Liječenje dijabetičkog makularnog edema

master's thesis

• Title (english): Treatment of diabetic macular edema
• Author: Karlo Ivan Prpić
• Mentor: Nenad Vukojević (mentor)
• Committee member: Tomislav Jukić (predsjednik povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Committee member: Nenad Vukojević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Dijabetički makularni edem (DME) jedan je od vodećih uzroka gubitka vida u zemljama razvijenog svijeta. DME se razvija u sklopu dijabetičke retinopatije (DR) kao mikrovaskularne komplikacije u pacijenata oboljelih od dijabetesa melitusa (DM). Kompleksna patofiziologija uključuje aktivnost slobodnih kisikovih radikala, hiperglikemije, upalnih čimbenika te vaskularnog endotelnog čimbenika rasta (VEGF) koji zajedno dovode do povećane propusnosti krvnih žila mrežnice te nakupljanja tekućine u retinalnom i subretinalnom prostoru čime se mijenja makularna struktura i funkcija. Prevalencija DME-a ovisi o duljini trajanja i tipu dijabetesa melitusa (DM) u pacijenata. Pacijenti s DM-om tip 1 u riziku su za razvoj DME-a već tijekom prvih pet godina od postavljanja dijagnoze, dok čak 5% pacijenata s DM-om tip 2 u trenutku postavljanja dijagnoze ima DME. Prevalencija je izravno proporcionalna duljini trajanja DM-a te raste do 40% u 30 godina trajanja bolesti. Čimbenike rizika predstavljaju i hiperglikemija, hipertenzija, dislipidemija te trudnoća. Pri dijagnosticiranju DME-a osnovni postupci uključuju uzimanje kvalitetne anamneze i oftalmološki pregled, a kao metode slikovnog prikaza koriste se optička koherentna tomografija (OCT) i fluoresceinska angiografija (FA). Kao temeljni postupak liječenja podrazumijeva se sustavna metabolička kontrola hiperglikemije i hipertenzije radi sprječavanja pojave DME-a. U terapiji se danas koriste farmakološke i kirurške metode. Okosnica liječenja DME-a jesu intravitrealne injekcije anti-VEGF lijekova, a u farmakološki pristup pripadaju i lokalno primjenjeni kortikosterodi te nesteroidni protuupalni lijekovi (NSAID). Laserska fotokoagulacija zauzimala je važno mjesto u liječenju DME-a prije pojave uspješnog liječenja farmakološkim pristupom te je danas njena uloga sekundarna. U slučajevima kroničnog i teškog oblika DME-a kod kojeg je došlo do ireverzibilnih promjena na mrežnici terapijska metoda izbora je vitrektomija.

Abstract (english)

Diabetic macular edema (DME) is one of the leading causes of vision loss in the developed world. DME develops as a part of diabetic retinopathy (DR) as a microvascular complication in patients with diabetes mellitus (DM). Complex pathophysiology includes the activity of free oxygen radicals, hyperglycemia, inflammatory factors and vascular endothelial growth factor (VEGF) which together lead to increased permeability of retinal blood vessels and subsequent fluid accumulation in the retinal and subretinal spaces hence changing macular structure and funtion. Prevalence of DME depends on the duration and type of diabetes mellitus in patients. Patients with type 1 DM are at risk of developing DME as early as the first five years following diagnosis, while as many as 5% of patients with DM type 2 already have DME at the time of diagnosis. The prevalence rate is directly proportional to duration of DME and reaches up to 40% within 30 years. Risk factors include hyperglycemia, hypertension, dyslipidemia and pregnancy. Main means of diagnosing DME include taking a good history and ophthalmologic examination, while optical coherence tomography (OCT) and fluorescein angiography (FA) are used as imaging methods. Systemic metabolic control of hyperglycemia and hypertension to prevent DME are considered basic treatment procedures. Therapy today consists of pharmacological and surgical methods. Intravitreal injections of anti-VEGF drugs are the main treatment option. Pharacological approach includes topically applied corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Laser photocoagulation had an important role in the treatment of DME but became secondary after the introduction of successful pharmacological treatment. In cases of chronic and severe DME in which irreversible changes in the retina have occured, the therapeutic method of choice is vitrectomy.

• Keywords: dijabetes melitus; dijabetička retinopatija; dijabetički makularni edem; OCT; anti-VEGF
• Keywords (english): diabetes mellitus; diabetic retinopathy; diabetic macular edema; OCT; anti-VEGF
• Language: croatian
• URN:NBN: urn:nbn:hr:105:809746
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-09-13 08:23:47