Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Yoğun Arka Kapsül Kesafeti Olan Hastalarda Nd:YAG Laser Kapsülotomi Sonrası Korneal Endotel Değişiklikleri
Corneal Endothelial Changes Following Nd:YAG Laser Capsulotomy in Patients with Dense Posterior Capsular Opacification
Yücel ÖZTÜRKa, Eren GÖKTAŞb, Ümit ÇALLIc, Dilber ÇELİK YAPRAKc, Yeşim ORALd, Ayşegül PENBEd
aGöz Hastalıkları Kliniği, Sağlık Bilimleri Üniversitesi İstanbul Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
bGöz Hastalıkları Kliniği, Sinop Boyabat 75. Yıl Devlet Hastanesi, Sinop, TÜRKİYE
cGöz Hastalıkları Kliniği, Sağlık Bilimleri Üniversitesi Ümraniye Eğitim ve Araştırma Hastanesi, dGöz Hastalıkları Kliniği, Sağlık Bilimleri Üniversitesi İstanbul Kartal Dr. Lütfi Kırdar Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(2):75-9
doi: 10.5336/ophthal.2018-62184
Article Language: TR
Full Text
ÖZET
 Amaç: Arka kapsül kesafeti (AKK) tedavisinde kullanılan neodymium:yttrium-aluminumgarnet (Nd: YAG) lazerin korneal endotel sayısını azalttığını bildiren yayınlar olduğu gibi, değiştirmediğini gösteren yayınlarda mevcut. Yoğun AKK olan hastalarda laser enerjisinin işlem sırasında artırılması gerekmektedir. Yapılan yüksek enerjili Nd: YAG lazer kapsülotominin kornea endotel sayısına olan etkisini ve kullanılan lazer enerjisinin hücre değişiklikleriyle ilişkisinin araştırılmasıdır. Gereç ve Yöntemler: Yoğun AKK olan 37 hastanın psödofakik 41 gözü çalışmaya alındı. Hastaların lazer öncesi ve sonrası birinci haftadaki en iyi düzeltilmiş görme keskinliği (EİDGK), endotel hücre sayıları ölçüldü ve istatistiksel olarak karşılaştırıldı. Lazer sırasında uygulanan toplam enerji miktarı ile endotel hücre sayısındaki değişim arasında korelasyon olup olmadığı araştırıldı. Bulgular: Laser öncesi ortalama EİDGK 1,05±0,23 logMAR iken laser sonrası 1. haftada 0,05±0,06 log-MAR olarak bulundu. EİDGK laser öncesi ölçümlere göre laser sonrası 1. haftadaki ölçümde anlamlı derecede artmıştı. Endotel hücre sayısı laser öncesi 1889,6±580,8 (1006-3288) hücre/mm2 iken laser sonrası 1577,5±518,2 (851-3000) hücre/mm2 idi. Laser sonrası endotel hücre kaybı öncesine göre 312,05±443,17 hücre/mm2 (%16,6) az bulundu. Endotel hücre kayıplarına göre hastaları 3 gruba ayırdığımızda 20 (%48,7) gözde mm2'de 200 hücreden daha az, 12 (%29,2) gözde 200 ila 500 arasında, 9 (%21,9) gözde ise 500?den daha fazla hücre kaybı olduğu görüldü. Korneal endotel kaybı ile kullanılan laser enerji seviyeleri arasında belirgin korelasyon bulunmamaktaydı. Sonuç: AKK bulunan hastalarda Nd: YAG lazer kapsülotomi belirgin görme artışı sağlamakla beraber, kornea endotel hücre sayısında azalmaya neden olmuştur.

Anahtar Kelimeler: Arka kapsül kesafeti; Nd: YAG laser; endotel hücre sayısı
ABSTRACT
 Objective: There are several publications showing that the neodymium:yttrium-aluminum-garnet (Nd: YAG) laser used in the treatment of posterior capsule opacification (PCO) decreases or does not change the number of corneal endothelium. In patients with dense PCO, laser energy should be increased during the procedure. We investigated the effect of high energy Nd: YAG laser capsulotomy on corneal endothelial count and the relationship of laser energy used with cell changes. Material and Methods: 41 eyes of 37 patients with dense PCO were included in this study. Best corrected visual acuity (BCVA) and endothelial cells counts were measured at the baseline and at post-operative week 1, and statistical comparisons were performed. This study investigated whether or not there was a correlation between total laser energy delivery during the procedure and the change in endothelial cell counts. Results: The mean baseline BCVA was 1.05±0.23 logMAR, while the BCVA at post-operative week 1 was 0.05±0.06 logMAR. BCVA measurements were significantly higher at week 1 in comparison to the baselin. The mean endothelial cell count was 1889.6±580.8 (range: 1.006-3.288) cells/mm2 at the baseline while the mean post-operative endothelial cell count was 1577.5±518.2 (range: 851-3.000) cells/mm2. The reduction in endothelial cell counts after the procedure was found to be 312.05±443.17 cells/mm2 (16.6%). Patients were categorized into three groups based on endothelial cell losses; endothelial cell losses were less than 200 cells/mm2 in 20 (48.7%) eyes, 200 to 500 cells/mm2 in 12 (29.2%) eyes and more than 500 cells/mm2 in 9 (21.9%) eyes. No significant correlations were found between corneal endothelial loss and the laser energy delivery during the procedure. Conclusion: In patients with PCO's, Nd: YAG laser capsulotomy results in significant increase in visual acuity and a decrease in the number of corneal endothelial cells.

Keywords: Posterior capsular opacification; Nd: YAG laser; endothelial cell count
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