Therapie intraokulärer, ödematöser, proliferativer und neovaskulärer Erkrankungen durch intravitreales Triamcinolon-Acetonid

Zusammenfassung

Hintergrund: Rezente Studien deuten an, dass die intravitreale Injektion von kristallinem Triamcinolon-Acetonid möglicherweise eine therapeutische Zusatzoption zur Behandlung verschiedener intraokulärer, neovaskulärer, ödematöser und proliferativer Erkrankungen darstellt. Methode und Ergebnisse: Die relativ besten Therapieergebnisse sind wahrscheinlich bei intraretinalen ödematösen Erkrankungen zu erreichen, wie z. B. beim diffusen diabetischen Makulaödem und bei zystoiden Makulaödemen durch retinale Venenverschlüsse und Uveitis. Intravitreales Triamcinolon ist eventuell hilfreich zur angiostatischen Therapie bei Rubeosis iridis und proliferierenden ischämischen Retinopathien. Möglicherweise hat intravitreales Triamcinolon einen gewissen Einsatz bei der exsudativen altersassoziierten Makuladegeneration. Bei chronischer, therapieresistenter, okulärer Hypotonie am Übergang zur Phthisis bulbi kann manchmal durch eine intravitreale Injektion von Triamcinolon eine Steigerung des Augeninnendrucks und Stabilisierung erreicht werden. Die Rolle von intravitrealem Triamcinolon zur unterstützenden Therapie einer proliferativen Vitreoretinopathie ist unklar. Komplikationen der intravitrealen Triamcinoloninjektion sind eine okuläre Hypertension in ca. 50 % der injizierten Augen (bei einer Injektionsdosis von 25 mg Triamcinolon-Acetonid), was bei 1 % der injizierten Augen eine filtrierende Operation erfordert; ein kataraktogener Effekt und die postoperative infektiöse Endophthalmitis. Langzeitstudien von mehr als 3 Jahren Nachbeobachtungszeit fehlen, so dass über mögliche Spätkomplikationen keine wesentlichen Informationen vorliegen. Die Injektion kann mit einer Kataraktoperation kombiniert werden. Kataraktoperationen Monate nach der Injektion haben keine wesentlich erhöhte Komplikationsrate. Erfolgt auf eine erste intravitreale Injektion ein Visusanstieg, kann die Injektion wiederholt werden. Die Dauer der Wirkung einer intravitrealen Triamcinoloninjektion liegt wahrscheinlich zwischen 2 und 9 Monaten. Triamcinolon wurde bis zu 9 Monate nach einer Injektion von 25 mg im Kammerwasser nachgewiesen. Schlussfolgerungen: Die intravitreale Triamcinolontherapie ist möglicherweise eine zusätzliche Möglichkeit, um intraokuläre, ödematöse, neovaskuläre und proliferative Erkrankungen zu therapieren.

Abstract

Background: Recent studies have suggested that intravitreal triamcinolone acetonide may be a therapeutical possibility for treating of various intraocular neovascular, oedematous and proliferative diseases. Methods and results: Gain in visual acuity was relatively highest for eyes with intraretinal oedematous diseases such as diffuse diabetic macular oedema and various types of cystoid macular oedema due to reasons such as retinal venous occlusions and uveitis. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularisation and proliferative ischaemic retinopathies. Possibly, intravitreal triamcinolone may be helpful for exudative age-related macular degeneration. In eyes with chronic therapy resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure. The role of intravitreal triamcinolone as adjunctive treatment of proliferative vitreoretinopathy has not been determined so far. Complications of intravitreal triamcinolone include secondary ocular hypertension in about 50 % of the eyes injected, with one per cent of the eyes necessitating antiglaucomatous filtrating surgery; a cataractogenic effect; and postoperative infectious endophthalmitis. Long-term studies of more than 3 years follow-up have been missing so far, so that there is no reliable information on long-term complications. The injection can be combined with cataract surgery. Cataract surgery performed some months after the injection did not show a markedly elevated rate of complications. If vision increases after the intravitreal triamcinolone injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone ranges between 2 and 9 months. Triamcinolone acetonide was detected in the aqueous humour nine months after an intravitreal injection of 25 mg. Conclusions: Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular oedematous, neovascular and proliferative diseases.

Schlüsselwörter

Altersassoziierte Makuladegeneration - Antiangiogenese - diabetisches Makulaödem - Rubeosis iridis - Triamcinolon-Acetonid

Key words

Age-related macular degeneration - anti-angiogenesis - diabetic macular oedema - iris neovascularisation - triamcinolone acetonide

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