Morfološke promene makule nakon uspešne operacije ablacije retine metodom „nabiranja“ sklere
Sažetak
Uvod/Cilj. Optička koherentna tomografija spektralnog domena (OKTSD) je veoma korisna za precizno ispitivanje mikrostrukture makule. Cilj rada bio je da se procene morfološke promene makule nakon uspešne operacije ablacije retine (AR) metodom „nabiranja“ sklere koristeći metod OKTSD kao i procena njihovog uticaja na oporavak vida. Metode. Pregled OKTSD-om obavljen je na 27 očiju 1, 6 i 12 meseci nakon operacije „nabiranja“ sklere sa uspešnom anatomskom reparacijom regmatogene AR koja je istovremeno zahvatala i makularnu regiju. Pregled je bio izvršen u centralnom regionu makularne regije, promera 6 mm i uključivao je merenje centralne fovealne debljine, prosečne ukupne debljine retine (UDR) i debljine unutrašnjeg i spoljašnjeg sloja retine (SSR) pojedinačno. Numeričke vrednosti parametara svakog operisanog oka upoređene su sa vrednostima drugog (kontrolnog) oka istog bolesnika. Takođe, izvršena je analiza integriteta unutrašnjeg segmenta (US) i spoljašnjeg segmenta (SS) fotoreceptora i integriteta spoljašnje granične membrane (SGM). Rezultati. Tokom celokupnog perioda praćenja prosečna UDR i debljina SSR u repariranim regijama operisanih očiju bile su statistički značajno manje od odgovarajućih regija kontrolnih očiju. Postojala je statistički značajna razlika u UDR (nakon 1 meseca p = 0,021, posle 6 meseci p = 0,026, posle 12 meseci p = 0,027) i debljini SSR (posle 1 meseca p = 0,018, posle 6 meseci p = 0,019, nakon 12 meseci p = 0,021) između očiju sa preoperativnim trajanjem ablacije makule (AM) dužim od 2 nedelje i očiju sa kraćim preoperativnim trajanjem AM. Poremećaji US i SS fotoreceptora i SGM primećeni su na OKTSD pregledu nakon prvog postoperativnog meseca kod 37,04% očiju, nakon 6 meseci kod 29,6% očiju, a na kraju perioda praćenja kod 14,8% očiju. Utvrđena je statistički značajna razlika u učestalosti ovih promena u zavisnosti od preoperativnog trajanja AR (p = 0,007). Zaključak. Sveukupno umanjenje srednje debljine retine nakon uspešne anatomske reparacije AR rezultat je smanjenja debljine njenih spoljašnjih slojeva. Promene SGM, US i SS fotoreceptora uočene na ranim OKTSD snimcima uglavnom su povezane sa ograničenim oporavkom vida. Duže trajanje AM dovodi do oštećenja neurosenzornog tkiva retine, posebno fotoreceptora, što može objasniti nepotpun oporavak oštrine vida nakon uspešne reparacije AR metodom „nabiranja“ sklere.
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