Polisitemia vera hastalarında makula ve optik sinir başı mikrovaskülatürünün optik koherens tomografi anjiografi ile değerlendirilmesi
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Tarih
2023
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Polisitemia vera (PV) hastalarında makula ve optik sinir başı mikrovaskülatürünün, optik koherens tomografi (OKT) ve anjiyografi (OKTA) ile değerlendirilmesi, kan tetkikleri ile birlikte sağlıklı kontrol grubu ile karşılaştırılması amaçlandı.
Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Hastanesi Göz Hastalıkları Kliniği’ne göz muayenesi için Temmuz 2022-Haziran 2023 tarihleri arasında başvuran hasta ve sağlıklı kontrol grubunun verileri değerlendirildi. 18-60 yaş aralığında PV dışında sistemik hastalığı bulunmayan, optik disk ve retinada patoloji saptanmayan 37 hastanın iki gözü ve 30 sağlıklı kontrol grubunun iki gözü çalışmaya dahil edildi. Hastalara tam bir oftalmolojik muayene ve kan tetkiki yapıldı; Biyomikroskop ile ön segment ve fundus muayenesi, en iyi düzeltilmiş görme keskinliği (EİDGK), göz içi basıncı, OKT ve OKTA ölçümleri yapıldı. Toplanan veriler SPSS (Statistical Package for Social Sciences) 18.0 paket programı ile analiz edildi. Tüm testler için istatistiksel anlamlılık düzeyi p<0.05 olarak kabul edildi.
Bulgular: Çalışmaya PV tanısı olan 37 hastanın 74 gözü, 30 sağlıklı kişinin 60 gözü dahil edildi. PV hastalarının %78.4’ü (n=29), kontrol grubunun %40.0’ı (n=12) erkekti. Yaş ortalaması hasta grubunda 47.11 ± 12.67 yıl, kontrol grubunda 41.90 ± 10.34 yıl olarak tespit edildi. Yaşın gruplar arasında dağılımı istatistiksel olarak benzer bulundu (p=0.064). Hematolojik parametrelerden hemoglobin (Hb) ve hematokrit (Hct) düzeyleri hasta grubunda, kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek
V
bulundu (p<0.001). Albumin ve total protein düzeyi hasta ve kontrol grupları arasında istatistiksel olarak benzer tespit edildi (p>0.05). Hasta ve kontrol gruplarına ait gözler arasında EİDGK, foveal avasküler zon (FAZ) alanı ve koryokapilleris akım alanının dağılımında istatistiksel olarak anlamlı düzeyde bir fark izlenmedi (p>0.05). Yüzeyel kapiller pleksus (YKP) vasküler dansite (VD) (%) değerlerinden tüm alan (p=0.001), superior yarı (p=0.024), inferior yarı (p<0.001), parafovea (p=0.004) ve perifovea (p=0.002) hastalara ait gözlerde kontrol grubundaki gözlere kıyasla daha düşük tespit edildi. Derin kapiller pleksus (DKP) VD (%) değerlerinden tüm alan (p<0.001), superior yarı (p<0.001), inferior yarı (p<0.001), parafovea (p<0.001) ve perifovea (p=0.006) hastalara ait gözlerde kontrol grubundaki gözlere kıyasla daha düşük tespit edildi. DKP VD (%) parafovea (r=-0.287, p=0.001) ve temporal perivoea (r=-0.196, p=0.024) değerleri ile Hct düzeyi arasında negatif yönde korelasyon olduğu bulundu. Radyal peripapiller kapiller pleksus (RPKP) VD (%) değerlerinden tüm alan (p<0.001), peripapiller (p=0.001), superior yarı (p=0.001), inferior yarı (p=0.017), nasal superior (p<0.001) ve temporal inferior (p=0.027) sonuçları, hastalara ait gözlerde kontrol grubundaki gözlere kıyasla daha düşük bulundu. RPKP VD (%) tüm alan değeri ve Hct düzeyi arasında negatif yönde korelasyon olduğu bulundu (r= -0.415, p<0.001). OKT değerlerinden santral maküler kalınlık, temporal parafovea, superior parafovea, nazal parafovea ve inferior parafovea ölçümleri hasta grubunda, kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek belirlendi (p değerleri sırasıyla; p=0.001, p=0.008, p=0.016, p=0.002, p=0.008). Retina sinir lifi tabakası (RSLT) kalınlıklarından temporal inferior ölçümleri hasta grubunda kontrol grubuna göre istatistiksel olarak anlamlı düzeyde düşük kaydedildi (p=0.020). Diğer RSLT ölçümü sonuçlarının dağılımında istatistiksel fark belirlenmedi. RSLT ile RPKP VD (%) değerleri arasında pozitif yönde korelasyon tespit edildi (r=0.491, p<0.001).
