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\r\n Glokom (G\u00f6z Tansiyonu) Nedir? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom, g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n (G\u0130B) s\u0131kl\u0131kla g\u00f6rme sinirinin (optik sinir) fizyolojik olarak tolere edebilece\u011fi seviyenin \u00fczerine \u00e7\u0131kmas\u0131 sonucu geli\u015fen, optik sinir ba\u015f\u0131ndaki ganglion h\u00fccrelerinde apoptoza (programlanm\u0131\u015f h\u00fccre \u00f6l\u00fcm\u00fc) yol a\u00e7an ve tedavi edilmedi\u011finde kal\u0131c\u0131 g\u00f6rme kayb\u0131yla sonu\u00e7lanan kronik, ilerleyici bir optik n\u00f6ropatidir.<\/p>
Optik sinir, retina tabakas\u0131na ula\u015fan \u0131\u015f\u0131k uyaranlar\u0131n\u0131 elektrik sinyallerine d\u00f6n\u00fc\u015ft\u00fcrerek beyindeki g\u00f6rsel kortekse ileten yakla\u015f\u0131k 1,2 milyon sinir lifinden meydana gelir. Glokom hastalar\u0131nda bu sinir lifi tabakas\u0131 zamanla incelir, ekskavasyon (\u00e7ukurla\u015fma) derinle\u015fir ve beyne bilgi ak\u0131\u015f\u0131 kal\u0131c\u0131 olarak kesintiye u\u011frar.<\/p>
Halk aras\u0131nda “g\u00f6z tansiyonu” veya “karasu hastal\u0131\u011f\u0131” olarak da bilinen bu klinik tablo, vakalar\u0131n b\u00fcy\u00fck bir \u00e7o\u011funlu\u011funda sinsi bir seyir takip eder. Erken safhalarda hi\u00e7bir belirti vermedi\u011fi, a\u011fr\u0131 veya an\u00ee g\u00f6rme kayb\u0131 yaratmad\u0131\u011f\u0131 i\u00e7in optik sinir liflerinin \u00f6nemli bir k\u0131sm\u0131 tahrip olana kadar fark edilmeyebilir. Bu nedenle t\u0131p literat\u00fcr\u00fcnde “sessiz g\u00f6rme h\u0131rs\u0131z\u0131” (the silent thief of sight) olarak nitelendirilir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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\r\n H\u00fcm\u00f6r Ak\u00f6z Dinami\u011fi ve G\u00f6z \u0130\u00e7i Bas\u0131nc\u0131n\u0131n Olu\u015fum Mekanizmas\u0131 <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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G\u00f6z\u00fcn \u00f6n kamaras\u0131nda (kornea ile lens aras\u0131nda kalan alan) s\u00fcrekli bir s\u0131v\u0131 sirk\u00fclasyonu mevcuttur. Bu s\u0131v\u0131ya h\u00fcm\u00f6r ak\u00f6z ad\u0131 verilir. H\u00fcm\u00f6r ak\u00f6z, silier cisim (corpus ciliare) taraf\u0131ndan \u00fcretilir, arka kamaradan ge\u00e7erek g\u00f6z bebe\u011fi (pupilla) vas\u0131tas\u0131yla \u00f6n kamaraya ula\u015f\u0131r ve kornea ile irisin birle\u015fti\u011fi “\u00f6n kamara a\u00e7\u0131s\u0131” ad\u0131 verilen anatomik b\u00f6lgeden g\u00f6z\u00fc terk eder.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n S\u0131v\u0131n\u0131n g\u00f6z\u00fc terk etti\u011fi temel mekanizma iki yolla ger\u00e7ekle\u015fir: <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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1. Trabek\u00fcler Yol (Ana D\u0131\u015fa Ak\u0131m Yolu): <\/strong><\/p>
H\u00fcm\u00f6r ak\u00f6z\u00fcn yakla\u015f\u0131k %85-90’\u0131 trabek\u00fcler a\u011fdan (trabecular meshwork) ge\u00e7erek Schlemm kanal\u0131na, oradan da episkleral ven\u00f6z sisteme akar.<\/p>
2. \u00dcveoskleral Yol (Alternatif D\u0131\u015fa Ak\u0131m Yolu):<\/strong><\/p>
S\u0131v\u0131n\u0131n yakla\u015f\u0131k %10-15’i silier kas lifleri aras\u0131ndan ge\u00e7erek \u00fcveal ve skleral dokulara s\u00fcz\u00fcl\u00fcr.<\/p>
G\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n fizyolojik seviyede tutulabilmesi, \u00fcretilen h\u00fcm\u00f6r ak\u00f6z miktar\u0131 ile d\u0131\u015fa ak\u0131m h\u0131z\u0131 aras\u0131ndaki hassas dengeye ba\u011fl\u0131d\u0131r. Glokom tablosunda s\u0131v\u0131 \u00fcretimi genellikle normaldir; ancak d\u0131\u015fa ak\u0131m kanallar\u0131nda olu\u015fan diren\u00e7 (trabek\u00fcler a\u011fdaki t\u0131kan\u0131kl\u0131klar veya anatomik daralmalar) s\u0131v\u0131n\u0131n tahliyesini zorla\u015ft\u0131r\u0131r. G\u00f6z k\u00fcresi kapal\u0131 ve esnekli\u011fi s\u0131n\u0131rl\u0131 bir yap\u0131 oldu\u011fundan, i\u00e7eride biriken s\u0131v\u0131 hidrostatik bas\u0131nc\u0131 art\u0131r\u0131r. Y\u00fckselen bu bas\u0131n\u00e7, g\u00f6z\u00fcn en hassas n\u00f6ral yap\u0131s\u0131 olan optik sinir ba\u015f\u0131 \u00fczerine s\u00fcrekli mekanik stres ve vask\u00fcler bask\u0131 uygular.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n G\u00f6z \u0130\u00e7i Bas\u0131nc\u0131 Fizyolojisi: Ka\u00e7 Olmal\u0131 ve Nas\u0131l \u00d6l\u00e7\u00fcl\u00fcr? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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G\u00f6z i\u00e7i bas\u0131nc\u0131, milimetre c\u0131va (mmHg) cinsinden ifade edilir. Sa\u011fl\u0131kl\u0131 adult bir pop\u00fclasyonda ortalama g\u00f6z i\u00e7i bas\u0131nc\u0131 15-16 mmHg civar\u0131ndad\u0131r. Ancak istatistiksel standart sapmalar dahilinde normal kabul edilen g\u00f6z i\u00e7i bas\u0131nc\u0131 aral\u0131\u011f\u0131 10 mmHg ile 21 mmHg aras\u0131d\u0131r.<\/p>
Ok\u00fcler Hipertansiyon (21 mmHg \u00dczeri): G\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n 21 mmHg s\u0131n\u0131r\u0131n\u0131n \u00fczerinde \u00f6l\u00e7\u00fcld\u00fc\u011f\u00fc, ancak yap\u0131lan tetkiklerde (OCT, G\u00f6rsel Alan) hen\u00fcz g\u00f6rme sinirinde veya g\u00f6rme alan\u0131nda bir hasar\u0131n saptanmad\u0131\u011f\u0131 klinik durumdur. Bu hastalar “glokom \u015f\u00fcphelisi” olarak kabul edilir ve tedaviye ba\u015flanmasa dahi yak\u0131n takibe al\u0131n\u0131r.<\/li>
