Yaşa bağlı makula dejeneresansı olgularında "IOL-vip revolution" teleskopik intraokuler lens implantasyonu sonuçları
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Tarih
2016
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Yaşa bağlı makula dejeneresansı'na (YBMD) bağlı görme kaybı ve kataraktı olan olgularda IOL-Vip (visually impaired people) Revolution teleskopik intraoküler lens (IOL) kullanımının erken dönem sonuçlarını bildirmek. Gereç ve yöntem: Çalışmaya Ege Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Retina Birimi' nde takip edilen her iki gözünde senil katarakt ile birlikte kuru tip veya en az 6 aylık izlem sonucunda stabilize olmuş ileri evre neovasküler tip YBMD'si olan 12 olgunun 13 gözü dahil edildi. Tüm olgular özel bir simülatör (düşük görme tanı ve rehabilitasyon programı; IOL-Vip software) ile yapılan değerlendirmede ameliyat sonrası dönemde mevcut görme düzeylerinden en az 2 sıra artış olacağı tahmin edilen hastalardı. Software programı, TERA'ya dayanarak preoperatif ve postoperatif dönemdeki 'Newinflash' rehabilitasyon eğitimini tasarlamaktadır. Preoperatif dönemde 2 hafta, postoperatif dönemde 4 hafta rehabilitasyon eğitimi verildi. Cerrahi yöntem olarak tüm olgulara küçük kesili fakoemülsifikasyon cerrahisini takiben korneal kesi büyütülerek kapsüler kese içine "IOL-Vip (Intraocular lens for visually impaired people) Revolution" lens implante edildi. Hastalar postoperatif dönemde 1. gün, 5. gün, ve 1,2,3. aylarda görüldü. Görme keskinlikleri, kontrast duyarlılık, ön kamara derinliği, endotelyal hücre sayısı, santral kornea kalınlığı (SKK) ve National Eye Instute Visual Functioning Questionnaire-25 Türkçeleştirilmiş Şekli (VFQ-25/TR) sürüm 2000 anketi değerlendirildi. Bulgular: Yaş ortalamaları 72.31±8.53 (5-85) olan 7 erkek ve 6 kadın olgu çalışmaya dahil edildi. İmplante edilen negatif IOL gücü tüm olgularda standart olup eksi 46 idi. Pozitif IOL gücü ise ortalama 59±2 (57-62) diyoptri idi. Preoperatif EİDGK ETDRS eşeli ile 1.08±0.14(0.8-1.3) logMAR olduğu saptandı. Postoperatif EİDGK 0.81±0.16(0.56-1.1) logMAR (p=0.005) idi. Ameliyat edilmeyen diğer gözün preoperatif EİDGK 1 m mesafeden ETDRS eşeli ile, 1.13±0.36(0.66-1.8) logMAR iken postoperatif EİDGK 1.01±0.40(0.56-1.8) logMAR ölçüldü (p=0.021). Yaşam kalitesi ve ön kamara derinliğinde istatistiksel anlamlı artış saptandı (p=0.018, 0.008). Endotelyal hücre sayısında istatistiksel anlamlı azalma saptandı (p=0.002). Kontrast duyarlılık ve SKK'da istatistiksel anlamlı fark izlenmedi (p=0.133, 0.684). Hastaların ortalama izlem süresi 6.38±2.93(3-10) ay idi. Hastaların hiçbirinde intraoperatif dönemde ciddi komplikasyonla karşılaşılmadı. Postoperatif dönemde 1 hastada akut açı kapanması glokomu gelişti ve tedavi edildi. Subjektif olarak IOL-Vip Revolution sistemi iyi tolere edildi. Sonuç: Yaşa bağlı makula dejeneresansı'na bağlı az görme gelişmiş ve aynı zamanda kataraktı bulunan olgularda katarakt cerrahisi ile birlikte uygulanan "IOL-Vip Revolution" teleskopik lens sistemi ameliyat sonrası erken dönemde ön görülen görme artışını sağlamış, hastalar tarafından iyi tolere edilmiş ve güvenli bulunmuştur. Opere edilmeyen diğer gözde görsel iyileşme rehabilitasyon programının klinik sonuçlar üzerine olumlu etkisine bağlı olabilir.
