Značaj kliničkih parametara i načina lečenja za prognozu i postoperativni ishod regmatogenih ablacija retine
Sažetak
Uvod. Regmatogena ablacija retine (RAR) predstavlja odvajanje neurosenzornog sloja retine od retinalnog pigmentnog epitela subretinalnom tečnošću, što ugrožava vid bolesnika. U hirurškom lečenju RAR koriste se: operacija klasičnom metodom i pars plana vitrektomija (PPV). Na uspešnost operacije i postoperativni ishod mogu da utiču različiti faktori. Pacijenti sa RAR predstavljaju jedne od najtežih slučajeva za hirurško zbrinjavanje, pri čemu postoperativni vidni oporavak nije uvek kompletan.
Cilj. Cilj ove studije je analiza načina lečenja pacijenata sa RAR, kao i kliničkih parametara koji su od značaja za prognozu i postoperativni ishod.
Materjial i metode. U retrospektivnu sutudiju, sprovedenu na Klinici za očne bolesti Kliničkog centra Srbije u Beogradu, u periodu od 1. januara 2016. do 31. decembra 2016. uključena su 203 pacijenta, hospitalizovana zbog RAR. Statistička analiza rezultata o anatomskom i funkcionalnom ishodu operacija, dobijenih iz medicinske dokumentacije, vršena je t-testom, Vilkoksonovim (Wilcoxon) testom i χ2 testom.
Rezultati. Klasična operacija ablacije retine bila je metod izbora u lečenju 56,65% pacijenata, dok je PPV primenjena kod 43,35% pacijenata. Retina je uspešno reaplikovana kod 88,7% bolesnika operisanih klasičnom metodom i 67% operisanih PPV metodom. Parametri koji su uticali na anatomski uspeh operacije bili su: broj ruptura retine (p = 0,022) i zahvaćenost makule ablacijom (p < 0,001). Pokazan je statistički značajan porast vidnih oštrina pri otpustu u odnosu na izmerene vidne oštrine pri prijemu (p < 0,001). Funkcionalni uspeh procenjivan je na osnovu postoperativne vidne oštrine i zavisio je od: zahvaćenosti makule ablacijom, broja ruptura retine i vrste izvedene operacije.
Zaključak. Prikazani rezultati pokazaju da pacijenti sa RAR mogu da imaju dobar anatomski i funkcionalni oporavak, posebno oni sa jednom rupturom retine i još uvek neodvojenom makulom. Stoga je od značaja pacijente sa RAR hitno uputiti na hirurško lečenje pre nego što dođe do odvajanja makule, u cilju postizanja što boljih postoperativnih rezultata.
Ključne reči: regmatogena ablacija retine, klasična operacija ablacije retine, pars plana vitrektomija, anatomski uspeh operacije, funkcionalni uspeh operacije
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