Sonuç: PV hastalarında OKTA verilerinden YKP, DKP, RPKP VD değerlerinin azaldığı bulundu. OKT verilerinden santral maküler ve parafovea kadranlarının daha kalın olduğu bulundu. RSLT ölçümünde temporal inferior alanda incelme olduğu tespit edildi. Hct seviyesi ile DKP ve RPKP arasında negatif yönde korelasyon olduğu tespit edildi. Foveal avasküler bölge ve koryokapillaris akım alanı değerlerinde gruplar arasında farklılık olmadığı izlendi. PV hastalarında görülen Hct yüksekliği, oküler yapıları mikrovasküler düzeyde etkilediği düşünüldü. Hastalığın oküler etkilerinin tespiti
için OKT ve OKTA görüntüleme tekniklerinin kullanılması mikrovaskülatür üzerindeki değişikleri gösterebilir. Yeni yapılacak çalışmalarla birlikte OKTA, PV hastalarında yapılacak oftalmolojik incelemenin bir parçası olabilir.
Purpose: The aim of this study was to evaluate macular and optic nerve head microvasculature in polycythemia vera (PV) patients with optical coherence tomography (OCT) and angiography (OCTA) and to compare them with blood tests and healthy controls. Materials and Methods: The data of the patients and healthy control group who applied to Necmettin Erbakan University, Medical Faculty Hospital, Ophthalmology Clinic for ophthalmologic examination between July 2022 and June 2023 were evaluated. Both eyes of 37 patients aged 18-60 years with no systemic diseases other than polycythemia vera and no optic disc or retinal abnormalities and two eyes of 30 healthy control subjects were included in the study. Patients underwent a complete ophthalmologic examination and blood tests; anterior segment and fundus examination with slit lamp, best corrected visual acuity (BCVA), intraocular pressure, OCT and OCTA measurements were performed. The collected data were analyzed with SPSS (Statistical Package for Social Sciences) 18.0 package program. Statistical significance level was accepted as p<0.05 for all tests. Results: Total of, 74 eyes of 37 patients with PV and 60 eyes of 30 healthy subjects were included to the study. PV patients were 78.4% (n=29) and 40.0% (n=12) of the control group were male. The mean age was 47.11 ±12.67 years in the patients group and 41.90 ±10.34 years in the control group. The distribution of age between the groups was statistically similar (p=0.064). Among the hematologic parameters, hemoglobin VIII (Hb) and hematocrit (Hct) levels were significantly higher in the patient group than in the control group (p<0.001). Albumin and total protein levels were statistically similar between the patient and control groups (p>0.05). There was no statistically significant difference in the distribution of BCVA, foveal avascular zone (FAZ) area and choriocapillary flow area between the eyes of the patient and control groups (p>0.05). Among the superficial capillary plexus (SCP) vascular density (VD)(%) values, the whole area (p=0.001), superior half (p=0.024), inferior half (p<0.001), parafovea (p=0.004) and perifovea (p=0.002) were lower in the eyes of the patients compared to the eyes of the control group. Deep capillary plexus (DCP) VD (%) values in the whole field (p<0.001), superior half (p<0.001), inferior half (p<0.001), parafovea (p<0.001) and perifovea (p=0.006) were lower in the eyes of the patients compared to the eyes of the control group. DCP VD (%) parafovea (r=-0.287, p=0.001) and temporal perivoea (r=-0.196, p=0.024) values were negatively correlated with Hct level. Radial peripapillary capillary plexus (RPCP) VD (%) values including whole area (p<0.001), peripapillary (p=0.001), superior half (p=0.001), inferior half (p=0.017), nasal superior (p<0.001) and temporal inferior (p=0.027) were lower in the eyes of the patients compared to the eyes of the control group. There was a negative correlation between RPCP VD (%) whole field value and Hct level (r= -0.415, p<0.001). Central macular thickness, temporal parafovea, superior parafovea, nasal parafovea and inferior parafovea measurements of OCT were significantly higher in the patient group compared to the control group (p values were p=0.001, p=0.008, p=0.016, p=0.002, p=0.008, respectively). Among retinal nerve fiber layer (RNFL) thicknesses, temporal inferior measurements were significantly lower in the patient group compared to the control group (p=0.020). There was no statistical difference in the distribution of other RNFL measurements. There was a positive correlation between RNFL and RPCP VD (%) values (r=0.491, p<0.001). Conclusions: In PV patients, OCTA data showed that the vessel density of the SCP, DCP, and RPCP decreased. The central macular and parafoveal quadrants were found to be thicker in OCT data. RNFL measurement revealed thinning in the temporal inferior area. There was a negative correlation between hematocrit level and DCP and RPCP. There was no difference in foveal avascular area and choriocapillaris flow area values. Elevated hematocrit in PV patients was thought to affect the ocular structures at microvascular level. The use of OCT and OCTA imaging techniques for the detection of ocular effects of the disease may show changes in the microvasculature. With further studies, OCTA may be a part of the ophthalmologic examination in PV patients.
