Die Rolle der Anti-VEGF-Therapie in der Behandlung des diabetischen Makulaödems

Zusammenfassung

Das diabetische Makulaödem (DME) und die diabetische Retinopathie sind die häufigsten Erblindungsursachen des mittleren Erwachsenenalters. Goldstandard der Therapie war bisher die parazentrale Laserkoagulation. Therapierefraktäre Verläufe, das fehlende Ansprechen bei einer ischämischen Makulopathie und Komplikationen limitieren das Verfahren. Die Suche nach nicht destruktiven Verfahren führte zu Untersuchungen von Vascular-Endothelial-Growth-Factor(VEGF)-Inhibitoren, die die Gefäßleckage und damit die Ödembildung reduzieren sollen. Therapeutische Antikörper-Fragmente gegen VEGF sind in der Behandlung der altersassoziierten Makuladegeneration (AMD) in verschiedenen Ländern zugelassen und haben sich bewährt. Zurzeit sind einige Anti-VEGF-Medikamente in Zulassungsverfahren. Erste Daten der Zulassungsstudien deuten auf eine Überlegenheit der Anti-VEGF-Therapie gegenüber der Laserkoagulation hin. Ziel dieser Übersichtsarbeit ist die Darstellung der vorliegenden Daten im Hinblick auf Dosierung, Injektionsschemata und eine praktikable klinische Anwendung.

Abstract

Diabetic macular edema (DME) and proliferative retinopathy are common causes for blindness in middle-aged patients. The gold standard for treatment has been laser coagulation. Limitations of this therapy are refractive DME, ischaemic diabetic maculopathy and complications after laser application. The need for a non-destructive and effective strategy has led to investigations regarding vascular endothelial growth factor (VEGF) inhibitors for reduction of vessel leakage and oedema formation. VEGF antibody fragments have been approved for age-associated macular degeneration (AMD) in different countries and have proved to be safe and effective. Trials for different anti-VEGF compounds are nearing completion or are completed. Published data show a superiority of anti-VEGF therapy compared to laser coagulation. In the present article, data regarding dose, injection scheme and practicable application form are reviewed.

Schlüsselwörter

Retina - diabetisches Makulaödem - Anti-VEGF-Therapie

Key words

retina - diabetic macular oedema - anti-VEGF therapy

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