Retina ven dal tıkanıklığı olan hastalarda kombine intravitreal deksametazon implant ve anti-vegf enjeksiyonu sonrası anatomik ve fonksiyonel sonuçların retrospektif olarak değerlendirilmesi
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Date
2017
Authors
Yaşar, Sefa
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada kombine deksametazon implant ve anti-VEGF (aflibercept) enjeksiyonunun retina ven dal tıkanıklığına (RVDT) bağlı olan maküla ödemi üzerine etkisi ve komplikasyonları irdelenmiştir. RVDT'ye bağlı kistoid maküla ödemi (KMÖ) nedeni ile Nisan 2014 ile Nisan 2017 tarihleri arasında kombine intravitreal deksametazon implantasyonu ve anti-VEGF (aflibercept) enjeksiyonu yapılmış 30 hastanın 30 gözü ve sadece deksametazon implantasyonu yapılmış 30 hastanın 30 gözüne ait dosyalar geriye dönük olarak incelendi. Enjeksiyon öncesinde ve enjeksiyondan sonra her ay maküla ödemi nüks edene kadar hastaların "Early Treatment of Diabetic Retinopathy Study" (ETDRS) eşeli ile düzeltilmiş en iyi görme keskinlikleri (DEİGK) ve göz içi basınçları (GİB) ölçülerek, optik koherens tomografisi (OKT) ile vitreomaküler ara yüzey değerlendirilerek santral maküler kalınlık (SMK) ölçüldü ve kaydedildi. Tüm enjeksiyonlar sonrasında her iki grupta da anlamlı ve benzer anatomik ve fonksiyonel iyileşme gözlendi. Her iki grupta yaklaşık 8 aylık izlem süresince ortalama enjeksiyon sayısı 2,23 olarak bulundu. İlk enjeksiyon sonrasında DEİGK'ye ve en düşük SMK değerine ulaşma süresi kombine tedavi grubunda (sırasıyla 1,66 ve 2,03 ay) deksametazon grubuna (sırasıyla 2.36 ve 2.63 ay) göre anlamlı olarak daha kısa olarak saptandı (sırasıyla p:0,022 ve 0,037). Tekrar enjeksiyon zamanı her iki grupta ortalama 3,7 aydı. Deksametazon grubunda 2 gözde (%6) enfeksiyöz endoftalmi gelişti. Diğer komplikasyonlar ise her iki grupta benzer saptandı. Sonuç olarak, deksametazon implanta anti-VEGF ilavesi, özellikle ilk enjeksiyon sonrasında daha hızlı anatomik ve görsel iyileşme ile sonuçlanmaktadır. Bu nedenle, özellikle hızlı iyileşmenin hedeflendiği yoğun maküla ödemli RVDT olgularında kombine deksametazon implant ve anti-VEGF tedavisi tercih edilebilir bir seçenek olarak görülebilir.
In this study, we evaluated the effects and the complications of combined dexamethasone intravitreal implant (DEX implant) and anti-VEGF injection (aflibercept) for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). A total of 30 eyes of the 30 patients in DEX implant group and 30 eyes of the 30 patients in the combination therapy group who had cystoid macular edema due to the branched retinal vein occlusion, got hospitalized between April 2014 and April 2017 were retrospectively evaluated upon their patient records. Best-corrected visual acuity (BCVA) with Early Treatment of Diabetic Retinopathy Study (ETDRS) scale and intraocular pressure (IOP) of the patients were thoroughly evaluated; vitreomacular intermediate surface was evaluated with spectral-domain optic coherence tomography (OCT) and central macular thickness (CMT) were measured and recorded before injection and monthly after injections until macular edema relapses. Significant and similar anatomical and functional improvements were observed in both groups after all injections.The average number of injections was 2.23 during the approximately 8 months follow-up period in both groups. Time to reach the BCVA and the lowest CMT value was significantly shorter in the combined treatment group (1.66 and 2.03 months respectively) than the dexamethasone group (2.36 and 2.63 months respectively)(p:0.022 ve 0.037 respectively). The re-injection time was 3.7 months in both groups. In the dexamethasone group, infectious endophthalmitis developed in 2 eyes (6%). Other complications were similar in both groups. In conclusion, DEX implant results in a faster anatomical and visual improvement after anti-VEGF addition, especially after the first injection. Therefore, combined DEX implant and anti-VEGF treatment may be preferred, especially in cases of intense macular edema with BRVO targeted to rapid healing.
In this study, we evaluated the effects and the complications of combined dexamethasone intravitreal implant (DEX implant) and anti-VEGF injection (aflibercept) for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). A total of 30 eyes of the 30 patients in DEX implant group and 30 eyes of the 30 patients in the combination therapy group who had cystoid macular edema due to the branched retinal vein occlusion, got hospitalized between April 2014 and April 2017 were retrospectively evaluated upon their patient records. Best-corrected visual acuity (BCVA) with Early Treatment of Diabetic Retinopathy Study (ETDRS) scale and intraocular pressure (IOP) of the patients were thoroughly evaluated; vitreomacular intermediate surface was evaluated with spectral-domain optic coherence tomography (OCT) and central macular thickness (CMT) were measured and recorded before injection and monthly after injections until macular edema relapses. Significant and similar anatomical and functional improvements were observed in both groups after all injections.The average number of injections was 2.23 during the approximately 8 months follow-up period in both groups. Time to reach the BCVA and the lowest CMT value was significantly shorter in the combined treatment group (1.66 and 2.03 months respectively) than the dexamethasone group (2.36 and 2.63 months respectively)(p:0.022 ve 0.037 respectively). The re-injection time was 3.7 months in both groups. In the dexamethasone group, infectious endophthalmitis developed in 2 eyes (6%). Other complications were similar in both groups. In conclusion, DEX implant results in a faster anatomical and visual improvement after anti-VEGF addition, especially after the first injection. Therefore, combined DEX implant and anti-VEGF treatment may be preferred, especially in cases of intense macular edema with BRVO targeted to rapid healing.
Description
Keywords
Retina ven dal tıkanıklığı, Deksametazon implant, Anti-VEGF, Branched retinal vein occlusion, Dexamethasone implant
Citation
Yaşar, S. (2017). Retina ven dal tıkanıklığı olan hastalarda kombine intravitreal deksametazon implant ve anti-vegf enjeksiyonu sonrası anatomik ve fonksiyonel sonuçların retrospektif olarak değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.