Glaskörperersatz als Möglichkeit zur protrahierten Freisetzung von Medikamenten im Glaskörper

 

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Zusammenfassung

Trotz wesentlicher technischer Verbesserungen in der vitreoretinalen Chirurgie ist insbesondere die proliferative Vitreoretinopathie ein ungelöstes Problem. Inzwischen ist klar geworden, dass ein chirurgischer Ansatz allein nicht ausreichend ist. Vielmehr wäre die Kombination von chirurgischen Standardverfahren wie der Pars-plana-Vitrektomie mit einem Glaskörperersatz und einer gleichzeitigen adjuvanten pharmakologischen Behandlung zur Unterdrückung der Wundheilung wünschenswert. Aufgrund der geringen therapeutischen Breite und der kurzen biologischen Halbwertzeit im Glaskörperraum ist die Verwendung von Medikamententrägersystemen zur verzögerten Freisetzung antiproliferativer Substanzen sinnvoll. Da im Rahmen der Vitrektomie ohnehin ein Glaskörperersatz im Sinne einer Endotamponade erforderlich ist, liegt die Kombination des Glaskörperersatz mit einer Medikamententrägerfunktion nahe. Diese Übersichtsarbeit stellt die wichtigsten Fortschritte auf dem Weg zu einer verzögerten Freisetzung von Medikamenten aus einem Glaskörperersatz vor. Selbst Standardtamponaden wie Silikonöl und auch Gase können durchaus als Medikamententräger eingesetzt werden. Inzwischen werden aber zunehmend polymere Hydrogele als Glaskörperersatz mit möglichen Medikamententrägereigenschaften entwickelt, welche neben günstigen Tamponadeeigenschaften eine protrahierte Medikamentenfreisetzung über mehrere Wochen bis Monate aufweisen.

Abstract

Despite major improvements of vitreo-retinal surgical techniques proliferative vitreoretinopathy (PVR) remains a major challenge. Surgical therapy alone may not be sufficient in complicated cases of PVR. A combination of standard techniques such as pars plana vitrectomy with a vitreous substitute and a simultaneous adjuvant pharmacological treatment for the suppression of undesired proliferation of retinal cells and retinal scarring may be a promising therapeutic approach. However, due to the narrow therapeutic range and the short biological half-life of most anti-proliferative or anti-inflammatory drugs in the vitreous cavity, intravitreal slow-release systems for extended drug delivery are desirable. Vitrectomy for PVR normally requires a vitreous substitute. Consequently, a vitreous substitute that could also serve as a slow-release system for anti-proliferative or anti-inflammatory drugs would provide several advantages. This review gives an overview of recent developments of slow-release systems that may also be suitable as vitreous substitutes. Even standard internal tamponades such as silicone oils or gases may serve as extended drug-release systems under certain conditions. In the mean time polymerised hydrogels have been developed, which apart from providing an adequate tamponade effect, may facilitate an extended intravitreal release of various anti-proliferative and anti-inflammatory drugs for several weeks.

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PD Dr. Peter Szurman

Universitäts-Augenklinik, Department für Augenheilkunde, Eberhard-Karls-Universität

Schleichstr. 12

72076 Tübingen

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Fax: ++ 49/70 71/29 46 74

Email: peter.szurman@med.uni-tuebingen.de