Katarakt Hastalarında Monofokal ve Akomodatif Göz İçi

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Katarakt Hastalarında Monofokal ve Akomodatif Göz İçi
<HQL7ÕS'HUJLVL
Orijinal makale
.DWDUDNW+DVWDODUÕQGD0RQRIRNDOYH$NRPRGDWLI
*|]øoL/HQVL.XOODQÕPÕQÕQ.DUúÕODúWÕUÕOPDVÕ
øKVDQ<,/0$=1, Leyla YAVUZ
2
2
1
)DWLK'HYOHW+DVWDQHVL*|]+DVWDOÕNODUÕ.OLQL÷L75$%=21
.DUWDO(÷LWLPYH$UDúWÕUPD+DVWDQHVL*|]+DVWDOÕNODUÕ.OLQL÷Lø67$1%8/
ÖZET
*LULú .DWDUDNWOÕ KDVWDODUGD NXOODQÕODQ PRQRIRNDO YH
DNRPRGDWLI J|] LoL OHQVOHULQLQ J|UVHO VRQXoODUÕ NDUúÕODúWÕUÕOPÕúWÕU
Materyal ve Metot: RetrospektiI oDOÕúPD\D NDWDUDNWÕ
olan KDVWDQÕQJ|]DOÕQGÕ13 KDVWDQÕQ 21 gözüne
KDVWD LNL WDUDIOÕ KDVWD WHN WDUDIOÕ ameliyat oldu)
WIOL-CF DNRPRGDWLI J|] LoL OHQVL WDNÕOGÕ YH EX KDVWDODU
Grup 1 olarak sÕQÕIODQGÕUÕOGÕ'L÷HUKDVWDQÕQJ|]QH
KDVWD LNL WDUDIOÕ KDVWD WHN WDUDIOÕ ameliyat oldu)
Acriva monofokal göz içi leQVLWDNÕOGÕYHEXKDVWDODU*UXS
RODUDNVÕQÕIODQGÕUÕOGÕø]OHPVUHVLher iki grup için de 6
D\GÕ. øNL JUXS X]DN YH \DNÕQ J|UPH VRQXoODUÕ DoÕVÕQGDQ
NDUúÕODúWÕUÕOGÕ $\UÕFD JUXSODUGD DPHOL\DW VRQUDVÕ NRUQHDO
endotel hücre VD\ÕVÕ ve göz içi EDVÕQFÕ GH÷LúLNOikleri
GH÷HUOHQGLULOGL
Bulgular: $PHOL\DW VRQUDVÕ ayda ortalama en iyi
G]HOWLOPLúX]DNJ|UPHNHVNLQOLNOHUL*UXS 1 için 0,91±0,1
(0,LOHDUDOÕ÷ÕQGD*UXS 2 için 0,9±0,1 (0,LOHDUDOÕ÷ÕQGD LGL *UXS¶GHNL KDVWDODUÕQ G]HOWLOPHPLú \DNÕQ
görmesi ortalama 1,52±1, -DHJHU LOH -DHJHU DUDOÕ÷ÕQGD LGL *UXS’de \DNÕQ J|UPH NHVNLQOL÷L Grup 2’ye
göre LVWDWLVWLNVHO RODUDN DQODPOÕ GHUHFHGH daha iyi idi
(p<0,05). Her iki grupta 6 D\OÕN takip VRQUDVÕQGD, korneal
endotel hücre VD\ÕVÕ YH J|] LoL EDVÕQoODUÕQGD DQODPOÕ ELU
GH÷LúLNOL÷HUDVWODQPDGÕ
7DUWÕúPD .DWDUDNW KDVWDODUÕQGD WIOL-CF akomodatif
göz içi lensi ile Acriva monofokal göz içi lensi kadar
EDúDUÕOÕ X]DN J|UPH VRQXoODUÕ elde edilebilir. Buna ilave
RODUDN\DNÕQJ|UPHde VD÷ODQDELOLU
Anahtar Kelimeler: Fakoemulsifikasyon; akomodasyon;
göz içi lensi; katarakt
*ø5øù
.DWDUDNWJHOLúPHNWHRODQONHOHUGH|QOHQHELOLUN|Ulük QHGHQOHULDUDVÕQGDELULQFLVÕUDGDGÕU1.
*QP]H NDGDU JHOLúHQ FHUUDKL \|QWHPOHU
DUDVÕQGD IDNRHPOVLILNDV\RQ HQ SRSOHU \|QWHP
KDOLQHJHOPLú\D\JÕQODúPÕúWÕU2.
