Kombinierte intravitreale Therapie zur Behandlung der altersbedingten Makuladegeneration

Zusammenfassung

Seit Einführung der intravitrealen Anti-VEGF-Monotherapie konnte bei einem signifikanten Teil der Patienten mit feuchter altersbedingter Makuladegeneration (AMD) der Visus stabilisiert bzw. verbessert werden. Es wird jedoch zunehmend über Sicherheit, Effektivität und ökonomische Aspekte der verschiedenen Konzepte therapeutischer Möglichkeiten diskutiert. Im Rahmen einer prospektiven Fallserie wurde 24 bis 36 Stunden nach initialer fotodynamischer Therapie bei 52 Patienten mit choroidealen Neovaskularisationen bei AMD eine intravitreale Kombinationstherapie durchgeführt. Dabei wurde eine intravitreale Eingabe von BSS, Dexamethason und Bevacizumab (= Multiple Therapie) ohne Parazentese mit dem Intrector® durch eine selbstadaptierende 23-Gauge-Kernvitrektomie ermöglicht, da dieser einen doppelläufigen Kanal für Aspiration und Injektion besitzt. Nach 14 Monaten zeigte sich durchschnittlich ein Visusgewinn von 0,18 Snellen Zeilen, mit einer Visusstabilisierung bei 14 / 52 (27 %) und einem Visusgewinn bei 38 / 52 (73 %) der Patienten. Dieses sichere pharmakochirurgische Therapiekonzept führte zu niedrigen intravitrealen Anti-VEGF-Wiederholungsraten 13 / 52 (25 %).

Abstract

Since the introduction of anti-VEGF drugs for the treatmet of CNV in age-related macular degeneration (AMD), visual acuity can be stabilised or improved in a significant number of patients. There is an ongoing debate on the safety, efficiency and economic aspects related to current intravitreal therapeutic concepts. Twenty-four to 36 hours after 80 % low-fluence verteporfin photodynamic therapy (PDT) a combined phrarmacosurgical intravitreal therapy for 52 patients with wet AMD was conducted (multiple therapy). By performing a 23-gauge core vitrectomy with the Intrector®, an intravitreal substitution with BSS, dexamethasone and bevacizumab was achieved via a self-adapting two-channel cannula for aspiration and injection in one probe tip. After 14 months the mean gain in visual acuity (VA) was 0.18 Snellen lines, with VA stabilisation in 14 / 52 (27 %) and VA gain in 38 / 52 (73 %) of the patients. This safe pharmacosurgical regimen indicated a low intravitreal retreatment rate of (13 / 52) 25 %.

AMD - Kombinationstherapie - Intrector - Anti-VEGF - Multiple Therapie

AMD - combined therapy - Intrector - anti-VEGF - multiple therapy

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