Effect of Intravitreal Ranibizumab Injection on Different Optical Coherence Tomographic Patterns of Diabetic Macular Edema

Yıl 2022, , 386 - 392, 30.09.2022

Muhammed Altınışık , Havvanur Bayraktar Arif Koytak

https://doi.org/10.34087/cbusbed.1090312

Öz

Objective: To compare the early therapeutic effect of intravitreal ranibizumab (IVR) injection in eyes with diabetic macular edema (DME) of different patterns determined by spectral-domain optical coherence tomography (SD-OCT).
Materials and Methods: Medical records of nonproliferatif diabetic retinopathy (NPDR) patients who had a single IVR injection for DME were analyzed retrospectively. Eyes with a clinically significant DME and a central foveal thickness (CFT) ≥ 250 µm determined by SD-OCT were included. Best-corrected visual acuity (BCVA), CFT and total macular volume (TMV) values before and after the injection were recorded. Eyes were divided into sponge-like diffuse retinal thickening (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) groups according to SD-OCT. Sub-analyzes were performed to exclude the effect of baseline CFT disparity.
Results: A total of 101 eyes (44 DRT, 40 CME and 17 SRD) were included in the study. While there was no difference between the baseline BCVA and TMV values (p>0.05), the CFT values were ranked as SRD, CME and DRK (p<0.001). There was no significant difference regarding the change in BCVA and TMV (p=0.32 and 0.35 respectively). Both SRD and CME groups showed greater reductions (37% vs 23%) in CFT than DRT group (13%) (p<0.001). This significance was also maintained when groups were randomized to be free of the bias associated baseline CFT values (p = 0.04).
Conclusion: In DME cases, the best anatomical response to IVR can be observed in SRD cases. The increase in BCVA in the early period is similar between the groups.

Anahtar Kelimeler

Diabetic macular edema, optical coherence tomography, ranibizumab, cystoid macular edema, serous retinal detachment

Diyabetik Makula Ödeminde İntravitreal Ranibizumab Enjeksiyonunun Farklı Optik Koherens Tomografi Morfolojileri Üzerindeki Etkisi

Öz

Giriş ve Amaç: Spektral-domain optik koherens tomografi (SD-OKT) ile belirlenen farklı paternlerdeki diyabetik maküla ödemi (DMÖ) olgularında intravitreal ranibizumab (İVR) enjeksiyonunun erken dönem etkinliğini karşılaştırmak.
Gereç ve Yöntemler: Tek doz İVR uygulanmış nonproliferatif diyabetik retinopatiye sekonder DMÖ olguları retrospektif olarak analiz edildi. Klinik anlamlı santral DMÖ’sü olan ve santral fovea kalınlığı (SFK)≥250 µm olan gözler çalışmaya dahil edildi. Olgular SD-OKT morfolojisine göre; süngerimsi diffüz retina kalınlaşması (DRK), kistoid maküla ödemi (KMÖ) ve seröz retina dekolmanı (SRD) gruplarına ayrıldı. Gruplar enjeksiyon öncesi ve enjeksiyon sonrası birinci ay kontrollerinde, en iyi düzeltilmiş görme keskinliği (EİDGK), SFK ve total maküla volümü (TMV) değişimi açısından karşılaştırıldı. SFK değişimi üzerindeki başlangıç SFK değerlerinin etkisini dışlamak için ANCOVA analizi ve gruplar arasında randomizasyon yapılarak alt analizler yapıldı.
Bulgular: Çalışmaya 101 olgu (44 DRK, 40 KMÖ ve 17 SRD) dahil edildi. Gruplar yaş ve cinsiyet dağılımı açısından benzerdi (p>0,05). Başlangıç EİDGK ve TMV değerleri arasında anlamlı fark yok iken (p>0,05), başlangıç SFK değerleri büyükten küçüğe doğru sırası ile SRD, KMÖ ve DRK şeklinde sıralandı (p<0.001). Enjeksiyon sonrası EİDGK ve TMV, gruplar arasında benzer oranda değişim gösterdi (p=0.32 ve 0.35 sırası ile). SFK açısından ise, iyiden kötüye doğru sırası ile SRD (%37), KMÖ (%23) ve DRK (%13) şeklinde bir azalma tespit edildi (p<0.001). Gruplar, başlangıç SFK etkisinden arındırılmak için randomize edildiğinde de bu anlamlılık korundu (p=0,04).
Sonuç: DMÖ olgularında, İVR’ye en iyi anatomik cevap SRD olgularında gözlenebilir. Erken dönemde EİDGK'deki artış, gruplar arasında benzerdir. SRD ve iyi anatomik cevabın analiz edilmesi ve fonksiyonel sonuçları açısından uzun takipli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Diyabetik maküla ödemi, optik koherens tomografi, ranibizumab, kistoid maküla ödemi, seröz retina dekolmanı

