Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
An Evaluation of the Efficacy of Intravitreal Dexamethasone Implant in Treatment-Naive and Treatment-Resistant Diabetic Macular Edema Patients: A Retrospective Research
İntravitreal Deksametazon İmplant Etkinliğinin Naif ve Tedaviye Dirençli Diyabetik Makular Ödem Hastalarında Değerlendirilmesi: Bir Retrospektif Çalışma
Dilek UZLUa, Nurcan GÜRSOYa, Hidayet ERDÖLa, Nurettin AKYOLa, Mehmet KOLAa, Murat GÜNAYa
aDepartment of Ophthalmology, Karadeniz Technical University Faculty of Medicine, Trabzon, TURKIYE
Turkiye Klinikleri J Ophthalmol. 2022;31(1):26-33
doi: 10.5336/ophthal.2021-84524
Article Language: EN
Full Text
ABSTRACT
 Objective: To evaluate the effectiveness of single-dose intravitreal dexamethasone implant in treatment-resistant and -naive diabetic macular edema patients. Material and Methods: Twenty-five eyes of 18 diabetic patients receiving intravitreal dexamethasone between January 2017 and March 2020 were included in the study. Changes in best corrected visual acuity (BCVA), intraocular pressure, and retinal and choroidal thickness were determined before, and 1, 4, and 6 months after treatment. Results: Eleven of the 25 eyes had not previously received any anti-vascular endothelial growth factor injection, while the other 14 eyes had received a mean 9.28±6.83 anti-vascular endothelial growth factor injections. Initial BCVA was 0.81±0.46 logMAR, compared to 0.65±0.44 logMAR at 1 month, 0.66±0.45 logMAR at 4, and 0.78±0.44 logMAR at 6. While a significant difference was observed between initial and 1st month BCVA (p=0.005) a statistically significant difference was not observed between initial and 6th month BCVA values (p>0.05). Mean retinal thickness was 490.56±186.56 μm at baseline, 301.24±139.63 μm at 1 month, 304.84±129.97 μm at 4 month and 378.44±212.33 μm at 6 month. Retinal thickness decreased significantly at 1, 4, and 6 months compared to baseline (p<0.05). Initial mean subfoveal choroidal thickness was 300.32±32.78 μm, decreasing to 263.68±30.87 μm at 1 month, 258.44±31.5 μm at 4 month, and 268.20±40.10 μm at 6 month. The changes observed in choroidal thickness at 1, four and 6 months compared to baseline were statistically significant (p<0.05). A statistically significant difference in retinal thickness between patients with treatment resistant edema and patients with naive edema was only observed in the 1st month (p=0.001). Conclusion: Significant decreases in retinal and choroidal thickness were observed both in patients with diabetic macular edema refractory to anti-VEGF therapy and in treatment-naive diabetic macular edema patients administered dexamethasone, while visual acuity increased, particularly in the 1st and 4th months.

Keywords: Diabetic macular edema; intravitreal injection; dexamethasone implant; naive macular edema; refractory edema
ÖZET
 Amaç: Tedaviye dirençli ve naive diyabetik makular ödem hastalarında intravitreal tek doz deksametazon implant etkinliğini değerlendirmek. Gereç ve Yöntemler: Çalışmaya Ocak 2017-Mart 2020 tarihleri arasında intravitreal deksametazon uygulanan 18 diyabet hastasının 25 gözü dâhil edildi. Hastaların en iyi düzetilmiş görme keskinliği (EDGK), göz içi basınç ölçümü, retina ve koroidal kalınlık değişimleri tedavi öncesi ve tedavi sonrası 1, 4 ve 6. ayda değerlendirildi. Bulgular: Yirmi beş gözün 11'ine daha önce hiç antivasküler endotelyal büyüme faktörü enjeksiyonu yapılmamış olup, diğer 14 göze ortalama 9,28±6,83 antivasküler endotelyal büyüme faktörü enjeksiyonu yapılmıştı. EDGK başlangıçta 0,81±0,46 logMAR, 1. ayda ortalama 0,65±0,44 logMAR, 4. ayda ortalama 0,66±0,45 logMAR, 6. ayda ortalama 0,78±0,44 logMAR idi. Başlangıç ve 1. ayda EDGK açısından istatistiksel anlamlı farklılık izlenirken (p=0,005), başlangıç ve 6. Ay EDGK arasında istatistiksel anlamlı farklılık izlenmedi (p>0,05). Ortalama retinal kalınlık başlangıçta 490,56±186,56 μm, 1. Ayda 301,24±139,63 μm, 4. ayda 304,84±129,97 μm ve 6. ayda ise 378,44±212,33 μm idi. Retinal kalınlıkta başlangıç değerlerine göre diğer aylar arasında istatistiksel anlamlı azalma mevcuttu (p<0,05). Ortalama subfoveal koroidal kalınlık başlangıçta 300,32±32,78 μm, 1. ayda ortalama 263,68±30,87 μm, 4. ayda 258,44±31,5 μm ve 6. ayda ortalama 268,20±40,10 μm idi. Koroidal kalınlık değişimi açısından başlangıca göre 1, 4 ve 6. aydaki ölçümlerle anlamlı farklılık bulundu (p<0,05). Tedaviye dirençli ödemi olan hastalarla naif ödemi olan hastalar arasında sadece retinal kalınlık açısından tedavinin 1. ayında istatistiksel anlamlı farklılık izlendi (p=0,001). Sonuç: Çalışmamızda intravitreal deksametazon uygulanan hem anti-VEGF tedaviye direnç gösteren hem de naif diyabetik makular ödem hastalarında retinal kalınlık ve koroidal kalınlıkta anlamlı azalma gözlenirken, görme keskinliği özellikle 1 ve 4. aylarda artış göstermiştir.

Anahtar Kelimeler: Diyabetik makula ödemi; intravitreal enjeksiyon; deksametazon implant; naif makula ödemi; refrakter ödem
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