G\u00f6z Tansiyonu D\u00fc\u015f\u00fckl\u00fc\u011f\u00fc (Hipotoni): G\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n 6 mmHg’nin alt\u0131na d\u00fc\u015fmesi durumudur. Genellikle ge\u00e7irilmi\u015f cerrahiler, g\u00f6z i\u00e7i travmalar veya inflamasyon (\u00fcveit) sonras\u0131 geli\u015fir. Makulopatiye ve g\u00f6rme kalitesinde ciddi d\u00fc\u015f\u00fc\u015fe yol a\u00e7abilir.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n G\u00f6z \u0130\u00e7i Bas\u0131nc\u0131n\u0131n Zamansal ve Fizyolojik De\u011fi\u015fimleri (Diurnal Variasyon) <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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G\u00f6z i\u00e7i bas\u0131nc\u0131 sabit bir de\u011fer de\u011fildir; g\u00fcn i\u00e7inde (diurnal ritim) dalgalanmalar g\u00f6sterir. Sa\u011fl\u0131kl\u0131 bireylerde g\u00fcn i\u00e7i dalgalanma 2-5 mmHg aras\u0131nda kal\u0131rken, glokom hastalar\u0131nda bu fark 8-10 mmHg seviyelerine \u00e7\u0131kabilir. Bas\u0131n\u00e7 genellikle kortizol salg\u0131s\u0131n\u0131n artt\u0131\u011f\u0131 ve s\u0131rt\u00fcst\u00fc yat\u0131\u015f pozisyonunun venous bas\u0131nc\u0131 art\u0131rd\u0131\u011f\u0131 sabah\u0131n erken saatlerinde en y\u00fcksek seviyededir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n G\u00f6z Tansiyonu \u00d6l\u00e7\u00fcm\u00fc ve Tetkik Y\u00f6ntemleri <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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G\u00f6z tansiyonu tek ba\u015f\u0131na elle muayene edilerek veya sadece hava \u00fcfleyen cihazlarla kesin olarak de\u011ferlendirilemez. Hassas klinik tan\u0131 i\u00e7in \u015fu y\u00f6ntemler kullan\u0131l\u0131r:<\/p>
1. Goldmann Applanasyon Tonometresi:<\/strong><\/p>
G\u00f6z i\u00e7i bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fcnde alt\u0131n standart (gold standard) kabul edilen tekniktir. Biyomikroskop (\u0131\u015f\u0131kl\u0131 muayene mikroskobu) \u00fczerine monte edilen \u00f6zel bir prizma vas\u0131tas\u0131yla, korneay\u0131 belirli bir alanda d\u00fczle\u015ftirmek i\u00e7in gereken kuvvet hesaplanarak \u00f6l\u00e7\u00fcm yap\u0131l\u0131r. \u00d6l\u00e7\u00fcm \u00f6ncesinde g\u00f6ze lokal anestezik ve florosein damlat\u0131l\u0131r.<\/p>
2. Non-Kontak (Hava \u00dcflemeli) Tonometri:<\/strong><\/p>
Korneaya temas etmeden, kontroll\u00fc bir hava jeti p\u00fcsk\u00fcrterek korneadaki esnemeyi \u00f6l\u00e7en tarama y\u00f6ntemidir. Pratik olmas\u0131 nedeniyle poliklinik taramalar\u0131nda s\u0131k kullan\u0131l\u0131r; ancak y\u00fcksek de\u011ferlerde mutlaka applanasyon tonometresi ile do\u011frulanmal\u0131d\u0131r.<\/p>
3. Rebound Tonometri (iCare): <\/strong><\/p>
Korneaya \u00e7ok hafif ve h\u0131zl\u0131 bir mikro-probla dokunarak \u00f6l\u00e7\u00fcm yapan, anestezi gerektirmeyen, \u00e7ocuklarda ve uyum g\u00fc\u00e7l\u00fc\u011f\u00fc \u00e7eken hastalarda tercih edilen y\u00f6ntemdir.<\/p>
3. Pakimetri (Kornea Kal\u0131nl\u0131k \u00d6l\u00e7\u00fcm\u00fc):<\/strong><\/p>
Tonometre cihazlar\u0131, kornea kal\u0131nl\u0131\u011f\u0131n\u0131 ortalama 530-550 mikron kabul ederek hesaplama yapar. Ancak santral kornea kal\u0131nl\u0131\u011f\u0131 (SKK) ince olan bireylerde (\u00f6rne\u011fin 490 mikron) g\u00f6z tansiyonu oldu\u011fundan d\u00fc\u015f\u00fck, kal\u0131n olan bireylerde (\u00f6rne\u011fin 600 mikron) ise oldu\u011fundan y\u00fcksek \u00f6l\u00e7\u00fcl\u00fcr. Bu nedenle her glokom \u015f\u00fcphelisinde pakimetri ile kornea kal\u0131nl\u0131\u011f\u0131 \u00f6l\u00e7\u00fclerek “d\u00fczeltilmi\u015f g\u00f6z i\u00e7i bas\u0131nc\u0131” de\u011feri elde edilmelidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokom \u00c7e\u015fitleri ve Etiyolojik S\u0131n\u0131fland\u0131rma <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom, tek bir hastal\u0131k de\u011fil; anatomik mekanizmalar\u0131na, etiyolojilerine ve ortaya \u00e7\u0131kt\u0131klar\u0131 ya\u015f grubuna g\u00f6re farkl\u0131la\u015fan geni\u015f bir hastal\u0131k grubudur.<\/p>
A. Primer A\u00e7\u0131k A\u00e7\u0131l\u0131 Glokom (PAAG)<\/strong><\/p>
Glokom vakalar\u0131n\u0131n yakla\u015f\u0131k %80-85’ini olu\u015fturan en yayg\u0131n formdur. \u00d6n kamara a\u00e7\u0131s\u0131 anatomik olarak a\u00e7\u0131kt\u0131r; ancak trabek\u00fcler a\u011f\u0131n h\u00fccresel ve matriks d\u00fczeyindeki mikroskobik bozulmalar\u0131 nedeniyle s\u0131v\u0131n\u0131n mikro-kanallardan ge\u00e7i\u015f direnci artm\u0131\u015ft\u0131r. A\u011fr\u0131s\u0131zd\u0131r, \u00e7ok yava\u015f ilerler ve hastalar genellikle son safhaya kadar hi\u00e7bir \u015fikayet hissetmezler.<\/p>
B. Kapal\u0131 (Dar) A\u00e7\u0131l\u0131 Glokom (PKAG)<\/strong><\/p>
G\u00f6z\u00fcn \u00f6n kamara a\u00e7\u0131s\u0131n\u0131n anatomik olarak iris k\u00f6k\u00fc taraf\u0131ndan fiziksel olarak kapat\u0131lmas\u0131 veya daralt\u0131lmas\u0131 sonucu olu\u015fur.<\/p>
Kronik Dar A\u00e7\u0131l\u0131 Glokom:<\/strong> A\u00e7\u0131, zaman i\u00e7inde kademeli ve a\u011fr\u0131s\u0131z olarak kapan\u0131r.<\/li>
Akut A\u00e7\u0131 Kapanmas\u0131 Krizi (Glokom Krizi):<\/strong> \u0130risin ans\u0131z\u0131n trabek\u00fcler a\u011f\u0131 tamamen t\u0131kamas\u0131yla g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n saatler i\u00e7inde 50-70 mmHg seviyelerine f\u0131rlad\u0131\u011f\u0131 acil medikal durumdur. \u015eiddetli g\u00f6z ve ba\u015f a\u011fr\u0131s\u0131, bulant\u0131, kusma, g\u00f6rmede ani bulan\u0131kl\u0131k ve \u0131\u015f\u0131klar etraf\u0131nda renkli halkalar (h\u00e2lo) g\u00f6r\u00fclmesi ile karakterizedir. Acil tedavi uygulanmazsa g\u00fcnler i\u00e7inde kal\u0131c\u0131 k\u00f6rl\u00fck geli\u015febilir.<\/li><\/ul>
C. Normal Tansiyonlu Glokom (NTG) \/ D\u00fc\u015f\u00fck Tansiyonlu Glokom<\/strong><\/p>
G\u00f6z i\u00e7i bas\u0131nc\u0131 s\u00fcrekli olarak 21 mmHg’nin alt\u0131nda (statistiki normal s\u0131n\u0131rlar i\u00e7inde) seyretmesine ra\u011fmen, optik sinir ba\u015f\u0131nda glokomat\u00f6z \u00e7ukurla\u015fma ve karakterize g\u00f6rme alan\u0131 kay\u0131plar\u0131n\u0131n geli\u015fti\u011fi tablodur.<\/p>
Mekanizma: <\/strong>Bu hastalarda ana fakt\u00f6r y\u00fcksek bas\u0131n\u00e7tan ziyade, optik sinir ba\u015f\u0131n\u0131n mekanik bas\u0131nca kar\u015f\u0131 a\u015f\u0131r\u0131 duyarl\u0131l\u0131\u011f\u0131 veya n\u00f6ronlar\u0131 besleyen mikro-damarsal yap\u0131lardaki perf\u00fczyon bozuklu\u011fudur (vask\u00fcler yetmezlik).<\/li>
