Der Einfluss von intravitrealem Aflibercept auf das retinale Gefäßkaliber bei Patienten mit diabetischem Makulaödem

Zusammenfassung

Fragestellung Die diabetische Retinopathie ist durch eine gestörte retinale Gefäßautoregulation gekennzeichnet mit retinaler Hyperperfusion im Frühstadium und Kapillarausfall mit peripherer Ischämie im Spätstadium. Die initiale retinale Gefäßdilatation deutet auf eine Progression der Erkrankung hin und die anschließende Vasokonstriktion signalisiert einen proliferativen Zustand. In dieser Pilotstudie untersuchen wir den Einfluss des intravitrealen Aflibercepts auf den Durchmesser der retinalen Gefäße bei Patienten mit diabetischem Makulaödem.

Methoden Zwölf Augen von 9 Patienten mit diabetischem Makulaödem wurden während der ersten 3 Monate der Behandlung mit Aflibercept untersucht. Es wurden das Kaliber der Netzhautarterien und -venen sowie das zentrale Netzhautarterien- und -venenäquivalent registriert. Das diabetische Makulaödem wurde im Verlauf der Behandlung mit dem Netzhautgefäßkaliber korreliert.

Ergebnisse Die Behandlung mit Aflibercept führt zur signifikanten Reduktion des Durchmessers der Netzhautarterien sowie des zentralen Netzhautarterienäquivalents. Die Netzhautvenen zeigten zwar eine Vasokonstriktion, die aber keine Signifikanz erreichte. Es kam zudem zur signifikanten Reduktion des Makulaödems. Diese korrelierte aber nicht mit dem vaskulären Kaliber der Netzhaut.

Schlussfolgerung Diese Pilotstudie zeigt zum ersten Mal, dass Aflibercept möglicherweise zur signifikanten Reduktion des retinalen arteriellen Gefäßkalibers führt. Ob diese Reaktion auf die intravitreale Anti-VEGF-Behandlung auch eine Verbesserung der retinalen Gefäßhomöostase widerspiegelt, muss in weiteren Studien verifiziert werden.

Abstract

Purpose Diabetic retinopathy is characterised by impaired retinal vascular autoregulation with signs of early retinal hyperperfusion and subsequent capillary drop out and peripheral ischemia. Initial retinal vascular dilation indicates disease progression and subsequent constriction signals a proliferative state. In this pilot study, we examined the effect of intravitreal aflibercept on retinal vessel diameter in patients with diabetic macular oedema.

Methods Twelve eyes of nine treatment-naive patients with diabetic macular oedema were examined during the first three months of treatment with aflibercept. The calibers of retinal arteries and veins and the central retinal arterial and vein equivalent were registered over the course of treatment. The evolution of the diabetic macular oedema was also registered and correlated to the retinal vascular caliber.

Results During treatment, there was a significant reduction in the diameter of retinal arteries as well as in the central retinal arterial equivalent. The calibers of the retinal veins were also reduced, but not significantly. Macular oedema was significantly reduced, which however did not correlate with the vascular caliber changes.

Conclusions This pilot study demonstrates for the first time a possible significant reduction in retinal arterial caliber under aflibercept treatment for diabetic macular oedema. Further studies are needed to verify whether this response to intravitreal anti-VEGF treatment also signifies an improvement in retinal vascular homeostasis.

Schlüsselwörter

diabetische Retinopathie - Aflibercept - diabetisches Makulaödem - intravitreale Therapie

Key words

diabetic retinopathy - Aflibercept - intravitreal therapy - diabetic macular edema

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