{"id":543,"date":"2012-07-15T11:01:43","date_gmt":"2012-07-15T08:01:43","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=543"},"modified":"2012-07-15T11:01:43","modified_gmt":"2012-07-15T08:01:43","slug":"helikopter-pilotlarinda-prk-veya-lasik-sonrasi-gorme-ve-ucus-performansindaki-iyilesme","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=543","title":{"rendered":"Helikopter pilotlar\u0131nda PRK veya LASIK sonras\u0131 g\u00f6rme ve u\u00e7u\u015f performans\u0131ndaki iyile\u015fme"},"content":{"rendered":"
\n
\"\"<\/a>Amerikan Kara Kuvvetleri Ulusal Muhaf\u0131z G\u00fcc\u00fc havac\u0131lar\u0131n\u0131n %32\u2019si refraksiyon kusurlar\u0131n\u0131 d\u00fczeltmek i\u00e7in g\u00f6zl\u00fck veya kontakt lens kullan\u0131m\u0131na ihtiya\u00e7 duymaktad\u0131r. G\u00f6zl\u00fckler genellikle koruyucu maske sistemleri veya ba\u015fa monte edilen cihazlarla ilgili sorunlar\u0131 beraberinde getirmektedir. Kontakt lenslere ise t\u00fcm havac\u0131lar adapte olamamakta ve askeri \u015fartlarda pek de uygun olmamaktad\u0131r. Fotorefraktif Keratektomi (PRK), 1994\u2019ten beri askeri havac\u0131lar i\u00e7in uygunlu\u011fu kan\u0131tlanm\u0131\u015f bir tedavi y\u00f6ntemi olmu\u015ftur. Fakat Hava Kuvvetleri ara\u015ft\u0131r\u0131c\u0131lar\u0131na g\u00f6re baz\u0131 PRK\u2019l\u0131 olgularda, parlak \u0131\u015f\u0131kta kontrast duyarl\u0131l\u0131\u011f\u0131nda azalma saptanmas\u0131 t\u00fcm sonu\u00e7lar\u0131n olumlu olmad\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Laser In Situ Keratomilesius\u2019da (LASIK), PRK\u2019ya g\u00f6re g\u00f6rmedeki iyile\u015fme daha \u00e7abuk olmakla birlikte, LASIK\u2019te askeri u\u00e7u\u015flarda, flebin stabilizasyonu ve g\u00f6rme kalitesi \u00fczerinde kesin kan\u0131tlanmam\u0131\u015f riskler tespit edilmi\u015ftir.<\/div>\n

Helikopter u\u00e7u\u015flar\u0131nda endi\u015felerden bir tanesi, PRK veya LASIK\u2019in d\u00fc\u015f\u00fck ayd\u0131nlatma ve d\u00fc\u015f\u00fck kontrastda u\u00e7u\u015f performans\u0131na etkisidir. Di\u011fer bir endi\u015fe konusu ise, PRK veya LASIK sonras\u0131 gece g\u00f6rmede meydana gelen de\u011fi\u015fiklikler ve pilotun u\u00e7u\u015fa d\u00f6nebilmesi i\u00e7in g\u00f6rmenin ne kadar erken iyile\u015fti\u011fidir. Bu \u00e7al\u0131\u015fma Amerikan Kara K. Black Hawk (UH-69) pilotlar\u0131nda, PRK veya LASIK sonras\u0131 g\u00f6rmedeki iyile\u015fmeyi ve bunun u\u00e7u\u015f performans\u0131na olan etkisini g\u00f6stermek i\u00e7in prospektif olarak d\u00fczenlenmi\u015ftir.<\/p>\n

