Dirençli diyabetik makula ödemi tedavisinde kombine intravitreal triamsinolon – bevacizumab ile topikal nepafenak tedavisinin kısa dönem etkisi

Authors : Handan Hatun Bardak, Murat Günay, Yavuz Kamil Bardak, Mustafa Muhterem Ekim

Pages : 0-0

View : 17 | Download : 8

Publication Date : 2016-03-30

Article Type : Research Paper

Abstract :Amaç: Anti-VEGF tedaviye dirençli diyabetik makula ödemi insert ignore into journalissuearticles values(DMÖ);’nde kombine intravitreal bevacizumab insert ignore into journalissuearticles values(IVB);-triamsinolon asetonid insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(2 mg, 0.05 ml);-İVB insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(DGK); ve santral makula kalınlığı insert ignore into journalissuearticles values(SMK); tedavi öncesi, tedaviden 1 ay ve 3 ay sonra tekrarlandı. Bulgular: Hastaların 9 insert ignore into journalissuearticles values(% 56);`u kadın, 7 insert ignore into journalissuearticles values(% 44);`si erkek olup ortalama yaşı 62,75±5,73 yıl insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(p<0.05);. Kombine intravitreal enjeksiyon öncesi DGK 1.29±0.84 Log Mar olup kombine enjeksiyondan 1 ay sonraki DGK 0.93±0.74 Log Mar, 3 ay sonraki DGK ise 0.89±0.72 Log Mar olarak ölçüldü. Kombine enjeksiyon öncesine göre, enjeksiyondan 1 ay ve 3 ay sonraki DGK değerlerindeki değişiklik anlamlıydı insert ignore into journalissuearticles values(p<0.05);. Kombine enjeksiyondan 3 ay sonraki kontrolde 10 insert ignore into journalissuearticles values(% 62.5); hastaya tekrar intravitreal enjeksiyon gerekti. Sonuç: Anti VEGF tedaviye dirençli DMÖ`de kombine İVB-İVTA enjeksiyonu ile beraber topikal nepafenak uygulaması etkin ve güvenilir bir tedavi yöntemidir. Anahtar Kelimeler: Bevacizumab, diyabetik makula ödemi, nepafenak, triamsinolon asetonid. SHORT TERM EFFECT OF COMBINED INTRAVITREAL TRIAMCINOLONE-BEVACIZUMAB WITH TOPICAL NEPAFENAC TREATMENT IN REFRACTORY DIABETIC MACULAR EDEMA SUMMARY Purpose: To investigate the short term effect of combined intravitreal triamcinolone acetonide insert ignore into journalissuearticles values(IVTA); and bevacizumab insert ignore into journalissuearticles values(IVB); injection with topical nepafenac in diabetic macular edema insert ignore into journalissuearticles values(DME); refractory to anti-vascular endothelial growth factor. Material and Methods: 16 eyes of 16 patients with refractory DME were included the study. IVTA insert ignore into journalissuearticles values(2mg 0.05ml); and IVB insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(CVA); and central macular thickness insert ignore into journalissuearticles values(CMT); repeated before the injection, 1 month and 3 months after the injection. Results: Nine insert ignore into journalissuearticles values(56 %); patients were women and 7 insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(p<0.05); with respect to CMT before treatment. Before treatment CVA was 1.29±0.84 Log Mar and 1 month after combined injection CVA was 0.93±0.74 Log Mar and 3 months after CVA was 0.89±0.72 Log Mar. There was significant change in CVA 1 month and 3 months after injection insert ignore into journalissuearticles values(p<0.05); with respect to CVA before treatment. Three months after combined injection 10 insert ignore into journalissuearticles values(62.5 %); patients needed intravitreal injection. Conclusion: Combined IVTA-IVB injection together with topical nepafenac treatment is safe and effective procedure in DME refractory to anti-VEGF therapy. Key words: Bevacizumab, diabetic macular edema, nepafenac, triamcinolone acetonide
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