zaman yüksek fotopik PÇ değeri orta ve ileri evre glokom grubunda anlamlı yüksek saptandı (sırasıyla p=0,003 ve p=0,001). DÇ, PKS, PDG ve PDH açısından gruplar arasında anlamlı fark yoktu (tüm değerler için p>0,05). PKGen, PKG ve PKH parametreleri açısından orta ve ileri evre glokom olgularında kontrol grubu ile karşılaştırıldığında anlamlı fark tespit edilirken (tüm değerler için p<0,05); PDS ölçümü sadece ileri evre glokom grubu ile kontrol olguları arasında anlamlı idi (p=0,004). Sonuç: Glokom evresinde ilerleme ile birlikte pupilla fonksiyonlarında kantitatif değişimler gözlemlendi. Bu sonuçlar, glokomun otonom sinir disfonksiyonu ile ilişkili olabileceğini göstermiştir.

Anahtar Kelimeler: Otonom sinir sistemi; primer açık açılı glokom; pupillometri
ABSTRACT
 Objective: To determine static and dynamic pupillary functions in patients with primary open-angle glaucoma (POAG) and evaluate their association with glaucoma stage. Materials and Methods: In this cross-sectional comparative study, newly diagnosed POAG patients and healthy control participants were included. POAG participants were classified as early stage (Group 1; n=32), moderate stage (Group 2; n=35) and advanced stage (Group 3; n=30) according to the stage of glaucomatous damage. The control group consisted of 30 healthy participants (Group 4). Pupillary functions of the patients were evaluated with an automatic pupillometry system. Static characteristics were scotopic, mesopic, low photopic, and high photopic pupil diameter (PD, mm); dynamic characteristics were resting diameter (RD, mm), amplitude of pupil contraction (APC, mm), latency of pupil contraction (LPC, ms), duration of pupil contraction (DPC, ms), velocity of pupil contraction (VPC, mm/s), latency of pupil dilation (LPD, ms), duration of pupil dilation (DPD, ms), and velocity of pupil dilation (VPD, mm/s). The data obtained were evaluated by analysis of variance between groups. Results: The high photopic PD value was found to be significantly higher in the moderate and advanced stage glaucoma group compared with the controls (p=0.003 and p=0.001, respectively). There was no significant difference between the groups in terms of RD, DPC, LPD, and VPD (p>0.05 for all). While a significant difference was detected in moderate and advanced stage glaucoma patients in terms of APC, LPC, and VPC parameters compared to the control group (p<0.05 for all), DPD measurement was significant only between the advanced glaucoma group and control subjects (p=0.004). Conc lusion: Quantitative changes in pupillary functions were observed with the progression of the glaucoma stage. These results showed that glaucoma may be associated with autonomic nervous dysfunction.

Keywords: Autonomic nervous system; primary open angle glaucoma; pupillometry
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