)DNRHPOVLILNDV\RQ FHUUDKLVLQLQ \D\JÕQODúPDVÕQÕQ HQ |QHPOL QHGHQOHUL DUDVÕQGD NoN ELU
korneal kesi gerektirmesi ve bu sayede ameliyat
VRQUDVÕG|QHPGHDVWLJPDWÕGL÷HUFHUUDKLOHUHRUDQOD
GDKDD]LQGNOHPHVLDPHOL\DWVUHVLQLQNÕVDOÕ÷ÕYH
EXQXQJHWLUGL÷LKDVWDNRQIRUXNRPSOLNDV\RQRUD<D]ÕúPDDGUHVL
'UøKVDQ<,/0$=
Fatih Devlet Hastanesi G|]+DVWDOÕNODUÕ.OLQL÷L7UDE]RQ
e-mail : [email protected]
<D]ÕQÕQJHOGL÷LWDULK
: 17.05.2012
<D\ÕQDNDEXOWDULKL
: 02.06.2012
ABSTRACT
Comparison of monofocal and accommodating
intraocular lenses in patients with cataract
Introduction: The aim of this study is to compare the
visual outcomes of monofocal and accommodating
intraocular lenses in patients with cataract.
Material and Method: 42 eyes of 26 patients with
cataract were included in this retrospective study. 21
eyes of 13 patients (8 patients had bilateral, 5 patients
had unilateral surgery) had WIOL-CF accommodating
intraocular lens implantation and they classified as
Group 1. Other 21 eyes of 13 patients (8 patients had
bilateral, 5 patients had unilateral surgery) had Acriva
monofocal intraocular lens and they classified as Group2.
Follow-up time was 6 months for both groups. Distance
and near vision results were compared between two
groups. Also changes in corneal endothelial cell count
and intraocular pressure were evaluated in each group.
Results: At postoperative sixth month mean bestcorrected visual acuity was 0.91±0.1 (range: 0.7 and 1)
in Group 1 and 0.9±0.1 (range: 0.7 and 1) for Group2.
Mean uncorrected near vision for Group1 was 1.52±1.03
(range: Jaeger1 and Jaeger4). Near visual acuity was
statistically significantly better in Grup 1 against Grup 2.
(p<0.05) After 6 months follow up time, there was no
significant change in corneal endothelial cell count and
intraocular eye pressure for both groups.
Discussion: With WIOL-CF accommodating intraocular
lens, successful distance vision results as Acriva
monofocal intraocular lens can be achieved in patients
with cataract. Additionally near vision can be obtainable.
Key
Words:
Phacoemulsification;
intraocular lens; cataract
accommodation;
QÕQÕQ GúNO÷ |]HOOLNOH HNVSXOVLI KHPRUDML JLEL
FLGGL NRPSOLNDV\RQODUÕQ oRN GDKD VH\UHN UDVWODQPDVÕVD\ÕODELOLU3.
Son \ÕOODUGD JHOLúHQ IDNR FHUUDKLVL\OH ELUOLNWH
\DSD\ J|] LoL OHQVOHULQGH GH KÕ]OÕ ELU JHOLúLP ROPXúWXUdR÷XOHQVNoNNRUQHDONHVLOHUGHQNDUWXú
YH HQMHNW|U \DUGÕPÕ\OD LPSODQWDV\RQX \DSÕODELOLU
KDOHJHOPLúWLU5HWLQDNRUX\XFX|]HOOLNWH89ILOWUHOL
lensler kXOODQÕPD JLUPLúWLU4. Difraktif-refraktif
PXOWLIRNDOOHQVOHUWRULNJ|]LoLOHQVOHULVRQ\ÕOODUGD
NXOODQÕPD JLUHQ GL÷HU OHQVOHUGHQGLU5-6. Son olarak
GD GR÷DO LQVDQ OHQVLQLQ |QHPOL ELU |]HOOL÷L RODQ
akomodasyonu taklit eden (psödoakomodasyon
yapan göz içi lensi ya da akomodatif göz içi lensi
GHQLUJ|]LoLOHQVOHULNXOODQÕPDJLUPLúWLU7,8.
