Tek doz intravitreal deksametazon implant ile tedavi edilen diyabetik maküla ödemi olan olgularda fonksiyonel ve anatomik sonuçların belirleyicileri
Başlık çevirisi mevcut değil.
- Tez No: 494428
- Danışmanlar: YRD. DOÇ. DR. MUHAMMED NURULLAH BULUT
- Tez Türü: Tıpta Uzmanlık
- Konular: Göz Hastalıkları, Eye Diseases
- Anahtar Kelimeler: Dexamethasone, Diabetic macular edema, Visual acuity, Optical coherence tomography, Predictive factor, Treatment outcomes
- Yıl: 2018
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi
- Ana Bilim Dalı: Göz Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 121
Özet
Amaç: Bu çalışmanın amacı DMÖ nedeniyle tek doz DEX uygulanmış hastaların 6 aylık takiplerinde anatomik ve fonksiyonel sonuçlarını incelemek ve bu kısa dönem sonuçları etkileyen belirleyicileri tespit etmektir. Gereç ve Yöntem: Bu retrospektif çalışmaya DMÖ nedeniyle tek doz DEX enjeksiyonu uygulanan ve en az 6 ay takibi bulunan 36 hastanın 42 gözü dahil edildi. DEİGK etkileyebilecek patolojisi olan, 6 ay içinde ek tedavi gören, 6 ay içinde cerrahi geçiren ve vitrektomize olan gözler çalışma dışında bırakıldı. Takip muayenelerinde başlangıç, 3. ay ve 6. ayda DEİGK, GİB ve SMK ölçümleri yapıldı. Hastaların yaş, cinsiyet, daha önce yapılmış olan intravitreal enjeksiyon ve LFK öyküsü, kan HbA1c, Hb, kreatinin ve total kolesterol düzeyi, enjeksiyon öncesinde ölçülen sistolik ve diyastolik kan basıncı, diyabetin süresi, diyabet için aldığı tedavi (oral, oral + insülin), PDR varlığı, lens durumu (fakik, psödofakik), maküler ödemin tipi (SRD, DRK, KMÖ), sert eksuda varlığı, ERM varlığı incelendi ve kaydedildi. Gözler, başlangıç – 3. ay (B-3) ve başlangıç – 6. ay (B-6) arasında DEİGK' de
Özet (Çeviri)
Aim: The purpose of this study was to investigate the anatomical and functional outcomes of 6 months follow up and determine the predictors affecting these short term outcomes of patients who received single dose DEX for DME. Materials and Methods: In this retrospective study, we enrolled 42 eyes of 36 patients who recieved single dose DEX for DME and who had minimum 6 months follow up. Eyes with pathology that could affect the BCVA, who received additional treatment within 6 months, underwent surgery within 6 months, and vitrectomized eyes were excluded from the study. In the follow up examinations, BCVA, IOP and CMT measurements were performed at baseline, 3rd and 6th months. Age, gender, history of intravitreal injections, history of LPC, blood HbA1c, Hb, creatinine, total cholesterol levels, pre-injection systolic and diastolic blood pressure, duration of diabetes, diabetes treatment (oral, oral + insulin), PDR presence, lens status ( phakic, pseudophakic), macular edema type (SRD, DRT, CME), presence of hard exudate and presence of ERM were recorded. Eyes were categorized into 8 groups at 3. months and 6. months based on change in BCVA baseline – 3. months (B3) and baseline – 6. months (B-6) < 5 letter gain (F1) or ≥ 5 letter gain (F2) and improvement in CMT < 50 micron (A1) and ≥ 50 micron (A2) (B-3F1, B-3F2, B-3A1, B-3A2, B-6F1, B-6F2, B-6A1, B-6A2). Parameters were evaluated by correlation analysis within the whole group and the groups were compared within themselves. Statistically significant and correlated parameters were evaluated as predictors. Results: There were 30 eyes (15 female, 15 male) in B-3F2 group and 12 eyes (3 female, 9 male) in B-3F1 group. The mean number of patients receiving insulin treatment, presence of LPC history, absence of intravitreal injection history, baseline mean BCVA (logMAR), baseline mean CMT and improvement in CMT at 3. month were significantly higher and mean CMT value at 3. month was significantly lower in B-3F2 group. There were 24 eyes (9 female, 15 male) in B-6F2 group and 18 eyes (9 female, 9 male) in B-6F1 group. Baseline BCVA (logMAR), B-3 letter gaining, B-6 CMT improvement, presence of pseudophakic status, presence of PDR were significantly higher and mean CMT value at 3. month was significantly lower in B-6F2 group. The type of macular edema was significantly different among the groups. There were 30 eyes (15 female, 15 male) in B-3A2 group and 12 eyes (3 female, 9 male) in B-3A1 group. The mean total cholesterol level, mean number of patients receiving insulin treatment, baseline mean BCVA (logMAR), B-3 letter gaining, baseline mean CMT and absence of intravitreal injection history were significantly higher and mean Hb level and CMT value at 3. month were significantly lower in B-3A2 group. The type of macular edema was significantly different among the groups. There were 24 eyes (12 female, 12 male) in B-6A2 group and 18 eyes (66 female, 12 male) in B-6A1 group. The mean HbA1c level, mean number of patients receiving insulin treatment, B-3 letter gaining, B-6 letter gaining, baseline mean CMT, improvement in CMT at 3. month and mean number of eyes who had hard exudates were significantly higher and diabetes duration was significantly lower in B-6A2 group. The type of macular edema was significantly different among the groups. Topical anti - glaucomatous treatment was initiated in 3 patients (7.14%) due to IOP elevation and IOP was controlled. None of the patients need filtration glaucoma surgery. During 6 months follow-up, 3 cases (6.66%) underwent surgery due to cataract development and these patients were excluded from the study. Conclusion: We evaluated the parameters that could affect both anatomical and functional outcome in a 6 month short-term period of previously treated or untreated DME patients and concluded that ≥ 5 letter gaining at 3. month and presence of SRD at baseline were predicted the better anatomical and functional results at 6. month.
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