Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Psödoeksfoliasyonu Olan ve Olmayan Bireylerin Katarakt Ameliyatı Öncesi ve Sonrası Ön Segment Yapılarının Ultrason Biyomikroskobisi ile Değerlendirilmesi: Prospektif Klinik Çalışma
The Evaluation of the Anterior Segment Structures of Individuals with and Without Pseudoexfoliation Before and After Cataract Surgery by Ultrasound Biomicroscopy: Prospective Clinical Study
Bediz ÖZENa, Hakan ÖZTÜRKa
aSağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi, Göz Kliniği, İzmir, Türkiye
Turkiye Klinikleri J Ophthalmol. 2022;31(3):164-71
doi: 10.5336/ophthal.2022-90550
Article Language: TR
Full Text
ÖZET
 Amaç: Anormal materyal birikimi nedeniyle psödoeksfoliyasyonun eşlik ettiği kataraktlı olguların, cerrahiye verecekleri biyomekanik yanıtlar, sadece kataraktı olanlarınkinden farklılıklar gösterebilir. Çalışmada psödoeksfoliyasyonu olan ve olmayan bireylerin, katarakt ameliyatı öncesi ve sonrası ön segment yapılarının ultrason biyomikroskopisiyle (UBM) değerlendirilmesi ve verilerinin karşılaştırılması amaçlandı. Gereç ve Yöntemler: Sorunsuz fakoemülsifikasyon cerrahisi geçiren 102 olgu değerlendirildi. Psödoeksfoliyasyonu olmayan kataraktlı olgular Grup-1 (n=54), psödoeksfoliyasyonu olan kataraktlı olgular Grup-2 (n=48) olarak belirlendi. Grupların ameliyat öncesi ve ameliyat sonrası 3.aydaki; aksiyel uzunlukları, ön kamara derinlikleri (ÖKD), açı açıklığı mesafeleri (AAM500), trabeküler ağ-iris açıları (TİA500), açı sonlanma alanları (ASA500) ve göz içi basınçları (GİB) karşılaştırıldı. Bulgular: Ameliyat öncesi lens kalınlığı, Grup-1'e göre Grup-2'de daha fazlaydı (p=0,013). Gruplarda; ameliyat öncesi döneme göre ameliyat sonrası ÖKD (sırasıyla p=0,014; p=0,008), AAM500 (p=0,036; p=0,020), TİA500 (p=0,021; p<0,001) ve ASA500 (p=0,043; p=0,034) değerleri daha fazlayken, GİB'i daha düşüktü (p=0,012; p<0,001). Ameliyat sonrası TİA500 değeri, Grup-1'e göre Grup-2'de daha fazlaydı (p=0,046). Grup-1 ve Grup-2'de, TİA500 değişimi; ameliyat öncesi AAM500 (sırasıyla r=-0,352, p=0,048; r=-0,386, p=0,039), TİA500 (r=-0,406, p=0,023; r=-0,438, p=0,011) ve ASA500 (r=-0,363, p=0,045; r=-0,371, p=0,042) değerleriyle negatif koreleydi. Sonuç: Her iki grupta da fakoemülsifikasyon cerrahisi sonrası ön kamaranın derinleştiğini, açının genişlediğini ve GİB'in düştüğünü saptadık. Ameliyat sonrası dönemde, sadece kataraktı olanlara kıyasla, psödoeksfoliyasyonlu olguların trabeküler ağ-iris açıları daha genişti. Çalışmada gözlemlenen bu anatomik değişiklikler, psödoeksfoliyatif glokomlu olgularda katarakt geliştiğinde GİB'in düşürülmesinde daha büyük bir klinik öneme sahip olabilir.

Anahtar Kelimeler: Fakoemülsifikasyon; göz içi basıncı; katarakt; psödoeksfoliyasyon; ultrason biyomikroskopi
ABSTRACT
 Objective: Due to abnormal material accumulation, biomechanical responses of cases with cataract accompanied by pseudoexfoliation to surgery may show differences from those with only cataract. In study, it was aimed to evaluate anterior segment structures of individuals with and without pseudoexfoliation before and after cataract surgery by ultrasound biomicroscopy (UBM) and to compare their data. Material and Methods: The 102 cases undergoing uneventful phacoemulsification surgery were evaluated. Cataract cases without pseudoexfoliation were determined as Group-1 (n=54), and cataract cases with pseudoexfoliation as Group-2 (n=48). Axial lengths, anterior chamber depths (ACD), angle opening distances (AOD500), trabecular meshwork-iris angles (TIA500), angle recess areas (ARA500), and intraocular pressures (IOP) of groups at preoperative and postoperative 3rd month were compared. Results: Preoperative lens thickness was higher in Group-2 than in Group-1 (p=0.013). In groups, compared to preoperative period, postoperative ACD (p=0.014; p=0.008, respectively), AOD500 (p=0.036; p=0.020), TIA500 (p=0.021; p<0.001) and ARA500 (p=0.043; p=0.034) values were higher, while IOP was lower (p=0.012; p<0.001). Postoperative TIA500 value was higher in Group-2 than in Group-1 (p=0.046). In Group-1 and Group-2, TIA500 change was negatively correlated with preoperative AOD500 (r=-0.352, p=0.048; r=-0.386, p=0.039), TIA500 (r=-0.406, p=0.023; r= -0.438, p=0.011) and ARA500 (r=-0.363, p=0.045; r=-0.371, p=0.042) values. Conclusion: We determined that anterior chamber deepened, angle widened, and IOP decreased after phacoemulsification surgery in both groups. In postoperative period, trabecular meshwork-iris angles of cases with pseudoexfoliation were wider than those with only cataract. These anatomical changes observed in study may have greater clinical significance in reducing IOP when cataracts develop in pseudoexfoliative glaucoma cases.

Keywords: Phacoemulsification; intraocular pressure; cataract; pseudoexfoliation; ultrasound biomicroscopy
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