Diabetik maküla ödeminde intravitreal Bevacizumab etkinliğinin değerlendirilmesi
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Giri?: Bu çalışmada DMÖ tedavisinde intravitreal bevacizumab uygulamasının, GK, GİB ve SFK olan etkileri araştırıldı. Materyal-Metod: Dicle Üniversitesi Tıp Fakültesi Göz Hastalıkları Kliniği?nde Aralık 2007-Aralık 2009 tarihleri arasında DMÖ tanısıyla takipleri bulunan ve DMÖ tedavisi için intravitreal bevacizumab ( Altuzan, F.Hoffman-La Roche, Switzerland ) enjeksiyonu uygulanan 35 hastanın 39 gözü çalışma kapsamına alındı. Olguların yaş ortalamaları 56.42 ±11.25 yıl idi. Olgulara enjeksiyon öncesi GK, GİB ve OKT ile SFK bakıldı. Çekilen FA?da makülada ödem saptanan tüm hastalarda, OKT`de SFK en az 300 ve üzerindeydi. Makülada ödem saptanan bu olgulara 1.25 mg/0.1 ml bevacizumab enjeksiyonu uygulandı ve olgular enjeksiyondan sonraki 1. ayda tekrar kontrol edilip GK, GİB ve OKT ile SFK bakıldı. SFK?sı 300 µ ve üzerinde olan olgulara 2. ve 3. Enjeksiyon uygulandı. Bulgular: Olguların EÖ, GK ortalama snellen eşelinde 0.206 ± 0.17 sıra idi ve 1. ES 1. aydaki ortalama GK 0.294 ± 0.22 idi ve istatiksel olarak anlamlı artış izlendi ( p < 0.05 ). DMÖ?sü devam eden 28 göze 1. enjeksiyondan ortalama 1 ay sonra 2. intravitreal bevacizumab enjeksiyonu yapıldı, 1 ay sonraki ortalama GK 0.285 ± 0.23 sıra idi ve bu 1. ES 1. ay GK ile karşılaştırıldığında istatiksel olarak anlamlı fark görülmedi ( p > 0.05 ). 2. ES DMÖ?sü devam eden 12 göze ortalama 1 ay sonra 3. intravitreal bevacizumab enjeksiyonu yapıldı, 3. ES 1.aydaki GK ortalama 0.417 ± 0.31 sıra idi ve bu 2. enjeksiyon 1. ay GK ile karşılaştırıldığında istatiksel olarak anlamlı artış izlendi ( p < 0.05 ). Enjeksiyon öncesi SFK ortalamaları 464.5 ± 115.35 µ idi ve 1. ES 1. ay SFK ortalamaları 332.11 µ ± 127.60 idi ve EÖ „ne göre karşılaştırıldığında istatiksel olarak anlamlı düşüş izlendi ( p < 0.05 ). DMÖ?sü devam eden 28 göze 2. intravitreal bevacizumab enjeksiyonu yapıldı ve 1 ay sonraki SFK ortalamaları 402.50 µ ± 124.00 idi ve bu 1. ES 1. ay SFK ile karşılaştırıldığında istatistiksel olarak anlamlı düşüş gözlemedik( p > 0.05 ). 2. ES DMÖ?sü devam eden 12 göze 3. intravitreal bevacizumab enjeksiyonu uygulandı ve 3. ES 1. ay SFK ortalamaları 370.0 µ ± 142.31 idi ve bu 2. enjeksiyon 1.ay SFK ile karşılaştırıldığında istatistiksel olarak anlamlı düşüş gözlenmedi ( p > 0.05 ). 3. enjeksiyondan sonra SFK?da düşüş izledik ancak bu anlamlı değildi. EÖ GİB 13.11 ± 2.80 49 mmHg ve 1. ES GİB 13.31 ± 3.22 mmHg idi EÖ ile 1. ES 1 aydaki GİB arasında istatistiksel olarak fark bulunmadı ( p > 0.05 ). 2.ES 1. Ay GİB 13.72 ± 3.04 mmHg idi ve 1. Enjeksiyon ile 2. ES GİB arasında istatistiksel olarak fark bulunmadı ( p > 0.05 ). 3. ES 1. Ay GİB 14.27 ± 2.72 mmHg idi ve 2. ES GİB ile 3. ES 1. Aydaki GİB arasında istatistiksel olarak anlamlı fark bulundu ( p < 0.05 ). Olgularda ES ciddi komplikasyona rastlanmadı. Sonuçlar: DRP?ye bağlı gelişen DMÖ tedavisinde intravitreal bevacizumab enjeksiyonunun GK?yi arttırdığı ve SFK?ı azalttığı görüldü. Ancak tekrar enjeksiyonlara gerek olabileceği görüldü.
