Zusammenfassung
Die altersabhängige Makuladegeneration (AMD) gehört zu den häufigsten Ursachen einer Erblindung in westlichen Industrienationen. Die meisten AMD-Patienten leiden an der trockenen Frühform der AMD, die feuchte AMD mit ihrer choroidalen Neovaskularisation (CNV) stellt die Haupterblindungsursache aller AMD-Patienten dar. Neue Perspektiven in der Therapie der AMD wurden mit pharmakologischen Verfahren entwickelt, die zur Behandlung aller Subtypen der exsudativen AMD zur Verfügung stehen. In der Pathophysiologie der feuchten AMD ist eine Vielzahl von inhibierenden und induzierenden Wachstumsfaktoren wie der vaskuläre endotheliale Wachstumsfaktor (VEGF) besonders wichtig. Das sezernierte VEGF scheint durch seine angiogene und permeabilitätssteigernde Wirkung eine entscheidende Rolle bei der Pathogenese von CNV und Makulaödemen zu haben. Diese Erkenntnisse führten zu dem heute verwendeten therapeutischen Ansatz, eine kompetitive VEGF-Blockade durch intravitreal applizierte Anti-VEGF-Medikamente zu erreichen. Durch die Anti-VEGF-Medikamente kommt es zur raschen Abnahme der retinalen Dicke. Die optische Kohärenztomographie (OCT) ist ein wertvolles Instrument in der Verlaufskontrolle, darf aber nur als Entscheidungshilfe gelten. Die klinische Nachkontrolle der Patienten und die weitere Therapieempfehlung müssen sich immer am klinischen Gesamtbild orientieren. Als entscheidendes Kriterium für eine erneute Behandlung gilt der Visus.
Abstract
Age-related macular degeneration (AMD) is one of the most common causes of blindness in western industrialised nations. Most AMD patients suffer from the dry early form of AMD; however, wet AMD with choroidal neovascularization (CNV) is the main cause of blindness in all AMD patients. New prospects have been developed in AMD treatment using pharmacological methods available for treating all subtypes of exudative AMD. A number of inhibiting and inducing growth factors, such as vascular endothelial growth factor (VEGF), are particularly important in the pathophysiology of wet AMD. The secreted VEGF appears to play a crucial role in the pathogenesis of CNV and macular edemas as a result of its angiogenetic and permeability-enhancing effect. This recognition led to the treatment approach now used, i.e., competitive VEGF blocking through intravitreal adminsitration of anti-VEGF drugs. The anti-VEGF durgs lead to a rapid decrease in retinal thickness. Optical coherence tomography (OCT) is a valuable monitoring tool, but may only be used to assist in decision-making. Clinical follow-up of patients and further treatment recommendations must always be guided by the overall clinical picture. Visual acuity is regarded as the decisive criterion for repeat treatment.
Notes
Persönliche Kommunikation Dr. Tim U. Krohne, Univ. Bonn.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Nicole Eter und Carsten H. Meyer wurden von Novartis Pharma AG, Nürnberg, und Pfizer GmbH, Karlsruhe, für Vorträge und die Teilnahme an Advisory Boards finanziell unterstützt. Die Augenklinik der Universität Bonn nimmt an diversen wissenschaftlichen Studien zu verschiedenen AMD-Therapien teil.
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Meyer, C., Helb, HM. & Eter, N. Monitoring von AMD-Patienten unter Anti-VEGF-Therapie. Ophthalmologe 105, 125–142 (2008). https://doi.org/10.1007/s00347-008-1702-6
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DOI: https://doi.org/10.1007/s00347-008-1702-6
Schlüsselwörter
- Altersabhängige Makuladegeneration (AMD)
- Exsudative AMD
- Anti-VEGF-Therapie
- Erblindung
- Optische Kohärenztomographie (OCT)