Publication: Primer Açık Açılı Glokom Tedavisinde Kullanılan Topikal İlaçların Perilimbal Vaskülariteye Etkisinin Optik Koherens Tomografi Anjiografi İle Değerlendirilmesi
Abstract
Amaç: Primer açık açılı glokom hastalarında farklı sayıda molekül içeren antiglokomatöz damlaların perilimbal konjonktival vasküler yapı üzerine olan etkisinin ön segment-optik koherens tomogafi anjiografi kullanılarak ortaya koyulması ve diğer glokom bulguları ile olan ilişkisinin incelenmesi Hastalar ve Yöntem: Ondokuz Mayıs Üniversitesi Göz Hastalıkları Glokom Kliniğinde bir aydan uzun süredir primer açık açılı glokom tanısı ile takip edilen ve topikal tedavi alan 35 yaş üstü hastalar ve bu hastaların yaş-cinsiyet eşleştirilmiş kontrolleri çalışmaya dahil edildi. Katılımcıların perilimbal konjonktival vasküler dansiteleri ön segment-optik koherens tomogafi anjiografi kullanılarak yüzeyel ve derin pleksusta ve dört kadranda görüntülendi; kullanılan molekül sayısı ve etken maddesi, ilaç kullanım süresi ve rutin glokom muayenesinde değerlendirilen göz içi basıncı, retina sinir lifi tabakası kalınlığı ve standart otomatik perimetriye göre glokom evresi ile olan ilişkisi incelendi. Görüntü analizi ImageJ yazılımı ve AngioTool eklentisi kullanılarak yapıldı. Bulgular: Çalışmaya toplam 90 hastanın 151 gözü ve 18 kontrolün 36 gözü dahil edildi. Ortalama vasküler dansite, yüzeyel ve derin pleksusta sırasıyla hasta grubunda %23,4±5 ve %24,6±5 iken kontrol grubunda %18,9±3 ve %20,3±3,6 bulundu (p<0,001). Kullanılan molekül sayısına göre hastaların yüzeyel ve derin pleksus ortalama vasküler dansiteleri kontrollerden yüksek bulundu (sırasıyla tek:%23,9±4,7, p<0,001 ve 24,7±4,7, p<0,001; iki:%21,8±4,6, p=0,03 ve 23,3±4,6, p=0,04; üç: %22,6±4,8, p=0,01 ve %24,0±4,5, p=0,008; dört:%25,3±5,3, p<0,001 ve %26,3±5,7, p<0,001). Bir yıldan uzun süre tedavi alan hastaların ortalama vasküler dansiteleri yüzeyel ve derin pleksusta kontrollerden yüksek bulunurken (sırasıyla 1-5yıl:%23,8±5,2, p<0,001 ve %25,0±5,3, p<0,001; >5 yıl:%22,9 ±4,5 p<0,001 ve %24,2±4,6, p<0,001), 1 yıldan kısa süreli tedavi alan hastaların vasküler dansiteleri ile kontrollerinki arasında anlamlı fark bulunmadı (%22,2±6,3, p=0,38 ve %22,5±4,7, p=0,75). Kadranlara göre değerlendirildiğinde, kısa ve uzun süreli ilaç kullanımında kontrol grubuna göre hem yüzeyel hem de derin pleksusta, alt ve üst kadran vasküler dansiteleri artmış bulundu p<0,05). Kullanılan molekül sayısı ile glokom evresi arasında anlamlı pozitif korelasyon izlendi (r=0,32, p<0,05). Hastaların vasküler dansite değerleri glokom evrelerine göre kıyaslandığında evreler arası anlamlı fark tespit edilmedi (tüm karşılaştırmalar için p>0,05). Hem yüzeyel hem derin pleksusta prezervan kullanımı ile vasküler dansite arasında istatistiksel anlam saptanmadı (sırasıyla p=0,11 ve p=0,19). Tartışma ve Sonuç: Glokom hastalarında anti-glokomatöz damlalarının kullanımına bağlı oküler yüzey değişiklikleri sıklıkla gözlenen bir yan etkidir. Ön segment-optik koherens tomogafi anjiografi ile oküler yüzeyde anti-glokomatöz damlaların etkisini araştırdığımız bu çalışmamızda, hasta grubunda kontrol grubuna kıyasla yüzeyel ve derin pleksus vasküler dansite değerlerinde anlamlı artış tespit edilmiştir. Artan molekül sayısı ve tedavi süresiyle birlikte vasküler dansite artışı gözlemlenmiş ancak glokom evreleri ile vasküler dansite arasında belirgin fark bulunmamıştır. Ayrıca, prezervan kullanımı ile vasküler dansite arasında istatistiksel anlamlı bir ilişki tespit edilmemiştir. Bu bulgular glokom hastalarının takibinde tedavi seçeneklerinin belirlenmesi açısından, ön segment-optik koherens tomogafi anjiografiden görüntüleme yöntemi olarak yararlanabileceğini göstermiştir. Anahtar Sözcükler: Optik Koherens Tomografi Anjiografi, Glokom, Vasküler Dansite
