AHMET YALÇIN, Yasin Yücel BUCAK, Ahmet Şahap KÜKNER, Didem SERİN, Sedat ÖZMEN

Retina ven dal tıkanıklığına bağlı maküla ödemindeprimer ıntra vitreal bevakizumab enjeksiyonu

Amaç: Retina ven dal tıkanıklığına (RVDT) bağlı maküla ödemi olan hastalarda primer tedavi olarak intravitreal bevakizumab (İVB) enjeksiyonunun etkinliğini değerlendirmek. Gereç ve Yöntem: RVDT’ye bağlı maküla ödemi olan 12 hastanın 12 gözü çalışmaya alındı. Hastaların hepsinde RVDT’ye bağlı makülada ödem, hemoraji ve görme keskinliğinde azalma mevcuttu. Daha önce herhangi bir tedavi almamış olan hastalar çalışmaya alındı. Enjeksiyon öncesi tüm hastalara fundus floresein anjiografi (FFA) çekildi. Tüm hastalara intravitreal 1,25mg/0,05ml bevakizumab enjeksiyonu yapıldı. Enjeksiyon öncesi ve sonrası görme keskinliği, fundus bulguları ve komplikasyonlar kaydedildi. Bulgular: Hastaların 8’i kadın, 4’ü erkekti. Yaş ortalamaları 59,4 yıl (22-76 yıl) idi. Tüm hastalara tek enjeksiyon yapıldı. RVDT gelişmesi ile IVB enjeksiyonu arasında geçen ortalama süre 23,9 gün (5 -75 gün) idi. Hastaların ortalama takip süresi 134,5 gün (16–570 gün) idi. Enjeksiyon öncesi ortalama görme keskinliği 0,9±0,4 ve enjeksiyon sonrası son takipte görme keskinliği 0,3 ± 0,3 LogMAR idi (p

Primary intravitreal bevacizumab ınjection in macular eudema due to branched retinal vein occlusion

Objective: To evaluate the effectiveness of primary intravitreal bevacizumab (IVB) injection in macular edema due to branched retinal vein occlusion (BRVO). Materials and Methods: Twelve eyes of 12 patients with macular edema due to BRVO were included in the study. Macular edema, hemorrhage and decreased visual acuity due to BRVO were observed in all patients. Patients who have had not take any prior treatment because of BRVO were invol- ved in the study.Fundus fluorecein angiography was taken before injection in all patients. Intravitreal injection of 1.25mg/0.05ml bevacizumab was performed in all patients. Visual acuity, fundus findings, and complications were recorded before and after injection. Results: Eight patients were women and 4 patients were men. Mean age of the subjects was 59.5 years (22-76 years). Single IVB injection was per- formed in all patients. The time interval between the BRVO development and IVB injection was 23.9 days (5-75 days). Mean follow up was 134.5 days (16–570 days). Mean visual acuities were 0.9±0.4 and 0.3±0.3 LogMAR before injection and on the last follow up visit after injection, respecti- vely (p<0.002). After primary IVB injection, decreased macular eudema and improved visual acuity were detected in all patients. Localized subcon- jonctival hemorrhages were observed in 3 patients. Serious complications which may deteriorate the vision were not developed in any patients. Conclusion: Primary IVB injection in patients with macular eudema due to BRVO may be an effective and safe treatment option.

PDF

___

1.Noma H, Minamoto A, Funatsu H, et al. Intravitreal levels of vascular endothelial growth factor and interleukin-6 are corre- lated with macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2006; 244: 309-315.
2.Costa RA, Jorge R, Calucci D, Melo LA, Cardillo J A, Scott I U. İVB (avastin) for central and hemicentral retinal vein occ- lusions: IBeVO study. Retina 2007; 27: 141–149.
3.Hsu J, Kaiser RS, Sivalingam A, et al. İVB (avastin) in cent- ral retinal vein occlusion. Retina 2007; 27: 1013–1019.
4.Iturralde D, Spaide RF, Meyerle CB, et al. İVB (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina 2006; 26: 279–284.
5.Pai SA, Shetty R, Vijayan PB, et al. Clinical, anatomic, and electrophysiologic evaluation following İVB for macular ede- ma in retinal vein occlusion. Am J Ophthalmol 2007; 143: 601–606.
6.Priglinger SG, Wolf AH, Kreutzer TC, et al. İVB injections for treatment of central retinal vein occlusion: six-month re- sults of a prospective trial. Retina 2007; 27: 1004–1012.
7.Spandau UH, Ihloff AK, Jonas JB. İVB treatment of macular oedema due to central retinal vein occlusion. Acta Ophthalmol Scand 2006; 84: 555–556.
8.Stahl A, Agostini H, Hansen LL, Feltgen N. Bevakizumab in retinal vein occlusion results of a prospective case series. Gra- efes Arch Clin Exp Ophthalmol 2007; 245: 1429–1436.
9.Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group: Am J Ophthalmol 1984; 98: 271–282.
10.Evaluation of grid pattern photocoagulation for macular edema in central retinal vein occlusion. The Central Retinal Vein Occlusion Study Group M report. Ophthalmology 1995; 102: 1425–1433.
11.Russo V, Barone A, Conte E, Prascina F, Stella A, Noci ND. Bevakizumab compared wıth macular laser grid photocoagula- tion for cystoid macular edema in branch retinal vein occlu- sion. Retina 2009; 29: 511-515.
12.Hayashi K, Hayashi H. Intravitreal versus retrobulbar injecti- ons of triamcinolone for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 2005; 139: 972–982.
13.Bashshur ZF, Ma’luf RN, Allam S, Jurdi FA, Haddad RS, Noureddin BN. Intravitreal triamcinolone for the management of macular edema due to nonischemic central retinal vein occ- lusion. Arch Ophthalmol 2004; 122: 1137–1140.
14.Shulman S, Ferencz JR, Gilady G,Ton Y, Assia E. Prognostic factors for visual acuity improvement after intravitreal triam- cinolone injection. Eye 2007; 21: 1067-1070.
15.Tewari HK, Sony P, Chawla R, Garg SP, Venkatesh P. Pros- pective evaluation of intravitreal triamcinolone acetonide in- jection in macular edema associated with retinal vascular di- sorders. Eur J Ophthalmol 2005; 15: 619-626.
16.Gregori NZ, Rosenfeld PJ, Puliafito CA, et al. One-year safety and efficacy of intravitreal triamcinolone acetonide for the management of macular edema secondary to central retinal vein occlusion. Retina 2006; 26: 889-895.
17. Rosenfeld PJ, Fung AE, Puliafito CA. Optical coherence to- mography findings after an intravitreal injection of Bevakizu- mab (Avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 2005; 36: 336- 339.
18. Moschos, MM, Moschos M. Intraocular Bevakizumab for macular edema due to CRVO. Documenta ophthalmologica 2008; 116: 147–152.
19.Wu L, Arevaldo JF, Roca JA, et al. Comparison of two doses of İVB (Avastin) for treatment of macular edema secondary to branch retinal vein occlusion: results from the Pan-American Collaborative Retina Study Group at 6 months of Follow-Up. Retina 2008; 28: 212–219.