Diyatebitk maküla ödeminde intravitreal ranibizumab ve aflibercept tedavisinin görsel ve anatomik sonuçları
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Date
2020
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Trakya Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Bu çalışmanın amacı diyabetik maküla ödemi güncel tedavisinde; göz içi 2 mgaflibercept ve göz içi 0,5 mg ranibizumabuygulamasınıngörme keskinliği üzerine olanetkilerinive anatomik prognoza etkisini retrospektif olarakirdelemektir. Çalışmamıza Edirne Trakya Üniversitesi Tıp Fakültesi Hastanesi Göz HastalıklarıRetina Biriminde Ocak 2014 ileŞubat 2019 tarihleri arasındaDiyabetik maküla ödemi tanısıile anti-vasküler endotelyal büyüme faktörü tedavisi uygulanan hastalar retrospektif olarakdahil edildi.Çalışmamızda hastalar iki gruba ayrılarak; diyabetik maküla ödemi nedeniyleintravitreal ranibizumab tedavisi uygulanan69 göz ile intravitreal afliberceptuygulanan 56gözün anatomik ve fonksiyonel sonuçları karşılaştırıldı. Her iki grupta da hastalarabaşlangıçta birer ay ara ile ardışık 3 yükleme dozu yapıldı, 3 aydan sonrapro re nata tedavirejimi uygulandı.Hastaların enjeksiyon öncesinde Snellen eşeli ile alınan görme keskinliğideğerleri ‘’Logarythmof Minimum Angle of Resolution’’ölçeğine çevrildi.Ön segmentinbiyomikroskopik muayenesi ve indirekt oftalmoskopi ile fundus muayenesi yapıldı.Göziçibasıncı Goldmann aplanasyon tonometrisiyle ölçüldü. 1 yıl boyunca tüm hastalar 4 haftaaralıklarla muayene edildi. Enjeksiyon sonrası her iki grubun görme keskinliği ve santral maküla kalınlığınabakıldığında; grup içi aylara göre karşılaştırmada intravitreal ranibizumabenjeksiyonu sonrasıgörme keskinliğinde 3.ayda (p=0,002), 6.ayda (p=0,003) ve 12.ayda (p=0,023) anlamlıiyileşme gözlendi; santral maküla kalınlığında ise 3.ay (p?0,001), 6.ay (p?0,001) ve 12.ayda(p?0,001) anlamlı gerileme gözlendi. İntravitreal aflibercept enjeksiyonu sonrası görmekeskinliğinde 3.ayda anlamlı iyileşme (p=0,021), 6.ayda iyileşme (p=0,133), 12.ayda iseazalma izlendi (p=0,884); santral maküla kalınlığında ise3.ay (p?0,001), 6.ay (p?0,001) ve 12.ayda (p?0,001)anlamlı gerileme gözlendi.Gruplar arası görme keskinliğinde istatistikselolarak3.ay (p=0,833), 6.ay (p=0,896) ve 12.ayda (p=0,435) anlamlıfark gözlenmedi.Gruplararası santral maküla kalınlığı karşılaştırıldığında 6.ayda aflibercept uygulanan gruptaistatistiksel olarak anlamlı düzeyde daha fazla azalma saptandı(p=0,029).Başlangıçgörmekeskinliği düşük gözler(Snellen 20/400-20/40~LogMAR 1,30-0,30)incelendiğinde ise; grupiçi aylara göre karşılaştırmada intravitreal ranibizumab enjeksiyonu sonrası görmekeskinliğinde 3.ayda (p=0,001), 6.ayda (p?0,001) ve 12.ayda (p=0,004) anlamlı iyileşmegözlendi; santral maküla kalınlığında ise 3.ay (p?0,001), 6.ay (p?0,001) ve 12.ayda (p?0,001)anlamlı gerileme gözlendi. İntravitreal aflibercept enjeksiyonu sonrası görme keskinliğinde3.ayda (p=0,106), 6.ayda (p=0,183)ve12.ayda(p=0,948) iyileşme izlendi; santral makülakalınlığında ise 3.ay (p?0,001), 6.ay (p?0,001) ve 12.ayda (p?0,001) anlamlı gerilemegözlendi. Gruplar arası görme keskinliğinde istatistiksel olarak3.ay (p=0,240), 6.ay (p=0,210)ve 12.ayda (p=0,052) anlamlı fark gözlenmedi. Gruplar arası santral maküla kalınlığıkarşılaştırıldığında 3.ayda (p=0,004) ve 6.ayda (p=0,007) aflibercept uygulanan gruptaistatistiksel olarak anlamlı düzeyde daha fazla azalma saptandı. Diyabetik maküla ödemi tedavisinde hem intravitreal ranibizumab ve hem deintravitreal aflibercept tedavilerinin görme keskinliğini arttırdığı ve santral makülakalınlığında anlamlı düşme sağladığı izlendi, ancakaltıncı ayda iki tedavi arasında santralmaküla kalınlığında anlamlı farklılık görüldü.Başlangıç görme keskinliği düşük gözlerde isehem intravitreal ranibizumab hem intravitreal aflibercept tedavilerinin görme keskinliğiniarttırdığı ve santral maküla kalınlığında anlamlı düşme sağladığı saptandı, ancak 6 ve 12.aydaiki tedavi arasında santral maküla kalınlığında anlamlı farklılık tespit edildi.Diğer taraftanintravitreal enjeksiyon uygulaması sonrası gelişebilecek olası lokal ve sistemikkomplikasyonlar nedeniyle, hasta seçimine dikkat edilmeli, gerekli önlemler alınmalı vetedavi sonrası hastalar iyi takip edilmelidir.
