Şerife Gülhan KONUK, Özlem EKŞİ YÜCEL, Ertuğrul CAN

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

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

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.

Keywords:

Dexamethasone implant, Macular edema, Retinal vein occlusion,

PDF

___

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.