Emrah ÖZTÜRK, Burak ESENER, Abuzer GÜNDÜZ

Farklı etyolojilere bağlı maküler ödem tedavisinde deksametazon implantın etkinliği

Amaç: Dört farklı etyolojiye bağlı gelişen maküler ödeminin tedavisinde intravitreal DEX implant enjeksiyonunun etkinliğini değerlendirmek.Gereç ve Yöntem: Bu bir retrospektif vaka kontrol çalışmasıdır. Bu çalışmaya 2014-2018 arasında diyabetik retinopati (DR), branş retinal ven oklüzyonu (BRVO), santral retinal ven oklüzyonu (CRVO) ve posterior üveit (PU) olmak üzere dört farklı etiyolojiden köken alan intravitreal DEX implant uygulaması yapılmış 177 hasta dahil edilmiştir. En iyi düzeltilmiş vizüel aküite (BCVA) ve merkezi makula kalınlığı (CMT) enjeksiyon öncesi, enjeksiyon sonrası 1., 3. ve 6. aylarda değerlendirildi.Bulgular: Seksen bir hastada DR (%45.8), 44 BRVO (%24.9), 35 CRVO (%19.8) ve 17 PU (%9.6) vardı. Enjeksiyondan sonra DR, BRVO ve PU gruplarında BCVA'da istatistiksel olarak anlamlı bir fark vardı, ancak CRVO grubunda anlamlı bir fark gözlenmedi.. Enjeksiyondan sonra tüm gruplarda CMT'de istatistiksel olarak anlamlı bir azalma olduğu gözlenmiştir. Bir ayda CMT'deki değişiklik DR grubunda 153.4 ± 137 µ m, BRVO'da 161.1 ± 151 µ m, CRVO'da 270.5 ± 189 µ m ve PU grubunda 142.2 ± 174 µ m idi.Sonuç: İntravitreal DEX implantı, çeşitli etiyolojilere sekonder maküler ödemli hastalarda CMT'yi azalttığı, CRVO olan hastalar hariç çeşitli etiyolojilere ikincil olarak maküler ödemli hastalarda BCVA'yı iyileştirdiği sonucuna varılmıştır.

Anahtar Kelimeler:

Diabetic retinopathy, Intravitreal dexamethasone, Macular edema, Posterior uveitis, Retinal vein occlusion

Efficacy of dexamethasone implant in the treatment of macular edema due to different etiologies

Purpose: The aim of this study was to evaluate the effectiveness of intravitreal DEX implant injection in the treatment of macular edema due to four different etiologies.Materials and Methods: This is a retrospective and case control study. A total of 177 patients who underwent intravitreal DEX implant between 2014 and 2018 for four different etiologies, which are diabetic retinopathy (DR), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO) and posterior uveitis (PU), were included in the study. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated in pre-injection, 1st, 3rd, and 6th months post-injection.Results: Eighty-one patients (45.8%) had DR, 44 (24.9%) had BRVO, 35 (19.8%) had CRVO, and 17 (9.6%) had PU. There was a statistically significant difference in BCVA in the DR, BRVO and PU groups after the injection, but no significant difference was observed in the CRVO group. It is observed that there was a statistically significant decrease in CMT in all groups after the injection. The change in CMT in the 1st month was 153.4 ± 137 µm in the DR group, 161.1 ± 151 µm in the BRVO, 270.5 ± 189 µm in the CRVO and 142.2 ± 174 µm in the PU group.Conclusion: The intravitreal DEX implant reduces the CMT in patients with macular edema secondary to various etiologies and improves BCVA in patients with macular edema secondary to various etiologies except for patients with CRVO.

Keywords:

Diabetic retinopathy, Intravitreal dexamethasone, Macular edema, Posterior uveitis, Retinal vein occlusion,

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1. Lam WC, Albiani DA, Yoganathan P, et al. Real-world assessment of intravitreal dexamethasone implant (0.7 mg) in patients with macular edema: the CHROME study. Clin Ophthalmol. 2015;9:1255-68.
2. Wolfensberger TJ, Gregor ZJ. Macular edema-- rationale for therapy. Dev Ophthalmol. 2010;47:49- 58.
3. Sarao V, Veritti D, Boscia F, Lanzetta P. Intravitreal steroids for the treatment of retinal diseases. Sci World J. 2014;2014:989501.
4. Kwak HW, D'Amico DJ. Evaluation of the retinal toxicity and pharmacokinetics of dexamethasone after intravitreal injection. Arch Ophthalmol. 1992;110:259-66.
5. Bansal R, Bansal P, Kulkarni P, Gupta V, Sharma A, Gupta A. Wandering Ozurdex((R)) implant. J Ophthalmic Inflamm Infect. 2012;2:1-5.
6. Haller JA, Bandello F, Belfort R, Jr, Blumenkranz MS, Gillies M, Heier J. et al. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117:1134-46e3.
7. Dutra Medeiros M, Postorino M, Navarro R, GarciaArumi J, Mateo C, Corcostegui B. Dexamethasone intravitreal implant for treatment of patients with persistent diabetic macular edema. Ophthalmologica. 2014;231:141-6.
8. Zalewski D, Raczynska D, Raczynska K. Five-month observation of persistent diabetic macular edema after intravitreal injection of Ozurdex implant. Mediators Inflamm. 2014;2014:364143.
9. Chhablani J, Bansal P, Veritti D, Sambhana S, Sarao V, Pichi F et al. Dexamethasone implant in diabetic macular edema in real-life situations. Eye (Lond.). 2016;30:426-30.
10. Totan Y, Guler E, Guragac FB. Dexamethasone intravitreal implant for chronic diabetic macular edema resistant to intravitreal bevacizumab treatment. Curr Eye Res. 2016;41:107-13.
11. Haller JA, Bandello F, Belfort R, Jr., Blumenkranz MS, Gillies M, Heier J et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011;118:2453-60.
12. Bezatis A, Spital G, Hohn F, Maier M, Clemens CR, Wachtlin J et al. Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up -- the SOLO study. Acta Ophthalmol. 2013;91:e340-7.
13. Lowder C, Belfort R, Jr., Lightman S, Foster CS, Robinson MR, Schiffman RM et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129:545-53.
14. Tomkins-Netzer O, Taylor SR, Bar A, Lula A, Yaganti S, Talat L et al. Treatment with repeat dexamethasone implants results in long-term disease control in eyes with noninfectious uveitis. Ophthalmology. 2014;121:1649-54.
15. Sorkin N, Loewenstein A, Habot-Wilner Z, Goldstein M. Intravitreal dexamethasone implant in patients with persistent macular edema of variable etiologies. Ophthalmologica. 2014;232:83-91.
16. Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C et al. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol. 2007;125:309-17.