.: ORİJİNAL ARAŞTIRMA
Patolojik Miyopi ile Birlikte Olan Regmatojen Retina Dekolmanlarında 25 Gauge Vitrektomi Cerrahisinin Sonuçları:Retrospektif Çalışma
Results of 25 Gauge Vitrectomy Surgery in Rhegmatogenous Retinal Detachments Associated with Pathological Myopia: Retrospective Study
Turkiye Klinikleri J Ophthalmol. 2023;32(2):99-104
doi: 10.5336/ophthal.2022-94012
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Patolojik miyopi, gözün aksiyel uzunluğunda artışla birlikte retinada yapısal bozuklukların görüldüğü bir hastalıktır ve regmatojen retina dekolmanı (RRD) ile ilişkili olabilmektedir. Çalışmamızda, kliniğimizde RRD için 25 Gauge vitreoretinal cerrahi (VRC) uygulanan patolojik miyopi olgularının demografik ve klinik özellikleri ile cerrahi sonuçlarını incelemek amaçlanmıştır. Gereç ve Yöntemler: Ulucanlar Göz Eğitim ve Araştırma Hastanesi Retina Biriminde, Ocak 2019-Aralık 2021 tarihleri arasında tek cerrah tarafından patolojik miyopiye bağlı RRD için VRC uyguladığımız 69 hastanın dosyaları retrospektif olarak incelendi. Yaş, cinsiyet gibi demografik özellikleri; detaylı ön ve arka segment muayeneleri, dekolman alanları, yırtık yerleşimleri, preoperatif ve en son takip görme keskinlikleri ile göz içi basınçları, kullanılan tamponadlar ve gelişen komplikasyonlar kaydedildi. Bulgular: Olguların 33'ü (%47,8) erkek ve 36'sı (%52,2) kadındı. Yaş ortalamaları 45,4±13,05 yıl idi. Olguların 21'inde alt yarıda, 40 olguda üst yarıda (3'ü dev yırtık), 8 hastada hem alt hem de üst yarıda yırtık olduğu saptandı. Tamponad olarak 64 olguda silikon yağı, 3 olguda C3F8 ve 2 olguda SF6 gazları kullanılmıştı. Olguların preoperatif en iyi düzeltilmiş görme keskinliği (EİDGK) medyan değeri 1,7 logMAR (minmum:1,9, maksimum:0,4), son takipte ise EİDGK medyan değeri 0,5 logMAR (minimum:1,2, maksimum:0,3) idi. Olguların 9'unda nüks RD oluştu. En sık nüks sebebi, proliferatif vitreoretinopati (7 olgu) gelişimi idi. Cerrahi sonrası en sık izlenen komplikasyon 10 (%14,5) olgu da görülen katarakt idi. Sonuçlar: Miyopik RD'ler de özellikle arka stafilom varlığında arka kutba yeterli tamponad sağlanamaması endişesi olursa günümüzde bile silikon yağı öncelikli tercih edilebilmektedir. Patolojik miyopiye bağlı RRD tedavisinde 25 Gauge vitrektomi ile başarılı anatomik ve fonksiyonel sonuçlar elde edilebilmektedir.
Anahtar Kelimeler: Pars plana vitrektomi; patolojik miyopi; retina dekolmanı
Amaç: Patolojik miyopi, gözün aksiyel uzunluğunda artışla birlikte retinada yapısal bozuklukların görüldüğü bir hastalıktır ve regmatojen retina dekolmanı (RRD) ile ilişkili olabilmektedir. Çalışmamızda, kliniğimizde RRD için 25 Gauge vitreoretinal cerrahi (VRC) uygulanan patolojik miyopi olgularının demografik ve klinik özellikleri ile cerrahi sonuçlarını incelemek amaçlanmıştır. Gereç ve Yöntemler: Ulucanlar Göz Eğitim ve Araştırma Hastanesi Retina Biriminde, Ocak 2019-Aralık 2021 tarihleri arasında tek cerrah tarafından patolojik miyopiye bağlı RRD için VRC uyguladığımız 69 hastanın dosyaları retrospektif olarak incelendi. Yaş, cinsiyet gibi demografik özellikleri; detaylı ön ve arka segment muayeneleri, dekolman alanları, yırtık yerleşimleri, preoperatif ve en son takip görme keskinlikleri ile göz içi basınçları, kullanılan tamponadlar ve gelişen komplikasyonlar kaydedildi. Bulgular: Olguların 33'ü (%47,8) erkek ve 36'sı (%52,2) kadındı. Yaş ortalamaları 45,4±13,05 yıl idi. Olguların 21'inde alt yarıda, 40 olguda üst yarıda (3'ü dev yırtık), 8 hastada hem alt hem de üst yarıda yırtık olduğu saptandı. Tamponad olarak 64 olguda silikon yağı, 3 olguda C3F8 ve 2 olguda SF6 gazları kullanılmıştı. Olguların preoperatif en iyi düzeltilmiş görme keskinliği (EİDGK) medyan değeri 1,7 logMAR (minmum:1,9, maksimum:0,4), son takipte ise EİDGK medyan değeri 0,5 logMAR (minimum:1,2, maksimum:0,3) idi. Olguların 9'unda nüks RD oluştu. En sık nüks sebebi, proliferatif vitreoretinopati (7 olgu) gelişimi idi. Cerrahi sonrası en sık izlenen komplikasyon 10 (%14,5) olgu da görülen katarakt idi. Sonuçlar: Miyopik RD'ler de özellikle arka stafilom varlığında arka kutba yeterli tamponad sağlanamaması endişesi olursa günümüzde bile silikon yağı öncelikli tercih edilebilmektedir. Patolojik miyopiye bağlı RRD tedavisinde 25 Gauge vitrektomi ile başarılı anatomik ve fonksiyonel sonuçlar elde edilebilmektedir.
