Tip 2 Diabetik Makula Ödemli Hastalarda Tedavi Karşılaştırması

Year 2022, , 13 - 18, 01.03.2022

Abdülhekim Yarbağ

https://doi.org/10.26453/otjhs.934309

Abstract

Amaç: Diyabetik makula ödemi (DMÖ) tanılı hastalarda; intravitreal triamsinolon asetonid (İVTA), laser fotokoagülasyon (LFK) ve LFK ile kombine İVTA tedavilerinde etkinlik araştırması yapmak amaçlanmıştır.
Materyal ve Metot: Hastalar rastlantısal olarak üç ayrı gruba ayrıldı: Grup 1, 22 hastanın 30 gözünden oluşmakta olup yaş ortalaması 63,2 yıl idi. Grup 2, 22 hastanın 34 gözünden oluşmakta olup yaş ortalaması 59,9 yıl idi. Grup 3 ise 21 hastanın 27 gözünden oluşmakta olup yaş ortalaması 64,5 yıl idi. Olgulara tedavi öncesi ve sonrası 1. 3. 6. ve 9. aylarda en iyi düzeltilmiş görme keskinliği, göziçi basınç (GİB) ölçümü ve fundus muayenesini içeren tam göz muayenesi yapıldı. PERG (Pattern Elektroretinografi) testi ile P50 amplitüdü, HRTII (Heidelberg Retina Tomograph II) testi ile ÖHD (Ödem Harita Değeri) ölçüldü.
Bulgular: Grup 1’de (İVTA+LFK) görme keskinliği 26 (%86,6) gözde artarken, 3 (%10) gözde değişmedi, 1 (%3,3) gözde azaldı. Grup 2’de (LFK) görme keskinliği 18 (%52,9) gözde artarken, 10 (%29,4) gözde değişmedi, 6 (%17,6) gözde azaldı. Grup 3’te (İVTA) görme keskinliği 20 (%74) gözde artarken, 7 (%25,9) gözde değişmedi, azalma hiçbir olguda gözlenmedi.
Sonuç: IVTA ile birlikte lazer FK kullanımının, tek başına IVTA ve lazer FK kullanımından daha etkili olduğunu gözlemledik. 

Keywords

Diabetik makula ödemi, intravitreal triamsinolon asetonid, laser fotokoagülasyon

Thanks

Uzmanlık tez danışmanı olan Prof. Dr. Abdullah ÖZKIRIŞ’a katkılarından dolayı teşekkür ederiz.

Comparison of Treatment in Patients with Type 2 Diabetic Macular Edema

Abstract

Objective: In the study, it was aimed to compare the effectiveness of intravitreal triamcinolone acetonide (IVTA), laser photocoagulation (LPC), and the LPC combined with IVTA treatments in patients with diabetic macular edema (DME).
Materials and Methods: The patients were randomly separated into three groups: Group 1 (IVTA+LFC) consisted of 30 eyes of 22 patients, and the average age was 63.2 years. Group 2 (LFC)consisted of 34 eyes of 22 patients and the mean age was 59.9 years. Group 3(IVTA) consisted of 27 eyes of 21 patients with a mean age of 64.5 years. The complete eye examination including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurements, and the fundus inspection was carried out before and 1. 3. 6. and 9. months after the treatment. P50 amplitudes were measured with the PERG test, and edema map values (EMV) were measured with HRT II.
Results: In Group 1, the BCVA increased in 26 eyes (86.6%), did not change in 3 eyes (10%), and decreased in one eye (3.3%). In Group 2, the BCVA increased in 18 eyes (52.9%), did not change in 10 eyes (29.4%), and decreased in 6 eyes (17.6%). In Group 3, the BCVA increased in 20 eyes (74%) and did not change in 7 eyes (25.9%).
Conclusions: We observed the use of the laser FC combined with IVTA seems to be more effective than using each other of IVTA and laser FC solely. 

Keywords

Diabetic macular edema, intravitreal triamcinolone acetonide, laser photocoagulation

