FOTOKOAGÜLASYONA YANIT VERMEYEN D‹YABET‹K D‹FFÜZ MAKÜLA ÖDEM‹NDE ‹NTRAV‹TREAL TR‹AMS‹NOLON ASETON‹D‹N ANATOM‹K VE GÖRSEL PROGNOZA ETK‹S‹ THE EFFECT OF INTRAVITREALLY ADMINISTERED TRIAMCINOLONE ACETONIDE ON ANATOMIC AND VISUAL PROGNOSIS IN DIFFUSE DIABETIC MACULAR EDEMA RESISTANT TO PHOTOCOAGULATION

Lütfi K›rdar, Kartal E¤itim, Araflt›rma Hastanesi, Göz Klini¤i
unpublished
Bu çal›flmada fotokoagülasyona dirençli diyabetik diffüz maküla ödeminde intravitreal kristalize kortizonun (triamsi-nolon asetonid) anatomik ve görsel prognoza etkisini araflt›rmak a m a ç l a n d ›. Yafllar› 52 ile 75 aras›nda de¤iflen diya-betli 30 hastan›n diffüz maküla ödemli 39 gözüne intravitreal 4 mg/0.1 ml triamsinolon asetonid enjekte edildi. Olgular›n tümüne daha önce lazer fotokoagülasyonu uygulanm›flt›. Olgular fundus fluoresein anjiyografisi (FFA) ve görme keskinli¤i yönünden 1.,
more » ... nli¤i yönünden 1., 3. ve 6. aylarda de¤erlendirildi. G ö z l e r i n 1., 3. ve 6. aylarda yap›lan düzeltilmifl görme keskinli¤i ölçümleri s›ras›yla ortalama 0.35±0.16; 0.38±0.18 ve 0.32±0.16 olarak bulundu. Düzeltilmifl görme keskin-liklerinde 1. ayda ortalama 0.13±0.12; 3. ayda ortalama 0.17±0.12 ve 6. ayda ortalama 0.11 ± 0. 11'lük art›fl izlendi. Birinci ayda 25 gözde (%64.1) FFA'da düzelme izlenirken, 14 gözde (%35.9) FFA'da iyileflme gözlenmedi. Te d a v i öncesi ortalama 15.38±2.40 mmHg olan göz içi bas›nçlar›nda 1. ayda %24.2, 3. ayda %14.1 ve 6. ayda %12.2'lik art›fl saptand›. Göz içi bas›nc› 12 olguda 21 mmHg'n›n üzerine ç›kt› ve bu gözlerde göz içi bas›nc› topikal monoterapi ile kontrol alt›na al›nd›. Lazer fotokoagülasyona cevap vermeyen diyabetik diffüz maküla ödeminde, intravitreal triamsi-nolon asetonidin geçici bir süre için de olsa, gerek anatomik, gerekse görsel düzelme sa¤layan, tecrübeli hekimler için uygulamas› kolay, maliyeti düflük ve komplikasyonlar› kabul edilebilir düzeyde bir tedavi yöntemi oldu¤u gözlendi. Anahtar Sözcükler: ‹ntravitreal triamsinolon; intravitreal kortikosteroid; d i ffüz maküla ödemi; diyabetik maküla ödemi. To assess the effect of intravitreally administered triamcinolone acetonide on anatomic and visual prognosis in diffuse diabetic macular edema resistant to photocoagulation was aimed in this study. 4 mg/0.1 ml triamcinolone ace-tonide was injected intravitreally to thirty-nine eyes of thirty diabetic patients aged between 52 and 75. All eyes had a previous history of at least one session of laser photocoagulation. The fundus fluorescein angiographic and visual results of all cases were recorded in the first, third and sixth months after the injection. The best corrected visual acuities of the eyes were measured 0.35±0.16, 0.38±0.18 and 0.32±0.16 in first, third and sixth months respectively. The mean improvement of the best corrected visual acuities were found to be 0.13±0.12 in the first month, 0.17±0.12 in the third, and 0.11±0.11 in the sixth month. Twenty-five eyes (64.1%) showed marked improvement in fundus fluorescein angiographic findings while fourteen eyes (35.9%) showed no improvement. The mean intraocu-lar pressure which was 15.38±2.40 mmHg before the treatment, was found to be increased 24.2% in the first month, 14.1% in the third and 12.2% in the sixth month after the treatment. Intraocular pressure was measured above 21 mmHg in 12 cases, all who responded well to topical monotherapy. Intravitreally administered triamcinolone ace-tonide was found to be an easy and low-cost agent with an acceptable rate of complications, which temporarily yields anatomic and visual improvements in diffuse diabetic macular edema cases resistant to photocoagulation.
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