Purpose: Evaluation of the effects of antiglaucoma drops containing different numbers of molecules on perilimbal conjunctival vascular structure using anterior segment optical coherence tomography angiography in primary open-angle glaucoma patients, and analysis of their relationship with other glaucoma findings Patients and Methods: Patients aged over 35 who were diagnosed with primary open-angle glaucoma and had been receiving topical treatment for more than one month at Ondokuz Mayıs University Glaucoma Clinic were included in the study, along with age- and sex-matched controls. The perilimbal conjunctival vascular densities of the participants were imaged in the superficial and deep plexuses across four quadrants using anterior segment optical coherence tomography angiography. Relationships were analyzed between the number and active ingredients of the drugs used, duration of drug use, and routine glaucoma examination parameters such as intraocular pressure, retinal nerve fiber layer thickness, and glaucoma stage based on standard automated perimetry. Image analysis was performed using ImageJ software with the AngioTool plugin. Results: The study included 151 eyes of 90 patients and 36 eyes of 18 controls. The mean vascular density in the superficial and deep plexuses was significantly higher in the patient group (23.4%± 5 and 24.6%± 5, respectively) compared to the control group (18.9%± 3 and 20.3%± 3.6, respectively; p < 0.001). Based on the number of molecules used, the mean vascular density in the superficial and deep plexuses was higher in patients than in controls, with values for single-molecule use at 23.9%± 4.7 (p < 0.001) and 24.7%± 4.7 (p < 0.001); for two molecules, 21.8%± 4.6 (p = 0.03) and 23.3%± 4.6 (p = 0.04); for three molecules, 22.6%± 4.8 (p = 0.01) and 24.0%± 4.5 (p = 0.008); and for four molecules, 25.3%± 5.3 (p < 0.001) and 26.3%± 5.7 (p < 0.001). Patients treated for over one year had significantly higher vascular density values in the superficial and deep plexuses compared to controls, with values of 23.8%± 5.2 (p < 0.001) and 25.0%± 5.3 (p < 0.001) for 1–5 years of treatment, and 22.9%± 4.5 (p < 0.001) and 24.2%± 4.6 (p < 0.001) for treatment exceeding five years. However, no significant difference was found between patients treated for less than one year (22.2%± 6.3, p = 0.38 and 22.5%± 4.7, p = 0.75) and controls. When evaluated according to quadrants, both short- and long-term drug use groups exhibited increased vascular densities in the inferior and superior quadrants of both the superficial and deep plexuses compared to the control group (p<0.05). A significant positive correlation was observed between the number of molecules used and glaucoma stage (r = 0.32, p < 0.001). When comparing vascular density values across glaucoma stages, no significant differences were found (p > 0.05 for all comparisons). Furthermore, no statistically significant relationship was observed between the use of preservatives and vascular density in the superficial (p = 0.11) or deep plexuses (p = 0.19). Discussion and Conclusion: In glaucoma patients, ocular surface changes resulting from the use of anti-glaucoma eye drops are frequently observed as a side effect. In this study, which investigated the effect of anti-glaucoma drops on the ocular surface using anterior segment optical coherence tomography angiography, we detected a significant increase in both superficial and deep plexus vascular density values in the patient group compared to the control group. With a higher number of molecules and longer treatment duration, an increase in vascular density was observed; however, no significant difference was found between glaucoma stages and vascular density. Additionally, no statistically significant relationship was found between preservative use and vascular density. These findings indicate that anterior segment optical coherence tomography angiography may serve as a useful imaging modality for guiding treatment options in the follow-up of glaucoma patients. Keywords: Optical Coherence Tomography Angiography, Glaucoma, Vascular Density
