Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Santral Seröz Koryoretinopatili Hastalarımızda Tanı ve Tedavi
Diagnosis and Treatment in Our Patients with Central Serous Corioretinopathy
Nilay KANDEMİR BEŞEKa
aGöz Hastalıkları Kliniği, Sağlık Bilimleri Üniversitesi İstanbul Beyoğlu Göz Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2019;39(4):345-52
doi: 10.5336/medsci.2019-65128
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada, santral seröz koryoretinopati (SSKR)'li olgularda tanı, tedavi yöntemleri ve sonuçlarının bildirilmesi amaçlanmıştır. Gereç ve Yöntemler: Primer SSKR tanısı alan hastaların kayıtları retrospektif olarak incelendi. Tüm hastaların düzeltilmiş en iyi görme keskinlikleri (GK), ön segment biyomikroskopisi ve fundus muayeneleri, optik koherens tomografi ve floresein anjiyografi tetkikleri ile beraber aldıkları tedavi yöntemleri kaydedildi. Prognostik parametreler incelendi. Altı aydan kısa süren olgular akut, uzun süren olgular kronik SSKR olarak sınıflandırıldı. Bulgular: Seksen hastanın (58 erkek; yaş ortalaması 44,75±9,6 yıl) 103 gözü çalışmaya dâhil edildi. Akut SSKR 44 (%42,8) gözde, kronik SSKR 59 (%57,2) gözde tespit edildi. Akut SSKR olgularında GK'de artış ortalama 2,4±5,3 sıra iken, kronik SSKR olgularında 0,2±3,4 sıra artışı izlendi (p=0,005). Retina pigment epitelyal (RPE) atrofisi olmayan gözlerde sonuç GK'de artış saptanırken (p<0,001), RPE atrofisi olan gözlerde GK'de değişim saptanmadı (p=0,67). Başlangıç GK iki grup arasında benzer (p=0,79) iken son takipte RPE olmayan grupta GK daha yüksek bulundu (p=0,001). Fokal lazer fotokoagülasyon (LFK) uygulanan 12 gözden 6'sında görmede artış görüldü, diğer 6 gözde ise GK değişmedi (p=0,074). Kronik SSKR'li 6 (%10,2) göze fotodinamik tedavi (FDT) uygulandı. FDT öncesi ve sonrası görme keskinliği sabit kaldı (p=0,20), fakat hiçbir gözde nüks görülmedi. Sonuç: SSKR olgularında tanı anında RPE atrofisinin varlığı, görsel prognozu etkileyen en önemli parametredir. Akut SSKR olguları GK'de artış ile iyileşirken, kronik vakalarda iyileşme olsa da GK artışı sınırlı kalmaktadır. LFK ve FDT seçilmiş vakalarda kullanılabilecek bir yöntemdir.

Anahtar Kelimeler: Santral seröz koryoretinopati; fluoresein anjiografi; optik kohorens tomografi; fotodinamik tedavi
ABSTRACT
 Objective: In this study we aimed to report diagnosis, treatment methods and results in cases with central serous chorioretinopathy (CSCR). Material and Methods: The records of the patients with primary CSCR were retrospectively evaluated. Visual acuity (VA), biomicroscopy and fundus examinations, optical coherence tomography, fluorescein angiography results and the treatment modalities were recorded. Prognostic paramaters were evaluated. Cases with a disease lasting ≤ 6 months were categorised as acute and those >6 months as chronic. Results: 103 eyes of 80 patients (58 male; mean age 44.75±9.6 years) were included. Acute CSCR was detected in 44 (42.8%) and chronic CSCR in 59 (57.2%) eyes. Gain in VA in acute cases was 2.4±5.3 lines, while in chronic cases was 0.2±3.4 lines (p=0.005). VA improvement was observed in eyes without RPE atrophy (p<0.001), whereas no improvement was noted in eyes with RPE atrophy (p=0.67). The final VA was better in eyes without RPE atrophy (p=0.001), while initial VA was similar (p=0.79) between the groups. Among the 12 eyes that underwent focal laser photocoagulation (LPC) VA increased in 6 eyes and remained stable in the rest (p=0,074). Photodynamic therapy (PDT) was performed on 6 (10.2%) eyes with chronic CSCR. Following PDT mean VA remained stable (p=0.20). Conclusion: In CSCR cases RPE atrophy at time of diagnosis was found to be the most important prognostic parameter. While VA improvement was noted in acute cases, chronic cases heal with limited VA gain. LPC and PDT are the methods used in the treatment of selected cases.

Keywords: Central serous chorioretinopathy; flourescein angiography; optical coherence tomography; photodynamic therapy
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