Sonu\u00e7lar :<\/strong>\u00a0 Ortalama ya\u015f\u0131 38 (28-49 ya\u015f aral\u0131\u011f\u0131nda), cerrahi \u00f6ncesi g\u00f6zl\u00fck re\u00e7etesinin sferik kar\u015f\u0131l\u0131\u011f\u0131 -1.52D (-0.75 ve -6.00D) olan, 20 helikopter pilotu (40 g\u00f6z) \u00e7al\u0131\u015fmaya al\u0131nd\u0131. PRK ve LASIK gruplar\u0131 aras\u0131nda demografik olarak fark saptanmad\u0131. Cerrahi \u00f6ncesinde PRK ve LASIK gruplar\u0131 aras\u0131nda ya\u015f, refraktif hatalar\u0131n sferik kar\u015f\u0131l\u0131\u011f\u0131, g\u00f6rsel performans ve u\u00e7u\u015f deneyimi a\u00e7\u0131s\u0131ndan fark yoktu. PRK\u2019l\u0131 olgularda cerrahiden sonraki 1.haftada, cerrahi \u00f6ncesine g\u00f6re g\u00f6rme d\u00fczeyinde istatistiksel olarak anlaml\u0131 azalma saptand\u0131; bu etkinin LASIK\u2019te g\u00f6r\u00fclmemesi daha \u00f6nceki \u00e7al\u0131\u015fmalarla da ortaya konmu\u015ftur. LASIK\u2019li olgularda postoperatif 1. haftadaki YKGK, cerrahi \u00f6ncesi ile ayn\u0131 idi. 1. ve 6. ayda g\u00f6rme performans\u0131 a\u00e7\u0131s\u0131ndan LASIK ve PRK aras\u0131nda anlaml\u0131 fark bulunmad\u0131. Erken cerrahi sonras\u0131 d\u00f6nemde PRK\u2019da d\u00fczeltilmi\u015f g\u00f6rmedeki azalma, sadece d\u00fczeltilmemi\u015f g\u00f6rme keskinli\u011fini de\u011fil; YKGK, DKGK ve kontrast duyarl\u0131l\u0131\u011f\u0131n\u0131 da etkilemekteydi. DKGK ve g\u00f6rme keskinli\u011findeki azalma u\u00e7u\u015f ve s\u00fcr\u00fc\u015f performans\u0131ndaki azalma ile de do\u011fruland\u0131. Postoperatif 1.haftada LASIK yap\u0131lanlar\u0131n d\u00fczeltilmemi\u015f g\u00f6rme keskinli\u011fi, d\u00fczeltilmi\u015f y\u00fcksek kontrasttaki g\u00f6rme keskinli\u011fi ve kontrast duyarl\u0131l\u0131\u011f\u0131, PRK yap\u0131lanlara g\u00f6re daha y\u00fcksek tesbit edildi. LASIK\u2019li olgular postoperatif 1. haftada YKGK\u2019de cerrahi \u00f6ncesi durumlar\u0131na d\u00f6nd\u00fc. Postoperatif 6. ay sonu\u00e7lar\u0131nda ise PRK ve LASIK aras\u0131nda DGK, YKGK, DKGK a\u00e7\u0131s\u0131ndan fark bulunmad\u0131.<\/div>\n

\nTart\u0131\u015fma :<\/strong>\u00a0 Di\u011fer i\u015f alanlar\u0131ndan farkl\u0131 olarak \u00e7ok d\u00fc\u015f\u00fck refraksiyon kusuruna sahip olan havac\u0131lardan % 22\u2019si ile 32\u2019sinin ortalama refraksiyon kusuru, miyoplar i\u00e7in -1.34 D, hipermetroplar i\u00e7in +0.94 D\u2019dir.<\/div>\n

