Diyabetik makuler ödem hastalarında katarakt cerrahisi sonrası makulopatinin değerlendirilmesi
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: İntravitreal deksametazon implant veya anti-VEGF ile tedavi edilen diyabetik makuler ödem hastalarında komplikasyonsuz katarakt cerrahisi sonrası diyabetik makulopatideki değişimlerin değerlendirilmesi. GEREÇ VE YÖNTEM: Ege Üniversitesi Tıp Fakültesi Hastanesi Göz Hastalıkları Anabilim Dalı Retina biriminde, Ocak 2017 ile Haziran 2020 tarihleri arasında diyabetik makuler ödem nedeniyle takip edilen hastaların verileri retrospektif olarak tarandı. İntervitreal anti-VEGF veya intervitreal deksametazon implant tedavisi yapılan ve takiplerinde katarakt geliştiği için komplikasyonsuz katarakt cerrahisi yapılan 51 hastanın 66 gözü çalışmaya dahil edildi. Hastaların yaş, cinsiyet, diyabetes mellitus süreleri ile preoperatif, postoperatif 1. hafta, 1. ay, 3.ay kontrollerindeki en iyi düzeltilmiş görme keskinliği, göz içi basıncı, ve optik koherans tomografiyle (OKT) elde elden santral makuler kalınlık (SMK) değerleri kaydedildi. BULGULAR: İntravitreal deksametazon implant yapılmış olan gözler (grup 1) ve intravitreal anti-VEGF(aflibercept veya ranibizumab) enjeksiyonu yapılmış olan gözler(grup 2) şeklinde 2 grup oluşturuldu. Daha sonra grup 1’deki gözler intravitreal deksametazon implantasyonu sonrası 90 gün içerisinde katarakt cerrahisi yapılmış olanlar(grup 1a) ve 90 günden uzun süre sonra katarak cerrahisi yapılmış olanlar (grup 1b) şeklinde ikiye ayrıldı ve sonuçta 3 grup oluşturuldu. Grup 1a’da 28 göz (n=26), grup 1b’de 15 göz(n=13) ve grup 2’de 23 göz (n=20) yer aldı. Grup 1’deki hastaların yaş ortalaması 64,09 ± 4,85 yıl, grup 2’deki hastaların yaş ortalaması ise 65,21 ± 6,27 yıl idi. Gruplar arasında yaş, cinsiyet, diyabetes mellitus süreleri, göz içi basınçları ve en iyi düzeltilmiş görme keskinlikleri açısından anlamlı fark yoktu (p değerleri > 0,05). Grup 1a’da preoperatif ortalama SMK 439,14 ± 153,88 µ, postoperatif 1.ay kontrolde ortalama SMK 434,39 ± 142,95 µ, 3. Ay kontrolde ortalama SMK 569,03 ±170,23µ, grup 1b’de sırasıyla ortalama SMK değerleri 362,20 ± 138,59 µ, 459,00 ± 202,23 µ, 408,73 ± 179,84 µ ve grup 2’de ise sırasıyla 360,21 ± 141,47 µ, 443,56 ± 186,25 µ, 421,86 ± 165,31 µ olarak ölçüldü. Gruplar arasında preoperatif ve postoperatif 1. Ay SMK açısından anlamlı fark yokken ( sırasıyla p=0,109 ve 0,906) postoperatif 3. Ay SMK açısından gruplar arasında istatistiksel anlamlı fark bulundu (p=0,003). Preoperatif SMK ile postoperatif 1. Ay ve 3.ay SMK arasında pozitif korelasyon saptandı (sırasıyla p=0,000, r=0,618 ve p=0,000 ,r=0,553). Postoperatif 1.ay SMK değerleri ile postoperatif 3.ay SMK değerleri arasında da pozitif korelasyon olduğu görüldü (p=0,000 ,r=0,438). SONUÇ: Bu çalışmada elde edilen sonuçlara göre intravitreal enjeksiyonlarla diyabetik makuler ödem tedavisi görmekte olan hastaların katarakt cerrahisi öncesi makula ödemlerinin olmaması veya makuladaki uzun süreli stabilite postoperatif dönemde daha iyi durumda bir makula elde edilmesini sağlayabilir.
