OÊı·ÏÌÔÏÔÁ›· - Πανελλήνια Οφθαλμολογική Εταιρεία

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 157·ÏÏoÈÒÛÂˆÓ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· Î·È ÂӉ¯fiÌÂÓ· Ù˘ÎfiÚ˘ appleo˘ appleÂÚÈoÚ›˙o˘Ó ÙËÓ ‰˘Ó·ÙfiÙËÙ· ÌÈ·˜ Âapple·Ú-Îo‡˜ Ì˘‰Ú›·Û˘ appleo˘ Â›Ó·È ·ÎfiÌË appleÈo ·Ó·Áη›·ÛÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜. ∏ ÛÙÂÓ‹ ÎfiÚË Â›Ó·È appleoÏ‡Û˘¯Ófi appleÚfi‚ÏËÌ· ÛÙ· Ì¿ÙÈ· appleo˘ ¤¯o˘Ó ˘appleo‚ÏËı›Û ‚ÈÙÚÂÎÙoÌ‹. ÀappleoÏoÁ›˙ÂÙ·È fiÙÈ Ë ÎfiÚË ÌÂÁ¤ıo˘˜Î¿Ùˆ ÙˆÓ 3 mm apple·Ú·ÙËÚÂ›Ù·È ÛÙo 30,4% appleÂÚ›appleo˘ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ, οÙÈ appleo˘ ÂappleÈ‚¿ÏÏÂÈ ‰ÈÂÁ¯ÂÈ-ÚËÙÈο ÙËÓ Â˘Ú›· ¯Ú‹ÛË ‰È·ÛÙoϤˆÓ Ù˘ ÎfiÚ˘(Lacalle 1998). ∏ apple·Úo˘Û›· apple¿ÏÈ Ú‹ÍÂˆÓ ÛÙË ˙›Ó-ÓÂÈo ˙ÒÓË ÂappleÈ‚¿ÏÏÂÈ ÙËÓ ÙÚoappleoappleo›ËÛË Ù˘ Ù¯ÓÈ΋˜appleo˘ appleÚo‚ϤappleÂÈ, apple.¯., ÙoÓ ÂӉ¯fiÌÂÌÓo ·appleoÎÏÂÈÛÌfiÙ˘ Ê·ÎoıÚ˘„›·˜ Î·È ÙËÓ ÂÊ·ÚÌoÁ‹ ÌÈ·˜ Â͈appleÂÚÈ-Ê·ÎÈ΋˜ ·Ê·›ÚÂÛ˘. ∂apple›Û˘ Ë apple·Úo˘Û›· ÌÈ·˜ Û¯¿-Û˘ ÛÙo oapple›ÛıÈo appleÂÚÈÊ¿ÎÈo ·applefi appleÈı·Ófi ÙÚ·˘Ì·ÙÈ-ÛÌfi ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ appleÚoËÁËı›Û˘ ‚ÈÙÚÂÎÙo-Ì‹˜ appleÂÚÈoÚ›˙ÂÈ ÙËÓ ¤Ó‰ÂÈÍË Ê·ÎoıÚ˘„›·˜, ÂÓÒ Û˘-ÓÈÛÙ¿ apple·Ú¿ÏÏËÏ· Î·È Ûo‚·Úfi ÏfiÁo ·appleoÊ˘Á‹˜ Ùo˘Ì·Û¿˙ ÌÂÙ¿ ÙËÓ ·Ó·ÈÛıËÛ›·, ÁÈ·Ù› ˘apple¿Ú¯ÂÈ Î›Ó-‰˘Óo˜ Ù˘ ‰È·Ê˘Á‹˜ Ùo˘ apple˘Ú‹Ó· ÛÙo oapple›ÛıÈo ÙÌ‹Ì·Ùo˘ ‚oÏ‚o‡ (Hutton 1987, Wilbrandt 1994).3. ∏ ‚ÈoÌÂÙÚ›· ÛÙ· Ì¿ÙÈ· ·˘Ù¿ ·ÎoÏo˘ı› Ìȷȉȷ›ÙÂÚË Û˘ÏÏoÁÈÛÙÈ΋. ∂¿Ó appleÚfiÎÂÈÙ·È ÁÈ· Ì¿ÙÈ·appleo˘ ‰ÂÓ ¤¯o˘Ó ÛÈÏÈÎfiÓË, Ë Ì¤ÙÚËÛË ·ÎoÏo˘ı› Ùo˘˜ÎoÈÓo‡˜ ηÓfiÓ˜. Èı·ÓÒ˜ Ó· appleÚo·„o˘Ó ‰Â‰o̤-Ó· appleo˘ ¤¯o˘Ó ÂappleËÚ·Ûı›, Î·È ÂÚÌËÓ‡oÓÙ·È, ·applefiÌ›· ÂappleÈÌ‹Î˘ÓÛË Ùo˘ ‚oÏ‚o‡, ÂappleÂȉ‹ apple·Ú¿ÏÏËÏ· ¤-¯ÂÈ ÙoappleoıÂÙËı› Î·È ¤Ó·˜ appleÂÚÈ‚Úo¯ÈÛÌfi˜. ∏ apple·Úo˘-Û›· fï˜ ÂÓ‰o‚oÏ‚È΋˜ ÛÈÏÈÎfiÓ˘ ηıÈÛÙ¿ ÙË ‚Èo-ÌÂÙÚ›· ·ÛÙ·ı‹ Î·È ÂappleÈÛÊ·Ï‹, οÙÈ appleo˘ ηıÈÛÙ¿·Ó·applefiÊ¢ÎÙË ÛÙȘ appleÂÚÈÛÛfiÙÂÚ˜ ÊoÚ¤˜ ÙËÓ ¤ÌÌÂÛË̤ÙÚËÛË, ‰ËÏ·‰‹ ÙoÓ ˘appleoÏoÁÈÛÌfi Ù˘ ÈÛ¯‡o˜ Ùo˘ÂÓ‰oÊ·Îo‡ ̤ۈ Ù˘ ‚ÈoÌÂÙÚ›·˜ Ùo˘ ¿ÏÏo˘ Ì·ÙÈo‡.ÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜ appleÚ¤appleÂÈ Ó· Û˘Ó˘appleoÏoÁ›˙ÂÙ·ÈÎ·È Ó· appleÚoÛÌÂÙÚ¿Ù·È Âapple›Û˘ Î·È Ë appleÈı·Ó‹ ÌÂÙ·‚o-Ï‹ appleo˘ ÂÈÛ‹Á·Á ÛÙËÓ ‰È¿ıÏ·ÛË ·applefi ÙËÓ ÂappleÈÌ‹Î˘Ó-ÛË Ùo˘ ‚oÏ‚o‡ ¤Ó·˜ Û˘Ó˘apple¿Ú¯ˆÓ ‚Úfi¯o˜. Ú¤appleÂÈÛÙo ÛËÌ›o ·˘Ùfi Ó· Á›ÓÂÈ ÌÓ›· Ùo˘ ÁÂÁoÓfiÙo˜ fiÙÈ ËÂÓ‰o‚oÏ‚È΋ ÛÈÏÈÎfiÓË ÂÈÛ¿ÁÂÈ Ì˘ˆapple›· –7 ‰ÈoappleÙÚÈÒÓÛÙ· ¿Ê·Î· Ì¿ÙÈ·, ˘appleÂÚÌÂÙÚˆapple›· +4 ‰ÈoappleÙÚÈÒÓÛÙ· ¤Ìʷη Î·È +2 ‰ÈoappleÙÚÈÒÓ ÛÙ· „¢‰o-Ê·ÎÈο. ∂appleo̤ӈ˜, Â¿Ó ˘apple¿Ú¯ÂÈ Ë appleÚfi‚Ï„Ë, apple.¯.fiÙÈ Ë ÛÈÏÈÎfiÓË ı· apple·Ú·Ì›ÓÂÈ ÌfiÓÈÌ· ÛÙo ¯ÒÚo Ùo˘˘·ÏoÂȉo‡˜, appleÚ¤appleÂÈ o ÂÓ‰oÊ·Îfi˜ appleo˘ ı· ÙoappleoıÂÙËı›ӷ Â›Ó·È Î·Ù¿ ‰‡o ‰ÈoappleÙڛ˜ ÈÛ¯˘ÚfiÙÂÚo˜ (¢Â-ÚÂÎÏ‹˜ 1989, 1992, 1995).4. ∏ ÂappleÈÏoÁ‹ Ù˘ Ù¯ÓÈ΋˜ Î·È Ùo˘ ›‰o˘˜ Ùo˘ÂÓ‰oÊ·Îo‡ appleo˘ ı· ¯ÚËÛÈÌoappleoÈËı› ·ÎoÏo˘ıo‡ÓοappleoÈo˘˜ ÁÂÓÈο apple·Ú·‰ÂÎÙo‡˜ ηÓfiÓ˜, apple¤Ú· ·applefiÙo˘˜ oappleo›o˘˜ o οı ¯ÂÈÚo˘ÚÁfi˜ ¤¯ÂÈ ÙËÓ appleÚoÛˆappleÈ΋Ùo˘ ¿appleo„Ë. ŸÏoÈ Û˘ÌʈÓo‡Ó, apple.