Öz
Objective: To evaluate the efficacy of intravitreal ranibizumab treatment and factors affecting the treatment in neovascular type age-related macular degenerationMethods: Ranibizumab injected 60 eyes of 60 patients with the diagnosis of neovascular age-related macular degeneration in our clinic were analyzed retrospectively. After three consecutive 3-month follow-up dose injection, decision to perform re-injections was according to best corrected visual acuity, fundus fluorescein angiography and optical coherence tomography findings in consecutive month follow-up. Patients were evaluated in terms of number of ranibizumab injections, pre-treatment and follow-up best-corrected visual acuity, central macular thickness, factors affecting the treatment and recurrence.Results: 30 (50%) of patients were male and 30 (50%) were women with a mean age of 67 ± 9.14 . While pretreatment visual acuity average of the cases was 1.12 ± 0.69 logMAR, at the end of 12th month was 0.92 ± 0.63 logMAR. While pre-treatment mean central macular thickness was 343.1 ± 97 µm, in the 12th month was 286 ± 75.5 µm. While the first 3 injections were enough in 20 (33.3%) eyes, but 40 (66.7%) eyes had to be re-injected. Average number of injections was 4.23 ± 1.21. While there was no significant correlation between recent functional and anatomical success with age, gender, type of lens and membrane type, more vision gain was obtained in patients with initial lower visual acuity. The age of patients, pre-treatment visual acuity, membrane type were found to have no significant effect on recurrence rate. Membranes with classic component required more injection than occult type.Conclusion: After intravitreal injection of ranibizumab which is safe and effective in neovascular type of age-related macular degeneration more vision gain was obtained in patients with initial lower visual acuity and presence of classic component initial higher visual acuity, lower age required more injection
Anahtar Kelimeler
Age-related macular degeneration ranibizumab vascular endothelial growth factor
Kaynakça
- Evans J, Wormald R. Is the incidence of registrable age related maculopathy increasing? Br J Ophthalmol 1996;80:9-14.
- Neely KA, Bressler NM, Bressler SB. Clinical characteristics, epidemiology and natural history of age related macular degeneration. Ophthalmol Clin North Am 1996;6:291-306.
- Bressler NM, Bressler SB, Hawkins BS, et al. Submacular
- Surgery Trials Pilot Study Investigators. Submacular surgery trials randomized pilot trial of laser photocoagulation
- versus surgery for recurrent choroidal neovascularization
- secondary to age-related macular degeneration: I. Ophthalmic outcomes Submacular surgery trials pilot study report
- number 1. Am J Ophthalmol 2000;130:387-407.
- Lewis H, Kaiser PK, Lewis S, Estafanous M. Macular translocation for subfoveal choroidal neovascularization in age-
- related macular degeneration: a prospective study. Anı J
- Ophthalmol 1999;128:135-146.
- Argon laser photocoagulation for neovascular maculopathy. Five-year results from randomized clinical trials. Macular Photocoagulation Study Group. Arch Ophthalmol
- ;109:1109-1114.
- Harding S. Photodynamic therapy in the treatment of subfoveal choroidal neovascularisation. Eye 2001;15:407-412.
- Rosenfeld PJ, Brown DM, Heier JS, et al. MARINA Study
- Group. Ranibizumab for neovascular age-related macular
- degeneration. N Engl J Med 2006 5;355:1419-31.
- Brown DM, Kaiser PK, Michels M, et al. ANCHOR Study
- Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med
- ;355:1432-1444.
- Abraham P, Yue H, Wilson L. Randomized, double masked,
- sham controlled trial of ranibizumab for neovascular age
- related macular degeneration: PIER study. Am J Ophthalmol 2010;150:315-324.
- Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular
- age-related macular degeneration: year 2 of the PrONTO
- Study. Am J Ophthalmol 2009 Jul;148:43-58.
- Holz FG, Amoaku W, Donate J, et al. SUSTAIN Study
- Group. Safety and efficacy of a flexible dosing regimen of
- ranibizumab in neovascular age-related macular degeneration: the SUSTAIN study. Ophthalmology 2011;118:663-671.
- Şengül A, Artunay Ö, Yüzbaşıoğlu E, ve ark. Yaşa bağlı maküla dejenerasyonuna ikincil gelişen koroid neovaskülarizasyonlarında intravitreal ranibizumab tedavi sonuçlarımız. Ret-Vit 2010;18:143-148.13. Aslankara A, Öner FK, Yaman A, ve ark. Yaş tip yaşa bağlı maküla dejenerasyonunda intravitreal ranibizumab enjeksiyonu. Ret-Vit 2010;18:134-138.