0RQRIRNDO OHQVOHU LON NXOODQÕPD JLUHQ J|] LoL
OHQV JUXEXGXU 6RQ \ÕOODUGD NDWODQPD |]HOOL÷L RODQ
93
ø<ÕOPD]YH/<DYX]
ve bu sayede daha küçük korneal kesilerden göz
içine implante edilebilen monofokal lensler daha
\D\JÕQ NXOODQÕOPD\D EDúODQPÕúWÕU %X PRQRIRNDO
OHQVOHUVLOLNRQDNULOLN\DGDKLGURMHO\DSÕGDGÕU
dDOÕúPDPÕ]GD PRQRIRNDO OHQV RODUDN DNULOLN
hLGURIRELN \DSÕGD RODQ $FULYD 8'613 (VSY, TürNL\HJ|]LoLOHQVLQLNXOODQGÕN
Monofokal lensOHULQ HQ ROXPVX] WDUDIÕ QRUPDO
LQVDQ OHQVLQLQ |]HOOL÷L RODQ DNRPRGDV\RQX VD÷OD\DPDPDVÕYHEXQHGHQOHDPHOL\DWVRQUDVÕG|QHPGH KDVWDODUÕQ \DNÕQ J|UPH LoLQ J|]ON \D GD
NRQWDNWOHQVJLELJ|UPH\DUGÕPFÕODUÕQDLKWL\DoGX\PDVÕGÕU6RQ\ÕOODUGDJHOLúWLULOHQakomodatif lensler
LOHEXVRUXQDúÕOPD\DoDOÕúÕOPÕúWÕU
$NRPRGDV\RQ VÕUDVÕQGD VLOL\HU NDVÕQ NDVÕOPDVÕ
VRQXFX úHNOLQGH GH÷LúLNOLN PH\GDQD JHOPHVL, bu
OHQVOHULQoDOÕúPDVÕQÕVD÷ODU9,10%XúHNLOGH÷LúLNOL÷Lnin
vitreusu itmesi ve vitreusun geri etkisiyle göz içi
OHQVLQLQ RSWLN NÕVPÕ |QH GR÷UX KDUHNHW HGHU YH
NÕUÕFÕOÕNDUWPÕúROXU11. Bu grup lenslerde haptik ince,
RSWL÷LQ |QH KDUHNHWLQH L]LQ YHULU úHNLOGH WDVDUODQPÕúWÕU YH G]JQ oDOÕúPDVÕ LoLQ KDVWDGD YLWUHXV
SDWRORMLVLQLQROPDPDVÕJHUHNPHNWHGLU11.
%L]LPoDOÕúPDPÕ]GDNXOODQGÕ÷ÕPÕ]DNRPRWLIOHQV
olan WIOL-CF (A.M.I Care, Çek Cumhuriyeti) lensi
LVH IDUNOÕ \DSÕGDGÕU gQFHOLNOH KDSWLNVL]GLU YH NDSsül içini normal insan lensi gibi tam olarak doldurPDNWDGÕU/HQVLQ|]HOOL÷LVLO\HUFLVLPLQDNRPRGDV\RQVRQXFXúHNLOGH÷LúWLUPHVL\OHERPEHOL÷LQLQDUWPDVÕGÕU %X VD\HGH NÕUÕFÕOÕN DUWDU YH \DNÕQ J|UPH
VD÷ODQPÕúROXU$NRPRGDWLIOHQVOHUVLO\HUNDVÕOPDQÕQ oRN ]D\ÕIODGÕ÷Õ GHNDG YH VRQUDVÕQGD HWNLQOL÷LQL ND\EHWWL÷LQGHQ oRN LOHUL \DúODUGD |QHULOPHmektedir.
dDOÕúPDPÕ]Ga, WIOL-CF akomodatif lensinin
NDWDUDNW DPHOL\DWÕ VRQUDVÕ X]DN YH \DNÕQ J|UPH
VRQXoODUÕQÕGH÷HUOHQGLUPH\LYHEXVRQXoODUÕPRQRIRNDO$FULYDJ|]LoLOHQVLQGHQHOGHHWWL÷LPL]VRQXoODUODNÕ\DVODPD\ÕDPDoODGÕN
MATERYAL ve METOT
dDOÕúPDPÕ] UHWURVSHNWLI RODUDN SODQODQGÕ YH
D\QÕ FHUUDKL HNLS WDUDIÕQGDQ - \ÕOODUÕ
DUDVÕQGD \DSÕODQ NDWDUDNW DPHOL\DWÕ oDOÕúPD\D
DOÕQGÕ KDVWDQÕQ J|]QH DNRPRGDWLI OHQV
WDNÕOGÕYHEXKDVWDODU*UXSRODUDNVÕQÕIODQGÕUÕOGÕ
Grup 1’deki hastalardan 8 tanesi iki gözünden,
WDQHVL WHN J|]QGHQ DPHOL\DW ROGX 'L÷HU KDVWD\D PRQRIRNDO OHQV WDNÕOGÕ YH *UXS RODUDN
VÕQÕIODQGÕUÕOGÕ *UXS 2’deki hastalardan 8 tanesi iki
gözünden, 5 tanesi tek gözünden ameliyat oldu.
