Santral seröz koryoretinopatili hastaların optik koherens tomografi anjiografi ile kapiller yoğunluklarının kantitatif olarak değerlendirilmesi
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Tarih
2021
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Selçuk Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı, OKTA kullanılarak akut ve kronik SSKR hastalarında etkilenmiş gözlerdeki vasküler dansiteyi (VD) kantitatif olarak değerlendirmek ve elde edilen verileri hem sağlıklı kontrol grubu hem de SSKR tanısı konulmuş hastanın etkilenmemiş gözü ile kıyaslayarak retinal pleksuslardaki ve koryokapillaristeki vasküler değişiklikleri incelemek. Gereç ve Yöntem: Temmuz 2018-Eylül 2019 tarihleri arasında Selçuk Üniversitesi Göz Hastalıkları Anabilim Dalında oftalmolojik muayene sonucu SSKR tanısı almış olan 61 hastanın 122 gözü (etkilenmiş ve etkilenmemiş) çalışmaya dahil edildi. Semptomları 4 aydan uzun süren 31 hasta kronik SSKR; semptomları 6 aydan kısa süren 30 hasta ise akut SSKR kabul edildi. Cinsiyet ve yaş olarak benzer sağlıklı 30 kişinin 30 gözü kontrol grubu olarak alındı. Olguların OKT ve OKTA (DRI OCT Triton, Topcon, Tokyo, Japan) görüntüleri ve kantitatif verileri derlendi. Bulgular: Çalışmaya katılan hastaların yaş ortalamaları akut grupta 41.36±8.75 kronik grupta 49.6±7.20 kontrol grubunda 42.26±7.13 yıl idi. Akut SSKR'li hastaların etkilenmiş gözlerinde etkilenmemiş gözlerine ve kontrol grubuna kıyasla yüzeyel kapiller pleksusa ait VD (VDy) değerlerinde istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Akut SSKR'li hastaların etkilenmiş gözlerinde derin kapiller pleksusa ait VD (VDd) değerleri ise etkilenmemiş gözlerine göre yüksek saptandı (p=0.032). Akut grupta etkilenmemiş gözleri ve kontrol grubu arasında VDd değerleri açısından istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Akut SSKR'li hastaların etkilenmiş gözlerinde dış retinaya ait VD (VDdr) değerleri etkilenmemiş gözlere ve sağlıklı kontrol grubuna göre düşük saptandı (sırasıyla p<0.001, p<0.001). Akut SSKR'li hastaların etkilenmiş gözlerinde koryokapillarise ait VD değerleri (VDkk), etkilenmemiş gözlere ve sağlıklı kontrol grubuna göre düşük saptandı (sırasıyla p<0.001, p<0.001). Akut SSKR'li hastaların etkilenmemiş gözleri ile kontrol grubu arasında VDdr ve VDkk açısından istatistiksel olarak anlamlı fark saptanmadı. Akut SSKR'li hastaların etkilenmiş gözlerinde santral maküla kalınlığı (SMK) ve santral maküla hacmi (SMH), etkilenmemiş gözlere ve kontrol grubuna kıyasla yüksekti. Akut SSKR'li hastaların etkilenmiş ve etkilenmemiş gözlerinde subfoveal koroid kalınlığı (SFKK) ve subfoveal koroid hacmi (SFKH) kontrol grubuna göre yüksekti (p<0.001). Akut SSKR'li hastaların etkilenmiş ve etkilenmemiş gözleri arasında SFKK ve SFKH açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Akut SSKR'li hastalarda SMK ile görüş kalitesi arasında negatif yönde korelasyon mevcuttu. Ancak OKTA parametreleri ile en iyi düzeltilmiş görme keskinliği arasında bir ilişki saptanmadı. Akut SSKR'li hastalarda SMK ve SMH ile VDy ve VDd arasında pozitif yönde korelasyon mevcuttu. Kronik SSKR'li hastalarda etkilenmiş gözlerinde etkilenmemiş gözlerine ve kontrol grubuna kıyasla VDy değerlerinde istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Kronik SSKR'li hastaların etkilenmiş gözlerinde VDd değerleri, etkilenmemiş gözlere ve sağlıklı kontrol grubuna kıyasla yüksekti (sırasıyla; p<0.001, p<0.001). Kronik SSKR'li hastaların etkilenmemiş gözlerinde VDd değerleri kontrol grubuna göre düşük saptandı (sırasıyla; p<0.040, p<0.018). Kronik SSKR'li hastaların etkilenmiş gözlerinde VDdr değerleri, etkilenmemiş gözlere ve sağlıklı kontrol grubuna göre düşük saptandı (p<0.05). Kronik SSKR'li hastaların etkilenmiş gözlerinde VDkk değerleri, etkilenmemiş gözlere ve sağlıklı kontrol grubuna göre düşük saptandı (sırasıyla p<0.001, p<0.001). Kronik SSKR'li hastaların etkilenmemiş gözleri ile kontrol grubu arasında VDdr ve VDkk açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Akut ve kronik SSKR'li hastaların etkilenmiş gözleri karşılaştırıldığında, VDd santral değerleri etkilenmiş akut grupta etkilenmiş kronik gruba göre düşük saptandı (p=0.011). VDdr inferiyor ise etkilenmiş akut grupta etkilenmiş kroniğe göre yüksekti (p=0.044). Akut ve kronik SSKR'li hastaların etkilenmemiş gözleri karşılaştırıldığında VDd süperiyor değerleri etkilenmemiş akut grupta etkilenmemiş kronik gruba göre yüksek saptandı (p=0.015). VDkk inferiyor değerleri ise etkilenmemiş akut grupta etkilenmemiş kronik gruba göre yüksekti (p=0.018). Kronik SSKR'li hastaların etkilenmiş gözlerinde SMK ve SMH, etkilenmemiş gözlere ve kontrol grubuna kıyasla yüksekti. Kronik SSKR'li hastaların etkilenmiş ve etkilenmemiş gözlerinde SFKK ve SFKH kontrol grubuna göre yüksekti (p<0.001). Kronik SSKR'li hastaların etkilenmiş ve etkilenmemiş gözleri arasında SFKK ve SFKH açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Kronik SSKR'li hastalarda SMK ve OKTA parametreleri ile görüş kalitesi arasında ilişki saptanmadı. Kronik SSKR'li hastalarda SMK ve SMH, VDy ile pozitif yönde korele idi. SMK, SMH, VDy ve VDd ise VDkk ile negatif yönde korele idi. SFKK ve SFKH ile VDy arasında negatif yönde bir ilişki saptandı. SMK ve SMH'daki artış, VDy, VDd artışı ve VDkk'daki azalma ile ilişkiliydi. Hem akut hem kronik SSKR'li hastalarda VDkk ile VDdr arasında pozitif yönde korelasyon mevcutken SMK ile SFKK arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Sonuç: OKTA akut ve kronik santral seröz koryoretinopatide koryokapillaris hipoperfüzyonunu ve DKP ve dış retinadaki vasküler değişiklikleri göstermektedir. Bu sebeple OKTA, hastalığın tanı ve takibinde faydalıdır. Ayrıca noninvaziv bir metod olan OKTA ile gösterilen etkilenmemiş gözdeki derin kapiller pleksusa ait vasküler dansite değişiklikleri preklinik dönemde saptanarak hastalık bilateral hale gelmeden erken dönemde saptanmasına olanak sağlar. Akut ve kronik SSKR'li hastalarda DKP'ye ait VD'deki farklılıklar, hastalığın sınıflandırılması ve takiplerde akut formun kroniğe ilerleyişini öngörmek amacıyla OKTA'nın pratikte kullanılabileceğini göstermektedir. OKTA ile SSKR hastalarının etkilenmemiş gözdelerindeki altta yatan değişikliklerin tespitini yapıp erken müdahale edebilmek ve SSKR patogenezisindeki mikrovasküler süreçleri daha iyi anlayabilmek için OKTA alanındaki gelecekteki gelişmelerle birlikte daha büyük ölçekli çalışmalar yapılması gerekmektedir.
