Prognostische Faktoren beim chronisch-diabetischen Makulaödem nach intravitrealer Therapie

 

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Zusammenfassung

Hintergrund: Seit wenigen Jahren wird zunehmend Bevacizumab und Triamcinolonazetat (TA) zur Behandlung des diabetischen Makulaödems intravitreal eingesetzt. Es ist jedoch ungeklärt, welche Patienten davon profitieren. In dieser Studie untersuchen wir Faktoren, die das Visuslangzeitergebnis nach intravitrealen Injektionen bei DMÖ beeinflussen. Methoden: Es wurden 50 Augen (37 Patienten) analysiert, die bei diabetischem Makulaödem mit intravitrealem Bevacizumab, Triamcinolon oder beidem behandelt wurden und eine Mindest-Nachbeobachtungszeit von 6 Monaten hatten. Ausgewertet wurden klinische, angiografische und OCT-Befunde. Ergebnisse: Nach einer mittleren Beobachtungszeit von 14,6 ± 6 Monaten stieg der Visus bei 22 Augen signifikant an und fiel bei 28 Augen ab. Das Vorliegen eines, im OCT sichtbaren zystoiden Makulaödems korrelierte mit einem ungünstigen Visuslangzeitergebnis (p < 0,001), wohingegen ein frühes Ansprechen (nach 5 Wochen) auf die Therapie mit einer Visusverbesserung (p = 0,016) verbunden war. Die initiale zentrale Makuladicke im OCT, die Art des Wirkstoffs bei Monotherapie, Alter und Geschlecht hatten keinen Einfluss auf das Visuslangzeitergebnis. Schlussfolgerung: Bei initialem zystoidem diabetischem Makulaödem ist die Visusprognose ungünstig. Eine intravitreale Behandlung sollte vor Entwicklung eines zystoiden Makulaödems begonnen werden, da dann ein Ansprechen auf die Therapie schon bei einer niedrigen Zahl von Injektionen wahrscheinlich ist. Ein frühes Ansprechen auf die Therapie ist ein guter Vorhersageparameter für einen guten Endvisus.

Abstract

Background: In recent years, intravitreal bevacizumab and triamcinolone acetonide (TA) have been widely used to treat diabetic macular oedema (DMO). However, the indication criteria are not clear. The purpose of this study was to evaluate factors which are decisive for long-term visual outcome after intravitreal drug treatment for eyes with DMO. Materials and Methods: Fifty eyes (37 patients) treated with intravitreal bevacizumab, TA, or sequentially with both for DMO with a minimum follow-up period of 6 months were analysed retrospectively. The eyes with an increase of best-corrected visual acuity (BCVA) at the last visit were classified as gainers, and eyes with stable or decreased BCVA as non-gainers. Clinical and imaging findings were evaluated. Results: BCVA significantly increased in 22 eyes and decreased in 28 eyes after a mean follow-up period of 14.6 ± 6 months after initial intravitreal intervention. Unfavourable for the long-term visual outcome was the presence of cystoid macular oedema (CMO, p < 0.001), whereas an early response at 5 weeks into therapy indicated a positive outcome (p = 0.016). The initial central macular thickness measured by OCT, the type of agent used in monotherapy, age and gender were without influence on long-term visual acuity. Conclusions: An initial CMO is unfavourable for the prognosis of long-term visual outcome of DMO. Hence, benefit from intravitreal treatment with bevacizumab and/or TA is more likely in the early stages of chronic DMO before CMO has evolved. In eyes without CMO even a low number of injections is beneficial. An early response following intravitreal bevacizumab or TA is a predictor of long-term benefit.

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Dr. Rainer Guthoff

Augenklinik, Universität Würzburg

Josef-Schneider-Str. 11

97080 Würzburg

Phone: ++ 49/9 31/20 12 03 51

Fax: ++ 49/9 31/20 12 04 91

Email: r.guthoff@uni-wuerzburg.de