Anjiografik Erken Hiperfloresansın Kistoid Diyabetik Maküler Ödem Tedavisindeki Prognostik Rolü

Yıl 2022, Cilt: 11 Sayı: 2, 181 - 187, 14.07.2022

Eyup Karahan , Melek Köroğlu Gozde Sahın Vural , Sami Yılmaz , Ercan Gömleksiz Cenap Güler

https://doi.org/10.53424/balikesirsbd.983853

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Balaratnasingam, C., Inoue, M., Ahn, S., McCann, J., Dhrami-Gavazi, E., Yannuzzi, L. A., & Freund, K. B. (2016). Visual Acuity Is Correlated with the Area of the Foveal Avascular Zone in Diabetic Retinopathy and Retinal Vein Occlusion. Ophthalmology, 123(11), 2352–2367. https://doi.org/10.1016/j.ophtha.2016.07.008
• Boyer, D. S., Yoon, Y. H., Belfort, R. J., Bandello, F., Maturi, R. K., Augustin, A. J., Li, X.-Y., Cui, H., Hashad, Y., & Whitcup, S. M. (2014). Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology, 121(10), 1904–1914. https://doi.org/10.1016/j.ophtha.2014.04.024
• Browning, D. J., Glassman, A. R., Aiello, L. P., Beck, R. W., Brown, D. M., Fong, D. S., Bressler, N. M., Danis, R. P., Kinyoun, J. L., Nguyen, Q. D., Bhavsar, A. R., Gottlieb, J., Pieramici, D. J., Rauser, M. E., Apte, R. S., Lim, J. I., & Miskala, P. H. (2007). Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology, 114(3), 525–536. https://doi.org/10.1016/j.ophtha.2006.06.052
• Early Treatment Diabetic Retinopathy Study Design and Baseline Patient Characteristics: ETDRS Report Number 7. (1991). Ophthalmology, 98(5), 741–756. https://doi.org/10.1016/S0161-6420(13)38009-9
• ERDURMAN, F. C. (2013). Refrakter Kistoid Makula Ödeminde Anti-VEGF’lerin Kullanımı. Turkiye Klinikleri Ophthalmology - Special Topics, 6(2), 71–75. https://www.turkiyeklinikleri.com/article/en-refrakter-kistoid-makula-odeminde-anti-vegflerin-kullanimi-65403.html
• Fickweiler, W., Schauwvlieghe, A.-S. M. E., Schlingemann, R. O., Maria Hooymans, J. M., Los, L. I., & Verbraak, F. D. (2018). PREDICTIVE VALUE OF OPTICAL COHERENCE TOMOGRAPHIC FEATURES IN THE BEVACIZUMAB AND RANIBIZUMAB IN PATIENTS WITH DIABETIC MACULAR EDEMA (BRDME) STUDY. Retina (Philadelphia, Pa.), 38(4), 812–819. https://doi.org/10.1097/IAE.0000000000001626
• Kulikov, A. N., Sosnovskii, S. V, Berezin, R. D., Maltsev, D. S., Oskanov, D. H., & Gribanov, N. A. (2017). Vitreoretinal interface abnormalities in diabetic macular edema and effectiveness of anti-VEGF therapy: an optical coherence tomography study. Clinical Ophthalmology (Auckland, N.Z.), 11, 1995–2002. https://doi.org/10.2147/OPTH.S146019
• Lee, J., Moon, B. G., Cho, A. R., & Yoon, Y. H. (2016). Optical Coherence Tomography Angiography of DME and Its Association with Anti-VEGF Treatment Response. Ophthalmology, 123(11), 2368–2375. https://doi.org/10.1016/j.ophtha.2016.07.010
• Otani, T., Kishi, S., & Maruyama, Y. (1999). Patterns of diabetic macular edema with optical coherence tomography. American Journal of Ophthalmology, 127(6), 688–693. https://doi.org/10.1016/s0002-9394(99)00033-1
• Ozaki, H., Hayashi, H., Vinores, S. A., Moromizato, Y., Campochiaro, P. A., & Oshima, K. (1997). Intravitreal sustained release of VEGF causes retinal neovascularization in rabbits and breakdown of the blood-retinal barrier in rabbits and primates. Experimental Eye Research, 64(4), 505–517. https://doi.org/10.1006/exer.1996.0239
• Roh, M. I., Kim, J. H., & Kwon, O. W. (2010). Features of optical coherence tomography are predictive of visual outcomes after intravitreal bevacizumab injection for diabetic macular edema. Ophthalmologica. Journal International d’ophtalmologie. International Journal of Ophthalmology. Zeitschrift Fur Augenheilkunde, 224(6), 374–380. https://doi.org/10.1159/000313820
• Ryan, S. J., & Ogden, T. E. (1989). Retina (Issue 1. c.;3. c.). Mosby.
• Shimura, M., Yasuda, K., Nakazawa, T., Hirano, Y., Sakamoto, T., Ogura, Y., & Shiono, T. (2011). Visual outcome after intravitreal triamcinolone acetonide depends on optical coherence tomographic patterns in patients with diffuse diabetic macular edema. Retina (Philadelphia, Pa.), 31(4), 748–754. https://doi.org/10.1097/IAE.0b013e3181f04991
• Shin, H. J., Lee, S. H., Chung, H., & Kim, H. C. (2012). Association between photoreceptor integrity and visual outcome in diabetic macular edema. Graefe’s Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, 250(1), 61–70. https://doi.org/10.1007/s00417-011-1774-x
• Wells, J. A., Glassman, A. R., Ayala, A. R., Jampol, L. M., Bressler, N. M., Bressler, S. B., Brucker, A. J., Ferris, F. L., Hampton, G. R., Jhaveri, C., Melia, M., & Beck, R. W. (2016). Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology, 123(6), 1351–1359. https://doi.org/10.1016/j.ophtha.2016.02.022
• Yau, J. W. Y., Rogers, S. L., Kawasaki, R., Lamoureux, E. L., Kowalski, J. W., Bek, T., Chen, S.-J., Dekker, J. M., Fletcher, A., Grauslund, J., Haffner, S., Hamman, R. F., Ikram, M. K., Kayama, T., Klein, B. E. K., Klein, R., Krishnaiah, S., Mayurasakorn, K., O’Hare, J. P., … Wong, T. Y. (2012). Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care, 35(3), 556–564. https://doi.org/10.2337/dc11-1909