Purpose: The aim of this study was to quantitatively evaluate the vascular density (VD) of affected eyes in acute and chronic central serous chorioretinopathy (CSCR) patients using optical coherence tomography angiography (OCTA) and to examine the vascular changes in the retinal plexuses and choriocapillaris by comparing the obtained data with both the healthy control group and the unaffected eye of the patient diagnosed with CSCR. Materials and Methods: 122 eyes (affected and unaffected) of 61 patients who were diagnosed with CSCR as a result of ophthalmological examination at the Department of Ophthalmology of Selcuk University between July 2018 and September 2019 were included in the study. 31 patients with chronic CSCR with symptoms lasting more than 6 months; 30 patients whose symptoms lasted less than 6 months were accepted as acute CSCR. Thirty eyes of 30 healthy individuals with similar gender and age with acute CSCR patients were taken as the control group. OCT and OCTA (DRI OCT Triton, Topcon, Tokyo, Japan) images and quantitative data of the cases were collected. Results: The mean age of the patients participating in the study was 41.36 ± 8.75 years in the acute group, 49.6 ±7.20 years in the chronic group and 42.26 ± 7.13 years in the control group. There was no statistically significant difference in VD values of the superficial capillary plexus (VDs) in the affected eyes of the patients with acute CSCR compared to the unaffected eyes and the control group (p>0.05). VD values of the deep capillary plexus (VDd) in the affected eyes of the patients with acute CSCR were found higher than the unaffected eyes (p=0.032). There was no statistically significant difference in VDd values between unaffected eyes in the acute group and the control group (p>0.05). VD values of the outer retina (VDo) were found to be lower in the affected eyes of the patients with acute CSCR compared to the unaffected eyes and the healthy control group (p<0.001, p<0.001, respectively). VD values of choriocapillaris (VDcc) were found lower in affected eyes of patients with acute CSCR compared to unaffected eyes and healthy control group (p<0.001, p<0.001, respectively). There was no statistically significant difference in VDo and VDcc between the unaffected eyes of patients with acute CSCR and the control group. Central macular thickness (CMT) and central macular volume (SMV) were higher in the affected eyes of patients with acute CSCR compared to unaffected eyes and the control group. Subfoveal choroidal thickness (SFCT) and subfoveal choroidal volume (SFCV) were higher in affected and unaffected eyes of patients with acute CSCR compared to the control group (p<0.001). There was no statistically significant difference between affected and unaffected eyes of patients with acute CSCR in terms of SFCT and SFCV (p>0.05). There was a negative correlation between CMT and vision quality in patients with acute CSCR. However, there was no relationship between OCTA parameters and best corrected visual acuity. There was a positive correlation between CMT, CMV, VDs, VDd in patients with acute CSCR. In patients with chronic CSCR, no statistically significant difference was found in VDs values in the affected eyes compared to unaffected eyes and control group (p>0.05). VDd values in affected eyes of patients with chronic CSCR were higher than unaffected eyes and healthy control group (p<0.001, p<0.001, respectively). VDd values were found to be lower in the unaffected eyes of the patients with chronic CSCR compared to the control group (p<0.040, p<0.018, respectively). VDo values in the affected eyes of the patients with chronic CSCR were lower than the unaffected eyes and control group (p<0.05). VDcc values in the affected eyes of the patients with chronic CSCR were lower than the unaffected eyes and control group (p<0.001, p<0.001, respectively). There was no statistically significant difference in VDdr and VDkk between the unaffected eyes of the patients with chronic CSCR and the control group (p>0.05). When the affected eyes of patients with acute and chronic CSCR were compared, VDd central values were found to be lower in the affected acute group compared to the affected chronic group (p=0.011). However, VDo inferior was higher in the affected acute group than the affected chronic group (p=0.044). When the unaffected eyes of the patients with acute and chronic CSCR were compared, VDd superior values were found to be higher in the unaffected acute group compared to the unaffected chronic