Göz içi basıncı yüksek olan hifemalı hastalarda tedavi ve prognoz

Yıl 2020, Cilt: 6 Sayı: 1, 93 - 99, 23.04.2020

Müslüm Toptan , Ali Şimşek

https://doi.org/10.30569/adiyamansaglik.626472

Cited By: 1

Öz

Amaç: Göz içi basıncı yüksekliği olan hifemalı hastalarda tedavi yaklaşımı ve sonuç görmeye etkili faktörlerin incelenmesi.
Gereç ve Yöntem: Ağustos 2015 ve Ağustos 2019 tarihleri arasında tanı ve tedavisi yapılmış 55 hastanın dosyası retrospektif olarak incelendi.
Bulgular: Hastaların %44’ü 10-20 yaş aralığında idi. Künt travmatik hifemaya en sık neden olan etyolojik faktör odun parçası (%37,5) idi. Medikal tedavi 38 (%69,1) hastada GİB’ını 25 mmHg altına düşürerek etkili oldu. Medikal tedavi ile GİB düşüşü sağlanamayan 12 (%2,8) hastaya ön kamara lavajı, 2 (%3,6) hastaya ön vitrektomi, 2 (%3,6) hastaya katarakt ekstraksiyonu yapıldı. Ön kamara lavajına rağmen GİB yüksekliği mevcut olan 1 (%1,8) hastaya trabekülektomi uygulandı. Görmeyi etkileyen en önemli faktörün bu hastalarda oluşan ek retinal hasar olduğu tespit edildi.
Sonuç: Hifemanın en sık komplikasyonu olan GİB yüksekliğinde medikal tedaviye ek olarak cerrahi tedavi gerekebilir. Yüksek seviye hifema miktarıyla birlikte arka segment bulgularının varlığı sonuç görme keskinliğini daha kötü etkilemektedir.

Anahtar Kelimeler

Göz içi basıncı, Hifema, Komplikasyon

Destekleyen Kurum

yok

Treatment and prognosis in hyphema patients with high intraocular pressure

Öz

Aim: To investigate the treatment approach and outcome factors in hyphema patients with high intraocular pressure.

Materials and Methods: The records of 55 patients who were diagnosed and treated between August 2015 and August 2019 were reviewed retrospectively.

Results: 44% of the patients were between 10-20 years of age. The most common etiologic factor causing blunt traumatic hyphema was wood fragment (37.5%). Medical treatment was effective in 38 patients (69.1%) by lowering the IOP to less than 25 mmHg. Anterior chamber lavage was performed in 12 (21.8%) patients who could not achieve IOP reduction with medical treatment, anterior vitrectomy was performed in 2 (3.6%) patients, and cataract extraction was performed in 2 (3.6%) patients. Trabeculectomy was performed in 1 patient (1.8%) who had elevated IOP despite anterior chamber lavage. The most important factor affecting visual acuity was additional retinal damage in these patients.

Conclusion: Surgical treatment may be required in addition to medical treatment in the high IOP, which is the most common complication of hyphema. The presence of posterior segment findings with a high level of hyphaema may have a worse effect on visual acuity.

