.: ORİJİNAL ARAŞTIRMA
Yırtıklı Retina Dekolmanı ve Tam Kat Makula Deliği Nedeniyle Pars Plana Vitrektomi Uygulanan Hastaların Değerlendirilmesi: Retrospektif Kesitsel Araştırma
Evaluation of Patients Underwent Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment and Full Thickness Macular Hole: Retrospective Cross-Sectional Study
Turkiye Klinikleri J Ophthalmol. 2024;33(3):184-9
doi: 10.5336/ophthal.2024-103669
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Bu çalışmanın amacı, tam kat makula deliği (TKMD) ve regmatojen retina dekolmanlı (RRD) hastalarda cerrahi yöntemleri, kullanılan tamponadları ve klinik sonuçlarını incelemekti. Gereç ve Yöntemler: Bu kesitsel, retrospektif çalışmaya RRD ve TKMD tanısı alan, 23 gauge pars plana vitrektomi (PPV) uygulanmış, intravitreal tamponad olarak silikon yağı, C3F8 (%12) veya SF6 (%20) kullanılan tüm hastalar dâhil edildi. Tüm hastalara PPV öncesi fakoemülsifikasyon ile katarakt cerrahisi yapıldı ve tek parçalı, tek odaklı, akrilik, hidrofobik, katlanabilir göz içi lens bag içine implante edildi. Bulgular: Çalışma süresince RRD nedeniyle cerrahi uygulanan 386 hasta incelenmiş ve 11 hastada (%2,85) eşlik eden TKMD saptanmıştır. Üç hastada (%27,3) ise evre B veya üzeri proliferatif vitreoretinopati (PVR) tespit edilmiştir. İlk cerrahide hastaların 5'ine (%62,5) inverted iç limitan membran (ILM) flebi ve 3 (%37,5) hastaya ILM soyma uygulanmıştır. İlk cerrahilerden sonra tüm hastalarda retinal adezyon sağlanmıştır. İki hastada makula deliğinin sebat ettiği ve bir hastada takiplerde makula deliğinin tekrarladığı görülmüştür. Makula deliği sebat eden iki hastanın ikinci cerrahisinde kalan ILM dokusunun tamamı çıkarılmıştır. Nüks makula deliği olgusunda ise greft olarak Descemet membranı kullanılmıştır. İkinci cerrahiden sonra tüm hastaların TKMD'si kapalıydı. Sonuç: RRD ve TKMD hastalarında vitrektomi ile birlikte ILM soyma ve inverted ILM flep yöntemleri etkin cerrahi yöntemlerdir ayrıca kombine cerrahide, tek bir prosedür klinik ve maliyet açısından avantaj sunacaktır.
Anahtar Kelimeler: İç limitan membran; makula deliği; pars plana; retina dekolmanı; vitrektomi
Amaç: Bu çalışmanın amacı, tam kat makula deliği (TKMD) ve regmatojen retina dekolmanlı (RRD) hastalarda cerrahi yöntemleri, kullanılan tamponadları ve klinik sonuçlarını incelemekti. Gereç ve Yöntemler: Bu kesitsel, retrospektif çalışmaya RRD ve TKMD tanısı alan, 23 gauge pars plana vitrektomi (PPV) uygulanmış, intravitreal tamponad olarak silikon yağı, C3F8 (%12) veya SF6 (%20) kullanılan tüm hastalar dâhil edildi. Tüm hastalara PPV öncesi fakoemülsifikasyon ile katarakt cerrahisi yapıldı ve tek parçalı, tek odaklı, akrilik, hidrofobik, katlanabilir göz içi lens bag içine implante edildi. Bulgular: Çalışma süresince RRD nedeniyle cerrahi uygulanan 386 hasta incelenmiş ve 11 hastada (%2,85) eşlik eden TKMD saptanmıştır. Üç hastada (%27,3) ise evre B veya üzeri proliferatif vitreoretinopati (PVR) tespit edilmiştir. İlk cerrahide hastaların 5'ine (%62,5) inverted iç limitan membran (ILM) flebi ve 3 (%37,5) hastaya ILM soyma uygulanmıştır. İlk cerrahilerden sonra tüm hastalarda retinal adezyon sağlanmıştır. İki hastada makula deliğinin sebat ettiği ve bir hastada takiplerde makula deliğinin tekrarladığı görülmüştür. Makula deliği sebat eden iki hastanın ikinci cerrahisinde kalan ILM dokusunun tamamı çıkarılmıştır. Nüks makula deliği olgusunda ise greft olarak Descemet membranı kullanılmıştır. İkinci cerrahiden sonra tüm hastaların TKMD'si kapalıydı. Sonuç: RRD ve TKMD hastalarında vitrektomi ile birlikte ILM soyma ve inverted ILM flep yöntemleri etkin cerrahi yöntemlerdir ayrıca kombine cerrahide, tek bir prosedür klinik ve maliyet açısından avantaj sunacaktır.
