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Selektive Retinatherapie

Methodik, Technik und Online-Dosimetrie

Selective retina therapy

Methods, technique, and online dosimetry

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Zusammenfassung

Die selektive Retinatherapie (SRT) wird zurzeit als neue, schonende Laserbehandlungsmethode für verschiedene Erkrankungen des Augenhintergrunds evaluiert, die mit einer reduzierten Funktion des retinalen Pigmentepithels (RPE) assoziiert werden. Mit der SRT wird im bestrahlten Areal lediglich das RPE behandelt, ohne die angrenzende neurosensorische Netzhaut mit den Photorezeptoren und die unter dem RPE liegende Aderhaut zu schädigen. Die Therapie führt idealerweise zu einer Regeneration des RPE und einem gesteigerten Metabolismus am chorioretinalen Übergang. Im Gegensatz zur etablierten Laserphotokoagulation, bei der die bestrahlten und umgebenden Areale der Netzhaut komplett verödet werden, bleiben bei der SRT Skotome vollständig aus. Der Artikel gibt eine Übersicht über die Methodik und die Mechanismen zu selektiven RPE-Effekten und resümiert In-vitro- und vorklinische Ergebnisse zur Bandbreite der Selektivität für verschiedene Bestrahlungsparameter. Die Beschreibung einer optoakustischen Methode zur Online-Visualisierung der optisch nicht sichtbaren Effekte und damit zur Dosimetrie ohne angiographische Kontrolle runden die Übersicht ab.

Abstract

Selective retina therapy (SRT) is currently under evaluation, as a new and very subtle laser method, for the treatment of retinal disorders associated with a degradation of the retinal pigmentary epithelium (RPE). SRT makes it possible to selevtively effect the RPE, sparing the adjacent neural retina with the photoreceptors and also the choroid below the RPE. In the best case, the therapy leads to regeneration of the RPE and a long-term metabolic increase at the chorio-retinal junction. In contrast to conventional laser photocoagulation, which is associated with complete thermal necrosis of and around the treated site, absolutely no scotoma occurs in SRT. This paper reviews the methods and mechanisms behind the selective effects of the RPE. In vitro and preclinical results are used to describe the bandwidth of selective effects with respect to different irradiation settings. An optoacoustic technique is introduced to visualize effects that cannot be seen by ophthalmoscopy and to facilitate dosimetry control without recourse to angiography completes the report.

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Danksagung

Die Autoren danken dem Bundesministerium für Bildung und Forschung (BMBF) für die Förderung des Projekts (FKz: 13N7309 und 01EZ0408), dem Studiensponsor Lumenis Inc. sowie Christian Wacker.

Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindungen mit folgender Firma hin: Lumenis – Sponsor der Multicenterstudie. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Deutschland

    R. Brinkmann, G. Schüle, J. Neumann & R. Birngruber

  2. Augenklinik der Universität Regensburg, Regensburg, Deutschland

    C. Framme

  3. Klinik für Augenheilkunde, UK-SH, Campus Kiel, Kiel, Deutschland

    E. Pörksen, H. Elsner & J. Roider

  4. Institut für Biomedizinische Optik der Universität zu Lübeck, Peter-Monnik-Weg 4, 23562, Lübeck, Deutschland

    R. Brinkmann, D. Theisen-Kunde & R. Birngruber

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  1. R. Brinkmann
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  2. G. Schüle
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  3. J. Neumann
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  4. C. Framme
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  5. E. Pörksen
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  6. H. Elsner
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  7. D. Theisen-Kunde
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  8. J. Roider
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  9. R. Birngruber
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Correspondence to R. Brinkmann.

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Brinkmann, R., Schüle, G., Neumann, J. et al. Selektive Retinatherapie. Ophthalmologe 103, 839–849 (2006). https://doi.org/10.1007/s00347-006-1416-6

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