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Bevacizumab zur Therapie des sekundären Makulaödems nach venösen Gefäßverschlüssen

Bevacizumab for treatment of macular edema secondary to retinal vein occlusion

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Zusammenfassung

Mit der Entwicklung von VEGF-Inhibitoren zur Therapie des Makulaödems nach venösen retinalen Verschlüssen besteht die Möglichkeit, direkt in die pathogenetische Kaskade einzugreifen. Erste Studienergebnisse mit der intravitrealen Injektion des VEGF-Antikörpers Bevacizumab sind viel versprechend und weisen auf das Potenzial einer neuen hoch wirksamen antiödematösen Therapie bei retinalen Gefäßverschlüssen hin. In vielen Fällen kann innerhalb von Tagen ein deutlicher Rückgang des Makulaödems erreicht werden – verbunden mit einem klinisch relevanten Visusanstieg. Erste eigene Ergebnisse mit einer Nachbeobachtungszeit von 3 Monaten ergaben einen Visusanstieg von 1 oder mehr Zeilen bei 93% und von 4 oder mehr Zeilen bei 27% der Augen. Die Visusverbesserung ging mit einer deutlichen Reduktion der zentralen Netzhautdicke in der optischen Kohärenztomographie (OCT) einher, die jedoch weniger nachhaltig war (Reduktion um 64% nach 1 Monat und 28% nach 3 Monaten). Relevante Nebenwirkungen wurden nicht beobachtet. Die Wirkdauer von Bevacizumab bei intravitrealer Gabe ist derzeit noch nicht bekannt. Wiederholte Injektionen scheinen erforderlich zu sein, um auch längerfristig eine Befundstabilisierung zu erreichen. Kontrollierte Langzeitstudien sind hier notwendig und gegenwärtig in Planung, um standardisierte Behandlungsprotokolle für eine sichere und effektive klinische Anwendung dieser Off-Label-Therapie zu etablieren.

Abstract

Application of VEGF inhibitors represents a treatment option for macular edema secondary to retinal vein occlusion that targets the disease at the causal molecular level. First reports on intravitreal injections of bevacizumab show promising morphological and functional effects and demonstrate that bevacizumab is a potent antiedematous agent in this context. A significant reduction of the central retinal thickness followed by a rapid improvement of visual acuity may be achieved within days. In a pilot study with a review period of 3 months, we found a significant improvement of one or more lines in 93% and four or more lines in 27% of eyes. This was associated with a concomitant significant reduction in central retinal thickness, which, however, was not sustained by a single injection (64% reduction after 1 month and 28% after 3 months). No relevant adverse events were noted. The duration of action after intravitreal bevacizumab administration is currently unknown. Reinjections will be necessary to maintain a lasting beneficial effect. Prospective, controlled long-term studies are mandatory to develop standardized treatment protocols that allow a safe and effective application of this off-label therapy.

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Authors and Affiliations

  1. Universitätsaugenklinik Bonn

    M. Ladewig & F. G. Holz

  2. Abt. I, Universitätsaugenklinik Tübingen, Schleichstraße 12, 72076 , Tübingen

    G. B Jaissle, F. Ziemssen, K. Petermeier, P. Szurman, F. Gelisken, M. Völker & K. U. Bartz-Schmidt

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  1. G. B Jaissle
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  2. F. Ziemssen
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  3. K. Petermeier
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  4. P. Szurman
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  5. M. Ladewig
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  6. F. Gelisken
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  7. M. Völker
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  8. F. G. Holz
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  9. K. U. Bartz-Schmidt
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Correspondence to G. B Jaissle.

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Jaissle, G.B., Ziemssen, F., Petermeier, K. et al. Bevacizumab zur Therapie des sekundären Makulaödems nach venösen Gefäßverschlüssen. Ophthalmologe 103, 471–475 (2006). https://doi.org/10.1007/s00347-006-1355-2

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  • DOI: https://doi.org/10.1007/s00347-006-1355-2

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