¯., fiÙÈ oÈ ÂÓ-‰oÊ·Îo› ÛÈÏÈÎfiÓ˘ ·appleoÙÂÏo‡Ó ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙȘappleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜. ∂›Ù ÁÈ·Ù› ˘apple¿Ú¯ÂÈ ÛÈÏÈÎfiÓË,›Ù ˘apple¿Ú¯ÂÈ Ùo ÂӉ¯fiÌÂÓo Ó· Âapple·Ó·¯ÚËÛÈÌoappleoÈ-Ëı› ·˘Ù‹. Δo ›‰Èo ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙȘ appleÂÚÈappleÙÒÛÂȘappleo˘ ˘apple¿Ú¯ÂÈ ·¤ÚÈo. °ÂÓÈÎfi˜, Âapple›Û˘, ηÓfiÓ·˜ ›-Ó·È Ë ÂÊ·ÚÌoÁ‹ ÛÎÏËÚÈ΋˜ ‹ ÛÎÏËÚoÎÂÚ·ÙÈ΋˜ Ùo-Ì‹˜ ÛÙËÓ 12 Ë ÒÚ·, ÂappleÂȉ‹ Â›Ó·È ÛÙ·ıÂÚ‹, Âappleo˘ÏÒ-ÓÂÙ·È appleÈo ÁÚ‹ÁoÚ· Î·È Â›Ó·È appleÈo ·ÛÊ·Ï‹˜ ÁÈ·Ù›appleÚoÛٷهÂÙ·È ·applefi Ùo apple¿Óˆ ‚ϤʷÚo, ÂÓÒ ·ÓÙ›ıÂ-Ù·, Ë ÎÂÚ·ÙÈ΋ ÙoÌ‹ ‹ Ë ÎÚoÙ·ÊÈ΋ ÙoÌ‹ ıˆÚo‡-ÓÙ·È ·appleoÚÚÈapple٤˜ ÛÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜ ÁÈ·Ù›·ÎÚÈ‚Ò˜ ‰ÂÓ appleÏËÚo‡Ó ÙȘ apple·Ú·apple¿Óˆ appleÚo¸appleoı¤ÛÂȘ(Mc Dermott 1997).∏ ÂappleÈÏoÁ‹ Ùo˘ ›‰o˘˜ Ùo˘ ÂÓ‰oÊ·Îo‡ ÎÏ›ÓÂÈÌ¿ÏÏoÓ appleÚo˜ ÙË ÌÂÚÈ¿ ÂÓfi˜ ƒªª∞ ÂÓ‰oÊ·Îo‡‰È·Ì¤ÙÚo˘ 7 ¯ÈÏ., ¯ˆÚ›˜ ÙÚ‡apple˜, appleo˘ ÙoappleoıÂÙ›ٷȷapplefi ÙË 12 Ë ÒÚ·. ∞˘Ùfi ÂÎÊÚ¿˙ÂÈ ÙËÓ appleÚoÙ›ÌËÛË ÙˆÓappleÂÚÈÛÛfiÙÂÚˆÓ ¯ÂÈÚo˘ÚÁÒÓ (Mc Dermott 1997, McCuen 1980). To ̤ÁÂıo˜ Î·È Ùo ›‰o˜ Ùo˘ ÂÓ‰oÊ·-Îo‡ ·˘Ùo‡ ·ÛÊ·ÏÒ˜ Ù·ÈÚÈ¿˙o˘Ó appleÂÚÈÛÛfiÙÂÚo ÌÂÙËÓ ÛÎÏËÚoÎÂÚ·ÙÈ΋ ÙoÌ‹ ÁÈ· appleÚoÊ·Ó›˜ ÏfiÁo˘˜.