{"id":324,"date":"2012-06-30T11:38:09","date_gmt":"2012-06-30T08:38:09","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=324"},"modified":"2012-06-30T11:38:09","modified_gmt":"2012-06-30T08:38:09","slug":"fotorefraktif-keratektomi-sonrasi-ucustan-ayirma-olgusu","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=324","title":{"rendered":"Fotorefraktif Keratektomi Sonras\u0131 U\u00e7u\u015ftan Ay\u0131rma Olgusu"},"content":{"rendered":"
\n

\"\"<\/a>Fotorefraktif keratektomi (PRK<\/strong>) literat\u00fcrde geni\u015f bir \u015fekilde \u00e7al\u0131\u015f\u0131lm\u0131\u015f olup, havac\u0131l\u0131ktaki potansiyel uygulamalar\u0131 g\u00f6zden ka\u00e7mam\u0131\u015ft\u0131r. PRK ve laser in-situ keratomileusis (LAS\u0130K<\/strong>) gibi korneal refraktif cerrahilerin (KRC<\/strong>) komplikasyon oranlar\u0131 olduk\u00e7a d\u00fc\u015f\u00fckt\u00fcr. Genel olarak tahmin edilebilirli\u011fi, d\u00fc\u015f\u00fck komplikasyon oranlar\u0131, y\u00fcksek ba\u015far\u0131 oran\u0131, stabilitesi ve g\u00fcvenirli\u011fi PRK\u2019n\u0131n, u\u00e7ucularda uygulanmas\u0131n\u0131n kabul\u00fcnde \u00f6nemli olmu\u015ftur. Bu nedenle U.S. Hava Kuvvetleri (USAF) PRK\u2019y\u0131, A\u011fustos 2000\u2032de USAF Havac\u0131l\u0131k ve \u00d6zel G\u00f6rev Fotorefraktif Keratektomi Waiver ve Surveillance (\u0130stisnai karar ve G\u00f6zetim) Program\u0131 alt\u0131nda kabul etti. LAS\u0130K, 2006\u2032da ba\u015flang\u0131\u00e7ta baz\u0131 u\u00e7ucu personel i\u00e7in kabul edilmi\u015fken daha sonra 2007 y\u0131l\u0131nda t\u00fcm USAF u\u00e7ucular\u0131 i\u00e7in geni\u015fletilmi\u015ftir.<\/p>\n

USAF u\u00e7ucuc\u0131lar\u0131, kariyerleri boyunca kat\u0131 g\u00f6rsel kurallar\u0131 kar\u015f\u0131lamak zorundad\u0131rlar. Refraksiyon kusurlar\u0131 ilk defa 1975 y\u0131l\u0131nda -1,5 diyoptri miyopiye kadar olan adaylar\u0131n pilotaj e\u011fitimine uygun olabilecekleri \u015feklinde geni\u015fletilmi\u015ftir. KRC\u2019nin kabul\u00fcnden \u00f6nce sadece g\u00f6zl\u00fck ve kontakt lensler (KL<\/strong>), USAF pilotlar\u0131n\u0131n standart alt\u0131 g\u00f6rmelerini d\u00fczeltebilen y\u00f6ntemler olarak bulunmaktayd\u0131. Askeri havac\u0131l\u0131kta rutin KL kullan\u0131m\u0131n\u0131n s\u0131k g\u00f6r\u00fclen komplikasyonlar\u0131: Korneal yabanc\u0131 cisimler, u\u00e7u\u015f esnas\u0131nda akselerasyon (+Gz) etkisiyle yer de\u011fi\u015ftirmi\u015f veya kaybolmu\u015f KL, r\u00f6latif kuru ve %5-15 nemli kokpitte hidrasyon zorluklar\u0131 (g\u00f6z kurumas\u0131), vs\u2019dir. PRK\u2019n\u0131n komplikasyonlar\u0131 olarak da \u015funlar s\u00f6ylenebilir: Refraktif a\u015f\u0131r\u0131 d\u00fczeltme, az d\u00fczeltme, ablasyon zon desantralizasyonu, ind\u00fcklenmi\u015f astigmatizma, dik santral adac\u0131k, g\u00f6rsel distorsiyonlar, gece kama\u015fmalar\u0131, halo, gecikmi\u015f epitelyal iyile\u015fme, epitelyal erozyonlar, steril korneal infiltrat, mikrobiyal ve imm\u00fcnolojik keratit, kuru g\u00f6z sendromu ve herpes simpleks reaktivasyonu bulunmaktad\u0131r.<\/p>\n

