Graves hastalığında statik ve dinamik pupillometri parametrelerinin incelenmesi
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Tarih
2025
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada Graves hastalığında statik ve dinamik pupillometri
parametrelerinin değerlendirilmesi, elde edilen parametrelerin Graves oftalmopatisi ve
steroid tedavisi alma durumu ile ilişkilerinin incelenmesi amaçlandı.
Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Hastanesi Göz
Hastalıkları Polikliniği’nde, Ocak 2017 ile Mayıs 2023 tarihleri arasında Graves
oftalmopati açısından takip edilen 66 olgu ile 28 sağlıklı kontrol grubu dahil edildi. Graves
hastalığı bulunan olgularda pupillometri değerleri oküler tutulumu olmayan, oküler
tutulumu bulunup steroid almayan ve oküler tutulum nedeniyle steroid tedavisi alan olmak
üzere 3 gruba ayrılarak sağlıklı kontrol grubu ile karşılaştırıldı. Nörolojik hastalıklar,
travma gibi başka bir nedene bağlı optik sinir hastalığı, glokom ve pupiller anormallikler
(sineşi, anizokori) gibi durumlar ile pupil mekaniğini etkileyen sistemik ilaç kullanım
öyküsü olan olgular çalışma dışı bırakıldı. Statik ve dinamik pupillometri ölçümleri
bilgisayarlı otomatize kantitatif pupillometri cihazı kullanılarak yapıldı. Olguların retina
sinir lifi kalınlığı ölçümleri optik koherens tomografi kullanılarak gerçekleştirildi.
Araştırma sonucu elde edilen veriler bilgisayar ortamında Statistical Package for Social
Sciences 20.0 paket programı ile analiz edildi.
Bulgular: Gruplar arasında statik pupillometri parametreleri (skotopik pupil çapı,
mezopik pupil çapı, düşük fotopik pupil çapı ve yüksek fotopik pupil çapı) açısından
anlamlı fark saptanmadı. Dinamik pupillometri parametreleri açısından steroid alan grupta
(Grup I) PK (pupil kontraksiyonu) amplitüdü 1.66±0.37 mm, steroid almayan ve oküler
tutulumu olan grupta (Grup II) 1.60±0.36 mm, oküler tutulumu olmayan grupta (Grup III)
1.92±0.35 mm iken kontrol grubunda (Grup IV) 2.05±0.38 mm olarak ölçüldü. Grup I ve
Grup II’nin PK amplitüdü Grup IV’deki değerlerden düşüktü (sırasıyla p=0.006, p=0.001).
Grup II’nin PK amplitüdü de Grup III’ten daha düşüktü (p=0.002). Grup I’in PK hızı
5.63±0.91 mm/s, Grup II’nin 5.42±1.03 mm/s, Grup III’ün 6.32±0.89 mm/s iken Grup
IV’de ise 6.58±0.84 mm/s olarak bulundu. Grup I ve II’nin PK hızının Grup IV’e göre
daha düşük olduğu saptandı (sırasıyla p=0.004, p=0.001). Grup II’nin PK hızı, Grup III’den daha düşüktü (p=0.012). Grup I’de PD (pupil dilatasyonu) hızı 1.76±0.36 mm/s,
Grup II’de 1.59±0.33 mm/s, Grup III’de 2.09±0.38 mm/s iken Grup IV’de ise 2.05±0.55
mm/s olarak ölçüldü. PD hızı açısından karşılaştırıldığında; Grup II’de, Grup III ve Grup
IV’e göre daha düşük değerler ölçüldü (p=0.001, p=0.006). Grup I’in PD hızı Grup III’e
göre anlamlı şekilde düşüktü (p=0.03). Grupların RNFL ortalamaları arasında anlamlı fark
saptanmadı.
Sonuç: Graves oftalmopatinin statik pupillometri parametrelerini etkilemediği,
bununla birlikte belirli dinamik pupillometri parametreleri üzerinde olumsuz etkiye neden
olduğu söylenebilir. Daha kapsamlı çalışmalar gerekmekle birlikte klinik çalışmalarda
pupillometrik inceleme yapılırken, graves oftalmopatisinin dinamik pupillometri
parametrelerindeki olumsuz etkisi göz önünde bulundurulmalıdır.
