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Moderne Arzneimitteltherapie der altersabhängigen Makuladegeneration

Modern pharmacotherapy of age-related macular degeneration

  • Arzneimitteltherapie
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Zusammenfassung

Die altersabhängige Makuladegeneration (AMD) ist in allen Industrienationen inzwischen die häufigste Ursache für eine Erblindung. Allein in Deutschland sind ca. 4,5 Mio. Menschen betroffen. Angesichts der demographischen Entwicklung wird die Anzahl der Betroffenen weiter zunehmen. Die Spätstadien der Erkrankung gehen u. a. mit einem Verlust der zentralen Sehschärfe, damit der Lesefähigkeit sowie häufig der selbständigen Lebensführung einher. Basierend auf neuen Erkenntnissen zur Pathogenese konnten neben etablierten Verfahren wie der Laserchirurgie und der photodynamischen Therapie neue pharmakologische Behandlungsansätze entwickelt werden. Mittels intravitrealer Injektion antiangiogener Präparate, die die biologische Wirkung von VEGF („vascular endothelial growth factor“) neutralisieren, können Wachstum und Permeabilität neovaskulärer Membranen bei der AMD beeinflusst werden. Auch für intravitreal und juxtaskleral applizierte Steroidderivate konnten positive Effekte gezeigt werden. Im Bereich der Prophylaxe sind bei klar definierten Befundkonstellationen anti-oxidative Mischpräparate (AREDS-Medikation) sinnvoll. Die Früherkennung spielt bei allen gegenwärtigen Behandlungsansätzen eine zentrale Rolle, da Interventionen nur in einem frühen Stadium der Erkrankung greifen können.

Abstract

Age-related macular degeneration (AMD) is now the most common cause for blind registration in all developed countries. Epidemiologic data indicate that there are 4.5 mio affected in Germany with constant increase in incidence and prevalence with subsequent considerable health economic implications. Late manifestations of the disease result in the inability to read and to perform daily tasks. Therefore, there is an urgent need for efficacious prophylactic and therapeutic measures to prevent irreversible loss of central vision. Based on a better understanding of the underlying molecular mechanisms new therapeutic approaches have been brought forward and expand previous approaches such as thermal laser surgery or photodynamic therapy. Repeated intravitreal injection of anti-VEGF (vascular endothelial growth factor) agents as well as cosrticosteroids have a beneficial effect on growth and permeability of neovascular membranes. The risk for progression from early to late stages of AMD can be reduced with certain antioxidative preparations (AREDS medication) in presence of defined funduscopic signs. Early diagnosis is key for all currently availabe interventions since a beneficial effect can only be achieved in early stages of the disease process.

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Interessenkonflikt:

Der korrespondierende Autor ist Principal investigator bei klinischen Studien mit Macugen® und Lucentis®.

Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Universitäts-Augenklinik, Bonn

    F. G. Holz, H. M. Helb, A. Bindewald-Wittich & H. P. N. Scholl

  2. Universitäts-Augenklinik, Ernst-Abbe-Straße 2, 53127, Bonn

    F. G. Holz

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  1. F. G. Holz
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  2. H. M. Helb
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  3. A. Bindewald-Wittich
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  4. H. P. N. Scholl
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Correspondence to F. G. Holz.

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Holz, F.G., Helb, H.M., Bindewald-Wittich, A. et al. Moderne Arzneimitteltherapie der altersabhängigen Makuladegeneration. Internist 47, 192–198 (2006). https://doi.org/10.1007/s00108-005-1545-z

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  • DOI: https://doi.org/10.1007/s00108-005-1545-z

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