Gülistan OYUR, Leyla HAZAR, Zeynep ALKIN, Mehmet ÇAKIR

İdiopatik makula deliği cerrahisinde uzun dönem sonuçlarımız

Amaç: İdiopatik makula deliği cerrahisinde 23G sütürsuz vitrektomi ile triamsinolon asetonid kullanılarak iç limitan membran soyulmasını değerlendirmek.Materyal ve Metot: Beyoğlu Göz Eğitim ve Araştırma Hastanesi’nde 2006-2011 yıllarında, makula deliği nedeniyle 23 Gauge pars plana vitrektomi (PPV) ile iç limitan membran (İLM) (triamsinolon asetonid yardımıyla) soyulan ve göz içi gaz tamponadı uygulanan 44 hastanın 49 gözüne ait veriler retrospektif olarak incelendi. Yaş, cinsiyet, makula deliği evresi, en iyi düzeltilmiş görme keskinliği (GK), semptom süresi, cerrahi sonrası fonksiyonel başarı ve optik kohorens tomografi ile anatomik olarak değerlendirildi.Bulgular: Ortalama yaşları 67 ±9,51 olan hastaların 28’i kadın (%57,1) ve 21’i (%42,9) erkekti. Deliklerin 26 tanesi (%53,1) evre 3, 20 tanesi (%40,8) evre 4, 3 tanesi ise (%6,1) evre 2 idi. Hastaların şikayet süresi ortalama 4,14±3,22 ay (1-12 ay) idi. Ortalama 13,81± 9,44 ay (6-58 ay) takip edilen hastaların 44’ünde (%89,8) anatomik başarı elde edildi. Snellen eşeline göre 2 veya daha fazla sıra görme artışı olan hasta oranı %51 (25 göz) oldu. Görme kaybı 6 aydan daha az olan vakaların hem preoperatif en iyi düzeltilmiş GK hem de postoperatif en iyi düzeltilmiş GK’ları daha iyi saptandı. Son vizitteki en iyi düzeltilmiş GK ile deliğin evresi, delik çapı, preoperatif en iyi düzeltilmiş GK ve tamponad çeşiti arasında anlamlı ilişki bulunmadı. Ameliyat sonrası, 33 hastada (%67,3) katarakt, 3 hastada (%6,1) hipotoni gelişti. Sonuç: 23 G sütürsuz PPV ile triamsinolon asetonid kullanılarak İLM soyulması uygulanan idiopatik makula deliği tedavisinin yüksek anatomik ve fonksiyonel başarı ile sonuçlandığı görüldü. Erken dönemde başvuru ve erken cerrahinin sonuç en iyi düzeltilmiş GK’yı etkileyen en önemli faktör olduğu sonucuna varıldı.

Anahtar Kelimeler:

makula deliği, triamsinolon asetonid, iç limitan membran

Long term results of surgery for idiopathic macular hole

Background: To evaluate the success and complications of internal limiting membrane peeling using triamcinolone acetonide with 23 Gauge sutureless vitrectomy in the treatment of idiopathic macular hole.Methods: The study enrolled 44 patients (49 eyes) who performed 23 Gauge pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling (used triamcinolone acetonide) and intraocular gas tamponade for macular hole at 2006-2011 in Beyoğlu Eye Training and Research Hospital. Stage, best corrected visual acuity (BCVA), symptom duration , postoperative functional and anatomic success with optical coherens tomography were evaluated.Results: The mean age was 67±9.51. Twenty eight (57.1%) were female and 21 (42.9%) were male. Twenty six (53.1%) of the holes were stage 3, 20 (40.8%) were stage 4 and 3 (6.1%) were stage 2. The mean duration of complaints of macular hole was 4.14 ±3.22 months (1-12 months). The mean follow-up period was 13,81± 9,44 months (6-58 months). Anatomical success was achieved in 44 (89.8%) patients. It was two or more lines of visual increase 51% (25 eyes) with snellen. It was observed that preoperative BCVAs were better in patients with a history of visual loss less than 6 months. There was no statistically significant relationship between the last BCVA and hole diameter, hole stage, preoperative BCVA and type of tamponade. Postoperatively, 33 patiens (67.3%) developed cataract and 3 patiens (6.1%) hypotonia. Conclusions: 23 G sutureless PPV with triamcinolone acetonide assisted İLM peeling results in high anatomical and functional success for the treatment of idiopathic macular hole. It was concluded that early surgery was the most important factor affecting BCVA.

Keywords:

macular hole, triamcinolone acetonid,

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