Yaşa bağlı maküla dejenerasyonunun yaş tipinde intravitreal ranibizumab enjeksiyonun etkinliğinin araştırılması

Year 2018, Volume: 15 Issue: 3, 166 - 175, 12.12.2018

Müslüm Toptan , Ahmet Satıcı Ayhan Sağlık

Abstract

Amaç: Yaşa bağlı maküla dejenerasyonunun yaş tipinde intravitreal ranibizumab enjeksiyonun etkinliğinin araştırılması.

Materyal ve Metod: Haziran 2009 ile Haziran 2011 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalında yaş tip yaşa bağlı maküla dejenerasyonu tanısıyla intravitreal ranibizumab uygulanan ve en az 12 ay izlenen 60 hastanın 60 gözü retrospektif olarak incelenmiştir. Hastalara ranibizumab tedavisi öncesi ve sonrası her kontrolde en iyi düzeltilmiş görme keskinliği ölçümü ve detaylı oftalmolojik muayene yapılmıştır. Tedavi öncesi hastaların renkli fundus fotoğrafları ve fundus floresein anjiografi çekimleri yapılmıştır. Daha sonra fundus floresein anjiografi çekimleri 2 ayda bir gerçekleştirilmiştir. Tedavi şeması olarak ilk 3 ay, ayda bir kez ranibizumab intravitreal olarak uygulanmıştır. 3. aydan sonra en az bir Snellen sırası görme azalması olan, intraretinal veya preretinal hemorajisi bulunan, fundus floresein anjiografide orta derece veya artmış sızıntısı olan olgularda koroid neovaskülarizasyonu aktif olarak kabul edilmiş ve tedavi tekrarlanmıştır. Hastalar her ay kontrole çağrılmıştır. Tedavi sonrası en iyi düzeltilmiş görme keskinliği, ranibizumab enjeksiyon sayısı araştırılmıştır.

Bulgular: Hastaların ortalama yaşı 72,0±7.13 (56-84) idi. Olguların % 53 ü kadın, % 47 si erkek idi. Ortalama takip süresi 16.81±7.34 (12-30) ay idi. Hastaların fundus floresein anjiografide bulgularına göre 60 gözün 32 (% 53) sinde gizli tip, 20 (% 33) sinde baskın klasik tip ve 8 (% 13) inde minimal klasik tip koroid neovaskülarizasyon saptanmıştır. Tedavi öncesi en iyi düzeltilmiş görme keskinliği ortalama logMAR değerleri 0.67±0.29 iken tedavi sonrası 12. ayda 0.59±0.30 olarak saptanmıştır. Gözlerin % 83 ünde görmenin aynı kaldığı veya arttığı saptanmıştır. 3 logMAR sırası ve üzeri kazanımı olan 10 (% 16,6) hasta, 3 sıradan az kazancı olan 16 (% 26,6) hasta, 3 sıradan az kaybı olan 7 (% 11,6) hasta, 3 sıradan fazla kaybı olan 3 (% 5) hasta olduğu saptanmıştır. Ranibizumab uygulanan gözlerde görme keskinliğinde istatistiksel olarak anlamlı düzeyde artış saptanmıştır (p < 0.01). Lezyon tipine göre subgruplar arasında görme artışı bakımından istatistiksel açıdan anlamlı düzeyde bir farklılık saptanmamıştır ( p > 0.05). Takip süresi boyunca ortalama 4.54±1.32 intravitreal ranibizumab enjeksiyonu yapılmıştır. Enjeksiyon sonrası 1. günde 2 gözde GİB değerlerinin 40 mmHg nın üzerinde olduğu saptanmış olup bir hastada akut açı kapanması glokomu, 2 gözde üveitik reaksiyon görülmüştür. Hastalarımızın hiçbirinde sistemik yan etkiye rastlanmamıştır.

Sonuç: Yaşa bağlı maküla dejenerasyonunun yaş tipinde intravitreal ranibizumab enjeksiyonu ile görme keskinliği artmıştır. Sabit uygulama aralığından farklı olarak hastalığın aktivasyon bulgularına göre tedavi uygulanması maliyet bakımından daha yararlı olacaktır. Gerektiğinde tekrarlanan ranibizumab enjeksiyonu her ay uygulananlara göre ilaca ve enjeksiyona bağlı yan etkileri azaltacaktır.

Keywords

Ranibizumab, maküla dejenerasyonu, neovaskülarizasyon

To evaluate the efficacy of intravitreal ranibizumab injection in wet type age- related macular degeneration

Abstract

Background: To evaluate the efficacy of intravitreal ranibizumab injection in wet type age-related macular degeneration.

Material and Methods: Sixty eyes of 60 patients treated with intravitreal ranibizumab injection for wet type age-related macular degeneration that were followed up for at least 12 months were evaluated retrospectively between june 2009 with june 2011 in Harran University Medical School Ophthalmology Department. Before and after ranibizumab treatment, in each control, measurement of best-corrected visual acuity and detailed ophthalmological examination were done to patients. Before treatment, color fundus photographs and fundus fluorescein angiography of patients were performed. Later, fundus fluorescein angiography was realized once in 2 months bimonths. First three months all patients were treated with intravitreal ranibizumab monthly in the treatment protocol. After the third month, chroidal neovascularization was regarded as active on the phenamenans with at least on Snellen line decrease in visual acuity, intraretinal or preretinal hemorrhage, moderate or increased leakage of fundus fluorescein angiography, and the treatment was repeated. Patients were called up to control every month. After treatment, best-corrected visual acuity, ranibizumab injection number was investigated.

Results: Thirty-two patients were female (53 %) and 28 (47 %) were male. Mean age was 72.0±7.13 (56-84) years. The mean follw-up period was 16.81±7.34 (12-30) months. According to fundus fluorescein angiography findings of patients out of 60 eyes 32 (53 %) of them were determined as occult type, 20 (33 %) of them were determined as predominantly classic type and 8 (13 %) of them were determined as minimally classic type choroidal neovascularization. While the average rates of logMAR were 0.67±0.29 before the treatment, on the 12th month after the treatment they were 0.59±0.30. On the 83 % of the eyes , the visual acuity was determined as the some or incresed. It was determined that there were 10 (16.6 %) patiens with 3 logMAR sequens and over acquisition, 16 (26.6 %) patients with a less acquisition of 3 sequences, 7 (11.6 %) patients with a less loss of 3 sequences, 3 (5 %) patients with a more loss of 3 sequences. The mean best-corrected visual acuity was significantly improved (p < 0.01) in all eyes with treatment ranibizumab but there was no statistical difference between the subgroups (p > 0.05). During follow-up period, about 4.54±1.32 intravitreal ranibizumab injection was performed. The first day after injection in both eyes intraocular pressure values were determined over 40 mmHg and acute angle-closure glaucoma in a patient and reaction was observed uveitis in both eyes. None of the patients with systemic side effects were seen.

Conclusion: Intravitreal ranibizumab injection was effective in increasing significantly in patients with wet type age-related macular degeneration. Unlike a fixed range of toolkid, a treatment according to the findings of activation of the disease will be more useful in terms of costs. Considering the ones applied every month, ranibizumab injection repeated as needed will reduce the side effects of drug and injection.

Keywords

Intravitreal ranibizumab, Macular degeneration, Neovascularization

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