LASIK\u2019li olgular\u0131n 1. haftadaki t\u00fcm \u00f6l\u00e7\u00fcmleri, PRK yap\u0131lan olgular\u0131n cerrahi sonras\u0131 1. ayki g\u00f6rmesinden daha iyiydi. LASIK sonras\u0131 g\u00f6rme keskinli\u011fi stabilitesindeki iyile\u015fmenin, PRK\u2019daki yara yeri iyile\u015fmesine g\u00f6re erken olu\u015fu daha \u00f6nceki \u00e7al\u0131\u015fmalarla da tespit edilmi\u015ftir. LASIK\u2019li olgular YKGK a\u00e7\u0131s\u0131ndan cerrahi sonras\u0131 1. haftada, cerrahi \u00f6ncesi durumlar\u0131yla ayn\u0131 hatta daha iyi performansa sahipti. LASIK ve PRK aras\u0131nda postoperatif 1. ve 6. ayda g\u00f6rme performans\u0131nda anlaml\u0131 fark saptanmad\u0131. Bu \u00e7al\u0131\u015fma PRK yap\u0131lanlarda erken cerrahi sonras\u0131 d\u00f6nemde d\u00fczeltilmi\u015f g\u00f6rmedeki azalman\u0131n YKGK, DKGK ve kontrast duyarl\u0131l\u0131\u011f\u0131n\u0131 da etkiledi\u011fini ortaya koymu\u015ftur. Kontrast duyarl\u0131l\u0131\u011f\u0131ndaki ve DKGK\u2019deki azalma, u\u00e7u\u015f ve s\u00fcr\u00fc\u015f performans\u0131yla da g\u00f6sterilmektedir. Cerrahi sonras\u0131 g\u00f6rsel parametrelerdeki iyile\u015fme ve stabilite, PRK veya LASIK sonras\u0131 g\u00f6reve ne zaman d\u00f6n\u00fclece\u011fi hakk\u0131nda da fikir vermektedir. 9 LASIK\u2019li olgunun tamam\u0131n\u0131n ve 11 PRK\u2019l\u0131 olgunun 6\u2019s\u0131n\u0131n, postoperatif 1. haftada u\u00e7u\u015f g\u00f6revlerine geri d\u00f6nebilece\u011fi umuluyordu ama hi\u00e7biri u\u00e7u\u015fa bu d\u00f6nemde ba\u015flamad\u0131. 20 pilotun 19\u2019u 1. ayda u\u00e7u\u015fa d\u00f6nd\u00fc. 1 tanesinde de bulan\u0131k g\u00f6rme, azalm\u0131\u015f DKGK, kontrast duyarl\u0131l\u0131\u011f\u0131 olmas\u0131 ve \u0131\u015f\u0131k etraf\u0131nda halo g\u00f6rmesi nedeniyle 1. ayda u\u00e7u\u015fa d\u00f6nemedi. \u00c7al\u0131\u015fma, bu pop\u00fclasyon i\u00e7in burada sunulan g\u00f6rme performans\u0131 a\u00e7\u0131s\u0131ndan en duyarl\u0131 testin, k\u00fc\u00e7\u00fck harf kontrast testi oldu\u011funu g\u00f6sterdi.<\/p>\n

1. haftada PRK yap\u0131lanlarda g\u00f6r\u00fc\u015f performans\u0131 ile ilgili t\u00fcm \u00f6l\u00e7\u00fcmlerde istatiksel olarak anlaml\u0131 d\u00fc\u015f\u00fc\u015f saptansa da, u\u00e7u\u015f performans\u0131nda azalma saptanmad\u0131. PRK\u2019l\u0131larda bu \u00e7al\u0131\u015fma periyodu boyunca t\u00fcm u\u00e7u\u015f \u015fartlar\u0131nda u\u00e7u\u015f performans\u0131 ayn\u0131 kalm\u0131\u015ft\u0131r. LASIK\u2019liler ise gece yard\u0131ms\u0131z g\u00f6r\u00fc\u015f ve gece g\u00f6r\u00fc\u015f g\u00f6zl\u00fc\u011f\u00fcyle u\u00e7u\u015flar\u0131nda geli\u015fme g\u00f6sterdi, fakat g\u00fcnd\u00fcz simulat\u00f6r u\u00e7u\u015f performans\u0131 ayn\u0131 kald\u0131. U\u00e7u\u015f performans\u0131n\u0131n g\u00f6rme performans\u0131yla zay\u0131f korele oldu\u011fu tek d\u00f6nem, cerrahi sonras\u0131 erken d\u00f6nemdi.<\/p>\n

