Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Makula Deliği Cerrahisinde İki Farklı İç Limitan Membran Soyma Tekniğinin Değerlendirilmesi
Evaluation of Two Different Internal Limiting Membranes Peeling Techniques in Macular Hole Surgery
Semra TİRYAKİ DEMİRa, Dilek GÜVENa, Mehmet Egemen KARATAŞa, Mehmet DEMİRa, Selam Yekta ŞENDÜLa, Ayşe Burcu DİRİMa
aGöz Hastalıkları Kliniği, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(3):181-8
doi: 10.5336/ophthal.2018-64035
Article Language: TR
Full Text
ÖZET
 Amaç: Primer makula deliği (MD) cerrahisinde uygulanan iki farklı iç limitan membran (İLM) soyma tekniğinin görme prognozuna etkisi ve delik kapanma oranlarının değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2015-Şubat 2017 tarihleri arasında, idiyopatik MD tanısı ile opere edilmiş hastalar retrospektif olarak değerlendirildi. Hastaların operasyon öncesi; görme keskinliği (GK), görsel semptom süresi ve MD evresi kaydedildi. OKT ile MD'nin minimal ve taban çap ölçümleri yapıldı. İLM soymak için; bir cerrah İLM forsepsi (Grup 1), diğer cerrah membran kazıyıcıyı (Grup 2) kullandı. Hastaların operasyon sonrası; bir, üç ve altıncı ay GK ve delik kapanma oranları kaydedildi. Bulgular: Grup 1'de 26, Grup 2'de 11 olmak üzere toplam 37 göz değerlendirildi. Görsel semptom süresi Grup 1'de 8,7±13,1 (1-60) ay, Grup 2'de 10,5±7,8 (2-24) ay idi. Cerrahi öncesi ve sonrası altıncı ay GK sırayla Grup 1'de 0,11±0,09, 0,33±0,26 iken; Grup 2'de 0,09±0,09, 0,22±0,25 bulundu. Grup 1'de 14 (%53,8) göz, grup 2'de 8 (%72,7) gözde evre 4 MD mevcuttu. Operasyon öncesi, MD'nin minimal ve taban çapı sırayla Grup 1'de 523±224 μ, 1025,1±320 μ iken; Grup 2'de 487,9±151 μ, 976,2±294 μ idi. Grup 1'in %73,1'i, Grup 2'nin %63,6'sında altıncı ayda MD tam kapanma görüldü. Her iki grupta delikte kapanma olan ve olmayanlar arasında deliğin minimal ve taban çap ölçümleri arasında fark saptanmadı. Sonuç: İki farklı İLM soyma tekniği ile MD kapanma oranları benzerdir ve GK'de artış sağlamaktadır. İleri evre kronik hastalarda cerrahi öncesi minimal ve taban çapı ölçümleri ile delik kapanması arasında ilişki bulunmamaktadır.

Anahtar Kelimeler: Elmas tozlu membran kazıyıcı; iç limitan membran soyma forsepsi; makula deliği cerrahisi
ABSTRACT
 Objective: To evaluation of the effect of two different internal limiting membrane (ILM) peeling techniques on visual prognosis and hole closure rates in primary macular hole (MH) surgery. Material and Methods: Patients who were operated on due to MH were evaluated retrospectively between January 2015- February 2017. Preoperative visual acuity (VA), visual symptom duration and stage of MH were recorded. Minimal and base diameter measurements of MH were performed with OCT. For peeling the ILM; a surgeon used the ILM forceps (Group 1), and the other surgeon used a membrane scraper (Group 2). The VA and hole closure rates of patients were recorded at 1, 3, 6 months after the operation. Results: Thirty-seven eyes (26 in Group 1 and 11 in Group 2) were included. The symptom duration was 8.7±13.1 (1-60) months in Group 1; 10.5±7.8 (2-24) months in Group 2. Preoperative VA and postoperative 6th month VA were respectively 0.11±0.09 and 0.33±0.26 in Group 1; 0.09±0.09, 0.22±0.25 in Group 2. There were 14 (53,8%) eyes in group 1, 8 (72,7%) eyes in group 2 had stage 4 MH. Before operation; minimum and base diameter were respectively 523±224 μ and 1025.1±320 μ in Group 1; in Group 2, it was 487.9±151 μ, 976.2±294 μ. The MH was closed 73.1% in Group 1 and 63.6% in Group 2. Conclusion: The MH closure rates are similar for two different ILM peeling techniques and it increases VA. In advanced stage chronic cases; there is no relationship between hole closure with minimal and base diameter measurements of the MH before operation.

Keywords: Diamond dusted membrane scraper; internal limiting membranes peeling forceps; macular hole surgery
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