Behçet hastalığı'nda multimodal görüntüleme bulgularının karşılaştırılması
Yükleniyor...
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Behçet Hastalığı (BH), ataklar ve remisyonlarla seyreden kronik okluziv tipte
vaskülit ile karakterize multisistemik kronik bir hastalıktır. Primer olarak oral ve genital
mukozayı, deriyi ve gözleri tutan BH’yin etyolojisi tam olarak bilinmemektedir. BH olan
hastaların yaklaşık %70 inde oküler inflamasyon ortaya çıkmaktadır.Bunların çoğunluğunda
panüveit ve retinal vaskülit görülmektedir. Vaskülit tanısında Fundus Flöresein Anjiyografi
(FFA) altın standart tanı tetkikidir. Optik Koherens Tomografi (OKT), Optik Koherens
Tomografi Anjiyografi (OKTA) maküla anatomisi, retina katmanları ve mikrovasküler
değişiklikleri gösteren Behçet üveiti tanı ve takibinde kullanılan diğer görüntüleme
yöntemleridir. Bu çalışmada BH’de üveit varlığında veya yokluğunda görüntüleme
bulgularının karşılaştırılması, tanı ve takipte güvenilirliklerinin değerlendirilmesi
amaçlandı.
Yöntem: Şubat 2021 ve Şubat 2022 tarihleri arasında, Necmettin Erbakan Üniversitesi
Meram Tıp Fakültesi Hastanesi Göz Hastalıkları Kliniği’nde takip edilen, BH’ye sekonder
gelişen üveiti olan hastalar, Romatoloji Kliniği’nde takip edilen üveit geçirmeyen Behçet
hastaları ve rutin göz muayenesi için başvuran hastalar dahil edildi. Hastaların OKT ile
santral maküler kalınlık (SMK), EDİ-OKT ile subfoveal koroidal kalınlık (SFKK), OKTA
ile foveal avasküler zon alanı (FAZ), total derin kapiller pleksus dansitesi, total yüzeyel
kapiller pleksus dansitesi, derin parafoveal kapiller pleksus dansitesi ve yüzeysel parafoveal
kapiller pleksus dansitesi ve peripapiller kapiller pleksus dansitesi değerleri elde edildi.
Ayrıca Behçet üveiti hastalarının FFA görüntülemeleri değerlendirildi. Optik disk tutulumu,
makula tutulumu ve vasküler arkadlar esas alınarak yapılan ayrıma göre superior, inferior,
temporal ve nasal alanlardaki tutulumlar puanlandırıldı. Her bir bölgedeki tutulum +1 puan
olarak değerlendirildi. Bu puanlar gruplar arasında istatistiksel olarak karşılaştırıldı. Bu
değerlerin görme keskinliği ve hastalık süresi ile korelasyonu değerlendirildi.
Bulgular: Çalışmaya 79 hastanın ve 39 kontrol grubunun toplam 236 gözü dahil edildi.
Hastalar 18-63 yaş aralığında olup yaş ortalaması oküler tutulumu olan grupta 37.35 yıl,
oküler tutulumu olmayan grupta 36,21 yıl, kontrol grubunda 33,79 yıl idi. Oküler tutulumu
iii
olan hastaların %48,6’sı kadın, % 51,4’ü erkek, oküler tutulumu olmayan grubun %35,7’si
kadın, %64,3’ü erkek; kontrol grubunun %51.3’ü kadın, %48.7’si erkekti. Hastalık süresi
oküler tutulumu olan grupta ortalama 6,49 yıl, oküler tutulumu olmayan grupta 6.71 yıldı.
Grupların FAZ alanı, total yüzeysel kapiller pleksus dansitesi, total derin kapiller pleksus
dansitesi, derin perifoveal kapiller pleksus dansitesi yüzeysel perifoveal kapiller pleksus
dansitesi ve peripapiller kapiller pleksus dansitesi ortalamalarında istatistiksel olarak anlamlı
fark saptandı. Oküler tutulumu olan grupta kapiller pleksus dansiteleri diğer gruplara göre
düşük; FAZ alanı diğer gruplardan yüksek saptandı. Oküler tutulumu olan grupta FFA
değerlendirilmesi ile bu parametrelerin pozitif yönde (FAZ alanı dışında), FAZ alanının
negatif yönde ilişkili olduğu görüldü.
Sonuç: Optik koherens tomografi anjiyografi (OKTA), Behçet üveitinde tekrarlayan ataklar
sonucu, nihai görme keskinliğiyle ilişkli maküler mikrovasküler değişiklikleri saptamada
invaziv olmayan önemli bir görüntüleme yöntemidir. OKTA aynı zamanda oküler tutulumu
olmayan Behçet Hastalarında da vaskülit nedeniyle azalan derin ve yüzeyel kapiller rezerv
hakkında bilgi verebilir.
