Makulaödem bei Uveitis – Steroide oder VEGF-Inhibitoren?

Zusammenfassung

Das Makulaödem ist eine der häufigsten zu einer dauerhaften und irreversiblen Reduktion des Sehvermögens führende Komplikation im Krankheitsverlauf einer Uveitis. Durch die optische Kohärenztomografietechnologie (OCT-Technologie) und die Fluoreszenzangiografie (FAG) kann das Makulaödem häufiger detektiert werden. Makulaödeme finden sich in unterschiedlichsten morphologischen Variationen auch bei Uveitisaugen und können bei jeder Form der Uveitis auftreten. Nachfolgend muss dann auch konsequent behandelt werden. Während Makulaödeme bei aktiver Inflammation meist sehr gut auf eine entzündungshemmende systemische Therapie reagieren, trifft dies für Makulaödeme bei klinisch reizfreien Augen häufig nicht zu. Nach den aktuellen Behandlungsempfehlungen sollten Dexamethasonimplantate, die sowohl die aktive Inflammation als auch das Makulaödem reduzieren, als 1. intravitreale Therapie genutzt werden. An 2. Stelle kommen Vascular-endothelial-Growth-Factor-Inhibitoren (VEGF-Inhibitoren) zum Einsatz. Bei der Wahl des Therapeutikums sind neben dem Entzündungsgrad auch die bisherigen Komplikationen, wie ein Glaukom, und auch die Komplikationsrate der gewählten Therapie, wie Augeninnendrucksteigerung und Kataraktinduktion, zu beachten, sodass bei Vorliegen entsprechender Kontraindikationen VEGF-Inhibitoren auch das Therapeutikum der ersten Wahl sein können. Mit beiden intravitrealen Wirkstoffgruppen kann eine Besserung des Makulaödems erzielt werden.

Abstract

Macular edema in uveitis patients is certainly the most frequent complication leading to a permanent and irreversible reduction in vision during the course of the disease. Thanks to optical coherence tomography (OCT) technology and fluorescein angiography (FAG), significantly more macular edemas are detected. Macular edema can be found in various uveitis varieties and can show different clinical patterns. All macular edema should be treated. Macular edema with active inflammation usually reacts very well to general uveitis treatment. In the case of eyes without visible inflammation, however, the response to such therapy is usually less effective. According to the latest treatment recommendations, dexamethasone implants should be used as the first intravitreal therapy. Vascular endothelial growth factor inhibitors (VEGF inhibitors) are second-line treatment regimens. The choice of therapy is, therefore, primarily based on the degree of inflammation and the individual complications, such as glaucoma, lens situation or previous increase in IOP after steroid administration. These individual complications may allow using VEGF inhibitors as first line treatment. An improvement in the macular edema can be achieved with both groups of active substances.

Schlüsselwörter

Uveitis - Makulaödem - Kortikosteroide - VEGF-Inhibitoren

Key words

uveitis - macular edema - corticosteroids - VEGF inhibitors

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