\u0130li\u015fkili Tablolar:<\/strong> Raynaud fenomeni (so\u011fukta el ve ayaklarda morarma), migren, gece d\u00fc\u015f\u00fck tansiyonu (nocturnal dip) ve sistemik dola\u015f\u0131m bozukluklar\u0131 olan bireylerde daha s\u0131k g\u00f6r\u00fcl\u00fcr.<\/li><\/ul>
D. Konjenital ve J\u00fcvenil (\u00c7ocukluk\/Gen\u00e7lik \u00c7a\u011f\u0131) Glokom<\/strong><\/p>
Do\u011fumdan itibaren veya hayat\u0131n ilk y\u0131llar\u0131nda ortaya \u00e7\u0131kan geli\u015fimsel tip glokomlard\u0131r.<\/p>
Primer \u0130nfantil (Bebeklik) Glokomu:<\/strong> \u00d6n kamara a\u00e7\u0131s\u0131n\u0131n anne karn\u0131ndaki geli\u015fimi s\u0131ras\u0131nda Trabek\u00fclodisgenezis (doku art\u0131\u011f\u0131 mevcudiyeti) nedeniyle olu\u015fur. Bebeklerde sclera ve kornea esnek oldu\u011fu i\u00e7in y\u00fckselen g\u00f6z i\u00e7i bas\u0131nc\u0131 g\u00f6z k\u00fcresinin b\u00fcy\u00fcmesine yol a\u00e7ar (Buftalmus \/ \u00d6k\u00fcz G\u00f6z\u00fc g\u00f6r\u00fcnt\u00fcs\u00fc). En belirgin semptomlar: Fotofobi (\u0131\u015f\u0131ktan rahats\u0131z olma ve g\u00f6z\u00fc ka\u00e7\u0131rma), Epifora (a\u015f\u0131r\u0131 sulanma) ve Blefarospazm (g\u00f6z kapaklar\u0131n\u0131 kasarak kapatma) \u00fc\u00e7l\u00fcs\u00fcd\u00fcr. Kornea saydaml\u0131\u011f\u0131n\u0131 kaybederek mat, puslu (\u00f6demli) bir g\u00f6r\u00fcn\u00fcm al\u0131r.<\/li>
J\u00fcvenil Glokom:<\/strong> 3 ila 35 ya\u015flar\u0131 aras\u0131nda ortaya \u00e7\u0131kan, genellikle otozomal dominant ge\u00e7i\u015f g\u00f6steren ve y\u00fcksek g\u00f6z i\u00e7i bas\u0131nc\u0131 de\u011ferleriyle seyreden tiptir.<\/li><\/ul>
E. Sekonder Glokomlar <\/strong><\/p>
Ba\u015fka bir g\u00f6z hastal\u0131\u011f\u0131, travma veya sistemik fakt\u00f6r sonucunda g\u00f6z i\u00e7i s\u0131v\u0131 dinami\u011finin bozulmas\u0131yla geli\u015fir:<\/p>
Ps\u00f6doeksfolyatif (PEX) Glokom:<\/strong> G\u00f6z i\u00e7i dokular\u0131ndan d\u00f6k\u00fclen fibriller, kepek benzeri protein bazl\u0131 materyallerin (eksfoliasyon maddesi) trabek\u00fcler a\u011f\u0131 t\u0131kayarak bas\u0131nc\u0131 y\u00fckseltmesidir. Olduk\u00e7a agresif seyirlidir ve ila\u00e7 tedavisine diren\u00e7 g\u00f6sterme e\u011filimi y\u00fcksektir.<\/li>
Pigmenter Glokom:<\/strong> \u0130risin arka y\u00fczeyinin lens liflerine s\u00fcrt\u00fcnmesi sonucu d\u00f6k\u00fclen pigment gran\u00fcllerinin \u00f6n kamara a\u00e7\u0131s\u0131n\u0131 s\u00fczge\u00e7 gibi t\u0131kamas\u0131yla olu\u015fur. Genellikle gen\u00e7, miyop erkeklerde g\u00f6r\u00fcl\u00fcr.<\/li>
Neovask\u00fcler Glokom:<\/strong> Diyabetik retinopati veya retinal ven t\u0131kan\u0131kl\u0131\u011f\u0131 gibi iskemiye (oksijensizli\u011fe) yol a\u00e7an hastal\u0131klarda, retinadan salg\u0131lanan VEGF maddesi nedeniyle \u00f6n kamara a\u00e7\u0131s\u0131nda yeni ve patolojik damarlar\u0131n olu\u015fmas\u0131 (rubeosis iridis) ve bu damarlar\u0131n a\u00e7\u0131y\u0131 kapatmas\u0131yla meydana gelir. Tedavisi son derece g\u00fc\u00e7 ve a\u011fr\u0131l\u0131 bir t\u00fcrd\u00fcr.<\/li>
Steroid \u0130nd\u00fckl\u00fc Glokom:<\/strong> Kortikosteroid i\u00e7eren g\u00f6z damlalar\u0131n\u0131n, pomadlar\u0131n\u0131n, enjeksiyonlar\u0131n\u0131n veya sistemik kortizon ila\u00e7lar\u0131n\u0131n uzun s\u00fcreli kullan\u0131m\u0131 sonucu trabek\u00fcler d\u0131\u015fa ak\u0131m direncinin artmas\u0131yla geli\u015fir.<\/li>
Uveitik Glokom: <\/strong>G\u00f6z i\u00e7i iltihabi reaksiyonlar\u0131n (\u00fcveit) h\u00fccresel d\u00f6k\u00fcnt\u00fclerle drenaj kanallar\u0131n\u0131 t\u0131kamas\u0131 veya yap\u0131\u015f\u0131kl\u0131klara (sine\u015fi) yol a\u00e7mas\u0131 sonucu olu\u015fur.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Risk Fakt\u00f6rleri ve Patofizyoloji: G\u00f6z Tansiyonu Neden Olur ve Y\u00fckselir? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom multifakt\u00f6riyel bir hastal\u0131kt\u0131r. Optik sinirin hasar g\u00f6rmesine yol a\u00e7an iki temel teorik mekanizma bulunmaktad\u0131r:<\/p>
1. Mekanik Teori:<\/strong><\/p>
Y\u00fckselen g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n, optik sinir liflerinin g\u00f6z k\u00fcresinden d\u0131\u015far\u0131 \u00e7\u0131kt\u0131\u011f\u0131 “lamina kribrosa” ad\u0131 verilen delikli yap\u0131ya fiziksel bask\u0131 uygulayarak axoplasmik ak\u0131\u015f\u0131 (sinir i\u00e7i besin iletimini) durdurmas\u0131 ve h\u00fccresel y\u0131k\u0131m\u0131 ba\u015flatmas\u0131.<\/p>
2. Vask\u00fcler Teori:<\/strong><\/p>
Optik sinir ba\u015f\u0131n\u0131 besleyen siliyer arter sistemindeki kan ak\u0131m\u0131n\u0131n azalmas\u0131, mikro-iskemi geli\u015fmesi ve serbest radikallerin etkisiyle sinir dokusunun oksijensiz kalarak harabiyete u\u011framas\u0131.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Temel Risk Fakt\u00f6rleri: <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u0130leri Ya\u015f:<\/strong> 40 ya\u015f sonras\u0131 risk katlanarak artar. 70 ya\u015f \u00fcst\u00fcnde g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 en y\u00fcksek seviyededir.<\/li>
Genetik \/ Aile \u00d6yk\u00fcs\u00fc: <\/strong>Birinci derece akrabalar\u0131nda glokom olan bireylerde risk 4 ila 9 kat daha y\u00fcksektir.<\/li>
Y\u00fcksek G\u00f6z \u0130\u00e7i Bas\u0131nc\u0131:<\/strong> En \u00f6nemli ve m\u00fcdahale edilebilir tek primer risk fakt\u00f6r\u00fcd\u00fcr.<\/li>
K\u0131rma Kusurlar\u0131:<\/strong> Y\u00fcksek Miyopi (A\u00e7\u0131k a\u00e7\u0131l\u0131 glokom riskini art\u0131r\u0131r), Y\u00fcksek Hipermetropi (Kapal\u0131 a\u00e7\u0131l\u0131 glokom riskini art\u0131r\u0131r).<\/li>
Santral Kornea \u0130nceli\u011fi:<\/strong> Kornea kal\u0131nl\u0131\u011f\u0131n\u0131n 500 mikronun alt\u0131nda olmas\u0131 glokomat\u00f6z hasar riskini ba\u011f\u0131ms\u0131z olarak art\u0131r\u0131r.<\/li>
Sistemik Hastal\u0131klar:<\/strong> Diyabet, Sistemik Hipertansiyon, Hipotansiyon, Migren, Vasospazm, Uyku Apne Sendromu.<\/li>
Uzun S\u00fcreli Kortizon Kullan\u0131m\u0131:<\/strong> Duyarl\u0131 ki\u015filerde g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131 belirgin \u015fekilde y\u00fckseltir.<\/li>
