Diyabetik Maküla Ödeminde Unilateral ve Bilateral Uygulanan İntravitreal Ranibizumab Tedavisinin Anatomik ve Görsel Sonuçları

Yıl 2018, Cilt: 8 Sayı: 3, 158 - 164, 01.12.2018

Erdinç Bozkurt Osman Öndaş

Öz

Amaç: Diyabetik
makula ödemi olan hastalarda unilateral ve bilateral uygulanan intravitreal
ranibizumab tedavisinin anatomik ve görsel sonuçlarının karşılaştırılması amaçlanmıştır.

Materyal ve Metod:  Atatürk Üniversitesi Tıp Fakültesi Göz
Hastalıkları Kliniği’nde Nisan 2012-Mayıs 2017 tarihleri arasında diyabetik
makula ödemi (DMÖ) olan ve birer ay ara ile toplam 3 kez intravitreal
ranibizumab (İVR) enjeksiyonu uygulanan hastaların dosyaları retrospektif
olarak incelendi. Yaş, cinsiyet, diyabetin süresi, şikayetler ile ilk ranibizumab
tedavisi arasındaki süre, uygulanan diğer tedaviler, takip süresi, göz içi
basıncı, görme keskinliği (EDGK) kaydedildi. İstatistiksel analizlerde paired-t
testi kullanıldı, p<0.05 olması anlamlı kabul edildi.

Bulgular: Çalışmaya;
DMÖ olan 43’ü erkek, 37’si kadın, yaşları 59-82 olan, 80 hastanın 120 gözü
dahil edildi. 40 hasta unilateral, 40 hasta bilateral DMÖ nedeniyle tedavi
edildi. İlk kez tedavi gören hastalara birer ay ara ile toplam 3 kez İVR
enjeksiyonu uygulandı. Ortalama diyabet süresi unilateral olgularda 10.6 yıl,
bilateral olgularda 11,2 yıl idi. Şikayetler ile ilk ranibizumab tedavisi
arasındaki süre, unilateral olgularda 21gün, bilateral olgularda 18gün idi.
Takip süresi unilateral olgularda ortalama 6.3 ay, bilateral olgularda 6.7 ay
idi. Başvuru anında ortalama EDGK unilateral olgularda 0.19±0.23(Snellen), bilateral
olgularda sağ gözlerde 0.21±1.35, sol gözlerde 0.29±0.76 (p˃0,05), 6.ayda ise
sırasıyla 0.2±0.32, 0.53±2.59, 0.49±1.92 (p˃0,05)idi. OCT incelemesinde; başvuru
anında ortalama santral foveolar kalınlığı (SFK) unilateral olgularda
458.1±177.6µm, bilateral olgularda sağ gözlerde 412.5±233.8µm, sol gözlerde
463.2±721.9 µm (p˃0,05), tedavi sonrası 6.ayda ise sırasıyla; 301.3±129.6µm,
297.3±316, 280.1±317.3 µm (p˃0,05)idi.

Sonuç: Unilateral
İVR uygulanan hastaların diğer gözlerinde SFK’ında ve görme düzeyinde anlamlı
bir değişiklik saptamadık. Bilateral ve unilateral İVR uygulamaları
kıyaslandığında, EDGK ve SFK’ındaki değişim açısından istatistiksel olarak
anlamlı farkın olmadığı ve bilateral İVR uygulamasının sinerjistik etkisinin
olmadığı kanaatindeyiz.

Anahtar Kelimeler

Diyabetik makula ödemi, görme keskinliği, intravitreal ranibizumab, santral foveolar kalınlık

Anatomical and Visual Outcomes of Unilateral and Bilateral Intravitreal Ranibizumab Treatment Applied in Diabetic Macular Edema

Öz

Aim: Comparison of anatomical and
visual results of unilateral and bilateral intravitreal ranibizumab treatment
in patients with diabetic macular edema.

Material-Method: The files of patients with
diabetic macular edema (DME) who underwent intravitreal ranibizumab (IVR) for a
total of 3 times between April 2012 and May 2017 were reviewed retrospectively
at Ataturk University Ophtalmology Department. Age, gender, duration of
diabetes, duration between complaints and first ranibizumab treatment, other
treatments, follow-up period, intraocular pressure, best corrected visual
acuity (BCVA) were recorded. The paired-t test was used for statistical
analysis, p<0.05 was considered significant.

Results: 120 eyes of 80 patients with DME, whose 43 were
males, 37 were females and 59-82 years old were included. 40 patients were
treated unilaterally because of DME and 40 patients were treated bilaterally
due to DME. Mean BCVA was 0.19±0.23 (Snellen) in unilateral cases, 0.21±1.35 in
the right eye, 0.29±0.76 in the left eye in bilateral case p˃0.05) at the time
of admission, in the 6^thmonth, the mean
values ​​were 0.42±0.32, 0.53±2.59, 0.49±1.92 (p˃0.05), respectively. Mean
central foveolar thickness (CFT) was 458.1±177.6 μm in unilateral cases,
412.5±233.8μm in right eye and 463.2±721.9μm in left eye (p˃0,05) in bilateral
cases. After treatment, at the 6^th month, respectively; mean CFT was
301.3±129.6 μm, 297.3±316 µm, 280.1±317.3 μm (p˃0.05).

Conclusion: We didn’t determine any significant change in CFT
and BCVA in the other eyes of the patients applied unilateral IVR. When comparing
unilateral IVR with bilateral IVR, we conclude that there isn’t statistically
significant difference in terms of changes in BCVA and CFT and there isn’t
synergistic effect of bilateral IVR administration.

Anahtar Kelimeler

Diabetic macular edema, visual acuity, intravitreal ranibizumab, central macular thickness

Kaynakça

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