Anahtar Kelimeler

Intraocular pressure, Hyphema, Complication

Kaynakça

• 1. Wilson FM. Traumatic hyphema. Pathogenesis and management. Ophthalmology. 1980;87(9):910-9.
• 2. Ghafari AB, Siamian H, Aligolbandi K, Vahedi M. Hyphema caused by trauma. Med Arch. 2013;67(5):354-6.
• 3. Gottsch JD. Hyphema: diagnosis and management. Retina. 1990;10(1):S65-71.
• 4. Yıldırım N, Gürsoy H. Glokom Oluşturan Acil Göz Hastalıkları. Turkiye Klinikleri J Ophthalmol-Special Topics. 2011;4:37-47.
• 5. Shingleton BJ, Kuhn F. Anterior Chamber-Mechanical Globe Injuries. In Kuhn F, PieramiciDJ (eds), Ocular Trauma-Principles and Practice. Chapter 17, Section III.131-78.
• 6. Başer EF, Seymenoğlu RG. Künt Göz Yaralanmaları. Turkiye Klinikleri J Ophthalmol-Special Topics. 2011;4:81-92.
• 7. Cho J, Jun BK, Lee YJ, Uhm KB. Factors associated with the poor final visual outcome after traumatic hyphema. Korean J Ophthalmol. 1998;12(2):122-9.
• 8. Pass AF. Traumatic hyphema. In: Onofery BE, Skorin L., Holdeman NR, editors. Ocular Therapeutics Handbook - A Clinical Manual. Philadelphia, Lippincott-Raven, 1998; 329-34.
• 9. Bengtsson E, Ehinger B. Treatment of traumatic hyphaema. Acta Ophthalmol (Copenh). 1975;53(6):914-23.
• 10. Edwards WC, Layden WE. Traumatic hyphema. A report of 184 consecutive cases. Am J Ophthalmol. 1973;75(1):110-6.
• 11. Kennedy RH, Brubaker RF. Traumatic hyphema in a defined population. Am J Ophthalmol. 1988;106(2):123-30.
• 12. Coles WH. Traumatic hyphema: an analysis of 235 cases. South Med J. 1968;61(8):813-6.
• 13. Crouch ER Jr, Williams PB: Trauma: ruptures and bleeding, in Tasman W, Jaeger EM (eds): Duane's Clinical Ophthalmology. Philadelphia; JB Lippincott, 1993:1–18.
• 14. Rakusin W. Traumatic hyphema. Am J Ophthalmol. 1972;74(2):284-92.
• 15. Williams C, Laidlaw A, Diamond J, Pollock W, Bloom P. Outpatient management of small traumatic hyphaemas: is it safe? Eye (Lond). 1993;7 (1):155-7.
• 16. Darr JL, Passmore JW. Management of traumatic hyphema. Am J Ophthalmol, 1967;63:134-36.
• 17. Henry MM. Nonperforating eye injuries with hyphema. Am J Ophthalmol. 1960;49:1298-300.
• 18. Parrish R, Bernardino V Jr. Iridectomy in the surgical management of eight-ball hyphema. Arch Ophthalmol. 1982;100(3):435-7.
• 19. Hill K. Cryoextraction of total hyphema. Arch Ophthalmol. 1968;80(3):368-70.
• 20. Belcher CD 3rd, Brown SV, Simmons RJ. Anterior chamber washout for traumatic hyphema. Ophthalmic Surg. 1985;16(8):475-9.
• 21. McCuen BW, Fung WE. The role of vitrectomy instrumentation in the treatment of severe traumatic hyphema. Am J Ophthalmol. 1979;88(5):930-4.
• 22. Kearns P. Traumatic hyphaema: a retrospective study of 314 cases. Br J Ophthalmol. 1991;75(3):137-41.
• 23. Read J, Goldberg MF. Comparison of medical treatment for traumatic hyphema. Trans Am Acad Ophthalmol Otolaryngol, 1974;78:799-815.
• 24. Read J. Traumatic hyphema: surgical vs medical management. Ann Ophthalmol. 1975;7(5):659-62
• 25. Eagling EM. Ocular damage after blunt trauma to the eye. Its relationship to the nature of the injury. Br J Ophthalmol, 1974;58:126-40.
• 26. Howard GM, Hutchinson BT, Fredrick AR. Hyphema resulting from blunt trauma—gonioscopic, tonographic, and ophthalmoscopic observation following resolution of the hemorrhage. Trans Am Acad Ophthalmol Otolaryngol, 1965;69:294-306.
• 27. Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol. 2002; 47:297-334.
• 28. Cassel GH, Jeffers JB, Jaeger EA. Wills Eye Hospital Traumatic Hyphema Study. Ophthalmic Surg. 1985;16(7):441-3.
• 29. Fong LP. Secondary hemorrhage in traumatic hyphema. Predictive factors for selective prophylaxis. Ophthalmology. 1994;101(9):1583-8.
• 30. Yasuna E. Management of traumatic hyphema. Arch Ophthalmol. 1974;91(3):190-1.
• 31. Thomas MA, Parrish RK 2nd, Feuer WJ. Rebleeding after traumatic hyphema. Arch Ophthalmol. 1986;104(2):206-10.
• 32. Demircan N, Fırıncıoğulları E, Güleç A ve ark. Delici olmayan göz travmalarında arka segment bulguları. MN Oftalmoloji 1996;3(3): 107-11.
• 33. Yılmaz A, Özgün C, Yıldırım A ve ark. Treatment and prognosis in the traumatic hyphema. Ulus Travma Acil Cerrahi Derg. 1996; 2(1): 75-80.