7P KDVWDODUÕQ DPHOL\DW |QFHVL YH DPHOL\DW VRQUDVÕ ay kontrollerinde, korneal endotel hücre
VD\ÕVÕ 7RSFRQ VSHNOHU PLNURVNRSX LOH |OoOG
2DNODQG 1- 86$ *|] LoL EDVÕQoODUÕ *ROGPDQQ
DSODQDV\RQ WRQRPHWULVL LOH |OoOG <DNÕQ J|UPH
94
NHVNLQOL÷L -DHJHU LOH FP¶GHQ X]DN J|UPH
NHVNLQOLNOHUL VWDQGDUW 6QHOOHQ Húeli ile 6 m.’den ve
RQGDOÕNRODUDN|OoOG (Tablo 1).
Grup LoLQ NXOODQGÕ÷ÕPÕ] DNRPRGDWLI J|] LoL
lensi WIOL-CF (A.M.I Care, Çek Cumhuriyeti) idi.
Bu akomodatif göz içi lensi yapay göz içi lensleri
DUDVÕQGD LQVDQ GR÷DO OHQVLQH DQDWRPLN \DSÕVÕ
LWLEDUÕ\OD HQ oRN EHQ]H\HQLGLU +DSWLNVL] \DSÕGDGÕU
YHWPNDSVOLoLQLGR÷DOLQVDQOHQVLJLELGROGXUXU
/HQVLQ WRSODP oDSÕ , PP LOH PP DUDVÕQGD
GH÷LúPHNWHGLU/HQVLQ|Q-DUNDoDSÕ,1 mm ile 1,4
PP DUDOÕ÷ÕQGDGÕU .DSVO RSDNODúPDVÕQÕ |QOH\LFL
NHVNLQ NHQDU |]HOOL÷i mevcuttur. Yüksek su içerikli
bir lenstir (%42). Lensin yüzeyi negatif yüklüdür
YH EX VD\HGH SURWHLQ GHSR]LWOHUH KFUH \DSÕúÕNOÕNODUÕQDL]LQYHUPH\HQ|]HOOLNWHGLU
Grup LoLQ NXOODQGÕ÷ÕPÕ] PRnofokal göz içi
lensi Acriva UD613 (VSY, Türkiye) idi. Bu göz içi
OHQVLQLQ RSWLN oDSÕ PP YH WRSODP oDSÕ mm. LGL %LNRQYHNV PRGLIL\H & KDSWLN GL]D\QOÕ derece KDSWLNDoÕOÕDNULOLNPRQRIRNDOJ|]LoLOHQVLGLU .HVNLQ NHQDUOÕ ROGX÷XQGDQ DUND NDSVO RSDNODúPDVÕQÕ |QOH\LFL |]HOOLNWHGLU $FULYD OHQVL PRQRbORNWHNSDUoDGÕU
/HQV JF KHVDSODQÕUNHQ ILUPDODUÕQ EHOLUWWL÷L $
NRQVDQW GH÷HUOHUL YH 65.-,, IRUPO NXOODQÕOGÕ
.DWDUDNW DPHOL\DWODUÕ PRGHUQ IDNRHPXOVLILNDV\RQ
\|QWHPL\OH\DSÕOGÕ7PKDVWDODUDVXEWHQRQDQHVtezi (3,5 cc Lidokain HCl 20 mg/ml-Epinefrin HCl)
X\JXODQGÕ 2,8 mm. ana korneal kesi ve iki adet
\DQ JLULú NXOODQÕOGÕ Katarakt fako yöntemi ile
X]DNODúWÕUÕOGÕNWDQ VRQUD DQD NHVL JHQLúOHWLOPHGHQ
her iki göz içi lensi de kendi enjektörleriyle kapVOHU NHVH LoLQH \HUOHúWLULOGL 9LVNRHODVWLN PDGGH
temL]OHQGL YH \DUD VÕ]GÕUPD]OÕN NRQWUROOHUL \DSÕOGÕ
Subkonjonktival antibiyotik ve steroid enjekte
edildi (Gentamisin sülfat ampul 1 cc ve Deksametazon ampul 1 cc). Ameliyat olan tüm hastalara
12 gün süreyle antibiyotik ve steroid damlalar
(Siprofloksasin HCl 3,5 mg/ml damla, Prednizolon
DVHWDW GDPOD JQGH NH] NXOODQGÕUÕOGÕ +DVWDODU
DPHOL\DW VRQUDVÕ JQ KDIWD D\ D\ YH
6. ayda kontrol edildi. Kontrollerde görme muayenesi, biyomikroskopik muayene, fundus muayenesi,
Goldmann aplanasyon tonometrisi ile göz içi
EDVÕQFÕ |OoP \DSÕOGÕ D\ NRQWUROQGH LODYH
RODUDN NRUQHDO HQGRWHO KFUH VD\ÕODUÕ |OoOG
<DNÕQJ|UPHLoLQVWDQGDUW-DHJHUVLVWHPLNXOODQÕOGÕ
7P LVWDWLVWLNVHO DQDOL]OHU 6366 SURJUDPÕ LOH
\DSÕOGÕ $PHOL\DW |QFHVL YH VRQUDVÕ J|UPH NHskinOL÷LQGHNLNRUQHDOHQGRWHOKFUHVD\ÕVÕQGDNLYHJ|]
LoL EDVÕQFÕQGDNL GH÷LúLNOLNOHU HúOHúWLULOPLú |UQHNOHP
W WHVWL LOH LVWDWLVWLNVHO RODUDN GH÷HUOHQGLULOGL
¶WHQ GúN S GH÷HUOHUL LVWDWLVWLNVHO RODUDN DQODPOÕ NDEXO HGLOGL dDOÕúPDPÕ]GDNL KDVWDODUÕn ayGÕQODWÕOPÕúRQDPÕDOÕQPÕúWÕU
ø<ÕOPD]YH/<DYX]
Tablo 1. +DVWDODUÕQ$PHOL\DWgQFHVL%LOJLOHUL
<Dú
Refraktif Kusur (s.e.)
