Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Diyabetik Makuler Ödem Tedavisinde İntravitreal Aflibercept ve Ranibizumab Enjeksiyonunun Kornea Endoteline ve Ön Kamaraya Etkisi
The Effect of Intravitreal Injection of Aflibercept and Ranibizumab on Cornea Endothelium and Anterior Chamber in Patients with Diabetic Macular Edema
Veysel CANKURTARANa, Serdar ÖZATEŞb
aHatay Mustafa Kemal Üniversitesi Tayfur Ata Sökmen Tıp Fakültesi, Göz Hastalıkları ABD, Hatay, TÜRKİYE
bKars Harakani Devlet Hastanesi, Göz Hastalıkları Kliniği, Kars, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2020;29(1):1-6
doi: 10.5336/ophthal.2019-64910
Article Language: TR
Full Text
ÖZET
 Amaç: İntravitreal ranibizumab ve aflibercept enjeksiyonu yapılan gözlerdeki kornea endotel sayısı ve morfolojisinin ve ön kamara anatomisinin incelenmesidir. Gereç ve Yöntemler: Bu prospektif ve kesitsel çalışmaya, diyabetik makuler ödem nedeni ile tedavi edilen 51 hastanın 102 gözü dâhil edildi. Hastaların tek gözüne 1 ay ara ile üç doz intravitreal ranibizumab ya da aflibercept enjeksiyonu uygulandı. Ranibizumab enjeksiyonu yapılan hastalar ranibizumab grubuna (n=26), aflibercept enjeksiyonu yapılan hastalar aflibercept grubuna (n=25) dâhil edildi. Her iki grupta da hastaların tedavi edilmeyen gözleri kontrol grubu olarak alındı. Hastaların endotel hücre sayısı (EHS), hücre alanı değişim katsayısı (CV), altıgen şekilli hücre (HKZ) yüzdesi, merkezi kornea kalınlığı (MKK), ön kamara derinliği (ÖKD), ön kamara hacmi (ÖKH), iridokorneal açı (İKA) ve horizontal ön kamara çapı (HÖKÇ) değerlendirmeleri yapıldı. Bulgular: Aflibercept ve ranibizumab grubunda hem tedavi edilen gözlerde hem de kontrol gözlerde tedavi öncesi ve sonrasında ortalama korneal endotel hücre sayısı, CV ve HKZ yüzdesi bakımından istatistiksel olarak anlamlı fark yoktu. Her iki gruptaki ortalama MKK değeri hem tedavi edilen gözlerde hem de kontrol gözlerde tedavi öncesinde tedavi sonrasına göre anlamlı olarak daha fazla idi (p<0,05). Her iki grupta, tedavi edilen ve kontrol gözlerde ortalama ÖKD, ÖKH, İKA ve HÖKÇ değerleri arasında tedavi öncesi ve sonrası anlamlı bir fark izlenmedi. Sonuç: Çalışmamız, intravitreal aflibercept ve ranibizumab enjeksiyonunun kornea endotelinde ve ön kamara yapısında herhangi bir değişikliğe sebep olmadığını göstermiştir.

Anahtar Kelimeler: Aflibercept; ranibizumab; makular ödem; kornea; endotel
ABSTRACT
 Objective: To assess the effect of intravitreal injection of aflibercept and ranibizumab on cornea endothelium and anterior chamber structure in patients with diabetic macular edema. Material and Methods: One hundred and two eyes of the 51 patients with diabetic macular edema were included in this prospective and cross-sectional clinical study. Intravitreal aflibercept or ranibizumab injection was administered for three times with one-month intervals to only one eye of the patients. Patients formed ranibizumab group (n=26) and aflibercept group (n=25) according to administered drug. Contralateral eyes, which were not treated, in both groups formed the control group. Main outcomes were endothelial cell density (ECD), coefficient of variation of cell area (CV), percentage of hexagonal cells (HEX), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), horizontal anterior chamber diameter (HACD). Results: Mean ECD, CV and HEX before and after treatment were similar in treated and untreated eyes in aflibercept and ranibizumab groups. Mean CCT value before treatment were higher in both treated and untreated eyes than mean CCT value after treatment in both groups (p<0.05). Mean ACD, ACV, ICA and HACD were similar before and after treatment in treated and untreated eyes in both groups. Conclusion: Present study showed that intravitreal injection of aflibercept and ranibizumab did not affect corneal endothelium and anterior chamber morphology.