G\u00f6z Travmalar\u0131:<\/strong> K\u00fcnt travmalar a\u00e7\u0131 gerilemesine (angle recession) ve y\u0131llar sonra sekonder glokoma yol a\u00e7abilir.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokom Kal\u0131tsal ve Genetik midir? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Evet, glokom genetik yatk\u0131nl\u0131\u011f\u0131 son derece y\u00fcksek bir hastal\u0131kt\u0131r. Molek\u00fcler genetik \u00e7al\u0131\u015fmalarda glokom ile ili\u015fkili birden fazla gen lokusu tan\u0131mlanm\u0131\u015ft\u0131r:<\/p>
MYOC (Myocilin): <\/strong>Primer a\u00e7\u0131k a\u00e7\u0131l\u0131 glokom ve j\u00fcvenil glokom vakalar\u0131yla do\u011frudan ili\u015fkilidir.<\/li>
OPTN (Optineurin):<\/strong> Normal tansiyonlu glokom vakalar\u0131nda s\u0131k\u00e7a tespit edilir.<\/li>
CYP1B1: <\/strong>Primer konjenital glokom vakalar\u0131n\u0131n otozomal resesif ge\u00e7i\u015finde anahtar rol oynar.<\/li><\/ul>
Ailesinde glokom tan\u0131s\u0131 bulunan t\u00fcm bireylerin 35 ya\u015f\u0131ndan itibaren y\u0131ll\u0131k rutin glokom tarama muayenelerinden ge\u00e7mesi medikal bir zorunluluktur.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Klinik Belirtiler ve \u0130lerleme S\u00fcreci: Hastal\u0131k Nas\u0131l Anla\u015f\u0131l\u0131r? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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A\u00e7\u0131k a\u00e7\u0131l\u0131 glokomun en tehlikeli yan\u0131 erken ve orta safhalarda hi\u00e7bir a\u011fr\u0131, k\u0131zar\u0131kl\u0131k, \u00e7apaklanma veya hissi belirti vermemesidir. Hastan\u0131n g\u00f6rme keskinli\u011fi (kar\u015f\u0131ya bakt\u0131\u011f\u0131nda g\u00f6rd\u00fc\u011f\u00fc detaylar) hastal\u0131\u011f\u0131n son a\u015famas\u0131na kadar %100 seviyesinde kalabilir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n G\u00f6rme Alan\u0131 Kayb\u0131 ve \"T\u00fcnel G\u00f6rme\" Mekanizmas\u0131 <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokomat\u00f6z hasar ilk olarak retinan\u0131n perifer (\u00e7evre) liflerinde ba\u015flar. Bu nedenle ilk kay\u0131plar \u00fcst, alt veya yan g\u00f6rme alanlar\u0131nda skotom (k\u00f6r nokta) \u015feklinde ortaya \u00e7\u0131kar.<\/p>
Erken Evre:<\/strong> Hastan\u0131n fark edemedi\u011fi, sadece bilgisayarl\u0131 g\u00f6rme alan\u0131 testinde \u00e7\u0131kan k\u00fc\u00e7\u00fck nasal (burun taraf\u0131) veya dairesel g\u00f6rme alan eksiklikleri.<\/li>
Orta Evre:<\/strong> G\u00f6rme alan\u0131ndaki k\u00f6r noktalar\u0131n birle\u015ferek geni\u015flemesi; hastan\u0131n yan\u0131ndan ge\u00e7en ara\u00e7lar\u0131, e\u015fyalar\u0131 veya insanlar\u0131 fark etmekte zorlanmas\u0131, tak\u0131l\u0131p d\u00fc\u015fmelerin ba\u015flamas\u0131.<\/li>
\u0130leri Evre (T\u00fcnel G\u00f6rme):<\/strong> D\u0131\u015f \u00e7evre tamamen karanl\u0131\u011fa b\u00fcr\u00fcnm\u00fc\u015ft\u00fcr. Hasta sanki uzun bir borunun veya t\u00fcnelin i\u00e7inden bak\u0131yormu\u015f gibi sadece tam kar\u015f\u0131daki dar bir alan\u0131 g\u00f6r\u00fcr.<\/li>
Son Evre (K\u00f6rl\u00fck):<\/strong> T\u00fcnelin de kapanmas\u0131yla santral g\u00f6rme tamamen kaybolur ve \u0131\u015f\u0131k alg\u0131s\u0131 dahi yitirilebilir.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokom A\u011fr\u0131 Yapar m\u0131? Ba\u015f A\u011fr\u0131s\u0131 ve G\u00f6z A\u011fr\u0131s\u0131 \u0130li\u015fkisi <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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A\u00e7\u0131k A\u00e7\u0131l\u0131 Glokom:<\/strong> Kesinlikle a\u011fr\u0131 yapmaz. Hastalar g\u00f6zlerinde bas\u0131n\u00e7, dolgunluk veya a\u011fr\u0131 hissetmezler.<\/li>
Kapal\u0131 A\u00e7\u0131l\u0131 Glokom Krizi: <\/strong>Dayan\u0131lmaz derecede \u015fiddetli, g\u00f6z i\u00e7ine lokalize olan ve ayn\u0131 taraftaki \u015fakak ile ba\u015f b\u00f6lgesine yay\u0131lan \u015fiddetli a\u011fr\u0131 yapar. A\u011fr\u0131ya bulant\u0131, kusma ve kalp h\u0131z\u0131nda yava\u015flama (bradikardi) e\u015flik edebilir.<\/li>
Ge\u00e7ici Tansiyon Y\u00fckselmeleri:<\/strong> G\u00f6z tansiyonunun 30-40 mmHg band\u0131na \u00e7\u0131kt\u0131\u011f\u0131 durumlarda g\u00f6z\u00fcn arkas\u0131nda hafif bir k\u00fcnt a\u011fr\u0131, a\u011f\u0131rl\u0131k hissi veya ak\u015fam saatlerinde \u0131\u015f\u0131klar\u0131n etraf\u0131nda renkli harelenmeler g\u00f6r\u00fclebilir.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokom \u0130lerler mi? \u0130lerleme (Progresyon) Nas\u0131l Durdurulur? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom m\u00fcdahale edilmedi\u011fi takdirde do\u011fas\u0131 gere\u011fi s\u00fcrekli ilerleyen bir hastal\u0131kt\u0131r. Bir kez \u00f6len retina ganglion h\u00fccresi ve optik sinir lifi kendisini yenileyemez (rejenerasyon yetene\u011fi yoktur). Bu nedenle glokomda ama\u00e7 kaybolan g\u00f6rmeyi geri getirmek de\u011fil, mevcut g\u00f6rme seviyesini korumak ve ilerlemeyi durdurmakt\u0131r.<\/p>
\u0130lerlemenin durdurulmas\u0131 tamamen g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n hastaya \u00f6zel hesaplanan “Hedef Bas\u0131n\u00e7” seviyesine \u00e7ekilmesi ve bu seviyede 24 saat boyunca stabil tutulmas\u0131 ile m\u00fcmk\u00fcnd\u00fcr.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Tan\u0131 ve Te\u015fhis Y\u00f6ntemleri: Glokom Muayenesi Nas\u0131l Yap\u0131l\u0131r? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom tan\u0131s\u0131 tek bir testle konulamaz. Kapsaml\u0131 bir glokom analiz protokol\u00fc gerektirir:<\/p>
1. Gonyoskopi (A\u00e7\u0131 Muayenesi)<\/strong><\/p>
\u00d6zel aynal\u0131 bir lens (Goldmann 3 aynal\u0131 lens veya gonyolens) kornea \u00fczerine yerle\u015ftirilerek g\u00f6z\u00fcn \u00f6n kamara a\u00e7\u0131s\u0131n\u0131n direkt olarak g\u00f6rselle\u015ftirilmesidir. A\u00e7\u0131n\u0131n a\u00e7\u0131k, dar veya kapal\u0131 oldu\u011fu, pigmentasyon derecesi, yap\u0131\u015f\u0131kl\u0131klar (sine\u015fi) ve patolojik yap\u0131lar\u0131n varl\u0131\u011f\u0131 bu muayene ile saptan\u0131r. Glokom tipinin belirlenmesinde kritik rol oynar.<\/p>