USAF Brooks City-Base (San Antonio, TX) Havac\u0131l\u0131k ve Uzay T\u0131bb\u0131 Merkezi\u2019nin Kons\u00fcltasyon Servisi\u2019ndeki (ACS<\/strong>) bilgilerin g\u00f6zden ge\u00e7irilmesiyle 4 Ocak 2010 itibar\u0131yla %19,9\u2032u pilot olan ve KRC\u2019nin bir formu uygulanan (\u00e7o\u011funlukla PRK) 1975 USAF hava personeli belirlenmi\u015ftir. Baz\u0131 USAF hava personelinin ge\u00e7ici olarak PRK\u2019ya ba\u011fl\u0131 komplikasyonlardan dolay\u0131 ge\u00e7ici olarak u\u00e7u\u015ftan kesilmesine ra\u011fmen, bu makalede USAF pilotu olup PRK sonras\u0131 ilk kal\u0131c\u0131 u\u00e7u\u015ftan kesilen pilot bildirilmektedir.<\/p>\n

OLGU<\/strong>:\u00a0 <\/strong>46 ya\u015f\u0131nda, total 3,920 saat askeri u\u00e7u\u015fu olan C-130 k\u0131demli pilotu. Her iki g\u00f6z\u00fcnden V\u0130SX Star S4 Excimer Laser cihaz\u0131 ile 21 Nisan 2008 tarihinde (bazal refraksiyonlar\u0131 sa\u011f g\u00f6zde +1.00-1.00\u00d782 ve sol g\u00f6zde +1.00-1.00 x95 ve d\u00fczeltilmemi\u015f g\u00f6rme keskinli\u011fi sa\u011f g\u00f6zde 20\/40 sol g\u00f6zde 20\/25) komplikasyonsuz PRK ge\u00e7irmi\u015ftir. Ge\u00e7mi\u015f oftalmolojik \u00fcyk\u00fcs\u00fcnde bir \u00f6zellik yoktur. Postoperatif d\u00f6nemde u\u00e7u\u015ftan kesildi\u011finde korneal inflamasyon, rahats\u0131zl\u0131k hissi ve skar geli\u015fimini azaltmak i\u00e7in her iki g\u00f6z\u00fcne topikal %0.1 florometalon asetat (FA<\/strong>) g\u00fcnde 4 kez uygulanm\u0131\u015ft\u0131r.<\/p>\n

Postop 7. g\u00fcndeki optometrik takipte d\u00fczeltilmemi\u015f uzak g\u00f6rme keskinli\u011fi (UDVA<\/strong>) sa\u011f ve sol g\u00f6zlerde s\u0131ras\u0131yla 20\/40 ve 20\/25 olarak bulunmu\u015ftur. En iyi d\u00fczeltilmi\u015f g\u00f6rme keskinli\u011fi her iki g\u00f6zde 20\/15 olarak tespit edilmi\u015f, rezid\u00fcel refraktif hata ise sa\u011f g\u00f6zde<\/p>\n

-2.00+0.75\u00d7126, sol g\u00f6zde -0.25+0.75\u00d7137 olarak bulunmu\u015ftur. G\u00f6z i\u00e7i bas\u0131nc\u0131 (G\u0130B<\/strong>) aplanasyon y\u00f6ntemiyle her iki g\u00f6zde 21 mmHg olarak \u00f6l\u00e7\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

