Pharmakologische Ansätze zur Prävention der Cataracta secundaria

Zusammenfassung

Trotz der enormen Verbesserung von OP-Techniken und Intraokularlinsen (IOL) bezüglich Material und Design stellt die Cataracta secundaria immer noch die häufigste Langzeitkomplikation nach extrakapsulärer Kataraktoperation dar. Wir wissen heute, dass ein scharfkantiges Optikkantendesign in Zusammenwirkung mit einer sorgfältigen Hydrodissektion sowie vollständig zirkulären Überlappung von Kapsulorhexis und IOL-Optik sowie eine Verklebung der Kapselblätter zu einer signifikanten Reduktion der Nachstarbildung führt. Jedoch ist es immer noch nicht gelungen, das Nachstarproblem vollständig zu lösen. Schon in den 1980er-Jahren haben Forscher wie Hartmann et al. versucht, die Proliferation und Migration der Linsenepithelzellen durch Applikation pharmakologischer Substanzen zu hemmen bzw. zu minimieren. Zur überwiegend laborexperimentellen Anwendung kamen Zytostatika, Steroide, nichtsteroidale Antiphlogistika, Adhäsionshemmstoffe, Heparin, Lidocain, Suramin, Immunotoxine, photodynamische Therapieansätze und osmotisch wirksame Substanzen. In zahlreichen Studien wurde auch versucht, ein geeignetes Trägermaterial zu entwickeln, um eine längere Freisetzung und Wirkdauer zu gewährleisten. Bis vor kurzem war die klinische Anwendung solcher oft zellschädigender Substanzen jedoch schwierig, da die selektive Wirkung auf Linsenepithelzellen nicht gewährleistet werden konnte und eine Schädigung des umliegenden Gewebes berücksichtigt werden musste. Durch die Entwicklung des PerfectCapsule-Systems ist die vakuumabgedichtete selektive Irrigation des Kapselsackes möglich geworden. Dieser Artikel gibt einen Überblick über pharmakologische Ansätze und neue Entwicklungen zur Prävention der Cataract secundaria.

Abstract

Secondary cataract or posterior capsule opacification (PCO) is still the most frequent long-term complication of cataract surgery. Tremendous advances have been made, especially during the last 10 to 15 years, in terms of surgical techniques and improvement of implant technology. However, the problem of proliferation and migration of lens epithelial cells (LECs) postoperatively has not yet been solved completely although we know that a sharp optic edge of intraocular lenses (IOL) combined with hydrodissection, complete overlapping of capsulorhexis and IOL-optic as well as capsular bending reduce PCO formation significantly. In the 1980 s, investigators like Hartmann et al. began with the application of pharmacological substances in-vitro in order to successfully prevent LECs from proliferating and migrating. Cytostatic drugs, steroids, non-steroidal antiphlogistics, adhesion inhibitors, heparin, lidocaine, suramin, immunotoxins, photodynamic therapy and osmotic effective solutions were tested. In several studies different drug delivery systems were investigated in order to provide a longer and more effective impact on LECs. However, the in-vivo use has been viewed critically since the selective targeting of LECs was not possible and serious damage to the surrounding tissue had to be considered. Recently, the development of the PerfectCapsule System for vacuum-sealed capsule irrigation allows the selective targeting of LECs inside the capsular bag. This survey gives an update on past, current and future means and trends to reduce or prevent PCO formation pharmacologically.

Schlüsselwörter

Cataracta secundaria - Nachstar - Linsenepithelzellen - pharmakologische Prävention

Key words

Secondary cataract - posterior capsule opacification - lens epithelial cells - pharmacological prevention

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