- Gupta OP, Shienbaum G, Patel AH, et al. A treat and extend
- regimen using ranibizumab for neovascular age-related
- macular degeneration clinical and economic impact. Ophthalmology 2010;117:2134-2140.
- Ünlü N, Acar MA, Üney G, et al. Yaşa bağlı maküla dejenerasansında Anti-VEGF tedavisinde rekürrens zamanı.
- Ret-Vit 2012;20:22-26.
- Hörster R, Ristau T, Sadda SR, et al. Individual recurrence
- after anti-VEGF therapy for age-related macular degeneration. Grafes Arch Clin Exp Ophthalmol 2011;249:645-652.
- Kang S, Roh YJ. One-year results of intravitreal ranibizumab for neovascular age-related macular degeneration and
- clinical responses of various subgroups. Jpn J Ophthalmol
- Jul;53:389-395.
- Ünlü N, Hazırolan D, Acar MA, ve ark. Yaşa bağlı maküla
- dejenerasyonunda inravitreal ranibizumab uygulamalarında son fonksiyonel ve anatomik başarıya etkili faktörler. Ret-Vit 2011;19:103-107.
- Menghini M, Kurz-Levin MM, Amstutz C, et al. Response
- to ranibizumab therapy in neovascular AMD - an evaluation of good and bad responders. Klin Monbl Augenheilkd 2010;227:244-248.
- Shona O, Gupta B, Vemala R, Sivaprasad S. Visual acuity
- outcomes in ranibizumab-treated neovascular age-related
- macular degeneration; stratified by baseline vision. Clin
- Experiment Ophthalmol 2011;39:5-8.
Neovasküler tip yaşa bağlı makula dejenerasyonunda intravitreal ranibizumab uygulamalarında tedavi etkinliği ve rekürrens üzerinde etkili olan faktörler
Öz
Amaç: Neovasküler tip yaşa bağlı maküla dejenerasyonu (YBMD) nedeniyle uygulanan intravitreal ranibizumab enjeksiyonunun etkinliğini ve tedavi üzerinde etkili olan faktörleri değerlendirmek
Yöntemler: Kliniğimizde neovasküler tip YBMD'de intravitreal ranibizumab enjeksiyonu uygulanan 60 hastanın 60 gözü retrospektif olarak incelendi. Hastalara birer ay arayla 3 doz enjeksiyon yapıldıktan sonra aylık takiplerde en iyi düzeltilmiş görme keskinliği (EİDGK), fundus fluoresein anjiografi (FFA) ve optik kohorens tomografi (OKT) bulgularına göre enjeksiyon tekrarı uygulandı. Hastalar; enjeksiyon sayısı, takip süresi, tedavi öncesi ve kontrollerdeki EİDGK, santral makula kalınlığı (SMK), başarıda, rekürrens üzerinde etkili olan faktörler açısından değerlendirildi.
Bulgular: 30'u (%50) erkek 30'u (%50) kadın olan hastaların ortalama yaşı 67±9,14 (50-84) yıl idi. Olgulardaki tedavi öncesi ortalama görme keskinliği 1,12 ± 0,69 logMAR iken 12. ayda ise, 0,92 ± 0,63 logMAR idi. Tedavi öncesi ortalama SMK 343,1±97 µm iken, 12. ayda ise 286 ± 75,5 µm saptandı. 20 gözde (%33,3) ilk 3 enjeksiyon yeterli olurken 40 gözde (%66,7) enjeksiyon tekrarı gerekti. Ortalama enjeksiyon sayısı 4,23±1,21 idi. Son fonksiyonel ve anatomik başarıyla yaş, cinsiyet, lens tipi ve membran tipi arasında anlamlı bir ilişki bulunmazken başlangıç görmesi düşük olan olgularda daha fazla görme kazancı elde edildi. Rekürrens oranının yaş, başlangıç görme düzeyi ve membran tipi ile istatistiksel olarak anlamlı ilişkisi gözlenmese de klasik komponenti olan membranlar gizli tipe oranla daha fazla enjeksiyon gerektirdi.
Sonuç: Neovasküler tip YBMD'de etkin ve güvenilir bir yöntem olan ranibizumab enjeksiyonu sonucu en fazla görme kazanımı başlangıç görmesi düşük olan olgularda elde edilirken klasik komponent varlığı, yüksek başlangıç görme keskinliği ve düşük yaş daha fazla ilave enjeksiyon gerektirmektedir.
