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 %.
Schlüsselwörter
AMD - Kombinationstherapie - Intrector - Anti-VEGF - Multiple Therapie
Key words
AMD - combined therapy - Intrector - anti-VEGF - multiple therapy
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Prof. Frank Koch
Abteilung für Netzhaut und Glaskörperchirurgie, Zentrum für Augenheilkunde, Klinikum
der Johann Wolfgang Goethe Universität Frankfurt/Main
Theodor-Stern Kai 7
60590 Frankfurt/Main
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eMail: fkoch1@mac1.com