Dirençli diyabetik makula ödemi tedavisinde kombine intravitreal triamsinolon – bevacizumab ile topikal nepafenak tedavisinin kısa dönem etkisi
Amaç: Anti-VEGF tedaviye dirençli diyabetik makula ödemi (DMÖ)'nde kombine intravitreal bevacizumab (IVB)-triamsinolon asetonid (İVTA) enjeksiyonu ile beraber topikal nepafenak tedavisinin etkinlik ve güvenilirliğinin değerlendirmek. Gereç ve Yöntemler: Dirençli DMÖ'lü 16 hastanın 16 gözü çalışmaya dahil edildi. Hastalara kombine İVTA (2 mg, 0.05 ml)-İVB (1.25 mg, 0.05 ml) enjeksiyonu yapıldı ve 3 ay süre ile topikal nepafenak 3x1 uygulandı. Hastaların tam oküler muayeneleri yapıldı, düzeltilmiş görme keskinliği (DGK) ve santral makula kalınlığı (SMK) tedavi öncesi, tedaviden 1 ay ve 3 ay sonra tekrarlandı. Bulgular: Hastaların 9 (% 56)'u kadın, 7 (% 44)'si erkek olup ortalama yaşı 62,75±5,73 yıl (ortalama±standart sapma) idi. Kombine intravitreal enjeksiyon öncesi SMK 437.44±76.34 mikron olup kombine enjeksiyondan 1 ay sonraki SMK 366.56±61.15 mikron, 3 ay sonraki SMK ise 309.75±61.17 mikron olarak ölçüldü. Kombine enjeksiyon öncesine göre, enjeksiyondan 1 ay ve 3 ay sonraki SMK değerlerindeki azalma anlamlıydı (p
Short term effect of combined intravitreal triamcinolone-bevacizumab with topical nepafenac treatment in refractory diabetic macular edema
Purpose: To investigate the short term effect of combined intravitreal triamcinolone acetonide (IVTA) and bevacizumab (IVB) injection with topical nepafenac in diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor. Material and Methods: 16 eyes of 16 patients with refractory DME were included the study. IVTA (2mg 0.05ml) and IVB (1.25mg 0.05ml) combined injection was performed and topical nepafenac was applied for three months. Ocular examination of patients was made, corrected visual acuity (CVA) and central macular thickness (CMT) repeated before the injection, 1 month and 3 months after the injection. Results: Nine (56 %) patients were women and 7 (44 %) patients were men and their mean age was 62,75±5,73 years. Before treatment CMT was 437.44±76.34 micron and 1 month after combined injection CMT was 366.56±61.15 micron and 3 months after CMT was 309.75±61.17 micron. There was significant reduction in CMT 1 month and 3 months after injection (p
___
- 1- Early Treatment Diabetic Retinopathy Study Group: Report Number 1. Photocoagulation for diabetic macular edema. Arch Ophthalmol. 1985 ; 103(12):1796-806.
- 2- Gillies MC, Sutter FK, Simpson JM, Larsson J, Ali H, Zhu M. Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a double-masked, placebocontrolled, randomized clinical trial. Ophthalmology. 2006; 113(9):1533-8.
- 3- Shimura M, Nakazawa T, Yasuda K, Shiono T, Iida T, Sakamoto T, et al. Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema. Am J Ophthalmol. 2008 ;145(5):854-61.
- 4- Biarnes M, Mones J,Villali JR, Arias L. As-needed treatment with ranibizum¬ab 0.5 mg in patients with neovascular age-related macular degeneration. Eur J Ophthalmol, 2011; 21(3): 282–9.
- 5- Wilson CA, Berkowitz BA, Sato Y, Ando N, Handa JT, de Juan E Jr. Treatment with intravitreal steroid reduces bloodretinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol. 1992; 110(8):1155-9.
- 6- Van Meter ME, Kim ES. Bevacizumab current updates in treatment. Curr Opin Oncol. 2010; 22(6):586-91.
- 7- Haritoglou C, Kook D, Neubauer A, Wolf A, Priglinger S, Strauss R, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 2006; 26(9): 999-1005.
- 8- Kim J H, Kang S W, Ha H S, Kim J R. Vitrectomy combined with intravitreal triamcinolone acetonide injection and macular laser photocoagulation for nontractional diabetic macular edema. Korean J Ophthalmol 2013; 27(3): 186- 93.