2. Fundus Muayenesi (Optik Sinir Ba\u015f\u0131 De\u011ferlendirmesi)<\/strong><\/p>
Damlal\u0131 veya damlas\u0131z olarak ophthalmoskop ya da biyomikroskopik lensler ile optik disk (g\u00f6rme sinirinin g\u00f6ze girdi\u011fi ba\u015f b\u00f6lgesi) incelenir.<\/p>
\u00c7ukur\/Disk Oran\u0131 (C\/D Oran\u0131):<\/strong> Optik disk merkezindeki \u00e7ukurlu\u011fun t\u00fcm diske oran\u0131 de\u011ferlendirilir. Normalde 0.3 civar\u0131nda olan bu oran\u0131n 0.5 \u00fczerine \u00e7\u0131kmas\u0131, iki g\u00f6z aras\u0131nda 0.2’den fazla fark olmas\u0131 veya \u00e7ukurlu\u011fun dikey eksende geni\u015flemesi glokomat\u00f6z hasar\u0131n g\u00f6stergesidir.<\/li>
Retinal sinir lifi tabakas\u0131 soluklu\u011fu ve optik disk kenar\u0131ndaki k\u0131ym\u0131ks\u0131 kanamalar (Notch ve Drance kanamalar\u0131) glokomun belirgin bulgular\u0131ndand\u0131r.<\/li><\/ul>
3. Optik Koherens Tomografi (OCT – G\u00f6rme Siniri Tomografisi)<\/strong><\/p>
G\u00fcn\u00fcm\u00fcz glokom tan\u0131s\u0131nda ve takibinde \u00e7\u0131\u011f\u0131r a\u00e7an, mikron d\u00fczeyinde \u00e7\u00f6z\u00fcn\u00fcrl\u00fck sunan non-invaziv bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir.<\/p>
RNFL (Retinal Nerve Fiber Layer) Analizi:<\/strong> Optik sinir etraf\u0131ndaki sinir lifi tabakas\u0131n\u0131n kal\u0131nl\u0131\u011f\u0131n\u0131 mikron cinsinden \u00f6l\u00e7er. Sa\u011fl\u0131kl\u0131 ve glokomat\u00f6z alanlar\u0131 renk kodlar\u0131yla haritaland\u0131r\u0131r.<\/li>
GHC (Ganglion H\u00fccre Kompleksi) Analizi: <\/strong>Retinan\u0131n makula (sar\u0131 nokta) b\u00f6lgesindeki ganglion h\u00fccrelerinin h\u00fccresel kayb\u0131n\u0131 g\u00f6sterir. Erken evre glokom yakalamada son derece hassast\u0131r.<\/li><\/ul>
4. Bilgisayarl\u0131 G\u00f6rme Alan\u0131 Testi (Perimetri)<\/strong><\/p>
OCT sinir dokusunun yap\u0131sal (anatomik) durumunu g\u00f6sterirken, G\u00f6rme Alan\u0131 testi sinirin fonksiyonel performans\u0131n\u0131 \u00f6l\u00e7er.<\/p>
Hasta karanl\u0131k bir kabin i\u00e7inde yar\u0131m k\u00fcre \u015feklindeki bir ekrana bakar ve farkl\u0131 noktalarda beliren farkl\u0131 \u015fiddetteki \u0131\u015f\u0131k uyaranlar\u0131n\u0131 g\u00f6rd\u00fc\u011f\u00fcnde elindeki butona basar.<\/li>
Bilgisayar, hastan\u0131n g\u00f6rme alan\u0131ndaki duyarl\u0131l\u0131k kay\u0131plar\u0131n\u0131, k\u00f6r noktalar\u0131 (skotom) ve genel \u0131\u015f\u0131k hassasiyetini analiz ederek bir harita \u00e7\u0131kar\u0131r.<\/li>
Glokom tan\u0131s\u0131 konulmas\u0131 ve hastal\u0131\u011f\u0131n evrelenmesi i\u00e7in olmazsa olmaz bir tetkiktir.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Tedavi Y\u00f6ntemleri ve Klinik Yakla\u015f\u0131mlar <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom tedavisinde g\u00fcncel t\u0131p d\u00fcnyas\u0131n\u0131n kabul etti\u011fi m\u00fcdahale edilebilir tek fakt\u00f6r g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n d\u00fc\u015f\u00fcr\u00fclmesidir. Tedavi yakla\u015f\u0131m\u0131 Medikal (\u0130la\u00e7), Lazer ve Cerrahi olmak \u00fczere \u00fc\u00e7 ana grupta toplan\u0131r.<\/p>
A. Medikal Tedavi (G\u00f6z Damlalar\u0131 ve \u0130la\u00e7lar)<\/strong><\/p>
Medikal tedavi \u00e7o\u011fu a\u00e7\u0131k a\u00e7\u0131l\u0131 glokom hastas\u0131nda ilk tercih edilen y\u00f6ntemdir. \u0130la\u00e7lar etki mekanizmalar\u0131na g\u00f6re ayr\u0131l\u0131r:<\/p>
Prostaglandin Analoglar\u0131 (Latanoprost, Travoprost, Bimatoprost):<\/strong> \u00dcveoskleral d\u0131\u015fa ak\u0131m\u0131 belirgin \u015fekilde art\u0131r\u0131r. G\u00fcnde 1 kez (gece) kullan\u0131l\u0131r.<\/li>
Beta-Blok\u00f6rler (Timolol, Betaksolol):<\/strong> Silier cisimden h\u00fcm\u00f6r ak\u00f6z \u00fcretimini azalt\u0131r. G\u00fcnde 1 veya 2 kez kullan\u0131l\u0131r.<\/li>
Alfa-2 Agonistler (Brimonidin):<\/strong> Hem s\u0131v\u0131 \u00fcretimini azalt\u0131r hem de d\u0131\u015fa ak\u0131m\u0131 art\u0131r\u0131r.<\/li>
Karbonik Anhidraz \u0130nhibit\u00f6rleri (Dorzolamid, Brinzolamid):<\/strong> S\u0131v\u0131 salg\u0131lanmas\u0131ndan sorumlu enzimi bask\u0131layarak \u00fcretimi k\u0131sar.<\/li>
Rho-Kinaz \u0130nhibit\u00f6rleri (Netarsudil):<\/strong> Trabek\u00fcler a\u011f\u0131n h\u00fccresel direncini d\u00fc\u015f\u00fcrerek do\u011frudan d\u0131\u015fa ak\u0131m\u0131 kolayla\u015ft\u0131r\u0131r.<\/li><\/ul>
Glokom Damlas\u0131 Yan Etkileri:<\/strong><\/p>
Lokal Yan Etkiler:<\/strong> G\u00f6zde k\u0131zar\u0131kl\u0131k, yanma, batma, g\u00f6z \u00e7evresinde koyula\u015fma (hiperpigmentasyon), kirpiklerde uzama ve kal\u0131nla\u015fma, g\u00f6z \u00e7ukurunda \u00e7\u00f6kme (prostaglandin periorbitopati).<\/li>
Sistemik Yan Etkiler:<\/strong> Beta-blok\u00f6rler sistemik emilim sonucu nab\u0131zda yava\u015flama (bradikardi), tansiyon d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc, ast\u0131m hastalar\u0131nda nefes darl\u0131\u011f\u0131 ve bronkospazma yol a\u00e7abilir. Bu nedenle sistemik hastal\u0131\u011f\u0131 olan bireyler hekimlerini bilgilendirmelidir.<\/li><\/ul>
Glokom Damlas\u0131 \u00d6m\u00fcr Boyu mu Kullan\u0131l\u0131r?<\/strong> Evet. Glokom kronik ve kontrol alt\u0131nda tutulmas\u0131 gereken bir s\u00fcre\u00e7tir. Kullan\u0131lan damlalar hastal\u0131\u011f\u0131 “k\u00fcr” etmez (tamamen ortadan kald\u0131rmaz); kullan\u0131ld\u0131\u011f\u0131 s\u00fcrece g\u00f6z bas\u0131nc\u0131n\u0131 bask\u0131lar. \u0130la\u00e7 b\u0131rak\u0131ld\u0131\u011f\u0131 anda bas\u0131n\u00e7 tekrar eski y\u00fcksek seviyelerine t\u0131rman\u0131r. Bu nedenle tedavinin kesintisiz ve \u00f6m\u00fcr boyu s\u00fcrd\u00fcr\u00fclmesi \u015fartt\u0131r.<\/p>
B. Lazer Tedavisi Y\u00f6ntemleri<\/strong><\/p>
Lazer uygulamalar\u0131 poliklinik \u015fartlar\u0131nda, lokal anestezi (damla) alt\u0131nda ger\u00e7ekle\u015ftirilen, kesi gerektirmeyen a\u011fr\u0131s\u0131z i\u015flemlerdir.<\/p>
