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Klin Monbl Augenheilkd 2017; 234(02): 191-193
DOI: 10.1055/s-0043-101819
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Können Anti-VEGF-Injektionen Glaukom oder okuläre Hypertension verursachen?

Can Anti-VEGF Injections Cause Glaucoma or Ocular Hypertension?
I. Lanzl
1   Augen Tagesklinik, Chiemsee Augen Tagesklinik, Prien
2   Augenklinik der Technischen Universität München, München
,
K. Kotliar
3   Medical Engineering and Technomathematics, FH Aachen – University of Applied Sciences, Jülich
› Author Affiliations
Further Information

Publication History

eingereicht 02 January 2017

akzeptiert 11 January 2017

Publication Date:
22 February 2017 (online)

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Zusammenfassung

Zur Behandlung neovaskulärer Makulaerkrankungen werden intravitreale antivaskuläre endotheliale Wachstumsfaktor-(Anti-VEGF-)Injektionen bei einer zunehmenden Anzahl an Patienten mit häufiger Frequenz angewandt. Da durch die Einspritzung der Substanzen das Volumen des Glaskörpers kurzzeitig erhöht wird, sind kurzdauernde Intraokulardruckerhöhungen nach Eingabe der Substanz bekannt. Es häufen sich jedoch nun auch Berichte, dass es zu einer langdauernden Intraokulardruckerhöhung nach multiplen Injektionen kommen kann. Dies kann auch bei Patienten der Fall sein, bei denen bisher kein Glaukom bekannt war. Zum Teil sind diese Druckerhöhungen mit lokalen drucksenkenden Medikamenten nicht ausreichend behandelbar und erfordern ein operatives Vorgehen, um einen Glaukomschaden zu vermeiden. Dies scheint häufiger bei ausgeeinzelten Produkten oder nach der Gabe von Bevacizumab der Fall zu sein. Der Mechanismus, der zu Entzündungen und/oder anhaltenden Druckerhöhungen führt, ist unbekannt. Möglicherweise führen Moleküle mit hohem Molekulargewicht, die sich in der Spritze befinden, wie Monomer-Antikörper, aggregierte Proteine oder Silikonöltröpfchen aus der Spritze zu einer Entzündung im Trabekelmaschenwerk oder einer Verlegung desselben und zur anschließenden Erhöhung des Augeninnendrucks. Eine Vermeidung von Silikonöltröpfchen in den Spritzen wäre wünschenswert. Intraokulardruckkontrollen nach IVOM sind auch im Verlauf nötig.

Abstract

An increasing number of patients receive intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections with a high frequency for the treatment of neovascular macular disease. Since the volume of the vitreous body is temporarily increased by the injection of the substances, a short-term intraocular pressure increase after the introduction of the substance is not uncommon. However, there are more and more reports indicating that multiple injections may lead to a long-term increase in intraocular pressure. This may also be the case in patients without a glaucoma history. In some cases, this pressure increase cannot be adequately treated with local pressure-reducing medication and requires an operative procedure in order to avoid glaucoma damage. This appears to be more common in products dispensed from broken bulk or after administration of bevacizumab. The mechanism leading to inflammation and/or a sustained increase in pressure is unknown. High molecular weight molecules present in the syringe, such as monomer antibodies, aggregated proteins, or silicone oil droplets from the syringe, may lead to inflammation in the trabecular meshwork or displacement thereof and a subsequent increase of the intraocular pressure. Avoiding silicone oil droplets in the syringes would be desirable. Intraocular pressure after intravitreal injections should also be monitored long term after the procedure.

Schlüsselwörter

Bevacizumab - Ranibizumab - vaskulärer endothelialer Wachstumsfaktor - Glaukom - Augeninnendruck - Silikonöltröpfchen

Key words

vascular endothelial growth factor - silicone oil droplets - intraocular pressure - glaucoma - bevacizumab - ranibizumab
 

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