Kaynakça

• Daruich, A, Matet, A, Moulin, A, et al., Mechanisms of macular edema: Beyond the surface, Progress in Retinal and Eye Research, 2018, 63, 20–68.
• Kadayıfçılar, S, Diabetik Makula Ödeminde Kanıta Dayalı Tedavi Yöntemleri, Retina-Vitreus, 2019, 28, 1–6.
• Yaşar, İ, Uçak, T, Azizi, S, et al., Diyabetik Maküla Ödeminde İntravitreal Ranibizumab Tedavisinin Klinik Sonuçları, MN Oftalmology, 2016, 23, 168–173.
• Hu, Y, Wu, Q, Liu, B, et al., Comparison of clinical outcomes of different components of diabetic macular edema on optical coherence tomography, Graefe's archive for clinical and experimental ophthalmology, 2019, 257, 2613–2621.
• Chen, N.N, Chen, W.D, Lai, C.H, et al., Optical coherence tomographic patterns as predictors of structural outcome after intravitreal ranibizumab in diabetic macula edema, Clinical Ophthalmology, 2020, 14, 4023–4030.
• Arvas, S, Çebi, A, Diyabetik Retinopati ve Diyabetik Makula Ödeminde Klinik Tanı ve Yeni Sınıflandırmalar, Güncel Retina, 2018, 2, 119–123.
• Otani, T, Kishi, S, Maruyama, Y, Patterns of diabetic macular edema with optical coherence tomography, American Journal of Ophthalmology, 1999, 127, 688–693.
• Shimura, M, Yasuda, K, Yasuda, M, et al., Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema, Retina, 2013, 33, 740–747.
• Arf, S, Sayman Muslubas, I, Hocaoglu, M, et al., Spectral domain optical coherence tomography classification of diabetic macular edema: a new proposal to clinical practice, Graefe's archive for clinical and experimental ophthalmology, 2020, 258, 1165–1172.
• Parodi Battaglia, M, Iacono, P, Cascavilla, M, et al., A pathogenetic classification of diabetic macular edema, Ophthalmic Research, 2018, 60, 23–28.
• Kang, S.W, Park, C.Y, Ham, D Il, The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema, American Journal of Ophthalmology, 2004, 137, 313–322.
• Bandyopadhyay, S, Bandyopadhyay, S.K, Saha, M, et al., Study of aqueous cytokines in patients with different patterns of diabetic macular edema based on optical coherence tomography, International Ophthalmology, 2018, 38, 241–249.
• Yamamoto, S, Yamamoto, T, Hayashi, M, et al., Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms, Graefe's archive for clinical and experimental ophthalmology, 2001, 239, 96–101.
• Yassin, S.A, Aljohani, S.M, Alromaih, A.Z, et al. Optical coherence tomography patterns of diabetic macular edema in a Saudi population, Clinical Ophthalmology, 2019, 13, 707–714.
• Acan, D, Karahan, E, Kocak, N, et al., Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema, International Journal of Ophthalmology, 2018, 11, 1204–1209.
• Kim, B.Y, Smith, S.D, Kaiser, P.K, Optical Coherence Tomographic Patterns of Diabetic Macular Edema, American Journal of Ophthalmology, 2006, 142, 405–412.
• Kim, M, Lee, P, Kim, Y, et al., Effect of intravitreal bevacizumab based on optical coherence tomography patterns of diabetic macular edema, Ophthalmologica, 2011, 226, 138–144.
• Wu, P.C, Lai, C.H, Chen, C.L, et al., Optical coherence tomographic patterns in diabetic macula edema can predict the effects of intravitreal bevacizumab injection as primary treatment, Journal of ocular pharmacology and therapeutics, 2012, 28, 59–64.
• Koytak, A, Altinisik, M, Sogutlu Sari, E, et al., Effect of a single intravitreal bevacizumab injection on different optical coherence tomographic patterns of diabetic macular oedema, Eye, 2013, 27, 716–721.
• Seo, K.H, Yu, S.Y, Kim, M, et al., Visual and morphologic outcomes of intravitreal ranibizumab for diabetic macular edema based on optical coherence tomography patterns, Retina, 2016, 36, 588–595.
• Kaya, M, Karahan, E, Ozturk, T, et al., Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema with Serous Retinal Detachment, Korean Journal of Ophthalmology, 2018, 32, 296.
• Bressler, S.B, Odia, I, Maguire, M.G, et al., Factors Associated with Visual Acuity and Central Subfield Thickness Changes When Treating Diabetic Macular Edema with Anti-Vascular Endothelial Growth Factor Therapy: An Exploratory Analysis of the Protocol T Randomized Clinical Trial, JAMA Ophthalmology, 2019, 137, 382–389.
• Giocanti-Aurégan, A, Hrarat, L, Qu, L.M, et al., Functional and anatomical outcomes in patients with serous retinal detachment in diabetic macular edema treated with ranibizumab, Investigative Ophthalmology & Visual Science, 2017, 58, 797–800.
• Sophie, R, Lu, N, Campochiaro, P.A, Predictors of Functional and Anatomic Outcomes in Patients with Diabetic Macular Edema Treated with Ranibizumab, Ophthalmology, 2015, 122, 1395–1401.
• Roh, M.I, Kim, J.H, Kwon, O.W, Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema, Ophthalmologica, 2010, 224, 374–380.