Zusammenfassung
Nachdem durch die VEGF-Inhibition eine signifikante Verbesserung für selektierte Patienten
mit einer neovaskulären altersabhängigen Makuladegeneration (AMD) erreicht werden
konnte, wird die Makulachirurgie – und hier unter anderem die Makulatranslokation
(FMT: full macular translocation) – deutlich seltener für die neovaskuläre AMD angewendet.
Dennoch kann diese Therapieoption in Einzelfällen sinnvoll sein. Eine prospektiv randomisierte
Studie wies auf die Überlegenheit der Translokation gegenüber der photodynamischen
Therapie (PDT) in Bezug auf eine möglichen Visusverbesserung hin. Weil trotz der operativen
Komplikationen und der Störung des Binokularsehens viele Patienten mit Lesevisus und
Lebensqualität deutlich von der FMT profitierten, sind Überlegungen gerechtfertigt,
ob die aufwendige Operation in bestimmten Situationen eine sinnvolle Alternative darstellen
kann. Hier muss berücksichtigt werden, dass den Zulassungsstudien von Anti-VEGF-Therapien
eine Selektion vorausging, die im Vergleich zur täglichen Routine einen erheblichen
Anteil der Patienten ausschloss. Deshalb können als mögliche Indikationen der FMT
unter anderem Therapieversager der Anti-VEGF-Therapie, Patienten mit ausgedehnten
submakulären Blutungen sowie Rupturen des Pigmentepithels gelten. Für die FMT sind
aber wichtige Einschränkungen wie z. B. hohe Hyperopie, eine gute Funktion des Partnerauges
und ausgedehnte Läsionen der choroidalen Neovaskularisation (CNV) zu beachten. Eine
ausführliche Aufklärung möglicher Kandidaten über die relevanten Komplikationen ist
eine selbstverständliche Vorbedingung.
Abstract
Since anti-VEGF treatment has been proven to achieve a significant improvement of
visual acuity in a cohort of patients with neovascular age-related macular degeneration
(AMD), macular surgery and particularly the macular translocation with 360° retinotomy
(FMT: full macular translocation) have lost their former popularity. However, the
approach of macular surgery still remains a promising therapy in selected cases. A
prospective randomised study, comparing FMT and photodynamic therapy in subfoveal
classic choroidal neovascularisation (CNV), recently showed the superiority of FMT
in terms of visual gain. In spite of the postoperative complications and the disturbed
binocular vision, the reading acuity and the life quality of many patients improved.
Therefore, it is justified to discuss the chances and advantages of the FMT at least
in selected cases. After all, case selection was an important determinant also in
the phase III studies of ranibizumab; many patients seen during the routine consulting
hours were excluded as a consequence of the study criteria. Most of them were suspected
to achieve a less favourable outcome of the anti-VEGF regimen. Thus, patients who
did not meet the inclusion criteria of recent studies or showed no response to the
anti-VEGF therapy, as well as patients with extensive submacular bleeding or ruptures
of the pigment epithelium can also be considered as candidates of FMT. Generally,
in the presence of highly effective anti-VEGF drugs, FMT can be discussed for second-line
treatment, if the fellow eye has poor function and no additional risk factors of the
affected eye are known (e. g., hyperopia, large lesion size, etc). Detailed information
relating to the potential adverse events have to be mentioned. Although the indication
is restricted, surgeons should have the continuing ability to perform the challenging
surgical procedure.
Schlüsselwörter
altersbedingte Makuladegeneration - Makulatranslokation - Anti-VEGF - Bevacizumab
- Ranibizumab - Pegaptanib
Key words
age-related macular degeneration - macular translocation - anti-VEGF - bevacizumab
- ranibizumab - pegaptanib
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PD Dr. Faik Gelisken
Department für Augenheilkunde, Eberhard-Karls-Universität Tübingen
Schleichstr. 12
72076 Tübginen
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