SLT (Selektif Lazer Trabek\u00fcloplasti):<\/strong> A\u00e7\u0131k a\u00e7\u0131l\u0131 glokom hastalar\u0131nda trabek\u00fcler a\u011fdaki belirli h\u00fccreleri hedef alarak h\u00fccresel yenilenmeyi tetikler ve drenaj\u0131 art\u0131r\u0131r. Damla kullanamayan, yan etki ya\u015fayan veya ek bas\u0131n\u00e7 d\u00fc\u015f\u00fc\u015f\u00fcne ihtiya\u00e7 duyulan hastalarda uygulan\u0131r. Etkisi 1-3 y\u0131l s\u00fcrebilir ve tekrarlanabilir.<\/li>
YAG Lazer \u0130ridotomi:<\/strong> Kapal\u0131 veya dar a\u00e7\u0131l\u0131 glokom hastalar\u0131nda irise lazer ile mikro bir delik a\u00e7\u0131larak arka ve \u00f6n kamara aras\u0131ndaki bas\u0131n\u00e7 fark\u0131 e\u015fitlenir. A\u00e7\u0131 kapanmas\u0131 krizini \u00f6nlemede hayat kurtar\u0131c\u0131 bir koruyucu tedavidir.<\/li>
Mikrodalga \/ Siklodiyot Lazer (Siklofotokoag\u00fclasyon):<\/strong> \u0130la\u00e7 ve cerrahiye yan\u0131t vermeyen ileri evre diren\u00e7li glokom vakalar\u0131nda, h\u00fcm\u00f6r ak\u00f6z \u00fcreten silier cisim dokusunun lazer enerjisi ile k\u0131smen tahrip edilerek s\u0131v\u0131 \u00fcretiminin azalt\u0131lmas\u0131 i\u015flemidir.<\/li><\/ol>
C. Cerrahi Tedavi (Glokom Ameliyat\u0131)<\/strong><\/p>
Medikal ve lazer tedavisine ra\u011fmen hedef g\u00f6z i\u00e7i bas\u0131nc\u0131na ula\u015f\u0131lamayan, optik sinir hasar\u0131 ve g\u00f6rme alan\u0131 kayb\u0131 ilerlemeye devam eden hastalarda cerrahi ka\u00e7\u0131n\u0131lmaz hale gelir.<\/p>
1. Trabek\u00fclektomi (Fist\u00fclizan Cerrahi)<\/strong> Glokom cerrahisinde alt\u0131n standart kabul edilen ameliyatt\u0131r.<\/p>
Mekanizma:<\/strong> G\u00f6z\u00fcn beyaz k\u0131sm\u0131 (sklera) alt\u0131nda mikro bir kapak\u00e7\u0131k ve drenaj kanal\u0131 (fist\u00fcl) olu\u015fturulur. G\u00f6z i\u00e7indeki fazla s\u0131v\u0131 bu kanaldan konjonktiva alt\u0131na s\u00fcz\u00fcl\u00fcr ve burada “bleb” ad\u0131 verilen bir s\u0131v\u0131 kabarc\u0131\u011f\u0131 olu\u015fturarak emilir.<\/li>
Ba\u015far\u0131:<\/strong> Bas\u0131nc\u0131 d\u00fc\u015f\u00fcrmede son derece etkilidir.<\/li><\/ul>
2. Glokom Drenaj \u0130mplantlar\u0131 (T\u00fcp \/ Valf Cerrahisi – Ahmed, Baerveldt \u015eantlar\u0131) <\/strong>Trabek\u00fclektomi uygulan\u0131p ba\u015far\u0131s\u0131z olmu\u015f, \u015fiddetli ok\u00fcler y\u00fczey hastal\u0131\u011f\u0131 bulunan veya sekonder glokomlu (neovask\u00fcler, \u00fcveitik) vakalarda tercih edilir.<\/p>
G\u00f6z i\u00e7ine mikro bir silikon t\u00fcp yerle\u015ftirilir; bu t\u00fcp g\u00f6z\u00fcn d\u0131\u015f duvar\u0131na monte edilen bir hazneye (valf) ba\u011flan\u0131r. S\u0131v\u0131 bu valf arac\u0131l\u0131\u011f\u0131yla g\u00f6z d\u0131\u015f\u0131na tahliye edilir.<\/li><\/ul>
3. M\u0130GS (Mikro-\u0130nvaziv Glokom Cerrahisi) <\/strong>Son y\u0131llarda geli\u015fen, minimal kesi ile uygulanan, komplikasyon riski d\u00fc\u015f\u00fck yeni nesil cerrahilerdir (iStent, Hydrus, Kahook Dual Blade vb.). Erken ve orta evre glokom hastalar\u0131nda veya katarakt ameliyat\u0131 ile kombine edilerek uygulan\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Ameliyat S\u00fcreci, Riskler ve \u0130yile\u015fme D\u00f6nemi <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom Ameliyat\u0131 Riskleri ve Komplikasyonlar\u0131<\/strong><\/p>
Glokom ameliyatlar\u0131 mikroskobik hassasiyet gerektiren maj\u00f6r g\u00f6z cerrahileridir. Olas\u0131 riskler \u015funlard\u0131r:<\/p>
Erken D\u00f6nem Hipotoni: <\/strong>G\u00f6z bas\u0131nc\u0131n\u0131n istenenden fazla d\u00fc\u015fmesi ve \u00f6n kamaran\u0131n s\u0131\u011fla\u015fmas\u0131.<\/li>
Hifema: <\/strong>\u00d6n kamaraya kan dolmas\u0131.<\/li>
Katarakt Geli\u015fimi: <\/strong>Cerrahi m\u00fcdahaleye ba\u011fl\u0131 olarak do\u011fal lensin saydaml\u0131\u011f\u0131n\u0131 yitirme s\u00fcrecinin h\u0131zlanmas\u0131.<\/li>
Blebitis ve Endoftalmi: <\/strong>Olu\u015fturulan s\u00fczme kabarc\u0131\u011f\u0131n\u0131n veya g\u00f6z i\u00e7inin enfeksiyon kapmas\u0131 (En ciddi komplikasyondur).<\/li>
Fist\u00fcl T\u0131kanmas\u0131 (Doku \u0130yile\u015fme Yan\u0131t\u0131):<\/strong> V\u00fccudun a\u00e7\u0131lan kanal\u0131 bir yara gibi alg\u0131lay\u0131p skarla (nedbe dokusu) kapatmas\u0131 ve ameliyat\u0131n ba\u015far\u0131s\u0131z olmas\u0131. (Bu durumu \u00f6nlemek i\u00e7in ameliyatta Mitomisin-C gibi antimetabolit ila\u00e7lar kullan\u0131l\u0131r).<\/li><\/ul>
Ameliyat Sonras\u0131 \u0130yile\u015fme ve G\u00f6rme Beklentisi<\/strong><\/p>
G\u00f6rme Seviyesi:<\/strong> Hastalar\u0131n bilmesi gereken en \u00f6nemli husus \u015fudur: Glokom ameliyat\u0131 g\u00f6rmeyi art\u0131rmak i\u00e7in yap\u0131lmaz; mevcut g\u00f6rmeyi korumak ve bas\u0131nc\u0131 d\u00fc\u015f\u00fcrmek i\u00e7in yap\u0131l\u0131r. Ameliyat\u0131n hemen ard\u0131ndan ilk birka\u00e7 hafta g\u00f6zde bulan\u0131kl\u0131k, batma ve sulanma olmas\u0131 normaldir. G\u00f6rme seviyesi 1-2 ay i\u00e7inde ameliyat \u00f6ncesi seviyesine d\u00f6ner.<\/li>
\u0130yile\u015fme S\u00fcreci:<\/strong> \u0130yile\u015fme ortalama 4 ila 8 hafta s\u00fcrer. Bu s\u00fcre\u00e7te hasta kortizonlu ve antibiyotikli damlalar\u0131 d\u00fczenli kullanmal\u0131d\u0131r.<\/li>
Dikkat Edilmesi Gerekenler:<\/strong> Ameliyatl\u0131 g\u00f6ze ilk bir ay su de\u011fdirilmemeli, g\u00f6z ovu\u015fturulmamal\u0131, a\u011f\u0131r kald\u0131r\u0131lmamal\u0131 ve \u0131k\u0131nma gibi kafa i\u00e7i bas\u0131nc\u0131n\u0131 art\u0131racak hareketlerden ka\u00e7\u0131n\u0131lmal\u0131d\u0131r.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n \u00d6zel Durumlar ve Hastal\u0131k Birliktelikleri <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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A. Glokom ve Katarakt Birlikteli\u011fi (Phacoglaucoma)<\/strong><\/p>
\u0130leri ya\u015f pop\u00fclasyonunda katarakt ve glokom s\u0131kl\u0131kla birlikte g\u00f6r\u00fcl\u00fcr.<\/p>
