Muhammed Mustafa KURT, Ferhat EVLİYAOĞLU, Çetin AKPOLAT

Diyabetik maküler ödemde kombine intravitreal bevacizumab ve grid lazer tedavisi etkinliğinin değerlendirilmesi

Amaç: Kombine intravitreal bevacizumab enjeksiyonu ve grid lazer fotokoagülasyonu tedavisinin diyabetik maküler ödemde etkinliğini retrospektif olarak araştırmak. Yöntemler: Retrospektif olarak yapılan çalışmada, diyabetik maküler ödemi olan hastalara tek doz intravitreal bevacizumab enjeksiyonu uygulandı ve dört hafta sonra da grid lazer fotokoagülasyonu yapıldı. Tedavi öncesi ve lazer tedavisi sonrası 1. ve 3. aylarda, tüm gözlerin optik koherens tomografisi çekildi ve detaylı oküler muayeneleri yapıldı. Çalışmada, santral maküler kalınlık, maküler hacim ve düzeltilmiş en iyi görme keskinliği parametrelerinin tedavi öncesi ve sonrasındaki değişimleri gözlemlendi. Göz içi basıncındaki değişimler ve oluşabilecek komplikasyonlar da değerlendirilmeye tabi tutuldu. Bulgular: Kombine tedavi sonrası, görme keskinliğinde iyileşme sağlandı ve santral maküler kalınlık ortalamasında 96,91 (%24,94) mikronluk bir azalma meydana geldi. Kombine tedavi sonrası santral maküler kalınlık, maküler hacim ve düzeltilmiş en iyi görme keskinliği ortalamalarındaki değişiklikler istatistiksel olarak anlamlı bulundu (p ? 0,05). Göz içi basıncı ortalamasında anlamlı bir değişiklik saptanmadı (p = 0,95). İntravitreal enjeksiyon veya lazer fotokoagülasyona bağlı komplikasyon gelişmedi. Sonuç: Kombine intravitreal bevacizumab enjeksiyonu ve grid lazer fotokoagülasyonu tedavisinin diyabetik maküler ödemli hastalarda santral maküler kalınlık ve maküla hacminde azalma, görme keskinliğinde iyileşme sağladığı gözlemlendi. Dolayısıyla kombine intravitreal bevacizumab enjeksiyonu ve grid lazer fotokoagülasyonu diyabetik maküler ödemde ilk tedavi seçeneği olarak kullanılabilir.

Evaluation of efficacy of combined intravitreal bevacizumab and grid laser treatment in diabetic macular edema

Objective: To evaluate the efficacy of combined treatment of intravitreal bevacizumab injection followed by grid laser photocoagulation in patients with diabetic macular edema Methods: Patients with diabetic macular edema received single dose intravitreal bevacizumab injection and followed by grid laser photocoagulation treatment four weeks later in the retrospectively conducted study. All eyes had underwent a complete ophthalmic examination including optical coherence tomography at baseline and at first and third month after laser treatment. The changes between outcome and baseline measurements in central macular thickness, macular cube volume and best-corrected visual acuity were observed. The changes in intraocular pressure and any reported complication were also evaluated. Results: After the combined therapy the reduction in the mean of central macular thickness was 96.91 ?m (24.94%) with a corresponding improvement in best-corrected visual acuity. The reduction in the mean of central macular thickness and the improvement in the mean of best-corrected visual acuity were statistically significant (p ? 0.05). There was no significant changes in the mean of IOP (p = 0.95). No complication related to the intravitreal injection or laser photocoagulation was reported in the treated eyes.Conclusion: Combined therapy with intravitreal bevacizumab injection and sequential grid laser photocoagulation appeared to be effective in reducing central macular thickness and cube volume and improving visual acuity. A combination of intravitreal bevacizumab injection and sequential grid laser photocoagulation could be used as an initial treatment of diabetic macular edema.

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