Tevfik OĞUREL, Kemal ÖRNEK, Reyhan OĞUREL, Zafer ONARAN

Diyabetik retinopatili gözlerde katarakt ameliyatı sonunda ön kamaraya deksametazon verilmesinin makula ödemi üzerine etkisi

Amaç: Diyabetik retinopati (DR)’li hastalarda katarakt ameliyatı sonunda ön kamaraya verilen deksametazonun maküla ödemi (MÖ) üzerine muhtemel etkilerinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Çalışmaya DR’li ve makula ödemi olan 28 katarakt hastası dahil edildi. Bütün hastalara katarakt operasyonu öncesinde en iyi düzeltilmiş görme keskinlikleri (EDGK), biyomikroskopik ön segment değerlendirmesi, Goldmann üç aynalı lensi ile fundus muayeneleri ve Goldmann aplanasyon tonometresi ile göz içi basınç (GİB) ölçümlerinden oluşan oftalmolojik muayenenin ardından, maküla ödeminin değerlendirilmesi amacıyla fundus floresein anjiyografi (FFA) çekildi. Katarakt operasyonunun sonunda hastalara kesi yerinden 0,1 cc deksametazon verildi. Hastalar birinci ay sonunda EDGK, GİB ve FFA ile değerlendirildi.Bulgular: Çalışmaya yaşları 52-87 arasında değişen ve diyabetik makula ödemi (DMÖ) olan 18 (%64,3) kadın ile 10 (%35,7) erkek hastanın 31 gözü dahil edildi. Hastaların tamamında tip 2 diyabet mevcuttu. Olguların ortalama yaşı 65,25±8,57 olup gözlerden 16 (%25,8)’ sında diffüz, 8 (%25,8)’ inde kistoid, 7 (%22,6)’ sinde hem diffüz hem de kistoid makula ödemi (KMÖ) mevcuttu. 19 (%61,3) hastada postoperatif makula ödeminde herhangi bir değişiklik gözlenmezken 12 (%38,7) hastada maküler ödemde azalma söz konusuydu (p=0,201). Operasyon öncesi en iyi düzeltilmiş görme keskinliği 0,10±0,11 olup, operasyon sonrası 1.ay görme keskinliği 0,2±0,22 düzeylerindeydi. Bu artış istatistiksel olarak anlamlıydı (p˂0.001). Sonuç: DMÖ ve kataraktı olan gözlerde, katarakt ameliyatı sonunda ön kamaraya deksametazon uygulamasının, cerrahi işlemin MÖ üzerine olan olumsuz etkisini azalttığı görülmektedir.

Anahtar Kelimeler:

Deksametazon, makula ödemi, katarakt, diyabetik retinopati

The effect of intracameral dexamethasone used at the end of cataract surgery on macular edema in eyes with diabetic retinopathy

Aim: To evaluate the effect of intracameral dexamethasone on diabetic macular edema injected at the end of cataract surgery in patients with diabetic retinopathy.Material and Method: Thirty patients with diabetic retinopathy and cataract were included in this study. All patients underwent a complete ophthalmic examination which consisted best-corrected visual acuity (BCVA), anterior segment evaluation with slit lamp microscopy, fundus examination with Goldman three mirror lens, intraocular pressure (IOP) measurement with applanation tonometry before cataract surgery. Fundus fluorescein angiography (FFA) was taken following each ocular examination. At the end of cataract surgery 0,1 cc dexamethasone was given intracamerally from the cataract incision. Each patient was reevaluated with BCVA, IOP and FFA at 1st month after surgery. Results: Thirty one eye of 18 (%64.3) women and 10 (%35.7) mans who ages ranging from 52 to 87 were enrolled in this study. All of patients had type 2 diabetes. Mean age of the patients was 65.25±8.57 and 16 (%25.8) eyes had diffuse diabetic macular edema, 8 (%25.8) eyes had cystoid macular edema and 7 (%22.6) eyes had both diffuse diabetic macular edema and cystoid diabetic macular edema. Macular edema did not change in 19 (%61.3) eyes and decreased in 12 (%38.7) eyes. The mean corrected visual acuity was preoperatively 0.10±0.11, postoperatively 0.2±0.22 at first month. Postoperative increase in vısual acuity was found statistically significant (p˂0,001). Conclusion: Intracameral dexamethasone injection appears to be effective in reducing the effect of surgery on diabetic macular edema in eyes with diabetic retinopathy and cataract

Keywords:

Dexamethasone, macular edema, cataract, diabetic retinopathy,

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