\u015ei\u015fen katarakt\u00f6z lens \u00f6n kamara a\u00e7\u0131s\u0131n\u0131 daraltarak tansiyonu y\u00fckseltebilir (Fakomorfik Glokom).<\/li>
G\u00fcn\u00fcm\u00fcz cerrahi tekniklerinde, hem katarakt\u0131 olan hem de glokom ilac\u0131 kullanan hastalara Fakoem\u00fclsifikasyon (Katarakt) + Glokom Cerrahisi (M\u0130GS veya Trabek\u00fclektomi) ayn\u0131 seansta (Kombine Cerrahi) uygulanarak tek operasyonla iki sorun birden \u00e7\u00f6z\u00fclebilmektedir. Katarakt ameliyat\u0131 tek ba\u015f\u0131na dahi \u00f6n kamara a\u00e7\u0131s\u0131n\u0131 geni\u015fleterek g\u00f6z i\u00e7i bas\u0131nc\u0131nda 2-4 mmHg’lik bir d\u00fc\u015f\u00fc\u015f sa\u011flayabilir.<\/li><\/ul>
B. Glokom ve Migren \u0130li\u015fkisi<\/strong><\/p>
\u00d6zellikle Normal Tansiyonlu Glokom (NTG)<\/strong> hastalar\u0131nda migren insidans\u0131 belirgin \u015fekilde y\u00fcksektir. Her iki hastal\u0131\u011f\u0131n temelinde de “vask\u00fcler dysregulation” (damarsal b\u00fcz\u00fc\u015fme ve kan ak\u0131m\u0131 d\u00fczensizli\u011fi) yatmaktad\u0131r. Migren ataklar\u0131 s\u0131ras\u0131nda optik sinir ba\u015f\u0131ndaki kan ak\u0131m\u0131n\u0131n ge\u00e7ici olarak kesintiye u\u011framas\u0131 n\u00f6ronal hasar\u0131 h\u0131zland\u0131rabilir.<\/p>
C. Glokom ve Gebelik<\/strong><\/p>
Gebe hastaland\u0131\u011f\u0131nda medikal tedavi stratejisi de\u011fi\u015ftirilmelidir. Bir\u00e7ok glokom damlas\u0131 (\u00f6rne\u011fin Alpha-2 agonistler ve Karbonik anhidraz inhibit\u00f6rleri) teratojenik riskler ta\u015f\u0131yabilir. Gebeli\u011fin ilk trimesterinde ila\u00e7lar olabildi\u011fince azalt\u0131lmal\u0131, gerekiyorsa g\u00fcvenli kabul edilen ajanlara ge\u00e7ilmeli veya gebelik \u00f6ncesi SLT (Lazer) uygulanarak ila\u00e7 ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 ortadan kald\u0131r\u0131lmal\u0131d\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokom \u0130le Ya\u015fam, Beslenme ve Tamamlay\u0131c\u0131 Yakla\u015f\u0131mlar <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom hastalar\u0131n\u0131n g\u00fcnl\u00fck ya\u015fam kalitelerini korurken g\u00f6z i\u00e7i bas\u0131n\u00e7lar\u0131n\u0131 stabil tutmak i\u00e7in dikkat etmeleri gereken ya\u015fam tarz\u0131 fakt\u00f6rleri \u015funlard\u0131r:<\/p>
D\u00fczenli \u0130la\u00e7 Kullan\u0131m\u0131 ve Saat Disiplini<\/li>
Y\u0131ll\u0131k ve 3-6 Ayl\u0131k Periyodik Kontroller<\/li>
Do\u011fru Egzersiz Se\u00e7imi (A\u011f\u0131r A\u011f\u0131rl\u0131k ve Ba\u015f A\u015fa\u011f\u0131 Pozisyonlardan Ka\u00e7\u0131nma)<\/li>
S\u0131v\u0131 T\u00fcketim D\u00fczeni (Bir Defada A\u015f\u0131r\u0131 Su \u0130\u00e7meme)<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Beslenme ve Diyetin Glokoma Etkisi <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokomu tamamen iyile\u015ftiren veya tek ba\u015f\u0131na tedavi eden hi\u00e7bir besin, diyet veya vitamin kombinasyonu yoktur. Ancak genel n\u00f6roproteksiyonu (sinir korumas\u0131n\u0131) ve vask\u00fcler sa\u011fl\u0131\u011f\u0131 desteklemek amac\u0131yla \u015fu beslenme al\u0131\u015fkanl\u0131klar\u0131 \u00f6nerilir:<\/p>
Antioksidandan Zengin Beslenme:<\/strong> Koyu ye\u015fil yaprakl\u0131 sebzeler (\u0131spanak, paz\u0131, karalahana), b\u00f6\u011f\u00fcrtlen, yaban mersini gibi antosiyanin ve l\u00fctein zengini g\u0131dalar optik sinir sa\u011fl\u0131\u011f\u0131n\u0131 destekler.<\/li>
Omega-3 Ya\u011f Asitleri:<\/strong> Somon, ton bal\u0131\u011f\u0131, ceviz ve keten tohumu gibi Omega-3 kaynaklar\u0131n\u0131n g\u00f6z i\u00e7i kan ak\u0131m\u0131n\u0131 ve ok\u00fcler y\u00fczey sa\u011fl\u0131\u011f\u0131n\u0131 olumlu etkiledi\u011fi g\u00f6sterilmi\u015ftir.<\/li>
Ginkgo Biloba: <\/strong>\u00d6zellikle Normal Tansiyonlu Glokom hastalar\u0131nda ocular kan ak\u0131m\u0131n\u0131 art\u0131rd\u0131\u011f\u0131na dair klinik \u00e7al\u0131\u015fmalar bulunmakla birlikte, hekim kontrol\u00fc olmadan kullan\u0131lmamal\u0131d\u0131r.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokom Hastalar\u0131 Ne Yememeli \/ Ne Yapmamal\u0131? <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Bir Defada A\u015f\u0131r\u0131 S\u0131v\u0131 T\u00fcketimi:<\/strong> K\u0131sa bir s\u00fcre i\u00e7inde (\u00f6rne\u011fin 5-10 dakika) 1-1.5 litre su i\u00e7ilmesi, kan\u0131 suland\u0131rarak g\u00f6z i\u00e7i bas\u0131nc\u0131nda ge\u00e7ici ve ani 5-8 mmHg’lik s\u0131\u00e7ramalara (spike) neden olabilir. S\u0131v\u0131 t\u00fcketimi g\u00fcne yay\u0131lmal\u0131d\u0131r.<\/li>
A\u015f\u0131r\u0131 Kafein T\u00fcketimi: <\/strong>Y\u00fcksek miktarda kafein (birka\u00e7 fincan sert kahve) g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131 ge\u00e7ici olarak y\u00fckseltebilir. T\u00fcketim g\u00fcnl\u00fck 1-2 fincan ile s\u0131n\u0131rland\u0131r\u0131lmal\u0131d\u0131r.<\/li>
Sigara ve T\u00fct\u00fcn \u00dcr\u00fcnleri:<\/strong> Sigara, optik siniri besleyen k\u0131lcal damarlarda vazokonstriksiyona (daralmaya) ve oksidatif strese yol a\u00e7arak glokomat\u00f6z hasar\u0131 h\u0131zland\u0131r\u0131r.<\/li>
Kafa \u0130\u00e7i Bas\u0131nc\u0131n\u0131 Art\u0131ran Hareketler:<\/strong>
Yogadaki ba\u015f\u00fcst\u00fc duru\u015f pozisyonlar\u0131 (Headstand \/ Sirsasana) g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131 iki kat\u0131na \u00e7\u0131karabilir ve glokom hastalar\u0131 i\u00e7in tehlikelidir.<\/li>
A\u011f\u0131r a\u011f\u0131rl\u0131k kald\u0131rma (Valsalva manevras\u0131 gerektiren diren\u00e7 egzersizleri) ve \u00fcflemeli m\u00fczik aletleri \u00e7almak g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131 anl\u0131k olarak belirgin \u015fekilde y\u00fckseltir.<\/li><\/ul><\/li>
