Retinal ven oklüzyonu olan hastalarda intravitreal deksametazon implant enjeksiyonu sonrası anatomik ve fonksiyonel sonuçların değerlendirilmesi
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Date
2015
Authors
Yılmaz, Hakan
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada yeni bir tedavi yöntemi olan deksametazon implantın intavitreal olarak tek doz uygulanmasının Retina ven tıkanıklığına bağlı olan makula ödemi üzerine etkisi ve komplikasyonları irdelenmiştir. RVT'ye bağlı kistoid makula ödemi (KMÖ) saptanan ve bu nedenle Şubat 2013 ile Nisan 2014 tarihleri arasında intravitreal olarak 0,7 mg deksametazon implante edilmiş 53 hastanın 53 gözüne ait dosyalar geriye dönük olarak incelendi. Enjeksiyon öncesinde ve enjeksiyondan sonra 1 hafta, 1. ay, 3. ay ve daha sonra her 3 ayda bir makula ödemi nüksedene kadar hastaların Early Treatment of Diabetic Retinopathy Study (ETDRS) eşeli ile en iyi görme keskinlikleri ve göz içi basınçları (GİB) ölçüldü, ön ve arka segment muayeneleri eksiksiz olarak yapıldı, time-domain optic koherens tomografi (OKT) ( Carl Zeiss Meditec, Stratus OCT, Model 3000) ile vitreomakuler ara yüzey değerlendirildi ve santral makuler kalınlık (SMK) (merkezi 3 mm'lik alan) ölçüldü ve kaydedildi. Çalışmamızda retinal ven dal tıkanıklığı (RVDT) grubunda enjeksiyon sonrası daha birinci haftada istatistiksel anlamlı görme artışı elde edildi. Maksimum görme artışı 1.ayda elde edilirken, 3. ve 6. aylarda ortalama görme keskinliği azalma eğiliminde olmakla birlikte başlangıca göre hala anlamlı olarak daha yüksekti. Dokuzuncu ayda ise görme başlangıç seviyesine dönmüştü. Santral retinal ven tıkanıklığı (SRVT) grubunda ise görme ancak 1. ayda anlamlılığa yakın düzeyde (p=0.06) artış gösterdi, takiben 3. ayda azalma eğilimine girdi ve 6. ayda başlangıç seviyesine geri döndü. Santral makula kalınlığındaki değişime baktığımızda ise, RVDT hastalarına görmedeki artışa paralel bir SMK incelmesi izlendi. SRVT grubunda ise daha 1. haftada anlamlı bir SMK incelmesi (p=0.01) görülürken, görmedeki artışın ise daha geç olarak 1. ayda gerçekleştiği tespit edildi. Sonuç olarak, çalışmamızın bulguları intravitreal deksametazon implant tedavisinin retinal ven oklüzyonuna bağlı makula ödeminde anatomik ve fonksiyonel iyileşme sağladığını göstermektedir. Maksimum etki enjeksiyondan sonra 1 ile 3 aylık dönemde ortaya çıkmakta, takiben etki azalmaktadır. Retinal ven dal tıkanıklığı olan hastalara göre, SRVT olgularında olumlu etki daha sınırlı olmakta ve daha kısa süre devam etmektedir.
In this study, we evaluated the effects and the complications of the intravitreal implementation of the one dose dexamethasone implant on the macular edema due to the retinal vein occlusion (RVO). A total of 53 eyes of the 53 patients who had cystoid macular edema due to the retinal vein occlusion, got hospitalized between February 2013 and April 2014 and treated with 0.7 mg of dexamethasone were retrospectively evaluated upon their patient records. Best visual acuity with Early Treatment of Diabetic Retinopathy Study (ETDRS) scale and intraocular pressure of the patients were thoroughly evaluated; vitreomacular intermediate surface was evaluated with time-domain optic coherence tomography (OCT) and central macular thickness (3 mm of central area) was measured and recorded before and 1 week, 1 month, 3 month after injection and then once every 3 month until macular edema relapses. In our study, statistically significant improvement on visual acuity was achieved in branch retinal vein occlusion (BRVO) group even 1 week after injection. Maximal improvement of visual acuity was achieved in first month; then average visual acuity has been still significantly higher than basal values although there was a tendency towards decreasing. However, visual acuity had returned to the initial values at ninth month. In central retinal vein occlusion (CRVO) group, visual acuity was barely increased significantly (p=0.06) at first month; then entered into a tendency towards decreasing and returned to the basal values at sixth month. When the difference between central macular thickness was evaluated, there were a SMT thinning parallel with increasing of visual acuity in BRVO patients. However, there was a significant (p=0.01) central retinal thickness (CRT) thinning even in the first week and it was found that increase in the visual acuity occured later as first month. In conclusion, results of our study indicates that intravitreal dexamethasone implant treatment provides anatomical and functional improvements in macular edema due to retinal vein occlusion. Maximal impact occurs in the period of 1-3 month after injection and subsequently diminishes. Compared with the patients who had retinal vein branch occlusion, impact is smaller and maintaned shorter in CRVO cases.
In this study, we evaluated the effects and the complications of the intravitreal implementation of the one dose dexamethasone implant on the macular edema due to the retinal vein occlusion (RVO). A total of 53 eyes of the 53 patients who had cystoid macular edema due to the retinal vein occlusion, got hospitalized between February 2013 and April 2014 and treated with 0.7 mg of dexamethasone were retrospectively evaluated upon their patient records. Best visual acuity with Early Treatment of Diabetic Retinopathy Study (ETDRS) scale and intraocular pressure of the patients were thoroughly evaluated; vitreomacular intermediate surface was evaluated with time-domain optic coherence tomography (OCT) and central macular thickness (3 mm of central area) was measured and recorded before and 1 week, 1 month, 3 month after injection and then once every 3 month until macular edema relapses. In our study, statistically significant improvement on visual acuity was achieved in branch retinal vein occlusion (BRVO) group even 1 week after injection. Maximal improvement of visual acuity was achieved in first month; then average visual acuity has been still significantly higher than basal values although there was a tendency towards decreasing. However, visual acuity had returned to the initial values at ninth month. In central retinal vein occlusion (CRVO) group, visual acuity was barely increased significantly (p=0.06) at first month; then entered into a tendency towards decreasing and returned to the basal values at sixth month. When the difference between central macular thickness was evaluated, there were a SMT thinning parallel with increasing of visual acuity in BRVO patients. However, there was a significant (p=0.01) central retinal thickness (CRT) thinning even in the first week and it was found that increase in the visual acuity occured later as first month. In conclusion, results of our study indicates that intravitreal dexamethasone implant treatment provides anatomical and functional improvements in macular edema due to retinal vein occlusion. Maximal impact occurs in the period of 1-3 month after injection and subsequently diminishes. Compared with the patients who had retinal vein branch occlusion, impact is smaller and maintaned shorter in CRVO cases.
Description
Keywords
Retina ven tıkanıklığı, Deksametazon implant, Retinal vein occlusion, Dexamethasone implant
Citation
Yılmaz, H. (2015). Retinal ven oklüzyonu olan hastalarda intravitreal deksametazon implant enjeksiyonu sonrası anatomik ve fonksiyonel sonuçların değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.