TY - JOUR T1 - Diyabetik Maküla Ödeminde Unilateral ve Bilateral Uygulanan İntravitreal Ranibizumab Tedavisinin Anatomik ve Görsel Sonuçları TT - Anatomical and Visual Outcomes of Unilateral and Bilateral Intravitreal Ranibizumab Treatment Applied in Diabetic Macular Edema AU - Bozkurt, Erdinç AU - Öndaş, Osman PY - 2018 DA - December JF - Kafkas Journal of Medical Sciences JO - KAFKAS TIP BİL DERG PB - Kafkas Üniversitesi WT - DergiPark SN - 2146-2631 SP - 158 EP - 164 VL - 8 IS - 3 LA - tr AB - Amaç: Diyabetikmakula ödemi olan hastalarda unilateral ve bilateral uygulanan intravitrealranibizumab tedavisinin anatomik ve görsel sonuçlarının karşılaştırılması amaçlanmıştır.Materyal ve Metod:  Atatürk Üniversitesi Tıp Fakültesi GözHastalıkları Kliniği’nde Nisan 2012-Mayıs 2017 tarihleri arasında diyabetikmakula ödemi (DMÖ) olan ve birer ay ara ile toplam 3 kez intravitrealranibizumab (İVR) enjeksiyonu uygulanan hastaların dosyaları retrospektifolarak incelendi. Yaş, cinsiyet, diyabetin süresi, şikayetler ile ilk ranibizumabtedavisi arasındaki süre, uygulanan diğer tedaviler, takip süresi, göz içibasıncı, görme keskinliği (EDGK) kaydedildi. İstatistiksel analizlerde paired-ttesti 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 gözüdahil edildi. 40 hasta unilateral, 40 hasta bilateral DMÖ nedeniyle tedaviedildi. İlk kez tedavi gören hastalara birer ay ara ile toplam 3 kez İVRenjeksiyonu uygulandı. Ortalama diyabet süresi unilateral olgularda 10.6 yıl,bilateral olgularda 11,2 yıl idi. Şikayetler ile ilk ranibizumab tedavisiarasındaki süre, unilateral olgularda 21gün, bilateral olgularda 18gün idi.Takip süresi unilateral olgularda ortalama 6.3 ay, bilateral olgularda 6.7 ayidi. Başvuru anında ortalama EDGK unilateral olgularda 0.19±0.23(Snellen), bilateralolgularda sağ gözlerde 0.21±1.35, sol gözlerde 0.29±0.76 (p˃0,05), 6.ayda isesırasıyla 0.2±0.32, 0.53±2.59, 0.49±1.92 (p˃0,05)idi. OCT incelemesinde; başvuruanında ortalama santral foveolar kalınlığı (SFK) unilateral olgularda458.1±177.6µm, bilateral olgularda sağ gözlerde 412.5±233.8µm, sol gözlerde463.2±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: UnilateralİVR uygulanan hastaların diğer gözlerinde SFK’ında ve görme düzeyinde anlamlıbir değişiklik saptamadık. Bilateral ve unilateral İVR uygulamalarıkıyaslandığında, EDGK ve SFK’ındaki değişim açısından istatistiksel olarakanlamlı farkın olmadığı ve bilateral İVR uygulamasının sinerjistik etkisininolmadığı kanaatindeyiz. KW - Diyabetik makula ödemi KW - görme keskinliği KW - intravitreal ranibizumab KW - santral foveolar kalınlık N2 - Aim: Comparison of anatomical andvisual results of unilateral and bilateral intravitreal ranibizumab treatmentin patients with diabetic macular edema.Material-Method: The files of patients withdiabetic macular edema (DME) who underwent intravitreal ranibizumab (IVR) for atotal of 3 times between April 2012 and May 2017 were reviewed retrospectivelyat Ataturk University Ophtalmology Department. Age, gender, duration ofdiabetes, duration between complaints and first ranibizumab treatment, othertreatments, follow-up period, intraocular pressure, best corrected visualacuity (BCVA) were recorded. The paired-t test was used for statisticalanalysis, p<0.05 was considered significant.Results: 120 eyes of 80 patients with DME, whose 43 weremales, 37 were females and 59-82 years old were included. 