Serdar BİLİCİ, Neriman SELÇUK, Tuba GÜLTEKİN-EROL, Suat Hayri UĞURBAŞ

COVID-19 Karantina Sürecinin Diyabetik Makula Ödemi Tedavisine Etkileri

Amaç: COVID-19 pandemisi nedeniyle tedaviye verilen aranın diyabetik maküla ödemi (DMÖ) olgularındaki anatomik ve fonksiyonel etkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: COVID-19 nedeniyle anti-vasküler büyüme faktörü (VEGF) tedavisine ara verilen DMÖ olguları çalışmaya dahil edildi. Olguların yaş, cinsiyet, tedaviye verilen ara süresi ve tekrar tedavi sonrası enjeksiyon sayısı ile takip süresi kaydedildi. Karantina öncesi son vizitleri (V0), karantina sonrası ilk (V1) ve son vizitlerindeki (V2) görme keskinlikleri (GK) ve optik koherans tomografi ile santral makula kalınlığı (SMK) değerlendirildi. Olgular tedaviye verilen ara süresine göre 18 hafta ve altı (Grup-1) ile 18 hafta üzeri (Grup-2) olarak alt gruplara ayrıldı ve analiz edildi. Bulgular: Çalışmaya yaş ortalaması 63,1 yıl (42-80 yıl arası) olan 89 olgunun 89 gözü dahil edildi. Pandemi sürecinde tedaviye verilen ara ortalaması 21,03 hafta (12-48 hafta) olarak saptandı. Tekrar tedaviye başlanan olguların ortalama takip süresi 31,2 hafta (8 - 52 hafta) olup bu süreç içerisinde ortalama 2,98 (1-8) anti-VEGF tedavi uygulanmıştı. Tüm grupta V0, V1 ve V2 vizitlerindeki ortalama GK sırasıyla 0,64, 0,64 ve 0,63 LogMAR (p=0,168), ortalama SMK değerleri sırasıyla 383,06, 434,82 ve 373,27 mikron (p<0,001) bulunmuştur. Grup 1’de V0, V1 ve V2 vizitlerindeki ortalama GK sırasıyla 0,53, 0,50 ve 0,52 LogMAR (p=0,263); ortalama SMK değerleri sırasıyla 358,72, 386,59 ve 389,70 mikron (p=0,056) olarak bulunmuştur. Grup 2’de V0, V1 ve V2 vizitlerindeki ortalama GK sırasıyla 0,78, 0,83 ve 0,74 LogMAR (p=0,176); ortalama SMK değerleri sırasıyla 409,09, 486,42 ve 355,70 (p<0,001) olarak bulunmuştur. Sonuç: DMÖ olgularında Anti-VEGF tedavisinde gecikme süresi arttıkça SMK’de kötüleşme izlenirken, kısa dönemde tekrar tedaviye başlanmasıyla GK’de bir kötüleşme olmadan SMK değerlerinde düzelme elde edilmiştir. Bu sonuç, olgulara daha önce uygulanan anti- VEGF tedavinin kısa dönemli tedavi gecikmelerinde koruyucu olduğunu düşündürmektedir.

Anahtar Kelimeler:

Anti-vaskuler büyüme faktörü, COVID-19, Diyabetik makula ödemi, Optik koherens tomografi

Effects of COVID-19 Lockdown on Diabetic Macular Edema Treatment

Aim: Evaluating the anatomical and functional effects of delay in diabetic macular edema treatment due to the COVID-19 lockdown. Material and Methods: DME cases of which anti-vascular growth factor (VEGF) treatment was interrupted due to COVID-19 lockdown were included in the study. Age, gender, interval time of the treatment delay, number of injections after retreatment and follow-up period were recorded. Visual acuity (VA) and central macular thickness (CMT) of the participants at the last visit before the lockdown (V0), the first (V1) and the last (V2) visit after the lockdown were evaluated. The cases were divided into subgroups based on delay in treatment: 18 weeks or less (Group-1) and over 18 weeks (Group-2). Results: 89 eyes of 89 patients with average age of 63.1 (42-80) were included in the study. The average delay in the treatment during the pandemic period was 21.03 (12-48) weeks. The average follow-up period after the initiation of retreatment was 31.2 (8-52) weeks, and an average of 2.98 (1-8) anti-VEGF treatments were carried out during this period. The mean VA of V0, V1 and V2 visits of the whole group were determined as 0.64, 0.64, and 0.63 LogMAR (p=0.168), respectively, the mean CMT values were found as 383.06, 434.82, and 373.27 microns (p<0.001), respectively. The mean VA of V0, V1 and V2 visits were 0.53, 0.50 and 0.52 LogMAR (p=0.263) in Group 1 and, 0.78, 0.83 and 0.74 LogMAR (p=0.176) in Group 2, respectively. The mean CMT values of V0, V1 and V2 visits were found as 358.72, 386.59 and 389.70 microns (p=0.056) in Group 1 and, 409.09, 486.42 and 355.70 (p<0.001) in Group 2, respectively. Conclusion: In DME cases, as the delay time in anti-VEGF treatment increased, worsening was observed in CMT, while CMT values improved without any worsening in VA after re-starting treatment in the short term. This result suggests that the anti-VEGF treatment for DME has a protective effect in short-term treatment delays.

Keywords:

Anti-vascular growth factor, COVID-19, Diabetic macular edema, Optical coherence tomography,

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