Purpose: Evaluation of the effects of antiglaucoma drops containing different numbers of molecules on perilimbal conjunctival vascular structure using anterior segment optical coherence tomography angiography in primary open-angle glaucoma patients, and analysis of their relationship with other glaucoma findings Patients and Methods: Patients aged over 35 who were diagnosed with primary open-angle glaucoma and had been receiving topical treatment for more than one month at Ondokuz Mayıs University Glaucoma Clinic were included in the study, along with age- and sex-matched controls. The perilimbal conjunctival vascular densities of the participants were imaged in the superficial and deep plexuses across four quadrants using anterior segment optical coherence tomography angiography. Relationships were analyzed between the number and active ingredients of the drugs used, duration of drug use, and routine glaucoma examination parameters such as intraocular pressure, retinal nerve fiber layer thickness, and glaucoma stage based on standard automated perimetry. Image analysis was performed using ImageJ software with the AngioTool plugin. Results: The study included 151 eyes of 90 patients and 36 eyes of 18 controls. The mean vascular density in the superficial and deep plexuses was significantly higher in the patient group (23.4%± 5 and 24.6%± 5, respectively) compared to the control group (18.9%± 3 and 20.3%± 3.6, respectively; p < 0.001). Based on the number of molecules used, the mean vascular density in the superficial and deep plexuses was higher in patients than in controls, with values for single-molecule use at 23.9%± 4.7 (p < 0.001) and 24.7%± 4.7 (p < 0.001); for two molecules, 21.8%± 4.6 (p = 0.03) and 23.3%± 4.6 (p = 0.04); for three molecules, 22.6%± 4.8 (p = 0.01) and 24.0%± 4.5 (p = 0.008); and for four molecules, 25.3%± 5.3 (p < 0.001) and 26.3%± 5.7 (p < 0.001). Patients treated for over one year had significantly higher vascular density values in the superficial and deep plexuses compared to controls, with values of 23.8%± 5.2 (p < 0.001) and 25.0%± 5.3 (p < 0.001) for 1–5 years of treatment, and 22.9%± 4.5 (p < 0.001) and 24.2%± 4.6 (p < 0.001) for treatment exceeding five years. However, no significant difference was found between patients treated for less than one year (22.2%± 6.3, p = 0.38 and 22.5%± 4.7, p = 0.75) and controls. When evaluated according to quadrants, both short- and long-term drug use groups exhibited increased vascular densities in the inferior and superior quadrants of both the superficial and deep plexuses compared to the control group (p<0.05). A significant positive correlation was observed between the number of molecules used and glaucoma stage (r = 0.32, p < 0.001). When comparing vascular density values across glaucoma stages, no significant differences were found (p > 0.05 for all comparisons). Furthermore, no statistically significant relationship was observed between the use of preservatives and vascular density in the superficial (p = 0.11) or deep plexuses (p = 0.19). Discussion and Conclusion: In glaucoma patients, ocular surface changes resulting from the use of anti-glaucoma eye drops are frequently observed as a side effect. In this study, which investigated the effect of anti-glaucoma drops on the ocular surface using anterior segment optical coherence tomography angiography, we detected a significant increase in both superficial and deep plexus vascular density values in the patient group compared to the control group. With a higher number of molecules and longer treatment duration, an increase in vascular density was observed; however, no significant difference was found between glaucoma stages and vascular density. Additionally, no statistically significant relationship was found between preservative use and vascular density. These findings indicate that anterior segment optical coherence tomography angiography may serve as a useful imaging modality for guiding treatment options in the follow-up of glaucoma patients. Keywords: Optical Coherence Tomography Angiography, Glaucoma, Vascular Density
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