Hasta cerrahiden 24 g\u00fcn sonra sa\u011f g\u00f6zde bulan\u0131k g\u00f6rme, subjektif azalm\u0131\u015f kontrast ve azalm\u0131\u015f renk alg\u0131lama hissi ile uyand\u0131; her iki g\u00f6zde a\u011fr\u0131l\u0131 g\u00f6z hareketleri e\u015flik ediyordu. Ayn\u0131 g\u00fcn yap\u0131lan optometrik de\u011ferlendirmede sa\u011f g\u00f6zde 52 mmHg, sol g\u00f6zde 42 mmHg \u015feklinde y\u00fckselmi\u015f g\u00f6z i\u00e7i bas\u0131n\u00e7lar\u0131 bulundu. Hastaya tedavi olarak hemen %2 pilokarpin damla 4 saatte bir %0,5 timolol damla g\u00fcnde 2 kez ba\u015fland\u0131 ve FA g\u00fcnde 2 kez olacak \u015fekilde azalt\u0131ld\u0131. Nonkontakt (NCT<\/strong>) G\u0130B \u00f6l\u00e7\u00fcmleri 2 saat sonra her iki g\u00f6zde 22 mmHg olarak \u00f6l\u00e7\u00fcld\u00fc. Renkli g\u00f6rme, kontrast sensitivite, ve fundus muayene bulgular\u0131 o g\u00fcn yap\u0131lan vizitte not edilmemi\u015fti.<\/p>\n

Cerrahi sonras\u0131 29. g\u00fcn fundus muayenesinde sa\u011f g\u00f6zde optik disk \u00f6demi g\u00f6r\u00fcld\u00fc. Ayn\u0131 g\u00fcn yap\u0131lan oftalmoloji kons\u00fcltasyonunda her iki g\u00f6zde aplanasyon G\u0130B de\u011feri 33 mmHg olarak bulundu, sa\u011f g\u00f6zdeki optik disk \u00f6deminin ya non arteritik Anterior \u0130skemik Optik N\u00f6ropati (A\u0130ON<\/strong>) veya bulbar optik n\u00f6rite sekonder olabilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc (\u015eekil 1). PRK\u2019dan 30 g\u00fcn sonra \u00e7ekilen disk foto\u011fraflar\u0131 sa\u011f g\u00f6zde optik sinir \u00f6demi ve sol g\u00f6zde normal g\u00f6r\u00fcn\u00fcml\u00fc optik diski g\u00f6stermekteydi. Etkilenmeyen normal sol optik diskde minimal \u00e7ukurlu\u011fu olan ve A\u0130ON\u2019ye yatk\u0131nl\u0131k yaratan bir anatomi g\u00f6r\u00fclmekteydi, bu durum s\u0131kl\u0131kla \u2018disc-at-risk<\/strong>\u2018 olarak tan\u0131mlanmaktayd\u0131.<\/p>\n

Hastaya gece topikal %0.03 bimatoprost, oral acetazolamid 250 mg (g\u00fcnde 2 kez) ve 325 mg aspirin (g\u00fcnde 1 kez) tedavi ba\u015fland\u0131 ve FA 4 g\u00fcn i\u00e7inde h\u0131zl\u0131 bir \u015fekilde kesildi. Ertesi g\u00fcn yap\u0131lan kontrol muayenesinde G\u0130B sa\u011f g\u00f6zde 13 mmHg, sol g\u00f6zde 15 mmHg olarak \u00f6l\u00e7\u00fcld\u00fc.<\/p>\n

Akut g\u00f6rme kayb\u0131ndan 8 g\u00fcn sonra \u00e7ekilen beyin ve orbita MRG normal olarak bulundu. Haziran 2008\u2032de yap\u0131lan n\u00f6ro-oftalmoloji kons\u00fcltasyonu ile steroide ba\u011fl\u0131 ok\u00fcler hipertansiyona sekonder geli\u015fen A\u0130ON tan\u0131s\u0131 konuldu. Hasta, \u015eubat 2009\u2032da ileri inceleme i\u00e7in ACS\u2019ye refere edildi. O d\u00f6nemde yap\u0131lan muayenede UDVA sa\u011f g\u00f6zde 20\/50, sol g\u00f6zde 20\/17 olarak bulundu. En iyi d\u00fczeltilmi\u015f g\u00f6rme keskinli\u011fi sa\u011f g\u00f6zde 20\/50 ve sol g\u00f6zde 20\/15 d\u00fczeyinde, rezid\u00fcel refraksiyon ise sa\u011f g\u00f6zde -0.25+0.25\u00d7105, sol g\u00f6zde pl+0.25\u00d7172 idi. Sa\u011f g\u00f6zde ciddi g\u00f6rme alan\u0131 daralmas\u0131 mevcuttu, sa\u011f g\u00f6zde hafif RAPD, \u00e7oklu renk g\u00f6rme tarama testinde tespit edilen ve anamoloskop testiyle hafif oldu\u011fu teyid edilen edinsel k\u0131rm\u0131z\u0131\/ye\u015fil renk g\u00f6rme bozuklu\u011fu bulundu. \u0130l\u00e2ve olarak hastan\u0131n sa\u011f g\u00f6zde kontrast sensitivitesi ve uzak stereopsisi azalm\u0131\u015f (40 arc\/s) olarak tespit edildi. Sol g\u00f6zde renk g\u00f6rme ve kontrast sensitivite normaldi. Bu komplikasyonlara ve rezid\u00fcel g\u00f6rsel fonksiyon kayb\u0131na ba\u011fl\u0131 olarak hasta kal\u0131c\u0131 olarak u\u00e7u\u015ftan kesildi.<\/p>\n