The aim of this study was to evaluate the current treatment of diabetic macular edema;to investigatethe effect of intraocular 2 mg aflibercept andintraocular 0.5 mg ranibizumab onvisual acuity and anatomic prognosis retrospectively. Patients who were diagnosed with diabetic macular edema between January 2014 andFebruary 2019 in Edirne Trakya University Medical Faculty Hospital Eye Diseases RetinaUnit were included in this study retrospectively. In our study, patients were divided into twogroups; the anatomical and functional results of 69 eyes treated with intravitreal ranibizumabfor diabetic macular edema and 56 eyes treated with intravitreal aflibercept were compared. Inboth groups, patients were initially given 3 consecutive loading doses at intervals of 1 month,and after 3 months pro re nata treatment regimen was administered. The visual acuity valuesof the patients taken with Snellen chart before the injection were converted to ’Logarythm ofMinimum Angle of Resolution’ scale. Biomicroscopic examination of the anterior segmentand fundus examination by indirect ophthalmoscopy were performed. Intraocular pressurewas measured by Goldmannapplanation tonometry. All patients were examined at 4-weekintervals for 1 year. When visual acuity and central macular thickness of both groups were examined;visual acuity improved significantly at 3 rd month (p=0,002), 6 61 th month(p = 0,003) and 12 month (p=0,023) after intravitreal ranibizumab injections; central macular thickness decreased th significantly at 3 rd month (p?0,001), 6 th month (p?0,001) and 12 th month (p?0,001). Afterintravitreal aflibercept injection, visual acuity improved significantly in the 3 month(p=0,021), improved in the 6 th month (p=0,133), and decreased in the 12 th month (p=0,884);central macular thickness decreased significantly at 3 rd month (p?0,001), 6 th month (p?0,001)and 12 th month (p?0,001). There was no statistically significant difference in visual acuitybetween the groups at 3 rd month (p=0,833), 6 th month (p = 0,896) and 12 th month(p=0,435).When central macular thickness was compared between groups, there was a statisticallysignificant decrease in aflibercept group in the 6 th month (p=0,029).When eyes with lowinitial visual acuity (Snellen 20/400-20/40 ~ LogMAR 1,30-0,30) were examined; visualacuity improved significantly at 3 rd month (p=0,001), 6 th month (p?0,001) and 12 month(p=0,004) after intravitreal ranibizumab injection; central macular thickness decreasedsignificantly at 3 rd month (p?0,001), 6 th month (p?0,001) and 12 th month (p?0,001). Visualacuity improved after 3 rd month (p=0,106), 6 th month (p=0,183) and 12 th month (p=0,948)after intravitreal aflibercept injection; central macular thickness decreased significantly at 3 month (p?0,001), 6 th month (p?0,001) and 12 th month (p?0,001). There was no statisticallysignificant difference invisual acuity between the groups at 3 rd month (p=0,240), 6 month(p=0,210) and 12 th month (p=0,052). When the central macular thickness was comparedbetween the groups, a statistically significant decrease was observed in the aflibercept groupin the 3 rd month (p=0,004) and in the 6 th month (p=0,007).In the treatment of diabetic macular edema, both intravitreal ranibizumab and intravitreal aflibercept treatments increased visual acuity and significantlydecreased centralmacular thickness, but there wasa significant difference in central macular thickness betweenthe two treatments in the sixth month. In eyes with low initial visual acuity, both intravitrealranibizumab and intravitreal aflibercept treatments increased visual acuity and significantlydecreased central macular thickness, but there was a significant difference in central macularthickness between the two treatments at 6 th and 12 th months. On the other hand, due topossible local and systemic complications that may occur after intravitreal injection, patientselection should be considered, necessary precautions should be taken and patients should befollowed up well after treatment.
