Diyabetik Makula Ödemli Hastalarda Deksametazon İmplantının Retina Sinir Lifi Tabakası ve Optik Sinir Çukurluk/Disk Oranı Üzerine Etkisi

Amaç: Bu çalışmanın amacı diyabetik maküla ödemi bulunan hastalarda tek doz intravitreal Deksametazon (DEX) implantının peripapiller retina sinir lifi tabakası (RNFL) kalınlığına ve optik sinir çukurluk/disk (C/D) oranına etkisini araştırmaktır. Gereç ve Yöntemler: İntravitreal DEX implant enjeksiyonu öncesi peripapiller RNFL kalınlık ölçümleri ve renkli fundus fotoğrafları enjeksiyondan 6 ay sonrası ile karşılaştırıldı. Fundus fotoğraflarının C/D oranları Image-J programı kullanılarak hesaplandı. Bulgular: Kırk üç hastanın 58 gözüne intravitreal DEX implant enjeksiyonu yapıldı. Ortalama global ve sektörel RNFL kalınlık değerleri bazal değere göre hafif bir incelme gösterdi. Global ve nazal incelme istatistiksel olarak anlamlıydı (sırasıyla; p=0,021, p=0,036). DEX implant enjeksiyonundan 6 ay sonra C/D değerinde hafif bir artış gözlendi, ancak bu artış istatistiksel olarak anlamlı değildi (p=0,258). Hastaların %17’sinde göz içi basıncı 25 mmHg’nin üzerindeydi ve medikal tedavi ile kontrol altına alındı. Sonuç: Bu çalışmada diyabetik maküla ödemi olan hastalarda tek doz intravitreal DEX tedavisinden 6 ay sonra global ve nazal peripapiller retina sinir lifi tabakasında hafif fakat belirgin bir incelme gözlemlendi. Bu azalma, C/D değerinde önemli bir morfolojik değişikliğe neden olmadı.

Anahtar Kelimeler:

Deksametazon implant, Diyabetik maküler ödem, İntravitreal enjeksiyon, Optik disk ve retina sinir lifi tabakası analizi, Vasküler endotelyal büyüme faktörü

The Effect of Dexamethasone Implant on Retinal Nerve Fiber Layer and Optic Nerve Cup-to-Disk Ratio in Patients with Diabetic Macular Edema

Aim: The aim of this study is to investigate the effect of single-dose intravitreal Dexamethasone (DEX) implant on peripapillary retinal nerve fiber layer (RNFL) thickness and cup-to-disc (C/D) ratio in patients with diabetic macular edema. Material and Methods: Peripapillary RNFL thickness measurements and colored fundus photographs were compared before and 6 months after intravitreal DEX implant injection. The cup-to-disc ratios of fundus photographs were calculated using the Image-J program. Results: Fifty-eight eyes of 43 patients were treated with intravitreal DEX implants. The mean global and sectoral peripapillary RNFL thickness value had a slight thinning over the basal value. The global and nasal thinning was statistically significant (respectively; p=0.021, p=0.036). A small increase in C/D value was observed 6 months after the DEX implant injection; however, these changes were not statistically significant (p=0.285). The intraocular pressure was over 25 mmHg in 17% of the patients and it was controlled by medical treatment. Conclusion: In this study, in patients with diabetic macular edema, a mild but significant thinning of the global and nasal peripapillary retinal nerve fiber layer was observed 6 months after single-dose intravitreal implant treatment. This reduction did not cause a significant morphological change in the C/D value.

Keywords:

Dexamethasone implant, Diabetic macular edema, Intravitreal injection, Optic disc and nerve fiber layer imaging and analysis, Vascular endothelial growth factor (VEGF),

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