Diyabetik Retinopatide Maküla ve Peripapiller Retinanın Değerlendirilmesinde Heidelberg Retinal Tomografi III Cihazı Retina Modülünün Kullanımı

Yıl 2024, Cilt: 21 Sayı: 3, 366 - 374

Yusuf Işık , Mustafa Güzey Ali Karnaz

https://doi.org/10.35440/hutfd.1395689

Öz

Amaç: Heidelberg retinal tomografi (HRT) III cihazının diyabetik retinopati tanı ve tedavi takibindeki etkinliğini değerlendirmek.
Materyal ve metod: Ocak 2012- Ocak 2014 tarihleri arasında kliniğimizde diyabetik maküler ödem tanısı alan ve laser fotokoagülasyon veya laser fotokoagülasyon ile kombine intravitreal anti-VEGF kombine tedavisi uygulanan 58 olgunun 109 gözü ile diyabet tanısı olmayan 32 olgunun 60 gözü değerlendirildi. Diyabetik maküler ödemi olan hastaların tedavi sonrası 3. ve 6. aylarda kontrolleri yapıldı.
Bulgular: Çalışmaya alınan olguların yaş ortalamaları çalışma grubunda 60.45±6.9 yıl, kontrol grubunda 58.47±5.3 yıl idi. Diyabetik maküler ödemli 109 gözün 45 tanesine laser fotokoagülasyon uygulamasını takiben intravitreal anti-VEGF enjeksiyonu yapılırken 64 göze ise yalnızca laser fotokoagülasyon tedavi-si uygulandı. Heidelberg retinal tomografi III cihazı ile elde edilen maküler ve optik sinir başı çevresi kalınlık ve ödem değerleri çalışma grubunda kontrol grubuna kıyasla anlamlı olarak daha yüksek tespit edildi. Diyabetik maküler ödemi olan grupta hem laser fotokoagülasyon hem de laser fotokoagülasyon ile kombine intravitreal anti-VEGF tedavisi alan hastaların 3. ve 6. ay kontrol Heidelberg retinal to-mografi III cihazı ile elde edilen değerlerinde anlamlı düzeyde gerileme tespit edildi.
Sonuç: Yaptığımız çalışma Heidelberg retinal tomografi III cihazı ile elde edilen maküla ve optik sinir başı çevresinin kalınlık ve ödem değerleri diyabetik retinopati hastalığının tanı ve takibi için etkili bir araç olduğunu göstermektedir.

Anahtar Kelimeler

Heidelberg retinal tomografi, diyabetik retinopati, diyabetik maküler ödem

Usage of the Heidelberg Retinal Tomography III Device's Retina Module in The Evaluation of Macula and Peripapillary Retina in Diabetic Retinopathy

Öz

Background: The aim of this study was to evaluate the effectiveness of Heidelberg Retinal Tomography (HRT) III in the diagnosis and follow-up of diabetic retinopathy.
Materials and Methods: A total of 109 eyes from 58 patients diagnosed with diabetic macular edema, who received either laser photocoagulation or combined intravitreal anti-VEGF therapy with laser photocoagulation, between January 2012 and January 2014 in our clinic, were evaluated. Additio-nally, 60 eyes from 32 patients without diabetes were included as a control group. Follow-up exami-nations were conducted at 3 and 6 months after treatment for patients with diabetic macular edema.
Results: The mean age of the study group was 60.45±6.9 years, and for the control group, it was 58.47±5.3 years. Among the 109 eyes with diabetic macular edema, 45 eyes underwent intravitreal anti-VEGF injection following laser photocoagulation, while 64 eyes received laser photocoagulation treatment alone. The values of macular and optic nerve head thickness and edema obtained by Hei-delberg Retinal Tomography III were significantly higher in the study group compared to the control group. In the group with diabetic macular edema, a significant decrease in Heidelberg Retinal Tomog-raphy III values was observed in patients who received both laser photocoagulation and combined intravitreal anti-VEGF therapy at the 3. and 6. month follow-up.
Conclusions: The results of our study indicate that the measurement of macular and optic nerve head thickness and edema using Heidelberg Retinal Tomography III is an effective tool for the diagnosis and follow-up of diabetic retinopathy.