The aim of this study was to evaluate the current treatment of diabetic macular edema;to investigatethe effect of intraocular 2 mg aflibercept andintraocular 0.5 mg ranibizumab onvisual acuity and anatomic prognosis retrospectively. Patients who were diagnosed with diabetic macular edema between January 2014 andFebruary 2019 in Edirne Trakya University Medical Faculty Hospital Eye Diseases RetinaUnit were included in this study retrospectively. In our study, patients were divided into twogroups; the anatomical and functional results of 69 eyes treated with intravitreal ranibizumabfor diabetic macular edema and 56 eyes treated with intravitreal aflibercept were compared. Inboth groups, patients were initially given 3 consecutive loading doses at intervals of 1 month,and after 3 months pro re nata treatment regimen was administered. The visual acuity valuesof the patients taken with Snellen chart before the injection were converted to ’Logarythm ofMinimum Angle of Resolution’ scale. Biomicroscopic examination of the anterior segmentand fundus examination by indirect ophthalmoscopy were performed. Intraocular pressurewas measured by Goldmannapplanation tonometry. All patients were examined at 4-weekintervals for 1 year. When visual acuity and central macular thickness of both groups were examined;visual acuity improved significantly at 3 rd month (p=0,002), 6 61 th month(p = 0,003) and 12 month (p=0,023) after intravitreal ranibizumab injections; central macular thickness decreased th significantly at 3 rd month (p?0,001), 6 th month (p?0,001) and 12 th month (p?0,001). Afterintravitreal aflibercept injection, visual acuity improved significantly in the 3 month(p=0,021), improved in the 6 th month (p=0,133), and decreased in the 12 th month (p=0,884);central macular thickness decreased significantly at 3 rd month (p?0,001), 6 th month (p?0,001)and 12 th month (p?0,001). There was no statistically significant difference in visual acuitybetween the groups at 3 rd month (p=0,833), 6 th month (p = 0,896) and 12 th month(p=0,435).When central macular thickness was compared between groups, there was a statisticallysignificant decrease in aflibercept group in the 6 th month (p=0,029).When eyes with lowinitial visual acuity (Snellen 20/400-20/40 ~ LogMAR 1,30-0,30) were examined; visualacuity improved significantly at 3 rd month (p=0,001), 6 th month (p?0,001) and 12 month(p=0,004) after intravitreal ranibizumab injection; central macular thickness decreasedsignificantly at 3 rd month (p?0,001), 6 th month (p?0,001) and 12 th month (p?0,001). Visualacuity improved after 3 rd month (p=0,106), 6 th month (p=0,183) and 12 th month (p=0,948)after intravitreal aflibercept injection; central macular thickness decreased significantly at 3 month (p?0,001), 6 th month (p?0,001) and 12 th month (p?0,001). There was no statisticallysignificant difference invisual acuity between the groups at 3 rd month (p=0,240), 6 month(p=0,210) and 12 th month (p=0,052). When the central macular thickness was comparedbetween the groups, a statistically significant decrease was observed in the aflibercept groupin the 3 rd month (p=0,004) and in the 6 th month (p=0,007).In the treatment of diabetic macular edema, both intravitreal ranibizumab and intravitreal aflibercept treatments increased visual acuity and significantlydecreased centralmacular thickness, but there wasa significant difference in central macular thickness betweenthe two treatments in the sixth month. In eyes with low initial visual acuity, both intravitrealranibizumab and intravitreal aflibercept treatments increased visual acuity and significantlydecreased central macular thickness, but there was a significant difference in central macularthickness between the two treatments at 6 th and 12 th months. On the other hand, due topossible local and systemic complications that may occur after intravitreal injection, patientselection should be considered, necessary precautions should be taken and patients should befollowed up well after treatment.
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Keywords
Diyabetik Maküla Ödemi, Diyabetik Retinopati, İntravitrealenjeksiyon, Görme Keskinliği, Diabetic Macular Edema, Diabetic Retinopathy, Intravitreal Injection, Visual Acuity
