Adjuvan mitomisin-C ile cerrahi eksizyon sonrası konjonktival papillomlu hastalarda kuru göz parametrelerinin değerlendirilmesi

Amaç: Adjuvan Mitomisin C (MMC) ile cerrahi eksizyonu takiben konjonktival papillomlu hastalarda gözyaşı ozmolarite seviyelerindeki, gözyaşı fonksiyon testlerindeki ve kuru göz semptom skorlarındaki değişiklikleri değerlendirmek Materyal ve Metod: Konjonktival papilloma tanısı alan 30 hasta çalışmaya alındı. Gözyaşı ozmolaritesi, floresein kırılma zamanı, Schirmer I testi ve göz kapağı menisküs yüksekliği, adjuvan %0.02 MMC ile konjonktival cerrahi öncesinde ve sonrasında 1., 3. ve 6. aylarda değerlendirilerek kaydedildi. Ameliyat öncesi ve sonrası 1., 3., 6. aylarda alınan kuru göz semptom anketi skorları kaydedildi. Her kontrol ziyaretinde kaydedilen test sonuçlarının ortalama değerleri karşılaştırıldı. Bulgular: Çalışmaya alınan hastaların ortalama yaşı 37 ± 9.5 idi. Schirmer I test skorları, FBUT değerleri, kuru göz semptom skorları, göz kapağı menisküs yüksekliği skorları ve gözyaşı ozmolarite değerleri preoperatif ve kontrol ölçümlerinde anlamlı farklılık gösterdi (p<0.05). Bu fark postoperatif 1. ay kontrolünde daha belirgindi. Ölçüm değerleri, kuruluğun postoperatif 1. ayda en yüksek değere ulaştığını ve sonrasında giderek azalarak postoperatif 6. ayda preoperatif değerlere ulaştığını gösterdi. Sonuç: Bu çalışma ile MMC ile yapılan konjonktiva cerrahisinin geçici olarak kuru göz semptom skorlarında artışa ve anormal gözyaşı fonksiyon testlerine neden olabileceği gösterilmiştir.

Anahtar Kelimeler:

konjonktival papillom, mitomisin C, gözyaşı ozmolaritesi, kuru göz hastalığı

Evaluation of dry eye parameters in patients with conjunctival papilloma following surgical excision with adjuvant mitomycin-C

Aim: To evaluate the changes in tear osmolarity levels, tear function tests, and dry eye symptom scores in patients with conjunctival papilloma following surgical excision with adjuvant Mitomycin C (MMC). Material And Method: Thirty patients diagnosed with conjunctival papilloma were enrolled in the study. Tear osmolarity, fluorescein break-up time (FBUT), Schirmer I test and eyelid margin score were evaluated at baseline and 1st, 3rd, and 6th months after conjunctival surgery with adjuvant 0.02% MMC were recorded. Dry eye symptom questionnaire scores obtained preoperatively and at the 1st, 3rd, and 6th months after surgery were also recorded. The mean values of test results noted at each control visit were compared. Results: The mean age of the study population was 37±9.5 years. Schirmer I test scores, FBUT values, dry eye symptom scores, eyelid margin scores, and tear osmolarity values showed a significant difference between the preoperative measurements and follow-up visits (p<0.05). This difference was more apparent at the postoperative 1st-month visit. Measurement values showed that dryness peaked at the postoperative 1st month and gradually decreased afterward reaching the preoperative values at the postoperative 6th-month visit. Conclusion: This study showed that conjunctival papilloma surgery with MMC is associated with transiently increased dry eye symptom scores and abnormal tear function tests.

Keywords:

conjunctival papilloma, Mitomycin C, tear osmolarity, dry eye disease,

PDF

___

Sjö NC, von Buchwald C, Cassonnet P, et al. Human papillomavirus in normal conjunctival tissue and in conjunctival papilloma: types and frequencies in a large series. Br J Ophthalmol 2007; 91: 1014–5.
Kaliki S, Arepalli S, Shields CL, et al. Conjunctival papilloma: features and outcomes based on age at initial examination. JAMA Ophthalmol 2013; 131: 585–93.
Furdová A, Stopková A, Kapitánová K, Kobzová D, Babál P. Conjuctival lesions-the relationship of papillomas and squamous cell carcinoma to HPV infection. Cesk Slov Oftalmol 2018; 74: 92–7.
Theotoka D, Morkin MI, Galor A, Karp CL. Update on Diagnosis and Management of Conjunctival Papilloma. Eye Vis (Lond) 2019; 18; 6: 18.
Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Indian J Ophthalmol 2019 67: 1930–1948.
Huang YM, Huang YY, Yang HY, et al. Conjunctival papilloma: clinical features, outcome, and factors related to recurrence. Taiwan J Ophthalmol 2018; 8: 15–8
Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf 2017; 15 : 539-574.
Versura P, Profazio V, Campos EC. Performance of tear osmolarity compared to previous diagnostic tests for dry eye diseases. Curr Eye Res 2010; 35: 553–564
McGinnigle S, Naroo SA, Eperjesi F. Evaluation of dry eye. Surv Ophthalmol 2012; 57: 293–316.
Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 2000; 118: 615-21
Khong JJ, Muecke J. Complications of mitomycin C therapy in 100 eyes with ocular surface neoplasia. Br J Ophthalmol 2006; 90: 819-822.
Farahi A, Hashemi H, Mehravaran S. The effects of mitomycin C on tear function after photorefractive keratectomy: a contralateral comparative study. J Refract Surg 2013; 29: 260-4.
Stevenson W, Chauhan SK, Dana R. Dry eye disease: an immune-mediated ocular surface disorder. Arch Ophthalmol 2012; 130: 90-100.
Lemp MA, Bron AJ, Baudouin C, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol 2011; 151: 792–798
Tomlinson A, Khanal S, Ramaesh K, et al. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci 2006; 47: 4309–4315.
Jacobi C, Jacobi A, Kruse FE, Cursiefen C. Tear film osmolarity measurements in dry eye disease using electrical impedance technology. Cornea 2011; 30: 1289-92.
Sullivan BD, Eldridge DC, Berg M, et al. Diagnostic performance of osmolarity combined with subset markers of dry eye disease in an unstratified patient population. Invest Ophthalmol Vis Sci 2010; 51: 3380.
Ye F, Zhou F, Xia Y, Zhu X, Wu Y, Huang Z. Evaluation of meibomian gland and tear film changes in patients with pterygium. Indian J Ophthalmol 2017; 65: 233–7.
Hashemi H, Khabazkhoob M, Kheirkhah A, et al. Prevalence of dry eye syndrome in an adult population. Clin Exp Ophthalmol 2014; 42: 242–8.
Julio G, Lluch S, Pujol P, et al. Tear osmolarity and ocular changes in pterygium. Cornea 2012; 31: 1417–1421.
Ozsutcu M, Arslan B, Erdur SK, Gulkilik G, Kocabora SM, Muftuoglu O. Tear osmolarity and tear film parameters in patients with unilateral pterygium Cornea 2014; 33: 1174-8.