Purpose: The aim of this study was to evaluate macular and optic nerve head microvasculature in polycythemia vera (PV) patients with optical coherence tomography (OCT) and angiography (OCTA) and to compare them with blood tests and healthy controls. Materials and Methods: The data of the patients and healthy control group who applied to Necmettin Erbakan University, Medical Faculty Hospital, Ophthalmology Clinic for ophthalmologic examination between July 2022 and June 2023 were evaluated. Both eyes of 37 patients aged 18-60 years with no systemic diseases other than polycythemia vera and no optic disc or retinal abnormalities and two eyes of 30 healthy control subjects were included in the study. Patients underwent a complete ophthalmologic examination and blood tests; anterior segment and fundus examination with slit lamp, best corrected visual acuity (BCVA), intraocular pressure, OCT and OCTA measurements were performed. The collected data were analyzed with SPSS (Statistical Package for Social Sciences) 18.0 package program. Statistical significance level was accepted as p<0.05 for all tests. Results: Total of, 74 eyes of 37 patients with PV and 60 eyes of 30 healthy subjects were included to the study. PV patients were 78.4% (n=29) and 40.0% (n=12) of the control group were male. The mean age was 47.11 ±12.67 years in the patients group and 41.90 ±10.34 years in the control group. The distribution of age between the groups was statistically similar (p=0.064). Among the hematologic parameters, hemoglobin VIII (Hb) and hematocrit (Hct) levels were significantly higher in the patient group than in the control group (p<0.001). Albumin and total protein levels were statistically similar between the patient and control groups (p>0.05). There was no statistically significant difference in the distribution of BCVA, foveal avascular zone (FAZ) area and choriocapillary flow area between the eyes of the patient and control groups (p>0.05). Among the superficial capillary plexus (SCP) vascular density (VD)(%) values, the whole area (p=0.001), superior half (p=0.024), inferior half (p<0.001), parafovea (p=0.004) and perifovea (p=0.002) were lower in the eyes of the patients compared to the eyes of the control group. Deep capillary plexus (DCP) VD (%) values in the whole field (p<0.001), superior half (p<0.001), inferior half (p<0.001), parafovea (p<0.001) and perifovea (p=0.006) were lower in the eyes of the patients compared to the eyes of the control group. DCP VD (%) parafovea (r=-0.287, p=0.001) and temporal perivoea (r=-0.196, p=0.024) values were negatively correlated with Hct level. Radial peripapillary capillary plexus (RPCP) VD (%) values including whole area (p<0.001), peripapillary (p=0.001), superior half (p=0.001), inferior half (p=0.017), nasal superior (p<0.001) and temporal inferior (p=0.027) were lower in the eyes of the patients compared to the eyes of the control group. There was a negative correlation between RPCP VD (%) whole field value and Hct level (r= -0.415, p<0.001). Central macular thickness, temporal parafovea, superior parafovea, nasal parafovea and inferior parafovea measurements of OCT were significantly higher in the patient group compared to the control group (p values were p=0.001, p=0.008, p=0.016, p=0.002, p=0.008, respectively). Among retinal nerve fiber layer (RNFL) thicknesses, temporal inferior measurements were significantly lower in the patient group compared to the control group (p=0.020). There was no statistical difference in the distribution of other RNFL measurements. There was a positive correlation between RNFL and RPCP VD (%) values (r=0.491, p<0.001). Conclusions: In PV patients, OCTA data showed that the vessel density of the SCP, DCP, and RPCP decreased. The central macular and parafoveal quadrants were found to be thicker in OCT data. RNFL measurement revealed thinning in the temporal inferior area. There was a negative correlation between hematocrit level and DCP and RPCP. There was no difference in foveal avascular area and choriocapillaris flow area values. Elevated hematocrit in PV patients was thought to affect the ocular structures at microvascular level. The use of OCT and OCTA imaging techniques for the detection of ocular effects of the disease may show changes in the microvasculature. With further studies, OCTA may be a part of the ophthalmologic examination in PV patients.
Açıklama
Anahtar Kelimeler
Retina, Optik disk, Makula, Optik koherens tomografi anjiografi, Polisitemia vera, Retina, Optic disk, Macula, Optical coherence tomography anjiography, Polycythemia vera
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Scopus Q Değeri
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Künye
Ekici, E. (2023). Polisitemia vera hastalarında makula ve optik sinir başı mikrovaskülatürünün optik koherens tomografi anjiografi ile değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Göz Hastalıkları Anabilim Dalı, Konya.