Keywords: Aflibercept; ranibizumab; macular edema; cornea; endothelium
REFERENCES:
  1. Shweiki D, Itin A, Soffer D, Keshet E. Vascular endothelial growth factor induced by hypoxia may mediate hypoxia-initiated angiogenesis. Nature. 1992;359(6398):843-5. [Crossref]  [PubMed] 
  2. Eichler W, Yafai Y, Wiedemann P, Fengler D. Antineovascular agents in the treatment of eye diseases. Curr Pharm Des. 2006;12(21):2645-60. [Crossref]  [PubMed] 
  3. Falavarjani KG, Nguyen QD. Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature. Eye (Lond). 2013;27(7):787-94. [Crossref]  [PubMed]  [PMC] 
  4. Ambati BK, Nozaki M, Singh N, Takeda A, Jani PD, Suthar T, et al. Corneal avascularity is due to soluble VEGF receptor-1. Nature. 2006;443(7114):993-7. [Crossref]  [PubMed]  [PMC] 
  5. Gan L, Fagerholm P, Palmblad J. Vascular endothelial growth factor (VEGF) and its receptor VEGFR‐2 in the regulation of corneal neovascularization and wound healing. Acta Ophthalmol Scand. 2004;82(5):557-63. [Crossref]  [PubMed] 
  6. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991;98(5 Suppl):786-806. [Crossref] 
  7. Philipp W, Speicher L, Humpel C. Expression of vascular endothelial growth factor and its receptors in inflamed and vascularized human corneas. Invest Ophthalmol Vis Sci. 2000; 41(9):2514-22.
  8. Carneiro Â, Falcão M, Pirraco A, Milheiro-Oliveira P, Falcão-Reis F, Soares R. Comparative effects of bevacizumab, ranibizumab and pegaptanib at intravitreal dose range on endothelial cells. Exp Eye Res. 2009;88(3):522-7. [Crossref]  [PubMed] 
  9. Ari S, Nergiz Y, Aksit I, Sahin A, Cingu K, Caca I. Evaluation of intracameral injection of ranibizumab and bevacizumab on the corneal endothelium by scanning electron microscopy. J Ocul Pharmacol Ther. 2015;31(2):100-5. [Crossref]  [PubMed] 
  10. Lass JH, Benetz BA, Menegay HJ, Tsipis CP, Cook JC, Boyer DS, et al. Effects of repeated intravitreal aflibercept injection on the corneal endothelium in patients with age-related macular degeneration: outcomes from the RE-VIEW Study. Cornea. 2018;37(5):596-601. [Crossref]  [PubMed] 
  11. Pérez-Rico C, Benítez-Herreros J, Castro-Rebollo M, Gómez-Sangil Y, Germain F, Montes-Mollón MÁ, et al. Effect of intravitreal ranibizumab on corneal endothelium in age-related macular degeneration. Cornea. 2010;29(8):849-52. [Crossref]  [PubMed] 
  12. Guzel H, Bakbak B, Koylu MT, Gonul S, Ozturk B, Gedik S. The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema. Cutan Ocul Toxicol. 2017;36(1):5-8. [Crossref]  [PubMed] 
  13. Chang JH, Garg NK, Lunde E, Han KY, Jain S, Azar DT. Corneal neovascularization: an anti-VEGF therapy review. Surv Ophthalmol. 2012;57(5):415-29. [Crossref]  [PubMed]  [PMC] 
  14. Stevenson W, Cheng SF, Dastjerdi MH, Ferrari G, Dana R. Corneal neovascularization and the utility of topical VEGF inhibition: ranibizumab (Lucentis) vs bevacizumab (Avastin). Ocul Surf. 2012;10(2):67-83. [Crossref]  [PubMed]  [PMC] 
  15. Su DH, Wong TY, Wong WL, Saw SM, Tan DT, Shen SY, et al. Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology. 2008;115(6):964-8.e1. [Crossref]  [PubMed] 
  16. McNamara NA, Brand RJ, Polse KA, Bourne WM. Corneal function during normal and high serum glucose levels in diabetes. Invest Ophthalmol Vis Sci. 1998;39(1):3-17.
  17. Wen JC, Cousins SW, Schuman SG, Allingham RR. Dynamic changes of the anterior chamber angle produced by intravitreal anti-vascular growth factor injections. Retina. 2016;36(10):1874-81. [Crossref]  [PubMed] 
  18. Alkin Z, Perente I, Altan C, Konstantinidis A, Ozkaya A, Yuksel K, et al. Changes in anterior segment morphology after intravitreal injection of bevacizumab and bevacizumab-triamcinolone acetate combination. Eur J Ophthalmol. 2013;23(4):504-9. [Crossref]  [PubMed] 

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