Nd:YAG lazer arka kapsülotomi boyutunun refraksiyon ve göz içi basinç değerleri üzerine etkisi

Amaç: Sekonder katarakt(SK) katarakt cerrahisinin en sık geç komplikasyonudur. Hastalar görme keskinliğinde azalma,parlama ve ışığa duyarlılıktan şikayetçidir. Neodymium:yttrium-aluminum-garnet (Nd:YAG) lazer kapsülotomi SK için standarttedavidir. Arka kapsülotominin en sık görülen komplikasyonu GİB (göz içi basıncı) artışıdır. Göz içi basıncındaki bu artış geçiciolmasına rağmen, 10 mmHg'dan yüksek ise glokomatöz hasara neden olabilir. Kapsülotomi büyüklüğünün refraktif durumüzerine etkisi tartışmalıdır. Bu çalışmadaki amaç kapsülotomi boyutuyla görsel prognoz, refraktif değişiklikler, göz içi basınçartışı ve komplikasyonlar arasındaki ilişkiyi değerlendirmektir.Materyal ve Metod: Bu çalışmada 74 hastanın 74 gözü retrospektif olarak incelendi. Çalışmaya Etimesgut Devlet Hastanesi’nebaşvuran SK’lı olgulardan Nd: YAG lazer kapsülotomi ile tedavi edilen hastalar dahil edildi. Tüm hastalara en iyi düzeltilmişgörme keskinliği (EİDGK), refraksiyon muayenesi, yarıklı lamba biyomikroskopi muayenesi, GİB ölçümü ve arka segmentmuayenesi dahil olmak üzere tüm ziyaretlerde tam bir göz muayenesi yapıldı. Kapsülotomi boyutu, skotopik pupil büyüklüğünegöre belirlendi. Skotopik pupil boyutu yarıklı lamba biyomikroskopi ile ölçüldü. Olgular kapsülotomi boyutuna göre <4 mm (grup1) ve >4 mm (grup 2) olmak üzere 2 gruba ayrıldı.Bulgular: Hastaların yaş ortalaması grup 1’de 73.9±9.3(aralık: 58–101) ve grup 2’de 75.2±7.9(aralık: 55–95) idi.Grup 1’dehastaların 19 erkek ve 20 hasta kadın; grup 2’de 17 erkek ve 18 hasta kadındı. Ortalama yaş ve cinsiyetler açısından iki gruparasında anlamlı fark yoktu. İki grup arasında başlangıç EİDGK, manifest refraksiyon sferik eşdeğeri(MRSE) ve GİB düzeylerideğerlendirildiğinde anlamlı fark yoktu. Kapsülotomi öncesi ve sonrası grup içi karşılaştırmalarında her iki grupta da kapsülotomisonrasında kapsülotomi öncesine göre MRSE anlamlı olarak düşük; EİDGK, 1.saat GİB değerleri anlamlı olarakyüksekti.(sırasıyla, p<0.001; p<0.001; p<0.001) Kapsülotomi öncesi ve sonrası sferik eşdeğerler arasındaki farklarkarşılaştırıldığında grup 2’de grup 1’e göre anlamlı olarak hipermetropi yönüne doğru daha fazla kayma mevcuttu. Kapsülotomiöncesi GİB ve sonrası 1.saat GİB değerleri arasındaki farka bakıldığında grup 2’de grup 1’e göre anlamlı olarak fazla artış vardı.Sonuç: Görsel kazanım açısından, geniş kapsülotomi yapılmasının 4 mm’den küçük kapsülotomiye göre herhangi bir avantajıbulunmamıştır. Ancak geniş kapsülotomi yapılan hastalarda komplikasyon görülme olasılığının arttığı gözlenmiştir.

Anahtar Kelimeler:

Göz içi basıncı, Kapsül açıklık boyutu, Kapsül opasifikasyon, Lazerler, Refraksiyon

Influence of size of Nd:YAG laser posterior capsulotomy on refraction and intraocular pressure values

Background: Posterior capsular opacity (PCO) is the most common late complication of cataract surgery. Patients complain ofdecreased visual acuity, glare and sensitivity to light. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy is thestandard treatment for PCO. The most common complication of posterior capsulotomy is intraocular pressure (IOP) increase.Although this increase in IOP is temporary, a glaucomatous injury may occur if it is higher than 10 mmHg. The effect of the sizeof the capsulotomy on the refractive status is discussed. The aim of this study is to evaluate the relationship between visualprognosis, refractive changes, intraocular pressure increase and complications in terms of capsulotomy size.Material and Methods: In this study, 74 eyes of 74 patients were evaluated retrospectively. Patients treated with Nd: YAG lasercapsulotomy were included in the cases of PCO who applied to the Etimesgut State Hospital to study. All patients underwent afull ocular examination at all visits, including best corrected visual acuity (BCVA), refraction examination, slit lampbiomicroscopy examination, IOP measurement, and posterior segment examination. The size of the capsulotomy wasdetermined according to the size of the scotopic pupil. The size of the scotopic pupil was measured by slit-lamp biomicroscopy.According to the size of the capsulotomy, 2 groups were divided into <4 mm (group 1) and >4 mm (group 2).Results: The mean age of the patients was 73.9±9.3 (range: 58-101) in the group 1 and 75.2±7.9 (range: 55-95) in the group2. In group 1, 19 of the patients were male and 20 were female; in group 2, 17 patients were male and 18 patients were female.There were 19 male and 20 female patients in group 1; 17 male and 18 female patients were in group 2. There was nosignificant difference between the two groups in terms of mean age and sex. There was no significant difference between thetwo groups when BCVA, manifest refraction spherical equivalent (MRSE) and IOP levels were evaluated. In the intra-groupcomparison pre and post-capsulotomy, MRSE was significantly lower in both groups post-capsulotomy than pre-capsulotomy,and the values of BCVA and 1st hour IOP were significantly higher in both groups post-capsulotomy than precapsulotomy.(p<0.001; p<0.001; p<0.001, respectively) Comparing the differences of spherical equivalents values betweenbefore and after capsulotomy, there was a significant shift toward hypermetropia in group 2 compared to group 1. When precapsulotomyand post-capsulotomy 1st hour intraocular pressure values were compared, group 2 showed significantly higherincrement than group 1.Conclusions: In terms of visual gain, large capsulotomy size has no advantage over capsulotomy less than 4 mm. However,the incidence of complications was observed to increase in patients who underwent capsulotomy larger than 4 mm.

Keywords:

Capsule opasification, Intraocular pressure, Lasers, Refraction, Size of capsulotomy,

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