Retinal Ven Tıkanıklığına Bağlı Oluşan Maküler Ödem Tedavisinde İntravitreal Deksametazon İmplantın Erken Dönem Sonuçları

Yıl 2019, Cilt: 9 Sayı: 2, 163 - 166, 30.06.2019

Şerife Gülhan Konuk Özlem Ekşi Yücel Ertuğrul Can

https://doi.org/10.16899/gopctd.534198

Öz

Amaç:
Santral retinal ven tıkanıklığı (SRVT) ve retinal ven dal tıkanıklığına (RVDT)
bağlı oluşan maküler ödem (MÖ) tedavisinde deksametazon implantın altı aylık
etkisini ve yan etkilerini değerlendirmek.
Gereç: Göz Hastalıkları Kliniğinde
SRVT (n=19) ve RVDT(n=18) sonucu oluşan MÖ nedeniyle tek doz intravitreal
dexametazon implant ile tedavi edilen 37 hasta (37 göz) çalışmaya dahil edildi.
Hastaların kayıtları retrospektif olarak incelendi. En az 6 ay boyunca, aylık
olarak takip edilen hastalar çalışmaya dahil edildi. Başlangıç ve tedavi
sonrası her kontrolde yapılmış olan; biyomikroskopik muayene bulguları, en iyi
düzeltilmiş görme keskinliği (EDGK) düzeyi ve spektral domain optik koherens
tomografi (OKT) ile santral maküler kalınlık (SMK) ölçümleri ve yan etkiler
kaydedilerek değerlendirildi.

Bulgular:
RVDT olguları grup 1 (n=18), SRVT olguları grup 2 (n=19) olmak üzere hastalar 2
gruba ayrıldı. Tüm hastalarda tedavi sonrası EDGK 4. aya kadar anlamlı
olarak artarken SMK değerleri anlamlı olarak azaldı (p<0.05). Tedavinin 4.
ayından sonra ise EDGK değeri tedavi öncesine göre istatistiksel olarak farklı
değildi. Maximum görme keskinliğindeki artış grup 2’ye kıyasla grup 1’de
anlamlı olarak fazla idi. İki grup arasında ortalama SMK azalması açısından
istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Tedavi edilen 8
hastada (%21,6) göz içi basınç artışı görüldü.

Sonuç:
SRVT ve RVDT’na ikincil maküler ödem olgularında intravitreal dexametazon implant,
ilk 6 ayda anatomik ve fonksiyonel düzelme sağlamıştır. Göz içi basıncı artışı
dışında yan etki görülmemiştir.

Anahtar Kelimeler

Deksametazon implant, maküler ödem, retinal ven tıkanıklığı

Early Results of the Intravitreal Dexamethasone Implant in the Treatment of Macular Edema Due to Retinal Vein Occlusion

Öz

Introduction: To
evaluate the six-month effect and side effects of dexamethasone implant in the
treatment of central retinal vein occlusion (SRVT) and retinal vein branch
occlusion (RVDT) induced macular edema (MO).

Material and Method:
Thirtyseven patients (37 eyes) who were treated with intravitreal dexamethasone
implant due to SRVT (n = 19) and RVDT(n = 18) in the Ophthalmology Department
were included in the study. Records of patients were reviewed retrospectively.
Patients who were followed up monthly for at least 6 months were included in
the study. It was performed at the beginning and after each treatment;
slit-lamp biomicroscopic examination findings, best corrected visual acuity
(EDGK), spectral domain optical coherence tomography (OKT) and central macular
thickness (SMK) measurements were done and side effects were recorded.

Results: The
patients were divided into two groups: RVDT group 1 (n = 18), SRVT group 2 (n =
19). In all patients, after the treatment, EDGK increased significantly up to
the 4th month, whereas the values ​​of SMK decreased significantly (p<0.05).
There was no significant difference between EDGK after the 4th month. The
increase in maximum visual acuity was significantly higher in group 1 than 2.
There was no statistically significant difference between the two groups in
terms of mean SMK reduction (p>0.05). In 8 (21.6%) patients treated with
intravitreal dexamethasone implant, intraocular pressure increased.

Discussion:
Intravitreal dexamethasone implant provides anatomic and functional improvement
in the first 6 months in patients with macular edema secondary to SRVT and
RVDT. No side effects were seen except intraocular pressure. 

Anahtar Kelimeler

Dexamethasone implant, Macular edema, Retinal vein occlusion

Kaynakça

• 1- Rogers S, McIntosh RL, Cheung N et al. The prevalence of retinal vein occlusion: pooled data from population studies from the united states, europe, asia, and australia. Ophthalmology. 2010; 117: 313-9.
• 2- Hoerauf H. Branch retinal vein occlusion. In: Joussen AM, Gardner TW, Kirchhof B, Ryan SJ, eds. Retinal Vascular Disease. Philadelphia: Springer. 2007; 467–506.
• 3- O'Mahoney PR, Wong DT, Ray JG. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008; 126: 692-9.
• 4- Cheung N, Klein R, Wang JJ et al. Traditional and novel cardiovascular risk factors for retinal vein occlusion: the multiethnic study of atherosclerosis. Invest Ophthalmol Vis Sci. 2008; 49: 4297–302.
• 5- Capone A Jr, Singer MA, Dodwell DG et al. Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion. Retina. 2014; 34: 342–51.
• 6- Chen SD, Sundaram V, Lochhead J, Patel CK. Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2006; 141: 876–83.
• 7- Ip MS, Scott IU, VanVeldhuisen PC et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5. Arch Ophthalmol. 2009; 127: 1101–14.
• 8- Bardak Y, Yıldızoğlu Ü, Çekiç O. İntravitreal triamsinolon asetonid enjeksiyonunun kısa ve uzun dönem yan etkileri. T Oft Gaz. 2006; 36: 416-421.
• 9- Campochiaro PA, Brown DM, Awh CC et al. Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology. 2011; 118: 2041-9.
• 10- Brown DM, Campochiaro PA, Bhisitkul RB et al. Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology. 2011; 118: 1594-602.
• 11- Brown DM, Heier JS, Clark WL et al. Intravitreal Aflibercept Injection for Macular Edema Secondary to Central Retinal Vein Occlusion: 1-Year Results From the Phase 3 COPERNICUS Study. Am J Ophthalmol. 2013; 155: 429–37.
• 12- Haller JA, Bandello F, Belfort R Jr et al. Randomized, Sham-Controlled Trial of Dexamethasone Intravitreal Implant in Patients with Macular Edema Due to Retinal Vein Occlusion. Ophthalmology. 2010; 117: 1134–46.
• 13- Michalska-Małecka K, Gaborek A, Nowak M, Halat T, Pawłowska M, Spiewak D. Evaluation of the effectiveness and safety of glucocorticoids intravitreal implant therapy in macular edema due to retinal vein occlusion. Clin Interv Aging. 2016; 11: 699-705.