Anahtar Kelimeler: Pars plana vitrektomi; patolojik miyopi; retina dekolmanı
ABSTRACT
Objective: Pathological myopia, in which rhegmatogenous retinal detachments (RRD) is relatively common, is the nomenclature given to excessive axial elongation associated with structural changes in the posterior segment of the eye. In our study, it was aimed to examine the demographic and clinical characteristics and surgical results of pathological myopia cases who underwent 25 Gauge vitreoretinal surgery (VRS) for RRD in our clinic. Material and Method: The files of 69 patients who underwent VRS for RRD due to pathological myopia by a single surgeon between January 2019-December 2021 in the retina unit of Ulucanlar Eye Training and Research Hospital were retrospectively reviewed. Demographic characteristics such as age and gender; detailed anterior and posterior segment examinations, detachment areas, tear locations, preoperative and latest follow-up visual acuities and intraocular pressures, tamponades used, and complications were recorded. Results: Thirty-three (47.8%) of the cases were male and 36 (52.2%) were female. The mean age was 45.4±13.05 years. Tears were found in the lower half in 21 cases, in the upper half in 40 (3 giant tears) cases, and in both lower and upper halves in 8 patients. Silicone oil in 64 cases, C3F8 in 3 cases, and SF6 in 2 cases were used as tamponade. The preoperative BCVA median value of the cases was 1.7 logMAR (minimum:1.9, maximum:0.4), and at the last follow-up, the median BCVA was 0.5 logMAR (minimmum:1.2, maximum:0.3). Recurrent RD occurred in nine patients. The most common cause of recurrence was the development of proliferative vitreoretinopathy (7 cases). The most common complication after surgery was cataract, which was seen in 10 (14.5%) cases. Conclusion: In myopic RDs, especially in the presence of posterior staphyloma, silicone oil can be preferred as a priority even today if there is a concern that adequate tamponade cannot be provided to the posterior pole. Successful anatomical and functional results can be obtained with 25 Gauge vitrectomy in the treatment of RRD due to pathological myopia.
Keywords: Pars plana vitrectomy; pathological myopia; retinal detachment
Objective: Pathological myopia, in which rhegmatogenous retinal detachments (RRD) is relatively common, is the nomenclature given to excessive axial elongation associated with structural changes in the posterior segment of the eye. In our study, it was aimed to examine the demographic and clinical characteristics and surgical results of pathological myopia cases who underwent 25 Gauge vitreoretinal surgery (VRS) for RRD in our clinic. Material and Method: The files of 69 patients who underwent VRS for RRD due to pathological myopia by a single surgeon between January 2019-December 2021 in the retina unit of Ulucanlar Eye Training and Research Hospital were retrospectively reviewed. Demographic characteristics such as age and gender; detailed anterior and posterior segment examinations, detachment areas, tear locations, preoperative and latest follow-up visual acuities and intraocular pressures, tamponades used, and complications were recorded. Results: Thirty-three (47.8%) of the cases were male and 36 (52.2%) were female. The mean age was 45.4±13.05 years. Tears were found in the lower half in 21 cases, in the upper half in 40 (3 giant tears) cases, and in both lower and upper halves in 8 patients. Silicone oil in 64 cases, C3F8 in 3 cases, and SF6 in 2 cases were used as tamponade. The preoperative BCVA median value of the cases was 1.7 logMAR (minimum:1.9, maximum:0.4), and at the last follow-up, the median BCVA was 0.5 logMAR (minimmum:1.2, maximum:0.3). Recurrent RD occurred in nine patients. The most common cause of recurrence was the development of proliferative vitreoretinopathy (7 cases). The most common complication after surgery was cataract, which was seen in 10 (14.5%) cases. Conclusion: In myopic RDs, especially in the presence of posterior staphyloma, silicone oil can be preferred as a priority even today if there is a concern that adequate tamponade cannot be provided to the posterior pole. Successful anatomical and functional results can be obtained with 25 Gauge vitrectomy in the treatment of RRD due to pathological myopia.
Keywords: Pars plana vitrectomy; pathological myopia; retinal detachment
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