Tedavi Yöntemleri: Steroid Tedavisi
Kitapta bölümler > Araştırma Kitabı · 2021
Yazarlar: Filiz AFRASHİ
Diabetik Retinopati ve Makulopati, Araştırma Kitabı, Türkiye Klinikleri Yayınevi, Tanınmış Ulusal, Ulusal, 2021, ss 1-150, Türkiye, Ankara
Özet
<div class="t pg-1m0 pg-1x2 pg-1h3 pg-1y2 pg-1ff1 pg-1fs0 pg-1fc0 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(255, 255, 255); font-size: 40px; bottom: 42.9396px; height: 33.3594px; left: 276.593px;"><span style="background-color: rgb(0, 0, 0);">Tedavi Yöntemleri: Steroid Tedavisi Treatment Modalities: Steroid Treatment ÖZET Diyabetik makula ödemi (DMÖ), multifaktöriyel patogeneze sahip kronik bir patolojidir. Vasküler endotelial growth faktör (VEGF) ve çeşitli enflamatuar mediatörler DMÖ’li gözlerde artmaktadır. Anti-VEGF ajanlar çoğunlukla DMÖ tedavisinde ilk sırada seçilirken, DMÖ tedavi algoritmasında steroidlerin de önemli bir yeri vardır. Bugün kullanımda olan kortikosteroidler, triamsinolon asetonid (TA), deksametazon implant ve flosinolon asetonid (FA) implanttır. Kortikosteroidlerin VEGF inhibitörleri üzerine esas avantajları uzun etki süreleridir. Kortikosteroidlerin sık görülen yan etkileri, katarakt gelişimi, katarakt progresyonu ve oküler hipertansiyondur. Daha az tatmin edici güvenlik problemleri nedeniyle, kortikosteroidler genellikle DMÖ’de 2. seçenek olarak kullanılırlar. İntravitreal kortikosteroid implant kullanımının avantajları, tedavi yükünü azaltması ve vitrektomize gözlerde bile farmakokinetiğinin bilinebilmesidir. Psödofak gözler, vitrektomize gözler, aylık tedaviyi sürdürmede güçlük çeken uzun süreli DMÖ’li gözler kortikosteroid implantlarla primer tedaviden yarar görebilirler. Flosinolon asetonid implant ise diğer tedavilere yetersiz yanıt veren ağır kronik DMÖ olguları için ayrılmalıdır. Anah tar Ke li me ler: Deksametazon; diyabetik retinopati; flosinolon asetonid</span>; makula ödemi; triamsinolon asetonid 1 Tedavi Yöntemleri: Steroid Tedavisi Treatment Modalities: Steroid TreatmentÖZET Diyabetik makula ödemi (DMÖ), multifaktöriyel patogeneze sahip kronik bir patolojidir. Vas-küler endotelial growth faktör (VEGF) ve çeşitli enflamatuar mediatörler DMÖ’li gözlerde artmaktadır. Anti-VEGF ajanlar çoğunlukla DMÖ tedavisinde ilk sırada seçilirken, DMÖ tedavi algoritmasında ste-roidlerin de önemli bir yeri vardır. Bugün kullanımda olan kortikosteroidler, triamsinolon asetonid (TA), deksametazon implant ve flosinolon asetonid (FA) implanttır. Kortikosteroidlerin VEGF inhibitörleri üzerine esas avantajları uzun etki süreleridir. Kortikosteroidlerin sık görülen yan etkileri, katarakt geli-şimi, katarakt progresyonu, ve oküler hipertansiyondur. Daha az tatmin edici güvenlik problemleri ne-deniyle, kortikosteroidler genellikle DMÖ’de 2. seçenek olarak kullanılırlar. İntravitreal kortikosteroid implant kullanımının avantajları, tedavi yükünü azaltması ve vitrektomize gözlerde bile farmakokineti-ğinin bilinebilmesidir. Psödofak gözler, vitrektomize gözler, aylık tedaviyi sürdürmede güçlük çeken uzun süreli DMÖ’li gözler kortikosteroid implantlarla primer tedaviden yarar görebilirler. Flosinolon asetonid implant ise diğer tedavilere yetersiz yanıt veren ağır kronik DMÖ olguları için ayrılmalıdır. Anah tar Ke li me ler: Deksametazon; diyabetik retinopati; flosinolon asetonid; makula ödemi; triamsinolon asetonid 1</div><div class="t pg-1m0 pg-1x3 pg-1h4 pg-1y3 pg-1ff1 pg-1fs1 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 72px; bottom: 634.13px; height: 60.0469px; left: 344.582px;"> </div><div class="t pg-1m0 pg-1x4 pg-1h4 pg-1y4 pg-1ff1 pg-1fs1 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 72px; bottom: 612.131px; height: 60.0469px; left: 212.368px;">Tedavi Yöntemleri: Steroid Tedavisi </div><div class="t pg-1m0 pg-1x5 pg-1h5 pg-1y5 pg-1ff1 pg-1fs2 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 56px; bottom: 584.8px; height: 46.7031px; left: 229.701px;">Treatment Modalities: Steroid Treatment</div><div class="t pg-1m0 pg-1x6 pg-1h6 pg-1y6 pg-1ff2 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff106; line-height: 1.07324; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 32px; bottom: 530.082px; height: 27.4375px; left: 179.715px;">ÖZET <span class="pg-1ff1 pg-1ws1" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; word-spacing: 0.9472px; position: relative; unicode-bidi: bidi-override;">Diyabetik makula ödemi (DMÖ), multifaktöriyel patogeneze sahip kronik bir patolojidir. Vas-</span></div><div class="t pg-1m0 pg-1x6 pg-1h7 pg-1y7 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws2" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: -1.0528px; color: rgb(35, 31, 