Anahtar kelimeler: Yaşa bağlı makula dejenerasyonu, ranibizumab, vasküler endotelyal büyüme faktörü
Anahtar Kelimeler
Yaşa bağlı makula dejenerasyonu ranibizumab vasküler endotelyal büyüme faktörü
Kaynakça
- Evans J, Wormald R. Is the incidence of registrable age related maculopathy increasing? Br J Ophthalmol 1996;80:9-14.
- Neely KA, Bressler NM, Bressler SB. Clinical characteristics, epidemiology and natural history of age related macular degeneration. Ophthalmol Clin North Am 1996;6:291-306.
- Bressler NM, Bressler SB, Hawkins BS, et al. Submacular
- Surgery Trials Pilot Study Investigators. Submacular surgery trials randomized pilot trial of laser photocoagulation
- versus surgery for recurrent choroidal neovascularization
- secondary to age-related macular degeneration: I. Ophthalmic outcomes Submacular surgery trials pilot study report
- number 1. Am J Ophthalmol 2000;130:387-407.
- Lewis H, Kaiser PK, Lewis S, Estafanous M. Macular translocation for subfoveal choroidal neovascularization in age-
- related macular degeneration: a prospective study. Anı J
- Ophthalmol 1999;128:135-146.
- Argon laser photocoagulation for neovascular maculopathy. Five-year results from randomized clinical trials. Macular Photocoagulation Study Group. Arch Ophthalmol
- ;109:1109-1114.
- Harding S. Photodynamic therapy in the treatment of subfoveal choroidal neovascularisation. Eye 2001;15:407-412.
- Rosenfeld PJ, Brown DM, Heier JS, et al. MARINA Study
- Group. Ranibizumab for neovascular age-related macular
- degeneration. N Engl J Med 2006 5;355:1419-31.
- Brown DM, Kaiser PK, Michels M, et al. ANCHOR Study
- Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med
- ;355:1432-1444.
- Abraham P, Yue H, Wilson L. Randomized, double masked,
- sham controlled trial of ranibizumab for neovascular age
- related macular degeneration: PIER study. Am J Ophthalmol 2010;150:315-324.
- Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular
- age-related macular degeneration: year 2 of the PrONTO
- Study. Am J Ophthalmol 2009 Jul;148:43-58.
- Holz FG, Amoaku W, Donate J, et al. SUSTAIN Study
- Group. Safety and efficacy of a flexible dosing regimen of
- ranibizumab in neovascular age-related macular degeneration: the SUSTAIN study. Ophthalmology 2011;118:663-671.
- Şengül A, Artunay Ö, Yüzbaşıoğlu E, ve ark. Yaşa bağlı maküla dejenerasyonuna ikincil gelişen koroid neovaskülarizasyonlarında intravitreal ranibizumab tedavi sonuçlarımız. Ret-Vit 2010;18:143-148.13. Aslankara A, Öner FK, Yaman A, ve ark. Yaş tip yaşa bağlı maküla dejenerasyonunda intravitreal ranibizumab enjeksiyonu. Ret-Vit 2010;18:134-138.
- Gupta OP, Shienbaum G, Patel AH, et al. A treat and extend
- regimen using ranibizumab for neovascular age-related
- macular degeneration clinical and economic impact. Ophthalmology 2010;117:2134-2140.
- Ünlü N, Acar MA, Üney G, et al. Yaşa bağlı maküla dejenerasansında Anti-VEGF tedavisinde rekürrens zamanı.
- Ret-Vit 2012;20:22-26.
- Hörster R, Ristau T, Sadda SR, et al. Individual recurrence
- after anti-VEGF therapy for age-related macular degeneration. Grafes Arch Clin Exp Ophthalmol 2011;249:645-652.
- Kang S, Roh YJ. One-year results of intravitreal ranibizumab for neovascular age-related macular degeneration and
- clinical responses of various subgroups. Jpn J Ophthalmol
- Jul;53:389-395.
- Ünlü N, Hazırolan D, Acar MA, ve ark. Yaşa bağlı maküla
- dejenerasyonunda inravitreal ranibizumab uygulamalarında son fonksiyonel ve anatomik başarıya etkili faktörler. Ret-Vit 2011;19:103-107.
- Menghini M, Kurz-Levin MM, Amstutz C, et al. Response
- to ranibizumab therapy in neovascular AMD - an evaluation of good and bad responders. Klin Monbl Augenheilkd 2010;227:244-248.
- Shona O, Gupta B, Vemala R, Sivaprasad S. Visual acuity
- outcomes in ranibizumab-treated neovascular age-related
- macular degeneration; stratified by baseline vision. Clin
- Experiment Ophthalmol 2011;39:5-8.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Temmuz 2015 |
| Gönderilme Tarihi | 8 Temmuz 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 42 Sayı: 2 |