Anti-VEGF tedavisine dirençli diyabetik makula ödeminde intravitreal deksametazon implant sonrası Optik Koherens Tomografi Anjiyografi (OKT-A) ile makular vasküler dansite ve foveal avasküler zon değişikliklerinin değerlendirilmesi

Evaluation of Macular Vascular Density and Foveal Avascular Zone Changes by Optic Coherence Tomography Angiography (OCT-A) After Intravitreal Dexamethasone Implant in Diabetic Macular Edema Resistant to Anti-VEGF Treatment Purpose: To analyze changes in BCVA , central retinal thickness (CRT), choroidal thickness, foveal avascular zone (FAZ) width and vascular density, and especially to evaluate the utility of OCT-A in monitoring and treatment response in anti-VEGF treatment resistant DME patients before and after Dexamethasone implant. Material and Method: Akdeniz University Faculty of Medicine Hospital, Department of Ophthalmology Retina Unit, between September 2017 and June 2019 diabetic retinopathy files were reviewed retrospectively. Thirty-four eyes of 34 patients who underwent intravitreal dexamethasone implantation for the first time after receiving at least 5 doses of intravitreal Anti-VEGF (bevacizumab, ranibizumab, or aflibersept) treatment for DME, and those who continued despite DME, were considered resistant to anti-VEGF was included. Results: The mean preoperative BCVA was 0.86 ± 0.36 logMAR, while the postoperative first month and third month were 0.70 ± 0.35 logMAR and 0.68 ± 0.40 logMAR, respectively (P<0,05). Intraocular pressure was 15.5 ± 2.8 mm / Hg preoperatively and 16.3 ± 3.3mm / Hg and 17.1 ± 4.6 mm / Hg in the first and third month, respectively. Central Retinal Thickness (CRT) was found to be 413 ± 86 microns preoperatively, 296 ± 72 and 332 ± 99 microns at postoperative first month and third month. CRT decreased significantly at postoperative first month and third month (P <0.005). The mean preoperative choroidal thickness was 238 ± 69 microns, 235 ± 68 microns in the first month and 242 ± 67 microns in the third month. There was no significant change in choroidal thickness (P> 0.05). In measurements performed with OCT-A; The mean FAZ area of preoperative superficial plexus was 0.350 ± 0.120 mm2, whereas it was 0.292 ± 0.132 mm2 and 0.311 ± 0.153 mm2 in the first month and third month, respectively. There was a significant decrease in superficial plexus FAZ area in both first and third months (P <0.005). The mean preoperative deep vascular plexus FAZ area was 0.651 ± 0.313 mm2, while postoperative first month and third month were 0.481 ± 0.247 mm2 and 0.575 ± 0.259 mm2, respectively. In the deep retinal vascular plexus, a significant change was detected in the FAZ area in the first month only (P <0.05). However, there was a re-expansion of the FAZ area at the third month and there was no significant change compared to the pre-injection (P> 0.05). The mean of preoperative superficial total vascular density was 39.1, 39.1 at the first and 39.4 at the third month. Deep retinal plexus total vascular density was 43.2 preoperatively, 43.4 at the first and 43.6 at the third month postoperatively. There was no significant change in the mean total vascular density in both superfacial and deep plexus at first month and third Dmonths after dexamethasone implantation (P> 0.05). Conclusion: After intravitreal dexamethasone implant therapy in patients with anti-VEGF-resistant DME, there was a significant reduction in the FAZ area but no significant change in vascular density. It was found that dexamethasone treatment was an effective, reliable and feasible treatment method in anti-VEGF-resistant DME and the use of OCT together with OCT-A in the follow-up of patients provided additional benefit.