PURPOSE: Evaluation of changes in diabetic maculopathy after uncomplicated cataract surgery in diabetic macular edema patients treated with intravitreal dexamethasone implant or anti_VEGF. MATERİAL AND METHODS: The data of patients who were followed up for diabetic macular edema between January 2017 and June 2020 at Ege University Faculty of Medicine Hospital Department of Ophthalmology Retina Unit were retrospectively reviewed. Sixty-six eyes of 51 patients who underwent intravireal anti-VEGF or itravirteal dexamethasone implant treatment and underwent cataract surgery without complications due to cataract development in their follow-up were included in the study. The ages, gender, duration of diabetes mellitus, preoperative, postoperative 1st week, 1st month, 3rd month controls best corrected visual acuity, intraoculer pressure, central macular thickness (CMT) obtained by optical coherence tomography (OCT) values of the patients were recorded. RESULTS: Two groups were formed as eyes with intravitreal dexamethasone implantation (group 1) and eyes with intravitreal anti-VEGF (aflibercept or ranibizumab) injection (group 2). Later, eyes in group 1 were divided into two groups: those who underwent cataract surgery within 90 days after intravitreal dexamethasone implantation (group 1a) and those who underwent cataract surgery after 90 days (group 1b), resulting in 3 groups. There were 28 eyes (n=26) in group 1a, 15 eyes (n=13) in group 1b , and 23 eyes (n=20) in group 2. The average age of the patients in group 1 was 64.09± 4.85 years, and the average age of the patients in group 2 was 65.21 ± 6.27 years. There was no significant difference between the groups in terms of age, gender, duration of diabetes mellitus, intraoculer pressures and best corrected visual acuity ( p values˃ 0.05). In group 1a , the preoperative mean CMT was 439.14 ± 153.88 µ, the postoperative first month control was 434.39 ± 142.95 µ, the mean CMT at the 3rd month control was 569.03 ± 170.23 µ , mean CMT values were 362.20 ± 138.59 µ, 459.00 ± 202.23 µ, 408.73 ± 179.84µ in group 2 and 360.21 ± 141.47 µ, 443.56, respectively. It was measured as ± 186.25 µ, 421.86 ± 165.31 µ. While there was no significant difference between the groups in terms of preoperative and postoperative 1st month CMT( p=0.109 and 0.906, respectively), a statistically significant difference was found between the groups in terms of postoperative 3rd month CMT (p=0.003). There was a positive correlation between preoperative and postoperatve 1st and 3rd month CMT (p=0.000, r=0.618 and p=0.000, r=0.553, respectively.) There was also a positive correlation between postoperative 1st month and postoperative 3rd month CMT values (p=0.000, r,0.438). CONCLUSİON: The result of this study showed that if the patients under diabetic macular edema treatment with intravitreal injections have no macular edema or in case of long term macular stability, cataract surgery may provide a better macula postoperatively.
PURPOSE: Evaluation of changes in diabetic maculopathy after uncomplicated cataract surgery in diabetic macular edema patients treated with intravitreal dexamethasone implant or anti_VEGF. MATERİAL AND METHODS: The data of patients who were followed up for diabetic macular edema between January 2017 and June 2020 at Ege University Faculty of Medicine Hospital Department of Ophthalmology Retina Unit were retrospectively reviewed. Sixty-six eyes of 51 patients who underwent intravireal anti-VEGF or itravirteal dexamethasone implant treatment and underwent cataract surgery without complications due to cataract development in their follow-up were included in the study. The ages, gender, duration of diabetes mellitus, preoperative, postoperative 1st week, 1st month, 3rd month controls best corrected visual acuity, intraoculer pressure, central macular thickness (CMT) obtained by optical coherence tomography (OCT) values of the patients were recorded. RESULTS: Two groups were formed as eyes with intravitreal dexamethasone implantation (group 1) and eyes with intravitreal anti-VEGF (aflibercept or ranibizumab) injection (group 2). Later, eyes in group 1 were divided into two groups: those who underwent cataract surgery within 90 days after intravitreal dexamethasone implantation (group 1a) and those who underwent cataract surgery after 90 days (group 1b), resulting in 3 groups. There were 28 eyes (n=26) in group 1a, 15 eyes (n=13) in group 1b , and 23 eyes (n=20) in group 2. The average age of the patients in group 1 was 64.09± 4.85 years, and the average age of the patients in group 2 was 65.21 ± 6.27 years. There was no significant difference between the groups in terms of age, gender, duration of diabetes mellitus, intraoculer pressures and best corrected visual acuity ( p values˃ 0.05). In group 1a , the preoperative mean CMT was 439.14 ± 153.88 µ, the postoperative first month control was 434.39 ± 142.95 µ, the mean CMT at the 3rd month control was 569.03 ± 170.23 µ , mean CMT values were 362.20 ± 138.59 µ, 459.00 ± 202.23 µ, 408.73 ± 179.84µ in group 2 and 360.21 ± 141.47 µ, 443.56, respectively. It was measured as ± 186.25 µ, 421.86 ± 165.31 µ. While there was no significant difference between the groups in terms of preoperative and postoperative 1st month CMT( p=0.109 and 0.906, respectively), a statistically significant difference was found between the groups in terms of postoperative 3rd month CMT (p=0.003). There was a positive correlation between preoperative and postoperatve 1st and 3rd month CMT (p=0.000, r=0.618 and p=0.000, r=0.553, respectively.) There was also a positive correlation between postoperative 1st month and postoperative 3rd month CMT values (p=0.000, r,0.438). CONCLUSİON: The result of this study showed that if the patients under diabetic macular edema treatment with intravitreal injections have no macular edema or in case of long term macular stability, cataract surgery may provide a better macula postoperatively.
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