group (p=0.015). VDcc inferior values were higher in the unaffected acute group than in the unaffected chronic group (p=0.018). In the affected eyes of patients with chronic CSCR, CMT and CMV were higher compared to unaffected eyes and the control group. In the affected and unaffected eyes of the patients with chronic CSCR, SFCT and SFCV were higher than the control group (p<0.001). There was no statistically significant difference between the affected and unaffected eyes of patients with chronic CSCR in terms of SFCK and SFCV (p>0.05). No correlation was found between CMT and OCTA parameters and visual acuity in patients with chronic CSCR. CMT and CMV were positively correlated with VDs in patients with chronic CSCR. On the other hand, CMT, CMV, VDs and VDd were negatively correlated with VDcc. There was a negative correlation between SFCT, SFCV and VDs. The increased CMT and CMV was associated with the increased VDs, VDd, and decreased VDcc. While there was a positive correlation between VDcc and VDo in both acute and chronic CSCR patients, there was no statistically significant correlation between CMT and SFCT. Conclusion: OCTA shows choriocapillaris hypoperfusion and vascular changes in DCP and outer retina in acute and chronic central serous chorioretinopathy. For this reason, OKTA is useful in the diagnosis and follow-up of the disease. In addition, OCTA allows early detection of the disease before it becomes bilateral, with vascular density changes of the deep capillary plexus in the unaffected eye. VD of DCP in patients with acute and chronic CSCR may be used in practice in order to classify the disease and predict the progression of the acute form to chronicity in follow-up. In order to detect the underlying changes in the unaffected eyes of CSCR patients with OCTA and to be able to intervene early and better understand the microvascular processes in the pathogenesis of CSCR, larger-scale studies are required with future developments in the field of OCTA.
Purpose: The aim of this study was to quantitatively evaluate the vascular density (VD) of affected eyes in acute and chronic central serous chorioretinopathy (CSCR) patients using optical coherence tomography angiography (OCTA) and to examine the vascular changes in the retinal plexuses and choriocapillaris by comparing the obtained data with both the healthy control group and the unaffected eye of the patient diagnosed with CSCR. Materials and Methods: 122 eyes (affected and unaffected) of 61 patients who were diagnosed with CSCR as a result of ophthalmological examination at the Department of Ophthalmology of Selcuk University between July 2018 and September 2019 were included in the study. 31 patients with chronic CSCR with symptoms lasting more than 6 months; 30 patients whose symptoms lasted less than 6 months were accepted as acute CSCR. Thirty eyes of 30 healthy individuals with similar gender and age with acute CSCR patients were taken as the control group. OCT and OCTA (DRI OCT Triton, Topcon, Tokyo, Japan) images and quantitative data of the cases were collected. Results: The mean age of the patients participating in the study was 41.36 ± 8.75 years in the acute group, 49.6 ±7.20 years in the chronic group and 42.26 ± 7.13 years in the control group. There was no statistically significant difference in VD values of the superficial capillary plexus (VDs) in the affected eyes of the patients with acute CSCR compared to the unaffected eyes and the control group (p>0.05). VD values of the deep capillary plexus (VDd) in the affected eyes of the patients with acute CSCR were found higher than the unaffected eyes (p=0.032). There was no statistically significant difference in VDd values between unaffected eyes in the acute group and the control group (p>0.05). VD values of the outer retina (VDo) were found to be lower in the affected eyes of the patients with acute CSCR compared to the unaffected eyes and the healthy control group (p<0.001, p<0.001, respectively). VD values of choriocapillaris (VDcc) were found lower in affected eyes of patients with acute CSCR compared to unaffected eyes and healthy control group (p<0.001, p<0.001, respectively). There was no statistically significant difference in VDo and VDcc between the unaffected eyes of patients with acute CSCR and the control group. Central macular thickness (CMT) and central macular volume (SMV) were higher in the affected eyes of patients with acute CSCR compared to unaffected eyes and the control group. Subfoveal choroidal thickness (SFCT) and subfoveal choroidal volume (SFCV) were higher in affected and unaffected eyes of patients with acute CSCR compared to the control group (p<0.001). There was no statistically significant difference between affected and unaffected eyes of patients with acute CSCR in terms of SFCT and SFCV (p>0.05). There was a negative correlation between CMT and vision quality in patients with acute CSCR. However, there was no relationship between OCTA parameters and best corrected visual acuity. There was a positive correlation between CMT, CMV, VDs, VDd in patients with acute CSCR. In patients with chronic CSCR, no statistically significant difference was found in VDs values in the affected eyes compared to unaffected eyes and control group (p>0.05). VDd values in affected eyes of patients with chronic CSCR were higher than unaffected eyes and healthy control group (p<0.001, p<0.001, respectively). VDd values were found to be lower in the unaffected eyes of the patients with chronic CSCR compared to the control group (p<0.040, p<0.018, respectively). VDo values in the affected eyes of the patients with chronic CSCR were lower than the unaffected eyes and control group (p<0.05). VDcc values in the affected eyes of the patients with chronic CSCR were lower than the unaffected eyes and control group (p<0.001, p<0.001, respectively). There was no statistically significant difference in VDdr and VDkk between the unaffected eyes of the patients with chronic CSCR and the control group (p>0.05). When the affected eyes of patients with acute and chronic CSCR were compared, VDd central values were found to be lower in the affected acute group compared to the affected chronic group (p=0.011). However, VDo inferior was higher in the affected acute group than the affected chronic group (p=0.044). When the unaffected eyes of the patients with acute and chronic CSCR were compared, VDd superior values were found to be higher in the unaffected acute group compared to the unaffected chronic group (p=0.015). VDcc inferior values were higher in the unaffected acute group than in the unaffected chronic group (p=0.018). In the affected eyes of patients with chronic CSCR, CMT and CMV were higher compared to unaffected eyes and the control group. In the affected and unaffected eyes of the patients with chronic CSCR, SFCT and SFCV were higher than the control group (p<0.001). There was no statistically significant difference between the affected and unaffected eyes of patients with chronic CSCR in terms of SFCK and SFCV (p>0.05). No correlation was found between CMT and OCTA parameters and visual acuity in patients with chronic CSCR. CMT and CMV were positively correlated with VDs in patients with chronic CSCR. On the other hand, CMT, CMV, VDs and VDd were negatively correlated with VDcc. There was a negative correlation between SFCT, SFCV and VDs. The increased CMT and CMV was associated with the increased VDs, VDd, and decreased VDcc. While there was a positive correlation between VDcc and VDo in both acute and chronic CSCR patients, there was no statistically significant correlation between CMT and SFCT. Conclusion: OCTA shows choriocapillaris hypoperfusion and vascular changes in DCP and outer retina in acute and chronic central serous chorioretinopathy. For this reason, OKTA is useful in the diagnosis and follow-up of the disease. In addition, OCTA allows early detection of the disease before it becomes bilateral, with vascular density changes of the deep capillary plexus in the unaffected eye. VD of DCP in patients with acute and chronic CSCR may be used in practice in order to classify the disease and predict the progression of the acute form to chronicity in follow-up. In order to detect the underlying changes in the unaffected eyes of CSCR patients with OCTA and to be able to intervene early and better understand the microvascular processes in the pathogenesis of CSCR, larger-scale studies are required with future developments in the field of OCTA.
Açıklama
Anahtar Kelimeler
Santral Seröz Koryoretinopati, Optik Kohorens Tomografi Anjiyografi, Swept-Source Optik Kohorens Tomografi, Vasküler Dansite, Central Serous Chorioretinopathy, Optical Cohorens Tomography Angiography, Swept-Source Optical Coherence Tomography, Vessel Density
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Özcan, H. G. (2021). Santral seröz koryoretinopatili hastaların optik koherens tomografi anjiografi ile kapiller yoğunluklarının kantitatif olarak değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