TARTI\u015eMA<\/strong>: <\/strong>Anterior iskemik optik n\u00f6ropati, 50 ya\u015f\u0131ndan sonra g\u00f6r\u00fclen en s\u0131k akut optik sinir hastal\u0131\u011f\u0131d\u0131r; g\u00f6rme keskinli\u011finde, g\u00f6rme alan\u0131nda, stereopsis ve renk g\u00f6rmede bozulmayla giden g\u00f6rsel fonksiyon bozuklu\u011funa sebep olur. A\u0130ON, optik disk \u00f6demine sebep olan optik sinir ba\u015f\u0131n\u0131n suboptimal oksijenizasyonuna ba\u011fl\u0131 olarak geli\u015fti\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n

Optik disk sirk\u00fclasyonundaki yetmezlik, olay\u0131 ba\u015flatan sebep olarak \u00f6ne s\u00fcr\u00fclse de, subklinik iskeminin optik sinir liflerinin, destek yap\u0131lar\u0131n\u0131n ve kapillerlerin diskte s\u0131k\u0131\u015fmas\u0131na ba\u011fl\u0131 oldu\u011fu hipotez edilmektedir. Konjenital olarak k\u00fc\u00e7\u00fck ve kalabal\u0131k optik diskte subklinik iskemiden enfarkta ge\u00e7i\u015fin daha fazla oldu\u011fu \u00f6ne s\u00fcr\u00fcld\u00fc\u011f\u00fcnden baz\u0131 yazarlar taraf\u0131ndan \u2018disc-at-risk\u2019 olarak tan\u0131mlanm\u0131\u015ft\u0131r. Hipermetropi A\u0130ON geli\u015fimi i\u00e7in muhtemel risk fakt\u00f6r\u00fc olarak belirtilmi\u015ftir. Son olarak, optik sinir ba\u015f\u0131n\u0131n lateral ve medial k\u0131sa posterior silier arter taraf\u0131ndan beslenen vask\u00fcler watershed zon i\u00e7erisindeki optik sinir ba\u015f\u0131n\u0131n pozisyonu ilave fakt\u00f6r olabilir.<\/p>\n

Korneal haze geli\u015fimi refraktif cerrahinin bilinen bir komplikasyonudur, ancak postoperatif topikal steroid g\u00f6z damlalar\u0131 ve non steroid antiinflamatuar tedavi korneal inflamasyon ve takip eden haze geli\u015fimini azaltmaktad\u0131r. Ok\u00fcler steroid kullan\u0131m\u0131na ba\u011fl\u0131 komplikasyonlar a\u00e7\u0131k\u00e7a belirtilmi\u015ftir. Literat\u00fcr g\u00f6zden ge\u00e7irildi\u011finde pop\u00fclasyonun %18-40\u2032\u0131n\u0131n steroid hassas oldu\u011fu g\u00f6r\u00fclmektedir; birka\u00e7 haftal\u0131k topikal ok\u00fcler steroid kullan\u0131m\u0131 ile G\u0130B\u2019de akut y\u00fckselme ya\u015famaktad\u0131rlar. Bu oran daha \u00f6nce primer a\u00e7\u0131k a\u00e7\u0131l\u0131 glokom tan\u0131s\u0131 alanlarda %46-92\u2032ye kadar y\u00fckselmektedir. Toplamda postoperatif d\u00f6nemde topikal steroid kullan\u0131l\u0131rsa hastalar\u0131n %12-25\u2032inde G\u0130B 24 mmHg ve daha \u00fcst\u00fcne \u00e7\u0131kmaktad\u0131r. G\u0130B\u2019nin steroide ba\u011fl\u0131 olarak trabek\u00fcler a\u011fda morfolojik ve fonksiyonel de\u011fi\u015fikliklerle artt\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n