Purpose: This study aimed to evaluate static and dynamic pupillometry measurements in Graves' disease and to examine the relationships of the obtained parameters with Graves' ophthalmopathy and steroid treatment. Materials and Methods: The study included 66 cases followed for Graves' ophthalmopathy and 28 healthy control subjects at the Necmettin Erbakan University Medical Faculty Hospital's Ophthalmology Clinic between January 2017 and May 2023. Pupillometry values in cases with Graves' disease were divided into 3 groups: those without ocular involvement, those with ocular involvement but not receiving steroids, and those receiving steroid treatment due to ocular involvement and compared with the healthy control group. Cases with neurological diseases, optic nerve disease due to other causes such as trauma, glaucoma, pupillary abnormalities (synechiae, anisocoria), or a history of using systemic drugs affecting pupil mechanics were excluded from the study. Static and dynamic pupillometry measurements were performed using a computerized automated quantitative pupillometry device. Retinal nerve fiber layer thickness measurements were conducted using optical coherence tomography. The data obtained from the research were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: No significant difference was detected between the groups in terms of static pupillometry parameters (i.e. scotopic pupil diameter, mesopic pupil diameter, low photopic pupil diameter, and high photopic pupil diameter). In terms of dynamic pupillometry parameters, PK (pupil contraction) amplitude was 1.66±0.37 mm in the group receiving steroids (group I), 1.60±0.36 mm in the group not receiving steroids and with ocular involvement (group II), and 1.92±0.35 mm in the group without ocular involvement (group III). while in the control group (group IV) it was measured as 2.05±0.38 mm. PK amplitude of group I and group II was lower than the healthy group (p=0.006, p=0.001, respectively). PK amplitude of group II was also lower than group III (p = 0.002). The PK rate of group I was 5.63±0.91 mm/s, group II was 5.42±1.03 mm/s, group III was 6.32±0.89 mm/s, while it was 6.58±0.84 mm/s in healthy individuals. The PK rate of Groups I and II was found to be lower than the healthy group (p=0.004, p=0.001, respectively). PK rate of Group II, III. was lower than the group (p = 0.012). PD (pupil dilation) speed was measured as 1.76±0.36 mm/s in group I, 1.59±0.33 mm/s in group II, 2.09±0.38 mm/sin group III, and 2.05±0.55 mm/s in healthy subjects. When compared in terms of PD speed; Lower values were measured in group II than in group III and the control group (p = 0.001, p = 0.006). PD rate of group I was significantly lower than group III (p = 0.03). No significant difference was detected between the RNFL averages of the groups. Conclusion: In the presented study, it was demonstrated that Graves' ophthalmopathy does not affect static pupillometry parameters; however, it has a negative impact on certain dynamic pupillometry parameters. Although more comprehensive studies are required, the negative effect of Graves ophthalmopathy on dynamic pupillometry parameters should be taken into consideration when performing pupillometric examination in clinical studies.
Purpose: This study aimed to evaluate static and dynamic pupillometry measurements in Graves' disease and to examine the relationships of the obtained parameters with Graves' ophthalmopathy and steroid treatment. Materials and Methods: The study included 66 cases followed for Graves' ophthalmopathy and 28 healthy control subjects at the Necmettin Erbakan University Medical Faculty Hospital's Ophthalmology Clinic between January 2017 and May 2023. Pupillometry values in cases with Graves' disease were divided into 3 groups: those without ocular involvement, those with ocular involvement but not receiving steroids, and those receiving steroid treatment due to ocular involvement and compared with the healthy control group. Cases with neurological diseases, optic nerve disease due to other causes such as trauma, glaucoma, pupillary abnormalities (synechiae, anisocoria), or a history of using systemic drugs affecting pupil mechanics were excluded from the study. Static and dynamic pupillometry measurements were performed using a computerized automated quantitative pupillometry device. Retinal nerve fiber layer thickness measurements were conducted using optical coherence tomography. The data obtained from the research were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: No significant difference was detected between the groups in terms of static pupillometry parameters (i.e. scotopic pupil diameter, mesopic pupil diameter, low photopic pupil diameter, and high photopic pupil diameter). In terms of dynamic pupillometry parameters, PK (pupil contraction) amplitude was 1.66±0.37 mm in the group receiving steroids (group I), 1.60±0.36 mm in the group not receiving steroids and with ocular involvement (group II), and 1.92±0.35 mm in the group without ocular involvement (group III). while in the control group (group IV) it was measured as 2.05±0.38 mm. PK amplitude of group I and group II was lower than the healthy group (p=0.006, p=0.001, respectively). PK amplitude of group II was also lower than group III (p = 0.002). The PK rate of group I was 5.63±0.91 mm/s, group II was 5.42±1.03 mm/s, group III was 6.32±0.89 mm/s, while it was 6.58±0.84 mm/s in healthy individuals. The PK rate of Groups I and II was found to be lower than the healthy group (p=0.004, p=0.001, respectively). PK rate of Group II, III. was lower than the group (p = 0.012). PD (pupil dilation) speed was measured as 1.76±0.36 mm/s in group I, 1.59±0.33 mm/s in group II, 2.09±0.38 mm/sin group III, and 2.05±0.55 mm/s in healthy subjects. When compared in terms of PD speed; Lower values were measured in group II than in group III and the control group (p = 0.001, p = 0.006). PD rate of group I was significantly lower than group III (p = 0.03). No significant difference was detected between the RNFL averages of the groups. Conclusion: In the presented study, it was demonstrated that Graves' ophthalmopathy does not affect static pupillometry parameters; however, it has a negative impact on certain dynamic pupillometry parameters. Although more comprehensive studies are required, the negative effect of Graves ophthalmopathy on dynamic pupillometry parameters should be taken into consideration when performing pupillometric examination in clinical studies.
Açıklama
Anahtar Kelimeler
Graves Hastalığı, Graves' Disease, Graves Oftalmopati, Graves' Ophthalmopathy, Pupillometri, Pupillometry, Tiroid Oftalmopati, Optik Sinir, Optic Nerve, Thyroid Ophthalmopathy, Pupilla, Pupil
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Orhan, Z. (2025). Graves hastalığında statik ve dinamik pupillometri parametrelerinin incelenmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Göz Hastalıkları Anabilim Dalı, Konya.