32); font-size: 32px; bottom: 520.582px; height: 26.7031px; left: 179.715px;">küler endotelial growth faktör (VEGF) ve çe<span class="pg-1ff3 pg-1ws0" style="font-family: pg-1fffb; line-height: 1.05029; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ş</span>itli enflamatuar mediatörler DMÖ’li gözlerde artmaktad<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı<span class="pg-1ff1 pg-1ls1" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; letter-spacing: -0.0032px; position: relative; unicode-bidi: bidi-override;">r. </span></span></div><div class="t pg-1m0 pg-1x6 pg-1h7 pg-1y8 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws3" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: -0.4192px; color: rgb(35, 31, 32); font-size: 32px; bottom: 511.082px; height: 26.7031px; left: 179.715px;">Anti-VEGF ajanlar ço<span class="pg-1ff3 pg-1ws0" style="font-family: pg-1fffb; line-height: 1.05029; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ğ</span>unlukla DMÖ tedavisinde ilk s<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>rada seçilirken, DMÖ tedavi algoritmas<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>nda ste-</div><div class="t pg-1m0 pg-1x6 pg-1h8 pg-1y9 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls2 pg-1ws4" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); letter-spacing: -0.1152px; -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: -1.0848px; color: rgb(35, 31, 32); font-size: 32px; bottom: 501.582px; height: 26.6875px; left: 179.715px;">roidlerin de önemli bir yeri vard<span class="pg-1ff4 pg-1ls0 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; letter-spacing: 0px; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>r. Bugün kullan<span class="pg-1ff4 pg-1ls0 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; letter-spacing: 0px; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>mda olan kortikosteroidler, triamsinolon asetonid (TA), </div><div class="t pg-1m0 pg-1x6 pg-1h8 pg-1ya pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls3 pg-1ws5" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); letter-spacing: 0.0256px; -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: 1.9744px; color: rgb(35, 31, 32); font-size: 32px; bottom: 492.082px; height: 26.6875px; left: 179.715px;">deksametazon implant ve flosinolon asetonid (FA) implantt<span class="pg-1ff4 pg-1ls0 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; letter-spacing: 0px; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>r. Kortikosteroidlerin VEGF inhibitörleri </div><div class="t pg-1m0 pg-1x6 pg-1h8 pg-1yb pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws6" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: 0.0704px; color: rgb(35, 31, 32); font-size: 32px; bottom: 482.582px; height: 26.6875px; left: 179.715px;">üzerine esas avantajlar<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span><span class="pg-1ls4 pg-1ws7" style="letter-spacing: 0.0032px; word-spacing: 0.0672px; position: relative; unicode-bidi: bidi-override;"> uzun etki süreleridir. Kortikosteroidlerin s</span><span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>k görülen yan etkileri, katarakt geli-</div><div class="t pg-1m0 pg-1x6 pg-1h7 pg-1yc pg-1ff3 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1fffb; line-height: 1.05029; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 32px; bottom: 473.082px; height: 26.7031px; left: 179.715px;">ş<span class="pg-1ff1 pg-1ws8" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; word-spacing: 0.5824px; position: relative; unicode-bidi: bidi-override;">imi, katarakt progresyonu, ve oküler hipertansiyondur. Daha az tatmin edici güvenlik problemleri ne-</span></div><div class="t pg-1m0 pg-1x6 pg-1h7 pg-1yd pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws9" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: 0.0896px; color: rgb(35, 31, 32); font-size: 32px; bottom: 463.582px; height: 26.7031px; left: 179.715px;">deniyle, kortikosteroidler genellikle DMÖ’de 2. seçenek olarak kullan<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı<span class="pg-1ff1" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; position: relative; unicode-bidi: bidi-override;">l</span>ı<span class="pg-1ff1" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; position: relative; unicode-bidi: bidi-override;">rlar. <span class="pg-1ff3" style="font-family: pg-1fffb; line-height: 1.05029; visibility: visible; position: relative; unicode-bidi: bidi-override;">İ</span></span></span>ntravitreal kortikosteroid </div><div class="t pg-1m0 pg-1x6 pg-1h8 pg-1ye pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1wsa" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: -0.3616px; color: rgb(35, 31, 32); font-size: 32px; bottom: 454.082px; height: 26.6875px; left: 179.715px;">implant kullan<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı<span class="pg-1ff1" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; position: relative; unicode-bidi: bidi-override;">m</span>ı<span class="pg-1ff1" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; position: relative; unicode-bidi: bidi-override;">n</span>ı</span>n avantajlar<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span>, tedavi yükünü azaltmas<span class="pg-1ff4 pg-1ws0" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;">ı</span> ve vitrektomize gözlerde bile farmakokineti-</div><div class="t pg-1m0 pg-1x6 pg-1h7 pg-1yf pg-1ff3 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1fffb; line-height: 1.05029; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 32px; bottom: 444.582px; height: 26.7031px; left: 179.715px;">ğ<span class="pg-1ff1 pg-1ls5 pg-1wsb" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; letter-spacing: 0.032px; word-spacing: 1.968px; position: relative; unicode-bidi: bidi-override;">inin bilinebilmesidir. Psödofak gözler, vitrektomize gözler, ayl</span><span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı<span class="pg-1ff1 pg-1ls5 pg-1wsb" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; letter-spacing: 0.032px; word-spacing: 1.968px; position: relative; unicode-bidi: bidi-override;">k tedaviyi sürdürmede güçlük çeken </span></span></div><div class="t pg-1m0 pg-1x6 pg-1h8 pg-1y10 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls6 pg-1wsc" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); letter-spacing: 0.0128px; -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: 1.9872px; color: rgb(35, 31, 32); font-size: 32px; bottom: 435.082px; height: 26.6875px; left: 179.715px;">uzun süreli DMÖ’li gözler kortikosteroid implantlarla primer tedaviden yarar görebilirler. Flosinolon </div><div class="t pg-1m0 pg-1x6 pg-1h7 pg-1y11 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 32px; bottom: 425.582px; height: 26.7031px; left: 179.715px;">asetonid implant ise di<span class="pg-1ff3" style="font-family: pg-1fffb; line-height: 1.05029; visibility: visible; position: relative; unicode-bidi: bidi-override;">ğ</span>er tedavilere yetersiz yan<span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı</span>t veren a<span class="pg-1ff3" style="font-family: pg-1fffb; line-height: 1.05029; visibility: visible; position: relative; unicode-bidi: bidi-override;">ğ<span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı</span></span>r kronik DMÖ olgular<span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı</span> için ayr<span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı</span>lmal<span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı</span>d<span class="pg-1ff4" style="font-family: pg-1ff108; line-height: 0.694336; visibility: visible; position: relative; unicode-bidi: bidi-override;">ı</span><span class="pg-1ls7" style="letter-spacing: -0.0064px; position: relative; unicode-bidi: bidi-override;">r. </span></div><div class="t pg-1m0 pg-1x6 pg-1h8 pg-1y12 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 32px; bottom: 416.082px; height: 26.6875px; left: 179.715px;"> </div><div class="t pg-1m0 pg-1x6 pg-1h6 pg-1y13 pg-1ff2 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1wsd" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff106; line-height: 1.07324; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; word-spacing: -8px; color: rgb(35, 31, 32); font-size: 32px; bottom: 406.582px; height: 27.4375px; left: 179.715px;">Anah tar <span class="_ pg-1_0" style="display: inline-block; color: transparent; z-index: -1; width: 8px; position: relative; unicode-bidi: bidi-override;"> </span>Ke li me ler:<span class="pg-1ff1 pg-1ws0" style="font-family: pg-1ff104; line-height: 1.04981; visibility: visible; word-spacing: 0px; position: relative; unicode-bidi: bidi-override;"> Deksametazon; diyabetik retinopati; flosinolon asetonid; </span></div><div class="t pg-1m0 pg-1x7 pg-1h8 pg-1y14 pg-1ff1 pg-1fs3 pg-1fc1 pg-1sc0 pg-1ls0 pg-1ws0" style="position: absolute; white-space: pre; transform-origin: 0px 100%; unicode-bidi: bidi-override; font-family: pg-1ff104; line-height: 1.04981; visibility: visible; transform: matrix(0.25, 0, 0, 0.25, 0, 0); -webkit-text-stroke: 0.015em transparent; text-shadow: none; color: rgb(35, 31, 32); font-size: 32px; bottom: 397.082px; height: 26.6875px; left: 215.709px;"> makula ödemi; triamsinolon asetonid </div>