Zusammenfassung
Die Anwendung systemischer Steroide nach vitreoretinalen Eingriffen und Plombenchirurgie zur Reduktion der Entzündungsreaktion und Vermeidung einer proliferativen Vitreoretinopathie ist weit verbreitet.
Methode
Mittels dieses Literaturüberblicks versuchen wir, den wissenschaftlichen Hintergrund im Sinne einer Evidence-based Medicine zu überprüfen und die Vor- und Nachteile gegeneinander abzuwägen. Im Vordergrund steht hier insbesonders die Frage nach der Sinnhaftigkeit der systemischen Applikation im Vergleich zu anderen Darreichungsformen sowie die in Studien bewiesene Wirksamkeit der Steroidgabe.
In den zitierten Arbeiten zeigt sich zwar die unumstrittene antünflammatorische und antiproliferative Wirkung der Steroide, eine einheitliche Linie bezüglich Dauer, Dosierung und Applikationsart der Steroidtherapie fehlt jedoch. Die intravitreale Verabreichung ist wesentlich besser durch Studien belegt als die systemische Applikation. Die subkonjunctivale oder peribulbäre Verabreichung erzielt wesentlich höhere lokale Wirkspiegel als die systemische Gabe. Weiters wurde die systemische Steroidgabe meist durch zusätzliche Medikation oder Erweiterung der chirurgischen Maßnahmen ergänzt, so dass die besseren Ergebnisse nicht allein auf der Steroidwirkung beruhen.
Schlussfolgerung
Neben den positiven Effekten der Steroidgabe sind die doch zahlreichen möglichen lokalen und systemischen Nebenwirkungen zu beachten.
Groß angelegte prospektive Studien bezüglich Applikationsform, Dauer und Dosierung einer perioperativen Steroidtherapie im Sinne einer Evidence-based Medicine wären wünschenswert.
Summary
To reduce inflammation and lower the risk of proliferative vitreoretinopathy treatment with systemic steroids after vitreoretinal surgery and scierai buckling procedures is widely used.
Method
This literature review tries to verify the scientific background in terms of evidence based medicine and to compare the advantages and disadvantages. Our essential question is to assess the usefulness of systemic application compared to other forms of administration.
The anti-inflammatory and anti-proliferative effect of the steroids is shown without controversy in the cited studies, but in terms of dosage, duration and application form of medication there is no consistent line. Intravitreal application is much better proven than systemic application. Subconjunctival and peribulbär injections should be recommend because of the higher local concentration with lower systemic side effects than after systemic administration. In most studies a combined therapy with additional administration of other drugs or additional surgery was used. So the better results cannot be seen as a consequence of steroid effect alone.
Conclusion
Beside the advantages of the administration of steroids the possible risks should be considered. Prospective studies in respect of the form of administration, duration and dosage of a perioperative steroid management in terms of an evidence based medicine would be desirable.
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Weingessel, B., Richter-Müksch, S., Sacu, S. et al. Sinnhaftigkeit der systemischen Steroidgabe nach vitreoretinalen Eingriffen und Plombenchirurgie. Spektrum Augenheilkd 19, 326–330 (2005). https://doi.org/10.1007/BF03163476
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DOI: https://doi.org/10.1007/BF03163476