Effect of grid laser photocoagulation, intravitreal triamcinolone acetonide and ıntravitreal bevacizumab on visual acuity in retinal vein occlusion

Retinal ven tıkanıklığında grid lazer fotokoagülasyon, intravitreal triamsinolon asetonid ve intravitreal bevacizumab'ın görme keskinliği üzerine etkisi

Abstract

Objective: To assess the efficacy of grid laser photocoagulation, intravitreal triamcinolone acetonide injection and intravitreal bevacizumab injection in patients with central retinal vein occlusion or branch retinal vein occlusion. Methods: In a retrospective assessment, 78 eyes of 78 patients (in May 2008-May 2010) with central retinal vein occlusion or retinal vein occlusion were reviewed according to initial and final best-corrected visual acuity. Retinal vein occlusion was diagnosed with fundus examination and fundus fluores- cein angiography. Cases who have additional ocular pathologies and neovascularization were excluded from the study. Grid laser photocoagulation was performed in 50 eyes, 4 mg intravitreal triamcinolone acetonide injection was performed in 8 eyes and 1.25 intravitreal bevacizumab injection was performed in 20 eyes. The best visual acuity was assessed before and after treatment. Best corrected visual acuity values obtained with Snellen were translated into logMAR units. At least one logMAR unit improvement in the visual acuity was considered a success. Results: Thirty three patients (40%) were male and 47 (60%) were female. The average age of the patients was 61 years (44-78 years). Sixty five patients had branch retinal vein occlusion, 13 had central retinal vein occlusion. Fifty five patients (71%) had perfused type and 23 patients (29%) had ischemic- type vein occlusion. Thirty four (44%) patients had hypertension, 26 (33%) patients had diabetes mellitus. The average observational period was 10.5 months (1-24 months). Initial visual acuity was 1.12 LogMAR in the CRVO group, while it was 1.08 LogMAR in the BRVO group. Mean final best-cor- rected visual acuity was 0.58 LogMAR in the CRVO group, 0.52 LogMAR in the BRVO group. There is a statistically significant increase in visual acuities in all three groups (p=0.0). For CRVO group, average visual acuity increase was 0.54 LogMAR with grid laser photocoagulation, 0.56 LogMAR with triamcinolone acetonide and 0.57 LogMAR with bevacizumab. For BRVO group, it was 0.52 LogMAR with grid laser photocoagulation, 0.58 LogMAR with triamcinolone acetonide and 0.63 LogMAR with bevacizumab. There was a statistically significant difference between grid laser photocoagulation group and bevacizumab group (p=0.0). There was no significant difference between the other treatments and intravitreal triamcinolone acetonide injection. There was no increase in intraocular pressure which can not be controlled with medical treatment. No major local or systemic complications were observed in the early period, depending on the applications. Conclusion: In the treatment of retinal vein occlusion, grid laser photocoagulation, intravitreal triamcinolone acetonide and intravitreal bevacizumab injections are effective. Intravitreal bevacizumab injection induced more increase in visual acuity than grid laser photocoagulation. There was no sta- tistically significant difference between intravitreal bevacizumab injection and intravitreal triamcinolone injection. Intravitreal bevacizumab therapy is an effective treatment method of retinal vein occlusion in the early period.

Özet

Amaç: Retinal ven tıkanıklıklığında, grid lazer fotokoagülasyon, intravitreal triamsinolon asetonid ve intravitreal bevacizumab enjeksiyonunun etkinli- ğinin araştırılması. Yöntemler: Kliniğimizde Mayıs 2008 ile Mayıs 2010 tarihleri arasında retinal ven tıkanıklığı olan 78 hastanın 78 gözü geriye dönük değerlendirildi. Retinal ven tıkanıklığı tanısı fundus muayenesi ile ve FFA çekilerek kondu. Elli göze grid lazer fotokoagülasyon, 8 göze 4 mg intravitreal triamsinolon asetonid, 20 göze 1.25 mg intravitreal bevacizumab uygulandı. Tedavi öncesi ve sonrası görme keskinliği değerlendirildi. Bulgular: Hastaların 31i (%40) erkek, 47si (%.60) kadındı. Yaş ortalaması 61di (44-78). Onüç gözde santral retinal ven tıkanıklığı (SRVT), 65 gözde retinal ven dal tıkanıklığı (VDT) mevcuttu. Otuzdört (%44) hastada hipertansiyon, 26 (%33) hastada diabetes mellitus saptandı. Ortalama takip süresi 10.5 aydı (1-24 ay). Başlangıç en iyi görme keskinliği SRVT grubunda ortalama 1.12 LogMAR iken, VDT grubunda ortalama 1.08 LogMAR idi. Son muayenede ortalama en iyi görme keskinlikleri SRVT grubunda 0.58 LogMAR, VDT grubunda 0.52 LogMAR olarak saptandı. Üç tedavi grubunda da görme keskin- liğinde istatiksel olarak anlamlı artma saptandı (p=0.0). SRVT grubunda grid lazer fotokoagülasyon uygulananlarda ortalama 0.54 LogMAR, intravitreal triamsinolon asetonid enjeksiyonu yapılanlarda ortalama 0.56 LogMAR, intravitreal bevacizumab enjeksiyonu yapılanlarda ortalama 0.57 LogMAR gör- me artışı saptandı. VDT grubunda ise grid lazer fotokoagülasyon uygulananlarda ortalama 0.52 LogMAR, intravitreal triamsinolon asetonid enjeksiyonu yapılanlarda ortalama 0.58 LogMAR, intravitreal bevacizumab enjeksiyonu yapılanlarda ortalama 0.63 LogMAR görme artışı sağlandı. Bevacizumab uygulananlar ile grid lazer fotokoagülasyon uygulananlar arasında istatiksel olarak anlamlı fark saptanmıştır (p=0.0). Triamsinolon asetonid ile diğer tedaviler arasında ise anlamlı fark saptanmamıştır. Sonuç: Retinal ven tıkanıklığı tedavisinde, grid lazer fotokoagülasyon, intravitreal triamsinolon asetonid ve intravitreal bevacizumab uygulamaları etkilidir. İntravitreal bevacizumab enjeksiyonu, grid lazer fotokoagülasyona göre görme keskinliğini daha çok arttırmıştır. İntravitreal bevacizumab enjeksiyonu ile intravitreal triamsinolon enjeksiyonu arasında ise istatiksel olarak anlamlı fark saptanmamıştır.