40 patients weretreated unilaterally because of DME and 40 patients were treated bilaterallydue to DME. Mean BCVA was 0.19±0.23 (Snellen) in unilateral cases, 0.21±1.35 inthe right eye, 0.29±0.76 in the left eye in bilateral case p˃0.05) at the timeof admission, in the 6thmonth, the meanvalues ​​were 0.42±0.32, 0.53±2.59, 0.49±1.92 (p˃0.05), respectively. Meancentral 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 bilateralcases. After treatment, at the 6th month, respectively; mean CFT was301.3±129.6 μm, 297.3±316 µm, 280.1±317.3 μm (p˃0.05).Conclusion: We didn’t determine any significant change in CFTand BCVA in the other eyes of the patients applied unilateral IVR. When comparingunilateral IVR with bilateral IVR, we conclude that there isn’t statisticallysignificant difference in terms of changes in BCVA and CFT and there isn’tsynergistic effect of bilateral IVR administration. CR - 1. Rehak J, Rehak M: Branch Retinal Vein Occlusion: Pathogenesis, Visual Prognosis, and Treatment Modalities Current Eye Research. 2008;33:111-131 CR - 2. Davidson J K. Clinical diabetes mellitus, diabetic eye disease. Thime Medica Publishers 1991;427-44. CR - 3. Ayyıldız O, Durukan AH, Ozgurtas T, Gunal A. A Comparison of Intravitreal Bevacizumab and Steroid Activity in an Experimental Uveitis Model. Curr Eye Res. 2015;40(12):1261-8. CR - 4. SCORE Study Research Group. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study report 6. Arch Ophthalmol. 2009;127:1115-28 20 CR - 5. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology. 1995;102:7-16. CR - 6. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BE. The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes. Ophthalmology. 2009;116:497-503 CR - 7. Fong AH, Lai TY. Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema. Clin Interv Aging 2013;8:467-83. CR - 8. Chun DW, Heier JS, Topping TM, Duker JS, Bankert JM. A Pilot Study of Multiple İntravitreal Injections of Ranibizumab in Patients with Center –Involving Clinically Significant Diabetic Macular Edema. Ophthalmology. 2006;113;1706-1712. CR - 9. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L et al. RISE and RIDE Research Group. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 2012;119:789-801. CR - 10. Nguyen QD, Shah SM, Heier JS, Do DV, Lim J, Boyer D et al. READ-2 Study Group. Primary End Point (Six Months) Results of the ranibizumab for edema of the macula in diabetes (READ-2) study. Ophthalmology 2009;116:2175-81. CR - 11. Bakri, S.J., Snyder, M.R., Reid, J.M., Pulido JS, Singh RJ. Pharmacokinetics of intravitreal ranibizumab (Lucentis). Ophthalmology. 114: 2179–2182, 2007. CR - 12. Wu Z, Sadda SR. Effects on the contralateral eye after intravitreal bevacizumab and ranibizumab injections: a case report. Ann Acad Med Singapore 2008;37:591–593 CR - 13. Acharya, Nisha R, Wantanee S, Ying Q, Kevin H, Salena LM OD Bılateral Effect Of Unılateral Ranıbızumab In Patıents Wıth Uveıtıs-Related Macular EDEMA Retina: October 2011 - Volume 31 - Issue 9 - p 1871-1876. CR - 14. Zehetner C., Kirchmair R., Huber S., Kralinger MT., Kieselbach GF. Plasma levels of vascular endothelial growth factor before and after intravitreal injection of bevacizumab, ranibizumab and pegaptanib in patients with age-related macular degeneration, and in patients with diabetic macular oedema. Br. J. Ophthalmol. 97:454–459, 2013. CR - 15. Barbazetto IA, Saroj N, Shapiro H, Wong P, Ho AC, Freund KB. Incidence of new choroidal neovascularization in fellow eyes of patients treated in the MARINA and ANCHOR trials. Am J Ophthalmol 2010;149:939–946. CR - 16. Bakbak B, Ozturk BT, Gonul S, Yilmaz M, Gedik S. Comparison of the effect of unilateral bevacizumab and ranibizumab on diabetic macular edema of the fellow eye. J Ocul Pharmacol Ther 2013;29(8):728-32. CR - 17. Sül S, Karalezli A. Turkiye Klinikleri J Ophthalmol.2018-60714 UR - http://dergipark.org.tr/tr/pub/kaftbd/issue//544697 L1 - http://dergipark.org.tr/tr/download/article-file/679689 ER -