Purpose: The efficacy of application of intravitreal bevacizumab for diabetic macular edema ( DME ) investigated in this study; visual acuity ( VA ), intraocular pressure ( İOP ) and central foveal thickness ( CFT ) were examined. Materials and Methods: Thirty nine eyes of 35 patients who were treated with intravitreal bevacizumab ( Altuzan, F.Hoffman-La Roche, Switzerland ) for DME between December 2007 to December 2009 were included to the study at Dicle University Faculty of Medicine eye department. The mean age of patients was 56.42 ± 11:25 years. Prior to injection VA, İOP and CFT were examined. In fundus fluorescein angiography macular edema was detected and the CFT was at least 300 ? at OCT ( Optical Chorence Tomography ) measurement, macular edema detected in these cases and 1.25 mg / 0.1 ml bevacizumab was injected, after 1 month injection patients were observed for VA,İOP. Results: Before injection of ( Bİ ), visual acuity (VA), while the average was 0.216 ± 0.17 and 1 month after injection VA was 0294 ± 0.22 and showed a statistically significant increase (p <0.05). 28 patients who DME was ongoing afford 1 month after first injection second intravitreal bevacizumab injection was performed. 1 month after second injection VA was 0.285 ± 0.23 and when compared with first injection VA was not significantly different statistically (p> 0.05). 12 patients who DME was ongoing afford third intravitreal bevacizumab injection was performed. 1 month after third injection VA was 0.417 ± 0.31 2 and when compared with second VA showed a statistically significant increase (p <0.05). Mean CFT was 464.5 ± 115.35 ? before injection. 1 month after first injection CFT was 332.11 µ ± 127.60 a statistically significant decrease was observed (p <0.05). 28 patients who DME was ongoing afford 1 month after first injection second intravitreal bevacizumab injection was performed and 1 month after second injection CFT was 402.50 µ ± 124.00 when compared with first injection there were no statistically significant decrease (p> 0.05). 12 patients who DME was ongoing afford third intravitreal bevacizumab injection was performed and 1 month after third injection CFT was 370.0 µ ± 142.31 when compared with second injection there were no statistically significant decrease was observed (p> 0.05). After third injection CFT decreased but it was not meaningful. Before injection İOP was 13.11 ± 2.80 mmHg, after 1 month first injection İOP was 13.31 ± 3:22 mm Hg when compared with firs injection statistically significant 51 differences were not found (p> 0.05) . After second injection İOP was 13.72 ± 3.04 mmHg, and when compared with first injection statistically significant differences were not found (p> 0.05).After third injection İOP was 14:27 ± 2.72 mmHg and when compared second injection the IOP was statistically significant difference was found (p <0.05). There were no serious complication after injections. Conclusion: Intravitreal bevacizumab injection in the treatment of DME due to DRP increased visual acuity and decreased foveal thickness was seen. Even if repeated injections will be needed.
Purpose: The efficacy of application of intravitreal bevacizumab for diabetic macular edema ( DME ) investigated in this study; visual acuity ( VA ), intraocular pressure ( İOP ) and central foveal thickness ( CFT ) were examined. Materials and Methods: Thirty nine eyes of 35 patients who were treated with intravitreal bevacizumab ( Altuzan, F.Hoffman-La Roche, Switzerland ) for DME between December 2007 to December 2009 were included to the study at Dicle University Faculty of Medicine eye department. The mean age of patients was 56.42 ± 11:25 years. Prior to injection VA, İOP and CFT were examined. In fundus fluorescein angiography macular edema was detected and the CFT was at least 300 ? at OCT ( Optical Chorence Tomography ) measurement, macular edema detected in these cases and 1.25 mg / 0.1 ml bevacizumab was injected, after 1 month injection patients were observed for VA,İOP. Results: Before injection of ( Bİ ), visual acuity (VA), while the average was 0.216 ± 0.17 and 1 month after injection VA was 0294 ± 0.22 and showed a statistically significant increase (p <0.05). 28 patients who DME was ongoing afford 1 month after first injection second intravitreal bevacizumab injection was performed. 1 month after second injection VA was 0.285 ± 0.23 and when compared with first injection VA was not significantly different statistically (p> 0.05). 12 patients who DME was ongoing afford third intravitreal bevacizumab injection was performed. 1 month after third injection VA was 0.417 ± 0.31 2 and when compared with second VA showed a statistically significant increase (p <0.05). Mean CFT was 464.5 ± 115.35 ? before injection. 1 month after first injection CFT was 332.11 µ ± 127.60 a statistically significant decrease was observed (p <0.05). 28 patients who DME was ongoing afford 1 month after first injection second intravitreal bevacizumab injection was performed and 1 month after second injection CFT was 402.50 µ ± 124.00 when compared with first injection there were no statistically significant decrease (p> 0.05). 12 patients who DME was ongoing afford third intravitreal bevacizumab injection was performed and 1 month after third injection CFT was 370.0 µ ± 142.31 when compared with second injection there were no statistically significant decrease was observed (p> 0.05). After third injection CFT decreased but it was not meaningful. Before injection İOP was 13.11 ± 2.80 mmHg, after 1 month first injection İOP was 13.31 ± 3:22 mm Hg when compared with firs injection statistically significant 51 differences were not found (p> 0.05) . After second injection İOP was 13.72 ± 3.04 mmHg, and when compared with first injection statistically significant differences were not found (p> 0.05).After third injection İOP was 14:27 ± 2.72 mmHg and when compared second injection the IOP was statistically significant difference was found (p <0.05). There were no serious complication after injections. Conclusion: Intravitreal bevacizumab injection in the treatment of DME due to DRP increased visual acuity and decreased foveal thickness was seen. Even if repeated injections will be needed.