A\u0130ON sonras\u0131 Havac\u0131l\u0131k t\u0131bb\u0131nda u\u00e7u\u015fla ilgili ek stres fakt\u00f6rlerinin tekrar eden maruziyetini dikkate almak gerekir. A\u0130ON patofizyolojisi, 8-10 bin ft (2,438-3,048 m) gibi bas\u0131n\u00e7l\u0131 kabin y\u00fcksekliklerinde ve artan G y\u00fck\u00fcnde (+Gz) hipoksiye hassasiyetin artt\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. \u2018Disc at risk<\/strong>\u2018 gibi anatomik olarak kalabal\u0131k optik sinir ba\u015f\u0131 durumlar\u0131 ek endi\u015fe yarat\u0131r. U\u00e7ucularda bu tip optik disklerde riskin artt\u0131\u011f\u0131n\u0131 g\u00f6steren bilinen \u00e7al\u0131\u015fma olmamas\u0131na ra\u011fmen ACS\u2019de de\u011ferlendirilmi\u015f, irtifada relatif hipoksiye, \u015f\u00fcpheli DCS ve y\u00fcksek G kuvvetlerine ba\u011fl\u0131 olarak iskemik hale ge\u00e7en \u2018disc-at-risk\u2019 bulunmaktad\u0131r.<\/p>\n

Bu olgu USAF havac\u0131lar\u0131nda PRK sonras\u0131 ilk kal\u0131c\u0131 u\u00e7u\u015ftan kesilme vakas\u0131 olmas\u0131na ra\u011fmen bir ba\u015fka USAF pilotu PRK sonras\u0131 1 y\u0131l u\u00e7u\u015ftan kesilmeye sebep olan bilateral A\u0130ON ya\u015fam\u0131\u015ft\u0131r. G\u00f6rme d\u00fczeyi 20\/20\u2032ye d\u00f6nmesine ra\u011fmen, A\u0130ON\u2019daki hassas sinirlerin teorik olarak y\u00fcksek G kuvvetleri ve kabin bas\u0131nc\u0131 kayb\u0131 durumlar\u0131nda tekrarlay\u0131c\u0131 maruziyet riski nedeniyle g\u00fcnl\u00fck 325 mg aspirin tedavisi ba\u015flanm\u0131\u015ft\u0131r. Ayr\u0131ca y\u00fcksek performansl\u0131 olmayan u\u00e7aklarda ve 8 bin ft\u2019den (2,438 m) fazla olmayan kabin irtifa\u0131nda u\u00e7u\u015f m\u00fcsaadesi verilmi\u015ftir.<\/p>\n

Literat\u00fcrde \u00e7ok say\u0131da KRC sonras\u0131 akut intraok\u00fcler bas\u0131n\u00e7 y\u00fckselmesine ba\u011fl\u0131 geli\u015fen kal\u0131c\u0131 g\u00f6rme kayb\u0131 olgu bildirilmi\u015ftir. Bu olgular\u0131n \u00e7o\u011funlu\u011funda g\u00f6rme kayb\u0131 glokomat\u00f6z hasara ba\u011fl\u0131d\u0131r; ancak disk \u00f6demi tan\u0131mlanamad\u0131\u011f\u0131 i\u00e7in A\u0130ON g\u00f6zden ka\u00e7m\u0131\u015f olabilir ve\/veya A\u0130ON ba\u015flang\u0131\u00e7 h\u0131z\u0131 tam olarak belirlenememi\u015f olabilir. Ancak bu olguda, topikal steroid kullan\u0131m\u0131 ile akut intraok\u00fcler bas\u0131n\u00e7 y\u00fckselmesine ba\u011fl\u0131 olarak hassas anatomik kalabal\u0131k diskte artm\u0131\u015f A\u0130ON geli\u015fim riskinin oldu\u011fu kanaatine var\u0131lm\u0131\u015ft\u0131r.<\/p>\n