U\u00e7u\u015f performans\u0131nda genel unsurlardan farkl\u0131 olarak periferik g\u00f6rme alan\u0131, g\u00f6rme bilgisini i\u015fleme ve kognitif fonksiyonlar rol oynamaktad\u0131r. Refraktif cerrahi, kontakt lensler gibi kokpitte g\u00f6zl\u00fckler i\u00e7in gerekli yeri azaltmaktad\u0131r. Ayn\u0131 zamanda parlak \u0131\u015f\u0131k, lens k\u0131r\u0131c\u0131l\u0131\u011f\u0131 ve g\u00f6zl\u00fcklerle ilgili kar\u015f\u0131 kar\u015f\u0131ya kal\u0131nan sorunlar\u0131 da ortadan kald\u0131rmaktad\u0131r. Erken cerrahi sonras\u0131 d\u00f6nemde tespit edilen, LASIK sonras\u0131 u\u00e7u\u015f performans\u0131n\u0131n art\u0131\u015f\u0131 ve PRK\u2019daki stabilite, g\u00f6rme alan\u0131ndaki artma veya g\u00f6zl\u00fcklerin neden oldu\u011fu problemlerin ortadan kalk\u0131\u015f\u0131yla a\u00e7\u0131klanabilir. Deneyimli havac\u0131lar, kendi yetenekleriyle u\u00e7u\u015f performans\u0131ndaki azalman\u0131n \u00fcstesinden gelebilmektedir.<\/p>\n

Bu ara\u015ft\u0131rman\u0131n sonucuna g\u00f6re, refraktif cerrahiden sonraki iyile\u015fme d\u00f6neminde, g\u00f6r\u00fc\u015f performans\u0131ndaki iyile\u015fme a\u00e7\u0131s\u0131ndan YKGK, kontrast duyarl\u0131l\u0131\u011f\u0131na g\u00f6re daha az duyarl\u0131 bulunmu\u015ftur. KHGK testi erken cerrahi sonras\u0131 d\u00f6nemden, 1. aya kadar olan zaman aral\u0131\u011f\u0131nda u\u00e7u\u015f performans\u0131ndaki iyile\u015fmeyi \u00f6nceden tahmin etmede di\u011ferlerine g\u00f6re \u00fcst\u00fcnd\u00fcr. YKGK t\u00fcm pilotlar i\u00e7in u\u00e7u\u015fa geri d\u00f6nme zaman\u0131 i\u00e7in yeterli g\u00fcven vermemektedir. D\u00fc\u015f\u00fck ayd\u0131nlatma \u015fartlar\u0131ndaki, azalm\u0131\u015f u\u00e7u\u015f performans\u0131 da, kontrast duyarl\u0131l\u0131\u011f\u0131ndaki azalma ile ilgili olabilir.<\/p>\n

Kaynak :<\/strong> Van de Pol C, Greig JL, Esrada A, et al. Aviat Space Environ Med 2007;78:547-553.<\/p>\n

\u00c7eviri :<\/strong> Dr. \u0130lkay K\u0131l\u0131\u00e7, Do\u00e7. Dr. \u015eansal Gedik\u00a0 (Ba\u015fkent \u00dcniversitesi T\u0131p Fak\u00fcltesi, G\u00f6z Hastal\u0131klar\u0131 ABD)<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Amerikan Kara Kuvvetleri Ulusal Muhaf\u0131z G\u00fcc\u00fc havac\u0131lar\u0131n\u0131n %32\u2019si refraksiyon kusurlar\u0131n\u0131 d\u00fczeltmek i\u00e7in g\u00f6zl\u00fck veya kontakt lens kullan\u0131m\u0131na ihtiya\u00e7 duymaktad\u0131r. G\u00f6zl\u00fckler genellikle koruyucu maske sistemleri veya ba\u015fa monte edilen cihazlarla ilgili sorunlar\u0131 beraberinde getirmektedir. Kontakt lenslere ise t\u00fcm havac\u0131lar adapte olamamakta ve askeri \u015fartlarda pek de uygun olmamaktad\u0131r. Fotorefraktif Keratektomi (PRK), 1994\u2019ten beri askeri havac\u0131lar i\u00e7in uygunlu\u011fu kan\u0131tlanm\u0131\u015f bir tedavi y\u00f6ntemi […]<\/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-543","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\/543","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=543"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/543\/revisions"}],"predecessor-version":[{"id":545,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/543\/revisions\/545"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=543"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=543"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=543"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}