(ø'*.
*ø%
KES
s.e.
(ø'*.
ortalama±sd
52,46±14
-1,51±2,76
0,38±0,18
14,66±3,61
2228±392
: 6IHULNHúGH÷HUGL\RSWUL
: (QL\LG]HOWLOPLúJ|UPHNHVNLQOL÷L
Grup1
HQGúNHQ\NVHN
27/75
-7,75/+4
0,05/0,7
10/21
1458/2914
ortalama±sd
54,61±10,67
-1,14±1,86
0,37±0,16
14,95±3,21
2222±335
Grup2
HQGúNHQ\NVHN
40/72
-5,5 /+2,5
0,1/0,6
10/20
1568/2873
*ø%*|]LoLEDVÕQFÕPP+J
sd: Standart sapma
.(6.RUQHDOHQGRWHOVD\ÕVÕKFUHPP2)
BULGULAR
Grup LoLQ NXOODQGÕ÷ÕPÕ] DNRPRGDWLI OHQVOHULQ
(WIOL-&) RUWDODPD NÕUÕFÕOÕN JF ,11±3,14 idi.
.XOODQGÕ÷ÕPÕ] NÕUÕFÕOÕN JF HQ GúN RODQ OHQV
17,5 diyoptri, en yüksek olan lens 27,5 diyoptri
LGL *UXS LoLQ NXOODQGÕ÷ÕPÕ] PRQRIRNDO OHQVOHULQ
(Acriva UD 61 RUWDODPD NÕUÕFÕOÕN JF ,11±
2,LGL.XOODQGÕ÷ÕPÕ]NÕUÕFÕOÕNJFHQGúNRODQ
lens 18 diyoptri, en yüksek olan lens 26,5 diyoptri
idi. Ameliyatlarda ve sonraki kontrollerde herhangi
ELUNRPSOLNDV\RQODNDUúÕODúÕOPDGÕ
Grup LoLQ DPHOL\DW VRQUDVÕ D\ NRQWUROQGH
HQ L\L G]HOWLOPLú J|UPH NHVNLQOL÷L (ø'*. VWDQGDUW 6QHOOHQ HúHOLQGH RQGDOÕN RODUDN RUWDODPD
0,91±0,1 (0,7–DUDOÕ÷ÕQGDLGL aydaki refraktif
kusurlar sferik eúGH÷HU RODUDN -1,00 ile +1,00
DUDOÕ÷ÕQGD\GÕ YH RUWDODPD 21±0,62 idi. Grup2
LoLQ DPHOL\DW VRQUDVÕ D\ NRQWUROQGH (ø'*.
ortalama 0,90±0,1 (0,6–DUDOÕ÷ÕQGDLGL aydaNLUHIUDNWLINXVXUODUVIHULNHúGH÷HURODUDN-1,25 ile
+0, DUDOÕ÷ÕQGD\GÕ YH RUWDOama 0,15±0,58 idi
ùHNLO.
