Der Einfluss des Glaskörpers auf die Pathogenese der altersabhängigen Makuladegeneration

 

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Zusammenfassung

Die altersabhängige Makuladegeneration (AMD) ist die häufigste Ursache für einen massiven Visusabfall mit Zentralskotom im Alter. Die AMD stellt eine multifaktorielle Erkrankung dar, die bis zum Einsatz von anti-VEGF in ihrer Therapiemöglichkeit äußerst limitiert war. Trotz aller Fortschritte ist allerdings in den meisten Fällen keine langfristige Heilung zu erreichen. Der Glaskörper wird aktuell – aufgrund seiner anatomischen Lokalisation an der Makula – als möglicher Co-Faktor in der Pathogenese der AMD diskutiert. Zahlreiche Autoren konnten einen anliegenden Glaskörper deutlich häufiger bei der exsudativen Form der AMD nachweisen. Altersunterschiede, genetische Abweichungen und Umweltfaktoren konnten dabei weitgehend ausgeschlossen werden. Entscheidend ist die Frage, inwieweit eine Beeinflussung des Glaskörpers die Entstehung und den Verlauf der AMD verändern kann. Hierzu liegen nur einzelne Fallberichte und Fallserien vor. Eine multizentrische, prospektive, verblindete, vergleichende, randomisierte klinische Studie zur enzymatischen Vitreolyse untersucht gegenwärtig die Effekte einer Glaskörperabhebung auf die Progression einer exsudativer AMD. Die Ergebnisse sind abzuwarten, um beurteilen zu können, inwieweit die Glaskörperabhebung eine Therapieoption der exsudativen AMD in Zukunft darstellen wird.

Abstract

Age-related macular degeneration (AMD) is the main cause of severe visual decease in elderly people in the industrialised countries. AMD is a multifactorial disease with only limited therapeutic options before anti-VEGF treatment was introduced. In spite of all the progress no long-term healing is possible. Actually, the vitreous is being investigated as a possible co-factor in the pathogenesis of AMD. Numerous authors demonstrated a higher incidence of vitreoretinal adhesion in exudative AMD by considering age, genetic and environmental factors. The essential question is whether the therapeutic release of vitreoretinal adhesion could affect the development and progress of AMD. Up to now only case reports and case series have demonstrated a positive effect on disease progress. An ongoing multicentre, prospective, comparative, randomised, double-blind clinical trial with enzymatic vitreolysis is now evaluting the effect of vitreoretinal release on the progress of AMD. The results are necessary to evaluate whether vitreoretinal release is a therapeutic option for the future.

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Prof. Dr. Stefan Mennel

Klinik für Augenheilkunde, Philipps-Universität Marburg

Robert-Koch-Str. 4

35037 Marburg

Phone: ++ 49/64 21/5 86 26 00

Fax: ++ 49/64 21/5 86 56 78

Email: stefan.mennel@lycos.com