- 9- Aiello LP, Bursell SE, Clermont A, Duh E, Ishii H, Takagi C, et al. Vascular endothelial growth factor-induced retinal permeability is mediated protein kinase C in vivo and supressed by an orally effective b-isoform-selective inhibitor. Diabetes. 1997; 46 (9):1473-80.
- 10- Rich RM, Rosenfeld PJ, Puliafito CA, Dubovy SR, Davis JL, Flynn HW Jr, et al. Short-term safety and efficacy of intravitreal bevacizumab (avastin) for neovascular agerelated macular degeneration. Retina. 2006; 26(5):495- 511.
- 11- Ozturk BT, Kerimoglu H, Bozkurt B, Okudan S. Comparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema. J Ocul Pharmacol Ther. 2011; 27 (4): 373–7.
- 12- Ford JA, Elders A, Shyangdan D, Royle P, Waugh N. The relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema: an indirect comparison in a systematic review. BMJ Ophthalmol. 2012; 345:e5182. doi: 10.1136/bmj.e5182.
- 13- Edelman J, Lutz D, Castro MR. Corticosteroids inhibit VEGF-induced vascular leakage in a rabbit model of bloodaqueous barrier breakdown. Exp Eye Res. 2005;80(2):249- 58.
- 14- Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008; 115 (9):144-7.
- 15- Karaçorlu M, Özdemir H, Karaçorlu S. Intravitreal triamcinolone as a primary therapy in diabetic macular edema.Eye. 2005 Apr;19(4):382-6.
- 16- Diabetic Retinopathy Clinical Research Network (DRCR. net), Beck RW, Edwards AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009; 127(3):245-51.
- 17- Flach AJ. Topical nonsteroidal antiinflammatory drugs in ophthalmology. Int Ophthalmol Clin. 2002; 42(1):1-11.
- 18- Schoenberger SD, Kim SJ. Nonsteroidal anti-inflammatory drugs for retinal disease. Int J Inflam. 2013; 2013:281981. doi: 10.1155/2013/281981.
- 19- Ke TL, Graff G, Spellman JM, Yanni JM. Nepafenac, a unique nonsteroidal prodrug with potential utility in the treatment of trauma-induced ocular inflammation: II. In vitro bioactivation and permeation of external ocular barriers. Inflammation. 2000;24 (4):371–84.
- 20- Kern TS, Miller CM, Du Y, Zheng L, Mohr S, Ball SL, et al. Topical administration of nepafenac inhibits diabetes induced retinal microvascular disease and underlying abnormalities of retinal metabolism and physiology. Diabetes. 2007; 56 (2): 373–9.
- 21- Callanan D, Williams P. Topical nepafenac in the treatment of diabetic macular edema. Clin Ophthalmol. 2008 Dec;2(4):689-92.
- 22- Hariprasad SM, Callanan D, Gainey S, He YG, Warren K. Cystoid and diabetic macular edema treated with nepafenac 0.1%. J Ocul Pharmacol Ther. 2007;23(6):585- 90.
- 23- Warren KA, Bahrani H, Fox JE. NSAIDs in combination therapy for the treatment of chronic pseudophakic cystoid macular edema Retina. 2010; 30(2):260-6.
- 24- Reis AC, Vianna RN, Reis RS, Cardoso GP. Intravitreal injection of ketorolac tromethamine in patients with diabetic macular edema refractory to retinal photocoagulation. Arquivos Brasileiros de Oftalmologia, 2010; 73( 4) 338– 42.
- ISSN: 1300-7416
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1994
- Yayıncı: SDÜ Basımevi / Isparta
Sayıdaki Diğer Makaleler
Terapötik indeksi dar olan ilaçlarda etkileşimler
Şenay Erdoğan DURMUŞ, Sevilay Akalp ÖZMEN, İLKNUR ÇALIK, Ali KURT, Hilal BALTA, Ebru ŞENER, Mehmet Eşref KABALAR, ESRA ÇINAR TANRIVERDİ
Bir adipositokin üyesi: Leptin
Çoklu intrakranial tüberkülomlar ve tüberküler beyin apsesi ile ilişkili akciğer tüberkülozu
Mustafa KAYAN, ÖNDER ÖZTÜRK, Esma Dilek ÜSTÜN, Mehmet MUNDUZ, Fatmanur KAYAN, Vedat Ali YÜREKLİ
Handan BARDAK, MURAT GÜNAY, Mustafa Muhterem EKİM, Yavuz BARDAK
Fahrettin KIRÇİÇEK, FİLİZ ALKAYA SOLMAZ, SADIK ÖZMEN, PAKİZE KIRDEMİR