References

• Ozkiris A, Evereklioglu C, Erkilic K, Tamcelik N, Mirza E. Intravitreal triamcinolone acetonide injection as primary treatment for diabetic macular edema. Eur J Ophthalmol. 2004;14:543-9. PMID: 28221662.
• Morrison JL, Hodgson LA, Lim LL, Al-Qureshi S. Diabetic retinopathy in pregnancy: a review. Clin Exp Ophthalmol. 2016;44(4):321-34. doi: 10.1111/ceo.12760
• Vijan S. In the clinic. Type 2 diabetes. Ann Intern Med. 2015;162(5):ITC1-16. doi: 10.7326/AITC201503030
• Yarbağ A, Yazar H, Akdoğan M, Pekgör A, Kaleli S.Refractive errors in patients with newly diagnosed diabetes mellitus. Pak J Med Sci. 2015;31(6):1481-4. doi: 10.12669/pjms.316.8204
• Pradeepa R, Mohan V. Prevalence of type 2 diabetes and its complications in India and economic costs to the nation. Eur J Clin Nutr. 2017;71(7):816-824. doi: 10.1038/ejcn.2017.40
• Klein R, Klein BEK, Moss SE, Davis MDl. The Wisconsin Epidemiologic Study Of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmology. 1984;102:520-6. doi: 10.1001/archopht.1984.01040030398010
• Kalın HA, Hiller R. Blindness caused by diabetic retinopathy. Am J Ophthalmol 1974;78:58-67. PMID: 4835055.
• Bresnick GR. Diabetic macular edema. A review. Ophthalmology. 1986;93:989-997.
• Browning DJ, Stewart MW, Lee C. Diabetic macular edema: Evidence-based management. Indian J Ophthalmol. 2018;66(12):1736-1750. doi: 10.4103/ijo.IJO_1240_18
• Tolentino MJ, Millet JW, Gragoudas ES. Intravenous injections of vascular endothelial growth factor produce retinal ischemia and microangiopathy in an adult primate. Ophthalmology. 1996;103:1820-1828.
• Ciulla TA, Amodor AG, Zinman B. Diabetic retinopathy and diabetic macular edema. Pathophysiology, screening and novel therapies. Diabetes Care. 2003;26:2653-2664.
• İsa Yuvacı, Hayrullah Yazar. Effects of the Topical Application of Cyclosporin A, Propolis and Dexamethasone on Oxidative Stress in Rats with Corneal Neovascularization. Online Turkish Journal of Health Sciences. 2020;5(2):271-280. https://doi.org/10.26453/otjhs.718950
• Blakenship GW. Diabetic macular edema and argon laser photocoagulation. A prospective randomized study. Ophthalmology. 1979;86:69-75.
• Schindler RH, Chandler DB, Thresher R. The clearance of intravitreal triamcinolone acetonide. Am J Ophthalmol. 1982;93: 415-417.
• Yazar H, Yarbag A , Balci M, Teker B, Tanyeri P. The effects of povidone iodine (pH 4.2) on patients with adenoviral conjunctivitisi J Pak Med Assoc. 2016;66(8):968-70. PMID: 27524529.
• Wilson CA, Berkowitz BA, Sato Y, Ando N, Handa JT. Treatment with intravitreal steroid reduces blood-retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmology. 1992;110:1155-59.
• Klein R, Klein BEK, Moss SE, Davis MD. The Wisconsin Epidemiologic Study Of Diabetic Retinopathy. Diabetic Macular Edema. Ophthalmology. 1984;91:1464-74.
• Klein BEK, Horak KL, Maynard JD, Lee KE, Klein R. Association of Skin Intrinsic Fluorescence with Retinal Microvascular Complications of Long Term Type 1 Diabetes in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmic Epidemiol. 2017;24(4):211-216. doi: 10.1080/09286586.2016.1269934
• Little JL, Zweng HC, Jack RL, Vassiliadis A. Techniques of argon laser photocoagulation of diabetic disk new vessels. Am J Ophthalmol. 1976;82:675-83.
• Bandello F, Battaglia Parodi M, Lanzetta P, Loewenstein A, Massin P, Menchini F, Veritti D. Diabetic Macular Edema. Dev Ophthalmol. 2017;58:102-138. doi: 10.1159/000455277
• Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273
• Kim EJ, Lin WV, Rodriguez SM, Chen A, Loya A, Weng CY. Treatment of Diabetic Macular Edema. Curr Diab Rep. 2019 Jul 29;19(9):68. doi: 10.1007/s11892-019-1188-4
• Peyman GA, Spitznaz M, Straatsma BR. Peroxidase diffusion in the normal and photocoagulated retina. Invest Ophthalmol Vis Sci. 1971;10:181-89.
• Özkırış A, Evereklioğlu C, İlhan Ö, Erkılıç K, Mirza E, Doğan H. Diabetik makula ödemi olan olgularda tek doz intravitreal triamsinolonun göz içi basıncına etkisi. Türk Oftalmoloji Gazetesi. 2005;35:426-30.
• Se Woong Kang, Ho-Seok Sa, Hee Yoon Cho, Jong Kim. Macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol. 2006;93:653-58.