OLNOHULG]HOWLOPHPLúRODUDNRUWDODPD-DHJHU 1,52±
1, -DHJHU LOH -DHJHU DUDOÕ÷ÕQGD LGL. Üç göz
+1 D ilaveyle, bir göz +1,5 D ilaveyle, bir göz +2
' LODYH\OH -DHJHU VÕUDVÕQÕ RNX\DELOGL *HUL NDODQ
J|]-DHJHUVHYL\HVLQL\DUGÕPVÕ]RNX\DELOGL
9DNDODUÕQVLQGH-DHJHU’inde Jaeger2
ve üstü, %90’ÕQGD-DHJHUYHVWJ|]ONV]\DNÕQ
görmeye ulDúÕOGÕ øNL JUXS DUDVÕQGD X]DN J|UPH
NHVNLQOL÷LEDNÕPÕQGDQDQODPOÕIDUN\RNWX (p=0,096).
<DNÕQJ|UPHYHDNRPRGDV\RQDPSOLWGDoÕVÕQGDQ
ise Grup GL÷HU JUXED J|UH LVWDWLVWLNVHO RODUDN
DQODPOÕ GHUHFHGH GDKD EDúDUÕOÕ EXOXQPXúWXU
(p=0,002).
ùHNLO Postop NRUQHDOHQGRWHOVD\ÕODUÕQGD.(6DQODPOÕ
GH÷LúLNOLN
ROPDGÕ
ùHNLO $PHOL\DW VRQUDVÕ RUWDODPD HQ L\L G]HOWLOPLú
J|UPHNHVNLQOL÷LQGHNL(ø'*.DUWÕú
Grup LoLQDPHOL\DWVRQUDVÕD\RUWalama göz
LoL EDVÕQFÕ GH÷HUL “76 mmHg (10 ile 20
DUDOÕ÷ÕQGD LGL .RUQHDO HQGRWHO KFUH VD\ÕVÕ LVH
ortalama 2144±428 hücre/mm2 (1190–DUDOÕ÷ÕQGDLGL$\QÕG|QHPGHNLRUWDODPDJ|]LoLEDVÕQFÕ
GH÷HUL *UXS 2 için 14,57±2,34 mmHg (12 ile 19
DUDOÕ÷ÕQGD LGL .RUQHDO HQGRWHO KFUH VD\ÕVÕ LVH
ortalama 2060±343 hücre/mm2 (1320–DUDOÕ÷ÕQGDidi ùHNLO
0RQRIRNDO J|] LoL OHQVOHU DPHOL\DW VRQUDVÕ
G|QHPGH EHNOHQGL÷L úHNLOGH \DNÕQ J|UPH LoLQ
HWNLVL] NDOGÕ *UXS 1’GH LVH \DNÕQ J|UPH NHVNLQ-
ùHNLO Postop J|] LoL EDVÕQoODUÕQGD *ø% DQODPOÕ
GH÷LúLNOLNROPDGÕ
$PHOL\DWVRQUDVÕ ayda Grup 1 ve Grup 2 için,
NRUQHDO HQGRWHO KFUH VD\ÕODUÕQGD DPHOL\DW |QFHVL
döneme göre istatistLNVHO RODUDN DQODPOÕ ELU GH÷LúLNOL÷H UDVWODQÕOPDGÕ*UXS 1 için p=0,089, Grup 2
için p=0, %HQ]HU úHNLOGH DPHOL\DW VRQUDVÕ ayda Grup 1 ve Grup LoLQ J|] LoL EDVÕQoODUÕQGD
ameliyat öncesi döneme göre istatistiksel olarak
DQODPOÕ ELU GH÷LúLNOL÷H UDVWODQPDGÕ *UXp 1 için
p=0,094, Grup 2 için p=0,096).
95
ø<ÕOPD]YH/<DYX]
7$57,ù0$
.DWDUDNW FHUUDKLVL VRQUDVÕ LGHDO RODQ J|UPH
NHVNLQOL÷LQLQ X]DN YH \DNÕQ LoLQ oDEXN NDOÕFÕ YH
J|]ON JHUHNWLUPH] úHNLOGH UHIUDNWLI KDWDVÕ] VD÷ODQPDVÕGÕU *QP]GH NDWDUDNW DPHOL\DWODUÕQGa
\D\JÕQ RODUDN NXOODQÕODQ monofokal göz içi lensleri
ile iyi bir uzak görPH VD÷ODQVD GDKL \DNÕQ J|UPH
\HWHUVL]OL÷L KDVWDODU WDUDIÕQGDQ EHOLUWLOHQ úLkayetleULQEDúÕQGDJHOPHNWHGLU
6RQ\ÕOODUGDNDWDUDNWDPHOL\DWÕVRQUDVÕQGD\DNÕQ
J|UPHQLQ VD÷ODQDELOPHVLne imkan verecek göz içi
OHQVOHUL JHOLúWLULOPH\H EDúODQPÕúWÕU 8]DN YH \DNÕQ
J|UPH\L ELUOLNWH VD÷OD\DQ J|] LoL OHQVOHUL KDOHQ
mükemmel olmaktan uzak olsa da akomodatif ve
PXOWLIRNDO J|] LoL OHQVOHUL\OH \DNÕQ J|UPH EHOLUOL
RUDQODUGD VD÷ODQDELOPHNWHGLU 0XOWifokal göz içi
lensleri, difraktif ve refraktif multifokal göz içi
OHQVOHULRODUDNLNLJUXEDD\UÕODELOLU12. Refraktif olanODU oRN VD\ÕGD IDUNOÕ RGDN X]XQOXNODUÕ VD÷OD\DQ
UDG\DO NRQVDQWULN VLPHWULN ]RQODUGDQ ROXúXU13.