Anahtar Kelimeler: İç limitan membran; makula deliği; pars plana; retina dekolmanı; vitrektomi
ABSTRACT
Objective: The aim of this study was to evaluate the surgical methods, tamponades used and clinical outcomes in patients with full-thickness macular hole (FTMH) and rhegmatogenous retinal detachment (RRD). Material and Methods: This cross-sectional, retrospective study included all patients diagnosed with RRD and FTMH who underwent 23-gauge pars plana vitrectomy (PPV) with silicone oil, C3F8 (12%) or SF6 (20%) as intravitreal tamponade. All patients underwent cataract surgery with phacoemulsification before PPV and a single-piece, monofocal, acrylic, hydrophobic, foldable intraocular lens was implanted into the bag. Results: During the study period, 386 patients who underwent surgery for RRD were analyzed and 11 patients (2.85%) had concomitant FTMH. Three patients (27.3%) had stage B or higher proliferative vitreoretinopathy (PVR). In the first surgery, 5 (62.5%) patients underwent inverted internal limiting membrane (ILM) flap and 3 (37.5%) patients underwent ILM peeling. Retinal adhesion was achieved in all patients after initial surgeries. Two patients had persistent macular hole and one patient had recurrence of macular hole during follow-up. In the second surgery of the two patients with persistent macular hole, all remaining ILM tissue was removed. Descemet's membrane was used as a graft in the recurrent macular hole case. After the second surgery, all patients had a closed FTMH. Conclusion: ILM peeling and inverted ILM flap methods in combination with vitrectomy are effective surgical methods in patients with RRD and FTMH, and in combined surgery, a single procedure will offer clinical and cost advantages.
Keywords: Internal limiting membrane; macular hole; pars plana; retinal detachment; vitrectomy
Objective: The aim of this study was to evaluate the surgical methods, tamponades used and clinical outcomes in patients with full-thickness macular hole (FTMH) and rhegmatogenous retinal detachment (RRD). Material and Methods: This cross-sectional, retrospective study included all patients diagnosed with RRD and FTMH who underwent 23-gauge pars plana vitrectomy (PPV) with silicone oil, C3F8 (12%) or SF6 (20%) as intravitreal tamponade. All patients underwent cataract surgery with phacoemulsification before PPV and a single-piece, monofocal, acrylic, hydrophobic, foldable intraocular lens was implanted into the bag. Results: During the study period, 386 patients who underwent surgery for RRD were analyzed and 11 patients (2.85%) had concomitant FTMH. Three patients (27.3%) had stage B or higher proliferative vitreoretinopathy (PVR). In the first surgery, 5 (62.5%) patients underwent inverted internal limiting membrane (ILM) flap and 3 (37.5%) patients underwent ILM peeling. Retinal adhesion was achieved in all patients after initial surgeries. Two patients had persistent macular hole and one patient had recurrence of macular hole during follow-up. In the second surgery of the two patients with persistent macular hole, all remaining ILM tissue was removed. Descemet's membrane was used as a graft in the recurrent macular hole case. After the second surgery, all patients had a closed FTMH. Conclusion: ILM peeling and inverted ILM flap methods in combination with vitrectomy are effective surgical methods in patients with RRD and FTMH, and in combined surgery, a single procedure will offer clinical and cost advantages.
Keywords: Internal limiting membrane; macular hole; pars plana; retinal detachment; vitrectomy
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