S\u0131k\u0131 Kravat ve Yaka:<\/strong> Boynu s\u0131kan dar yakalar ve tight ba\u011flanan kravatlar episkleral ven\u00f6z bas\u0131nc\u0131 art\u0131rarak g\u00f6z tansiyonunu y\u00fckseltebilir.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n Glokomda Bitkisel ve Do\u011fal Tedavi Yalan\u0131 <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u0130nternet ortam\u0131nda ve sosyal medyada pazarlanan “g\u00f6z tansiyonunu s\u0131f\u0131rlayan bitkisel k\u00fcrler”, “otlar” veya “damlalar” hi\u00e7bir bilimsel dayana\u011f\u0131 olmayan ve hastan\u0131n g\u00f6rmesini tehlikeye atan aldatmacalard\u0131r. Glokom, optik sinir yap\u0131s\u0131n\u0131 ilgilendiren anatomik ve mekanik bir bozukluktur. T\u0131bbi medikal damlalar\u0131n ve hekim kontrol\u00fcn\u00fcn b\u0131rak\u0131larak bitkisel k\u00fcrlere y\u00f6nelinmesi, hastalar\u0131n telafisi m\u00fcmk\u00fcn olmayan bir \u015fekilde k\u00f6rl\u00fc\u011fe s\u00fcr\u00fcklenmesine neden olmaktad\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n S\u0131k\u00e7a Sorulan Sorular (SSS) <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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1. Glokom tamamen ge\u00e7er mi?<\/strong><\/p>
Hay\u0131r. Glokom hipertansiyon veya diyabet gibi kronik, \u00f6m\u00fcr boyu s\u00fcren bir hastal\u0131kt\u0131r. Tamamen yok edilemez; ancak do\u011fru tedavi ve d\u00fczenli takip ile kontrol alt\u0131na al\u0131narak ilerlemesi \u00f6m\u00fcr boyu durdurulabilir.<\/p>
2. Glokom k\u00f6r eder mi?<\/strong><\/p>
Evet. Tedavi edilmeyen veya takipsiz b\u0131rak\u0131lan glokom vakalar\u0131 nihai evrede optik sinirin tamamen atrofisine (\u00f6l\u00fcm\u00fcne) neden olarak tam k\u00f6rl\u00fckle sonu\u00e7lan\u0131r. D\u00fcnya genelinde \u00f6nlenebilir k\u00f6rl\u00fcklerin ikinci en s\u0131k nedenidir. Ancak erken tan\u0131 ve disiplinli tedavi ile k\u00f6rl\u00fck riski yok denecek kadar d\u00fc\u015f\u00fck seviyelere indirilebilir.<\/p>
3. G\u00f6z tansiyonu damlam\u0131 bir g\u00fcn unutursam ne olur?<\/strong><\/p>
Tek bir dozun unutulmas\u0131 kal\u0131c\u0131 k\u00f6rl\u00fc\u011fe yol a\u00e7maz; ancak g\u00f6z i\u00e7i bas\u0131nc\u0131nda dalgalanmaya neden olur. Hat\u0131rland\u0131\u011f\u0131 anda damla damlat\u0131lmal\u0131d\u0131r. Ancak bir sonraki doz saati yakla\u015fm\u0131\u015fsa \u00e7ift doz damlat\u0131lmamal\u0131, normal takvime devam edilmelidir. Unutma al\u0131\u015fkanl\u0131k haline getirilmemelidir.<\/p>
4. Glokom muayenesi i\u00e7in hangi doktora gidilmelidir?<\/strong><\/p>
Glokom te\u015fhis ve takibi i\u00e7in bir G\u00f6z Hastal\u0131klar\u0131 Uzman\u0131na (Oftalmolog) ba\u015fvurulmal\u0131d\u0131r. Glokom alan\u0131nda \u00f6zelle\u015fmi\u015f G\u00f6z Hastal\u0131klar\u0131 Uzmanlar\u0131 (Glokom Spesiyalistleri) ileri evre veya cerrahi gerektiren vakalar\u0131n y\u00f6netimini \u00fcstlenirler.<\/p>
5. Lazer veya ameliyat olursam damla kullanmaktan tamamen kurtulur muyum?<\/strong><\/p>
Her zaman de\u011fil. SLT lazeri veya glokom ameliyatlar\u0131n\u0131n temel amac\u0131 g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131 d\u00fc\u015f\u00fcrmek veya kullan\u0131lan damla say\u0131s\u0131n\u0131 azaltmakt\u0131r. Ameliyat sonras\u0131nda hastalar\u0131n b\u00fcy\u00fck k\u0131sm\u0131 damlas\u0131z takibe ge\u00e7ebilse de, zamanla g\u00f6z i\u00e7i dokular\u0131n\u0131n iyile\u015fme yan\u0131t\u0131na ba\u011fl\u0131 olarak tekli damla tedavisine devam edilmesi gerekebilir.<\/p>
6. Her g\u00f6z tansiyonu y\u00fcksek olan ki\u015fi glokom hastas\u0131 m\u0131d\u0131r?<\/strong><\/p>
Hay\u0131r. G\u00f6z i\u00e7i bas\u0131nc\u0131 21 mmHg \u00fczerinde olup g\u00f6rme sinirinde ve g\u00f6rme alan\u0131nda hi\u00e7bir hasar bulunmayan bireyler “Ok\u00fcler Hipertansiyon” tan\u0131s\u0131 al\u0131r. Bu ki\u015filer glokom aday\u0131d\u0131r ancak hen\u00fcz glokom hastas\u0131 de\u011fildirler.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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\r\n \u00d6zet ve Sonu\u00e7 <\/h3>\r\n <\/div>\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Glokom, sinsi ilerleyi\u015fi ve geri d\u00f6nd\u00fcr\u00fclemez n\u00f6ronal kay\u0131plara yol a\u00e7mas\u0131 nedeniyle ok\u00fcler sa\u011fl\u0131\u011f\u0131n en ciddi tehditlerinden biridir. Hastal\u0131ktan korunman\u0131n veya mevcut doku kayb\u0131n\u0131 engellemenin tek yolu erken tan\u0131d\u0131r.<\/p>
40 ya\u015f\u0131n alt\u0131ndaki bireylerin 2-3 y\u0131lda bir,<\/li>
40 ya\u015f \u00fcst\u00fc bireylerin y\u0131lda bir,<\/li>
Ailesinde glokom \u00f6yk\u00fcs\u00fc bulunan ki\u015filerin ise 35 ya\u015f\u0131ndan itibaren her y\u0131l detayl\u0131 g\u00f6z tansiyonu ve optik sinir muayenesinden ge\u00e7mesi hayati \u00f6nem ta\u015f\u0131maktad\u0131r.<\/li><\/ul>
Unutulmamal\u0131d\u0131r ki, glokomda kaybedilen g\u00f6rme geri getirilemez; ancak erken te\u015fhis ve do\u011fru tedavi ile gelecekteki g\u00f6rmeniz tamamen koruma alt\u0131na al\u0131nabilir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"
Glokom (G\u00f6z Tansiyonu) Nedir? Glokom, g\u00f6z i\u00e7i bas\u0131nc\u0131n\u0131n (G\u0130B) s\u0131kl\u0131kla g\u00f6rme sinirinin (optik sinir) fizyolojik olarak tolere edebilece\u011fi seviyenin \u00fczerine \u00e7\u0131kmas\u0131 sonucu geli\u015fen, optik sinir ba\u015f\u0131ndaki ganglion h\u00fccrelerinde apoptoza (programlanm\u0131\u015f h\u00fccre \u00f6l\u00fcm\u00fc) yol a\u00e7an ve tedavi edilmedi\u011finde kal\u0131c\u0131 g\u00f6rme kayb\u0131yla sonu\u00e7lanan kronik, ilerleyici bir optik n\u00f6ropatidir. Optik sinir, retina tabakas\u0131na ula\u015fan \u0131\u015f\u0131k uyaranlar\u0131n\u0131 elektrik sinyallerine […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-15664","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/pages\/15664","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/comments?post=15664"}],"version-history":[{"count":10,"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/pages\/15664\/revisions"}],"predecessor-version":[{"id":15840,"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/pages\/15664\/revisions\/15840"}],"wp:attachment":[{"href":"https:\/\/www.draliolgun.com\/tr\/wp-json\/wp\/v2\/media?parent=15664"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}