Meryem Güler ALIŞ, Abdulkadir ALIŞ, Yusuf AKAR

Vitreomaküler Traksiyonlu Diyabetik Retinopatili Hastalarda Pars Plana Vitrektomiʼnin Anatomik ve Fonksiyonel Etkileri

Amaç: Diyabetik retinopatiye sekonder fibrovaskuler traksiyonel retina dekolmanı (TRD) olgularındapars plana vitrektominin (PPV) maküla üzerindeki anatomik ve fonksiyonel etkisini araştırmak.Gereç ve Yöntemler: 2003-2009 arasında Akdeniz Üniversitesi hastanesinde maküla tutulumlu aktiffibrovasküler membrana sekonder en az iki disk çapı maküla merkezli yeni TRD nedeniyle vitrektomiyapılmış 83 olgunun 83 gözü retrospektif olarak değerlendirildi. Olguların görme keskinlikleri, santralmaküla kalınlıkları (SMK) ve retina duyarlılıkları postoperatif 6. hafta, 3, 6, ve 12. aylardaki verileriile retrospektif olarak değerlendirildi. SMK, optik kohorens tomografi (OKT) ile retina duyarlılıklarıise mikroperimetri programı kullanılarak elde edildi. İstatistiksel analizler tanımlayıcı istatistiklerkullanılarak yapıldı, ANOVA ve Fisher’s PLSD çoklu karşılaştırma post hoc test, Pearson’s korelasyonve çoklu değişken biçimsel gerileme analizi. 0,05’ten küçük p değerleri anlamlı olarak kabul edildi.Bulgular: TRD olan 83 olgunun 72’sinde (%86,7) primer anatomik başarı sağlandı. Başarısızolguların (n:11), 5’inde rekürren preretinal traksiyonel membran ve ardından gelişen makülerdekolman saptandı. 4’ünde trokar giriş yerlerinde oluşan yırtıklara sekonder totale yakın retinadekolmanı gelişimi görüldü. Olguların 2’sinde ise rekürren vitre içi hemoraji (VİH) gelişirken buolguların birinde de hifema görüldü. İntraoperatif olarak en sık karşılaşılan komplikasyon ise 19 olguda(%22,9) iyatrojenik retina yırtıklarının gelişmesiydi. 13 hastada geçici ön kamara fibrin reaksiyonlarıgörüldü. Olguların preoperatif görme keskinlikleri el hareketleri ile 0,1 arasında iken postoperatif1.yılda görme keskinlikleri 1 mps ile 0,8 arasında idi. Hastalarımızda hem görsel keskinlikleri hemde retina duyarlılık ve SMK’da postoperatif dönemde istatistiksel olarak anlamlı düzelmeler görüldü.Sonuç: TRD hastalarında erken zamanda ve başarılı şekilde uygulanan PPV ile anatomik vefonksiyonel kazanım sağlanabilir.

Anatomic and Functional Effects of Pars Plana Vitrectomy in Patients with Diabetic Tractional Retinal Detachment

Objective: To evaluate the morphological and functional effects of pars plana vitrectomy (PPV) in eyes with fibrovascular tractional retinal detachment (TRD) secondary to diabetic retinopathy. Material and Methods: Between 2003 and 2009, 83 eyes of 83 patients who underwent vitrectomy for at least two disc diameters with macular involvement secondary to fibrovascular membrane were evaluated retrospectively. Visual acuity, central macular thickness and retinal sensitivities of the patients were evaluated retrospectively with the data from the 6th week, 3rd, 6th and 12th months. CMT was measured by optical coherence tomography (OCT). Retinal sensitivities were obtained by using microperimetry program. Statistical analyses were performed using descriptive statistics, ANOVA and Fisher's PLSD multiple comparison post hoc test, Pearsonʼs correlation and multivariate formal regression analysis. P values less than 0.05 were considered significant. Results: Primary anatomic success was achieved in 72 (86.7%) of the 83 patients. Five patients had recurrent preretinal tractional membrane and subsequently developed macular detachment. In 4 patients, retinal detachment developed due to tears around trocar entry sites. Recurrent intravitreal hemorrhage (IVH) was observed in 2 patients and hyphema was observed in one of these cases. The most common intraoperative complication was the development of iatrogenic retinal tears in 19 cases (22.9%). Transient anterior chamber fibrin reactions were seen in 13 patients. Preoperative visual acuities of the cases were between 0.1 and hand movements. In the first postoperative year, visual acuities were between counting fingers at 1 meter and 0.8. Visual acuity, retinal sensitivity and central macular thickness values were statistically significantly improved postoperatively. Conclusion: Anatomical and functional recovery can be achieved in patients with tractional retinal detachment if pars plana vitrectomyis done early and successfully.

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