Difraktif olanlarda ise, lensin üzerindeki küçük
EDVDPDNODU ÕúÕ÷Õ ELULQFLO RGDNWDQ X]DN LNLQFLO
RGD÷D\DNÕQGR÷UXGLIUDNVL\RQDX÷UDWÕU13.
Multifokal göz içi lenslerinin en büyük dezaYDQWDMODUÕ NRQWUDVW KDVVDVL\HWLQGH D]DOPD YH ORú
RUWDPODUGD PH\GDQD JHOHQ ÕúÕN VDoÕOPDVÕ JLEL
VRUXQODUGÕU14.
$NRPRGDV\RQ \DSDQ J|] LoL OHQVOHULQLQ JHOLúWLULOPHVLQGHNL WHPHO GúQFH NDWDUDNW DPHOL\DWÕ
VRQUDVÕ GR÷DO LQVDQ OHQVL RUWDPGDQ DOÕQVD GD VLOL\HU NDV IRQNVL\RQXQXQ \DúODUÕQD NDGDU VUPHsidir156LOL\HUNDVWDNLNDVÕOPDYH]RQOOHULQJHYúHmesi sonXFXNDSVO]HULQGHNLJHULFLHWNLD]DOÕUYH
DNRPRGDWLI J|] LoL OHQVLQLQ NÕUÕFÕOÕ÷Õ \D YLWUHQLQ
|QH LWLFL HWNLVL VD\HVLQGH OHQV RSWL÷LQLQ XIDN ELU
|QH KDUHNHWL\OH EXQD L]LQ YHUHQ KDSWLN GL]D\QODUÕ
sayesinde) ya da akomodatif göz içi lensinin
ERPEHOL÷LQLQ (ön-DUND oDSÕQÕQ DUWPDVÕ\OD ROXúXU
Crystalens AT- (\HRQLFV $%' RSWLN NÕVPÕQ
öne hareketine izin veren haptiklere sahiptir ve ilk
mekanizmaya örnektir16. $NRPRGDV\RQ oDEDVÕ
ELWWL÷LQGH RSWLN HVNL \HULQH \DQL JHUL\H G|necektir
ki bu hareketin 0.56-1,PPDUDVÕQGDROGX÷XQD
dair raporlar mevcuttur17 dDOÕúPDPÕ]GD NXOODQGÕ÷ÕPÕ]:,2/-CF akomodatif lensi ise ikinci prensibe
J|UHoDOÕúÕUYHVLOL\HUNDVÕOPDVRQXFX|Q-DUNDoDSÕ
artar.
.RUQHDO HQGRWHO KFUH VD\ÕVÕQGD YH J|] LoL
EDVÕQoODUÕQGDDPHOL\DWVRQUDVÕDQODPOÕGH÷LúLNOLNOHU
ROPDPDVÕ NRPSOLNDV\RQ \DúDQPDPDVÕ QHGHQL\OH
DUDúWÕUPDPÕ]GDNL lenslerin NXOODQÕPÕQÕ JYHQOL
bulduk. WIOL-CF akomodatif lensiyle özellikle
JQON DNWLYLWHOHU LoLQ |QHPOL RODQ -DHJHU \DNÕQ
görme seviyesine, Grup1 için %90 gibi çok yüksek
ELU RUDQGD XODúÕOPÕúWÕU %X KDVWDODU LoLQ DPHOL\DW
VRQUDVÕ G|QHPGH \DNÕQ J|]O÷QGHQ ED÷ÕPVÕ]OÕN
VD÷ODQDELOPLúWLU %L]LP oDOÕúPDPÕ]GD EHQ]HU oDOÕúmalardaki gibi akomodatif lensler ile monofokal
OHQVOHUH J|UH EHQ]HU X]DN J|UPH VRQXoODUÕ YH
GDKD EDúDUÕOÕ \DNÕQ J|UPH VRQXoODUÕ HOGH HGLOPLúWLU17-19. dDOÕúPDPÕ]GD RUWD\D oÕNDQ VRQXoODU
0HVoL YH DUN LOH 6DQGHUV YH DUN¶QÕQ \DSWÕ÷Õ
oDOÕúPDOara paralellik göstermektedir18-19.