Objective: Behçet’s Disease (BD) is a multisystemic chronic disease characterized by chronic occlusive vasculitis with attacks and remissions. The etiology of BD, which primarily affects oral and genital mucosa, skin and eye, is not exactly known. Ocular inflammation occurs in approximately 70% of patients with BD. Panuveitis and retinal vasculitis are seen in the majority of them. Fundus Fluorescein Angiography (FFA) is the gold standard diagnostic test in the diagnosis of vasculitis. Optical Coherence Tomography (OCT), Optical Coherence Tomography Angiography (OCTA) are other imaging methods used in the diagnosis and follow-up of Behçet’s uveitis, showing macular anatomy, retinal layers and microvascular changes. It was aimed to compare imaging findings in the presence or absence of uveitis in BD and to evaluate their reliability in diagnosis and follow-up. Methods: Patients followed for uveitis 2˚ to BD in NEU between Feb 2021 & Feb 2022, patients with BD without uveitis ans patients who applied routine eye exem were included. Central macular thickness (CMT) with OCT, subfoveal choroidal thickness (SFCT) with EDI-OCT, foveal avascular zone area (FAZ), total deep capillary plexus density, total superficial capillary plexus density, deep parafoveal capillary plexus density, superficial parafoveal capillary plexus density and peripapillary capillary plexus density values with OKTA were obtained. In addition, FFA imaging of patients with Behçet’s uveitis was evaluated. According to the distinction made on the basis of the vascular arcades, the superior, inferior, temporal, nasal areas, optic disc and macular involvement were scored. Involvement in each region was evaluated +1 point. These values were compared statistically between groups. Correlation of these values with visual acuity and disease duration was assessed. Results: A total of 236 eyes of 79 patients and 39 control groups were included in the study. The patients were between the ages of 18-63, with a mean age of 37.35 year in the group with ocular involvement, 36.21 year in the group without ocular involvement, and 33.79 year in the control group. Of the patients 48.6% were female, 51.4% were male; in group with ocular involvement 35.7% were female and 64.3% were male in the group without ocular involvement; 51.3% of the control group were female and 48.7% male. The mean disease v duration was 6.49 years in the group with ocular involvement and 6.71 years in the group without ocular involvement. A statistically significant difference was found in the mean FAZ area, total superficial capillary plexus density, total deep capillary plexus density, deep perifoveal capillary plexus density, superficial perifoveal capillary plexus density and peripapillary capillary plexus density of the groups. Capillary plexus densities were lower in the group with ocular involvement compared to the other groups; FAZ area was found higher than the other groups. In the group with ocular involvement, it was observed that parameters other than FAZ area were positively related and area was negatively related with the evaluation of FFA. Conclusion: Optical coherence tomography angiography (OCTA) is an important noninvasive imaging modality in detecting macular microvascular changes associated with final visual acuity as a result of recurrent episodes of Behçet's uveitis. OCTA can also provide information about the decreased deep and superficial capillary reserve due to vasculitis in Behçet’s patient without ocular involvement.
Objective: Behçet’s Disease (BD) is a multisystemic chronic disease characterized by chronic occlusive vasculitis with attacks and remissions. The etiology of BD, which primarily affects oral and genital mucosa, skin and eye, is not exactly known. Ocular inflammation occurs in approximately 70% of patients with BD. Panuveitis and retinal vasculitis are seen in the majority of them. Fundus Fluorescein Angiography (FFA) is the gold standard diagnostic test in the diagnosis of vasculitis. Optical Coherence Tomography (OCT), Optical Coherence Tomography Angiography (OCTA) are other imaging methods used in the diagnosis and follow-up of Behçet’s uveitis, showing macular anatomy, retinal layers and microvascular changes. It was aimed to compare imaging findings in the presence or absence of uveitis in BD and to evaluate their reliability in diagnosis and follow-up. Methods: Patients followed for uveitis 2˚ to BD in NEU between Feb 2021 & Feb 2022, patients with BD without uveitis ans patients who applied routine eye exem were included. Central macular thickness (CMT) with OCT, subfoveal choroidal thickness (SFCT) with EDI-OCT, foveal avascular zone area (FAZ), total deep capillary plexus density, total superficial capillary plexus density, deep parafoveal capillary plexus density, superficial parafoveal capillary plexus density and peripapillary capillary plexus density values with OKTA were obtained. In addition, FFA imaging of patients with Behçet’s uveitis was evaluated. According to the distinction made on the basis of the vascular arcades, the superior, inferior, temporal, nasal areas, optic disc and macular involvement were scored. Involvement in each region was evaluated +1 point. These values were compared statistically between groups. Correlation of these values with visual acuity and disease duration was assessed. Results: A total of 236 eyes of 79 patients and 39 control groups were included in the study. The patients were between the ages of 18-63, with a mean age of 37.35 year in the group with ocular involvement, 36.21 year in the group without ocular involvement, and 33.79 year in the control group. Of the patients 48.6% were female, 51.4% were male; in group with ocular involvement 35.7% were female and 64.3% were male in the group without ocular involvement; 51.3% of the control group were female and 48.7% male. The mean disease v duration was 6.49 years in the group with ocular involvement and 6.71 years in the group without ocular involvement. A statistically significant difference was found in the mean FAZ area, total superficial capillary plexus density, total deep capillary plexus density, deep perifoveal capillary plexus density, superficial perifoveal capillary plexus density and peripapillary capillary plexus density of the groups. Capillary plexus densities were lower in the group with ocular involvement compared to the other groups; FAZ area was found higher than the other groups. In the group with ocular involvement, it was observed that parameters other than FAZ area were positively related and area was negatively related with the evaluation of FFA. Conclusion: Optical coherence tomography angiography (OCTA) is an important noninvasive imaging modality in detecting macular microvascular changes associated with final visual acuity as a result of recurrent episodes of Behçet's uveitis. OCTA can also provide information about the decreased deep and superficial capillary reserve due to vasculitis in Behçet’s patient without ocular involvement.
Açıklama
Anahtar Kelimeler
Behçet Hastalığı, Üveit, Optik koherens tomografi, Fundus flöresein anjiyografi, Retina, Koroid, Behçet's Disease, Uveitis, Optical coherence tomography, Fundus fluorescein angiography, Retina, Choroid
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çiftci, Ş. N. (2023). Behçet hastalığı'nda multimodal görüntüleme bulgularının karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Göz Hastalıkları Anabilim Dalı, Konya.
