Işıl Merve TORUN, Erkan DUMAN, Nursal Melda YENEREL

Ranibizumab Tedavisine Dirençli Tip 1 Koroidal Neovasküler Membranlı Olgularda İntravitreal Aflibercept Uygulaması Sonuçlarımız

Amaç: Ranibizumab tedavisine dirençli tip 1 koroidal neovasküler membranlı olgularda intravitreal aflibercept tedavisinin etkinliğini araştırmak. Gereç ve Yöntemler: Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Göz Kliniği’ne Aralık 2012- Ocak 2016 tarihleri arasında başvurup, neovasküler tip yaşa bağlı makula dejenerasyonu (YBMD) tanısı alan, optik koherens tomografi (OKT) ve fundus floresein anjiografi (FFA) ile tip 1 koroidal neovasküler membranı (KNV) olduğu tespit edilen 22 hastanın 24 gözü geriye dönük olarak incelendi. Olguların ilk başvurularındaki ve ranibizumab tedavisi sonrasındaki en iyi düzeltilmiş görme keskinlikleri (EİDGK), fundus muayene bulguları ve OKT ile yapılan makula kalınlığı ölçümleri kaydedildi. İntravitreal aflibercept tedavisinin etkinliğini değerlendirmek için tedavi öncesi ve sonrasındaki EİDGK’leri, ortalama enjeksiyon sayıları ve ortalama makula kalınlıkları istatistiksel olarak karşılaştırıldı. İstatistiksel analizler için NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) programı kullanıldı. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodların (Ortalama, Standart Sapma, Medyan, Frekans, Oran, Minimum, Maksimum) yanı sıra; niceliksel verilerin karşılaştırılmasında normal dağılım göstermeyen parametrelerin iki grup karşılaştırmalarında ise Mann Whitney U testi kullanıldı. Normal dağılım göstermeyen üç ve üzeri grupların karşılaştırmalarında ise Kruskal Wallis test kullanıldı. Normal dağılım göstermeyen parametrelerin grup içi karşılaştırmalarında ise Wilcoxon Signed Ranks test kullanıldı. Anlamlılık p0,05). Sonuç: Çalışmamızda ranibizumab tedavisine dirençli neovasküler YBMD’nin intravitreal aflibercept enjeksiyonu ile tedavisinde anatomik iyileşme sağlandı. Retinadaki sıvı lokasyonunun, PED mevcudiyetinin, tedaviye dirençli vakalarda aflibercept etkinliğinde belirleyici faktör olmayabileceği düşünüldü.

Intravitreal Aflibercept Application in Patients with Type 1 Choroidal Neovascular Membrane Resistant to Ranibizumab Treatment Results

Aim: To research efficacy of intravitreal aflibercept injection treatment in patients who are resistant to ranibizumab treatment and having type 1 choroidal neovascular membranes. Material and Methods: Twenty four eyes of 22 patients having neovascular age related macular degeneration (AMD) diagnosed as type 1 choroidal neovascular membrane were identified by optical coherence tomography (OCT) and fundus fluorescein angiography at Haydarpasa Numune Research and Training Hospital between Dec’12 and Jan’16 and were analyzed retrospectively. Baseline and post-ranibizumab treatment of best-corrected visual acuity (BCVA), fundus findings and central retinal thickness with OCT of patients were recorded. In order to assess efficacy of intravitreal aflibercept treatment the mean numbers of injections, BCVA and the mean central retinal thickness were statistically compared with baseline and post- treatment figures. NCSS program (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) was used for statistical analysis. Descriptive analyses were presented using means and standard deviations for normally distributed variables. The Mann Whitney U test was used for the comparison of the quantitative data and the comparison of the parameters that did not show normal distribution between the two groups. Kruskal Wallis test was used for comparisons of groups of three or more that did not show normal distribution. Wilcoxon Signed Ranks test was used for in-group comparisons of parameters that did not show normal distribution. Significance was evaluated at p0.05). Conclusion: Anatomic improvement was confirmed in all patients who were resistant to ranibizumab. Retinal fluid location and existence of PED may not be a decisive factor at efficacy of aflibercept in patients resistant to ranibizumab.

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