Anjiografik Erken Hiperfloresansın Kistoid Diyabetik Maküler Ödem Tedavisindeki Prognostik Rolü

Abstract

Amaç: Çalışmanın amacı, fundus floresein anjiografi (FFA) görüntülerindeki floresans seviyesinin diyabetik maküler ödem prognozundaki öngördürücü değerini saptamaktır. Gereç ve Yöntem: Retrospektif tasarımlı bu çalışmada, diyabetik maküler ödem için intravitreal enjeksiyon (ranibizumab, aflibersept) tedavisi alan 21 hastanın 21 gözü değerlendirilmiştir. Demografik özelliklere ek olarak, tedavi öncesi ve sonrası en iyi düzeltilmiş görme keskinliği (EİDGK), santral retinal kalınlık (SRK) ve FFA’da erken evre floresans düzeyi kaydedilmiştir. Erken evre anjiografik florasansın tedaviye yanıt prognozunu gösterme etkisi değerlendirilmiştir. Gruplar reflektans düzeyine gore düşük ya da yüksek floresans olarak gruplandırılmıştır. Bulgular: Tedavi sonrası EİDGK anlamlı olarak artarken, ortalama SRK anlamlı olarak azalmıştır (p<0,05). Gruplar arasında EİDGK ve SRK değişimi açısından anlamlı fark saptanmamıştır (p=0.716, p=0.809, sırasıyla). Yüksek erken floresansı olan gözlerde SRK’daki değişim düşük floresan olan gözlerden daha yüksek saptanmıştır (p<0,05). Yüksek erken floresansı olan gözlerde daha geniş foveal avasküler zon ölçülmüştür. Sonuç: Bu çalışma sonucunda FFA’nın erken döneminde yüksek floresansı olan gözlerde daha fazla vasküler ve hücresel hasar bulunduğu gösterilmiştir. Bu bulgunun prognostik önemi ileride yapılacak çalışmalarda irdelenmelidir.

Keywords

• Diyabetik maküler ödem
• Fundus floresein anjiyografi
• Erken hiperfloresans
• İntravitreal enjeksiyon

The Prognostic Role of Early Hyperfluorescence in the Treatment of Cystoid Diabetic Macular Edema

Abstract

Aim: To evaluate the predictive value of fluorescence level in fundus fluorescein angiography (FFA) images for the prognosis of diabetic macular edema (DME). Material and Methods: In this retrospective study, 21 eyes of 21 patients who have been treated with intravitreal injection (ranibizumab, aflibercept) for DME were evaluated. In addition to demographic features, pre/post-treatment best-corrected visual acuity (BCVA) and central retinal thickness (CRT), early-stage reflectance of fluorescence in FFA were also quantified. The prognostic role of early angiographic reflectance in response to treatment were evaluated. Groups were defined as high or low early fluorescence according to the reflectance level in early angiographic phase. Results: After treatment, mean BCVA was increased and mean CRT was decreased significantly (p<0.05). There was no significant difference between groups regarding BCVA and CRT change (p=0.716, p=0.809, respectively). The change in CRT in eyes with higher early fluorescence was significantly higher than eyes with lower fluorescence. Eyes with higher fluorescence had a wider foveal avascular zone. Conclusion: This study demonstrated that more vascular and cellular damage is related to higher hyperfluorescence level in the early period of FFA. The prognostic significance of this finding deserves to be evaluated with further studies.

Keywords

• Diabetic macular edema
• Fundus fluorescein angiography
• Early hyperfluorescence
• İntravitreal injection

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