Proliferative Vitreoretinopathie: therapeutische Strategien

Zusammenfassung

Hintergrund: Die Entwicklung einer proliferativen Vitreoretinopathie (PVR) zählt zu den bedeutendsten Komplikationen vitreoretinaler Chirurgie und stellt die Retinologen bei der Indikationsstellung zur Behandlung und der operativen Versorgung oftmals vor eine Herausforderung. Material und Methoden: Eine Literaturübersicht aus PubMed sowie eigene Daten und Erfahrungen werden zusammengefasst. Ergebnisse: Bei den pharmakologischen Ansätzen zur Prävention und Therapie der proliferativen Vitreoretinopathie handelt es sich bisher lediglich um Konzepte, die im Rahmen präklinischer und weniger klinischer Studien untersucht wurden. Hier sind besonders antiinflammatorische und antiproliferative Substanzen zu erwähnen. Bei den chirurgischen Techniken reicht das operative Spektrum von der Buckelchirurgie bis hin zum Goldstandard der Pars-plana-Vitrektomie mit vorzugsweise Silikonölendotamponade. Das zusätzliche Anlegen einer Cerclage, einer Retinotomie oder Retinektomie kann helfen, die durch Traktion verkürzte Netzhaut zu entspannen und zur Anlage zu bringen. Schlussfolgerung: Die chirurgische Therapie stellt nach wie vor den wichtigsten Ansatzpunkt zur Behandlung der PVR dar. Eine medikamentöse Behandlungsstrategie zur Vermeidung oder Behandlung der PVR konnte bislang noch nicht etabliert werden.

Abstract

Background: Development of proliferative vitreoretinopathy (PVR) is one of the most important complications of vitreoretinal surgery. Reaching the decision to treat and surgical treatment itself are both challenging. Materials and Methods: Our own data and a review of the literature in PubMed are summarised. Results: Pharmacological approaches to the prevention and treatment of proliferative vitreoretinopathy have been limited to concepts that have been investigated in preclinical and a few clinical studies. Anti-inflammatory and antiproliferative substances may be mentioned in this context. Surgical techniques range from scleral buckling to the gold standard pars plana vitrectomy, preferably with silicone oil endotamponade. Applying an encircling band, retinotomy or retinectomy can be useful in reattaching the tractional shortened retina. Conclusion: Surgery is still the method of choice for the treatment of PVR. Pharmacological strategies to prevent or treat PVR have not been established.

Schlüsselwörter

proliferative Vitreoretinopathie - traktive Amotio - Silikonöl - Retinotomie - Komplikation

Key words

proliferative vitreoretinopathy - tractive retinal detachment - silicone oil - retinotomy - complication

^* geteilte Erstautorenschaft

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