Aktueller Stand der lokalen und systemischen Immunsuppression nach Keratoplastik

Zusammenfassung

Zur notwendigen systemischen Immunsuppression bei perforierender Hochrisikokeratoplastik steht MMF neben CsA als Standardtherapeutikum zur Verfügung, nachdem die Wirksamkeit in mehreren auch größeren Studien nachgewiesen wurde. Ob die Therapie mit MPA darüber hinaus Vorteile bietet, ist derzeit noch offen. Sirolimus und Tacrolimus sind wirksam, konnten sich aber aufgrund höherer Nebenwirkungen bisher nicht durchsetzen. Ein Zusatznutzen von Kombinationstherapien ist derzeit durch klinische Studien nicht belegt. Everolimus weist eine präklinisch vielversprechende immunsuppressive aber auch antiproliferative Wirkung auf. Lokale Präparationen der Immunsuppressiva als Monotherapie sind vermutlich als Alternative zur systemischen Therapie unzureichend. Ob sich lokale Kombinationstherapien als Alternative etablieren können, müssen die folgenden Jahre zeigen.

Abstract

Today MMF can be considered as standard treatment besides cyclosporin A for immunosuppression after high-risk perforating keratoplasty. The efficacy of systemic MMF for this indication has been documented in several clinical studies including multicentre designs. Whether or not MPA therapy offers further advantages is currently under discussion. Sirolimus and tacrolimus are effective but could not achieve clinical importance due to higher rates of side effects. An additional benefit of combination therapies is not proven by clinical studies up to date. Everolimus shows pre-clinically a promising immunosuppressive and antiproliferative effect. Topical preparations of immunosuppressants as monotherapy are obviously insufficient as alternatives for systemic immunosuppressive therapy. Whether or not topical combination therapies will become established as alternatives to systemic treatment has to be demonstrated in the following years.

Schlüsselwörter

Kornea - Pharmakologie - intraokulare Entzündungen

Key words

cornea - pharmacology - intraocular inflammation

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