Ú¤appleÂÈ fï˜ Ó· appleÚoÛÙÂı› Â‰Ò fiÙÈ Î·È ·applefi Ù˯ڋÛË ·Ó·‰ÈappleÏo‡ÌÂÓˆÓ ·ÎÚ˘ÏÈÎÒÓ ÂÓ‰oÊ·ÎÒÓ ‰È-·Ì¤ÙÚo˘ 6 ¯ÈÏ., Ùo˘˜ oappleo›o˘˜ ¯ÚËÛÈÌoappleoÈ‹Û·Ì Û·ÚÎÂÙ¿ appleÂÚÈÛÙ·ÙÈο Ì·˜, ¤¯o˘Ì ‰ÂÈ appleoχ ηϿ·appleoÙÂϤÛÌ·Ù· (¢ÂÚÂÎÏ‹˜ 2000).ÃÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋∏ ‚ÈÙÚÂÎÙoÌ‹ ·Ê·ÈÚ› Ùo ˘·ÏoÂȉ¤˜ Î·È ÛÙÂ-Ú› ·applefi Ùo Ê·Îfi Î·È ÙË ˙›ÓÓÂÈo ˙ÒÓË ¤Ó· Ê˘ÛÈoÏo-ÁÈÎfi ÛÙ‹ÚÈÁÌ· Ùo˘ oappleo›o˘ Ë ÛËÌ·Û›· ·Ó·‰ÂÈÎÓ‡Â-Ù·È appleoχ ¤ÌappleÚ·ÎÙ· ÛÙËÓ ¯ÂÈÚo˘ÚÁÈ΋ Ùo˘ ηٷÚ-Ú¿ÎÙË. ∂appleÈappleϤoÓ, Û˘Ó˘apple¿Ú¯o˘Ó ÛÙȘ appleÂÚÈappleÙÒÛÂȘ·˘Ù¤˜ appleoχ Û˘¯Ó¿ Î·È ¿ÏÏoÈ apple·Ú¿ÁoÓÙ˜ appleo˘Âapple·˘Í¿Óo˘Ó ÙË ‚·ÛÈ΋ ‰˘ÛÎoÏ›· appleo˘ appleÚo·appleÙÂÈ·applefi ÙËÓ ·appleo˘Û›· Ùo˘ ˘·ÏoÂȉo‡˜, fiappleˆ˜:1. ∏ ·ÓÂapple·Ú΋˜ Û˘Ó‹ıˆ˜ Ì˘‰Ú›·ÛË.2. O˘Ï¤˜ Î·È apple·Ú·ÌoÚÊÒÛÂȘ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ·.3. ∞‰‡Ó·ÙË ‹ Ûapple·Ṳ̂ÓË ˙›ÓÓÂÈo˜ ˙ÒÓË.4. £oÏÒÛÂȘ Ùo˘ oappleÈÛı›o˘ appleÂÚÈʷΛo˘.5. ƒ‹ÍÂȘ Î·È ·˘ÍË̤ÓË ÎÈÓËÙÈÎfiÙËÙ· Ùo˘ oappleÈ-Ûı›o˘ appleÂÚÈʷΛo˘.6. ∞ÛÙ·ı¤˜ ‚¿ıo˜ Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘.∏ ÂÏÏÈapple‹˜ Ì˘‰Ú›·ÛË ÌappleoÚ› ˆ˜ ¤Ó· ‚·ıÌfi Ó··ÓÙÈÌÂÙˆappleÈÛı› Ì Ùo˘˜ ‰È·ÛÙoÏ›˜ Ù˘ ›Úȉo˜. ∏apple·Ú·Û΢‹ fï˜ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· Â›Ó·È Î·Ù¿ η-ÓfiÓ· ‰‡ÛÎoÏË. ªÈ· ηϋ χÛË ÁÈ’ ·˘Ùfi Â›Ó·È Ë ‰ÈÂ-Ó¤ÚÁÂÈ· ÌÈ·˜ ·apple¢ı›·˜ ÙoÌ‹˜ Ì ¤Ó· ÎoÊÙÂÚfi Ì·-¯·ÈÚ›‰Èo apple¿Óˆ ÛÙo Û‡ÛÙËÌ· ÂappleÈappleÂÊ˘ÎfiÙo˜- ÛÎÏË-