Periokuläre subtenonale Triamcinoloninjektionen zur Behandlung von retinal angiomatösen Proliferationen (RAP) und okkulten choroidalen Neovaskularisationen

Zusammenfassung

Hintergrund: Häufig werden zur Therapie von okkulter CNV oder RAP intravitreale Injektionen von Triamcinolon zusammen mit PDT verabreicht. Die periokuläre subtenonale Applikation könnte eine risikoärmere Alternative sein. Patienten und Methoden: Retrospektive Fallserie von 39 Augen (38 Patienten) mit RAP (Gruppe A) oder mit okkulter CNV (Gruppe B), behandelt mit periokulärem Triamcinolon. Daten zu Wirksamkeit und Nebenwirkungen. Ergebnisse: Nach einer durchschnittlichen Nachbeobachtungsdauer von 10 - 11 Monaten haben in Gruppe A (19 Augen) 84 % < 3 Linien verloren. Davon stieg der Fernvisus in 26 % um ≥ 1 Linie. Bei 16 % fiel der Visus um ≥ 3 Linien. In Gruppe B (19 Augen) blieb der Visus in 100 % stabil, wobei 20 % ≥ 1 Linie gewonnen haben. Vergleichbare Resultate zeigten sich bei beiden Gruppen auch für den Vergrößerungsbedarf. Eine Augendruckerhöhung wurde in 15 % festgestellt. Schlussfolgerungen: Durch die mit wenig Nebenwirkungen behafteten subtenonalen periokulären Injektionen lässt sich bei Patienten mit RAP oder okkulter CNV ein mäßiger bis schwerer Visusverlust hinauszögern. Inwieweit kontrollierte Studien im Zeitalter der Anti-VEGF-Substanzen noch relevant sein können, wird der Einsatz dieser neuen Mittel bei exsudativer AMD in absehbarer Zukunft zeigen.

Abstract

Background: Intravitreal triamcinolone injections are used for the treatment of occult choroidal neovascularisations (CNV) combined with photodynamic therapy (PDT). However, this therapy is not without considerable risks. The periocular mode of application seems to be a logical alternative. Patients and Methods: A retrospective case series of 39 eyes with occult CNV either with retinal angiomatous proliferations (RAP) (group A) or with occult choroidal neovascularisation (CNV) (group B), treated with periocular triamcinolone was reviewed. Data regarding efficacy and side effects were extracted. Results: After a mean follow-up of 10 - 11 months 84 % in group A lost < 3 lines of visual acuity (VA). 26 % of them gained ≥ 1 line of VA. 16 % lost ≥ 3 lines of VA. In group B (19 eyes) VA was stable in 100 %, whereas 20 % gained ≥ 1 line. Both groups showed similar results for magnification requirement (MR). A rise in intraocular pressure was found in 15 %. Conclusion: In patients with RAP or occult CNV sub-tenon injections seem to delay moderate to severe visual loss. Whether larger randomised controlled studies regarding this treatment are still relevant in the era of anti-VEGF treatments remains to be seen.

Schlüsselwörter

subtenonales Triamcinolonacetonid - retinal angiomatöse Proliferation (RAP) - okkulte choroidale Neovaskularization (CNV) - altersabhängige Makuladegeneration (AMD)

Key words

sub-tenon triamcinolone acetonide - retinal angiomatous proliferation (RAP) - occult choroidal neovascularisation (CNV) - age-related macular degeneration (AMD)

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