Kontakt ultrasonik biyometri sonuçlarına kornea biyomekaniğinin etkisi
The effect of corneal biomechanicis on results of contact ultrasonic biometry
- Tez No: 460267
- Danışmanlar: PROF. DR. MEHMET AKİF ACAR
- Tez Türü: Tıpta Uzmanlık
- Konular: Göz Hastalıkları, Eye Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2016
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Ankara Eğitim ve Araştırma Hastanesi
- Ana Bilim Dalı: Göz Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 69
Özet
AMAÇ: Kornea biyomekaniği Goldmann aplanasyon tonometri (GAT) ölçüm sonuçlarını etkilemektedir. Kontakt ultrasonik biyometri de benzer bir ölçüm yöntemidir. Bu çalışmanın amacı kornea biyomekanik parametrelerinin ultrasonik biyometri sonuçlarına olası etkisinin optik biyometri ile karşılaştırılarak araştırılmasıdır. GEREÇ ve YÖNTEM: Aralık 2015-Haziran 2016 tarihleri arasında Sağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi Göz Kliniği'ne başvuran, fakoemülsifikasyon ve göz içi lens (GİL) implantasyonu planlanan 39 hastanın 46 gözü çalışmaya dahil edildi. Tüm hastalara ultrasonik biyometri (E-Z Scan AB5500+, Sonomed, NY) ile aksiyel uzunluk (AU) ve GİL gücü optik biyometri (AL Scan, Nidek, Japonya) ile AU, keratometre, merkezi kornea kalınlığı (MKK), ön kamara derinliği (ÖKD), beyazdan beyaza uzaklık, pupil çapı ve GİL gücü, oküler response analizörü (ORA) (Reichert Ophtalmic Instruments, Depew, NY) ile korneal histerezis (KH), korneal rezistans faktör (KRF), kornea kompanzasyonlu göz içi basıncı (GİBkk), goldmann ile korele göz içi basıncı (GİBg) ölçümleri yapıldı. Havalı tonometre (Shin-Nipon, Japonya) ve GAT (Haag-Streit, İsviçre) ile ölçülen göz içi basınçları kaydedildi. Ameliyat sonrası 1.ayda refraksiyon muayeneleri yapıldı. ORA ile ölçümler tekrarlandı. Elde edilen verilerin istatistiksel analizi SPSS 20.0 programı kullanılarak yapıldı ve P
Özet (Çeviri)
PURPOSE: Corneal biomechanics can effect the Goldmann applanation tonometry (GAT) measurement results. Contact ultrasonic biometry is a similar measurement method. The aim of this study is to investigate the probable effect of cornea biomechanical parameters on ultrasonic biometry results by comparison with optical biometry. MATERIAL and METHODS: Between December 2015 and June 2016 forty-six eyes of 39 patients with cataract that were scheduled for phacoemulsification and intraocular lens (IOL) implantation in the Sağlık Bilimleri University Ankara Training and Research Hospital Eye Clinic were included in the study. All patients were assessed with optical biometry (AL Scan, Nidek, Japan) and ultrasonic biometry (E-Z Scan AB5500+, Sonomed, NY). The parameters measured with optical biometry were axial length (AL), keratometry, central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white distance, pupil size and IOL power. Ultrasonic biometry was used for axial length (AL) measurement and IOL power calculation. The Ocular Response Analyzer (ORA) (Reichert Ophtalmic Instruments, Depew, NY) was used to measure corneal hysteresis (CH), corneal resistance factor, corneal compensated intraocular pressure (IOPcc) and Goldmann-correlated IOP (IOPg). Intraocular pressures measured with air tonometer (Shin-Nipon, Japan) and GAT(Haag-Streit, Swiss) were recorded. Examinations including refraction were performed on the first postoperative day. Measurements were repeated with ORA. Statistical analysis of the obtained data was performed using the SPSS 20.0 program and a value of p < 0.05 was considered as statistically significant. RESULTS: The mean age of the patients was 65.66 ± 10.18 (47-84) years. 13 (33.3%) were male and 26 (66.6%) were female. The mean AL measured by optical biometry was 23,34 ± 0,75 mm and by ultrasonic biometry was 23,27 ± 0,74 mm. (P = 0,03) The mean IOL power targeting emmetropization was calculated as 21.44 ± 1.79 D with optic biometry and 21.20 ± 1.79 D (p = 0.002) with ultrasonic biometry The mean IOL power that could be implanted (nearest high power with 0.5 D steps) was 21,64 ± 1,80 with optical and 21,48 ± 1,78 D (p = 0,051) with ultrasonic biometry. The measurements with ORA were (mean) CH: 10,03±1,51, CRF: 9,80±1,51, IOPcc 15,46±2,97, IOPg 14,46±2,87 mmHg. The mean IOP measured by air tonometer and GAT were 14.08 ± 3.54, 14.91 ± 2.87 mmHg respectively. Eyes were grouped to investigate the relation between CH and contact biometry. Group 1 involved 14 eyes with higher AL measured with ultrasonic biometry and group 2 involved 32 eyes with higher AL measured with optical biometry. In group 1 the mean CH was 9.30 ± 1.40 and it was 10.35 ± 1.47 mmHg in group 2. (P = 0.028) Eyes with low corneal hysteresis had statistically significant longer axial length with ultrasonic biometry compared to measurement with optical biometry unexpectedly. In group 1 CRF measurement was 9,20 ±1,34 and in group 2 it was found to be 10,06 ± 1,52 mmHg. (P = 0.07) There were no statistically significant differences between optical and ultrasonically measured AL and calculated IOL power. In the subjective refraction examination at the first postoperative month, mean spheric refractive error was 0,13 ± 0,32 D and spheric equivalent was 0,29 ± 0,35 D. The deviaton of spheric equivalent from target refraction measured with optic and ultrasonic biometriy were 0.29 ± 0.30 D, 0.48 ± 0.40 D, respectively (p = 0.004) There was no significant difference between groups in terms of spheric refractive error, spheric equivalent and deviation from target refraction. DISCUSSION: Corneal hysteresis was found to be statistically significantly low in eyes with an axial length measured unexpectedly longer with contact ultrasonic biometry than measured with optic biometry. Corneal hysteresis which is a good indicator of viscosity of the cornea may be a parameter than needs to be considered in axial length measurements with contact ultrasonic biometry. There was a high correlation between the contact ultrasonic biometry and optical biometry measurements but as the deviation from target refraction was higher with contact ultrasonic biometry, optical biometry measurements may be considered to be more accurate. Larger series are necessary to show the effect of corneal biomechanics on the results of contact ultrasonic biometry that was evaluated for the first time in this study.
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