6RQXo RODUDN X]DN J|UPH\L VD÷ODPDVÕ DoÕVÕQdan monofokal bir lensten geri kalmayan, ilave
RODUDN \DNÕQ J|UPH\L VD÷OD\DQ :,2/-CF akomoGDWLI OHQVLQLQ JYHQLOLUOL÷L DoÕVÕQGDQ GDKD X]XQ
G|QHPVRQXoODUÕQÕQJ|UOPHVLJHUHNOLROPDNODELUOLNWHNXOODQÕPÕQÕQEDúDUÕOÕROGX÷XVRQXFXQDYDUGÕN
REFERANSLAR
1. Brian G, Taylor H. Cataract blindness–challenges for the 21st
century. Bull World Health Organ 2001;79:249–56.
2. &RúNXQ 0 $QD\RO 0$ $OWÕQWDú $*. dDNPDN +% ùLPúHN ù
.DWDUDNW VHUWOL÷LQLQ IDNR SDUDPHWUHOHUL YH NRPSOLNDV\RQ JHOLúLPL ]HULQH
etkileri. Glo-Kat 2006;1:279-83.
3. Minassian DC, Rosen P, Dart JK, Reidy A, Desai P, Sidhu M, et al.
Extra capsular cataract extraction compared with small incision surgery by
phacoemulsification: a randomized trial. Br J Ophthalmol 2001;85(7):822–9.
4. Mainster MA, Turner PL. Blue-blocking Intraocular Lenses: Myth or
Reality?. American Journal of Ophthalmology 2009;147(1):8-10.
5. Hayashi K, Yoshida M, Hayashi H. All-distance visual acuity and
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Montes- Mico R. Toric intraocular lens versus opposite clear corneal
incisions to correct astigmatism in eyes having cataract surgery. Journal
Cat&Ref 2009;35(3):451-8.
7. Henderson BA. Accommodating IOLs. Ophthalmology 2008;115
(10):1850-1.
8. Sergienko
N.
Evaluation
of
the
Synchrony
dual-optic
accommodating intraocular lens. Journal Cat & Ref 2008;34(1):8-9.
9. Marchini G, Pedrotti E, Sartori P, Tosi R. Ultrasound biomicroscopic
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lenses: pilot study and hypothesis for the mechanism of accommodation. J
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10. Nawa Y, Ueda T, Nakatsuka M, Tsuji H, Marutani H, Hara Y, et al.
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chamber intraocular lens. J Cataract Refract Surg 2003;29(11):2069-72.
11. Cumming JS, Colvard DM, Dell SJ, Doane J, Fine IH, et al. Clinical
evaluation of the Crystalens AT-45 accommodating intraocular lens, results
96
of the U.S. Food and Drug Administration clinical trial. J Cataract Refract
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12. 0HVoL&.DUDNXUW<$\GÕQ1YHDUN'LIUDNWLI5HVWRUYHUHIUDNWLI
5H]RRP PXOWLIRNDO J|] LoL OHQVOHUOH NDWDUDNW DPHOL\DWODUÕ VRQUDVÕ J|UPH
fonksL\RQODUÕQÕQNDUúÕODúWÕUPDVÕ*OR-Kat 2009;4(3):183-8.
13. &DQ ø 3UHVEL\RSLQLQ FHUUDKL WHGDYLVL YH PXOWLIRNDO J|] LoL
lenslerinin yeri: Katarakt cerrahisinden refraktif göz içi lensi cerrahisine
JHoLú*OR-Kat 2007;2(1):1-12.
14. Baikoff G, Matach G, Fontaine A, Ferraz C, Spera C. Correction of
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DeMarco JKJ. et al. Age-related changes in human ciliary muscle and lens;
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1162-9.
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32(4):628-33
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2038-43.
18. Mesçi C, Erbil H, Sönmez A, Acar H. Katarakt operasyRQX VRQUDVÕ
erken dönem akomodatif göz içi lenslerin monofokal göz içi lenslerle görme
IRQNVL\RQODUÕ \|QQGHQ NDUúÕODúWÕUÕOPDVÕ *ORNRP-Katarakt Oftalmoloji
Dergisi 2007;2(1):47-50.
19. Sanders DR, Sanders ML. Visual performance results after
Tetraflex accommodating intraocular lens implantation. Opthalmology
2007;114(9):1679-84.

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