Kaynakça

• 1. Moreno a, Lozano M, Salinas P. Diabetic retinopathy. Nutr. Hosp. 2013;28 Suppl 2:53–6.
• 2. Kisilevsky M, Hudson C, Flanagan JG, Nrusimhadevara RK, Guan K, Wong T et al. Agreement of the Heidelberg Retina Tomograph II macula edema module with fundus biomi-croscopy in diabetic maculopathy. Arch. Ophthalmol. 2006;124:337–42.
• 3. Turner R. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–65.
• 4. Group ETDRSR. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study re-search group. Arch. Ophthalmol. 1985;103:1796–806.
• 5. Bandello F, Casalino G, Loewenstein a, Goldstein M, Pe-layes D, Battaglia Parodi M. Pharmacological approach to diabetic macular edema. Ophthalmic Res. 2014;51:88–95.
• 6. Lang GE. Laser treatment of diabetic retinopathy. Dev. Ophthalmol. 2007;39:48–68.
• 7. Zambarakji HJ, Amoaku WM, Vernon SA. Volumetric analy-sis of early macular edema with the Heidelberg retina tomograph in diabetic retinopathy. Ophthalmology. 1998;105:1051–9.
• 8. Ang A, Tong L, Vernon SA. Improvement of reproducibility of macular volume measurements using the Heidelberg retinal tomograph. Br. J. Ophthalmol. 2000;84:1194–7.
• 9. Çelik S, Batıoğlu F, Özmert E. Makula Ödeminin Saptanması ve Niceliksel Olarak Değerlendirilmesinde Optik Koherens Tomografi ve Heidelberg Retina Tomografisinin Kullanıl-ması ve Karşılaştırılması. Ret-Vit. 2006;14:105– 8.
• 10. Konno S, Akiba J, Yoshida A. Retinal thickness measure-ments with optical coherence tomography and the scanning retinal thickness analyzer. Retina. 2001;21:57–61.
• 11. Zambarakji HJ, Vernon SA, Spencer AF, Amoaku WM. Re-producibility of volumetric macular measurements in dia-betic patients with the Heidelberg Retina Tomograph. Doc. Ophthalmol. 1999;97:349–60.
• 12. Zambarakji HJ, Evans JE, Amoaku WM, Vernon SA. Repro-ducibility of volumetric measurements of normal maculae with the Heidelberg retina tomograph. Br. J. Ophthalmol. 1998;82:884–91.
• 13. Zambarakji HJ, Butler TK, Vernon SA. Assessment of the Heidelberg Retina Tomograph in the detection of sight-threatening diabetic maculopathy. Eye (Lond). 1999p. 136–44.
• 14. Kisilevsky M, Hudson C, Flanagan JG, Nrusimhadevara RK, Guan K, Wong T et al. Agreement of the Heidelberg Retina Tomograph II macula edema module with fundus biomi-croscopy in diabetic maculopathy. Arch. Ophthalmol. 2006;124:337–42.
• 15. Tong L, Ang A, Vernon SA, Zambarakji HJ, Bhan A, Sung V et al. Sensitivity and specificity of a new scoring system for diabetic macular oedema detection using a confocal laser imaging system. Br. J. Ophthalmol. 2001;85:34–9.
• 16. Degenring RF, Aschmoneit I, Kamppeter B, Budde WM, Jonas JB. Optical coherence tomography and confocal scan-ning laser tomography for assessment of macular edema. Am. J. Ophthalmol. 2004;138:354–61.
• 17. Pallikaris A, Skondra D, Tsilimbaris M. Intraobserver repeat-ability of macula measurements by confocal scanning laser tomography. Am. J. Ophthalmol. 2005;139:624–30.
• 18. Styles CJ, Park SJK, McGhee CNJ, Gamble G, Donaldson ML. Evaluating the use of a scanning laser-derived oedema in-dex to grade diabetic retinopathy and maculopathy. Clin Exp Ophthalmol 2007;35(1):18-23.