KRC\u2019de ileri teknikler geli\u015ftik\u00e7e komplikasyon oranlar\u0131 azalacak ve g\u00f6rsel keskinlik sonu\u00e7lar\u0131 daha iyi olacakt\u0131r. U\u00e7ucularda oldu\u011fu gibi kat\u0131 mesleki g\u00f6rsel gereklili\u011fin oldu\u011fu olgularda, fonksiyonel azalman\u0131n u\u00e7u\u015f kariyerini potansiyel olarak etkileyece\u011fi nadir komplikasyonlar dahi tamamen tart\u0131\u015f\u0131lmal\u0131d\u0131r. Ek olarak bu hastalar\u0131n postoperatif tedavileri \u00e7ok titiz olmal\u0131d\u0131r.<\/p>\n

Sonu\u00e7 olarak 30 mmHg \u00fczerinde olan artm\u0131\u015f G\u0130B\u2019de bas\u0131n\u00e7 d\u00fc\u015f\u00fcr\u00fcc\u00fc tedaviye yan\u0131t\u0131n de\u011ferlendirilmesi durumunda tedavinin ba\u015flang\u0131c\u0131ndan sonra 48 saat i\u00e7indeki takip uygun de\u011fildir. Bu pilotta G\u0130B d\u00fc\u015f\u00fcr\u00fcc\u00fc tedavinin ba\u015flamas\u0131ndan sonra 5. g\u00fcnde G\u0130B 30 mmHg\u2019ye y\u00fckselmi\u015ftir. Ayr\u0131ca baz\u0131 disklerin, KRC sonras\u0131 G\u0130B y\u00fckselmesine ba\u011fl\u0131 olaylara, \u00f6zellikle u\u00e7u\u015fla ilgili ek stres durumlar\u0131na daha hassas oldu\u011funu \u00f6ne s\u00fcrmekte, disc-at-risk\u2019li hastalar\u0131n daha s\u0131k\u0131 takip edilmesini, KRC sonras\u0131 steroid kullan\u0131m\u0131na ba\u011fl\u0131 G\u0130B y\u00fckselmesi durumunda agresif G\u0130B d\u00fc\u015f\u00fcr\u00fclmesi gereklili\u011fini \u00f6ne s\u00fcrmekteyiz.<\/p>\n

Kaynak<\/strong>:<\/strong> Davis RE, Ivan DJ, Rubin RM, Gooch JM, Tredici TJ, Reilly CD. Permanent grounding of a USAF pilot following photorefractive keratectomy. Aviat Space Environ Med 2010; 81:1041-4.<\/p>\n

\u00c7evirenler<\/strong>:<\/strong> Do\u00e7. Dr. \u015eansal Gedik<\/strong>, Yrd.Do\u00e7.Dr. Berker Bakbak<\/strong> (Sel\u00e7uk \u00dcniversitesi Sel\u00e7uklu T\u0131p Fak\u00fcltesi G\u00f6z Hastal\u0131klar\u0131 Anabilim Dal\u0131)<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Fotorefraktif keratektomi (PRK) literat\u00fcrde geni\u015f bir \u015fekilde \u00e7al\u0131\u015f\u0131lm\u0131\u015f olup, havac\u0131l\u0131ktaki potansiyel uygulamalar\u0131 g\u00f6zden ka\u00e7mam\u0131\u015ft\u0131r. PRK ve laser in-situ keratomileusis (LAS\u0130K) gibi korneal refraktif cerrahilerin (KRC) komplikasyon oranlar\u0131 olduk\u00e7a d\u00fc\u015f\u00fckt\u00fcr. Genel olarak tahmin edilebilirli\u011fi, d\u00fc\u015f\u00fck komplikasyon oranlar\u0131, y\u00fcksek ba\u015far\u0131 oran\u0131, stabilitesi ve g\u00fcvenirli\u011fi PRK\u2019n\u0131n, u\u00e7ucularda uygulanmas\u0131n\u0131n kabul\u00fcnde \u00f6nemli olmu\u015ftur. Bu nedenle U.S. Hava Kuvvetleri (USAF) PRK\u2019y\u0131, A\u011fustos 2000\u2032de USAF Havac\u0131l\u0131k ve […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-324","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/324","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=324"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/324\/revisions"}],"predecessor-version":[{"id":326,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/324\/revisions\/326"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=324"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=324"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=324"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}