Diyabetik Makular Ödemde İntravitreal Triamsinolon Enjeksiyonunun Klinik Sonuçları

ÖzAmaç: Diyabetik makula ödemi(DMÖ) tedavisi için intravitreal triamsinolon (İVTA)uygulanan hastalarda tedavinin etkinliğinin ve klinik sonuçlarının optical coherence to-mography(OCT) ile değerlendirilmesi.Gereç ve Yöntemler: Diffüz DMÖ olan 20 hastanın 23 gözüne 4 mg. triamsinolonenjekte edildi. Olguların preoperatif santral makula kalınlığı(SMK), postop 1.ay ve 3.ay SMK bulguları OCT ile karşılaştırıldı. Postoperatif vizyon ve göz içi basınç artışı kaydedildi. Hastaların takip süresi 3 aydı.Bulgular: 20 hastanın 11 i kadın 9 u erkek olup yaş ortalamaları 67,45 idi. Preoportalama SMK 687±171 mikrondu. Postop ortalama SMK 1. ayda 422±134 mikron, 3.ayda375±163 mikron bulundu. Tedavi uygulanan gözlerde görme keskinliği ortalaması preop 0,23±0,25 snellen sırasıyken postop 1. ayda 0,29±0,24, 3.ayda 0,34±0,26 bulundu. SMK azalması ilk ayda çok belirgindi.(p<0,05) Buna paralel görme keskinliğinde artış1. ayda anlamlıydı.(p=0,012) 3.ayda istatistiksel olarak anlamsız bulundu. İVTA sonra-sı GİB >21 mmhg % 26 oranında tespit edilmiştir. GİB artışı görülen tüm gözler medikal tedaviye cevap vermiştir.Tartışma ve Sonuç: Diyabetik makula ödemi tedavisinde intravitreal triamsinolon enjeksiyonu makula kalınlığında belirgin azalmaya yol açmaktadır. Çalışmamızda makula kalınlığındaki bu azalma erken dönemde çok belirgindi(postop 1.ay). Görme keskinliğinde ise 1.ayda anlamlı artış saptandı.

Anahtar Kelimeler:

Diyabetik makula ödemi, intravitreal triamsinolon, santral makula kalınlığı, göz içi basınç artışı, görme keskinliği

Clinical Results Of İntravitreal Triamcinoloneİnjection İn Diabetic Macular Edema

AbstractAim: To evaluate to the efficacy of intravitreal triamcinolone acetonide injection inpatient with diffuse diabetic macular edema, clinical results and OCT (Optical coheren-ce tomography) findings.Materials and Methods: 23 eye of 20 patients with diffuse diabetic macular edema received an intravitreal injection of 4mg triamcinolone acetonide. Preoperative central macular thickness compared with findings in the postoperative first month and third month by using spectral OCT. Postoperative and preoperative visual acuity and intraocular pressure were noted. Fol-low-up period was three months.Results: The mean preoperative central macular thickness was measured 687±171 microns. The first postoperative month, mean central macular thickness was measured 422±134 microns. The third postoperative month, mean central macular thickness was measured 375±163 microns. Meanvisual acuity was measured as 0,23±0,25, 0,29±0,24 and 0,34±0,26 lines at the preoperative, postoperative first monthand third month. Reduction in central macular thickness was very obvious the first month. Significant increase visual acuity seen in the first postoperative month. After intravitrealinjection of triamcinolone acetonid patients with intraocular pressure exceeding 21 mmhg were % 26. İntraocular pressure controlled by topical medication.

Keywords:

Triamcinolone acetonid, intravitreal injection, diabetic macular edema, centralmacular thickness; visualacuity,

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Kaynaklar 1.Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JMet al. The prevalence by staged severity of various types of dia-betic neuropathy, retinopathy, and nephropathy in a popula-tion-based cohort: the Rochester Diabetic Neuropathy Study.Neurology. 1993;43(4):817-24 2.Leibowitz HM, Krueger DE, Maunder LR, et al. An ophtal-mological and epidemiological study of cataract, glaucoma,diabetic retinopathy, macular degeneration and visual acu-ity in general population of adults. Surv Ophtalmol.1980;24:335-610 3. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wiscon-sin Epidemiologic Study of diabetic retinopathy XIV. Ten-yearincidence and progression of diabetic retinopathy.Arch Oph-talmol. 1994;112(9):1217-28 4. Ferris FL, Patz A. Macular edema. A complication of diabe-tic retinopathy. Surv Ophtalmol.1984;28:452-61 5. Hikichi T, Fujio N, Akiba J, Azuma Y, Takahashi M, YoshidaA. Association between the short-term natural history of dia-betic macular edema and the vitreomacular relationship in typeII diabetes mellitus.1997;104(3): 473-8 6. Stern AL, Taylor DM, Dalburg LA, Cosentino RT. Pseudop-hakic cystoid maculopathy: a study of 50 cases. Ophtalmology.1981;88(9);942-6 7.Bresnick GH. Diabetic maculopathy. A critical review high-lighting diffuse macular edema. Ophtalmology. 1983;90(11);1301-17 8. Bresnick GH. Diabetic macular edema;a review. Ophtalmo-logy. 1986;93(7):989-97 9.Klein R, Klein BE, Moss SE, Davis MD, Demets DL.The Wis-consin Epidemiologic Study of Diabetic Retinopathy.IV. Dia-betic macular edema. Ophtalmology . 1981;91(12):1464-74 10. Mcdonald HR, Schatz H. Grid photocoagulation for diffusemacular edema . Retina .1985;5(2):65-72 11.Koya D, King GL. Protein kinase C actiaiton and the develop-ment of diabetic complications. Diabetes . 1998;47(6):859-66 12. Martidis A, Duker JS, Greenberg PB, Rogers AH, PuliafitoCA, Reichel E et al. Intravitreal triamcinolone for refractory dia-betic macular edema. Ophtalmology . 2002;109(5):920-7 13. Jonas JB, Kreissig I, Soefker A, Degenring RF. İntravitreal in-jection of triamcinolone for diffuse diabetic macular edema.Arch ophtalmol.2003;121(1):57-61 14. De Boer JF, Cense B, Park BH, Pierce MC, Tearney GJ, Bou-ma BE. Improved signal-to-noise ratio in spectral- domain com-pared with time-domain optical coherence tomography. Op-tics Letters. 2003;28(21): 2067-9