Purpose: To evaluate the efficacy of the IOL-Vip (Intraocular lens for visually impaired people) Revolution telescopic intraocular lens (IOL) in Age-related Macular Degeneration (AMD) patients with senile cataract. Materials and Methods: This prospective nonrandomized, interventional case study was carried out at Ege University School of Medicine, Retina Unit of Ophthalmology Department. Thirteen eyes of 12 AMD patients (end stage non-vascular or stabilized neovascular type AMD) with senile cataract were enrolled to the study. Selection of the patients were carried out by means of a low vision diagnostic and rehabilitative program (IOL-Vip software) that evaluates residual visual function. The software designs the rehabilitation strategies (Newinflash) based on preoperative and postoperative training of the preferred retinal locus. Rehabilitation program was applied 2 weeks during the preoperative period and 4 weeks during the postoperative period.After the standard phacoemulsification surgery, incision site was enlarged and “IOL-Vip Revolution” was implanted to the capsular bag. The patients were examined during the postoperative period on the 1st day, 5th day, and within the 1st, 2nd, and 3rd months. Outcome measures were visual acuity, contrast sensitivity, anterior chamber depth, endothelial cell density, CCT and National Eye Instute Visual Functioning Questionnaire–25 (VFQ-25/TR). The statistical analysis was performed using SPSS software for Windows version 17.0 (SPSS Inc, Chicago, Illinois, USA). Results: The male/female ratio was 7/6 among the subjects. The mean age was 72.31±8.53 (57–85) years. The mean positive power of the IOL was 59±2 D and the negative IOL power was standard (-46D). The mean BCVA at the operated eye before and after the surgery were 1.08±0.14(0.8-1.3), 0.81±0.16 (0.56–1.1) logMAR, respectively (p=0.005). The mean BCVA at the non-operated eye before and after the surgery were 1.13±0.36(0.66-1.8) logMAR, 1.01±0.40(0.56-1.8) logMAR, respectively (p=0.021). A statistically significant increase in quality of life and ACD was detected (p=0.018, 0.008). A significant decrease in endothelial cell density was observed (p=0.002). No significant difference was detected in CCT and contrast sensitivity. (p=0.133, 0.684). The mean follow up period was 6.38±2.93(3–10) months. No intraoperative complication was recorded. As a postoperative complication, acute angle-closure glaucoma was detected in one patient. Subjectively, IOL-Vip Revolution system was tolerated well. Discussion: These early results showed that IOL-Vip Revolution telescopic IOL usage is a promising treatment option in AMD patients with senile cataract. It was well tolerated by the patients and was found to be safe. Rehabilitation program may have an important role in the restrored clinical results, which also provides a visual improvement at the nonoperative eyes.
Purpose: To evaluate the efficacy of the IOL-Vip (Intraocular lens for visually impaired people) Revolution telescopic intraocular lens (IOL) in Age-related Macular Degeneration (AMD) patients with senile cataract. Materials and Methods: This prospective nonrandomized, interventional case study was carried out at Ege University School of Medicine, Retina Unit of Ophthalmology Department. Thirteen eyes of 12 AMD patients (end stage non-vascular or stabilized neovascular type AMD) with senile cataract were enrolled to the study. Selection of the patients were carried out by means of a low vision diagnostic and rehabilitative program (IOL-Vip software) that evaluates residual visual function. The software designs the rehabilitation strategies (Newinflash) based on preoperative and postoperative training of the preferred retinal locus. Rehabilitation program was applied 2 weeks during the preoperative period and 4 weeks during the postoperative period.After the standard phacoemulsification surgery, incision site was enlarged and “IOL-Vip Revolution” was implanted to the capsular bag. The patients were examined during the postoperative period on the 1st day, 5th day, and within the 1st, 2nd, and 3rd months. Outcome measures were visual acuity, contrast sensitivity, anterior chamber depth, endothelial cell density, CCT and National Eye Instute Visual Functioning Questionnaire–25 (VFQ-25/TR). The statistical analysis was performed using SPSS software for Windows version 17.0 (SPSS Inc, Chicago, Illinois, USA). Results: The male/female ratio was 7/6 among the subjects. The mean age was 72.31±8.53 (57–85) years. The mean positive power of the IOL was 59±2 D and the negative IOL power was standard (-46D). The mean BCVA at the operated eye before and after the surgery were 1.08±0.14(0.8-1.3), 0.81±0.16 (0.56–1.1) logMAR, respectively (p=0.005). The mean BCVA at the non-operated eye before and after the surgery were 1.13±0.36(0.66-1.8) logMAR, 1.01±0.40(0.56-1.8) logMAR, respectively (p=0.021). A statistically significant increase in quality of life and ACD was detected (p=0.018, 0.008). A significant decrease in endothelial cell density was observed (p=0.002). No significant difference was detected in CCT and contrast sensitivity. (p=0.133, 0.684). The mean follow up period was 6.38±2.93(3–10) months. No intraoperative complication was recorded. As a postoperative complication, acute angle-closure glaucoma was detected in one patient. Subjectively, IOL-Vip Revolution system was tolerated well. Discussion: These early results showed that IOL-Vip Revolution telescopic IOL usage is a promising treatment option in AMD patients with senile cataract. It was well tolerated by the patients and was found to be safe. Rehabilitation program may have an important role in the restrored clinical results, which also provides a visual improvement at the nonoperative eyes.
